Articles filed under 'Breast Cancer'
Some women in their 40s can still get pregnant without assistance from fertility clinics. That’s good news for those who have postponed motherhood, but for women who have completed their family, continuing fertility can be problematic. Today, the Pill and the IUD (intra-uterine devices) are both considered good options for some women in their fourth decade. These two methods are much safer than, for example, in the 1960s and 1970s. In the past, most women over age 40 underwent a tubal ligation (a fallopian tube-tying procedure), or relied on condoms or vasectomy with their male partner.
Sterilization is now easier for women, thanks to a non-surgical method of tubal treatment called Essure. The new technique was approved by the U.S. government in 2002. No cutting of the abdomen or tying of the tubes is involved. Instead, the doctor works through the cervix, using a thin tube to insert small devices into the ends of the fallopian tubes. These “plugs” in about three months produce scarring to block the woman’s tubes, thus preventing ovulated eggs from reaching the uterus.
Women over 40 should continue to use birth control until well into menopause. This age group has been shown to have high abortion rates, similar to those of adolescents. Under certain conditions, the Pill is now safe for “older” women. The dosage of estrogen in today’s Pill is greatly reduced and considered by many physicians to be a good alternative for lean, healthy women over 40. The Pill has other benefits besides contraception for appropriate women. It can help to control irregular menstrual bleeding and hot flashes, reduce hip fractures and cases of ovarian cancer. Yet, some physicians urge caution even in lean and healthy women who are approaching menopause.
If a woman over 40 is significantly overweight, has high blood pressure or diabetes, the Pill would not be a good option. For them, the chances of dangerous blood clots rise sharply. Middle-aged women who are obese, who smoke, have migraine headaches or other identified risk factors might instead consider IUDs or progestin-only treatments termed “mini-pills.” Although higher breast cancer rates have been found in older women taking estrogen-progestin pills to control menopausal symptoms, women 35 and older taking oral contraceptives have not shown an increase in breast cancers.
Another birth control product called Implanon, FDA-approved in 2006, is a matchstick-sized plastic rod that is implanted under the skin of the upper arm. Implanon is similar to the earlier Norplant and can last up to three years.
Today’s IUDs are safer and more effective than those used by women in the 1970s. The earlier Dalkon Shield version resulted in a number of serious medical problems due to its defective design. A large class-action lawsuit was filed and millions in payouts were made over the years. American women and their physicians are again considering the IUD as a simple and effective method of birth control.
Women should discuss with their OB-GYN physician their preferences for contraception, the appropriateness for their age group and their individual health risks. New options in birth control methods and technologies greatly reduce the risk of an unwanted pregnancy.
San Francisco Chronicle, Mike Stobbe, AP story, April 5, 2008
http://www.msnbc.msn.com/id/23954260/
April 8th, 2008
A large study conducted over 24 years at Kaiser Permanente Medical Care Program in Oakland, California, concluded that having three or more alcoholic drinks a day can increase a woman’s risk of breast cancer by 30%. Those who drank one to two drinks per day had an increased breast cancer risk of 10%. Women who drank less than one drink per day showed no significant increased cancer risk. According to researchers at Kaiser, the risk of heavy drinking is roughly equivalent to smoking a pack of cigarettes a day or taking estrogenic hormones well beyond the menopause.
Of the 70,033 multi-ethnic women who supplied information during their health exams between 1978 and 1985, roughly 3,000 of them had been diagnosed with breast cancer by 2004. It mattered not what type of alcohol was consumed – wine (red or white), beer, or spirits – the end result was the same. Results were similar for all ages and ethnicities. Heavier drinking was related to breast cancer risk in each group (classified by the type of alcohol consumed).
Breast cancer is known to vary between populations, and only a small proportion of women are heavy drinkers. However, women who are heavy drinkers may translate to an extra 5% of all U.S. women developing breast cancer due to this lifestyle factor. The study provides more evidence to influence women who are heavy drinkers to cut back or quit. Those with a strong family history of breast cancer should consider eliminating alcohol entirely or drinking only on special occasions.
Source: Science Daily
September 28th, 2007
A German study indicates that women at high-risk for breast cancer can benefit from magnetic resonance imaging (MRI) scans by detecting a nonmalignant tumor called ductal carcinoma in-situ (DCIS). If the pre-cancerous growth is discovered and removed before it becomes malignant, breast cancer could be prevented. Almost all malignant breast cancer is believed to begin with DCIS.
Because MRI is expensive, about $1,000 to $1,500 per scan, the technology does not yet make sense as a routine screening tool for all women. However, for women who have a strong family history of cancer or a genetic mutation found through testing, MRI can be especially effective. Apart from the expense, MRI has a high rate of false positives – often detecting lesions that are harmless. MRI scanning of breasts should always be paired with mammography, which finds things that MRI doesn’t.
The German study of 7,319 women took place over a five-year period. MRI scanning found DCIS in 90% of the 167 high-risk women discovered to have the condition, while mammograms detected only 56% of DCIS cases.
Two Dutch researchers involved with the study published their findings and recommendations in Lancet medical journal. They suggested that MRI be tested in more women to determine whether the technology should be used as a standard screening tool. They also noted that autopsy results show 9% of women have undetected DCIS.
The American Cancer Society recommends for women at high risk that MRI screening be performed annually in conjunction with mammography starting at age 30.
About 1.2 million cases of breast cancer are diagnosed annually, and each year 500,000 women (and a small percentage of men) die of the disease.
Source: Yahoo News
August 11th, 2007
This spring, new information came out about breast cancer screening, much of it perplexing to women. Past guidelines for annual mammograms included women in their 40s. Now, a major medical group disputes the need to screen women between the ages of 40 and 49.
The American College of Physicians has issued new and controversial guidelines. Their rationale is that for every 10,000 women screened in their 40s, perhaps six might avoid death from breast cancer. In addition, a high percentage of false positives could lead to unnecessary biopsies, increased costs, and potential for injury. Younger women receiving annual screenings might also incur a tiny risk of cancer developing from radiation used in mammograms.
All medical groups and experts agree that women 50 and over should get regular annual mammograms. Some women are known to have a very high risk of developing breast cancer — based on a strong family history or genetic testing showing defective BRCA1 and BRCA2 genes. The American Cancer Society recommends screening mammograms and MRI imaging for these women, beginning at age 30. Sonograms are also used for more definitive imaging in high-risk young women whose breasts are quite dense.
Recently, a new study found that MRI scans can detect tumors mammograms missed in about 3% of women. This sensitive technology, not available in all hospitals, often picks up suspicious but harmless growths that need to be biopsied. The result can be costly procedures that might cause unnecessary alarm in women. For those few in whom cancer is found at an early stage, MRI can prove valuable and, hopefully, life-saving.
Another controversial subject is a computer-assisted program designed to help radiologists identify small cancers on mammograms. This system has proved to be no more effective than traditional mammography read by an experienced radiologist. The technology also has led to many false alarms requiring needless biopsies. About 30% of mammography centers use computer-assisted technology, and no clear medical benefits have been found. Government and private insurers may be re-evaluating whether these expensive systems are worth the price.
The best advice in the screening controversy is to assess your risks carefully with your physician and determine what is right for you. If you are very high risk for breast cancer, use all available technologies at an early age. Early detection is still the best strategy.
Source: New York Times
April 7th, 2007
For women with very dense breasts or a strong family history of breast or ovarian cancer, MRI can yield much greater detail than mammography. MRI is so sensitive that it can reveal many types of suspicious growths in the breast. For this reason, there may be more false-positive findings leading to some unnecessary biopsies and additional scans. But for women at high risk for the disease, MRI can find tumors when they are most treatable.
Breast MRI requires special equipment, software and trained radiologists, and the expense can be 10 times the cost of mammography. In addition, breast MRI may not be available outside large cities.
Women at high risk are defined as having at least a 20 to 25% chance of developing breast cancer over their lifetime. Most U.S. women have about a 9% lifetime risk. Those who inherited defective BRCA1 or BRCA2 genes – a condition involved in only 10 percent of breast cancers – have a lifetime risk ranging from 36 to 85% of getting the disease. Especially at risk are those whose mothers, sisters or daughters carry those mutations, even if the woman herself has not been tested.
Using MRI for breast scans is especially useful for women who have been diagnosed with cancer in one breast and who need to know the status of the other breast. This sensitive technology can find tiny tumors that mammograms have missed. If an early cancer is detected in the other breast, both can be treated at the same time. Studies have shown that 10% of women with cancer in one breast over time will also develop it in the second breast.
MRI scans are most useful in younger women with cancer diagnosed in one breast and those with dense tissue that mammograms do not clearly image. Older, post-menopausal women with early tumors and clear mammograms are less likely to need MRI imaging.
Breast MRI can cost between $1,000 and $2,000. It may not always be covered by medical insurance. Figuring out just who needs MRI scans in addition to mammography can be difficult and much will depend on having a knowledgeable referring physician. A simple risk calculator is available online at http://www.cancer.gov/bcrisktool/. Genetic counseling can also be valuable in determining a woman’s level of risk.
Sources: New York Times ; MSNBC
March 31st, 2007
Women with very dense breast tissue are five times more likely to get breast cancer than those whose breasts contain more fatty tissue, according to a recent study. Doctors should discuss this particular risk factor with their patients who have mammograms.
Fat appears dark on mammograms, but dense tissue is light like tumors, thus more easily hiding cancers. Not only are breast cancers more likely to be hidden by white on white, they also appear more frequently in dense breasts.
Density is a true risk factor, along with other strong predictors such as the woman’s age and whether she carries BRCA1 and 2 gene mutations. Yet, this condition is rarely taken into consideration or discussed between doctor and patient.
This new study — involving 1,112 women whose medical records were examined at cancer centers in Toronto and Vancouver, Canada — is published in a January 2007 issue of the New England Journal of Medicine. Women taking part who had at least 75% dense breasts showed five times more likelihood of developing cancer over the time frame studied than women with less than 10% density. It confirms previous studies that pointed to the masking effect and a separate biological risk.
In this particular study, cancers were 18 times more likely to be found in women with the densest breasts within the first year after their mammograms. These cancers were judged to have been present earlier but masked by the difficulty in diagnosing their condition.
Breast density involves the presence of more connective, duct-lining and milk-gland tissue than fat tissue. It is impossible for a woman to judge the density herself. It must be routinely evaluated with a mammogram.
This most important factor to note is that extremely dense breaks are “an incredible risk factor” that probably accounts for a large percentage of breast cancers being found. Woman whose mammograms indicate dense breast tissue should be followed up rapidly with more sensitive technologies such as digital mammograms, sonograms or magnetic resonance image (MRI).
Some medical experts believe that women with this significant risk factor may be one day be cautioned to make lifestyle changes and even be prescribed medications for cancer prevention. If genes that promote density can be identified, they could serve as targets for cancer drugs.
Source: Associated Press; CNN Health
January 20th, 2007
For the first time in years, breast cancer rates declined by more then 7% in 2003. The decline was greater in women 50 to 69, those most likely to use hormone replacement therapy (HRT). In those with estrogen-dependent types of tumors, the drop was 12%.
According to presenters at the recent San Antonio Breast Cancer Symposium, breast cancer was diagnosed in 14,000 fewer women than expected in 2003.
After the Women’s Health Initiative Study was stopped in July 2002 due to evidence of more risk than benefit of long-term HRT, many doctors urged post-menopausal women to go off their hormones. Within a year of this medical news, about half of the U.S. women who had been on HRT stopped their use.
Breast cancer had been steadily rising, about 2% annually, for decades. It is the most common major cancer in American women and the second leading cause of cancer deaths in women. All U.S. cancer registries reporting to the federal government in 2003 showed a decline in their statistical information on this type of female cancer.
Researchers believe it possible that some breast cancers were already present, but that cutting off estrogen stopped their growth or caused them to shrink to an undetectable size. They also postulate that mammogram usage has been leveling off, thus contributing to the decline in cancer detection and smaller statistics. A trend toward lower-dose and shorter duration HRT could also have played a role.
Statistics from one year do not tell the entire story. It will take time to know whether breast cancer is truly on the decline and establishing a definite downward trend. Breast cancer might still be present in some menopausal women who abandoned HRT, but slower growing, taking longer to be detected.
In 2006, some 213,000 cases of breast cancer are expected in U.S. women, with over a million new cases worldwide.
Source: CNN.com
December 15th, 2006
A new model for assessing a woman’s risk of developing breast cancer indicates that breast density is as important a factor as their age, family history, or prior breast biopsy. In a study that included more than 1 million women receiving annual screening mammograms, 11,638 women were diagnosed with breast cancer within a year.
Those more likely to develop breast cancer were found to have very dense breasts. These women are more difficult to image, as milk gland tissue and cancer tumors both appear white on the mammogram. Fatty tissue is less dense, appears clear, and is therefore easier for radiologists to find tumors.
After adjustment for age, study researchers found that the risk of developing breast cancer was nearly four times greater for women with very dense breasts, compared to women with mostly fat tissue in their breasts. Post-menopausal women tend to have less dense breasts that include more fatty tissue.
The new prediction models are expected to help doctors identify women who are most at risk for breast cancer so that necessary interventions may take place. Additional screening using sonograms or MRI are more effective for identifying tumors in women with dense breasts.
This study, published in the September 6 issue of the Journal of the National Cancer Institute, is the largest study so far in terms of population size and the number of risk factors examined.
Source: ScienceDaily.com
September 26th, 2006
Women who have inherited gene mutations that increase their risk for breast cancer may benefit from having annual magnetic resonance imaging (MRI) in addition to mammograms.
Defective BRCA1 and BRCA2 genes can increase a woman’s lifetime risk of getting breast cancer by 45% to 65%, according to a study published recently in the Journal of the American Medical Association. However, inherited gene mutations account for only 5% to 10% of all breast cancer cases.
Mammography is usually an effective screening tool for detecting breast cancer, but the results are not always accurate. For women with especially dense breasts, mammography can be inadequate. MRI is a much more sensitive imaging technology for these women. The drawbacks are that MRI is ten times as expensive and can increase the risk of false-positive results.
Women from families with strong histories of breast cancer often have genetic testing to learn whether they have inherited mutations in their BRCA1 and/or BRCA2 genes. If these genes are defective, they are also at higher risk for ovarian cancer.
Women with known genetic susceptibility sometimes opt to have both breasts removed (bilateral mastectomy), or they take drugs such as tamoxifen in hopes of preventing cancer. Others decide to follow screening guidelines and deal with breast cancer if and when it occurs.
After age 25, annual mammograms are recommended for women with mutations in BRCA1 and BRCA2 genes. Breast cancers are generally rare in women under age 35. For high-risk women between ages 35 and 55, annual screening with MRI and mammography would be a sound investment in their health. After age 55, women’s breasts are not as dense, and mammography alone would probably detect even small cancers.
Improvements in mammography including digital mammograms could soon make that technology almost as sensitive as MRI and also more cost effective.
Source: WebMD
Technorati Tags: Cancer, Breast Cancer, Womens Healthcare
June 3rd, 2006
In April, the National Cancer Institute announced that raloxifene (evista) was as good as tamoxifen at preventing invasive breast cancer. Their conclusion was based on a study of 20,000 high-risk women in which half were given tamoxifen and half raloxifene for a five-year period.
Statistical results were roughly equal, although raloxifene was touted as having fewer unwanted side effects than tamoxifen. There were 163 cases of breast cancer in the group taking tamoxifen, compared to 167 in women taking raloxifene. With either group, the cases of breast cancer that developed during the study were about half as many as if the women had not been treated.
Like those on tamoxifen, a very small number got uterine cancer or developed blood clots, potential side effects of either drug. With those on raloxifene, these conditions developed at a slightly lower rate, but the numbers are small and therefore not very statistically significant. These conditions could have developed by chance and not have been related to taking the drug.
The principal difference found was that raloxifene lowered the risk of “invasive” breast cancer, but did not protect for lobular and ductal carcinomas in situ. These non-invasive cancers can develop into invasive cancers, which are the type that kill, but they can be effectively treated when found early. Tamoxifen appears to lower the risk for both invasive and non-invasive cancers.
Taking either drug is risk reduction, not prevention. You are treating a large number of healthy women, who might develop unwanted side effects, while helping only a small number to avoid breast cancer. In 1,000 high-risk women, approximately 20 women treated would avoid getting breast cancer, while another 20 would develop it despite taking the medications. This means that 980 women are exposed to the drugs’ risks but will get no cancer benefit.
Since there is no way to predict who will get breast cancer, high-risk women must choose whether they wish to take the medications that can have unpleasant side effects such as hot flashes and other menopausal symptoms.
At some point in the future, we may be able to pinpoint who is actually at high risk of breast cancer. Then, taking these medications will make more sense for women who are otherwise healthy.
Another development on the horizon is a study to test a class of drugs called aromatase inhibitors, which are used to treat breast cancer. They may do a better job of prevention than either tamoxifen or raloxifene.
Source: New York Times, May 9, 2006, by Denise Grady
May 15th, 2006
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