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Early Detection Options for Breast Cancer

Posted Jun 19 2013 3:30pm
With news feeds blowing up about the story of Angelina Jolie’s double mastectomy, breast cancer is once again in the headlines. In my life, however, it is always in the forefront. My mother was just 44 years old when she was diagnosed with breast cancer and 50 when she finally succumbed to this awful disease. For nearly seven years, I watched and cared for Mom as she dealt with the frightening world of poking, prodding, nauseating medications and waiting, waiting, waiting for test results. Given the conflicting information out there, young women like me — possible heirs to the breast cancer legacy — feel confused about our options for avoiding the same fate as our mothers. Jolie’s double mastectomy will hopefully spur more awareness and information. It also, however, may trigger panic and rash decisions among those of us whose mothers died from breast cancer. Conventional medicine advises that we start getting annual mammograms at age 40. And yet, as I have come to understand, mammograms have a difficult time detecting cancer in small, dense, young breast tissue. In addition, some reputable studies seem to indicate that the ionizing radiation of a mammogram actually may cause cancer — ironically, through the very act of trying to prevent it. To set the record straight on early detection options available, I spoke with conventional, complementary, and alternative medicine leaders, as well as with high-profile survivors of breast cancer. Their advice, I discovered, is relevant not only to young women like me, but to all women. According to the Centers for Disease Control and Prevention, breast cancer is one of the leading causes of death in women of all races in the United States. One in eight women will be diagnosed with invasive breast cancer in her lifetime, with approximately 211,000 women diagnosed and 40,000 dying annually from the disease. The good news, says Lindsay Avner, founder and CEO of Bright Pink, is that breast cancer is “extremely treatable” when caught early. Like Jolie, Avner tested positive for the BRCA gene and chose to get a double mastectomy as a preventive measure. “As with any cancer, the earlier the diagnosis, the earlier treatment can begin, and the better the long-term outcome and survival rate,” confirms gynecologist Wendy Warner, M.D., director of Medicine in Balance and co-author of Boosting Your Immunity for Dummies. Early detection of breast cancer implies that a tumor is fairly small when discovered. As a result, explains Julie Taguchi, M.D., an oncologist at Sansum Medical Clinic, a woman has multiple and less-invasive options available to her, when it comes to conventional treatment. Lumpectomy, with or without radiation, may eliminate the tumor, without the need for chemotherapy, a mastectomy, or a complete removal of the axillary lymph nodes. “The idea of early detection is to reduce the amount of treatment,” Taguchi explains, “with the understanding that we are trying to save lives and prevent unnecessary therapies.” Celebrity actress and businesswoman Jaclyn Smith knows firsthand the importance of early detection. Like clockwork, she began getting annual mammograms once she turned 40. “When I respect someone’s opinion,” she says, referring to her team of medical professionals, “I do what they say.” In her late 50s, Smith was diagnosed with breast cancer. “When they told me, I said, ‘Take off both breasts,’” she recalls. Her husband, however — a doctor whom Smith refers to as “a walking encyclopedia of knowledge” — advised Smith that a lumpectomy could be just as effective, given the early detection. After Smith and her husband looked into the matter, Smith decided to pursue that route, and she has been cancer-free ever since. Smith credits the annual mammogram with saving her life. Some women, however, have had the opposite experience with mammograms. Award-winning actress Suzanne Somers reveals that she, too “obeyed all the rules.” After her 10th mammogram, she recalls, the doctor once again gave Somers a clean bill of health. He had just acquired a new ultrasound machine, however, and suggested that Somers give it a test run. “That’s where they found my large tumor that had been growing undetected for 10 years,” Somers recalls. “My 10 mammograms missed the tumor, which was against my chest wall; the ultrasound picked it up.” Not only do women have conflicting personal experiences with mammograms, but experts agree that mammograms are a mixed blessing. “At this time, mammograms are the most cost-effective and widely-available tool for breast cancer detection,” says Chandini Portteus, vice-president of Research, Evaluation and Scientific Programs for Komen Foundation, “but we know they’re not perfect. They may miss cancer or may report a false-positive result.” In addition, some experts caution, mammograms may exacerbate the problem of radiation, which is a recognized cause of breast cancer. “I don’t knock mammograms,” says Warner. “I just don’t understand why we primarily employ something that uses ionizing radiation to look for something that is caused by ionizing radiation.” Joseph Mercola, DO, a leading integrative medicine specialist, is especially concerned about the radiation from tomosynthesis, a three-dimensional (3D) mammography. A new technology that recently was approved by the FDA, tomosynthesis was designed to help doctors get a better picture of dense breast tissue, particularly in younger women, in the hopes of decreasing the number of false-positives. “The problem,” Mercola says, “is that 3D scanning requires multiple X-rays, exposing women to 1.5 to 3 times more radiation, depending on how many total exposures she gets.” [1] [2] [3] According to Otis Brawly, M.D., chief medical officer of the American Cancer Society, opting for a standard mammography or the newer tomosynthesis basically comes down to a batting average: “Mammography may cause a few cancers, maybe even a few deadly cancers,” he says, “but it leads to a net of saving lives.” A cost-benefit analysis of mammography and tomosynthesis, he continues, must take into consideration where a woman is in her life: “Both are better tests in women with older breasts. They are better [for] women in their 60s, compared to women in their 50s, and better for women in their 50s than women in their 40s, and not very good for women younger than 40.” Mammograms “can’t see through dense breasts, so they are basically worthless” for women under 40, concurs surgeon and breast cancer patient advocate Christine Horner, M.D., a former spokesperson for the American Cancer Society in Kentucky. In addition, she continues, research indicates that when women are in their 20s and 30s, the breast tissue is “far more radiosensitive” than when women are older. She cites a 2012 European study indicating that for women under 30 and BRCA1 positive (genetically predisposed to breast cancer), diagnostic radiation increases the risk of breast cancer risk by 90 percent. Clearly I am not getting any kind of mammogram in the foreseeable future, though I may get tested for the BRCA-1 gene, as did Jolie. Meanwhile, I am pleased to have discovered that the medical world has a few radiation-free tricks up its sleeve — useful, albeit not foolproof, in early detection of breast cancer: magnetic resonance imaging (MRI), ultrasound, and thermography. I plan on exploring these diagnostic options in a future blog post. Meanwhile, regardless of what diagnostic test a woman chooses, experts strongly advise three action steps for early detection and successful treatment of breast cancer: 1. Know your body. “Women should become familiar with the way their breasts normally look and feel,” says Portteus. “Knowing what is normal for you may help you see or feel changes in your breasts.” Brawley advises keeping in mind that most women who discovered cancer through self-examination did so through simple awareness and cursory checks, as opposed to monthly self-exams. 2. Build a medical team you trust. Avner emphasizes that it is critical for women to partner with doctors they trust, so as to develop early-detection and risk-reduction strategies tailored to their individual needs. Early detection, Brawley adds, must be followed up with effective medical treatment. 3. Develop healthy lifestyle habits. “Early detection is important,” says Warner, but “true prevention is more important.” Experts advise eating nutrient-dense foods, exercising regularly, managing stress, and getting ample sleep. By optimizing your health and wellness, you will reduce your chances of getting cancer in the first place. As the old saying goes, the best self-defense is avoidance. References: [1] http://www.usatoday.com/story/news/nation/2012/10/09/3d-mammogram-tomosynthesis/1615719/ [2] http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/MedicalDevices/MedicalDevicesAdvisoryCommittee/RadiologicalDevicesPanel/ucm226757.pdf [3] http://www.radiologytoday.net/archive/rt1111p32.shtml
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