Awareness to Understanding: Ending the Breast Cancer Confusion

October is coming to an end and with it an end to another Breast Cancer Awareness Month. How successful was this 2015 month of pink awareness? Perhaps this year more than most, the results were decidedly mixed.

 

The message that early detection saves lives was out there in many formats and for this we are grateful.

 

• If we have been successful in convincing one more woman that screening for breast cancer with yearly mammography can lead to successful treatment and improved survival, we are grateful.

 

• If we have educated women to know their biggest risk for breast cancer is being female and getting older, we are grateful.

 

• If the message that 75% of women with a new diagnosis of breast cancer will have no high risk factors has been understood, we are grateful.

 

We are grateful for the focus this month brings to a subject that touches all of our lives.

 

Tempering our enthusiasm is the concern that the positive messages of this month may have been overshadowed by confusion- confusion created by the new “guidelines” published by the American Cancer Society.  Did we really gain anything more than confusion from a new conflicting and not universally accepted set of guidelines? Here’s where we stand:

 

• We stand by the recommendations of the American College of Radiology and direct you to the site: End the Confusion from the Society of Breast Imaging if you have questions.

 

• We recommend annual screening mammography starting at age 40 for all women unless you have high risk factors for which screening may start earlier or include other studies like breast MRI.

 

• Please note, the American Cancer Society guidelines also support starting screening at age 40 “if they wish to do so.”  We hope you will all wish to do so in order to save the most lives possible.

 

• We recommend screening annually because just as science is not yet able to predict who will develop breast cancer, we are also unable to predict the aggressiveness of the cancer. Some grow rapidly, and we have all as breast imagers seen sizable tumors develop in less than 12 months in women of all ages.

 

And so, as another Halloween approaches, we are grateful for the spotlight of October on breast cancer. Our dream is that one day soon there will no longer be a need for this month of awareness, that breast cancer will no longer be a threat to women’s – and men’s- lives. Together we can get there!

 

(Image credit: “Pinktober pink october breast cancer awareness” by © Nevit Dilmen. Licensed under CC BY-SA 3.0 via Wikimedia Commons)

Paget’s Disease of the Breast – A Breast Cancer Story

It is now October (yikes – how did that happen?!?) meaning pumpkins, mums, football and multi-colored piles of leaves on the ground. It also means pink ribbons galore – from the bakery to your favorite makeup and more – pink ribbons are all around.

The statistics on breast cancer are sobering – 1 in 8 women will be diagnosed with breast cancer during her lifetime, and estimates say over 230,000 women and 2300 men will face a new diagnosis of breast cancer this year. It’s easy to be overwhelmed or feel numb when faced with numbers like these and easy to feel pink overload this month. To help keep the focus on the disease and the breast cancer survivor, I’d like to share a story of one such special lady with you.

Ms M. asked to meet with me one day to talk. Ms. M. was diagnosed with Paget’s disease of the breast, and at the time of her diagnosis, the cancer had already spread to the lymph nodes under her arm.  Her reason for wanting to meet with me? She wanted to share her story with others, hoping that her story could spare others some of her pain.

Paget’s disease of the breast is a rare form of breast cancer – about 1-4 % of breast cancers. Paget’s disease is a cancer involving the nipple and adjacent tissue. Tumors are usually present within the breast tissue as well, although may be difficult to find on mammography alone. Many times the underlying cancers are non-invasive, also called ductal carcinoma in situ.

The changes in the nipple range from the dramatic to the subtle. One of the reasons Ms M.’s cancer was not found earlier was the innocent look of the change. She described it as a smooth red bump on her nipple, about the size of a pencil eraser. Bumps on the nipple are common- but this one was new, larger than any others, and did not go away.

So what can Paget’s disease of the nipple look like and what changes should prompt a doctor’s evaluation?

• The nipple may be red, itchy and/ or scaly.
• Sometimes the changes may mimic a skin disorder like eczema.
• Flaky, thickened skin may be seen at or next to the nipple.
• The nipple may flatten or invert (pucker in).
• Nipple leakage or discharge may be seen as can oozing from the skin.
• Bumps that are new and persist, even if smooth like Ms. M’s can also be a sign of Paget’s disease.

What should you do?

• First, know yourself.  Know the normal look of your nipple and seek evaluation if your nipple changes.
• Any of the above signs or symptoms that persist should prompt a doctor’s visit.
• Mammography and possibly breast ultrasound will likely be the first steps in evaluation if you are over 30.
• Many times these tests will be negative and no abnormalities will be seen.
• If the changes do not improve or worsen, biopsy of the nipple and adjacent skin are the next step. Even if innocent looking, a bump that is new and hangs around needs to be biopsied- seek a second opinion if needed to get action. Because the cancer is rare and the changes so variable, diagnosis can be hard.

So Ms. M., here’s to you! Your mindful and courageous attitude, your desire to spread the word and in so doing help others is an inspiration.

This October, we salute you and stand with you.  We will fight the fight until a cure is found.

 

(Image credit: Autumn’s Flower free creative commons, by D Sharon Pruitt (Pink Sherbet Photography) via Flickr; Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0).)

Dr. Harrison Will Be Taking Your Calls on Dr. Mirabile’s Radio Show!

Great news! Our very own Dr. Linda Harrison will be the guest on Dr. James Mirabile’s radio show tomorrow, July 25th from 1-2p on KCMO Talk Radio (710 AM / 103.7 FM). We’re very excited about this!

Dr. Harrison will be fielding questions from callers and talking about dense breast tissue and – this is important – 3D mammography, the latest advancement in women’s breast health.

Please tune in! Please ask questions! Please have a wonderful weekend and take good care of yourself!

You can listen live here.

Submit your questions online here.

Breast Cancer: No Room at the Inn

Mold loves a musty basement, mosquitoes like standing water and certain bacteria love improperly cooked meats. Given the “right” environment, these buggers flourish. Conversely, if their environments become inhospitable, they don’t live long.

This simple truth got scientists thinking: Is it true for cancer as well? Recently published research in the Journal of the National Cancer Institute (JNCI) suggests that local environment can similarly influence tumor growth.

Breast and prostate cancers were tested in lab mice who were given chemotherapy and two conditions: a sedentary life or one with an exercise wheel. The mice who exercised fared better.

Here’s how: cancer cells (such as breast and prostate) thrive in areas of hypoxia, or low oxygen. That’s their sweet spot. With exercise comes greater oxygen into the tissues of the body and into the tumors. Improvement in number of blood vessels and smaller areas of poor perfusion or hypoxia were seen in the active mice.

So, score one more for exercise! Not only does it reduce the risk of breast cancer, but it may make tumor growth more difficult. Not a bad side effect for something good for your overall health.

(Image credit: No vacancy. by A National Acrobat via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

232,000 Breast Cancer Survivors. Wow. How?

The statistics for breast cancer get a little overwhelming and hard to appreciate. Two hundred thirty two thousand is the estimated number of women with a new breast cancer diagnosis last year – 232,000 more survivors in just one year. The more familiar statistic of a 1 in 8 chance of developing breast cancer in your lifetime is fairly well known – and this applies even if you have no family history of breast cancer.

This is (for the time being) the reality. However, here’s the good news: early detection saves lives – LOTS of lives. Before a cancer can be seen or felt, it can often be detected by mammography. Thus far, mammography and improved breast cancer treatments have raised the breast cancer survival rate up to 98%. Those new breast cancer survivors last year have the best odds yet of beating their disease.

Because 232,000 is a huge number, here are some ways to imagine it:…..

We could fill Kansas City’s Kauffman Stadium (go Royals!) more than 6 times over with survivors. The new breast cancer survivors could fill the city of Reno, Nevada. We could load 632 jumbo jets with survivors (and wouldn’t THAT be a party!).

Aside from figuring out the logistics of how to cram 632 jets full of people who are conquering their breast cancer, there’s a bigger question:

What does it take to ensure 232,000 is just the beginning? It takes a team. A team dedicated to treating every patient so that they have the best chance of beating the disease. And a team dedicated to finding breast cancers when they are most treatable.

Early detection happens with an effort by you and the rest of your health care team. First, know thyself. Performing monthly self-exams helps you know what’s a slight bumpiness from what’s a new lump. Observing your body for physical changes (rashes, dimpling, aching, etc.) is helpful – tell your doctor about ANY change! There are annual clinical exams by your doctor or healthcare practitioner starting at age 20. Every woman over the age of 40 (or earlier if at high risk) should have an annual mammogram.

Mammograms see into the breast tissue – beyond what can be felt or found even by a careful clinical breast exam. Mammograms are an incredibly powerful tool that allows us, your radiologist, to inspect the structures of the breast to identify good health… and even find bad news. But remember, bad news caught sooner is better than bad news later. The earlier the stage of breast cancer, the better the chances of survival. And the less intense the treatment.

So, until we can figure out how to prevent those 232,000 women from getting breast cancer in the first place, let’s fill more jets, more stadiums, more races for the cure, and more homes with wives, mothers, daughters, sisters and friends who are survivors. Let’s conquer breast cancer!

 

 

(Image credit: Aviodrome Lelystad Airport 09-08-05 by ArchAngel12 via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

1 in 8 Women Will Get Breast Cancer… and Half of Women Aren’t Doing Anything About It

This just in… one in eight women will get breast cancer in their lifetime. Not new news? Perhaps it needs repeating. Along with this: Early detection saves lives.

 

Why the need to repeat and re-emphasize? Approximately half of all women (half!) aren’t getting their annual screening mammograms. As professionals in women’s health – and breast imaging in particular – we couldn’t be bigger fans of proactive behaviors. Given that 50% of women in our country aren’t getting this potentially life-saving exam is concerning – and frustrating!

 

Mammography, clinical breast exams and monthly self-exams are the way to fight breast cancer. Sounds straightforward, right?

 

So, why the apathy? There are a lot of theories and undoubtedly lots of reasons which influence the action and/or lack of action by women.

 

Time. More than ever, women don’t have time to spare – between family and work, we’re pushed to our limits. There are, however, outpatient facilities that make it possible to walk-in without a doctor’s order for a screening mammogram and leave with results in-hand 20 minutes later. It can be done! Call ahead to find the best facility near you.

 

Cost. But if you have insurance, this should NOT be an issue. Annual screening mammograms are required to be covered by insurance plans under the ACA – without cost to you. There are also programs to assist the uninsured through nonprofits like the Komen Foundation. Money should not come between you and your best possible health!

 

Fear. There are lots of fears associated with that annual mammogram – but none should keep a woman from getting it done. There are fears of pain – who hasn’t heard the horror stories? But we promise you, with a caring technologist who knows your fears, we can get you through the brief seconds of compression and discomfort – promise! And then there are the bigger “what-if” fears. What if we find something? Remember, the vast majority of mammograms will have normal or benign, non-cancerous findings. And further, if we see you every year, it is more likely that your cancer will be found when it is small and treatable. Still fearful? Make that yearly appointment with a friend – life is always better with a friend at your side.

 

Armed with knowledge to conquer fear, money woes and time, you are better prepared to take care of yourself. Share with a friend or loved one – this might be the push they need to get their mammogram. While nearly half of women aren’t getting their annual screenings to ensure their best possible health, you don’t have to be a statistic. Let’s change the ratio!

(Image credit: shocked by anthony kelly via Flickr Copyright Creative Commons Attribution-NonCommercial-ShareAlike 2.0 Generic (CC BY-NC-SA 2.0))

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

Aspirin for Breast Health?

Aspirin to reduce recurrence of breast cancer? How does that work?

 

The explanation, published in the journal Cancer Research, is a bit complicated, but we can help highlight the main points.

 

In short, aspirin (part of a class of drugs known as  NSAIDs) can help inhibit the production of certain types of estrogen.

 

As we’ve discussed before, maintaining a healthy body weight is important when it comes to breast health. Women who are overweight or obese have a higher risk of breast cancer, as well as a harder time with treatments. There are multiple factors involved, but one of the keys is estrogen.

 

Estrogen is part of a healthy woman’s body, but too much of certain types of it live in fatty tissues. This excess estrogen can feed tumor growth in some types of breast cancers.

 

Here’s where aspirin was shown to help. For breast cancer patients with a high body mass index (overweight or obese), aspirin can reduce production of a type of estrogen which can be associated with hormone-receptor positive breast cancers. Overweight breast cancer patients who consistently used aspirin had a 52% reduction in new tumors compared to women not on aspirin. In science, that’s a big number and many potential lives saved.

 

This great article in Time explores in-depth the types of estrogen and how they are affected by aspirin for those of you wanting more scientific information.

 

We’re thrilled by this exploration of yet another way aspirin can be used to treat all manner of diseases. The role of aspirin in the future treatment of breast cancer will need further investigation. For now the biggest takeaway is that there’s hope. Inch by inch, pound by pound, cell by cell, we’re finding ways to ward off breast cancer.

 

 

(Image attribution: Aspirin1 by Mosesofmason via Wikimedia Commons Copyright Creative Commons Attribution-ShareAlike 3.0 Unported (CC BY-SA 3.0))

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

Question of the Day: Should All Women Be Tested for BRCA Mutations?

Is genetic testing for breast cancer for everyone? The truthful answer is we don’t know – at least not yet. But some of the brightest minds in science are stepping up to start the conversation.

 

Remember the BRCA mutations? Mutations in the BRCA 1 and BRCA 2  genes carry a high risk for breast and ovarian cancers. However, a mutation in the genes does not mean cancer is a certainty. Additionally, they are only one component of the genetics of breast cancer. Deciding how to manage future risk once a mutation is detected is a deeply personal choice.

 

This is why organizations like Bright Pink exist and where genetic counselors can be invaluable – to help young women who test positive find their own way to deal with the risks.

 

In the past, we’ve noted the debate on if and when to get tested for a BRCA 1 or BRCA 2 mutation. Dr. Mary Claire King (instrumental in discovering the mutation) is now recommending that all women over 30 should be tested. She has laid out her reasonings and the research behind them in an article published in the Journal of the American Medical Association. While only a small percentage of women will test positive, relying on family history alone will miss women with the genetic mutations and elevated risks.

 

An important discussion has been prompted. Concerns for costs of screening all women, the low percentage of women affected, and the presence of other genetic markers all compound the issue.  It will take more research and more time before there is conclusive evidence to guide us. For now, we patiently await that further science to conclude what’s best for women.

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

The Other Breast Cancer Gene: PALB2

Genetics, family history and breast cancer risk – now there’s a complicated subject. Much has been reported on the more common BRCA1 and BRCA2 genetic mutations and their associated risks, but other genes have a role. Researchers are beginning to uncover further genetic variations and have begun to study their implications for breast cancer risk.

 

One of these studies is making the local news rounds: a study on mutations in the PALB2 gene.

 

The New England Journal of Medicine published the study recently examining a group of patients in the UK with the mutation. Here are two important facts:

 

• PALB2 mutation carriers have a 35% chance of breast cancer by the age of 70. This is not as high a risk as BRCA mutation carriers but still significantly more than the average population.

 

• The PALB2 mutation means that for women younger than forty, they face a risk of breast cancer approximately 8-9x higher than their peers.

 

As with the more common BRCA mutations, the percentage of the population affected by this genetic variation is small (and yet to be accurately measured). A history of breast cancer in the family – whether by known genetic mutations or unknown factors – is a serious issue and should prompt a discussion with your doctor or genetic counselor on specific breast screening strategies based on that history.

 

Remember though as we learn more about PALB2, most cases of breast cancer (upwards of 75%) occur with zero family history. Not having relatives with breast cancer does not make you exempt – if you have breasts, are getting older and are female, you are at risk and need routine screening!

 

If you’d like to read more about PALB2, the NEJM study can be found here.

 

 

(Image credit: PALB2 BRCA2 by Antony Oliver via Wikimedia Commons Copyright Creative Commons Attribution-Share Alike 3.0 Unported license)

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!

 

Self Exams: Getting It Right

It’s hard to pat your own self on the back, so let us (virtually) do it for you! You’re taking great care of yourself! Exercising regularly (or at least trying hard, because it can be hard!). Eating well (mostly, with the exception of the occasional BBQ). Getting your annual screening mammograms. And… you are doing your monthly self breast exams too. Right?

 

Here’s how to make sure your breast self-exam is done right, just in case you need a refresher…

 

First off, know thyself! Some women have fibrocystic breasts (naturally lumpy-bumpy), some have lumpy- bumpiness which comes and goes during their cycle, and some have smooth breasts. You have to know what your normal is.

 

Next, know when to do your exam! Usually about 7-10 days into your cycle is when your breasts are the least sensitive and least lumpy-bumpy. This is a guideline – if it’s easier to remember to do this on a specific day of the month – the 1st, your birthday date, etc- that’s fine too.

 

Most importantly is the how. How does one do a self exam? By look and by feel. You’ll need a mirror and the pads of your fingers. There are several major things to be aware of:

 

• You want to look for changes in skin color and texture. Puckering, dimpling, pulling in of the skin or nipple… these are changes you need to bring to your doctor’s attention.

 

• After you take a good look in the mirror, you need to use your fingers. Pressure is important because lumps can hide behind tissue – the larger the breast the more pressure you will need to use. Laying down flattens the tissue and may make it easier to feel lumps. Remember to use the pads of your fingers – not your fingernails. The pads of your fingers are more sensitive – and less pokey! Make a pattern to ensure you feel all of your breast tissue – start at the nipple and spiral outward or go all the way up and down, then across. Either works, as long as you don’t miss a spot.

 

• Make sure you feel the tissue behind your nipple and the tissue around your breasts, especially the armpits – remember in many women breast tissue goes up in that area.

 

• What are you feeling for? Changes from last month, lumps and bumps. You want to be on the lookout for any lumps that are particularly hard, like “frozen peas.” Hard lumps don’t have to be large to be troublesome. If you feel something new, different or lump-like make an appointment to see your doctor. The next step may be a visit to your local friendly radiologist.

 

The whole process of a careful breast self-exam only takes a few minutes, but you are the first line of defense in breast health. You know yourself, and your doctor can help. Early detection saves lives!

 

 

(Image credit: Self-exam reminder by glokbell via Flickr Copyright Creative Commons Attribution 2.0 Generic (CC BY 2.0))

 

 

Diagnostic Imaging Centers blogs on regularly about women’s health at www.mammographykc.com and general radiology at www.diagnosticimagingcenterskc.com. Visit our sites for more helpful information!