This month, in recognition of Breast Cancer Awareness Month, Rx.magazine will be running a series of features on breast cancer. The editors and writers here have worked hard to bring you information that will dispel some of the myths about breast cancer and set straight the facts. Breast cancer will kill approximately 40,000 women in 2000; according to the American Cancer Society, approximately 182,800 women in the United States will be diagnosed with the disease this year. Along with skin cancer, breast cancer is the leading cancer among American women.

Risk factors

There are certain things that can increase your chances of getting the disease. For instance, the likelihood of getting breast cancer increases with age. More than 75 percent of women diagnosed with breast cancer are over the age of 50, while women under the age of 40 account for only 5 percent of cases.

Another major risk factor for developing breast cancer is having a primary relative (i.e., a mother or sister) with the disease. However, approximately 80 percent of women diagnosed with breast cancer do not have a primary relative with the disease, so every woman is at risk. The good news is that nearly 97 percent of women diagnosed at an early stage with breast cancer survive more than five years. Breast cancer cannot be prevented, and early diagnosis is the key to survival. For this reason, women should perform monthly breast self-examinations. (For instructions on how to do a BSE, see our Related Links section below.) According to the American Cancer Society, all women 20-39 should also get a clinical breast exam every three years, and women 40 and over should get a clinical breast exam and a mammogram every year.

Putting up a fight

We started off our Breast Cancer Awareness Month series with a photo essay on breast cancer. The essay tells the story of Gaila, a brave woman who chose an unconventional form of therapy. It chronicles her battle with, and survival of, her illness. As a conventionally trained medical doctor, it is difficult for me to condone abandoning traditional methods of fighting cancer; however, I know that my reluctance comes in part from not understanding alternative methods and having no training in that area. One thing I have learned over the years is that some things in medicine are inexplicable. Miracles do happen, and Gaila's story seems to be a case in point.

Like most people, I have a personal connection with breast cancer. My aunt Mary developed the disease, and it spread like Gaila's; both breasts were affected, as was her lymphatic system. Like Gaila, my aunt chose to fight the disease within the system she trusted most; for Aunt Mary, though, that system was conventional medicine.

Aunt Mary has always been a fighter. My earliest memories of her are at my grandfather's dairy farm, where she guided the hay baler up the cow lane to the sun-drenched hay fields behind the barn, shifting the old Farm-All tractor into low gear as she maneuvred it up the hill. One day, in her white T-shirt and faded jeans, she stopped, jumped down off the tractor, and headed over to the shade where we kept old Clorox jugs filled with well water. Andy, one of the hired hands, had just taken a drink, and his brown tobacco spittle dribbled down the side of the white jug. Aunt Mary didn't care -- she wiped it off with the bottom of her shirt, poured some water over her head, and took a long swig. She then leaped back onto the tractor and began baling the hay. Aunt Mary was a vision of vibrancy and self-reliance.

Later, my aunt moved to the city with her husband and five children, and some of the fondest memories of my youth are of my visits with them. Aunt Mary had her kids in quick succession, and her house was always filled with little ones. She clearly enjoyed her children, loved the visits from her nieces and nephews, and made time to head back to the farm to help out her parents, who still lived there.

When my mother called last year to tell me that Aunt Mary had breast cancer, I was speechless. She was the last person I ever expected to see ill. I still imagined her up on that tractor baling hay, and holding her own with the hired hands -- not battling disease from a hospital bed.

To make things worse, Aunt Mary's prognosis wasn't good. She required a bilateral mastectomy, radiation, and chemotherapy. To an internist like me, this sounded like the beginning of the end of her life -- a harsh treatment process from which she might never recover.

My mother kept me informed of my aunt's condition. She would admit that her older sister was not too happy about losing her hair, but remarked that Aunt Mary never complained. When I asked my father, who was a doctor, about Aunt Mary's prognosis, he said sadly, "Poor thing. She is trying to beat the odds." My mother, a devoutly religious woman, recited rosaries for Aunt Mary, trying to find some comfort through prayer.

Coming back from cancer

As many of you who read this column know, my father recently died. And my mother, who was married to my father for nearly 50 years, is alone. Don't get me wrong -- my mother is also self-reliant, but naturally we all worry about how she will cope with this huge change in her life. In the months since my father's death, guess who has been driving the seven-hour trip from New York to check on my mother and to spend time with her? Aunt Mary! She did recover from the cancer and from the harsh treatment she had to go through to fight it. She is again the picture of self-reliance and health.

Though a bit older, Aunt Mary is also a bit wiser, and she looks strong and happy. Recently, she and I visited my mother at the same time. Aunt Mary had brought a couple of her kids, now grown, along with their spouses and children. We all went to the beach, went out to eat, and spent time with my mother. We even talked about Aunt Mary's cancer. Characteristically, my aunt just shrugged it off. I asked if she should be taking it easy and relaxing more. "Why don't you stay in Rhode Island with Mom for a while?" I cajoled.

"Are you kidding?" Aunt Mary retorted. "I take care of the grandkids while my kids are at work. My kids would kill me. I need to get back." And off she went.

Related links:

Rx.magazine feature story: Online at Any Hour: The Value of Breast Cancer Support Groups

Rx.magazine feature story: A Test of Time: Breast Cancer Awareness and Treatment Through the Ages

Rx.magazine feature story: A Path of Her Own: One Woman's Journey with Breast Cancer

Outside link: Information on breast cancer from the American Cancer Society

Outside link: Information on breast cancer support groups from the National Alliance of Breast Cancer Organizations