Questions & Answers

Breast Cancer FAQs

Click on each question to link down to the answers.

Risk and Prevention
1. Is hormone replacement therapy safe?
2. Should I take soy estrogens--or eat tofu--to help prevent breast cancer?
3. Do regular mammograms save lives? What about breast self-exams?
4. My sister had breast cancer-what's my risk?
5. Can I ask for an ultrasound instead of a mammogram to check for breast cancer?
6. Are women who have had an abortion at higher risk of developing breast cancer?

Current Patient Questions
7. How can I receive financial assistance for breast cancer treatment?
8. How can I receive financial assistance for breast cancer treatment?
9. After a mastectomy, can I have my breast reconstructed?

Support Questions
10. Where can I find a breast cancer support group?
11. How can I help a friend or family member who has cancer?

Survivor Questions
12. As a breast-cancer survivor, should I take Tamoxifen?
13. Are there alternatives to Tamoxifen?
14. What is Herceptin?
15. What is Avastin?
16. I am a breast cancer survivor. Can I take soy estrogens to help with menopause symptoms? Are they safe for me?

Screening Questions
17. What's the difference between mammography and MRI?
18. What about the radiation from a mammogram? Is it safe?
19. Do mammograms hurt?
20. Digital vs. Film Mammography - Which is best?
21. Avoid false positive mammograms with expert radiologists

ANSWERS

1. Is hormone replacement therapy safe?

Approach hormone replacement therapy with caution. Taking postmenopausal estrogen replacement increases your risk of breast cancer. Women who have had breast cancer or who are at high risk of developing it should probably avoid hormone replacement therapy.

2. Should I take soy estrogens--or eat tofu--to help prevent breast cancer?

Soybeans and soy products (including tofu, soy milk, and miso) contain phytoestrogens or plant estrogens. These substances, which are similar to human estrogen although much weaker, are used by many women to control symptoms of menopause such as hot flashes. It is also believed that these phytoestrogens may help prevent breast cancer.

3. Do regular mammograms save lives? What about breast self-exams?

Yes, screening mammograms save lives. Because mammograms do not visualize every cancer, a complete breast health program also includes annual clinical breast examinations.

Breast self-examination (BSE) is also a component of a complete breast health program. Used in conjunction with clinical breast examination and mammography, BSE can facilitate early detection of some of the more elusive cancers. It is very helpful for a woman to be familiar with her own breast anatomy, so that she can provide information as to whether lumps or thickenings are new findings, or if they have been present for a long time. BSE is the best way for a woman to become familiar with her body.
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4. My sister had breast cancer-what's my risk?

If your sister was diagnosed with breast cancer when she was 65 years old, and no one else in your family has had breast or ovarian cancer, your risk is probably not much higher than average.

If your sister was diagnosed when she was 35 years old, and there are other women in your family with breast or ovarian cancer, your risk may be a lot higher than average. The specialists at the Cancer Genetics Clinic can help you figure out your risk. Call (206) 616-2135 for more information.

5. Can I ask for an ultrasound instead of a mammogram to check for breast cancer?

A mammogram is the most effective way to screen for breast cancer. Ultrasound is not used for routine breast cancer screening because it does not consistently detect early signs of cancer such as microcalcifications. For more on types of screening:

http://cis.nci.nih.gov/fact/5_14.htm
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6. Are women who have had an abortion at higher risk of developing breast cancer?

No, according to the National Cancer Institute. The NCI said in a recent report that neither induced abortion nor spontaneous abortion is associated with an increase in breast cancer risk.
www.cancer.gov/cancerinfo/ere-workshop-report
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7. How can I receive financial assistance for breast cancer treatment?

Financial assistance for the treatment of breast cancer can come from several places. The U.S. government has several programs which help patients pay for medical treatment, including Aid to Families with Dependent Children, Medicare, Medicaid and the Hill-Burton Program. Also, local affiliates of the Komen Foundation, the American Cancer Society and other cancer support organizations may be able to help. If you are a SCCA patient, please call our social work department at (206) 288-1076, or e-mail socialw@seattlecca.org for more information.
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8. How can I receive financial assistance for breast cancer treatment?

Financial assistance for the treatment of breast cancer can come from several places. The U.S. government has several programs which help patients pay for medical treatment, including Aid to Families with Dependent Children, Medicare, Medicaid and the Hill-Burton Program. Also, local affiliates of the Komen Foundation, the American Cancer Society and other cancer support organizations may be able to help. If you are a SCCA patient, please call our social work department at (206) 288-1076, or e-mail socialw@seattlecca.org for more information.
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9. After a mastectomy, can I have my breast reconstructed?

Yes, today most mastectomy patients can have breast reconstruction. Age is not a factor in determining a woman's suitability for reconstructive surgery, nor is the type of mastectomy or the placement of the mastectomy scar. Women who have had radical mastectomies (removal of the breast and chest wall muscles) or modified radical mastectomies (removal of the breast with the chest muscles left intact) can now have satisfactory breast reconstruction.

Also, it does not matter how much time has elapsed since a woman's original cancer surgery. Breast reconstruction can be performed at the same time as the mastectomy surgery or years later. Breast Reconstruction

10. Where can I find a breast cancer support group?

Ask your doctor, oncology nurse or an SCCA social worker socialw@seattlecca.org about breast cancer support groups. Or check the times and meeting places of SCCA support groups on the Web. The local chapter of the American Cancer Society will also have information about support groups in your area.
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11. How can I help a friend or family member who has cancer?

Helping a friend or family member who has cancer can be as easy as writing a letter of support, cooking a meal or offering to drive the person to the doctor. Let the friend or family member know that you are ready and willing to help by asking how they would like you to help. To read more: How to Help
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12. As a breast-cancer survivor, should I take Tamoxifen?

Tamoxifen (brand name, Nolvadex) is a drug that interferes with the activity of estrogen. Some breast cancer cells are "estrogen sensitive," meaning estrogen binds to these cells and stimulates them to grow and divide. Tamoxifen prevents the binding of estrogen and stops the cells from growing. Therefore, it can prevent or delay a recurrence of breast cancer for some women.

However, a recent randomized trial in postmenopausal women found that an aromatase inhibitor, anastrozole (Arimidex), was superior to tamoxifen in terms of recurrence-free survival.

13. Are there alternatives to Tamoxifen?

Tamoxifen has been found to be effective in preventing a recurrence of breast cancer however, a recent randomized trial in postmenopausal women found that an aromatase inhibitor, anastrozole (Arimidex), was superior to Tamoxifen in terms of recurrence-free survival. New Hormonal Treatments
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14. What is Herceptin?

Herceptin is a drug that until recently was only used to treat metastatic breast cancer (cancer that has spread from the breast to other parts of the body). It is an antibody that targets cancer cells that "over-express" (make too much of) a protein called HER2.

Herceptin is only effective for women whose breast cancer is HER2-positive. Because it is a targeted treatment that only attacks cancer cells, the side effects are milder than those of chemotherapy, which attacks all fast-growing cells.

Recently, doctors have begun to use Herceptin to treat women who have been newly diagnosed with HER2-positive cancer if their cancer has spread to the lymph nodes. Herceptin is recommended for these women as an adjuvant (post-surgery) treatment in combination with chemotherapy.

15. What is Avastin?

Avastin (generic name, bevacizumab) is a drug that inhibits the growth of blood vessels to tumors. It has been approved by the U.S. Food and Drug Administration to treat advanced colorectal cancer when combined with a chemotherapy drug.

New research shows that Avastin, combined with Taxol (paclitaxel), works well in slowing the progression of metastatic breast cancer. This is good news for women with advanced breast cancer because these drugs are targeted therapies, and typically have fewer and milder side effects than traditional chemotherapy drugs.

You may want to read more about this research:

16. I am a breast cancer survivor. Can I take soy estrogens to help with menopause symptoms? Are they safe for me?

Researchers are looking at these questions now. Until more is known, a woman who has or has had an estrogen-positive breast cancer should minimize her intake of phytoestrogens. The same is true for women who are taking tamoxifen.
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17. What's the difference between mammography and MRI?

Mammography uses an X-ray, where MRI, short for magnetic resonance imaging, uses radio waves and a powerful magnet linked to a computer to create detailed pictures of areas inside the body.

Mammography is an excellent tool for screening women at average risk for breast cancer It is easily accessible and less expensive than MRI.

Recent studies show that MRI is a great complement to mammography, especially in women who have been diagnosed with breast cancer. MRIs are now used most often as an adjunct to screening mammography in women who are at very high lifetime risk for breast cancer. It is also used to evaluate extent of disease in the newly diagnosed cancer patients, and can help guide treatment options. Breast MRI also detects unsuspected cancer in the opposite breast in 3 to 4 percent of these women. But at the present time, breast MRI is not considered a replacement for annual screening mammography.

In 2003, the American Society of Clinical Oncology reported on three studies that examined MRI screening for women who are at high risk for breast cancer. These studies concluded that MRI is a more sensitive in finding cancers than mammography, ultrasound, or clinical breast exams, however, it was revealed that MRIs give a higher number of “false positives,” too, which in turn can mean unnecessary tests, biopsies, and increased anxiety.

18. What about the radiation from a mammogram? Is it safe?

If you read much, you’re bound to run into articles that say yes, radiation causes cancer so it stands to reason that mammography would as well since it uses X-rays (radiation) to take images of the breast. Doctors have been looking at this assumption for years. That’s how the guidelines for what age mammograms should begin came about. The younger a person is the more sensitive they are to radiation damage, especially soft tissue like breast tissue. Therefore, it’s not recommended that women 25 to 39 get mammograms, unless there is a strong reason to do so, which your doctor will help you determine.

Like dental X-rays, mammograms use very small amounts of radiation to take images of the breast—images that can be life-saving. The risk of not getting a mammogram seems to be greater than getting them at this point in time. According to the National Cancer Institute, several large studies conducted around the world show that breast cancer screening with mammograms reduces the number of deaths from breast cancer for women ages 40 to 69, especially those over age 50.

Breast cancer is the most common non-skin cancer and the second leading cause of cancer-related death in the United States among women. The great news is that death rates from breast cancer have been declining since 1990, and these decreases are believed to be the result, in part, of earlier detection and improved treatment. Early detection = getting a mammogram.

19. Do mammograms hurt?

In the February 2005 issue of the American Journal of Roentgenology, a study was published suggesting that most women do not experience pain or anxiety during mammography screening, which of course goes against the common belief that mammograms hurt.

The study consisted of 150 women divided into three groups for their screening mammograms. In one group, the women listened to a relaxation tape during the mammogram. Another group listened to music during their mammogram. The third group didn’t listen to anything. After their mammograms, the women filled out questionnaires about how much pain and anxiety they experienced during the mammogram. The study found no significant differences regarding pain or stress in either of the groups.

"Virtually none of the participants experienced pain or anxiety. We were quite surprised at the outcome," the study investigator said in a prepared statement.

There are those holdouts though who’ll swear that their breasts are so sensitive just the idea of a mammogram is painful. This may especially be true for women with large breasts. Be sure to let the technologist know when you’re experiencing pain so they can reposition you during the test.

Bottom line: Mammograms should not be a painful experience.

20. Digital vs. Film Mammography - Which is best?

There are two kinds of mammograms: digital and conventional film. Both use X-ray radiation to produce an image of the breast, but conventional mammograms are read and stored on film, where digital mammograms are read and stored in a computer so the data can be enhanced, magnified, or manipulated for further evaluation. There are no other differences between the two.

Studies show that in most cases, digital mammograms read by specialized radiologists are over 20 percent more accurate at detecting breast cancer than traditional mammograms read by generalists. Breast expert radiologists read thousands of mammograms a year.

According to the National Cancer Institute, women with dense breasts who are pre- or perimenopausal (women who had their last menstrual period within 12 months of their mammograms) or who are younger than age 50 may benefit from having a digital rather than a film mammogram because subtle differences between normal and abnormal tissue may be easier to see. Recent studies support this, showing that digital mammography detects up to 28 percent more cancers than film mammography in the population of women mentioned above.

A 28 percent increase in accuracy means earlier detection, and most importantly, a better chance of a cure.

Other advantages to digital mammography over film mammography include improved ease of image access, transmission, retrieval and storage, and lower average radiation dose without a compromise in diagnostic accuracy.

In addition, digital mammograms are less likely than film mammograms to be lost. Digital mammograms require about three quarters the radiation dose of film mammography. However, the dose in film mammography is quite low and poses no significant danger to patients.

21. Avoid false positive mammograms with expert radiologists

The more experienced a radiologist is at reading mammograms, the more accurate the results will be.

The doctors who read mammograms are all board-certified radiologists and the more experienced ones are likely to be fellowship-trained, which earned them the title of breast imaging specialist. As a specialist, all they do is read mammograms -- thousands of them a year. Lots of studies have shown that doctors who specialize in mammography are more accurate at interpreting the images when compared to physicians with less experience.

So, what does this mean for you? Well, when you schedule your appointment for a mammogram, you can now ask if the radiologist reading the image is a general radiologist or a breast imaging specialist so you can be confident with the results you receive.

Patient Guide to Clinical Studies
Find out more about clinical studies, what they are, and how to participate in them.

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SCCA expert physicians discuss the latest in breast cancer on Patient Power.

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