Breast cancer is the most common cancer among females worldwide, impacting about one in eight women in their lifetimes. Most of those cases are diagnosed in females over 50, according to the U.S. Centers for Disease Control and Prevention.
But not all patients fit neatly within those statistics. Just ask Courtney Line and Skipper Martin.
Line, a mother of two young children in Hart County, was diagnosed with breast cancer when she was in her early 30s. Martin, a long-time political operative who was chief of staff to former Gov. Paul Patton, exemplifies the rare instance of breast cancer in men.
In both cases, early detection played a critical role in containing spread of the cancer.
"Whatever you've got, catch it early," says Martin. "We're making a lot of progress in cancer, but you've got to catch it early."
Estrogen and Breast Cancer
Doctors aren't sure why breast cancer is becoming more common in younger women or why cases seem to be more aggressive. Dr. Rachel Saunders, an OB-GYN at UK Healthcare, says one theory relates to the fact that girls are getting their first periods and entering puberty at a younger age. A couple of generations ago, girls started puberty at the age of 12 or 13. Saunders says girls are now starting as early as 8 or 9 years old.
"One of the risk factors for developing breast cancer is prolonged exposure to estrogen, which is the main hormone that gives us our feminine features," says Saunders. "If you're starting your period at 8 and then you don't go through menopause or you don't stop having periods until your mid-50s, then that's a long window in which you're being exposed to estrogen."
Environmental factors could be to blame, according to Saunders. Some research indicates that exposure to synthetic chemicals in plastics and common household cleaners may trigger early onset of puberty in girls and boys.
But even as scientists struggle to understand those links, guidance on breast cancer screening remains mixed. Saunders says she follows the American College of Obstetricians and Gynecologists, which recommends women start screening at age 40 and get mammograms once every one to two years until the age of 50, when they should be screened every year.
The United States Preventive Services Task Force, which is an independent group of primary care providers and prevention experts, recommends women wait until they turn 50 to start screening and then have mammograms every one or two years.
Saunders says she recommends women take an approach tailored to their backgrounds and needs.
"Talk to your doctor and talk about your personal genetics, your personal history and come up with a screening plan that makes you feel comfortable," she says.
Cases in Men and Younger Women
It was November of 2021 when Courtney Line received confirmation that she had invasive ductal carcinoma, the most common type of breast cancer.
"I was 31 years old when I was diagnosed," says Line. "I was shocked to say the least."
Since then, Line has had surgery as well as eight doses of chemotherapy and 25 rounds of radiation treatment. Her specific cocktail of drugs includes medication to shut down her hormones, which she says drove her particular type of cancer. Line says her son and daughter sometimes don't understand why she needs to rest so much. Instead of saying that Line is sick, Courtney and her husband, Justin, tell their children that mommy needs to "get healthy."
"We knew we were going to get through it no matter what, and we just went to war," says Justin Line.
The risk of a person developing breast cancer is higher among those who share a close relative with the cancer. But Dr. Jeffrey Hargis of the Norton Cancer Institute in Louisville cautions against only looking at family history. He says about 80 to 85 percent of patients do not have a mother or a sister with breast cancer.
The male body also produces estrogen, which means men can develop breast cancer as well. The body can also convert testosterone into a form of estrogen, adding to the potential risk, albeit a small one. Saunders says about one out of 833 men will develop breast cancer.
It was nine years ago that Andrew "Skipper" Martin discovered a pea-sized knot under his right nipple while showering one day. Because breast cancer cases are so rare in men, Martin says his doctor initially told him not to worry about the lump. But on his next visit, the doctor ordered a mammogram for Martin.
"It was interesting because I went into the room with five women and I'm the only man sitting there," recalls Martin. "One lady said, 'Sir are you in the right place?'"
The lump was determined to be cancerous, which led to a mastectomy for Martin, followed by regular doses of Anastrozole, a drug that blocks production of estrogen in the body, thus limiting the growth of any potential tumors. Martin says he was fortunate he caught the cancer before it had a chance to spread to other parts of his body.
"It's something men ought to watch - they ought to look for any bumps, knots, anything else, and then go to a doctor and say, 'What is this?'" he explains. "Don't dismiss it."
The Importance of Self-Exams and Screenings
The cases of both Martin and Line point to importance of self-examinations and early detection.
"Please, please, please, do your self-breast exams," says Line. "You rush through it or you think I don't really need to do this, but you do."
"If something's different and it doesn't get better over the course of a couple weeks, you need to see a doctor," says Hargis.
Unfortunately, the COVID pandemic interrupted regular mammograms for many women, according to Pam Temple-Jennings of the Kentucky Cancer Program, a state-funded initiative to promote awareness, early detection, and screenings for a variety of cancers. She says getting screened on a regular basis is the top action people can take to prevent developing an advanced case of cancer.
For women who have avoided mammograms because they don't have insurance or can't afford the copays charged by the insurance they do have, Temple-Jennings recommends the Kentucky Women's Cancer Screening Program provided through local health departments and health care providers.
"They can actually get a mammogram or a pap smear for free," she says. "Then if something is found, it will still pay for diagnostic screening and then it can help pay for treatment options."
Racial inequities in health care are a factor in breast cancer detection among Black women, according to Saunders. She says African American females are prone to more aggressive types of breast cancer, which is made worse by the fact that they are usually diagnosed a later stage of the disease.
"Unfortunately, a large population of African American people don't have easy access to doctors, don't have easy access to insurance," says Saunders. "There's also health care discrimination."
Treatments now include immunotherapy, which trains an individual's own immune cells to attack cancer cells in the body. Oncologists also create highly customized
treatment protocols for each case, which Hargis says gives patients a much better chance of preventing a recurrence of their cancer.
"Starting in about 1990, there has been a significant fall in overall mortality from breast cancer in the United States," says Hargis. "That's probably a combination of awareness, a combination of screening, and equally important is the very good treatment we have now."
