Breast cancer awareness: Debunking some common myths

I don’t have a family history of breast cancer. So, I won’t get it. This is one of the biggest myths Litton hears. Only about 2 out of 10 people diagnosed with breast cancer have a family history, according to the American Cancer Society. “Just because you don’t have a family history, does not mean you are safe,” Litton said.

If you have breast cancer, you’ll have to get a mastectomy. Mastectomies are not as commonly recommended as they were in the past. Even when a patient opts for a mastectomy, the surgery is likely not a radical mastectomy, where the entire breast is removed, but it’s usually partial, skin-sparing, simple or modified, according to the National Breast Cancer Foundation. Some researchers say 70 percent of mastectomies in women with breast cancer are unnecessary, because healthy breast tissue isn’t proven to significantly lower risk of recurrence. Often, breast-conserving surgery such as radiation can be done to spare the breast. “In the vast majority of cases, having a mastectomy does not change the overall survival of cancer they’ve been diagnosed with,” Litton said. Having a mastectomy only lowers breast cancer risk in the removed breast, but doesn’t lower cancer risk in other parts of the body, the American Cancer Society says.

Everyone with breast cancer needs chemotherapy. While treatment can include chemotherapy (which causes hair loss), it might not. A lot depends on the size of the cancer and the patient’s biology, Litton said. Surgery and radiation are among other treatment options available to patients.

Only lumps that are painful are cancerous. Cancerous lumps can be painful or painless. Any lump that persists for two weeks should be evaluated by a medical professional, Litton said.

Breast cancer is a death sentence. The majority of those diagnosed with stage III, stage II and stage I breast cancer survive at least 5 years after diagnosis, according to data from the American Cancer Society. Metastatic or stage IV breast cancers have a 5-year survival rate of about 22 percent.

A good diet can prevent and treat cancer. Litton said many diagnosed with breast cancer look for a “magic diet,” but the reality is “the patient is not in control of the cancer.” With that being said, a low-sugar, plant-based diet can help overall health.

Men can’t get breast cancer. While breast cancer in men is rare (less than 1 percent of all breast cancers), it happens. This is because men have breast tissue. Old age, high estrogen levels, radiation exposure, alcohol consumption, a strong family history of breast cancer, or genetic mutations can all increase a man’s risk of breast cancer, according to the American Cancer Society.

There’s one type of breast cancer. There are more than a dozen types of breast cancer. Common kinds are carcinomas, tumors that grow in organs and tissues. Most breast cancers are a type of carcinoma called adenocarcinoma that starts in the milk ducts or milk-producing glands. But, there are other kinds of breast cancer that start in the cells of muscle, fat or connective tissue. Visit cancer.org for more information on types and treatments of breast cancer.

Breast cancer genetics revealed: 72 new mutations discovered in global study

The genetic causes of breast cancer just got clearer.

Researchers from 300 institutions around the world combined forces to discover 72 previously unknown gene mutations that lead to the development of breast cancer. Two studies describing their work published Monday in the journals Nature and Nature Genetics. The teams found that 65 of the newly identified genetic variants are common among women with breast cancer. The remaining seven mutations predispose women to developing a type of breast cancer known as estrogen-receptor-negative breast cancer, which doesn't respond to hormonal therapies, such as the drug tamoxifen. The new discoveries add to previous research bringing the total number of known variants associated with breast cancer to nearly 180.

Beyond BRCA1 and BRCA2

The international team of 550 researchers across six continents, known as the OncoArray Consortium, included professor Doug Easton of the University of Cambridge, who led the investigation. "Essentially, we used blood samples from a very large number of women (nearly 300,000), about half of whom had had breast cancer," Easton explained in an email. Next, the researchers used the DNA from the samples to look for genetic mutations. "Think of a gene as a very long strand of DNA," said Dr. Otis Brawley, chief medical officer of the American Cancer Society, who was not involved in the research. DNA is made up of nucleic acids, and when a nucleic acid is incorrectly placed along the strand, this is referred to as a genetic mutation, noted Brawley.

Take BRCA1 and BRCA2, two well-known genes that confer a high risk of breast cancer when they contain mutations. There are 125,950 base pairs in the BRCA 1 mutation, noted Brawley. "Think of it as a 125,950 letter word," said Brawley. "A mutation is a misspelling such that the gene cannot code the proper protein." A gene that cannot code the proper protein leads to disease. According to the National Cancer Institute, 55% to 65% of women who inherit a BRCA1 mutation and around 45% of women who inherit a BRCA2 mutation will develop breast cancer by age 70. However, the BRCA1 and BRCA2 risk mutations, which are present in less than 1% of women, explain only a fraction of all inherited breast cancers. The consortium came together, then, to discover the other causes of breast cancer susceptibility -- the additional genetic mutations that can lead to this form of cancer.

Finding the other mutations

The researchers measured DNA at over 10 million sites across the genome, said professor Peter Kraft of Harvard T.H. Chan School of Public Health, a study author. "At each of these sites, we asked whether the DNA sequence in women with breast cancer was different than that in women without," said Kraft. "Because our study was so large, we could detect subtle differences between these two groups of women and be sure these differences were not due to chance." According to Jacques Simard, a study author and professor and researcher at Université Laval, Quebec City, the newly discovered mutations only slightly -- by anywhere from 5% to 10% -- increase a woman's risk of developing breast cancer. But even though, individually, these mutations don't have as big as an effect as BRCA1 and BRCA2 defects, there are many of them, so their "overall contribution is larger," said Easton. An individual woman, then, may have two or more of these common smaller risk gene mutations, and so her risk for developing breast cancer increases due to their combined effects. Kraft noted that "taken together, these risk variants may identify a small proportion of women who are at 3-times increased risk of breast cancer." Women found to have a number of these smaller risk genetic mutations, then, would likely benefit from earlier mammography screening. Simard agreed, noting that it may be time to "adapt" breast cancer screening guidelines based on this information instead of basing mammography guidelines on age alone. By doing so, Simard said, "we will detect a higher number of breast cancers."

Breast Cancer “Awareness” Misses These Painful Realities

You Don’t Need as Many Mammograms as You Think

Mammograms can detect cancers that would otherwise kill you, but they also can give false positives that result in more scans and biopsies that turn out to be negative. And they can result in you getting the full cancer patient experience for slow-growing or benign cancers that didn’t really need to be treated. So mammograms aren’t a “more is better” kind of thing. The US Preventive Services Task Force says you should get your first mammogram at age 50 (unless you really want to start earlier) and should get them every other year through age 74. Other organizations disagree slightly. The American Cancer Society wants people to start at age 45; the American College of Radiology and the American Congress of Obstetricians and Gynecologists says age 40. Each organization also has its own ideas for whether you should get them every year, every other year, or some combination that changes as you age. You may also get to stop getting mammograms at age 75 according to the USPTF; after that, they say there isn’t enough evidence to recommend for or against screening. Other organizations recommend different end dates, but generally there’s no point to detecting breast cancer if you’re likely to die of something else first. The American College of Radiology says it’s time to stop if you know you have less than seven years left to live, or if you wouldn’t act on an abnormal finding.

Not Everyone Thinks of Their Cancer as a “Battle”

Nobody wants to be a “victim” of cancer, so it feels positive to shift the focus toward the person with cancer as an active participant. Maybe they’re “fighting” cancer, or they’re a hero or a trooper. And if the worst happens, we say they “lost their battle.” But many people who have cancer don’t like this metaphor. If somebody is tough for beating cancer, that implies that people who died or whose disease got worse were somehow not tough or active enough. Many cancer patients feel uncomfortable with the idea that they’re supposed to be someone’s hero.

Cancer Treatment Is Incredibly Expensive

Even if you do catch your cancer early and “fight” your “battle” like you’re supposed to, you’ll face steep medical bills. A study of women with private insurance—that’s the kind you get through your employer or buy for yourself—found that women under 45 incurred $97,486 of extra medical costs (including those paid by insurance) in the year following diagnosis. Women aged 45 to 64 were more likely to catch their cancer earlier; their costs averaged $75,737. A previous study, on patients who were treated in 2010 (before the Affordable Care Act) also found costs to be astronomical. There was a large gap between how much the insurance company would pay and how much the treatment actually cost—on average $15,000 for stage I/II cancer and $50,000 for stage IV. (People’s out-of-pocket costs should be lower today. For example, the ACA made it illegal for insurance companies to cap their total benefits.) But even today, people with cancer still have plenty of expenses in the form of copays, deductibles, and coinsurance. Half of Americans would have a hard time affording even a $100 emergency, much less the thousands that cancer patients have to cough up.

Breast Cancer Prevention Tips

According to Texas Oncology, Texas ranks third in the United States in estimated new cases of breast cancer. Dr. V at Texas Oncology in Tyler says prevention is key to lowering the number of women that are diagnosed. Breast cancer is the second-deadliest cancer among American women and although it's not completely prevented, women can take steps to decrease risk and/or improve early detection. Regular screenings depending on your age is important, alongside a healthy lifestyle and regular exercise. These are just a few ways to lower the numbers.

Screening

• Women should check their breasts monthly. Report any changes to a physician immediately. 
• Women in their 20s and 30s should have a clinical breast exam every three years. 
• Women in their 30s should discuss their breast cancer risk level with a physician to determine the most appropriate cancer screening options, including mammograms and MRI screenings. 
• Women age 40 and older should discuss individual risk factors with a physician to determine recommended timing and most appropriate screenings, including annual mammogram, annual clinical breast exam, and annual MRI screening. 
• Women age 50 and older should have a mammogram and a clinical breast exam at least every two years after discussion with her physician, and if recommended by a physician, an annual MRI screening. 

Lifestyle

• Regular exercise, limiting alcohol intake, and maintaining a healthy body weight may reduce the risk of breast cancer. 

Higher Risk

• Women with a family history of breast cancer should discuss genetic testing with their physicians. If genetic tests indicate a woman is BRCA-positive, there are a number of risk reduction strategies to discuss with her physician. 
• Women with a first degree relative who had breast cancer before age 50 should begin receiving mammograms 10 years before reaching that relative’s age at diagnosis.

What’s the Connection Between Heart Disease and Breast Cancer?

It may seem like the ultimate insult, but having survived breast cancer can put you at higher risk of additional health problems later in life. The National Cancer Institute reports that the average five-year survival rate for breast cancer is now about 90 percent, thanks to advanced treatment protocols. However, some patients who’ve had radiation treatment and chemotherapy may be at higher risk of developing cardiovascular disease in what’s called a late side effect of treatment for breast cancer. This means that the heart problem may not surface for months or years after the conclusion of treatment. According to a report in the journal EJC Supplements, an open access companion journal to the European Journal of Cancer, cardiovascular disease is already the leading cause of death “accounting for 30 to 50 percent of all deaths in most developed countries. Because of this high background rate, even a minor increase in risk of CVD [resulting from cancer treatment] will have an important impact on morbidity and mortality.”

According to a 2016 article in the Cleveland Clinic Journal of Medicine, ischemic heart disease (a reduction in blood supply to the heart) is the most common cause of death after radiation treatments. Valve disorders and diseases of the heart muscle and the pericardial sac that encases it are also common. A disruption to the electrical pulses that make the heart pump can also occur. “Overall, compared with nonirradiated patients, patients who have undergone chest radiotherapy have a 2 percent higher absolute risk of cardiac morbidity and death at five years and a 23 percent increased absolute risk after 20 years,” the article notes.

Anju Nohria, director of the cardio-oncology program at Brigham and Women/Dana-Farber Cancer Institute in Boston, says the problem stems from radiation’s ability to kill healthy cells that are located within the field of radiation being administered to a breast cancer tumor. Radiation “essentially destroys the cancer cells preferentially because they’re rapidly multiplying and therefore more susceptible. But [radiation can] also cause some damage to any healthy tissue” nearby. She says this is particularly true for patients having radiation treatments on the left breast, as the heart sits under that breast and is therefore closer to radiation beams in some cases. “If the tumor is on the left side but in your armpit, maybe you’re fine. But if it’s right over the heart, you have a higher risk,” of developing CVD later on because of that proximity to exposure, Nohria says.

In an effort to avoid exposing the heart as much as possible, many doctors now deliver radiation treatment while patients are lying prone, “meaning that they’re lying on their stomachs with their breasts hanging down." That way, the breast is sort of separated from the chest wall, and the heart is less in the radiation field.” Radiation is delivered from the underside of the table. Some doctors are also using “very sophisticated radiation techniques where they can map out the tumor and try to exclude the heart from the radiation field to the extent possible,” she says.

Even so, some patients will experience problems while others won’t, and the risk of developing cardiac problems after radiation treatment is dependent on a number of factors, including the location of the tumor and dose of radiation administered. “If you need a lot of radiation because you have a large tumor or it’s a particularly malignant tumor,” then the higher the dose the heart may receive, Nohria says. A patient’s age and preexisting cardiac risk factors like high blood pressure, high cholesterol and diabetes can also elevate risk. Smokers or people who already have heart disease are also at higher risk, “because in a way the heart has already sustained some damage and now you’re giving it an additional kick, so to speak.”

Certain chemotherapies including anthracycline drugs and certain drugs within the Herceptin family of HER2 agonists have also been linked with an increased rate of cardiovascular disease in some breast cancer patients, Nohria says. Adriamycin, an anthracycline chemotherapy, causes a “weakening of the heart muscle in 8 to 9 percent of women. In the majority of these cases, it happens within the first year of treatment,” she says. So if you’re taking this drug, expect your doctor to keep tabs on your cardiovascular health. “As we’ve begun to realize this [risk], we’re being more vigilant looking for it in the first year after treatment.” If this cardiac toxicity is noted early, “you can put people on heart medicines that help the heart recover in a certain proportion of patients.” But a change in cardiac health won’t always be obvious early on, she says. “Sometimes you’ll have an asymptomatic decline in your cardiac function – the squeezing of the heart muscle – and it only manifests when the person comes up with symptoms, which can be a several-year lag.”

With some of the HER2 agonist drugs, cardiac problems may actually be reversible in some patients, Nohria says. “If you stop the drug, there’s a high likelihood that your heart will get better. But in a few cases, like 30 percent, it doesn’t get better. For those people, you have to manage them with cardiac medications to try to prevent it from getting worse.” Combination therapies can present additional challenges to managing cardiac disease risks. Again, as with radiation, dosage makes a difference in whether a patient will develop cardiac issues after chemotherapy. “The higher the dose, the higher the likelihood that you’ll have a problem. For instance, if you have metastatic disease and you’ve had many, many doses of the drug, your risk is higher.” Similarly, “women over the age of 60, women with preexisting risk factors and women with preexisting heart disease” all have a higher risk of developing CVD after chemo. Patients who receive a combination of chemotherapy and radiation, particularly if it’s on the left side, “have a double whammy. Plus if you’re older and have a lot of risk factors, that sort of magnifies your risk because they’re additive,” Nohria says.

As more doctors have become aware of the connection between breast cancer treatments and heart health later in life, many are taking steps to reduce the risk, particularly in patients who have other risk factors for cardiovascular disease. In many patients, this means some prep work before therapy begins. “If you’re in a good medical center, before they start you on these things they should be getting a good cardiac history and trying to optimize your cardiac risk factors before starting you on these medications,” Nohria says. Breastcancer.org also recommends that, “no matter how old you are, it’s a good idea to ask your doctor about your personal risk of treatment-related heart problems and whether or not visiting a cardiologist before treatment starts is a good idea for you.” In addition to evaluating your baseline heart function and assessing your risk factors, “you also may want to ask your oncologist how your heart function will be monitored during treatment.”

Myths about breast cancer debunked: Family history often has nothing to do with diagnosis

If you have breast cancer, you'll have to get a mastectomy.
Mastectomies are not as commonly recommended as they were in the past. Even when a patient opts for a mastectomy, the surgery is likely not a radical mastectomy, where the entire breast is removed, but it's usually partial, skin-sparing, simple or modified, according to the National Breast Cancer Foundation.

Some researchers say 70% of mastectomies in women with breast cancer are unnecessary, because healthy breast tissue isn't proven to significantly lower risk of recurrence. Often, breast-conserving surgery such as radiation can be done to spare the breast.

"In the vast majority of cases, having a mastectomy does not change the overall survival of cancer they've been diagnosed with," Litton said. Having a mastectomy only lowers breast cancer risk in the removed breast, but doesn't lower cancer risk in other parts of the body, the American Cancer Society says.

Everyone with breast cancer needs chemotherapy.
While treatment can include chemotherapy (which causes hair loss), it might not. A lot depends on the size of the cancer and the patient's biology, Litton said. Surgery and radiation are among other treatment options available to patients. Only lumps that are painful are cancerous.

Cancerous lumps can be painful or painless.
Any lump that persists for two weeks should be evaluated by a medical professional, Litton said.


Breast cancer is a death sentence.
The majority of those diagnosed with stage III, stage II and stage I breast cancer survive at least 5 years after diagnosis, according to data from the American Cancer Society. Metastatic or stage IV breast cancers have a 5-year survival rate of about 22%.

A good diet can prevent and treat cancer.
Litton said many diagnosed with breast cancer look for a "magic diet," but the reality is "the patient is not in control of the cancer." With that being said, a low-sugar, plant-based diet can help overall health.

Men can't get breast cancer.
While breast cancer in men is rare (less than 1% of all breast cancers), it happens. This is because men have breast tissue. Old age, high estrogen levels, radiation exposure, alcohol consumption, a strong family history of breast cancer, or genetic mutations can all increase a man's risk of breast cancer, according to the American Cancer Society.

There's one type of breast cancer.
There are more than a dozen types of breast cancer. Common kinds are carcinomas, tumors that grow in organs and tissues. Most breast cancers are a type of carcinoma called adenocarcinoma that starts in the milk ducts or milk-producing glands. But, there are other kinds of breast cancer that start in the cells of muscle, fat or connective tissue. Visit cancer.org for more information on types and treatments of breast cancer.

Women Manage Lymphedema After Bouts With Breast Cancer

A vine of pink begonia blooms climb up Kate Collins' left arm in what looks like a full sleeve of tattoos. People around town regularly stop her and ask about them only to realize, with a closer look, that there is a seam creeping up her arm. The flowers are not tattoos; they're a printed pattern on a compression sleeve, a band of medical grade material that she wears every day to ward off the swelling from lymphedema, a condition related to the breast cancer diagnosis she received a dozen years ago. Lymphedema can occur after a patient has her under-arm lymph nodes removed to determine whether her cancer has spread. Besides causing swelling, the condition can be painful and increase the risk of skin infections.

Sleeves, like the one Collins wears to keep her lymphedema at bay, feel like tightly wrapped ace bandages. "It's uncomfortable, it's hot and I hate wearing it," says Collins, 64, who had both her breasts and the lymph nodes on her left side removed. "But I figure if you've got to wear it — you might as well make a fashion statement." Collins keeps a basket of sleeves in the living room in her home in Northampton. The one with a bluish gray snake that wraps around her arm she wears while gardening. Another sports a smiling sun. All of them keep her lymphatic fluid — waste that is normally filtered out of the body by the lymph nodes — from pooling in her arm. She's had to give up wearing some of her rings or bangle bracelets because of swelling in her fingers and wrists. Summer used to be her favorite season, but because the sleeve makes her feel hot, she now stays inside in the air conditioning or goes out only in the cool morning air.

"It is a chronic disease," she says of lymphedema. "As if you don't remember that you had breast cancer ... here is a reminder." Once a woman has had lymph nodes under her arm removed, she is at permanent risk of developing lymphedema. And, when she gets it, there is no way to get rid of it. The two ways to ease the symptoms are the compression bands and light massage. It's a breast cancer side effect that hasn't gotten enough attention, says Collins. "Nobody told me that I was going to get lymphedema, nobody warned me," she says. "Wouldn't you think that my surgeon or my oncologist would say, 'by the way, you lost all your lymph nodes, you are at risk of lymphedema." But no one did. When her lymph nodes were removed a dozen years ago, a medical assistant in the New York hospital where she was being treated left her with a few cryptic words, "Sometimes ladies' arms swell." The lymphatic system looks much like a root system directly under the skin that runs throughout the body.

At certain junctions, pea-sized pockets, the lymph nodes, are working to pump and filter the body's fluid waste. People generally have between 500 and 700 lymph nodes throughout the body with 15 to 30 under each arm. The waste they carry is mostly blood cells, but there can also be bacteria or even fat mixed in. Doctors typically remove the lymph nodes to check for the spread of cancer cells. "It's kind of our garbage picker-upper system," says Lisa McCutcheon, an occupational therapist, who works with breast cancer survivors at Cooley Dickinson Hospital in Northampton. She teaches cancer survivors how to perform manual lymph drainage on their own bodies. It's a technique that is like an extremely light massage. "A manual lymphedema coach almost serves as a traffic cop," she says. "So, if there is swelling, I am going to teach them how to reroute it down a pathway that is a healthier pathway. It's almost like a highway system — if it gets backed up — nothing can move." People might have a feeling of fullness or achiness before they see any swelling. If they intervene quickly enough, there is hope they can prevent significant swelling, she says. "It's good to know what isn't normal, so you can catch any issues," she says.

"We are trying to give a lot of education around prevention and awareness, so if there is an issue people can act on it quickly." At the time of her cancer diagnosis, Collins was living in Long Island, New York working as a school district administrator, and the trauma of having both her breasts removed foremost on her mind. Those few words from the medical assistant about possible swelling didn't seem significant. "Did I process that? Of course I didn't. I was getting ready to get cut open and maybe die," she says. Doctors today are more conscious of making patients aware of the risk of lymphedema, says Michelle Helms, a general surgeon at Cooley Dickinson who treats women with breast cancer. Over the last 15 years there also has been a national movement to reduce the number of lymph nodes that are removed. Surgeons in the past might have stripped the armpits of them, leaving patients at high risk of developing lymphedema, but today surgeons are more careful to take only those that must go says Dr. Holly Michaelson, chief of surgery at Cooley Dickinson.

"Significant lymphedema is life altering and I think surgeons have done everything we can to make sure that fewer people get lymphedema," she says. These days, most breast cancer patients have just one or two lymph nodes removed. As a result, the condition is less common. Women who have fewer than four lymph nodes removed have a less than 4 percent chance of developing lymphedema. Women with more advanced breast cancer and have all of the lymph nodes removed, face a risk of up to 20 percent, Helms says. With the accompanying pain and swelling, this can significantly diminish a patient's quality of life. "You are kind of dragging a big old water balloon in the arm," she says. "This can be really tough." The stretched skin also becomes weak and can result in ulcers, which can easily lead to infections. By intervening quickly and being educated about the condition, women can lower their chances of developing severe infections, says McCutcheon. Melissa Ross of Florence caught her lymphedema early. A little more than a year after her surgery to remove both of her breasts, she noticed some slight swelling.

Her doctors at Cooley Dickinson had warned her about lymphedema, so she was looking for it. "I knew what it was right away," she says. She started learning about manual lymph drainage. "I sort of jumped on it. I didn't wait till it was really bad." Sometimes over a multi-week period she goes to see McCutcheon twice a week, but lately she's found ways to manage her symptoms at home. A dip in her backyard pool, she's found, eases the swelling. "Being submerged in water puts pressure on your lymphatic system, so it pushes the fluids out," she says. Other days, she jumps on a mini trampoline in her bedroom. The force of gravity can also works wonders, she says. ?????? Lymphedema never caused her significant pain; she still works part-time as a hairdresser, and rarely does she wear her compression sleeve. Sometimes her skin around her right elbow gets taut, but she knows how to manage it and she credits her mild condition with catching it early. Now retired, Collins wishes that someone had told her to seek treatment sooner. In the three years between her breast surgery and her lymphedema diagnosis, any small cut or scrap could leave her with a severe infection, and she had no idea why. "It is important to keep the skin healthy because the skin is a barrier," says McCutcheon. "If the lymphatic system is already slowed down — you can have an infection pretty seriously." This is what happen to Collins.

One night she woke up in a pool of sweat to find that her left arm had tripled in size and turned a dark shade of red. She rushed to the emergency room in pain and with a fever. Doctors diagnosed an infection that stemmed from a bug bite, but didn't mention lymphedema. The swelling still hadn't gone done six months later when she went to Cooley Dickinson for physical therapy for some herniated discs in her back. Her therapist, who was also certified lymphedema therapist, made the diagnosis. Since then Collins has learned to manage her lymphedema. She bought the collection of compression sleeves and the therapist taught her how to gently massage her arm to ease the swelling. "I don't have to go to work because I'm retired, so I manage my lymph fluid in the morning," she says. "Or I do it when I am putting lotion on my arm."

10 things breast cancer doctors wish you knew

1. I have breast cancer. Am I going to die? According to several doctors participating in Pink Power TODAY, this is a common question women ask immediately after being diagnosed. "Breast cancer is not a death sentence," Dr. Deepa Halaharvi, a board-certified general surgeon specializing in breast surgery, told TODAY via email. "Most people do really well and 5-year survival for all stages of breast cancer is 91 percent. We really need to be catching this at an early stage."

2. I don't have a family history of breast cancer. Why did I get it? "Most commonly, breast cancer is sporadic and most people (85 percent to 90 percent of breast cancer patients) don’t have a family history of breast cancer," said Halaharvi. "It’s a common misconception that it’s inherited through a family history. So regular screenings are very important, regardless of what your family history may be. At OhioHealth, we recommend average-risk women begin screening mammograms at age 40." According to the American Cancer Society, women ages 40 to 44 should start having annual mammograms if they want. Women ages 45 to 54 should get mammograms every year, and women 55 and older should switch to every two years, or can continue yearly screenings.

3. What are the most important risk factors for breast cancer? "A previous history of breast cancer, a significant family history of the disease (particularly when a genetic mutation in BRCA1 or BRCA2 are present), and specific conditions such as atypical hyperplasia and LCIS that are only detected when breast tissue is biopsied and examined microscopically," explained Dr. Freya Schnabel, the director of breast surgery at Perlmutter Cancer Center at NYU Langone. Schnabel noted that these risk factors have different magnitudes, and you should try to discuss with your doctor what makes a family history significant (close relatives, diagnosed at young ages, multiple generations).

4. I am a BRCA carrier. What do I need to know? "BRCA carriers are the highest risk group for breast cancer," stated Schnabel. "BRCA1 carriers are at risk for breast and ovarian cancer — their lifetime risk for breast cancer may be as high as 50 to 85 percent. BRCA2 carriers have a 40- to 60-percent lifetime risk for breast cancer, and are at an increased risk for ovarian cancer, and are also at increased risk for pancreatic cancer." According to Schnabel, BRCA carriers have three options to manage their breast cancer risk: intensive surveillance (to maximize the opportunity for early detection of disease should it occur) chemo-prevention (the use of drugs like tamoxifen to reduce the risk of developing breast cancer) risk-reducing surgery (bilateral mastectomies with reconstruction to lower the risk of breast cancer to as low as we can make it)

5. What can you tell me about the alcohol and breast cancer link? While countless studies support that wine is good for your heart health, you have to weigh these benefits against its link to cancer. "There is good evidence that alcohol increases the risk for breast cancer," Schnabel explained. "Specifically, women who drink at the rate of seven drinks per week have about a 20-percent increase in their risk for breast cancer."

6. My mother was diagnosed with breast cancer at 45, when should I start getting mammograms? "If you have a family history of breast cancer, you should start screening mammograms 10 years prior to your family member getting diagnosed," Halaharvi explained. "So in this case, you’d start at age 35. Again, make sure to talk with your physician and discuss your family history."

7. How quickly do I need to start treatment for my breast cancer? When you're first diagnosed, it may feel like there is pressure on you to decide on a treatment plan right away. But Dr. Lisa Newman, a breast cancer surgery specialist at Henry Ford Health System in Detroit, advises clients to take a beat to process everything and make the right decision for you. "You should not feel that you are 'racing the clock' — the cancer is not spreading or becoming more advanced in your breast or your body by the day," Newman said. "You have the time to make sure that you are properly informed about your cancer diagnosis and treatment options before jumping into something irreversible."

8. Should I get a second opinion? For many women, taking the time to weigh their options means getting more than one medical opinion, or looking into clinical trials or research studies, Newman said. "There is no magic deadline," she stressed. "But a general rule of thumb is that we don’t like to see patients delaying the start of their treatment more than four to six weeks after the diagnosis has been made. The stage and type of breast cancer can influence how quickly the treatment should be initiated."

9. There are so many conflicting reports about breast self-exams, should I be doing them? The American Cancer Society no longer recommends frequent breast self-exams because research has found they don't provide a clear benefit or save women's lives. However, it does stress that women should have self-breast awareness — "be familiar with how their breasts normally look and feel and report any changes to a health care provider right away." "Women should be aware of changes to their breasts such as a palpable mass, skin changes, nipple discharge, skin dimpling, nipple inversion and mass underneath the arms such as enlarged lymph nodes," Halaharvi stressed. "You don’t necessarily need to have a mass to have breast cancer such as inflammatory breast cancer (redness, an orange peel appearance) are seen."

10. How and when should I tell my children? This is one of those answers that is tricky, depending on the ages of your children, but Newman offered this advice: "In general it is best to be as honest with them as possible, because they are likely to sense and/or see that something major is happening, and it is important to provide them with reassurance that you are taking care of yourself," she said. "Very young children may need to also be reassured that cancer is not contagious like the flu, and older children may actually feel empowered if they are allowed to help out and provide support during your treatment. All children need to understand that the cancer diagnosis was not anyone’s fault."

Julia Louis-Dreyfus has breast cancer

Julia Louis-Dreyfus announced she has breast cancer in a post on her official Twitter account. "1 in 8 women get breast cancer. Today, I'm the one," Louis-Dreyfus wrote. The 56-year-old actress went on to say "The good news is that I have the most glorious group of supportive and caring family and friends, and fantastic insurance through my union." "The bad news is that not all women are so lucky, so let's fight all cancers and make universal healthcare a reality," she concluded.

The news comes on the heels of what has been a triumphant year for Louis-Dreyfus. She broke the record for the most Emmys won by a performer for a single role earlier this month, after snagging her sixth consecutive win for lead actress in a comedy for her work on HBO's "Veep." It was her seventh statue in that category overall as she had previously won in 2006 for "The New Adventures of Old Christine." HBO told CNN that Louis-Dreyfus received her diagnosis the day after her historic Emmy win.

Her health did not factor into the decision to end "Veep" with Season 7, which writers are currently working on. HBO added the show's production schedule will be adjusted if needed to accommodate its star. "Our love and support go out to Julia and her family at this time," HBO said in a statement. "We have every confidence she will get through this with her usual tenacity and undaunted spirit, and look forward to her return to health and to HBO for the final season of 'Veep.'" (HBO and CNN share parent company Time Warner.) Louis-Dreyfus has advocated for cancer research in the past by teaming up with the Livestrong Foundation, according to Web MD.

"I was asked, and it was a no-brainer," she told the site. The former "Seinfeld" star is also a long-time advocate of environmental causes and green living, leading to a Mediaplanet feature on her work. "My actions have an impact on humanity and generations to come," she told the publication.

Apple-shaped women are at risk of a deadlier form of breast cancer (and those who store fat on their thighs, hips and buttocks are prone to a more treatable form of the disease)

Apple-shaped women are at risk of developing a deadlier form of breast cancer, a new study suggests. But those who have a pear-shaped figure, with fat stored on their thighs, hips and buttocks, are prone to a more treatable form of the disease.

For years, scientists have warned of the dangers of obesity due to evidence of its role in triggering breast cancer among other health risks. But the Chinese study shows the link between obesity and this form of the disease to be more complex than previously thought.

They discovered women with a higher BMI, which measured subcutaneous fat, were more likely to have ER+ (oestrogen-receptor positive) breast cancer. This form of the disease can be influenced by oestrogen, as the hormone can attach to proteins in cancerous cells to stimulate growth. Patients are often given Tamoxifen, a drug that costs 6p a day and which work by blocking oestrogen, which is known to stimulate the formation of tumour cells.

In contrast, those with a high waist-to-hip ratio, showing belly fat, were more likely to have ER- (oestrogen-receptor negative) breast cancer. This form of the disease can't be tackled with hormone blocking drugs, and have to go down traditional chemotherapy routes. The greater risk of developing ER- breast cancer for women with a high waist-to-hip ratio existed even if they weren't obese, Shandong University scientists noted.

Lead researcher Dr Zhigang Yu said: 'A possible reason is that subcutaneous fat is involved in estrogen production, which may promote ER+ breast cancer. 'Visceral fat is more closely related to insulin resistance and may be more likely to promote ER- breast cancer.' The researchers said that clinicians should assess ER- risk by assessing a woman's body shape before prescribing Tamoxifen, which is often given to those at high risk.

Experts stressed the findings, published in The Oncologist, were important as breast cancer is becoming a 'pandemic'. Around one in eight women will develop breast cancer in their lifetime and the illness is becoming increasingly prevalent as the population ages. There were 55,222 new cases recorded in the UK in 2014 and 11,433 deaths. In the US, 252,710 are expected to receive a diagnosis this year. Around 40,000 will die.

Researchers recruited 1,316 women who were newly diagnosed with breast cancer for the study. They were compared to a control group. Body measurements were taken, alongside details of their form of cancer - whether it was ER+ or ER- breast cancer.

From Cancer to Career Changes, Kathy Bates Talks Life's Challenges

Kathy Bates knows how to roll with the punches. In the last 14 years, she has beaten both ovarian cancer and breast cancer. And, after a long and lauded career in film, the 69-year-old actress has shifted her focus to TV, starring in four seasons of FX’s American Horror Story and playing actress Joan Blondell in FX’s Feud. Next, she’ll star as Ruth, the owner of a California cannabis dispensary, in Netflix’s comedy Disjointed, out August 25.

An ongoing challenge for Bates is lymphedema, a blockage in the lymphatic system often triggered by removing lymph nodes during breast cancer surgery. The chronic condition causes excessive swelling in the arms and legs and affects 10 million Americans, “yet nobody really knows what it is,” says Bates. She’s now a spokesperson for the Lymphatic Education & Research Network (LE&RN). We caught up with Bates to talk about lymphedema, her newfound niche in TV and ditching the prosthetics after a double mastectomy.

Cancer and its aftermath changed my outlook in a profound way. I’ve become less of a hermit and I travel more. I really enjoy every moment of my life now. It’s not that every moment is terrific—we all go through tough times— but I try to be more present and grateful for the good times that I have. I realized that I had to get back in shape. I started walking more. I’ve lost around 55 pounds. Just being physically free of that extra weight has been liberating and has helped keep the [lymphedema] swelling down. I avoid salt and alcohol, too, because of lymphedema.

I’ve recently decided to “go flat.” I read that more and more women are doing that, and finally I came to the conclusion, “I don’t have breasts anymore, why do I have to pretend like I do?” I have prosthetics and I can put them on for a character, but in my own life I wear Spanx tanks under my shirts and I feel much more comfortable with that than having to strap on a bra with these fake boobs in them. That has given me a lot of freedom and confidence and I just feel better. TV has rejuvenated my career.

I’ve gotten to really push my envelope. Oftentimes, I’m cast as the sort of dumpy dishrag mother or best friend part, so to be able to play someone like [the twisted New Orleans socialite in American Horror Story] Madame Delphine LaLaurie, it’s a panoply of opportunities for an actor. And now I’m getting to do a sitcom with Disjointed. People will see a side of me they haven’t seen before. My two Yorkies are at the very center of my well-being and happiness. My favorite part of every day is when I get to come home and cuddle with them. Their philosophy is: it’s always a good time to take a nap. Wise creatures. I recently bought an electric guitar. I used to play guitar years ago. It brought me a lot of pleasure when I was a teenager growing up and was having tough times. Now that I’m navigating the waters of being older and going through some tough times adjusting to that, I decided I’d like to get back to what gave me joy.

My inner strength comes from my friends. I have a very close group of friends and family and we all help each other through our dark times. That love and support has really flourished in the last few years of being sick. I have really focused on mindfulness. That helps me make better choices both physically, psychologically, and emotionally. If something bad happens, rather than flying off the handle, I try to breathe and focus and wait till the anger/fear subsides so that I can really think through something and realize a) it isn’t about me or b) this is what I can do to change it. The things that I can’t do anything about, I have to learn to let go of.

I think I’ve been living my bucket list for the last few years. I’ve done and experienced so many wonderful things. If I went tomorrow, I wouldn’t be disappointed. I might want to go out and buy a Bentley or a sports car or something like that but then I’d think, “I don’t need all of that stuff.” But cars are always in my fantasy bucket list.

Is Yoga Helpful for Breast Cancer?

One of the most important things you can do to help yourself as a breast cancer patient or survivor is to exercise. But when you’re dealing with nasty side effects like severe nausea, fatigue, sleep disturbances and joint pain, exercising can seem like the most difficult thing to get yourself motivated to do. Nevertheless, virtually any kind of physical activity will help, and many doctors are now recommending that breast cancer patients take up yoga as their primary source of physical activity.

From helping ease the shock of your initial diagnosis to getting you stronger post-treatment, yoga offers a gentle form of physical activity, breath work and meditation exercises that can be tailored to your specific needs without taxing your body more than it can handle. Dr. Janice Kiecolt-Glazer, a researcher at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute who completed a study evaluating yoga’s impact on breast cancer survivors in 2014, says “yoga is an excellent option for patients. Part of what it’s helpful for is that in addition to the physical benefits, it appears to reduce fatigue and improve mood. And those are really important, because when women are going through a very stressful time in their lives, an intervention that helps with mood as well as fatigue and inflammation is really a good thing.”

The study included 200 women, some of whom performed hatha yoga, a style of gentle, restorative yoga, for 12 weeks, while the others were assigned to a control group that did not practice yoga. Participants were between two months and three years post-treatment, and three months after completing the classes, patients in the yoga group reported 57 percent less fatigue than their non-yoga counterparts. Inflammation in the body also dropped by 20 percent among those who practiced yoga. One of the most interesting findings, Kiecolt-Glazer says, is that a “dose-response relationship” seems to exist for breast cancer survivors who are using yoga to exercise and relax. This means that the more yoga the women in the study did, the bigger the improvements they saw. “That was partly a proof of concept because it would make sense that if something is good for you, doing it more within reasonable limits should show greater benefits. And that’s what we were able to show,” she says. Why exactly yoga is able to do this is still a “million-dollar question, ” Kiecolt-Glazer says. “We don’t know the particular mechanisms for it, but there’s certainly data from other studies that meditation by itself is useful, that breathing by itself is useful and there’s some mouse data showing that stretching may reduce local inflammation, so our best guess is that all of it probably matters.” Before you start a yoga practice, it’s best to consult your doctor to make sure you’re healthy enough for it. You should also take some time to find a high-quality instructor who has experience working with breast cancer patients.

If you’re dealing with certain side effects, you'll need to take extra care. Neuropathy – a condition in which nerve damage caused by chemotherapy or radiation treatments can cause pain, numbness or tingling in the extremities – can affect your balance. Osteoporosis, a side effect of some treatments, and bone metastasis, when cancer has spread to the bones, can both make your bones brittle, so you need to be careful not to hurt yourself further when doing yoga. An experienced instructor can help you navigate these additional concerns. Breastcancer.org reports that certain types of more strenuous yoga can put you at higher risk for developing lymphedema, swelling of the arm or trunk that results from a build-up of fluid after lymph nodes have been removed, so some yoga instructors tell patients to wear a compression garment when practicing. Still, a restorative yoga practice is usually a very safe option for most patients, especially when it’s led by an experienced instructor. Carol Krucoff, a yoga therapist with Duke Integrative Medicine and co-author of “Relax into Yoga for Seniors: A Six-Week Program for Strength, Balance, Flexibility, and Pain Relief,” says which poses and breathing techniques you begin with will likely be dictated by “where you are on your cancer journey. If you’re having active treatment, then energy level is going to factor into what would be most useful. And if you have a port,” a device that allows the doctor to infuse chemotherapy or draw blood without having to stick a needle in your arm every time, “that’s going to affect what you can do.”

You’ll need to communicate with your yoga instructor to find ways to work around these obstacles and limitations. That said, Krucoff says “breathing, meditation and relaxation are useful anywhere along the journey, including when people are actually sitting there having their chemo.” She says a teacher of hers encouraged cancer patients to “meditate on the actual chemo substance, not thinking of it as a poison, but thinking of it as a nectar that’s going to help the body reestablish health.” The findings of a 2012 study in The Journal of Alternative and Complementary Medicine seem to corroborate the use of this approach; study participants who used a program of pranayama, or yogic breathing, alongside their chemotherapy treatments experienced an increase in quality of life, a decrease in depression and anxiety, and a reduction in sleep disturbance and fatigue. When you’re ready to move, Krucoff says yoga can offer just the right amount of gentle physical activity. “If you’ve been cleared for activity, there are many exercises – stretching and opening the chest, supported back bend poses – that can be very helpful.” Gently stretching the arms up along a wall and moving slowly until you feel a gentle stretch may be helpful for regaining limb functionality after surgery where scar tissue may develop and limit your range of motion. She also recommends using props or working with a physical therapist or oncologic surgeon to make sure your form is safe with regard to where your incisions were and how they’ve healed. No matter how you approach it, Krucoff says the dividends that yoga practice can pay during treatment for breast cancer are many. “Cancer is a very interesting predicament, because many people feel like they’re fighting themselves and say, ‘I’m going to beat this thing!’ But this thing is also themselves, so there can be this sense of betrayal, so there we go to some of the principles of yoga.

Just learning to love yourself as you are, and make peace with all parts of yourself,” is part and parcel of a yoga practice and a powerful aspect of using it during your cancer journey. Krucoff says establishing a regular breathing practice and using guided imagery can help you come to a more peaceful place. And even if it’s very gentle, yoga is still considered a form of physical activity. For cancer patients here in the Western world who may only think of exercise as striving and sweating and achieving big goals, Krucoff says yoga is the opposite of this and a good way for breast cancer patients to develop a new relationship with a changed body. “The idea in yoga is we move to a point of challenge, where we feel like we’re being challenged, but we do not strain. So we find that balance between effort and surrender. That balance between courage and caution. That balance between doing and undoing.”

New treatment for advanced breast cancer: Ribociclib

This year, 253,000 women will be diagnosed this year with invasive breast cancer, and for women battling advanced forms of the disease, there’s now a new treatment. Doctors are calling it a first line of defense for advanced breast cancer. With a hot pink ride, decked out with lighted wheels, nothing is going to get in the way of mother Sally McGiffin and her daughter Shannon McGiffin.

Not even cancer. “When we first got diagnosis we sat and cried maybe half an hour to an hour, and then she looked at me and said this disease is not going to beat me,” Sally told Ivanhoe.

That attitude and a newly-approved FDA drug called Ribociclib, has kept Shannon McGiffin’s stage four metastic breast cancer under control. “It’s a miracle. It really is a miracle for me to be able to have survived this long.” Shannon said. Oncologist Heather Han, MD, of the Moffitt Cancer Center in Tampa, Florida says when combined with hormonal therapy, Ribociclib stops signals that cancer cells use to grow and divide. “I’m obviously very excited that this drug finally actually quickly got approved, and I’m able to be there to help patients to do better,” Dr. Han explained.

Doctor Han says the Ribociclib combination can be used as the first line of defense. The risk of progression or death has been reduced by 44 percent. Dr. Han continued, “So it’s been in clinical trial for several years, but FDA was able to approve it quickly when it showed dramatic improvement of the patients.” The side effects for her have been high blood sugar levels and fatigue. “I do spend a lot of my time sleeping,” Shannon admitted. For Shannon, it’s not a cure, but it has given her precious time with those who matter most. Candidates for this drug usually can be patients with newly diagnosed advanced breast cancer, hormone receptor positive and HER2 negative. Patients’ EKGs must be monitored in the first few weeks of taking the drug to make sure it doesn’t cause any cardiac issues.

One cancer is linked to highest suicide risk

Suicide is more common among cancer patients, but a new study suggests people suffering from lung cancer are at a higher risk than those who struggle with other forms of the disease.

For the study, researchers from Weill Cornell Medical College/New York Presbyterian Hospital analyzed information from a large patient database of 3,640,229 people, looking at suicide deaths for lung, prostate, breast and colorectal cancers individually. They found that over four decades, there were 6,661 suicides among cancer patients. When they compared suicides among cancer patients to the general population, the rate in patients with any kind of cancer was 60 percent higher.

"Cancer patients are under a lot of duress and stress when they're under treatment," said study author Dr. Jeffrey Port, a thoracic and cardiac surgeon at Weill Cornell Medical Center, told CBS News. When the scientists broke down the data on suicide by cancer type, they found dramatic differences. The suicide rate among lung cancer patients stood out: it was more than four times higher than the general population. They also found suicide rates were 40 percent higher than average among colorectal cancer patients, and 20 percent higher among those diagnosed with breast cancer or prostate cancer. Despite this, many doctors don't consider suicide risk in cancer patients, Port said. Patients may feel anxiety, depression or hopelessness after hearing stories from family members or friends who knew someone with the disease.

Port said doctors need to reassure their patients that every case is unique and that there are good treatments for early stage patients. "As lung cancer surgeons, we know the lung cancer diagnosis is a very serious diagnosis, but what's not out there is that patients with early stage disease are highly curable," said Port. What was most striking about the findings, Port said, is that 50 percent of suicides in lung cancer patients occurred in people who had what specialists consider highly treatable disease. "There's a disconnect about patients understanding their particular outcomes," he said. Suicide rates were also higher among Asians, men, older patients, those who were widowed, those who refused surgical treatment, and those with metastatic lung cancer , according to the study, which was presented at the American Thoracic Society 2017 International Conference, in Washington, D.C. Lung cancer (small cell and non-small cell types) is the second most common type among both men and women in the U.S. (not counting skin cancer, which was not included in the study).

The American Cancer Society estimates that in 2017, there will be about 222,500 new cases of lung cancer diagnosed and approximately 155,870 deaths from the disease. Lung cancer specialists don't tend to be well trained on the mental health side of patient care, said Port. "For us as a group it's striking that we're trained in medical school – we learn about the physical aspects of exam, but especially surgeons, we don't do a deeper dive into the psychosocial exams. It's pretty eye-opening that we should have to learn to ask patients, 'Are you sleeping, are you eating, how are your feeling about your diagnosis?' Doctors need to include these questions as part of the exam," said Port, adding that their care should be integrated with nurses and others who provide health care during cancer treatment.

One factor that may weigh heavily on the shoulders of patients: the consequences of lifelong health choices. "Eighty-five percent of our patients have traditionally been smokers and may have guilt about smoking all their life," Port said. But he also noted, "There's reason to be hopeful." "Each person's tumor is different genetically and we now have unique targeted therapies —immunotherapy — for early stage disease regardless of tumor type," he said. Dr. Joseph Weiner, an psychiatrist at Zucker Hillside Hospital, in Glen Oaks, New York, told CBS News that while the new study shows a correlation between lung cancer and suicide, other issues may come into play. "There may be other variables contributing that may be related to chemotherapies. And some people with lung cancer have changes in hormone secretions that may affect mood. A decrease in oxygen going to the brain may affect judgment and impulsivity, too," said Weiner.

Over much of Weiner's career he's worked with people who have had medical illnesses, including cancer. "I've gotten to see people suffer tremendously, emotionally. Some are unable to cope with a serious diagnosis and fall into depression, while others transcend their suffering and find hope even in the face of death," Weiner said. The way a doctor speaks to a cancer patient can have a big impact on that person's mental health and how he or she copes with the disease, said Weiner, whose wife died of lung cancer in 2015 almost a year after her diagnosis. He said she was a very strong person, but had some physicians who were better than others when it came to communication and compassion. "My wife asked her oncologist, 'Will I live long enough to watch my daughter graduate?' and the oncologist said, 'Now you're pushing it,'" said Weiner.

He said his wife was a strong person and didn't let it get in her way of focusing on her dream. But Weiner said a better alternative would have been to say, "I can't promise, but I can promise we'll try as hard as we can." For patients struggling with depression and suicide risk, words can have a powerful affect, he noted. Support can make a difference. "One of the destructive things a clinician can say is that there's nothing more we can do for you. There's always something we can do for you, whether it's pain management, symptom control, holding a hand, giving a hug, connecting with a chaplain or mental health provider, or discussing medication for depression and anxiety. It's not just the application of chemotherapy.

It's about the provision of humanity," he said. Most of all, he said doctors treating lung cancer and other cancer patients can provide hope. "Hope is broad. None of us live forever. What are we hoping for? Are we hoping to be loved? Are we hoping to leave a legacy for our lives? To see someone get married? Are we hoping to demonstrate to our loved ones that we can approach a life circumstance with great dignity? Are we looking to thank people? Are we looking to ask for forgiveness? I'm talking about hope as a process of how you want to live your life. Focusing on the day rather than the medical outcome."

Doctors still divided on when women should start mammograms

Despite what the American Cancer Society and other health organizations advise, many doctors still recommend routine mammograms to screen for breast cancer in younger and older women, a new paper suggests. Experts are divided on whether more screenings are beneficial. The American Congress of Obstetricians and Gynecologists recommends annual mammograms starting at 40 for all women, whereas the US Preventive Services Task Force recommends biennial mammograms starting at 50 for all women. In 2015, the American Cancer Society updated its guidelines to recommend that women with an average risk of breast cancer have the option to start screening with a mammogram every year starting at age 40, and should undergo regular mammogram screenings starting at age 45. n the new paper, many of the primary care physicians and gynecologists surveyed said they still recommended screening for women ages 40 to 44 last year. The paper was published in the journal JAMA Internal Medicine on Monday. "All guidelines agree that discussions about mammography should begin at age 40. There is universal agreement on this age.

Where the difference comes is the age at which screening should be recommended without the need for an informed decision," said Dr. Richard Wender, chief cancer control officer of the American Cancer Society, who was not involved in the new paper. About 12% of women born in the United States will develop breast cancer at some time during their lives, according to the National Cancer Institute. The new paper involved data on 871 primary care physicians and gynecologists in the United States who self-reported their breast cancer screening practices in a mailed survey from May to September 2016. The data came from the Breast Cancer Social Networks national survey, which included physicians who were randomly sampled from the American Medical Association's physician masterfile. Overall, 81% of physicians who completed the survey recommended screening for women 40 to 44; 88% for women 45 to 49; and 67% for women 75 and older. "Our results serve as a benchmark for breast cancer screening recommendations as guidelines continue to evolve," said Dr. Archana Radhakrishnan, a researcher at Johns Hopkins Medicine in Baltimore and lead author of the new paper. "Despite changes to guidelines, doctors are continuing to recommend routine mammograms to both younger and older women," she said. "The recommendations varied depending on physician specialty; gynecologists were the most likely to recommend screening." Among the physicians in the paper who recommended screening, 62.9% recommended annual examinations for women 40 to 44, 66.7% for women 45 to 49 and 52.3% for women 75 and older. "I trust the results of the paper. The response rate was high for a survey. The distribution of specialties was reasonable and clearly reported," Wender said. Dr. Mitva Patel said that she not only recommends annual screenings for women 40 and older, she follows those guidelines herself. "I am 42. I have had my annual mammogram at age 40, 41 and 42," said Patel, a breast radiologist at the Ohio State University Comprehensive Cancer Center, who was not involved in the paper.

She added that the American College of Radiology and the Society of Breast Imaging both recommend yearly screenings for women 40 and older. "I put myself in patients' shoes when I make a recommendation as a doctor, and I say, 'this is what I would do for myself,' " Patel said. "There are so many different recommendations, and it can be confusing. So it's important for patients to make their decision for screening with their primary care physician, and I'm encouraged that this study shows most primary care physicians still believe in annual screening starting at age 40." Guideline groups bring different perspectives and weigh different types of data differently, said the American Cancer Society's Wender. "Screening guidelines will constantly change in response to the emergence of new evidence. This is a good thing. As we learn more, we can refine guidelines based on new information. That's why it's important to keep updating guidelines. Groups are asked to balance the risks and benefits of a screening test," Wender said. "Ultimately, there is no perfect answer. Guideline groups must bring their own values into the recommendation. Breast cancer is a good example," he said. "The risk of developing breast cancer steadily increases as a woman gets older; that makes it very hard to choose one starting age that is right for everyone. That is why shared and informed decisions in younger women are recommended by some of the groups."

 Neither the American Cancer Society nor the US Preventive Services Task Force recommend routine mammograms for women 40 to 44 because they are more likely to offer downsides than benefits, according to an editorial published alongside the new paper in the journal JAMA Internal Medicine. Drs. Deborah Grady and Rita Redberg, professors at the University of California, San Francisco School of Medicine, co-authored the editorial. Potential risk factors that can come with mammograms are overdiagnosis, in which a cancer that would otherwise never cause symptoms or death is found, and false-positive results, in which a patient could unnecessarily experience anxiety and take on the discomfort and financial costs of additional tests, such as a biopsy. "One important issue is that payment systems in the United States typically reward ordering tests and procedures over taking the time to talk to patients about risks and benefits. The fear of litigation is often mentioned as a reason for unnecessary testing," Grady and Redberg wrote in their editorial. "Other excuses range from the influence of many decades of hype in the general and medical media, the idea that early treatment must be good, that knowing is better than not knowing, the allure of doing something rather than nothing, and the conviction that patients like more testing," they wrote. "Limiting coverage of tests known to be harmful is a win-win for patients and the national health care system." Grady and Redberg pointed to the US Preventive Services Task Force's recommendations to screen women 50 to 74 every other year as the appropriate guidelines to follow.

Dr. Andrew Kaunitz said he encourages his patients begin screening every two years at age 50, which is consistent with the US Preventive Services Task Force's recommendations. "There are many factors explaining differing recommendations," said Kaunitz, professor and associate chairman of the University of Florida's Department of Obstetrics and Gynecology in Jacksonville, who was not involved in the new paper. "Clinicians are concerned that if they do not recommend starting screening earlier and they have a patient diagnosed with breast cancer at a young age, they may be sued," he said. "Although the best evidence indicates the benefits of screening mammograms are in fact quite limited, breast cancer advocacy organizations have been vocal and effective in convincing the public as well as health professionals that screening mammograms have major unequivocal health benefits. This makes it hard to move away from recommendations to start screening early." Similar to the findings in the new report, a previous study found that 75.7% of primary health care providers reported screening practices in excess of those recommended by the US Preventive Services Task Force. That study was published in the Journal of General Internal Medicine last year. "From my experience, working with patients, most say that they want to catch the cancer early. They'd rather find out," said Patel, the breast radiologist. Although most breast cancers are found in women 50 and older, about 11% of all new cases of breast cancer in the US are found in women 45 and younger, according to the Centers for Disease Control and Prevention. "These women who are diagnosed in their 40s, their cancer can be more aggressive," Patel said.

Even if a woman receives a false-positive screening result, Patel said, the anxiety that woman may feel is often short-lived, and as for the risk of overdiagnosis, there seem to be conflicting data on how often breast cancers are overdiagnosed. "Overdiagnosis is a difficult concept for clinicians and patients to comprehend," said Kaunitz, who wrote a commentary in the journal OBG Management last month reporting that more than one-third of tumors found during breast cancer screenings represent overdiagnosis. Some studies suggest that less than 5% of screened breast cancers are overdiagnosed while others suggest that more than 50% are overdiagnosed. "So, there's a lot of talk about all these different risk factors, and some of these societies are placing more emphasis on one of these areas, whereas we should focus on saving the most number of years of life, which comes with early detection," Patel said. "Rather than emphasizing the negative aspects of screening such as cost, anxiety or overdiagnosis, we should focus on the most important benefit of early screening, which is early detection and the number of years of life this can bring to the patient," she said. Some experts argue that more research is needed to help inform recommendations.

"We are continually understanding more about breast cancer screening -- about who should get them, the different age groups of women who really benefit from it and how frequently women need to have mammograms," said Radhakrishnan, lead author of the new paper. "The guidelines are continuing to evolve, and there is more similarity now between the American Cancer Society and US Preventive Services Task Force guidelines," she said. "American Congress of Obstetricians and Gynecologists also reports convening a group to look at their own breast cancer screening guidelines. Amidst all of these changes, we need to make sure that both women and physicians are made aware of what the recommendations are."

Can My Breast Cancer Come Back?

As you come to the completion of your breast cancer treatments, it seems unfair to think you might have to deal with it again in the future. For many patients, treating breast cancer can be a painful, unpleasant experience, and once your doctor says you're clear of it, it seems like you should be able to carry on without ever having to worry about getting cancer again. But unfortunately, cancer can recur, and some breast cancer survivors struggle with anxiety for the rest of their lives over whether their cancer will come back. Upon completing surgery, radiation or chemotherapy, many patients assume that they're done with treatment and can move on. Some may even assume that simply finishing chemo means they're cured.

But Dr. Melissa Pilewskie, a surgical breast oncologist at Memorial Sloan Kettering Cancer Center in New York, says, "we tend to think of completing treatment as finishing surgery, chemotherapy and radiation. But a lot of women still have treatment going on for years." In the first year after the initial treatments have concluded, "many women will be on some kind of pill," often an anti-estrogen pill or other drug therapy to help prevent cancer cells from regenerating. Dr. Maggie DiNome , associate professor of surgery at the UCLA Santa Monica Breast Center at the David Geffen School of Medicine at UCLA, says that some women with hormone-positive breast cancer will be on drug therapy for upwards of five years.

And only after they complete that treatment can they be considered "cured." Still, even after being cancer-free for any length of time, it's possible your cancer could come back, although DiNome says the risk isn't as high as many women fear. For most women with breast cancer – those who developed the disease without a genetic mutation to aid it – the risk for recurrence is about 6 percent over 15 years, she says. And it's critical to put the fear of recurrence in an appropriate context for patients, she says. "You don't want patients to live a lifetime of anxiety that it's going to recur." At the same time, finally reaching the point where they can be considered cancer-free can create a strange feeling for some women. "When they're in active treatment and they're doing everything you ask them to do, they're comfortable being watched and tested. But then they reach their five-year mark off treatment and you're just monitoring them. That's a tricky scenario for some women – they almost feel like all of the sudden the net's been pulled out from under them," DiNome says. Pilewskie agrees.

"During treatment, most patients feel empowered, that they're doing something to deal with the disease. But once that stops, there can be a fear of what happens next. It's a waiting game of wondering whether something is going to happen. It can be hard emotionally to get back to a healthy lifestyle from that standpoint, and I'll often refer patients struggling with this for counseling and support groups." Recurrence can happen after a period of remission. Pilewskie refers to remission as "no evidence of disease," and this is when treatment will shift from actively battling the cancer to monitoring your body going forward.

 According to the American Cancer Society,"if cancer is found after treatment, and after a period of time when the cancer couldn't be detected, it's called a cancer recurrence." The ACS classifies the different types of recurrence you may experience as local recurrence, regional recurrence or distant recurrence. With a local recurrence, the cancer comes back in the original place it started. In regional recurrence, it returns to the lymph nodes near where it started. And in distant recurrence, the cancer comes back in another part of the body. The ACS reports that "the less time between when the cancer was thought to be gone and the time it came back, the more serious the situation. There's no standard length of time to decide if it's recurrence or progression. But most doctors consider recurrence to be cancer that comes back after you've had no signs of it for at least a year."

Progression, on the other hand, refers to cancer that never fully disappeared and continues to grow and change in the body. For example, if you're diagnosed with Stage 2 cancer and the disease progresses, you could be reclassified as having Stage 3 or 4 cancer. Also, if the cancer metastasizes, or invades a new organ, that would be considered a progression. In some cases, patients can be thought to have been in remission and then the cancer progresses, indicating that the first treatment protocol did not kill all of the cancer and additional treatment is needed. If it's determined that your cancer was in remission and at some point thereafter, cancer is again detected in your body, your doctor will run diagnostic tests to determine whether it's a recurrence or a new cancer altogether (called a second primary cancer); if it's the same type as you originally battled, chances are it's a recurrence. If it's a different type or has a different progression, then it's probably a second cancer.

The ACS reports that developing a second cancer "is much rarer than cancer recurrence, but it does happen. Having cancer once does not mean you cannot get another type of cancer in the future." Pilewskie says that having had breast cancer "does slightly increase the risk for a subsequent case." She also says that there are some second cancers that can be associated with breast cancer, but it's not necessarily the breast cancer itself that's caused this second illness; often there's an underlying genetic reason a person battles cancer more than once. The BRCA1 and BRCA2 genes are perhaps the most widely known genetic mutations associated with breast cancer, though there are other genetic factors that can predispose a person to cancer or elevate your risk for developing a second type of cancer. "Depending on the family history and genetics, breast and ovarian cancer are the two most commonly associated cancers, but in people with these genetic mutations, we also see an increase in pancreatic cancer. For men with these genes, breast cancer, prostate cancer, and some carcinomas may be associated." And what's more, simply surviving cancer – and living longer – can be its own risk factor for recurrence or developing a second cancer. According to Breastcancer.org, "the aging process is the biggest risk factor for breast cancer. That's because the longer we live, there are more opportunities for genetic damage (mutations) in the body. And as we age, our bodies are less capable of repairing genetic damage."

 Although as a whole, any kind of cancer can come back, Pilewskie says your chances of it returning can vary depending on the type of cancer you've had. "The more aggressive cancers may recur faster." With more aggressive forms of breast cancer, if it doesn't recur within the first two years, most likely you can be considered "cured." With slower-growing cancers, the cancer can return much later. Although many breast cancer survivors worry about their cancer coming back "sometimes I think that women overestimate their risk," Pilewskie says. She encourages anyone who's completed breast cancer treatment to have "a good conversation with their doctor about their actual risk of recurrence." Although there's no surefire way to prevent your cancer from coming back, there are a few lifestyle choices you can make to help reduce the chances. These are virtually the same things you're advised to do to help reduce your risk of developing breast cancer in the first place: eating right, controlling stress, getting enough sleep, managing your weight, participating in routine screening and exercising. It's this last item – exercise – that Pilewskie says she thinks holds the most promise for the future of cancer recurrence prevention.

"I just got back from a surgical oncology meeting and exercise is a hot topic. It's going to really come out in the research over the next few years what the specific links are" between breast cancer and exercise. She says she's hopeful that research will pinpoint a specific dose of exercise that's beneficial that doctors can prescribe their patients to reduce recurrence. "There's a lot of data looking at the impact of exercise on women to improve survival and lower recurrence rates. I think it's a complicated relationship in the effect of exercise and dietary factors," but she says breast cancer patients and survivors should strive to get back to a normal exercise routine as soon as possible. And be sure to keep all your follow-up appointments.

UCSF study: “Dense breasts” exceed all other breast cancer risk factors

A new UC San Francisco-led study shows that women with “dense breasts” are at increased risk for breast cancer, compared with women with a family history of the disease, their own history of benign lesions, and a first full-term pregnancy over age 30. The findings were published Thursday in the journal JAMA Oncology. Led by Natalie Engmann, a Ph.D. candidate in the UCSF Department of Epidemiology and Biostatistics, and Dr. Karla Kerlikowske, the researchers believe their work is the first large-scale study to measure the development of breast cancer according to the degree of breast density.

About 40 percent of women in the U.S. over age 40 have dense breast tissue, which makes it harder to identify cancer cells on a mammogram. As a result, 27 states including California have passed laws requiring health facilities to notify women when they have dense breasts. Proponents of the law say women can then decide if they want to take further action and undergo other imaging techniques, such as an ultrasound or MRI.

But critics say the laws cause women increased anxiety and cost because there is no consensus if the routine supplemental screening is worthwhile. The UCSF-led study evaluated the risk factors of more than 200,000 women ages 40 to 74. About 18,000 of the participants had different stages of breast cancer, while the rest did not. The researchers found that breast density was the most prevalent risk factor for the disease, and that 39.3 percent of breast cancers in pre-menopausal women and 26.2 percent in post-menopausal women might have been prevented if all women with higher breast density had been shifted to a lower density category.

The researchers also found that women with a high body mass index have lower breast density, though Engmann said age is also a strong determinant of breast density. Dense breasts are more common in younger women, said Engmann, and most women experience a sharp decline during menopause that continues in the post-menopausal period. However, she noted that post-menopausal estrogen and progestin therapy can reverse the decline of breast density with age. Tamoxifen, an estrogen hormone blocker, is the only treatment known to substantially reduce breast density, and thus the risk of breast cancer. But because the drug can have serious side effects, it is usually only recommended for women at high risk of breast cancer, with guidance from their physician. “Our study highlights the need for new interventions to reduce breast density for women at average risk,” Engmann said.

At the Fremont-based Cancer Prevention Institute of California, cancer epidemiologist Dr. Ingrid Oakley-Girvan was intrigued by the UCSF findings. “The exicting part about this article is that is really provides more evidence that there may be additional approaches we could use to reduce breast cancer,” she said. For example, along with some of her colleagues, Oakley-Girvan recently submitted a proposal to the U.S. Department of Defense to evaluate a nutritional soup product that may reduce inflammation in the breast in women with early breast disease. “Perhaps we should also consider expanding that work to women with dense breasts,” Oakley-Girvan said.

At UCSF, Engmann said that even though one link between dense breasts and breast cancer suggests that carrying extra pounds may protect women against the disease, since overweight and obese women are more likely to have fatty breasts, the study reinforced previous research that has determined a link between high body mass index and increased breast cancer risk in post-menopausal women. The researchers said that almost 23 percent of breast cancers in this group could have been averted if obese and overweight women attained a body mass index of less than 25, the equivalent of 155 lbs for a woman of 5 feet 6 inches.

By comparsion, the study found that factors commonly associated with breast cancer risk — a history of benign breast biopsy, a first-degree family history of breast cancer, and deferring childbirth until after 30 — each accounted for less than 10 percent of cases in the population. The study, which included three other co-authors, was supported by a National Cancer Institute-funded program.