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 have an ultrasound instead of a mammogram to check for breast cancer?
6. Are women who have had an abortion at higher risk for breast cancer?
7. How can I receive financial assistance for breast cancer treatment?
8. After a mastectomy, can I have my breast reconstructed?
11. As a breast cancer survivor, should I take tamoxifen?
12. Are there alternatives to tamoxifen?
13. What is Herceptin?
14. What is Avastin?
15. I am a breast cancer survivor. Can I take soy estrogens to help with menopause symptoms? Are they safe for me?
16. What’s the difference between mammography and MRI?
17. What about the radiation from a mammogram? Is it safe?
18. Do mammograms hurt?
19. Digital vs. film mammography: Which is best?
20. Why are expert radiologists important?
21. How often should I have a screening mammogram?
Approach hormone replacement therapy (HRT) 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 HRT. Talk with your doctor about HRT options and the risks and benefits for you.
Soybeans and soy products (including tofu, soy milk, and miso) contain phytoestrogens, or plant estrogens. These substances are similar to but much weaker than human estrogen. They are used by many women to control symptoms of menopause, such as hot flashes. It is also believed that the phytoestrogens found in soy-based foods may help prevent breast cancer.
Yes, screening mammograms save lives. Because mammograms do not detect 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 mammography and clinical breast examination, 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 or have been present for a long time. BSE is the best way for a woman to become familiar with how her breasts normally feel.
The answer depends on the specifics of your situation. 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.
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.
Financial assistance for the treatment of breast cancer can come from several places. The U.S. government has several programs that 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 an SCCA patient, please call our social work department at (206) 606-1076, or e-mail firstname.lastname@example.org for more information.
Yes, today most mastectomy patients can have breast reconstruction. Age is not a factor in determining whether a woman can have 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 have breast reconstruction.
Also, it does not matter how much time has elapsed since a woman’s original cancer surgery. Breast reconstruction, depending on the procedure, can be performed at the same time as the mastectomy surgery or years later.
Ask your doctor, oncology nurse or an SCCA social worker (e-mail email@example.com) about breast cancer support groups. Or check the times and meeting places of SCCA support groups. The local chapter of the American Cancer Society (ACS) will also have information about support groups in your area.
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.
Tamoxifen (Nolvadex) is a drug that interferes with the activity of estrogen. Some breast cancer cells are “estrogen sensitive,” meaning estrogen binds to receptors on these cells and stimulates the cells to grow and divide. (Such cancer is called hormone-receptor positive.) Tamoxifen prevents estrogen from binding and stops the cancer cells from growing. So it can prevent or delay a recurrence of breast cancer for some women.
However, large randomized trials in postmenopausal women found that aromatase inhibitors, (such as anastrozole (Arimidex) or exemestane (Aromasin)) was better than tamoxifen in terms of recurrence-free survival.
Tamoxifen (Nolvadex) has been found to be effective in preventing a recurrence of breast cancer. However, several randomized trials in postmenopausal women found that aromatase inhibitors (such as anastrozole (Arimidex) or exemestane (Aromasin)) are better than tamoxifen in terms of recurrence-free survival.
Trastuzumab (trade name Herceptin) is an engineered antibody that targets cancer cells that over-express (make too much of) a protein called HER2/neu. (Such cancer is called HER2 positive.) Herceptin is used to treat early-stage and metastatic (spread to other parts of the body) breast cancers.
Herceptin is effective only for women whose breast cancer is HER2 positive. Because it is a targeted treatment that just attacks cancer cells, the side effects are milder than those of chemotherapy, which damages all fast-growing cells.
Bevacizumab (Avastin) 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 some types of cancer but is no longer approved to treat breast cancer. Nonetheless, there is ongoing clinical research at SCCA testing Avastin in certain forms of breast cancer.
Researchers are looking at these questions now. Until more is known, women who have or have had estrogen-positive breast cancer should minimize their intake of phytoestrogens. (Estrogen-positive breast cancer is cancer that is stimulated by estrogen to grow and divide.) Ask your doctor about the latest research and how it applies to you. Women who are taking tamoxifen should also minimize their intake of phytoestrogens.
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 adjuncts to screening mammography in women who are at very high lifetime risk for breast cancer. But breast MRI is not considered a replacement for screening mammography.
The American Cancer Society recommends that a small number of women (less than 2 percent of women in the U.S.) be screened with MRI in addition to mammograms because these women have a family history of or a genetic tendency for cancer or because they have certain other risk factors. Ask your health-care provider whether you should have an MRI or other screening tests or start screenings earlier in life.
MRI is also used to evaluate the extent of breast cancer in patients whose disease is newly diagnosed, and it can help guide treatment options. Breast MRI also detects unsuspected cancer in the other breast in 3 to 4 percent of women with newly diagnosed breast cancer.
If you read much, you’re bound to run into articles that say radiation increases cancer risk. So it stands to reason that mammography would increase risk as well because 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 came about for the age when mammograms should begin. The younger a person is, the more sensitive they are to radiation damage, especially in 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. At this time, the risk of not getting mammograms seems to be greater than the risk of getting them. 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 74, especially for those over age 50.
Among women in the United States, breast cancer is the most common non-skin cancer and the second leading cause of cancer-related death. The great news is that death rates from breast cancer have been declining since 1990, and the decrease is believed to result, in part, from earlier detection and improved treatment. Early detection means getting a mammogram.
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 any 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.
Some women say 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 technician know if you experience pain during your mammogram so they can reposition you.
There are two kinds of mammograms: digital and conventional film. Both use X-ray radiation to produce an image of the breast. Conventional mammograms are read and stored on film. 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 more than 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 premenopausal or perimenopausal (women who had their last menstrual period within 12 months of their mammogram) 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. (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.) In addition, digital mammograms are less likely than film mammograms to be lost.
The doctors at SCCA who read mammograms are all board-certified radiologists, and the more experienced ones are likely to be fellowship-trained, which means they earned the title of breast imaging specialist. As specialists, 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 doctors with less experience.
So, what does this mean for you? When you schedule your appointment for a mammogram, ask if the radiologist reading the image is a general radiologist or a breast imaging specialist so you can be confident about the results you receive.
At SCCA, we follow the American Cancer Society (ACS) screening guidelines for mammography. ACS recommends women have an annual screening mammogram starting at age 40. For women with a 20 percent or greater lifetime risk for breast cancer, ACS recommends having an annual screening breast MRI (magnetic resonance imaging) scan in addition to a mammogram. If you have questions about your risk level or which screenings you should have and when, ask your health-care provider. If you are at high risk for breast cancer or ovarian cancer, SCCA has a special program to help you know which screenings are appropriate for you and how you can decrease your cancer risk. It’s called the Breast and Ovarian Cancer Prevention Program. Call the program coordinator at (206) 606-6990 with questions or to make an appointment.