The Truth About Breast Cancer
You can't believe every headline you read about breast cancer. Here's a reality check from experts and survivors.
Whether you keep up with the daily news using an app or by watching TV, chances are you pay close attention to whatever pops up about breast cancer. And if you sometimes find yourself confused by what you read or hear, you're not alone. "Reports on breast cancer studies often lack balance or context, which may make it hard for a woman to know what it all means for her," says Lisa Schwartz, M.D., codirector of the Center for Medicine and the Media at The Dartmouth Institute for Health Policy and Clinical Practice in Hanover, New Hampshire. To help make sense of the latest headlines, we asked the pros to rate them for accuracy and to set the record straight. Their clear explanations and advice will empower you not just to understand but also to outsmart this perilous disease.
Mammograms Are Not Reducing Cancer Deaths
Not true! "The research showed screening prevents fewer deaths than we had hoped, but it still saves lives," says Laura Esserman, M.D., professor of surgery and radiology and director of the University of California, San Francisco, Carol Franc Buck Breast Care Center.
The fine print: The study found that mammography isn't doing all that great a job at finding the worst cancers—the frequency with which deadly late-stage cancers were found only declined by 8% over the past 30 years. It also found mammography may be doing too good a job at spotting things that might never harm you. In fact, the study's authors estimated that more than 1 million women in the past three decades may have undergone biopsies, surgery, radiation and/or chemotherapy for problems that would never have actually caused illness.
Your takeaway: Mammograms are still worthwhile, since they detect some dangerous cancers. And experts generally agree that annual screening makes sense for women with certain risk factors—those who have a personal or family history of breast cancer, or those between age 40 and 49 who have been told they have extremely dense breast tissue. But women who are less vulnerable will want to talk to their doctor about sticking to the U.S. Preventive Services Task Force guidelines, which recommend mammograms every other year, starting at age 50. This scaled-back mammo schedule reduces your chances of undergoing unnecessary biopsies and more by almost 20% without increasing your chances of ending up with advanced breast cancer, according to a large new study. The truth is, some cancers don't spread or they grow so slowly that they're actually harmless. "Today, if a screening reveals lower-risk lesions like calcifications that, at their very worst, could be a condition called ductal carcinoma in situ (DCIS), there's enough evidence for me to recommend waiting and watching," says Dr. Esserman. "In my experience most of these turn out to be nothing, and it's very rare for changes to occur that require a biopsy or surgery later on."
Lumpectomy Beats Mastectomy for Survival
True. Women with early-stage breast cancer who had a small portion of their breast removed did just as well—and in some cases, better—than those who had their entire breast removed, according to a study from the Duke Cancer Institute in Durham, North Carolina.
The fine print: The researchers tracked over 100,000 women with early-stage breast cancer for 14 years and compared the outcomes of those who had a lumpectomy and radiation with those who had a mastectomy alone. Among women age 50 and over, those who had the breast-conserving surgery were up to 13% less likely to die from the disease during the follow-up. For women who were under age 50, survival was the same whichever treatment they chose.
Your takeaway: "Don't assume you'll do better if you have more extensive surgery," says Usama Mahmood, M.D., assistant professor of radiation oncology at the University of Texas MD Anderson Cancer Center in Houston. He says mastectomy rates have been rising, especially in young women, possibly because of fears that a lumpectomy won't get all the cancer out. "But this study, which confirms the results of other research, should reassure women who want to choose breast-conserving treatment that it's very safe and effective," says Dr. Mahmood.
Thousands of Women Die from Breast Cancer Caused by Drinking
Not exactly. A recent National Cancer Institute study did find new evidence linking alcohol to breast cancer. However, the amount consumed makes a difference. "This headline exaggerates the alarm and causes harm by making all women who drink think they are to blame if they get the disease," says Dr. Schwartz.
The fine print: Analyzing U.S. mortality data and nationwide surveys of alcohol use, the researchers estimated about 15% of breast cancer deaths are tied to liquor. "We didn't find any level of drinking to be completely safe, but the greatest risks were in those who had the most—three drinks a day or more," notes lead study author David E. Nelson, M.D., director of the Cancer Prevention Fellowship Program at the National Cancer Institute. He says the exact mechanism for how alcohol might play a role in cancer isn't fully understood, although one theory is that acetaldehyde, a chemical by-product of your body breaking it down, may cause cells to mutate.
Your takeaway: If you drink, keep it light—to one serving a day or less. If you're diagnosed with the disease, you may wonder if it's dicey to have alcohol once in a while. The answer appears to be no: A new study found that women who continued to have three to six drinks a week after being diagnosed were no more likely to die of breast cancer or cardiovascular disease than those who didn't partake at all.
Study Raises Concerns About a Faster Radiation Therapy for Breast Cancer
True. A quick, new and increasingly popular kind of radiation treatment did cause more complications than the traditional kind.
The fine print: Researchers from the University of Texas and Chicago analyzed the medical insurance claims of over 90,000 breast cancer patients and found that women who chose accelerated partial-breast irradiation (APBI)—a one-week treatment that delivers radiation to a targeted area of the breast via a catheter—were twice as likely to experience infection, bleeding or other problems as those who received whole-breast irradiation, which usually takes six or seven weeks. In addition, the women who had APBI were almost twice as likely to have a mastectomy in the following five years, which is a probable sign the cancer came back. Happily, there was no difference between the two treatment groups when it came to overall survival.
Your takeaway: "You need to be aware that there is greater uncertainty about the long-term pros and cons of APBI compared to traditional whole-breast irradiation," says study co-author Benjamin D. Smith, M.D., an associate professor of radiation oncology at the MD Anderson Cancer Center in Houston. He considers APBI very promising and suspects it won't be long before doctors are able to determine which patients are the best candidates for it. Until then, there's some good news for anyone worried about fitting whole-breast irradiation into a hectic schedule: "We've learned how to make the treatment faster and more convenient, bringing down the number of weeks you need it to three to four," notes Dr. Smith.
Diabetes Raises the Risk of Breast Cancer
True. When Australian researchers analyzed 43 studies on the connection between these two diseases, they found having type 2 diabetes raised the probability of developing breast cancer by 22%. If you had gestational diabetes—a short-lived form of the disease that goes away after pregnancy—you're not in elevated danger.
The fine print: It's not known how or why diabetes increases breast cancer chances, but it may be that an excess of insulin circulating in the bloodstream fuels the growth and spread of cancerous cells, according to study coauthor Guy D. Eslick, Dr.P.H., associate professor of surgery and cancer epidemiology at the University of Sydney.
Your takeaway: "It's reasonable to assume you can reverse your breast cancer risk by reversing your diabetes," says Eslick. He believes exercise and eating right to lose weight are the best tactics, but also recommends that women who are having trouble controlling their condition with lifestyle changes talk to their doctor about taking metformin. This diabetes drug may do double duty as a potent anti-breast-cancer agent, according to several preliminary studies.
Understanding Angelina Jolie's Decision
When actress Angelina Jolie, 38, announced in May that she'd had both breasts removed as a precautionary measure, it made headlines around the world. It also made many of us wonder who should have this surgery.
Prophylactic mastectomy may be a good choice for some women (like Jolie) who test positive for inherited gene mutations, known as BRCA1 or BRCA2. Carriers have about a 60% risk of eventually developing breast cancer compared to 12% for the average woman. Any woman who has had a close family member diagnosed with breast cancer by age 50 or two or more relatives diagnosed with ovarian cancer should consider testing. (Jolie's 61-year-old aunt died after a nine-year battle with breast cancer, and her mother died of ovarian cancer at 56.)
For women who test positive, prophylactic mastectomy isn't the only option. Close monitoring with mammograms and MRI scans can help catch breast cancer early, and medication, such as tamoxifen or raloxifene, can lower the risk too.
Real Wisdom from Real Survivors. Five women share sage advice for dealing with a diagnosis.
"Open your heart to help."
"I always did things for other people and took pride in never needing assistance myself," says Mia Koslow, 41, of Glen Ellyn, Illinois. Then neighbors gave her an Excel spreadsheet schedule of dinners they planned to deliver during the weeks of her chemo treatments in 2006. "It took me a while to acknowledge that I—not to mention my husband and kids—could use a hand," Mia says. "It became easier once I thought about how much pleasure comes from aiding others." Lotsahelpinghands.com lets you set up your own support community or one for a friend in need.
"Let movement heal you."
Annette Ramke, 41, of Jenkintown, Pennsylvania, underwent chemotherapy in 2008. "I got so caught up in being a busy mom and trying to make life normal that I completely neglected exercise." Then one day she decided to take a walk around the block, and it marked a turnaround. She realized, "Wow, I feel so much better!" Even during chemo, she found regular walking, yoga and Pilates helped bolster her energy. "Now staying active helps me feel confident, strong and back in control of my body," Annette says. Consider checking out Strength & Courage: Exercises for Breast Cancer Survivors ($20, strengthandcourage.net) or Yoga for Breast Cancer ($20, lbbc.org).
"Enlist a listener."
"The amount of info you have to process during a doctor's visit is overwhelming, especially when your feelings are in such high gear," recalls Cindy Sharkey, 43, of High Bridge, New Jersey, who was diagnosed in 2009. She found having her husband along was invaluable when it came to remembering things, although she jokes: "It probably would have been helpful to have even a third set of ears!" Keep notes and copies of all your lab results.
"Take care when doing research."
The first thing Susan Otto, 46, of Fishers, Indiana, did after learning in 2012 that the lump she found in her breast was cancerous was spend the day on the Internet surfing for more information. "By that night I was in tears because of all the terrifying and emotional things I'd read," she says. "It turns out that most of what I was reading didn't even pertain to me. Now I know better—I go to my oncologist when I have questions."
"Share your experience."
"I sent extensive e-mails about what I was going through to all my family and friends on a regular basis," says Mara B. Langer, 45, of San Mateo, California, who was diagnosed nine years ago. "They were really therapeutic. Plus they spared me from having to repeat details over and over again, while making it easier for people to feel
open and comfortable talking to me about it all." Create a group e-mail list or start your own blog at blogger.com or wordpress.com.
Originally published in the October 2013 issue of Family Circle magazine.
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