Posts Tagged ‘breast cancer’
Breast Screening Recommendations
This past November I was watching the morning news when I heard about new breast screening recommendations by the U.S. Preventive Services Task Force. I was horrified! The U.S. Preventive Services Task Force recommendations on screening mammography and self breast exams are not supported by evidence-based studies. The American Society of Breast Disease (a well respected group of breast specialists to which I belong) responded to the government’s new guidelines with the following:
The new U.S. Preventive Services Task Force’s recommendations on screening mammography, clinical breast exam, and self-examination conflict with the facts. There has been no new evidence to justify this questionable change in breast cancer screening guidelines.
The American Society of Breast Disease continues to recommend annual mammography for all women beginning at age 40. This position is based on long-standing, evidence-based studies which document that mammography saves lives through early detection.
The fact that only 50% of American women over age 40 have had a mammogram in the past year indicates that women need to be further encouraged rather than discouraged from obtaining this simple, non-invasive test. At a time of limited healthcare resources, prevention and early detection continue to be the most cost-effective means to control the economic and human burden of breast cancer. Although it is not perfect, mammography is the best screening tool we have, in terms of overall accuracy, cost, and practicality.
Forty years of research have yielded progressively convincing evidence of the benefits of screening mammography. Long-term follow-up of randomized controlled population-based screening trials – the gold standard in medical research – prove that mammography can reduce breast cancer mortality as much as 32% among women ages 40 to 70 years at entry into screening. Some recent studies from Sweden have found that mammography can lower breast cancer deaths by nearly 50%.
As dedicated breast specialists, we agree with the multiple studies that document a reduction in breast cancer deaths due to early detection of breast cancer through regular screening. In contrast to the USPSTF recommendation, the American Society of Breast Disease continues to encourage monthly breast self-examination as an integral part of every woman’s health routine, along with an annual clinical breast examination by a trained healthcare professional.
For most women, predicting breast cancer risk on the basis of possible risk factors can be unreliable. Fully 70% of all women diagnosed with breast cancer had no known risk before the time of diagnosis.
The current flurry of media-hyped recommendations will only serve to confuse the public. To advise women age 40 and older to skip annual screening because they have no family history of the disease is imprudent, irresponsible, and places their lives at unnecessary jeopardy.
Executive Committee: Gail Lebovic, MD is a Dallas-based oncoplastic breast surgeon and Society president; Stephen A Feig, MD is a breast imager at University of California, Irvince, and president-elect; Julio A Ibarra, MD is a pathologist at MemorialCare Hospital, Fountain Valley, California, and Society past president; Robert W. Carlson, MD is a medical oncologist at Stanford University and Society secretary/treasurer.
I hope this statement from a respected group of breast specialists helps to clear up any confusion about screening breast imaging and examinations.
If you’re 40 – start getting your mammograms!!
Making Strides Against Breast Cancer
In my last post, I began talking with you about cancer survivorship. Cancer survivorship is one of the most popular topics in oncology care and rightfully so. Today there are over 12 million cancer survivors. The increase in cancer survivorship occurred because of the many advances that we have made in oncology care in areas such as early cancer detection and treatment. The National Cancer Institute reported that of the 12 million cancer survivors, the highest percentage of cancer survivors are breast cancer survivors, who represent 23% followed by prostate cancer at 20%. For more information on the total breakdown, please visit cancer.gov.
For me it is more personal than that. I live with a cancer survivor—my mom. She celebrated her 10th anniversary as a breast cancer survivor. In August 1999, she was diagnosed with breast cancer had a mastectomy followed by radiation treatments. I was reminded again about the power of the word “cancer” when one of my closest friends called me two months ago to tell me she had too just been diagnosed with breast cancer. I remember the fear and dread in the sound of her voice. Despite the fact that more women survive with breast cancer today partly owing to early diagnosis, the announcement of the diagnosis is no less frightening to hear. Other people have different responses to a diagnosis of cancer as well. I remembered when one of my sister-in-laws was diagnosed with breast cancer; she was calm and accepting saying, “it is God’s will and I will not question him.” The differences in handling our life’s crisis are unique to us but it is important to remember in all of this that there is help and hope surrounding us as well. For more information on cancer survivorship support, visit canceradvocacy.org.
Breast Cancer affects 192,370 annually according to the American Cancer Society (2009). October is Breast Cancer Awareness Month. Holy Cross Hospital and the Bienes Comprehensive Cancer Center, in recognition of this are the Gold Sponsor for the American Cancer Society’s Annual Making Strides Against Breast Cancer (MSABC). For more information about our cancer center, please visit The Bienes Comprehensive Cancer Center’s website. We hope you will join us at the Huizenga Park in Fort Lauderdale on Saturday, October 10th for MSABC. For more information on MSABC, please check out or the American Cancer Society’s website.
Sun Sentinel’s Life’s Victories
In recognition of National Breast Cancer Awareness Month, Sun Sentinel will spotlight local breast cancer survivors in print and online throughout the month of October as part of it’s annual “Life’s Victories” program.
If you have been affected by breast cancer directly or indirectly, or know someone who has, share your/their story. To submit a story and photo of a loved one who died from breast cancer, click here. To submit a story and photo of a loved one who has survived breast cancer, click here.
Medical & Surgical Options for BRCA Positive People
Earlier this year, we talked about the BRCA testing for women at high risk for breast and ovarian cancer. Although only 5-10 % of persons having BRCA analysis actually test positive, this is usually devastating for these few people. They have many decisions to make and it can be a painful process. The screening options that are recommended are:
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Monthly breast self exam
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Semi annual clinical breast examination by the same health care provider
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Semi annual mammograms alternating with breast MRI
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Annual transvaginal ultrasounds (to visualize the ovaries)
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Some physicians exam the blood annually for a protein that is often elevated in persons with ovarian cancer (CA-125)
Some BRCA positive people choose medical or surgical options:
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Tamoxifen (an estrogen inhibitor) decreases breast cancer risk by 49%
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Bilateral mastectomy reduces risk by 90%
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Removal of the ovaries reduces the risk of ovarian cancer by 96% and breast cancer by 53%
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Oral contraceptives have been shown to lower ovarian cancer risk by 54%
These are difficult choices for many patients who are BRCA positive but it has also been my experience that women (in particular) who test negative but have a strong family history of breast cancer often do not hesitate to choose more intense screening and even bilateral mastectomies and removal of their ovaries. Many of our patients are young with small children or grandchildren and life is precious. It is their firm belief that being at very high risk for breast or ovarian cancer is an unacceptable reality. They are aggressive in screening and having surgery to reduce the risk.
What would you do if you were faced with these realities? I thought I knew before
I met some of these women. Let me know your thoughts.
About the Center
The Michael & Dianne Bienes Comprehensive Cancer Center in Fort Lauderdale, Florida is the Cancer Care Leader in Broward County. Dedicated to providing patients with precise diagnosis, the latest and most advanced treatment and aftercare options, we offer a multidisciplinary approach to care, a compassionate and spiritual healing environment, and an affiliation with the National Cancer Institute. We are also working together with Massachusetts General Hospital Cancer Center to provide South Florida residents with rapid access to specialized cancer care and genetics counseling.
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