Archive for breast cancer

Jun
30

MAMMOGRAMS- DO THEY SAVE LIVES OR NOT?

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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.

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May
16

Mammograms – What should a woman in menopause do?

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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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Apr
04

EMOTIONAL IMPACT OF BREAST CANCER ON YOUNG WOMEN

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A study is currently underway at Southern Methodist University, regarding the stress of breast cancer to women under 40 who contract a certain aggressive type.  This type is called Triple Negative Breast Cancer, or non-hormonal breast cancer. It is very aggressive and typically strikes African-American women early in life, usually 30′s to early 40′s.

Cancer groups and researchers have closely studied the psychological effects of cancer in older women, but this younger group is smaller and not so well studied. It is easy for people to lump women with breast cancer into the same category as far as psychological concerns, but there are some very real differences.

Younger women with breast cancer are often mid-career. Taking time off is often not as accepted or understood, especially if a woman wants to keep her diagnosis a secret from co-workers. There are not as many cancer patients their age that they can talk with or gain a support from; women who have similar concerns. Because they are young, people have the perception they should be able to recover quickly and “get on with it”.

As I read about the study that SMU is conducting, I thought about one of my patients and her recent journey through diagnosis and treatment of breast cancer. Similar to the participants in this study, she is young and diagnosed with breast cancer.  She is in the midst of a professional career and considered to be very good with her skills. She is also a single mother with her extended family some distance away. As she has moved through radiation and chemotherapy, she found herself profoundly tired and was struggling to keep up with the demands of her job. Initially, her supervisor and co-workers pitched in the help her with covering some of the more physically and mentally demanding parts of her job. Her treatment journey lasted longer than this accommodation however;  and after 6 months or more, she was pushed to resume her full duties or lose her job. This would have resulted in loss of medical benefits and cancer treatment.  As you can imagine, this was extremely stressful for her. Luckily for my patient, someone stepped in to help in a significant way. A supervisor in a different department who had a personal experience with breast cancer, created a position for this woman and she is happily employed and recovering from a year of cancer treatment and feeling that she is emerging from a dark tunnel.

My thoughts for people as I type are this:

Just because someone is young and looks healthy, they can still be profoundly sick.

If someone you have worked with who has always been a dependable co-worker, suddenly starts taking time off; think about the worst that could be going on. They might be dealing with something pretty bad.

If you have a friend, relative or co-worker who has breast cancer (or any cancer for that matter), give them positive affirmations daily if you can. Positive energy goes a long way to help people. Speak the words if you can, cancer patients of all ages need to hear words of encouragement.

Let us know your thoughts or experiences with this issue, add your comment to our website. We can all learn from each other.

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A reader recently posted a question:

What do you do when your health requires you to stop taking your hormone therapy?

Many specialists would simply say, stop your medication and in essence, deal with it. Your gynecologist or family practitioner could no doubt offer more advice than that. My first advice would be to contact your regular provider to ask their advice on controlling symptoms.

The time of menopause is also the time of increase risk of stroke, heart attacks, cancers, and blood clots or DVT ( deep vein thrombophlebitis). Estrogen and progesterone can cause inflammation of blood vessel walls, thus helping to cause stroke, blood clots, and heart attacks. Estrogens can fuel a breast cancer or other cancers of the female organs. Since having one cancer places you at risk for any other cancer, it makes sense to discontinue estrogen for any cancer a woman may experience.

So what do you do when you are told to suddenly stop the therapy which is helping you feel sane and in control?

There are many other therapies which are safe and can help control symptoms, but first you must check with you provider. One thing which will be vital for controlling the symptoms of menopause is a healthy life style. Because of how food is metabolized during this time, it is important to limit foods high in sugar as this can lead to fatigue and sometimes fuel hot flashes. It is also important to limit caffeine and alcohol as these items can trigger hot flashes both daytime and nighttime. Alcohol also causes difficulty with sleep mostly due to the sugar content.

We all know a bad night sleeping can lead to

  • fatigue, which leads to
  • low energy and avoidance of exercise,
  • leads to convenient food choices for comfort and ease of preparation.
  • lack of sex drive
  • difficulty concentrating
  • all of the above leading to low self esteem and possibly depression over lack of control

How do you gain control of all this?

A diet high in antioxidants helps. This means fresh fruits and vegetables, brightly colored or deep leafy green. Consuming less sugar, caffeine, and alcohol. If you are sensitive, a diet low in dairy. If you are not sure how dairy sensitive you are, stop all dairy for 1-2 months and see how you feel. You may have more energy, less respiratory problems and skin problems. Exercise of any kind that gets your heart beating faster and uses your muscles in a way not normally used in your average day.

For medical help when the above measures are not enough, there is clonodine or effexor (low dose) which can help with hot flashes. There are sleep aids which are generally safe for short periods of time. Doing cross word puzzles or other memory type games can help some with “brain fog”, as does some low dose antidepressants if applicable. Herbal products should be used with extreme caution if they contain soy or black cohosh; these products can theoretically be irritating to blood vessel walls as they are estrogen like in their action.

There are measures you can take to control your symptoms, nothing may be as completely relieving as hormone replacement therapy. Talk to your medical provider to get advice targeted to your health situation. Then, write us back and let us know what worked for you! Share your successes with our readers.

Anne V. PAC

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Oct
25

BREAST CANCER AND HORMONE THERAPY-RECENT NEWS

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If you have been listening to the news over the past week, you most likely have heard of a recent article to be published  regarding breast cancer and hormone therapy. This data comes from an extension study of women who participated in the Women’s Health Initiative, a study regarding effects of hormone therapy on women, which  ended in 2002.

The Women’s Health Initiative was a study designed to study the effects of  HRT on heart disease in post menopausal women. This study was stopped prematurely as it revealed an increase in stroke and heart attack in women taking estrogen and progesterone for menopausal symptoms. An increase in breast cancer was also seen, and it is some of this data which has been further analyzed.

Researchers have seen an increase in aggressive breast cancer which has already spread to lymph nodes, making it more advanced at time of diagnosis and therefor harder to treat. Additionally, the hormone therapy caused a decrease in sensitivity in screening, making it more difficult to detect on mammograms. The hormones used during this study was a pharmaceutical product called Prempro. There has been much discussion regarding this type of hormone preparation, versus  synthetic  and bio-identical hormones.

Careful analysis of the data indicates, however, that the increase in death from this aggressive type of cancer amounted to 2.6/10,000 women vs. 1.3/10,000 women not  taking these medications. There was also an increase in death from all causes for women diagnosed with breast cancer who also had taken hormones replacement therapy, 5.3/10.000 vs 3.4/10,000. Still, if you are one of those women, it is a significant increase to you.

So what does one do when faced with the symptoms of menopause that are disruptive to your life.

As in anything, you weigh the risk against the benefit. It is important to discuss your risk factors with your medical provider and decide how beneficial or harmful HRT may be for you. There are also many preparations available now, however you should know that these medications have not been studied so no one can really say whether they are safer than Prempro or not.

Hormone Therapy can seem like a life saver when you are in the throws of menopause but be aware if its risks before you begin taking these medications. I myself felt that HRT helped me to cope with all the symptoms of menopause that I was struggling with, and I felt the risk of 2-3 years of therapy was worth it. I weighed that risk, with  my family history; and committed myself to regular breast exams, mammography, and PAP smears.

Write in and tell us your stories of menopause and coping with symptoms; what you have or are taking to help as well as other strategies to deal with symptoms!

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Jul
15

Menopause News and Recent Research

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Anne Vaillancourt

Researchers are active in trying to identify ways women can move through menopause comfortably and in the most healthy fashion for them. Often times interesting studies are published or mentioned in meetings that the experts convene to discuss topics, both in the US as well as abroad. A few of the interesting topics I found in last weeks news are as follows:

Why does menopause happen well before our elderly years?

Researchers in the social sciences have been wondering this also. In most other species, the female species quickly die after loosing their reproductive capacity. Not so in Killer Whales and Pilot Whales who appear to have a similar social system as humans in terms of timing of menopause and life expectancy. It has been noted that these species of whale become genetically close to those they live with and are invested in the survival of the group. In humans, we already have this situation in that we often live with our families. It is surmised that post menopause, we are there to help the younger of our group raise their young. This tradition is especially demonstrated in other cultures mentioned in previous posting /cultural attitudes and menopause. In many African and Mayan cultures, the elder women become the sages and the leaders of their communities.


Sex and menopause is always a topic of discussion among men and women alike.

A recent study of a small group of British women, recently published in Journal of Psychology looked at this issue. Surprisingly, they found that other factors besides hormonal issues impacted a menopausal woman’s sex life the most. These included but were not confined to decreased sex drive of partner, carry for elderly parents. It is felt by researchers that social and psychological issues influence sexual behavior more than biologic issues. What do you think of this and is this the case with you and/or your friends?


There is now a blood test that researchers feel can predict when menopause may happen for a woman.
In a small study performed by the Shahad Behesh University of Medical Sciences in Tehran, Iran; 266 women aged 20-49 submitted blood samples of AMH (Anti-Mullerian Hormone) over a period of years. These women were part of a larger study of lipids and glucose begun in 1998. AMH is a hormone which is expressed in ovarian follicles and controls formation of primary follicles, thereby allowing only one follicle to develop monthly.It is only produced in small follicles and is felt to be a measure of ovarian follicle reserve. Certain levels were found to correlate with the onset of menopause, perhaps allowing women to consider when to start families in terms of work and career issues. Researchers at the above facility feel it may be a useful tool to help with family planning.


Another reason to take fish oil capsules is prevention of invasive ductal breast carcinoma.
Recently published in the Journal of American Association of Cancer Research is a small study indicating protection of this form of breast cancer with regular use of fish oil supplements containing EPA and DHA. A 32% reduction of invasive ductal carcinoma was seen.

It is reassuring that research continues on menopausal issues, as much of a woman’s productive life can be after her reproductive life. It is interesting to read of research from different countries as it seems much the research in the US can be presumed to be driven by the pharmacology industry.

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There are many ways to evaluate breast tissue for cancer

Which modality is used in which situations when screening for breast cancer or evaluating a breast lump Thank goodness we have ways of evaluating for breast cancer. Many women are concerned about the amount of radiation involved in mammograms.

When an area of concern is found,

  • what type of study is appropriate to fully evaluate this area?
  • d0 we need to do anything at all?

For decades we have had conventional mammography which utilizes X-rays (radiation) to look for areas of increased density within breast tissue. This is how many breast cancers will appear, as an area of increased density within the less dense breast tissue.

Because their breast tissue is already very dense, mammograms are not as useful in young women who find a mass in their breast. It is more difficult to detect a difference in densities. This is one situation where ultrasound is useful.

Ultrasound utilizes sound waves to penetrate breast tissue. These sound waves bounce against different structures and give a characteristic “signal” which can help to determine if a lump or mass is solid or fluid filled. Fluid filled is usually benign, solid CAN be a cancer but may also be a fibroadenoma (a benign problem). Ultrasound is also used in menopausal and post menopausal women to further evaluate a mass, in addition to mammograms.

Digital mammogram is a newer technology with utilizes X-rays as in conventional mammograms, but is analyzed more effectively and gives a greater detail. Many radiology practices use digital mammography for routine screening as it is more exact. Digital mammography generally involves less compression, and is therefore less painful. It does tend to be more expensive but may very well be worth it as there is less follow-up for questionable areas not well seen on conventional mammography.

MRI of the breast. This gives the most detailed picture of breast tissue. The MRI machine is very large and logistically would be unable to screen the numbers of women that are regularly screened in mammography suites.  MRI utilizes a magnetic type process and does not involve radiation. It is used primarily in staging of breast cancer or in patients who are at a high risk for breast cancer. It is extremely expensive and unfortunately at this point in time, not practical for mass screening.

It is important to understand the reasons different screening modalities are chosen, and to understand that although mammograms do involve radiation, they are the most practical screening method to use.  Many experts report figures that indicate the standard radiation exposure of a mammogram is equal to 3 months of normal environmental exposure. This does not seem like much unless you are someone who has had a lot of radiation already, or have a very strong family history of cancer. It is important to know there are other options of evaluation of breast tissue and it is important to speak with your provider to decide which method is best for you.

What has been your experience with breast cancer screening? Do you have questions about when to do it or how it is done. Let me know in the comments section.

Anne Vaillancourt

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Jun
29

A Breast Lump in Your Breast-Tips on what You do?

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Many women will not perform self breast exams because of fear. Fear that occurs when they find a lump. 8 out of 10 breast lumps are benign!

Self Breast Exam

Here is how your health care provider will decide whether your lump is benign or not.

The first thing a you should do when you find a breast nodule, is to see your health care provider as soon as possible. Make note of when your last menses was, if you are still menstruating, as benign breast lumps are often more prominent just before the menses.  Important factors which can contribute to breast nodules are whether there has been any recent trauma to the breast, such as a fall, punch, bite or other blows to the breast tissue. I have seen patients develop bruising after letting a small pet play on their chest while laying down and this bruising can also be in breast tissue, causing a lump-like swelling.  Additionally, it is important to tell the provider examining you whether you might be breast feeding as a localized infection (mastitis) can cause lump or mass like abnormality.

Your provider will examine you and then perhaps order an imaging test to decide whether a lump is worrisome or not.  If you are younger than 35-40 and have not had any pregnancies, most likely the first test will be an ultrasound. This will determine if the lump is solid or cystic. Not all solid lumps are cancer, most cystic lumps are not cancer. An ultrasound can also determine if there is an abnormal collection of calcifications which could indicate breast cancer.

Mammography will most likely be ordered if the ultrasound results are worrisome, however this is not the best first test in this younger age group due to the dense nature of breast tissue at this age. If, however, you have had several pregnancies and you have breast fed, your breast tissue may be less dense and a mammogram would then be more helpful.

If you are over 40, the first test will most likely be a mammogram with an ultrasound to follow if needed to further evaluate an area. The mammogram in this case would most likely be termed a diagnostic mammogram which gives more detail. Likewise the digital mammogram also gives more detail and may be the modality that your radiology practice uses.  An ultrasound may be done to further characterize or define the lump if a mammogram cannot do this for some reason.

In most cases, the investigation ends here.

If the lump has some suspicious characteristics such as

  • an irregular shape,
  • ill defined borders,
  • extra calcifications around it,
  • or if it seems to have a large amount of blood vessels going to and from it;

then a biopsy may be suggested.

Sometimes this biopsy is done by the radiologist, however more often than not, a breast surgeon will biopsy or even remove the lump to evaluate the cells microscopically. A simple needle biopsy is sometimes felt to actually help spread a potential cancer by accidentally allowing some cells to escape as the biopsy needle is removed from the area in question. For this reason, the lump is often totally removed.

Having a breast lump is very frightening in both its discovery and in the evaluation process. For this reason, the recent mammogram guidelines were issued with the intent to decrease unnecessary evaluation and worry over benign breast lumps. They are guidelines only, and their purpose is to help guide you in your decision process on breast cancer screening. These guidelines are meant to be discussed with your medical provider, many of whom believe they are too lax. They do however give some thought on how to approach screening with out undue cost and worry. The difficult conundrum is that breast cancers caught early can often be treated with less disfiguring surgery and scarring and with a better chance at preventing the spread of cancer cells.

What ever your decision is, talk it over with friends, family and health care professionals; don’t ignore this important health concern because of fear.

What do you think of the new guidelines?  What has been your experience or advice about having a lump evaluated or doing self examination? Leave me a note in the comments section.

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Jun
24

Health News for Women in Menopause

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Remember all the controversy about mammograms?

When should a woman begin to have them and how often. It seems that there is no formula in medicine.  What is the woman’s risk factors?  What sets her up to have a breast tumor?  We have written about this topic in posts on Breast Cancer tests for the type of Chemotherapy

Reduce your risk of Breast Cancer

The New Mammogram Screening Guidelines

Now there is a news article about the science behind the guidelines.  It is confusing when you try to apply a formula and not do what is best for patients.  Some women obviously need screening earlier and some can wait.  Click on the link to read more about the opinion of a Harvard Radiologist.

We all know that many women in menopause tend to gain weight. There are multiple factors for this that we have documented and some Ways to Eat we recommend to help with this problem. This news article on Weight gain after 50 being related to Diabetes after age 65 is one of a long list of reasons to become an expert on controlling your own eating and exercise habits.

What are your Challenges? Leave us a comment and tell us what you think, want and need.

Bruce Bair

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White spot is Breast Cancer seen on a Mammogram

Chemotherapy for breast cancer has come a long way from the early years of treatment options. There are several important tests that are performed  when a woman is diagnosed with breast cancer. Some of these tests determine which type of treatment is best suited for the type of breast cancer a woman may have. Genetic testing has become important in this regard and there is  new and  exciting information coming from the Researchers European Breast Cancer Conference held recently in Spain.

A recent study looked at 4 large breast cancer trials which included almost 3000 patients. There is evidence that the existence of an abnormality in a particular chromosome (17, called CEP17) is a “highly significant indicator” that a tumor will respond to a certain class of chemotherapy agents called the anthrocytes. Researchers feel this test will better tailor a chemotherapy regimen for women suffering from breast cancer. This could help avoid exposure to toxic drugs which are potentially ineffective in a given situation.

Additionally, a test has been available since 2004 which helps determine the level of risk for recurrence in stage 1/2 ER+ breast cancers which have not metastasized. This test is called Oncotype DX , and it is covered by medicare and most insurance companies. It does however come with a hefty cost of almost 4000 dollars. The 10 year risk of recurrence of this cancer in women is 15 %.  This test determines if that risk is actually lower or higher that 15%.

A study done by Loyola University involved an evaluation on how treatment decisions were changed by the results obtained from this test. The test looks at 21 genes and determines if risk of recurrence of  the above described breast cancers (estrogen receptor positive breast cancer that has not moved or metastasized outside the breast)  is either low, medium or high, as indicated by a numeric score. The oncologists in the study changed their treatment decisions and offering 31% of the time based on results of the test. Patients changed their treatment decisions 25% of the time as a result of the test, electing not to have chemotherapy to theoretically prevent recurrence of their cancer. Interestingly, 25% of oncologists in this study did not routinely order this test.

This begs the question of why such a test as this would not be ordered in this situation. Perhaps it is the cost of the test, however the economic issue of chemotherapy reimbursement has been a hotly contested item of late and particularly in regards to health care reform.  In recent years, several studies have looked at reimbursement rates and whether they may have influenced choice of chemotherapy agents, and the types of clinics treatment was provided in( private vs hospital based) in regards to many different types of cancer including breast cancer.  While we all want to trust the medical provider taking care of us through such a serious and devastating illness, it is important to be informed and knowledgeable about your or a loved one’s options. The Oncotype DX test appears to be an important test for breast cancer to help guide you and your provider in treatment decisions.

What are your thoughts? Leave me a comment below!

Anne Vaillancourt

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