October 2013

While October is designated as National Breast Cancer Awareness Month, I am dedicated to raising awareness and educating individuals about breast cancer throughout the entire year.  We provide the knowledge and resources for increased awareness, early detection, risk reduction and a strategy for treatment.  It’s time to get proactive and take charge of your own breast health, this month and every other month.

 

October 25, 2013

Q:

What do you do when you are homebound and can’t go out to get a mammogram or even a Pap smear? I am so scared about this and I cherish any help. I have been homebound for 40 years.

A:

Thank you for your question. First of all, there are several services available to you that provide medical services in the home. Physicians, nurses and home-care services can provide “house-call” type care depending on the need. Usually, there are eligibility requirements and this may depend on your level of debility, the level of care required, your financial need and if you are homebound. Without knowing most of the details of your specific situation, I would recommend contacting a social worker in your community to get started. Loyola social workers can be contacted at (708) 216-4044.

At a minimum, a physician can do a clinical breast exam. A mammogram can only be done at a location with mammogram equipment, and this would be outside of the home. Hospitals, outpatient facilities and mobile units have mammogram capabilities. The Illinois Breast and Cervical Cancer Program offers free mammograms, breast exams, pelvic exams and Pap tests to eligible women who do not have insurance. http://cancerscreening.illinois.gov/

October 25, 2013

Q:

Does having the surgery for breast implants increase my chances of having breast cancer?

A:

There is no link between breast implants and breast cancer.

Although breast implants do not increase the risk of breast cancer, the FDA has postulated a possible link between implants and a slight increase in the risk of anaplastic large cell lymphoma (ALCL). This is not a breast cancer; it is a rare systemic cancer of the immune system. This lymphoma has rarely been found in the breast tissue around the implants (about 3 in 100 million women). So far, there are too few cases to know if the risk of this lymphoma is really higher in women who have implants.

October 23, 2013

Q:

What can you tell me about the rates of breast cancer among different communities: African-American, Hispanic, Asian and Caucausian? And what about their access to care?

A:

White women have the highest breast cancer incidence rate of any racial or ethnic group, followed by African-American, Hispanic, Asian/Pacific Islander and American Indian/Alaska Native women, in that order. Under age 45, African-American women have a higher incidence of breast cancer than white women. African-American and Hispanic/Latina women are more likely than white women to be diagnosed with later-stage breast cancers. They also tend to have larger tumors than white women.

Race is not a risk factor for breast cancer. But the rates of getting and dying from breast cancer differ among ethnic groups.

Breast cancer incidence is lower among Asian-American and Pacific Islander women than for white and African-American women. Asian-American women who are new immigrants have lower rates of breast cancer than those who have lived in the U.S. for many years. For those born in the U.S., the risk is similar to that of white women (60 percent higher than women born in Asia).

Women from some races/ethnicities are more likely than others to have low income and lack health insurance. This often means they have less access to breast cancer screening and treatment and therefore may be diagnosed with later-stage breast cancer.

October 15, 2013

Q:

How large and/or robust are the studies about alcohol and breast cancer risk and what advice would you give to teens and young adult women about the increased drinking that can be more prevalent in this age bracket? Are younger women more susceptible to the effects of alcohol on their breast tissue? Is this why we seem to have more young women now with breast cancer? What about older women who drink?

A:

The use of alcohol is clearly linked to an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed. Compared with non-drinkers, women who consume one alcoholic drink a day have a very small increase in risk. Those who have two to five drinks daily have about 1½ times the risk of women who don’t drink alcohol. Excessive alcohol consumption is also known to increase the risk of developing several other types of cancer.

There have been many large and small studies evaluating the link between alcohol and breast cancer.  A recent study looked at the risk specifically for young women.  The study, which is published in the Journal of the National Cancer Institute, and performed by researchers from the Washington University School of Medicine in St. Louis, is based on data from 91,005 mothers who were part of the Nurses’ Health Study II from 1989 to 2009. They analyzed alcohol consumption during early adulthood and how that influenced the women’s risk of later developing breast cancer.  This study shows a link between drinking in young adulthood and increased risk of breast cancer.  This was an observational study (rather than a randomized prospective study). However, it does contribute to what we know about the risk associated with alcohol use in young women.

I do not think that alcohol consumption alone is the reason we see breast cancer in young women.  Remember that your risk of developing breast and ovarian cancer increases as you get older and about two-thirds of women who are diagnosed with breast cancer are over the age of 55.

For women of all ages, my recommendation is to limit your alcohol intake or to exclude it.  This, combined with healthy eating and maintaining a healthy body weight, will contribute a reduced risk.

October 9, 2013

Q:

What percentage of early-stage breast cancer patients will go on to have metastatic recurrences?

A:

A clinical trial called the NSABP B-14 looked at this question in patients with early breast cancer, negative lymph nodes and the presence of estrogen receptors (ER positive).  This was a prospective analysis of archived tissue from 668 Stage I or II patients with ER-positive, node-negative invasive breast cancer treated with tamoxifen. Twenty-nine percent of patients were 50 years old or younger and 62 percent had tumors that were 2.0 cm or smaller in size. For the overall study population the distant recurrence rate was 15 percent at 10 years. Distant breast cancer recurrence is when the cancer has spread to another organ within the body.

October 8, 2013

Q:

I’ve been having a lot pain in one of my breasts lately and I also found a lump in that same breast. I went to see my doctor and he found a second lump. An ultrasound was scheduled and results said it was fatty tissue, but why do I feel so much pain? Sometimes the pain is just so intense and can last up to 5 to 10 minutes. Then it goes away but happens all over again.

A:

Breast pain can range from mild to severe. It can affect you just a few days a month, for instance, just before your period, or can last for seven days or more each month. Breast pain may affect you just before your period or it may continue throughout the menstrual cycle. Postmenopausal women sometimes have breast pain, but breast pain is more common in younger, premenopausal women and perimenopausal women.

Most times, breast pain signals a noncancerous (benign) breast condition and rarely indicates breast cancer.  Breast pain is typically related to hormones.  Still, unexplained breast pain that doesn’t go away after one or two menstrual cycles or that persists after menopause and occurs in one specific area of your breast needs to be evaluated by your doctor.

October 8, 2013

Q:

I have no health care. Is there anywhere that I can get a free mammogram? I am 56 years old and never had one.

A:

Thank you for asking this question and taking the initiative to be proactive in getting your screening mammogram.

The Metropolitan Chicago Breast Cancer Task Force has launched a new citywide initiative known as “Beyond October – Saving Women’s Lives,” to run after the month of October.  This is a citywide effort to address the current funding crisis for uninsured women’s mammograms in metropolitan Chicago. Loyola is one of the hospitals participating in this program.  Patients can be seen at any of the Loyola screening locations, including Burr Ridge, North Riverside, Oak Brook, Orland Park and the Outpatient Center in Maywood.   All referrals are directed and coordinated through the task force.  To sign up for your free mammogram, please call (312) 942-1899 or go to:

http://www.chicagobreastcancer.org/site/epage/143173_904.htm

and under the News and Events column on the left-hand side of the page you will see a bullet point that says Sign Up for Free Mammograms.

October 7, 2013

Q:

What are the symptoms of breast cancer?

A:

The most common symptom of breast cancer is a new lump or mass.  It is important to have any new breast mass or lump or breast change checked by a health-care professional experienced in diagnosing breast diseases.

Other possible signs of breast cancer include:

  • Swelling of all or part of a breast (even if no distinct lump is felt)
  • Skin irritation, scaliness, redness, dimpling or thickening; any new skin or nipple changes
  • Breast or nipple pain
  • Nipple retraction or inversion (turning inward)
  • Nipple discharge (other than breast milk); bloody nipple discharge

October 7, 2013

Q:

My last mammogram showed some calcifications. I did a 6-month follow-up with ultrasound and I was told to return in 6 months. Should I be worried?

A:

Calcifications are tiny mineral deposits within the breast tissue. They look like small white spots on a mammogram. They may or may not be caused by cancer.

In most cases, the presence of microcalcifications does not mean a biopsy is needed. Calcifications may need to be followed with a 6-month interval mammogram to confirm that the calcifications have remained stable and haven’t changed over time.  Calcifications that remain stable are more likely to be benign.

I do not think that you should be worried.  It is likely that the 6-month follow-up mammogram is a precaution to confirm that there is no new change.  If the microcalcifications have a suspicious look and pattern, a biopsy will be recommended.

October 1, 2013

Q:

What causes breast cancer?

A:

There is not one straight-forward answer to this question.  At the present time, data supports that breast cancer is caused by a combination of both known and unknown factors, including genetics (such as family history of breast cancer and genetic mutations), lifestyle choices (such as diet, exercise habits and alcohol) and reproductive factors (such as age of menarche and menopause).

October 1, 2013

Q:

When should I start getting mammograms?

A:

Not all organizations agree on mammogram guidelines and this has been a topic of recent debate.  The American Cancer Society and other cancer organizations recommend screening beginning at age 40 and continuing annually.  Women who are deemed at high risk of developing breast cancer may need to start screening at an earlier age.  I recommend that women and their doctors discuss the overall risks and benefits, and decide together what is the most appropriate time for their first mammogram.

October 1, 2013

Q:

What do I do if I find a breast lump?

A:

If you find a breast lump, don’t panic.  There are many benign (noncancerous) breast lumps, for example cysts or dense breast tissue.  Still, DO NOT IGNORE IT.  It is extremely important that you see your doctor right away for a clinical breast exam.  This may be accompanied by a diagnostic mammogram and/or ultrasound to evaluate the mass.  If indicated, a biopsy may be performed.

October 1, 2013

Q:

How common is breast cancer?

A:

Breast cancer is the most common cancer among American women, except for skin cancers. About 1 in 8, or 12  percent of women in the U.S. will develop invasive breast cancer during their lifetime.

The American Cancer Society’s estimates for breast cancer in the United States for 2013 are:

  • About 232,340 new cases of invasive breast cancer will be diagnosed in women.
  • About 64,640 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is noninvasive and is the earliest form of breast cancer).
  • About 39,620 women will die from breast cancer.