Fly Well

Amazons (and how not to be one)

September 1, 2011

Sackier“Mythical female warriors who excised their right breast to better draw a bow.” In Greek, mazos means breast and “a” suffix equals “to be without.” Although Amazons were probably Scythian, are not artistically depicted breastless, and the name derives from another source (ha-mazan “fighting together” or “manless”) the former definition resonates with the dreaded word mastectomy. Willingly removing a breast inspires the question, “How can one avoid removing a breast?” By avoiding breast cancer.

The breast includes skin, nipple, surrounding, darker, areola, connective tissue, fat, milk glands, and ducts. Malignant diseases afflict each constituent, duct and gland cancer most commonly. In cancer, deviant cells multiply and behave badly causing breast distortion and destruction, traveling around the body, landing and starting new colonies (metastases) in armpit lymph nodes, bones, brain, lungs, liver, and skin. Imagine juvenile delinquents taking jet fighters up for a spin.

Although statistics reveal one in eight women may acquire breast cancer, risk is not uniform and of 250,000 cases a year, 50,000 are less dangerous non-invasive tumors and under 1 percent afflict men. Yes, men also get this disease. Roughly 40,000 a year die from breast cancer, only lung cancer is more vicious.

Risk factors include aging, family history, youthful age of first menstrual period, and late menopausal onset, none of which are under our control. Cancer threat is impacted by behaviors such as having children early or breast feeding, which are protective, or obesity, a high-fat diet, smoking, or being sedentary, which raise the stakes. Oral contraceptive pill use or hormone replacement therapy have variable effect. Stress reduction may minimize risk and improve outcomes.

Underarm shaving and deodorants have been implicated in breast cancer—women practicing this regime had earlier diagnoses. However, such women may be more physically aware, detecting abnormalities sooner; the evidence is inconclusive.

Debate rages whether breast self-exam (BSE) is useful; opponents maintaining it inspires unnecessary biopsies. I believe becoming familiar with your body makes perfect sense and recommend monthly BSE at the same time in the menstrual cycle, reporting changes to your doctor. Annual mammography is certainly not a female favorite, women find it uncomfortable and embarrassing but it helps find early, non-palpable cancers and should be considered after the fortieth birthday. Common symptoms include finding a lump in the breast or underarm, seeing dimpled skin or a nipple discharge. See your doctor promptly. Diagnostic tests after history and physical include ultrasound to ascertain if the lump is solid or contains fluid. Mammography, although not perfect, may show densities or “shadows,” tiny calcium specks or distorted anatomy. A needle can either withdraw fluid if the lump is a cyst or cells to examine under the microscope. Fancier tests such as molecular breast imaging may be proposed.

If a lump is malignant further evaluation will ascertain if cells have spread elsewhere in the body with blood tests and CT or other scans. If small and self-contained, the lump itself is removed (lumpectomy) possibly also axillary lymph nodes, filtering tissues in the armpit that may harbor cancer cells “leaving the pattern.” Tests on the tumor will define just how off kilter the cells are, whether they view estrogen like a rose bush views plant food and to check out the genetic behavior.

Cancer “stage” (size, lymph node, or other metastases) may dictate additional treatments including radiotherapy to zap lurking cancer, chemotherapy to kill sneaky emigrating cells, or medication to change the hormonal environment so cancer cells cannot flourish. Additional therapies such as yoga, acupuncture, and dietary modification may be helpful. Further surgery might be recommended, predicated on tumor type, size, and stage. If mastectomy (removal of the entire breast) is proposed, discuss reconstruction with your physicians; either at the time of surgery or later as several techniques exist.

Gary Crump, AOPA’s medical and mythical matters guru told me that during chemo or radiotherapy, one is disqualified from exercising flight privileges, but re-apply after completing treatment. If prescribed Tamoxifen, a common hormone modifier, certification can be completed while taking this reasonably innocuous drug. Following treatment, including lumpectomy or mastectomy, the FAA wants to see treatment records, current status report, brain MRI, and any other tests performed to rule out metastases; if there is none beyond regional lymph nodes, certification is pretty certain. However, if cancer has spread beyond local lymph nodes, the FAA wants three years of observation before certification. Thereafter, annual CT and brain MRI along with current status report is required.

Embark on any treatment regime well-informed. Aviators use all available information to plan a flight, so do likewise. Garner second opinions, surf to respected healthcare and patient advocacy websites, and ask questions. Cancer is a scary diagnosis, but survival is becoming likelier. As a pilot, the captain of your airship, you make life-defining decisions. As captain of your lifeship do likewise and prove the apocryphal Amazonian definition wrong.

Email the author at jonathan.sackier@aopa.org.

Jonathan Sackier