Archive for breast cancer
There are now new guidelines regarding the frequency of mammogram screening, and yes, this debate continues to go on!
These recommendations however, are backed by most professional medical organizations. The American Cancer Society agrees, and that carries a lot of weight.
These newest recommendation apply to women of low risk, and include starting age 45 instead of 40; and having a mammogram yearly until 55 yrs of age. At this point, women are recommended to have a mammogram every other year until within 10 yrs of life expectancy (when the average woman dies); then they can stop. The new recommendations recommend against monthly self breast exams, and against your medical provider doing breast exams.
If you are at high risk, ie have a family history of breast cancer or a personal history of cancer as well as some unhealthy life style practices; you are recommended to discuss your screening with your provider.
- In other words, if you have had a sister, mother, daughter with breast cancer; you are at higher risk and need to be screened more regularly and start a little earlier.
- If you have had any other cancer, you are considered at risk for future cancers from other sites; so you are at higher risk.
- If you smoke, drink more that 10-14 alcoholic drinks a week (ie 12 oz beer, 5 oz wine, 1-1.5 oz liquor), are in the obese weight category, and are not active; you should get regular screening.
Many providers, myself included, do not agree with the lack of provider breast exams. I personally, will not give that up in my clinical practice. A lump is a lump and how are you going to know it is not cancer unless it is found and evaluated?
The reason for this shift in recommendations involve trying to minimize aggressive and fear inducing procedures and treatments for abnormalities that ultimately are benign or so slow growing they will not impact longevity. Cancer occurring in the 40′s and early 50′s are felt to be more aggressive and faster moving.
One major and important organization, the American Congress of Obstetricians and Gynecologists do not agree with these new recommendations.
They feel screening should begin at age 40 and continue yearly, no end point specified. They still approve of self breast exams and yearly provider exams.
What do I, as a provider, recommend? Somewhere in the middle.
I do agree with yearly exams in the 40′s and 50′s. As stated above, if I see a woman for a yearly female exam, she is getting a breast exam. Self breast exams are fine every other month or so. It is probably ok to skip a year here and there with mammograms if someone is low risk. If a woman has no family history or personal history of cancer, but her healthy habits are not good; I will recommend yearly mammograms. I feel it is likely safe to stop screening in the late 70′s for most healthy women who expect to live well into their 80′s.
This is my take on the new recommendations. Let me know what your experiences, questions and thoughts are!
Breast cancer is scary, no getting around it. It is especially scary when we know someone who has struggled with it.
Mammograms are painful, more painful for some of us than for others. Add pain to fear, and it is no surprise many of us avoid the ordeal all together.
The most current recommendations for mammogram screening recently published by the USPSTF call for women to have screenings begin at age 50 and occur every other year. Beginning screening at 40 is at the discretion of the individual, taking into account their concerns and risk factors. These recommendations are contrary to the American Cancer Society, and the American College of Obstreticians and Gynecologists(ACOG).
One in six women with develop breast cancer in their 40′s, and there has been a 35% drop in breast cancer death since the mid 1980′s. This coincides with the regular use of mammograms for breast cancer screening. It is no wonder the two most learned medical societies on the subject do not agree with these recent recommendations.
When you are at higher risk for breast cancer, avoiding your mammogram is not really a good option. Sure, it is your choice to not get a mammogram. If you are at risk though, and you cannot change that risk; doesn’t it make sense to be proactive? To catch something before it is a big problem?
Avoiding the problem will not make it go away, but it may make the problem more profound when it lands on your doorstep.
Sure, there is a lot of confusing information about the benefit of mammograms. Many screening tests can bring up abnormalities that need to be evaluated, and are found to be benign. So now we have pain, fear, and extended fear over a false positive mammogram finding. I understand the desire to avoid testing all together.
There are steps you can take however, to help avoid some of the pain and some of the fear.
1. If you are at high risk for breast cancer, talk to your provider about having an MRI performed instead of mammography. It is more accurate, and less painful; but unfortunately not always covered by insurance.
2. If you have dense breast tissue but do not qualify for MRI, get a 3D mammogram. It is more accurate in looking at abnormal appearing dense breast tissue.
3. Bring a friend to your screening test to give you emotional support.
4. Decrease your risk factors: cut down on alcohol, exercise and optimize your weight, stop smoking, reduce the consumption of toxins in your water and food.
It is often women with several family members with breast cancer that are most fearful, for good reason. If you know someone like this who avoids screening altogether, lend them your support. Encouraged them to get a mammogram, it could ultimately ease their minds!
October is Breast Cancer Awareness month; a time we women can think about our risks for breast cancer and how we can reduce them. A time to share our thoughts, knowledge and experiences with friends and loved ones.
According to experts, breast cancer is lower in countries with more of a plant based diet. The same experts state that diet is responsible for 30-40% of all cancers!
Researchers here in the US have not yet been able to link a higher fat diet with a higher rate of breast cancer. A study is ongoing however, the WHEL -Women’s Healthy Eating and Living study, looking at the effect of lifestyle and eating on the risk of breast cancer. This study will not be finished for a few more years. A similar study is ongoing in Europe, called EPIC-European Prospective Investigation into Cancer. It is involving over 500,000 people in 10 countries; and looking at the link between lifestyle and cancer.
We do know however, that being overweight and drinking alcohol heavily, and maybe even moderately; are 2 lifestyle habits that are associated with an increase risk of breast cancer. This HAS been shown in studies.
It is all about the immune system, and that IS how you can take control. Eating a healthy diet full of important nutrients, such as you get from fresh fruits and vegetables, gives your body what it needs to support a healthy immune system. A diet low in foods with added chemicals or pesticides, reduces the chance of unhealthy cell changes that may promote cancer. And maintaining a healthy weight with reduced fat, also reduces the amount of estrogen that fat cells are known to emit.
A recent study has suggested that women with healthy diets and weights prior to a diagnosis of ovarian cancer, had a better success rate with treatment and lower mortality in the years following diagnosis. This information was collated from data of the Women’s Health Initiative. It is felt this is related to a more vibrant immune system in women with healthier diets.
There are several simple steps you can take to improve your diet:
- Buy one new vegetable every week you grocery shop, and experiment with different way to prepare, cooked or raw.
- Add chopped vegetables to soups or spaghetti sauces, either home prepared or jarred.
- Eat your fruits, don’t drink them. This gives you valuable fiber and reduces chance of unhealthy additives.
- Trim fat and remove skin from meats and poultry to reduce unhealthy fats
- Use less salad dressing. Even try some of the yoghurt bases salad dressing now in markets. I have tried several and they are very good, usually located in the produce part of the market, no the usual salad dressing isle.
- Think of your plate divided into 1/3 section. Meat or protein on 1/3, vegetables on 1/3 and whole grains or beans on a third. Or, 2/3 s veggies, 1/3 protein.
- Reduce your portion sizes of protein to total of 6 oz a day
- Limit your alcohol. Alcohol is basically a sugar. Healthy limits are no more than 7 beverages a week for women, with a serving size of 4-5 oz of wine, or 1 0z of liquor, or one 12 oz beer (not IPA as the alcohol content is higher in many IPA beers) So MEASURE your wine glasses to know how much you are actually getting when you pour! A huge goblet filled to the top is not 1 serving.
Take this month of October to decide if you are serious about improving your immune system and sustaining your health for years and decades to come.
Start with one suggestion above and work on it. When you have integrated this into your routine, and you no longer need to think about it because it is automatic; start on the next item you feel you can, and need to change.
Making long lasting and important changes need not be done overnight. If you can, great!
Most of us however, have to start slowly and deliberately. I know you can change, I have seen it daily in my work in medicine. When the motivation is there, the power is there, and the will is there.
Find your power and motivation to make needed changes, and work to escape the risk of cancer.
Part of being smart about your medical care and problems, is knowing the drugs, and the studies that prove the drugs work.
There are numerous breast cancer treatments, and most university or major hospital systems will treat according the current guidelines, ensuring consistency in quality treatment. Studies are done to see what combinations of chemotherapy agents work best with a specific cancer cell types. Now, it is also possible to see if you are genetically suited to have a specific treatment work for you, tailoring this therapy even more specifically for you.
I hope you never have to get to know the names of these drugs, but if you do; it is important to become familiar with what is considered the standard effective therapy for your type of cancer. Studies continue to be ongoing as researchers are committed to finding a cure for the specific cancer they are studying. Many of these researchers have a personal stake in finding a cure, a relative or loved one with the very diagnosis they are researching. That is powerful motivation.
Powerful motivation also comes in the form of doing what it takes on the part of patients, to live another day, week, and even years. To someone looking from the outside in, some measures seem desperate; only giving a few months longer survival. Wondering if the pain of treatment is worth only a few months longer of survival.
Exciting news on exactly this issue came recently from Spain regarding a study looking at the combination of chemotherapy agents to treat a certain type of breast cancer. The use of Herceptin along with Perjeta increased survival by an additional 15 1/2 months! That is powerful if you are that patient, waiting for more and better treatment and cure.
The HERS2 positive breast cancers that responded to this treatment is a specific type occurring in roughly 1 of 5 breast cancers. It is a protein produced by the cancer cells due to a mutation, that promotes the growth of cancer cells.
I hear many people voice the opinion that if they ever got cancer, they would not want to subject themselves to harsh chemotherapy. They would try for quality of life. I understand that feeling, however those feelings often change when it is you getting that diagnosis. Most of us are truly not ready to give in and give up when we are in our 50′s, 60′s and even 70′s.
The cancer research community is truly bonded together to find the best treatments and cures. Most of these researchers know each other, speak to each other, are connected professionally. Be informed about what will help you . The American Cancer Society webpage is an excellent resource, as well as the National Institute of Health website that lists ongoing clinical trials.
Receiving a diagnosis of breast cancer is terrifying and shocking. Find some time to come to terms with this news, and talk to loved ones. You will need someone to travel this journey with you, get them on board early.
Read about your specific type of tumor and learn what is considered the standard diagnostic testing and treatment, and take notes along the way. Question your provider about your treatment plan, ensure they are holding to the standard of care.
Enlist people to help you understand the diagnosis, treatment and success of treatments. Have one of your smart computer savvy relatives do computer searches on the best treatments. Find out what research protocols the medical centers around you are enrolled in. Many will be lined up with other university and large research systems, sharing information on successes and failures.
Remember to take care of yourself with plenty of rest, healthy nutrition, and get some exercise. These life style habits have been shown to boost response to treatment and survival. Take charge of this where and when you can. It will help you feel in control.
Hopefully the decision whether to undergo a CPM is not a need or priority for you.
I am talking about a contra-lateral prophylactic mastectomy.
The diagnosis of breast cancer can be devastating for a woman and her family. The diagnosis carries with it the fear of dying a painful death, not living long enough to fulfill life’s dreams, all in addition to fear of disfigurement.
Treatment for breast cancer has advanced tremendously in the last several decades. Because of the ability to tailor effective treatment through genetic testing and hormonal receptor testing, women often have choices between undergoing a lumpectomy in place of a mastectomy. The difference between having a small amount of tissue removed, or the entire breast.
The staging of a woman’s breast cancer often dictates when a mastectomy is preferable over a lumpectomy. In some cases, with some factors contributing to the potential aggressiveness for recurrence, such as BRCA testing; removal of the non involved breast is recommended. But this is not the usual case.
It comes as some surprise to breast cancer experts that there is an increasing trend for contra-lateral prophylactic mastectomies in young women with early stage breast cancer. The reason is not known..
The fear of breast cancer can cause a women to desire surgery quickly, as in now. Many women immediately begin to consider having the non affected breast removed. CPM rates have almost tripled in recent years.
A recent study has looked at the benefit for contra-lateral prophylactic mastectomy (CPM), and benefits for the most part are few. Granted, researchers are looking at the end point of increased survival; which I guess is what it is all about. Will I live longer if my other breast is removed?
But what is the chance of cancer in the non-affected breast with a diagnosis of cancer? Between 3-9% of women with a non BRCA gene mutation breast cancer will go on the develop breast cancer in the healthy breast.
It is not the usual course, but it happens.
There are many types of breast cancer, and I review them extensively in this prior article. While having cancer of most any kind increases your risk of other cancers, one kind in particular is strongly associated with occurrence of other cancers. So strong that specialist strongly encourage women with the BRCA gene mutation to have a mastectomy of the non cancerous breast. While it is reassuring that this type of breast cancer is unusual and only accounts for 5-10% of breast cancer; the fear of recurrence in the healthy breast is a fear hard to dismiss if you have a diagnosis of breast cancer.
While many women will not get breast cancer, not screening is not an optimal way to avoid the issue.
Even if you are not at risk for breast cancer, I want you to do one thing for me.
Schedule your routine screening mammogram if it has been longer than a year. If you have dense breast tissue, talk to your provider about having a 3D mammogram for screening in place of routine mammogram. This is more sensitive and lessens false positive results, or abnormality scares.
And if you are at risk for breast cancer; definitely schedule a mammogram, probably a diagnostic or 3D mammogram for greater accuracy in screening.
Scary as it is, early detection decreases the chance of spread and perhaps invasiveness of disease through early treatment. We hope the early detection increases and lengthens survival, offering a cure.
It seems that almost weekly, there is a new study or analysis of a study questioning or extolling the virtues of breast cancer screening. Several decades ago, the medical community was repeatedly encouraging women to get breast cancer screening, all in an effort to lower the death from breast cancer. Treatments were admittedly severe with total mastectomy, radiation therapy causing severe side effects, and harsh chemotherapy.
Breast cancer treatments have come a long way since then, and many women are successfully treated for breast cancer without disfiguring surgery or devastating radiation and chemotherapy. We may be tempted to attribute this improvement of treatment with earlier detection, and that may be the case for many women.
Many advancements include identifying specific cell types and tailoring treatment towards that cell type. This is where some of the controversy has arisen. There’s one type of cancer, called DCIS (ductal carcinoma in situ) that many women have been treated for and perhaps unnecessarily so.
Specialists initially felt this cancer type was as potentially life threatening as any type of breast cancer you may think of. It turns out however that this type is unlikely to ever progress beyond a localized tumor. This has caused many studies and data crunching to evaluate whether mammograms have actually lowered the breast cancer death rate.
It is clear that the final answer is not in yet. I suspect a more stratified evaluation guideline will eventually emerge regarding when and how often to get mammograms, and how having a higher risk for this disease will change that testing algorithm. For now however we are stuck with getting yearly or bi-yearly mammograms. I cannot help but believe that in many circumstances, a mammogram can discover a cancer earlier than it otherwise would have been discovered. In so doing, treatment would theoretically be kinder and gentler than the mastectomies and blasting radiation and chemotherapy of the 70′s and 80′s.
An interesting new study has introduced the use of a modality that is still somewhat controversial within the conventional medical community. It has been considered an alternative testing strategy, but this study raises its value.link to study***
Thermoscans have been around for a while and utilize the heat of blood flow to look for areas of growth within breast tissue. It does not use radiation, but an infrared technology. A growing cancer requires a blood supply that is otherwise not present to that degree in normal breast tissue. There for, an increased heat signal could indicate a growth. This will hopefully become a more accepted screening method within the medical community as it may give different information from standard mammograms.
Regardless of your personal feeling regarding breast cancer screening, it is wise to speak with your provider about your risk factors and determine a schedule and modality that is safe and effective for you.
Mammograms are part of most women’s health screening if they are over 40. Mammograms are never enjoyed, often feared for the information they may give forth; but usually endured on a regular basis. Woman are often relieved, if not happy; when they get their letter stating everything is fine for another year at least. Until now, most women were not routinely told if their breast tissue was dense and may limit the sensitivity of mammogram screening.
Mammograms detect a cancer by evaluating the density of normal breast tissue, and looking for an area of higher density which may represent an area of growth. Normal breast tissue is usually not all that dense by the time we are menopausal, and this is a normal changing associated with age. Any area that appears more dense than most the surrounding tissue is then felt to be abnormal, perhaps suspicious for a cancer. This is one reason that mammograms in younger women are usually not very good at picking up a cancer, as the breast tissue in younger women is usually fairly dense.
There are some women that do maintain density in the breast tissue as they age. Estrogen is one of the causes of breast tissue density, so it stands to reason that late onset menopause can cause breast tissue to remain dense because of prolonged amounts of estrogen in the system. For the same reason taking HRT can also cause breast tissue density. This, in and of itself is not a problem; except for the fact that screening accuracy can be affected.
If you have dense breast tissue, and you are at increased risk for breast cancer; you may want to talk to your provider about different forms of breast cancer screening such as MRI or ultrasound of a specific lump or mass. It is now required in some states that a patient be informed if her breast tissue is dense enough to limit sensitivity of screening.
Mammograms continue to be a useful and sensitive screening tool for detection of breast cancer. Like anything though, it has its’ limitations. They may be painful and a dreaded event; and many specialist would point out the amount of over diagnosis that a false positive mammogram causes. It is up to you and your provider what you do for screening and how often this screening occurs.
Another study has been published weighing in on the debate as to whether mammogram screening actually saves lives. In 2009, the US Prevention Services Task Force (USPSTF) published a statement regarding frequency and age for women to obtain mammograms. Much to the consternation of many groups in support of mammogram screening, routine screening to begin at age 40 was recommended against as it was felt that mortality was not improved by early detection of breast cancer.
Most of us do not like having mammograms, and we dread it every year that we go. We pray for that normal reading and become fearful when we get a “call back”, although most are for thankfully minor issues. How are we supposed to feel when an esteemed group such as the USPSTF states that not enough lives are saved to justify the money spent on screening between 40-50, or yearly screening between 50-60? How many of us know women who had a breast cancer discovered in their 40′s or early 50′s. Would this cancer have been larger, or spread to other areas if these women had waited for the “recommended” interval?
The data from this recent study was collated and analyzed in Sweden, involved 133,065 women over 7 years and these women were followed up after 29 years to assess incidence of disease and death. A 30% reduction of mortality was seen in this group, including women 40-50 screened every 2 years and women 50-75 screened on average every 33 months.
What these researchers found was that it took 1000-1500 mammograms to prevent one death from breast cancer.
So tell me, do you think that money is well spent?
I can think of many women off the top of my head, that I personally know, that I am very glad they had their mammograms in a timely fashion. I think their money was very well spent.
A new avenue for treating Breast Cancer – a protein has been identified that causes breast cancer cells to proliferate. This article explains what this finding may mean for women with breast cancer.
Do you know what perfluorocarbons are? PFC’s are chemicals due to phased out 2015 but they are still present in plastic ware, furniture, carpeting and non-stick cookware. One of the side effects of persistent exposure is early menopause.
Yoga has benefits beyond relaxation in breast cancer patients. Just the lowered cortisol levels are beneficial but there are other benefits too.
This has been a short post connecting you to new information about menopause and the most feared complication of womanhood, breast cancer. There is a new inexpensive Guide we have produced called the Menopause Guide to an Active Healthy Life. You have to be a free member or visit our Facebook page Facebook.com/FemaleMenopauseMentors to access this new information we are almost giving away. Sign up soon before the intoductory offer expires.
What are you doing about mammograms? Is your doctor recommending you get one yearly, every few years, or how often? Does he or she believe in the recent guidelines or do they think you should be screened more often? Anne weighs in with some advice for women in menopause.
What do you think? How should it be done for you? Join in our conversation here. You can find Mammogram guidelines at the National Cancer Institute, and the USPSTF
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