Breast Cancer Awareness Month

October is breast cancer awareness month, when focus is given to the disease that strikes one in eight American women. The disease is often treatable when caught early, but the effects on relationships and quality of life can linger.

Because breast cancer is partly genetic, women with a family history of the disease should be particularly concerned. Fifteen percent of women with breast cancer have a family history of the disease. In addition, some otherwise benign changes in breast tissue can raise the risk of developing cancer. Early menarche or late menopause are also linked to heightened risk. Certain medications, such as DES given to prevent miscarriage, can lead to breast cancer. These risks are primarily in older women; two-thirds of breast cancer cases are diagnosed in patients over 55.

However, genetic factors, particularly in the BRCA1 and BRCA2 genes, are the best predictor of breast cancer—although only around one in ten women with breast cancer have these mutations, 80 percent of women with the mutations develop the disease. What this means is that more and more young women are living with the knowledge that they will very likely develop cancer, 20 or 30 years down the road. While this can be empowering, allowing someone to take control of her own health care and prepare for treatment, it does somewhat hang over someone.

This is all the more true because treatment for breast cancer can involve removal of one or both breasts. This isn’t inevitable, however, as targeted therapy using medications that attack precancerous conditions in cells can completely treat cancer, and hormone blockers, such as tamoxifen and medications called aromatase inhibitors, deprive the cancer cells of the estrogen they need to survive.

Unfortunately, aromatase inhibitors—though rarely tamoxifen—can cause sexual dysfunction. Indeed, more than two-thirds of patients have some problem in the bedroom regardless of treatment. The reasons for this can vary. Mastectomy, particularly of only one breast, can make women feel less attractive, and thus less interested in sex. The stress of diagnosis and the fatigue associated with chemotherapy and other treatments can also be obstacles to enjoying the same degree of intimacy as before.

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