Chances are at some point you've worried about breast cancer. After all, one in eight American women will face a diagnosis in their lifetime, and this year a quarter-million women can expect to learn they have the disease, according to National Cancer Institute statistics. Still, there is some good news: The overall death rate for breast cancer declined by 30% between 1990 and 2007, due to earlier detection as well as improved treatments. "Fewer women are dying of breast cancer," says Margaret I. Cuomo, M.D., author of A World Without Cancer: The Making of a New Cure and the Real Promise of Prevention (Rodale Books), published this month. "But that's fewer white women. More African American women die of breast cancer than white women, which is unacceptable." To help you make sense of all the breast cancer-related information that's out there, we asked the nation's best experts to answer your top five questions and concerns. We think you'll be heartened by their wise advice.
1. Are mammograms always accurate?
While mammograms are considered the gold standard when it comes to detection (they catch about 80% of cancers), they're imperfect. "A 'normal' mammogram report doesn't mean that a woman doesn't have breast cancer," says Stacey Vitiello, M.D., a breast imaging and biopsy specialist at Montclair Breast Center in Montclair, New Jersey. "In fact, 10% to 20% of cancers won't be seen either because you have dense breasts—in that scenario, the cancer detection rate falls to only 40% to 50% of cancers being seen on a mammogram—or the tumor was located in an area of your chest that's difficult to image with mammography."
Always choose a facility that specializes in breast imaging and try to have your mammogram at the same place year after year. "This way, your radiologist can compare and contrast your films and analyze any changes," says D. David Dershaw, M.D., a radiologist and director emeritus of breast imaging at Memorial Sloan-Kettering Cancer Center in New York City. "Should you change facilities, bring your previous films with you."
Also, if you've been told you have dense or lumpy breasts, or have a family or personal history of breast cancer, advocate for yourself by asking about having more than an annual mammogram and physical examination of your breasts. "Enough data exists for me to recommend that my patients with a personal history of breast cancer be screened annually with a breast MRI in addition to a mammogram," Dr. Vitiello says. "MRI is the most sensitive tool we have for diagnosing early breast cancer, especially for someone whose original cancer wasn't seen on a mammogram."
2. When you don't have a family history of breast cancer, what tests will insurance companies cover?
It varies widely. "Most insurers will allow you to have an annual clinical breast exam, a physical examination of the breast performed by your internist or ob-gyn, and an annual screening mammogram for women 40 and over," says Dr. Vitiello. "Some will even allow a baseline mammogram at age 35." Call your carrier or visit its website to find out what expenses will be out-of-pocket. You could also consider looking online for local clinics that offer free exams.
Still, you may have to pay for your mammogram yourself. In 2009 the United States Preventive Services Task Force (USPSTF) recommended that women start mammography screenings at age 50 and have them performed every other year, rather than annually; that women not perform regular breast self-exams; and that doctors not examine their patients' breasts for lumps. "While most physicians and organizations, including the American Medical Association, the American College of Surgeons and the American Cancer Society, disagree with this recommendation, this may be a sticking point when you talk to your insurance company," Dr. Vitiello adds.
One more thing: In certain states, including Connecticut and Illinois, the law mandates that if you have dense breast tissue (60% of women under the age of 50 and 40% of women over 50 do), your insurer must allow you to have a breast ultrasound screening (sonogram) along with your mammogram. That's because dense breasts can make it harder to see cancer on the mammogram films. Find out more about the current legislation in your state by visiting the Are You Dense Advocacy site. "Bills regarding diagnostic tests for women with dense breasts are being considered in other states and at the federal level," she adds.
3. What can I eat to beat breast cancer?
What to Have: Researchers are working tirelessly to find natural phytochemicals in certain foods that may be as potent as breast cancer drugs. The produce currently being examined includes red grapes and white button mushrooms as well as pomegranates (thought to inhibit estrogen production and limit breast cancer cell growth) and blueberries (believed to be effective in fighting an aggressive breast cancer subtype). "Red grapes and white button mushrooms have been shown to block an enzyme that produces estrogens in postmenopausal women," says Melanie Palomares, M.D., assistant professor of population sciences and medical oncology and director of the High Risk Breast Clinic at City of Hope Comprehensive Cancer Center in Duarte, California. "Certain drugs, aromatase inhibitors, block the production of estrogen by inhibiting the same enzyme."
While these superfoods have been effective in labs, more funding is needed for clinical trials to show their impact on women. In the meantime, there's no doubt that eating these fruits and vegetables can help us stay healthy.
What to Avoid: Limiting fried and fast foods is key to preventing the disease. "If you look at epidemiologic studies, they've consistently shown that high dietary fat intake is associated with a higher risk of breast, colon and prostate cancer," says Dr. Palomares. "Plus, we know there's a link between obesity and breast cancer, so keep everyone at an ideal weight and encourage them to exercise."
Modeling the best behavior possible can do wonders to motivate your kids to eat healthfully. "I tried to always inspire my kids to have fruits and vegetables by creating a fun display of colorful produce whenever we sat down to a meal," says Julie Silver, M.D., an assistant professor at Harvard Medical School and a cancer survivor.
Restricting the amount of alcohol you drink is also key. "We know there is a correlation between alcohol and breast cancer both in terms of developing it and for it recurring," says M. Catherine Lee, M.D., a surgical oncologist specializing in breast cancer at the Center for Women's Oncology at Moffitt Cancer Center in Tampa, Florida. "That's why we generally tell patients to limit consumption."
4. What should I tell my daughter about breast cancer?
Marisa C. Weiss, M.D., oncologist, founder of BreastCancer.org and co-author (with her daughter) of Taking Care of Your "Girls": A Breast Health Guide for Girls, Teens, and In-Betweens (Three Rivers Press), helps you navigate a tough but critical conversation.
Bring it up casually. In a private setting, say something that anticipates her concerns, like: "I know you hear about breast cancer in the media and your friends might be talking about it. Do you have any questions?" Keep the conversation ongoing. Reassure her by saying, "If I don't know the answers, I will help you get them."
Dispel common myths. Girls talk. And with that talk comes a lot of misunderstanding. For example, your daughter may believe that a change in her breasts is a symptom of the disease or that breast cancer is caused by infection, tanning, drug use or breast injury. Dismiss any false impressions and explain that if she feels a lump or bump or notices a change she should tell you immediately. Urge her to talk to her doctor about the things that concern her as well. Also, reassure her that breast cancer is exceedingly rare in girls. It's even unusual for women under the age of 30.
Reveal her power. It takes a decade for the body to build the breast gland. During that time, your daughter is particularly vulnerable to ingredients she's putting in and on herself. Explain to her that breasts are responsive to a whole host of chemicals. So from the personal products she uses to her reproductive choices to her diet and fitness habits, she can have a positive impact on her future breast health.
Address your family's health history. If there's an inherited risk, take things slow. Until she's old enough to handle this information, ask your daughter's pediatrician and then her adolescent medicine physician to partner with you in handling her questions in an upbeat, careful way to avoid worrying her. If your daughter is sexually active and taking hormonal birth control, her ob-gyn should do annual breast exams.
5. There's no way to avoid all the substances experts have deemed dangerous—plastics, aluminum and parabens. What should I cut back on to lessen the chances of anyone in my family getting breast cancer?
Focus on the small ways you can change health habits, suggests cancer survivor Julie Silver, M.D., author of the new book Chicken Soup for the Soul: Hope & Healing for Your Breast Cancer Journey (Chicken Soup for the Soul). "It's really stressful to think about every single thing you put in your—or your family's—mouth or use in your home," she says. Here, her four smart tips for moms:
1) Go organic as often as you can, and first offer your kids fruits and vegetables when they say they're starving. They'll end up eating more of them.
2) Limit the number of ingredients in the meals you serve. Many foods contain preservatives, but by keeping food fresh and simple you'll feed your family better. For example, a pizza made from scratch using whole wheat flour, oil, tomato sauce and cheese is usually going to be better than a frozen or take-out version.
3) Avoid or limit alcohol—it may increase your risk of breast cancer even when you're not drinking excessively.
4) Cut back on the chemicals in your house. This includes foods, household products, lotions and even lawn fertilizers. "My lawn isn't nearly as green as my neighbor's, but it's probably more chemical-free," says Dr. Silver.
Extra Tip: How can you best assess your daughter's risk?
If you had breast cancer (or your mom did), you're likely concerned that your child will be next. However, many factors influence her risk, says Helena Chang, M.D., director of the Revlon/UCLA Breast Center in Los Angeles. "These include your age at the time of your diagnosis, if the cancer occurred in one or both breasts, if you had ovarian cancer in addition to breast cancer, if you carry the BRCA1 or BRCA2 mutation and the number of close relatives who have also had breast and/or ovarian cancer," she says. Discuss your concerns with your M.D. or even a genetic counselor to see if you need genetic counseling. "That's the best way for you and your daughter to learn her true risk and find ways to reduce it."
Originally published in the October 2012 issue of Family Circle magazine.
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