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Common Breast Cancer Questions, Answered! Slide 1
Q: How can I prevent breast cancer?
A: You can’t. But you can reduce your risk. “I’ve seen quite a few women who felt they were doing everything in their power to prevent breast cancer develop it anyway,” says Don S. Dizon, MD, a spokesperson for the American Society of Clinical Oncology (ASCO) and clinical codirector of gynecological oncology at Massachusetts General Hospital. “They were left thinking it was somehow their fault, but women should never feel blame for getting breast cancer.” While several factors that make you more prone to the disease have been identified, most are beyond your control: being female, getting older and having a family history of the disease. Instead, focus on making smart lifestyle choices to decrease your chances of becoming one of the 12% of American women who develop the illness at some point in their lifetime.
1. Watch the scale. “Maintaining a body mass index between 18.5 and 24.9 is a great goal for lowering cancer risk,” says Graham Colditz, MD, chief of public health sciences in the department of surgery at Washington University School of Medicine and a spokesperson for the Breast Cancer Research Foundation. A 5'4" 145-pound woman has a BMI of 24.9, for example.
2. Rally those endorphins. Whether you’re sweating up a storm Spinning, swimming or taking salsa lessons, doing 30 minutes of moderate physical activity daily or taking 10,000 steps a day can significantly decrease your odds.
3. Curb your drinking. While studies have shown that consuming moderate amounts of alcohol benefits heart health, the news isn’t so good regarding cancer risk, which it slightly increases. “If you enjoy an occasional cocktail or glass of wine with dinner, limit yourself to four or five drinks a week maximum,” advises Elisa Port, MD, associate professor of surgery, Icahn School of Medicine at Mount Sinai, and author of The New Generation Breast Cancer Book.
Q: Is mastectomy better than lumpectomy?
A: In short, no. "If a patient is eligible for lumpectomy combined with radiation therapy, her survival benefit is the same as that of someone opting for mastectomy,” says Susan Brown, MS, RN, director of program education at Susan G. Komen for the Cure. Your doctor will explain your safest medical options. Then, with all choices presented being equal, you can talk to your doctor about factoring in other considerations: your work schedule, for example, or cosmetic results.
What You Need to Know About Screening
Work your way down this testing checklist from Marc Hurlbert, PhD, executive director of the Avon Foundation Breast Cancer Crusade, to ensure you protect your two breast friends.
Know where you stand. Talk to your ob-gyn or family physician about your breast health and family history starting in your 20s, so you can understand your individual risk factors and keep on top of the best recommendations for you.
Research sites. Find a high-quality mammography facility near you by checking the American College of Radiology’s list of Breast Imaging Centers of Excellence at acr.org.
Make an appointment. Book a mammogram every year, starting at age 40. Mammography works best when you have it routinely so the results can be compared year to year.
Get your results. Once you’ve had a mammogram, it’s mandatory that the facility notify you in writing of the outcome within 30 days. If you haven’t received word, don’t shrug it off. Follow up.
Keep your records. If you change doctors, request that all your mammograms be put on a CD-ROM or flash drive so you can take them to your new mammography facility.
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Common Breast Cancer Questions, Answered Slide 3
Q: How do I figure out the best treatment for my type of cancer?
A: It may sound obvious, but you need to consult with doctors who specialize in breast cancer. “Today, with so many options for care available, a generalist couldn’t possibly stay up to speed,” says Port. “You want the person who has her finger on the pulse.” Experts also advise assembling your own dream team of health care providers to “captain” each phase of your recovery. “This type of multidisciplinary approach is going to become the rule rather than the exception,” says Dizon, who notes that it ensures all aspects of treatment are being considered and properly coordinated. The team may include:
1. A breast surgeon or surgical oncologist, who may have performed the biopsy that led to your diagnosis—although often that’s the breast radiologist—as well as the procedure to remove the cancer if surgery is required.
2. A medical oncologist, who oversees any treatment needed beyond surgery, such as chemotherapy and hormonal therapy.
3. A radiation oncologist, who directs the targeted radiation therapy, which is almost always given after lumpectomy (and sometimes needed after mastectomy).
4. A reconstructive surgeon, should you choose to undergo a mastectomy.
Q: What exactly are dense breasts?
A: Let’s start by deconstructing your décolletage. Breasts are a combination of three types of tissue: fibrous (connective tissue), glandular (milk ducts and lobules) and fatty. Dense breasts, which about 50% of women have, contain more fibrous and glandular tissue than fat. They also set off more alarm bells. Experts aren’t sure why, but women with very high breast density are more likely to develop breast cancer. Further complicating matters, it’s harder to detect tumors in them because both dense breast tissue and benign and cancerous lumps appear white on mammograms. Currently, 24 states require that physicians notify women who have undergone mammography (the only way to detect the issue) if they have dense breasts. However, while these women may benefit from enhanced imaging, via ultrasound, no medical consensus has yet been reached on whether routine supplemental screening for women with dense breasts is worthwhile. In fact, the downside of breast ultrasound is that it tends to generate lots of false positives, leading to unnecessary biopsies. If you’ve been told you have dense breasts, consult with your ob-gyn or primary care physician to determine your best course of action. “Risk factors like family history, previous biopsies and whether or not you’re on hormone replacement therapy should all be taken into consideration to figure out whether you would benefit from additional screening,” says Elisa Port, MD, author of The New Generation Breast Cancer Book.
Q: Where can I go for support once I'm diagnosed?
A: Reaching out to family and your social circle can help reduce anxiety and depression while potentially increasing the likelihood that you’ll complete your treatment. “We know compliance plays a huge part in reducing recurrence and improving outcomes,” says Brown. So don’t overlook or hold back from sharing with those closest to you. In addition, many national organizations, including the American Cancer Society, provide 24/7 support for those questions that plague you at 2 a.m. Get information on financial assistance for lodging for out-of-town care, transportation help and more under “Find Support & Treatment” at cancer.org. Clearinghouses like ManageCancer.org and CancerCare.org offer one-stop-surfing suggestions for everything from sites offering financial assistance with medical expenses, to sites that help you create personalized webpages for updating friends on your progress, to one-on-one counseling.
Q: Should I undergo genetic testing to determine my risk?
A: Not necessarily. While referrals for BRCA tests have skyrocketed since Angelina Jolie's announcement and the cost has plummeted, hereditary breast cancers are relatively rare. "The genetic mutation that Jolie had only occurs in about 5% to 10% of women with breast cancer," points out Judith Salerno, MD, MS, president and CEO of Susan G. Komen for the Cure. And if you're considering the newer multigene tests that look for other mutations in addition to BRCA1 and 2, be sure to manage your expectations. “These cancer panel tests cover anywhere from 6 to 50 genes,” says Galen Joseph, PhD, associate professor at the University of California San Francisco’s Helen Diller Family Comprehensive Cancer Center. But researchers don’t yet understand what all these mutations may mean, or whether they pose a high enough risk of cancer to act on the results. Bottom line: “Discuss your best plan with a genetic counselor,” says Susan Domchek, MD, director of the Basser Research Center for BRCA at the Abramson Cancer Center, University of Pennsylvania. They’ll help you analyze your risks (like a family history of breast or ovarian cancer) and the benefits of testing.
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Common Breast Cancer Questions, Answered! Slide 2
Scientists have made major strides in combating a disease that claims the lives of 40,000 American women every year thanks to...
Advances in screening and early detection. “Contrast-enhanced spectral mammography, where a dye is injected to help improve imaging, and tomosynthesis, which is 3-D imaging of the breast,
are two of the newer methods that are being used in clinics,” says Sharon Pitteri, PhD, an assistant professor at the Canary Center at Stanford for Early Detection.
Innovative treatment. Methods such as targeted therapy (in which a drug inhibits the growth of specific types of cancer cells) are continuing to improve outcomes and have led to better overall survival rates for certain types of early breast cancers, which are currently near 90%.
Customization of care. “We now understand breast cancers are as diverse as the population,” says Dizon. “Each type needs to be approached differently.” That includes being able to identify patients who would benefit from chemotherapy and those who can skip it.