Australia has one of the best rates of breast cancer survival in the world.
 
This is attributable in part to its breast cancer screening program, which has seen a significant decrease in the disease’s mortality rates among targeted populations.
 
Constant updates in cancer research, meanwhile, have led to growing awareness of factors that can impact risk, such as breast density and family history.
 
However, breast oncology and oncoplastic surgeon, and President of Breast Surgeons of Australia and New Zealand, Associate Professor Sanjay Warrier, believes it is important to keep striving to improve even further.
 
‘It’s not that we’re not doing things well, but can we do things better?’ he told newsGP.
 
Associate Professor Warrier is particularly concerned with women who fall outside the scope of current screening programs – namely women younger than 40, two of whom are diagnosed with breast cancer in Australia every day.
 
‘Most Australians assume breast cancer is a problem that only older women face, but that assumption is incorrect,’ Professor Warrier said.

When considering how best to address this issue, Associate Professor Warrier decided to focus on empowering young women, ideally within the high school curriculum, to carry out their own breast examinations.
 
‘It’s almost like it’s been a little bit of a taboo area,’ he said. ‘But the more informed [young women] are, the more empowered, relating to how to approach things moving forward.
 
‘So having an idea of how to approach a breast exam at an earlier age, when they’re potentially learning about other things like sex education, makes sense.’

It was from this concept that the ‘Look, lift, feel’ campaign was born. It is a phrase Associate Professor Warrier would like to see become as well known as SunSmart’s iconic ‘Slip, slop, slap’.
 
‘The idea is to have a campaign relating to assessing the breasts without it being overly cumbersome, in a way that’s easy to remember,’ he said.
 
‘This is a process I would like to see become ingrained into the lives of women all over the world, from an early age. The earlier the detection, the better.’
 
Self-examination is especially important among young women for a number of reasons.
 
‘Breast cancer in young women can be more dangerous than breast cancer in older women,’ Associate Professor Warrier said.
 
‘This is because young women’s breast tissue is usually denser than the breast tissue of older women, meaning that lumps are harder to notice.
 
‘Mammograms can be less effective for women under the age of 40 for this reason.’
 
Associate Professor Warrier sees GPs as central figures to the campaign, and to the process in general.
 
‘It’s got to start with the GP,’ he said. ‘GPs have always been the coalface for managing women’s health, and that shouldn’t change.
 
‘[The campaign is about] empowering women to have an idea of how to self-examine, and encourage patients who notice changes to have a clinical assessment with a GP.’
 
The self-examination process delineated by ‘Look, lift, feel’, is recommended to take about five minutes and be carried out every three months.
 
‘It’s important to spend time just being aware of what things look like, before touching,’ Associate Professor Warrier said.
 
‘So the idea is to “look” and then “lift” the arms up, focusing on the breasts, the nipples, and then areola.
 
‘When you lift the arms, you’re looking underneath the breasts as well, lifting the breasts with your contra-lateral arm when feeling.
 
‘And then “feeling” systematically, which can be done through three methods. One is a circular motion around the breasts; the other method is working down the breast which we call a vertical strip method, and the third is like a radial spoke where you start from the centre and work out, around the breast.’
 
Associate Professor Warrier wants the campaign to encourage women to become more attuned to their bodies, and aware of changes worthy of concern.
 
‘One aim is to increase awareness around [breast cancer], but to reduce anxiety, as well, in that by just being more aware of your body, you’ll be aware of what’s normal,’ he said.
 
‘But, importantly, it’s to pick up patients that would tend to dismiss changes within the breasts, while reiterating that the majority of those are benign changes, but promoting that if they notice something that doesn’t feel right, to present to their GP.’

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MILWAUKEE — Kenneth Wade said he has always valued his health. He eats healthy foods. He works out. He drinks plenty of water.

In 2015, when some of his friends told him about a pill called PrEP that could prevent him from getting HIV, he said he felt that learning more about it was a natural and important step to taking good care of himself.

“My sexual health is part of my health,” Wade said. “I asked my doctor my questions about it, and within a week I was on PrEP.”

Wade, 27, is a new brand ambassador for the AIDS Resource Center of Wisconsin’s awareness campaign “Stay PrEP’d Up,” which seeks to educate Milwaukeeans about the benefits of the medication and break down any stigmas about it.

PrEP stands for pre-exposure prophylaxis. It’s a daily prescription pill that can significantly reduce a person’s risk of contracting HIV, a virus that damages a person’s immune system, makes it harder to fight off infections and can lead to AIDS.

When taken consistently, PrEP can reduce someone’s chance of getting HIV through sex by more than 90% and of getting HIV through needles by more than 70%, according to the Centers for Disease Control and Prevention.

After years of substantial declines, rates of HIV diagnoses have stagnated in recent years. Research from the Centers for Disease Control and Prevention suggests that this is because prevention options like PrEP are being severely underutilized.

“PrEP is the fast lane to the end of the AIDS epidemic, as long as we can make sure the people who need access to it are getting it,” said Mike Gifford, president and chief executive officer of the AIDS Resource Center of Wisconsin.

In cities like Milwaukee, there are huge disparities in who is impacted by HIV, along with who accesses PrEP. African American gay and bisexual men are more affected by HIV than any other group, with Latino gay and bisexual men being the second most impacted group, according to the Centers for Disease Control and Prevention.

In 2017, 83% of the 118 new HIV diagnoses in Milwaukee were among people of color, according to the AIDS Resource Center of Wisconsin. Research from the Medical College of Wisconsin indicated that African American men are diagnosed with HIV at rates four times higher than white men.

Meanwhile, the Centers for Disease Control and Prevention reported that only 1.4% of African Americans and 2.5% of Latinos who could have potentially benefited from PrEP were prescribed it.

“If we don’t find ways to increase PrEP use to young people of color, we’re going to continue to see those disparities,” said Katherine Quinn, assistant professor at the Medical College of Wisconsin’s Center for AIDS Intervention Research.

PrEP is a good option for people who are HIV-negative but who face a higher risk of getting HIV, Quinn said. Factors that may heighten a person’s risk of getting HIV are having sex with someone who is HIV-positive, having sex within a social network where HIV is more common, having had sex without condoms, having multiple sexual partners or exchanging sex for drugs, food, money or a place to live, according to the Stay PrEP’d Up website.

Wade said he was initially hesitant about taking PrEP because he wasn’t sure if his insurance would cover it. But after doing some research, he learned that his clinic could make it affordable.

“I have found it very easy for me to get treatment,” Wade said.

Besides possible financial barriers, Wade said he has heard about stereotypes or misunderstandings that have made some of his peers skeptical of PrEP. For example, he said some people thought that the PrEP pill was for people who were HIV-positive, and that people would judge them if they took it.

“It’s really just about being safe and protected,” he said he wants others to know. — (AP) 

___

The nonprofit news outlet Milwaukee Neighborhood News Service provided this article to The Associated Press through a collaboration with Institute for Nonprofit News.

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MONTGOMERY, Ala. (AP) — As the federal government prepares to launch an ambitious initiative to end the HIV epidemic, the director of the Centers for Disease Control on Friday applauded an Alabama HIV clinic’s commitment to providing health services to rural communities.

Director Robert Redfield met with state public health officials and toured the Medical Advocacy & Outreach clinic in Montgomery to begin laying the groundwork for the decade-long federal campaign. HIV is the virus that causes AIDS.

Alabama is one of seven states the federal government is planning to target with additional expertise, resources and technology for its relatively high rate of new HIV infections among residents in rural areas.

The initiative — first announced by President Trump in his State of the Union address in February — aims to reduce new HIV infections by 75% in five years and at least 90% in 10 years.

The South accounted for more than half of the nearly 40,000 new HIV diagnoses in 2017, with 23% of new diagnoses occurring in suburban and rural areas, a disproportionately high distribution compared to the rest of the U.S., according to data from the CDC.

Redfield said targeting the epidemic in rural areas is particularly difficult because of both the limited access to health services and the increased stigma associated with homosexuality and HIV/AIDS as an illness.

“The true enemy of public health is stigma,” Redfield said after a meeting with state lawmakers, public health officials and physicians. “In rural America, stigma is an even greater issue.”

Redfield said the federal initiative, which has yet to be allocated funding, will focus on improving diagnoses, getting people into treatment, implementing prevention strategies, working with health departments on identifying hot spots and helping local communities develop a workforce to engage individuals living with HIV.

Scott Harris, Alabama’s state health officer, said the initiative will rely on conversations with local health-care providers to help design the kind of unique programs that will be most effective there.

“We have an opportunity to use people at the local level to help us understand exactly what’s going on in these particular communities,” Harris said.

Redfield, who began researching the virus more than 30 years ago, got a first-hand look at how Medical Advocacy & Outreach targets rural communities during a walk-through of the facility that included a brief presentation on the clinic’s telemedicine program, a video chat setup between a doctor and a patient described by some staff as the “crown jewel” of the clinic.

On a flat-screen TV situated at the front of a small room in the Montgomery clinic, Redfield greeted a nurse located in one of the organization’s ten satellite clinics. He then put on a pair of Bluetooth headphones which allows physicians to remotely hear the hearts, lungs or bowels of a patient via a digital stethoscope dozens of miles away.

Thomas Stephens, a spokesman for the clinic, said he hoped the visit gave Redfield a “personal,” ”human” perspective on the kind of on-the-ground programs aimed at stemming HIV/AIDS in rural Alabama.

“We want to suppress viral loads. We don’t want to suppress self-esteem,” said Jamil Dawson, MAO’s director of support services, to Redfield during his tour.

“I think I’m going to steal that,” Redfield said.

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