People who have rheumatoid arthritis (RA) often have gaps in their primary health care. This disease takes up a lot of room and it can lead to both the individual and the doctor to have metaphorical blinders, focusing only on RA. It’s important to take care of the rest of your health, as well, to make sure you stay as healthy as possible. Some preventive health screening can pose challenges for people with RA, when pain and mobility limitations can get in the way of how the tests are usually conducted. There usually are alternative ways to perform these tasks.
Today, PJ Hamel and I will talk about RA, breast health and mammograms. Women with RA may experience a range of challenges when it comes to breast health. From breast cancer risk to mammograms and other screening tools, we offer FAQs that are helpful to any woman with RA or other autoimmune condition.
Is there a link between autoimmune diseases such as rheumatoid arthritis (RA) and breast cancer?
One study, performed on mice, does show a link between metastatic (advanced) breast cancer and autoimmune diseases, including RA. The study identifies a type of cell (mast cell) common to each condition, and thought key to encouraging cancer growth. However, the study hasn’t been translated to humans yet, so results remain preliminary.
Other studies indicate that the use of biologics for treating autoimmune conditions, including RA, doesn’t raise overall cancer risk. However, biologic treatment does seem to raise the risk of some cancers to a small degree, while it reduces the risk of others - including breast cancer. (Cush, 2012) So, if you’re taking biologics, don’t stop because you’ve heard they increase your breast cancer risk; the evidence doesn’t support that link.
What can you do to manage the risk of breast cancer? _ _
Many of the chief risk factors for breast cancer - being a woman, growing older, carrying certain genetic mutations - are out of your control. But others (being overweight, smoking, drinking) can potentially be addressed with lifestyle changes.
A healthy diet benefits you in all kinds of ways, and a reduction in your breast cancer risk is one of them. Eating lots of fruits and vegetables has been shown to lower breast cancer risk; high-carotenoid fruits and veggies, those with brightly colored flesh, are your best choices.
A healthy diet also works to keep your weight in check. Postmenopausal women who’ve gained 55 pounds or more since age 18 are 1 1/2 times more likely to get breast cancer than those women who’ve maintained their weight. A weight gain of 22 pounds or more after menopause raises your breast cancer risk by almost 20%. (Hamel, 2012)
Finally, researchers have identified a direct link between alcohol consumption and breast cancer risk. As few as three drinks a week has been shown to increase breast cancer risk - which doesn’t mean you should automatically cut out that glass of wine you enjoy with dinner every night, since red wine is known to be good for heart health. The breast cancer/alcohol link is just another piece of information to add to your overall health strategy.
Is it important to do regular breast self-examinations in order to detect any cancer early?
The American Cancer Society no longer recommends BSE (breast self examination) as a necessary part of a woman’s regular health regimen. Instead, the society recommends women simply be aware of how their breasts look and feel.
If you’re a woman with RA, it may be difficult to do know and understand what your breasts feel like, due to limitations in movement. But feel whatever parts of your breast you can on a regular basis - say, when bathing - and be aware of any changes: thickening, a solid lump, or changes in skin texture. If you have a partner, s/he could help with the areas you can’t reach/see.
What is a mammogram?
A mammogram is the chief tool used to screen for breast cancer. It uses X-ray technology to identify any masses of tissue that aren’t part of your breast’s normal structure.
Most American women have their first baseline mammogram around age 40, with regular screening thereafter. There’s been disagreement in recent years about how often a woman should be screened, with some in the medical community sticking to the regular once-a-year regimen, and others claiming that most women only need to be screened every 2-3 years. Frequency of screening is something you should discuss with your doctor.
What happens during a mammogram?
Please read our post Your First Mammogram: Easy as 1-2-3 for an illustrated guide to the mammography process.
Some people with RA have contractures and fusions in their joints that mean limited mobility. Can this be an issue during a mammogram? _ _
Any responsible medical center offering mammograms will be fully versed in making things as easy as possible for women with mobility issues. Breast cancer screening is done chiefly on older women, some of whom use wheelchairs or walkers, are unable to stand for prolonged periods, and have difficulty raising their arms and/or twisting - many of the same challenges faced by women with RA.
How will you know for sure if the health center where you’re getting your mammogram will offer you a good experience? When you make your appointment, do the following:
- Ask if the mammography facility is FDA-approved.
- Tell the scheduler what accommodations you’ll need (e.g., you’re in a wheelchair; you can’t lift your arms; you need someone to help with dressing/undressing).
- Ask about access to the mammography room itself: How far away is the parking lot? Are corridors and dressing rooms large enough for wheelchair access?
Many facilities use a mammography machine that requires removing arms from the wheelchair the patient might be using. If you use a wheelchair, make sure the one you use that day has removable arms; otherwise, you may have to move to another chair.
Are there any alternatives for breast cancer screening other than mammograms?
While mammography is the main tool doctors use to screen for breast cancer, ultrasound and MRI are also used in special cases.
An ultrasound isn’t good at detecting masses in the breast, but it can be useful in determining whether an already-identified mass is a harmless fluid-filled cyst. Ultrasounds are performed with a "wand" run over the area of the breast in question, and don’t require any complicated movements on the part of the patient.
MRIs are used to more closely examine a lump that’s determined to be solid. They’re also used when a woman’s breast density is so high that the regular mammogram’s effectiveness drops. Since they’re quite expensive, they aren’t used for regular breast cancer screening.
An MRI requires the woman to lie flat and motionless on a narrow bench. Again, MRIs are delivered to all parts of the body for all kinds of conditions; if you need an MRI, the person delivering it should know how to handle any physical challenges you have.
If you need an ultrasound or MRI, make sure to tell the scheduler about your condition ahead of time, just as you did for a mammogram.
What happens if the mammogram finds something?
Most women having regular mammograms will experience a "callback" sometime during their life - a request from the radiologist to return for another "view." The vast majority of these callbacks result in a determination that the area in question was simply a fold of skin, scar tissue, or some other benign condition.
If, after another mammogram, the radiologist still isn’t certain what s/he’s seeing, you may be scheduled for a biopsy. Don’t panic; like callbacks, biopsies usually prove to be negative (no cancer) - about 85% of the time, in fact. A biopsy necessitates obtaining tissue from the area in question; sometimes this can be done with a needle, and sometimes a simple operation is required. If you’re scheduled for a biopsy, do your usual due diligence: Tell the scheduler about any mobility or other issues you have so that s/he can make accommodations.
Cush, J. (2012, August 1). Does Rheumatoid Arthritis or Biologic Therapy Increase Cancer Risk? Retrieved October 11, 2014, from www.rheumatology.org/publications/dsq/dsq_2012_08.pdf
Hamel, P. (2007, November 27). Top 10 Breast Cancer Risk Factors. Retrieved October 11, 2014, from http://www.healthcentral.com/breast-cancer/c/78/15009/top-10-risk
Study confirms link between breast cancer and autoimmune arthritis. (2012, April 2). Retrieved October 11, 2014, from http://www.news-medical.net/news/20120402/Study-confirms-link-between-breast-cancer-and-autoimmune-arthritis.aspx
Lene Andersen is the Community Leader for HealthCentral’s RA Community. Lene (pronounced Lena) is an award-winning writer, health and disability advocate, and photographer living in Toronto. She’s written several books, including Your Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain, and 7 Facets: A Meditation on Pain, as well as the award-winning blog, The Seated View. Follow Lene on Twitter @TheSeatedView and on Facebook. Watch her story on HealthCentral.