Many of my patients have recently been asking me what it means to have dense breasts.

They sometimes carry a letter saying that their mammograms showed heterogeneously (or extremely) dense breast tissue.

The U.S. government now mandates that radiologists report breast density on mammogram reports but offers no guidance on how to do so.

In this Breast Cancer Awareness month, I want to provide some information about the implications of having dense breasts.

Breast Density Reporting

Beginning September 10, 2024, the U.S. government mandated this:

“Mammography facilities must provide all patients receiving a mammogram with one of two Federal breast density notification statements (either “not dense” or “dense”).“

Additionally, the mammogram report sent to referring providers must include an assessment of the patient’s breast density.

Defining Breast Density

Dense breasts are a mammographic finding in which the breast tissue appears more glandular or fibrous relative to fatty tissue.

The breast comprises two types of tissue: glandular tissue, which produces milk, and fatty tissue, which provides support and cushioning.

Dense breasts contain more glandular and fibrous tissue and less fatty tissue, which makes them appear denser on a mammogram.

Four Categories of Breast Density

The American College of Radiology classifies breast density into four categories:

1. Almost entirely fatty: The breast comprises fatty tissue and is the easiest to read on a mammogram.
2. Scattered areas of fibroglandular density: Although some areas of glandular and fibrous tissue exist, the breast is still considered primarily fatty.
3. Heterogeneously dense: There are many glandular and fibrous tissue areas, and the breast is considered moderately dense.
4. Extremely dense: This means the breast is very dense, with a lot of glandular and fibrous tissue.

Patient Notifications

A radiologist — a doctor who reads your mammogram — assigns your breasts a density.

As noted above, s/he will place each mammogram into one of the four breast density categories.

Your mammogram report may offer these observations:

• If NOT DENSE: “Breast tissue can be either dense or not dense. Dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer. Your breast tissue is not dense. Talk to your healthcare provider about breast density, risks for breast cancer, and your situation.”
• If DENSE: “Breast tissue can be either dense or not dense. Dense tissue makes it harder to find breast cancer on a mammogram and also raises the risk of developing breast cancer. Your breast tissue is dense. In some people with dense tissue, other imaging tests and a mammogram may help find cancers. Talk to your healthcare provider about breast density, risks for breast cancer, and your situation.”

Let’s turn to the implications of breast density.

Breast Density Distribution

The American College of Radiology (ACR) observes the following population distribution of breast density:

About 10 percent have almost entirely fatty breasts. At the other extreme, 10 percent have extremely dense breasts.

Eighty percent fit into one of the middle categories.

What causes dense breast tissue?

It’s unclear why some women have dense breast tissue while others do not. You may be more likely to have dense breasts if you:

• Are younger. Breast tissue often becomes less dense with age.
• Have a lower body mass index. Individuals with less body fat are more likely to have dense breast tissue than women who are obese.
• Take hormone therapy for menopause. Those taking combination hormone therapy to relieve signs and symptoms of menopause are more likely to have dense breasts.

Breast Density Implications

Having dense breasts may increase your chances of getting breast cancer.

Moreover, dense breasts make it more challenging for radiologists (and their artificial intelligence friends) to spot cancer on mammograms.

Unfortunately, dense breast tissue appears white on a mammogram.

Lumps, both cancer and non-cancer, often appear white, too. I often say to my patients that dense breasts make it like you are looking for a snowball in a snowfield.

In summary, dense breasts can raise cancer risk and make mammograms less accurate.

Mammograms Are Still Important

First, while many of my patients with dense breasts initially think that mammograms are useless for them, mammograms are still a part of routine imaging.

After all, mammograms are the only medical imaging screening test proven to reduce breast cancer deaths.

Each week, my radiology team finds cancers on mammograms in women with dense breasts.

What Else Can You Do?

That said, here are some tactics you can use:

• Get digital breast tomosynthesis (DBT or 3-D mammograms). DBT creates breast images in slices from many angles, making abnormalities easier to see. Tomo mammograms increase the number of cancers discovered without other imaging.
• Consider ultrasound and magnetic resonance imaging (MRI). These advanced imaging approaches can help find cancers that a mammogram doesn’t indicate. However, breast MRI and ultrasound show many more findings that aren’t cancer (false positive), resulting in added testing.
• Know your breast cancer risk. We have many calculators (varying in complexity and weighing different factors — including family history).

There is no national standard for following up on dense breast reports.

Screening Recommendations

The American College of Radiology suggests that you talk with your healthcare provider and discuss your breast cancer risk.

Even if you have a low breast cancer risk (and have fatty breasts), you should get annual mammograms beginning at 40.

The U.S. Preventative Task Force recommends that all women get screened for breast cancer every other year, starting at age 40 and continuing through age 74.

The Real Problem

Radiologists must describe breast density on your mammogram report.

However, we don’t know what to do with this information.

For example, the American College of Radiology and the National Comprehensive Cancer Network recommend that women and their doctors consider supplemental screening.

On the other hand, the American College of Obstetricians & Gynecologists and the U.S. Preventive Services Task Force offer there is insufficient evidence of benefit to recommend additional tests.

Additional tests can detect more cancers than mammograms alone. However, we have no evidence that extra testing saves lives.

And This

Some studies raise concerns about the reliability of the system used to label breasts as dense or not dense.

A review article in Annals of Internal Medicine reported that radiologists reclassified up to 19 percent of women into a different breast density category — from dense to non-dense or vice versa — on their subsequent screening mammogram.

For those with dense breasts, we don’t know with certainty what the best practice is at this point.

The post Dense Breasts: The Hidden Risk You Can’t Ignore appeared first on Medika Life.

New research findings suggest that the future might be closer than you think.

I am an oncologist with a special interest in breast cancer.

I am watching closely as artificial intelligence infiltrates many aspects of the field.

That future might be closer than you think.

AI and Breast Cancer Screening

A new study published in Radiology, a journal of the Radiological Society of North America (RSNA), suggests artificial intelligence (AI) could be the game-changer we’ve been waiting for.

In this groundbreaking study, Danish researchers harnessed the power of artificial intelligence (AI) to analyze mammograms, yielding promising results:

Not only did AI find more breast cancers, but it also significantly reduced the rate of false positives.

Using this approach could mean fewer unnecessary biopsies and a lot more peace of mind for women undergoing breast cancer screening.

Let’s delve deeper into this exciting development and explore how AI might revolutionize the fight against breast cancer.

Study Details: AI and Breast Cancer Screening

The Danish study involved two groups of women aged 50 to 69 who received mammograms every two years.

Before AI

The first group had their mammograms read by two radiologists traditionally.

Enter AI

The second group’s mammograms were first analyzed by AI software trained to spot suspicious areas.

If the AI flagged a mammogram as likely normal, a single radiologist reviewed it.

Any mammograms raising concerns with the AI received a double read by radiologists with AI support.

Promising Results

Here are the study findings:

The artificial intelligence detected more breast cancers (0.82 percent) than the traditional method (0.70 percent). AI identified a higher percentage of smaller (under one centimeter) invasive cancers.

Notably, the AI approach significantly reduced false positives (1.6 percent) compared to the traditional method (2.4 percent), offering women a greater sense of reassurance.

The reduction in false positive results means fewer women undergoing unnecessary biopsies and worrying about potential cancer.

The AI system also helped radiologists by lowering their workload by one-third.

What’s Next?

While these results are exciting, more research is needed to ensure long-term effectiveness and avoid unnecessary diagnoses.

The AI system is also under development, and researchers are working on incorporating a woman’s past mammogram history for a more complete picture.

Important Note

Breast cancer screening guidelines can vary between countries.

Researchers conducted the study in Denmark, and the findings might not directly translate to other regions with different protocols.

Summary

This study showed that using AI alongside mammograms led to:

• Discovering more cancers: The AI system helped find a slightly higher percentage of breast cancers than traditional methods.
• Fewer false alarms: Women had a lower chance of being called back for unnecessary biopsies due to suspicious results that weren’t cancer.
• Lighter workload for doctors: The AI system helped radiologists work more efficiently by highlighting areas of concern.

While these initial findings are promising, it’s crucial to note that more studies are needed to confirm the long-term safety and effectiveness of AI-assisted screening.

This emphasis on ongoing research keeps the audience informed and aware of the evolving nature of healthcare practices.
As someone who helps those with breast cancer, I am excited.

As someone who helps those with breast cancer, I am excited.

The post Your Next Mammogram Could Be a Game Changer: AI Sees What We Miss appeared first on Medika Life.

In general, breast cancer in young women has a less favorable prognosis compared with older women.

Researchers recently evaluated breast cancer incidence among women ages 20 to 49 in the United States. They examined 20 years of data from the Surveillance, Epidemiology, and End Results program.

We’ll look at the findings in more detail, but here is the bottom line:

There were increases in breast cancer incidence rates among young U.S. women.

Background

I have the privilege of being involved in the medical care of hundreds of patients with breast cancer each year.

In the United States, breast cancer is the leading cause of cancer death among women aged 20 to 49.

That’s according to the American Cancer Society.

Young

Young women tend to develop more breast cancers that are biologically aggressive compared to older women.

What do I mean by “aggressive?” Young folks’ tumors tend to be larger and more advanced in stage.

Moreover, the cancers are less likely to have positive hormone receptor status (estrogen and progesterone receptors) and more likely to have overexpression of HER2, a growth factor receptor.

All of these factors can contribute to a poorer prognosis in young women with breast cancer.

Oh, there is also this: Breast cancer screening programs are not available for women under 40 who are not at very high risk.

Study

While we know that breast cancer has been rising among young women, there is not a lot of data about trend patterns based on cancer stage, race, and cancer biology.

Researchers analyzed data from the U.S. Surveillance, Epidemiology, and End Results registries. SEER is a public database from the National Cancer Institute with coverage of 27% of the U.S. population

They included women ages 20 to 49 who had been diagnosed with invasive breast cancer. The final analytic set included 217,815 women.

The investigators formatted age as five-year age groups (20–24, 25–29, 20–34, 35–39, 40–44, and 45–49 years).

Trends

What are the long-term trends in breast cancer incidence among women aged 20 to 49 years?

The graph comes from this paper, “Breast Cancer Incidence Among U.S. Women Aged 20 to 49 Years by Race, Stage, and Hormone Receptor Status,” appearing in JAMA Network Open.

Look at the recent upward trend line (in blue). Disturbing, to say the least.

Why?

Let’s try to tease out this uptrend in young breast cancer diagnoses.

Period effects

Could it be that breast cancer rates are rising among all age groups, with the younger population riding the incidence wave?

Cohort effects

Or is there something different about the younger population? Could it be environmental exposures or changes in other breast cancer risk factors?

It turns out it is both. The rising incidence of breast cancer among young cancer is due to two effects:

• a general increase in incidence over time
• the special risk of being born in the late 1970s to early 1980s.

Stage

The stage is the extent of breast cancer at presentation. The study offers a fascinating finding:

The rising cancer rates among young women are mostly due to more stage I and IV (metastatic, with spread to distant sites) disease. The increases are not because of stages II or III breast cancer.

The higher cancer rates are due primarily to stage I and stage IV cancers, not stage II and stage III cancers.

The higher rates of stage I are perplexing to me. I don’t think it is because of early detection; women with normal risk levels would not be candidates for screening studies (such as mammograms).

Maybe I am wrong, and women are more aware of being at high risk. More genetic testing might lead them to get early screening.

Estrogen receptor-positive

Much of the reported breast cancer increase among young women is a type known as estrogen receptor-positive (ER +).

The cells of this breast cancer type have receptors that allow them to use the hormone estrogen to grow.

Treatment with “anti-estrogen” (endocrine) therapy can block the growth of such cancer cells.

Why might we see a rise in estrogen receptor-positive breast cancer among young women?

This rise in incidence may reflect women tending to have fewer children and children later in life.

Stage IV (advanced)

The report also showed a rise in young women presenting with later-stage breast cancer.

Why?

This finding does not surprise me.

If breast cancer is rising in all age groups, including among young women, we will see greater numbers of women with advanced breast cancer.

Younger women generally should not have screening mammograms. If a woman presents with a palpable lump in her breast, she is more likely to have an advanced stage.

But why the recent change? The study authors suggest that an increase in overweight and obese women in the U.S. might play a role.

Historical studies associated higher body mass index (BMI) with higher breast cancer stage at presentation.

My take

I don’t know why breast cancer is rising among young women.

But, I am disturbed.

We may need to adjust our screening approaches as the contours of breast cancer epidemiology evolve.

We may need to address weight and other lifestyle factors, environmental toxins, and other potential risk factors.

The post Startling Statistic: Growing Trend of Breast Cancer in Younger Females appeared first on Medika Life.

The World Health Organization offers that in 2020, there were 2.3 million women diagnosed with breast cancer and 685,000 deaths globally. As of the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past five years, making it the world’s most prevalent cancer.

According to the American Cancer Society, there were an estimated 287,850 new cases of invasive breast cancer among women in the USA in 2022. In addition, 43,250 women died from the disease.

An estimated 51,400 cases of non-invasive ductal carcinoma in situ (DCIS) will be diagnosed among women. Although breast cancer is predominantly female, approximately 2,710 new cases and 530 deaths (about 1% of all breast cancer cases and deaths) will occur among men.

Fortunately, most individuals with early breast cancer become long-term survivors, according to new British research that finds a substantial reduction in the risk of death since the 1990s.

First, though, I want to explore the fascinating history of breast cancer. We begin in ancient Egypt.

Breast Cancer — Ancient History

Breast cancer has a long and complex history that spans centuries. Understanding and managing breast cancer has evolved significantly, improving diagnosis and survival rates.

Breast cancer has been documented since ancient Egypt, around 1600 BCE. The Edwin Smith Papyrus, an Egyptian medical text, mentioned a condition characterized by bulging tumors in the breast.

The treatment options during this time included cauterization or completely removing the affected breast.

Classical Antiquity

During the classical period, the Greek physician Hippocrates (460–370 BCE) referred to breast cancer as “karkinos” and described the spread of the disease to nearby lymph nodes.

He proposed that an imbalance of bodily fluids caused breast cancer. Surgical intervention was still the primary treatment, involving radical mastectomy or acidic substances to destroy the tumor.

Middle Ages

In the Middle Ages, breast cancer was often associated with superstitions and mysticism. It was believed to be caused by supernatural forces or punishment for immoral behavior.

Treatments included various herbal remedies, poultices, and even incantations. Surgery was rare and generally not recommended due to the high risk of infection.

Renaissance and Enlightenment.

During the Renaissance, medical knowledge and understanding of breast cancer advanced.

In the 16th century, French surgeon Ambroise Paré introduced a less invasive method of surgery called the “horizontal incision,” which spared the chest wall muscles. This technique reduced complications and improved outcomes for patients.

Breast Cancer in the 1700s and 1800s

18th and 19th Centuries

The 18th and 19th centuries witnessed significant progress in understanding breast cancer.

In 1775, the Scottish surgeon Benjamin Bell advocated for early diagnosis and surgical intervention, recommending lumpectomy (partial breast removal) instead of radical mastectomy. However, many surgeons still favored aggressive procedures.

In the 19th century, advances in anesthesia and aseptic techniques improved surgical outcomes. William Stewart Halsted, an American surgeon, introduced radical mastectomy in the 1880s, which involved removing the entire breast, underlying chest muscles, and axillary lymph nodes.

Radical mastectomy became the standard treatment for several decades despite its physical and psychological impact on patients.

Breast Cancer in the 1900s

20th Century

The 20th century brought further advancements in breast cancer research and treatment. In the 1940s, the use of X-rays for diagnostic purposes became widespread. This development led to mammography in the 1960s, revolutionizing early detection and screening efforts.

In the 1970s, the discovery of estrogen receptors in breast cancer cells led to the development of hormone therapies. Tamoxifen, a selective estrogen receptor modulator, became the first FDA-approved drug for breast cancer treatment in 1977.

Advances in imaging technologies, such as ultrasound and magnetic resonance imaging (MRI), provided additional tools for diagnosing and staging breast cancer.

In the 1980s, fine-needle aspiration biopsy allowed for less invasive and more accurate diagnosis.

Recent Advances in Breast Cancer Management

The 21st century brought significant progress in understanding the genetics of breast cancer. The discovery of BRCA1 and BRCA2 genes, which increase the risk of developing breast and ovarian cancer, provided valuable insights into the hereditary component of the disease.

Genetic testing and counseling have become important tools for risk assessment and personalized treatment planning.

Targeted therapies, such as Herceptin (trastuzumab), were developed to target breast cancer cells that overexpress the HER2 protein specifically. These treatments have shown remarkable efficacy, improving survival rates for HER2-positive breast cancer patients.

Surgery advances

Furthermore, advancements in surgical techniques, including breast-conserving (lumpectomy) and oncoplastic surgery, have improved cosmetic outcomes while ensuring effective cancer removal.

Today, breast cancer research continues to focus on personalized medicine, immunotherapies, targeted therapies, and early detection methods.

Public awareness

Public awareness campaigns and improved access to screening have contributed to earlier diagnoses and improved survival rates for breast cancer patients.

While breast cancer remains a significant health challenge, the ongoing efforts of researchers, healthcare professionals, and advocacy organizations are steadily advancing our understanding and treatment of this disease.

Breast Cancer is Common

Breast cancer remains a significant concern for women worldwide, impacting millions of lives annually.

Did you know women lose more disability-adjusted years to breast cancer than any other cancer type? Breast cancer occurs in every country and women (and, far less commonly, men) at virtually any age.

Most with breast cancer are diagnosed after puberty but with increasing rates in later life.

There was little change in breast cancer mortality from the 1930s through the 1970s. Fortunately, early detection programs combined with improved management tools led to survival improvements beginning in the 1980s.

However, recent research has brought forth an encouraging revelation: the vast majority of women diagnosed with early-stage breast cancer are likely to become long-term survivors.

This finding offers hope and underscores the tremendous progress in understanding, diagnosing, and treating breast cancer. Let’s explore the implications of this discovery, highlighting the key factors contributing to improved survival rates and the importance of continued research and support for breast cancer patients.

Breast Cancer Survival Rates Rising

Breast cancer treatment has witnessed remarkable advancements in recent decades, significantly improving the prognosis for patients.

The advent of early detection through widespread mammography screening programs has played a crucial role in identifying breast cancer at its nascent stages, enabling timely intervention and treatment. As a result, most breast cancer cases diagnosed today are at an early stage, where the tumor is confined to the breast or nearby lymph nodes.

Treatment modalities have evolved significantly in conjunction with early detection, incorporating a multidisciplinary approach tailored to each patient’s unique circumstances.

Surgery, radiation therapy, chemotherapy, targeted therapies, and hormone therapy are among the arsenal of treatments employed in breast cancer management. The personalized nature of these treatments ensures that patients receive the most appropriate interventions based on the characteristics of their cancer, such as hormone receptor status, HER2 status, and genetic mutations.

Research Fuels Breast Cancer Advances

The progress achieved in breast cancer treatment owes much to ongoing research and clinical trials. Scientists and medical professionals continuously strive to unravel the intricacies of breast cancer biology, leading to the development of novel therapeutic strategies and precision medicine approaches.

Clinical trials provide a platform for testing innovative treatment modalities, ensuring patients receive the most cutting-edge care. By participating in clinical trials, women with early breast cancer contribute to expanding the body of knowledge and improving outcomes for future generations.

Prognostic Factors for Survival

Various factors influence the prognosis for women diagnosed with early breast cancer. Several clinical and biological indicators are considered to predict the likelihood of long-term survival.

These include the following:

• Size and grade of the tumor
• Lymph node involvement
• Hormone receptor status
• HER2/neu overexpression
• Specific genetic mutations.

Determining these factors assists clinicians in devising optimal management plans and tailoring interventions based on individual patient needs.

Moreover, advancements in molecular diagnostics have led to the emergence of gene expression profiling tests, such as Oncotype DX and Mammaprint.

These tests analyze the activity of specific genes within the tumor and provide valuable information on the likelihood of disease recurrence and the potential benefit from chemotherapy.

By utilizing these predictive tools, healthcare providers can guide patients toward the most appropriate treatment decisions, reducing unnecessary interventions and focusing on therapies with proven efficacy.

Good News From a New Study

Receiving a breast cancer diagnosis can be devastating. Fortunately, most individuals diagnosed with early breast cancer become long-term survivors. That’s the finding of a new study in the British Medical Journal that reports the following:

There has been a substantial reduction in the risk of death since the 1990s.

The news is reassuring as a radiation oncologist specializing in breast cancer. The findings are also good news for most early breast cancer patients.

In the late 1900s, the average risk of dying from breast cancer (within five years of diagnosis) was 14 percent. Today, it has dropped to five percent. More than six in ten women diagnosed from 2010 through 2015 had a five-year risk of three percent or less.

The study authors analyzed National Cancer Registration and Analysis Service data for over 512,000 women diagnosed in England with early breast cancer between January 1993 and December 2015.

Early breast cancer is defined as confined to the breast or spreading only to the underarm (axillary) lymph nodes.

Breast Cancer: We Still Have Work to Do

The risk of breast cancer-related death was under three percent for nearly two-thirds (63 percent) of women, but it was over 20 percent for five percent.

While the increasing survival rates for women with early breast cancer offer tremendous hope, it is essential to acknowledge the psychosocial aspects of the disease.

Breast cancer diagnosis and treatment can profoundly impact a woman’s woman’s well-being, body image, and overall quality of life. Therefore, providing comprehensive psychosocial support to the patient’s crucial.

Supportive care programs, survivorship initiatives, and counseling services are vital in addressing breast cancer survivors and their psychological needs. These programs facilitate the adjustment to life after cancer treatment, helping individuals cope with anxiety, depression, and body image concerns.

By fostering a holistic approach to care, healthcare providers can empower survivors to embrace their new normal and live fulfilling lives beyond their breast cancer diagnosis.

Continued Research and Awareness are Key

While the latest findings on long-term survival rates in early breast cancer cause celebration, it is imperative to remember that breast cancer remains a significant global health challenge.

Continued research is vital to unravel the complexities of the disease, identify new therapeutic targets, and improve treatment outcomes for all patients. Robust support for breast cancer research initiatives and awareness campaigns is necessary to maintain the momentum in the fight against this formidable adversary.

Key points — A Triumph of Science: Breast Cancer Survival

Question. Can most women with early breast cancer expect to become long-term survivors? How much has survival improved recently?

Findings. In the late 1900s, the average risk of dying from breast cancer (within five years of diagnosis) was 14 percent. Today, it has dropped to five percent. More than six in ten women diagnosed from 2010 through 2015 had a five-year risk of three percent or less.

The study has its challenges. The findings were observational and can’t elucidate the causes of these reductions in death rates. Information on cancer recurrence was not available.

Another limitation is the current report focused on patients initially treated with surgery, not those treated with drugs (such as chemotherapy or anti-HER2 medicines) to reduce the size of their cancer before surgery or those whose cancer had already spread.

Final Thoughts: Breast Cancer Survival

Improved survival rates are likely the combination of early detection through mammography screening programs, advancements in management, personalized medicine approaches, and the contributions of bench research and clinical trials.

Meaning. Fortunately, most individuals with early breast cancer become long-term survivors, according to new British research that finds a substantial reduction in the risk of death since the 1990s.

The risk of breast cancer-related death is now under three percent for nearly two-thirds (63 percent) of women, but it was over 20 percent for five percent. We have made great progress, but we have much to do.

Improved survival rates can be attributed to early detection through mammography screening programs, advancements in treatment modalities, personalized medicine approaches, and the contributions of research and clinical trials.

The post A Triumph of Science: Breast Cancer Survival appeared first on Medika Life.

The breast cancer death rate dropped by nearly half (43 percent) from 1989 to 2020, according to findings published in CA: A Cancer Journal for Clinicians. Unfortunately, racial disparities persist.

This decline in breast cancer death rates is significant and may be attributed to earlier detection through awareness and screening plus management advances. While I welcome the improvements in breast cancer mortality, I want to focus on some key ways you may reduce your risk of being diagnosed with breast cancer.

Let’s get to the top ways to significantly reduce your chances of getting (or dying from) breast cancer.

1. Don’t smoke.

If you currently smoke cigarettes (and have for more than ten years), you have a higher risk of developing breast cancer. This finding is not particularly surprising, nor is the fact that the duration of smoking matters: Those smoking for 40 years have a 1.6-times greater risk of breast cancer than non-smokers.

Moreover, the number of years smoked before a first full-term pregnancy appeared to be associated with a higher risk of breast cancer than comparative years smoked after pregnancy. Cigarettes are linked to breast cancer development, and the timing of the smoking exposure matters.

Whether women who previously smoked have a higher risk of breast cancer remains under investigation.

2. Breastfeed

Breastfeeding is associated with slightly lower breast cancer risk, especially for those who opt to nurse for a year or more.

Breastfeeding is associated with only a modest risk reduction; a large pooled analysis that included individual data from 47 studies (including about 50,000 women with invasive breast cancer and 97,000 controls) estimated that for every year of breastfeeding, there appeared to be a 4.3 percent reduction in the relative risk of breast cancer. If your risk had been 15 percent, breastfeeding might drop by slightly less than one percent.

3. Postmenopausal weight loss

Some, but not all, studies show that weight loss in postmenopausal women may reduce breast cancer risk. For example, a meta-analysis that included 237,000 women with breast cancer (and four million controls) discovered weight loss associated with nearly one-fifth (18 percent) lower breast cancer risk.

The Nurse’s Health Study prospectively assessed weight change since menopause among approximately 50,000 women followed up to 24 years. Here are the results:

Women with no prior hormone therapy use who maintained a weight loss of at least 10 kilograms (22 pounds) had more than a halving of breast cancer risk than women who did not.

4. Child-bearing

A full-term pregnancy affects breast cancer, but this influence hinges upon the age of the first full-term birth. Women bearing children later in life have an increase in breast cancer risk.

The Nurses’ Health Study looked at women who never delivered a baby compared with child-bearing women. The cumulative incidence of breast cancer by age 70, compared with a woman bearing no children, was as follows:

• For women delivering a first child at age 20, the risk dropped by one-fifth (for a woman with a one in eight baseline risk in the USA or many parts of northern Europe, a decrease by about two to three percent).
• For women delivering a first child at age 25, the breast cancer risk dropped by one-tenth or just over one percent for a woman at average risk in the United States.
• For women delivering a first child at 35, the breast cancer risk rose by one-twentieth. This risk is comparable to a woman who never had a full-term pregnancy.

Breast cells fully differentiate during and after pregnancy, which may protect the breast from cancer. On the other hand, having a first birth at a later age may increase the risk by giving additional stimulation to breast cells that are more likely to develop (and more likely to be damaged).

5. Move

The available research suggests that physical activity is associated with a lower risk of breast cancer. A meta-analysis of 139 studies discovered:

Higher physical activity levels appeared to lower breast cancer risk by nearly one-quarter (a drop by 22 percent in relative risk). This risk reduction appeared similar in pre- and postmenopausal women and for high- versus light-intensity movement.

Because higher weight in premenopausal women is associated with a lower breast cancer risk (higher weight raises the risk in postmenopausal women), the drop in risk is not because of weight loss associated with physical activity.

Blood levels of hormones (such as estrogen), insulin, and insulin growth factor-1 (IGF-1) may impact risk.

6. Watch the alcohol

Alcohol consumption is associated with a higher risk of breast cancer driven by estrogen or progesterone hormones. For example, a study of nearly 52,000 postmenopausal Swedish women discovered this:

Increased alcohol intake appeared associated with estrogen receptor-positive breast cancer, with a 1.35-fold increase (if you have a baseline risk of 12 percent, it will rise by about four percent).

Could folic acid intake decrease the alcohol-associated increase in breast cancer risk? Observational studies hint that those who consume alcohol should take a multivitamin with folic acid, but our grain has supplemental folate in the USA.

7. Get appropriate screening

Women between the ages of 40 and 44 should consider beginning annual mammograms. Women ages 44 to 54 years should have annual screening, and those 55 and older have the option to test every one or two years. Breast cancers discovered by annual mammograms are usually smaller and less advanced than those discovered during mammograms every two years.

8. Get to know your genes

Modern medicine has made assessing one’s risk of developing various forms of cancer much simpler. This understanding of risk can be especially helpful for women with inherited gene mutations that make them particularly vulnerable to breast cancer. The American Cancer Society explains, “When it comes to breast cancer risk, the most important inherited gene changes are in the BRCA1 and BRCA2 genes. Women (and men) with one of these gene changes are said to have Hereditary Breast and Ovarian Cancer (HBOC) syndrome.”

9. Risk-reducing surgery or medicines

Some medicines may significantly reduce the chances of developing the disease for women with a higher-than-average breast cancer risk. Because risk-reducing drugs such as tamoxifen, raloxifene, or aromatase inhibitors have potential side effects, you will need to balance the pros and cons of the medicine.

This approach of using medicines to help reduce disease risk is chemoprevention. If you are considering this approach, first have a health care provider help determine your breast cancer risk.

The American Cancer Society explains that some important breast cancer risk factors include:

• Older age
• Having close relatives with a breast cancer history
• Having more menstrual cycles
• Having a history of invasive breast cancer or ductal carcinoma in situ (DCIS)
• A history of breast lobular carcinoma in situ (LCIS, atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)
• Having a gene mutation associated with a family cancer syndrome (such as a BRCA mutation)

10. Eat well

A limited number of studies suggest that there may be a connection between eating fruits and vegetables regularly and a lower risk of developing some aggressive forms of breast cancer.

I hope this article helps you understand how lifestyle influences breast cancer risk. Thank you for joining me today.

The post 10 Top Tips to Drop Your Breast Cancer Risk appeared first on Medika Life.

Breast cancer is the most commonly diagnosed cancer in women worldwide. While more commonly associated with women, it can also affect men, given the presence of breast tissue in both sexes. Diagnosis rates vary, but it is something to which both biological sexes are potentially vulnerable. It is imperative, therefore, that everyone understands how to conduct regular self-checks to help increase the detection of potential concerns. Early detection of cancer can help increase options for treatment, and subsequently improve long-term survival rates.

Conducting self-checks for breast cancer is important for everyone. Self-checks for women are recommended, in addition to regular screening. Great resources from the CDC help to explain breast cancer in men, and symptoms to look out for.

Early detection can be enhanced via conducting regular self-checks, as well as regular examinations by a medical professional. The frequency of recommended checkups may vary from person to person, based upon a number of factors. These include personal and family history of cancer, genetic predisposition, and other considerations. For example, for those persons who are known to have BRCA gene variants, it is often recommended that they conduct more frequent checkups to monitor breast, ovarian, and other health.

Although breast cancer awareness month only comes one month a year, its mission is one worth carrying out year-round. Raising awareness — to help improve detection, increase access to treatment, to improve support for patients and caregivers — each of these initiatives requires consistent attention.

The post The Importance of Breast Cancer Awareness appeared first on Medika Life.

As an Obgyn I do breast exams every day, but I never expected to find a mass on myself. When I did, immediate panic set in. Breast cancer is rare in men, but it does happen.

The next morning I had one of my partners repeat the exam to confirm the findings. She placed the order for a diagnostic mammogram like we do every day only this time, my name was in the space labeled PATIENT.

I will just sneak in quietly and anonymously

I arrived at the same women’s imaging center where I refer my patients. As I parked my car, that anxiety hit me in the pit of my stomach. Thoughts of “what if” filled my mind. Could it be cancer? What would I do?

As I mustered up the courage to walk inside, I felt more than simple fear. I felt vulnerable. I opened the door and scanned the room. I quickly noticed I was the only man, but I was greeted by two of my patients who happened to be in the waiting room. So much for anonymity.

As I was checking in, I heard, “Hi Dr. Livingston, it’s nice to see you” from the woman staffing the desk who also happened to be my patient. I am bordering on humiliation at this point. I was then escorted to the back for my mammogram.

It’s tough to stand with dignity in a gown with holes for your breasts

While I removed my shirt it crossed my mind that Poetic Justice was at play. I have ordered thousands of mammograms. Now it was my turn to experience what I ask of my patients. As the technician politely entered the room, I stood tall with an air of false confidence dressed in my hospital scrub pants and a paper top with holes for my breasts.

After exchanging small talk, she positioned my breast into a pancake appropriately for the X-Ray. Having heard from patients that mammograms can be painful, I was prepared for discomfort. While there was no physical pain, I confess to an extreme feeling of helplessness standing shirtless, alone in a room with my left breast compressed in a waffle iron. It was over in seconds, and I was able to get dressed.

Our minds take us to dark places

I sat alone in silence, waiting to hear the results. Intellectually, I knew the odds were overwhelming in my favor that the mass was benign. Still, negative possibilities flooded my thoughts.

My mind immediately went to cancer. I began to plan my last will and testament. I thought through which breast surgeon I would choose, and who I would go see for chemotherapy. Luckily, the doctor quickly reported the mass was benign. No sign of malignancy and surgery would not be necessary.

Leaving the center, I felt relief and compassion

The experience of getting a mammogram made me a better doctor. True, I will never experience giving birth, menstrual cramps or other gynecologic conditions that I treat. But now I have a better understanding of how women feel when they bravely enter those doors for cancer screening.

I also feel compassion for those who exit the doors with unfortunate, life-changing news. I understand the fear and anxiety of going for cancer screening, and now I have a story to share with any patient who is anxious about getting it done.

Most importantly, I feel gratitude not just for my results but also for the science and technology available to diagnose treatable illnesses.

Mammograms save lives.

The post When a Male Obgyn Gets a Mammogram appeared first on Medika Life.

We ran a simple and easy test to see if she carried the genetic mutations associated with an increased risk of breast cancer. Her test results indicated she was a carrier. Now she faced some difficult decisions. Should she undergo a prophylactic mastectomy or take a chance and have one more child. 

Many women know breast cancer runs in their family. They live in fear, wondering if they will also develop cancer. Some have heard about testing for the breast cancer genes, but are unsure how to pursue this option. 

Men and women with a family history of cancer may qualify for genetic testing to help make life-saving decisions. 

What are the breast cancer genes?

Genetic mutations in BRCA 1 and BRCA 2 are linked to an increased risk of breast cancer. Although the names sound similar, these two genes are not related at all. BRCA1, first identified in 1990, is on chromosome 17. BRCA2, identified in 1994, is located on chromosome 13.

Other gene mutations are linked to various cancers, but BRCA mutations are the most common and most well-known. 

Mutations in these two genes not only increase the risk of breast cancer but other cancers as well. BRACA 1 and 2 mutations increase the risk of ovarian and pancreatic cancer. 

A BRCA1 mutation can increase the risk of cervical, uterine, and colon cancer, while mutations on BRCA2 can increase stomach, gallbladder, bile duct cancer, and melanoma.

Mutations in the BRCA 1 and 2 genes change the function of the cells containing them. These genes are known as tumor suppressors. When functioning normally, their job is to create proteins to suppress cancer and help maintain cell growth.

When deleterious mutations are present, cells have the potential for unchecked growth leading to an increased risk of cancer.

Do I have the BRCA 1 and 2 genes?

Everyone has two copies of these genes. All of our cells contain genes holding our body’s genetic code. We all have BRCA 1 and 2 genes. The increased risk of cancer comes when we have a mutation in the gene. 

Gene mutations alter the genetic code inside of cells. Certain mutations change the function of cells. 

We inherit our genes from our parents. One copy comes from our mother and the other from our father. When we inherit one gene mutation from a parent, every cell in the body will possess one mutated copy of the gene and one normal copy.

People with no abnormal BRCA mutations have the lowest risk. One copy of a mutated gene increases cancer risk, but the other gene promotes tumor suppression. 

When two mutated copies are present, the lifetime risk of cancer increases to a dangerous degree. 

Because harmful mutations may be inherited from either our mother or the father, our complete family history is the best indicator of a potential mutation. Physicians will evaluate the maternal and paternal family cancer history to determine the risk level and the need for testing.

Doctors evaluate for specific risk factors:

• Breast cancer diagnosed before age 50 years
• Cancer in both breasts in the same woman
• Both breast and ovarian cancers in either the same woman or the same family
• Multiple breast cancers in the family
• Two or more primary types of BRCA1– or BRCA2-related cancers in one family member
• Cases of male breast cancer
• Ashkenazi Jewish ethnicity

Certain ethnic groups are also at a higher risk of having these mutations, including those with Ashkenazi Jewish backgrounds. Ashkenazi Jewish people have as high as a 1 in 40 chance of possessing a harmful BRCA1 or BRCA2 mutation.

How much does my cancer risk increase if I have a mutation?

Recent breast cancer statistics suggest that 1 in 8 women will develop be breast cancer in their lifetime. Approximately 60 percent of women who have inherited these harmful gene mutations will develop breast cancer. By age 70, the risk of breast cancer for mutation carriers is:

• 55–65 percent for BRCA1 carriers
• 45–55 percent for BRCA2 carriers

IIt’s essential to remember the following:

• Not all breast cancer is due to these genetic mutations. 
• Scientists’ best estimates suggest that only 5 to 10 percent of breast cancers are due to the mutations of BRCA1 and BRCA2.
• Not every woman with a harmful mutation gets cancer. 
• Not all women with the mutation will develop breast cancer, but more than half of them will, and many at an earlier age than the average diagnosis.

Testing For BRCA1 and 2 mutations

Genetic testing for these mutations is available for those who qualify. Thanks to the Affordable Care Act, insurance coverage is guaranteed if an individual meets testing criteria. But only about 2 percent of the general population will meet the strict testing guidelines.

Blood or saliva is collected for genetic testing in a doctor’s office to be sent to a testing company. It can take several weeks to receive the results. 

Genetic counseling both before and after the test is highly recommended. Learning about the presence of a cancer mutation can be emotionally and psychologically challenging. It is crucial to speak with an expert who can guide patients through the implications and possible options..

What are my options if I am a BRCA mutation carrier?

Women who do test positive have options. It is important to speak with a specialist well-versed in genetic counseling. The management is highly dependent on the patient’s age and family planning status. 

Patients will start an individualized cancer prevention plan. This often includes a twice-yearly clinical breast exam combined with Breast MRI and mammograms alternating every six months. Monthly breast self-examination may be encouraged.

Some may qualify for annual CA-125 blood tests combined with transvaginal ultrasound for ovarian cancer prevention. Young patients may be started on oral contraceptives to reduce the risk of ovarian cancer. 

BRCA 2 carriers will be referred for annual skin evaluation to monitor for melanoma. 

Some women may choose to freeze their eggs to preserve their fertility later in life. Egg preservation is an available option for carriers not ready to have a baby now, but who want to keep their options open.

Some women may choose risk-reduction surgery. The breasts and surrounding tissue can be removed to reduce the risk of breast cancer. This procedure is called a prophylactic bilateral mastectomy. Bilateral prophylactic mastectomy reduces breast cancer risk by 95 percent in women with a BRCA 1 mutation and 90% in a BRCA2 mutation carrier.

Ovarian cancer risk-reduction surgery is called a prophylactic bilateral salpingo-oophorectomy. The fallopian tubes and ovaries are surgically removed. Ovarian cancer risk decreases by 90%, and breast cancer risk reduces by 50% after removing the fallopian tubes and ovaries.

Removing the ovaries causes surgical menopause. Hot flashes and night sweats are two of the most common and frustrating menopausal symptoms.

Why is genetic testing important?

People with a strong family history of cancer often worry about getting cancer. Parents worry they may have passed on harmful genes to their children. 

Getting tested is simple and easy for those who meet testing criteria. When we find a negative test, indicating the mutation is not present, a weight of worry comes off the patient’s shoulders. 

When we find a positive test indicating a harmful mutation is present, we can individualize a cancer prevention plan to encourage early detection and prevention. Genetic testing can be a key step to a long and healthy life.

The post Here’s What You Need to Know About BRCA 1 and 2: The Breast Cancer Genes appeared first on Medika Life.

She left with life-changing news.

Exam, mammogram, and biopsy

Her breast cancer was confirmed, and she disappeared. We made phone calls, left messages, and sent certified letters to no avail. In medical terminology, we call this “lost to follow up.” She ghosted us.

We continued our pursuit. Months later she returned. She did not follow up with the breast surgeon or Oncologist. She didn’t like them. Her family had other opinions.

She was angry.

I could feel it.

This was life or death

I would like to say I encouraged her to seek treatment, but I didn’t. I pushed her to get help. Not a gentle nudge but a shove. It was intervention time. I spoke the cold, hard truth. The goal was to break the dangerous cycle of denial. After relentless encouragement, she promised to go.

The resentful look in her eyes told a different story.

She was not ready.

She just wanted to leave.

Surgery, chemotherapy, and radiation

I saw her a few months later. My intervention worked. She had bilateral mastectomies and removal of the lymph nodes. She was undergoing chemotherapy and radiation. She was still angry.

She resented me.

I knew it.

I reminded myself her care was all about her. This moment was not about me. My job was not to be liked but rather to help her get well. In desperate times, patients focus their frustration on what they can control. Patients need a place to channel their feelings and rage. My job that day was to be the target.

Fear manifests as anger. She was furious and frustrated.

But she was alive.

Three years later we meet again

She came to see me yesterday. With a huge smile on her face, she embraced me in a giant bear hug. She held the hug a little too long. She grabbed both my hands and squeezed them tight. We locked eyes. She said, “thank you.” She appreciated my fight to get her treatment.

Then, with a beaming smile, she told me her cancer was back.

My heart sinks

After three years of remission, her breast cancer came back. The metastatic disease has spread to the chest, lungs, and brain. It is inoperable. She is restarting chemotherapy. She qualified for an experimental protocol with a 2–3% survival rate over three years.

I am rarely speechless. I can not talk. Tears fill my eyes. I try to fight it.

I am the doctor she trusts to take care of her. I am losing it.

What? No? Not possible. That can’t be true. She has a teenage son.

Quickly, I process her reveal. Inoperable metastatic cancer. Experimental protocol. 2% survival rate.

I stop fighting my emotions. I cry. I manage to say, “I am so sorry.”

She looked me in the eye and said “But I am ok”

She explains she came today just to see me. She wants me to know she “is good.” Her spirits are great. This was the best she felt in years. It took a long time for her to get to this place of acceptance.

She has found joy in living.

She shares her story. In the past, she blamed me for finding her cancer. She was frustrated every office ended in bad news. She resented me for forcing her into treatment. She was furious she had cancer.

Now, she is at peace. She is thankful. She appreciates all that I did. She needs me to know she is no longer angry. She has accepted her fate. She has found a happy place. She is loved.

My eyes glisten with tears. Her eyes glimmer with joy.

I am in awe of her strength, her will, and her compassion. We finish our visit with another hug.

It was my turn to hold the hug too long.

Afterthoughts

I think about her often. I try to shake the memory. I can’t. She was closing the open loops. Seeking resolution.

When I think about her, I smile.

My heart fills with admiration and gratitude. I am thankful she blessed my life. I am thankful she came to see me. For 15 years, I had the honor of being her doctor.

She found her happy place.

I will find mine knowing the true reason for her visit was to say “Goodbye.”

The post How a Breast Cancer Patient’s Strength Inspires Her Doctor appeared first on Medika Life.