Thursday, June 10, 2010

Fortitude, As Known by Kaira W.

I was surprised to learn recently that a continuing controversy exists within the medical community about the value of breast self-examination. But, don’t tell that to Kaira W., who discovered a lump in her breast while performing a regular self-exam, and subsequently was diagnosed very recently with breast cancer. Yet, Kaira wears shoes that are lined with fortitude, propelling her forward with a remarkable will to endure, no matter what is required.

Kaira, a 32 year-old mother, whose three children all are under the age of 6, was faced with having to make critical decisions about her future and her family’s well-being. She immediately scheduled a double-mastectomy. As Kaira’s friend, Diane, describes, Kaira felt this aggressive solution to her illness was “the best way to protect her and her family's health.”

Diane admits that she is “awed and amazed” by Kaira’s extraordinary bravery. Despite her own dilemma, Kaira ". . . makes sure to get the word out on every step of her journey so that people understand it could happen to them and that we are not too young to get this horrible illness.”

With an eye toward supporting Kaira’s effort to “get the word out,” this tribute would be incomplete if it didn’t address breast self-examination, or BSE. As previously mentioned, the medical community seems to have divided into two camps: a) those who believe BSE has little or no value; and b) those who believe BSE is one of the primary instruments in the early detection of the disease.

As I considered the results of my own review of a number of articles on the subject, the dissenting conclusion seemed to be that BSE is of little value because:
  1. women don't do it; and
  2. women don't do it.

In her article Value of Breast Self-exam Questioned, author Elizabeth Smoots, MD, describes some of the difficulties women experience with this task: "Besides being difficult to do well, it’s hard to keep performing BSE consistently each and every month." Similarly, Mary K. Salazar and William B. Carter reported in their 1994 study entitled, A Qualitative Description of Breast Self-Examination Beliefs, that fewer than 40% of American women perform BSE with any regularity, and describe a variety of attitudes that contribute to that outcome, including ". . . too much time to do, too difficult, embarrassment about self-touch. . . ." Some estimate that the number of American women who do not perform BSE could be as high as 80%. Finally, there is consistent mention throughout the dissenting literature that those women who do perform BSE regularly often find benign lumps related to transient, cyclical changes, resulting in a higher rate of unnecessary biopsies.

So, what are practical options for women under the age of 40 who are not encouraged to have regular mammograms? Regardless of discussions to the contrary, much more information is available that underscores the importance of performing BSE regularly beginning at age 20 as part of a three-pronged approach to early detection. This comprehensive approach also includes clinical breast examinations (CBE) performed by a health professional every three years (or annually as we age), and mammograms, as discussed in a previous blog.

Multiple sites provide fabulous and detailed information for performing a BSE. In addition to Komen for the Cure, try out WebMD, About.Com, the American Cancer Society, or BreastCancer.Org for excellent guidance. One last site is worthy of mention because it also offers free shower card reminders. Go to HealthyWomen and download your free card, which was published in April of 2008 by the National Women's health Resource Center, Inc. Or, click on the image below for a larger version, print it out, stash it in a ziplock bag, and hang it in the shower.

Regardless of the guidance you choose for BSE, a number of common threads run through them. The first one is an emphasis on familiarity. Through regular BSE, you will become familiar enough with your breasts to recognize changes or symptoms that should be reported to your health care provider. Other common themes include the following:

  • Always discuss with your health care professional the types and frequency of screening appropriate for your history, risk and age.
  • Always combine BSE with CBE, and when appropriate, with mammograms.
  • Perform a BSE the week after your period, or on the first day of the month if you no longer are menstruating.
  • Perform BSE consistently, so that you are familiar with what is normal for your breasts.
  • Try to perform the examination in the shower. If that is not your preference, perform it lying down.
  • Check areas outside the breast, from the armpit to the collar bone, and below the breast, in addition to the breast itself and the nipple.
  • Report any changes in size or breast shape.
  • Report lumps, hard knots or thick areas.
  • Report swelling or redness.
  • Report any puckering or dimpling of the skin or nipple.
  • Report itchy, scaly sore or rash on the nipple or skin.
  • Report sudden discharge from the nipple.
  • Report new and continuous pain in a specific spot.

But, hey, enough of that serious stuff. Check Your Boobies! No kidding -- that's the name of the organization, whose mission is to ". . . educate women about breast health in a frank, fun, and fear-free manner. [They] are dedicated to the prevention and early detection of Breast Cancer." And, if you're tired of Tupperware or Pampered Chef parties, make sure to take note of the resources and testimonials on this site for planning your very own "CYB Party."

So, for Kaira W., who is compelled to spread the news about the importance of BSE: I'd like to borrow your shoes in the morning, though I know I cannot wear them. Instead, I'll carry them with me and draw from the fortitude that fills them. Together, we'll go forward, no matter what is required.

Here's to the next mile!

1 comment:

  1. Amazing! When Erin first shared what you were doing with your blog I was definitely impressed. It's awesome that you are still keeping up with it and finding different ways to give back.

    Again - Amazing! Thank you so much for thinking of Kaira.



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