Breast Cancer Awareness Columns

Diet and Breast Health

David R Arbutina, MD, FACS

You have probably come across information in one place or another that claims or suggests that certain foods can play a role in reducing a person’s risk of developing breast cancer.  How seriously should you take that information?  Is it fact or fiction?

The truth is there is currently no solid scientific evidence that proves any particular food item can significantly reduce breast cancer risk.  However, diet in general merits attention because of the role it can play in affecting certain risk factors for breast cancer.  One risk factor that can be affected by diet is obesity.  Obesity raises the risk for breast cancer because of how it affects estrogen.  Body fat contains estrogen, a hormone that can fuel development of certain cancers including breast cancer.  Postmenopausal women who become obese or gain significant weight are most at risk.

Consumption of alcohol is another risk factor for breast cancer that can be affected by diet.  Alcohol changes the way estrogen works in a woman’s body.  The higher the estrogen levels increase a woman’s estrogen exposure which is an important factor in breast cancer risk.

Talk to your doctor or a nutritionist about guidelines for what would be considered a healthy diet given your unique health circumstances.  A healthy diet not only supports general health it can also help you modify certain factors associated with breast cancer risk.

 

 

Medications to Help Prevent Breast Cancer

David R Arbutina, MD, FACS

Many people that are considered high risk for breast cancer often wonder if there is something that they can take to help prevent the chances of getting the disease.  There are medications that are reported to lower a woman’s risk for breast cancer, but not the risk of dying from breast cancer.  How could this be?  The answer may be that the medications prevent the less aggressive cancers but not the aggressive cancers which are fatal.  These medications are a type of hormone therapy.  They work by blocking the effects of estrogen and progesterone.  In normal circumstances, these hormones play an important role in female health but, because estrogen stimulates breast cells it can also stimulate abnormal cells and cancers.

The main form of medication used in breast cancer prevention is a selective estrogen receptor modulator (SERM).  Medications of this type are tamoxifen, raloxifene, and toremifene.  Tamoxifen is approved in the United States for prevention of breast cancer and when given daily for five years, tamoxifen lowers the risk of developing breast cancer by about 2%.  However, tamoxifen also carries the risk of significant side effects which can be fatal.  (For this reason it is not approved for preventative use in Canada.)   Women are advised to consult with their physician to determine if they are at high risk for developing breast cancer and therefore a candidate for breast cancer prevention medication.  The benefits and risks must be weighed carefully because these drugs have significant risks.

For treatment of patients with invasive breast cancers, Tamoxifen and Arimidex have been shown to improve survival significantly so the benefit outweighs the risks.  However, for cancer prevention the risks and benefits must be considered carefully!

Breast Augmentation and Breast Cancer Screening

Kelly Biggs, MD

Women with breast implants for augmentation should undergo annual screening mammography, just as women without implants. Both silicone and saline implants appear bright on a mammogram, and therefore can obscure a breast cancer. Because of this, women with breast implants will have a greater number of images taken of their breasts compared to women without implants. In addition to the two standard views acquired of each breast with any mammogram, those with implants will have two additional displaced views of each breast taken. For these images, the implant is displaced away from the native breast tissue by the technologist so that only breast tissue is seen. This combination permits the radiologist to assess the implant as well as the maximum amount of breast tissue possible. While the radiation dose is higher than a routine screening mammogram, the dose remains negligible as a significant risk factor.

Rupture of an implant is possible with mammography but exceedingly rare. Women should not forego screening mammography based on this risk, as it is far less than the risk of developing breast cancer. The risk of implant rupture is also possible when a breast biopsy is performed. This risk is also low as the implant is usually easily avoided by use of medical imaging during biopsy. When integrity of a silicone breast implant is in question, rather than breast cancer screening, the imaging modality of choice is magnetic resonance imaging (MRI). MRI is very good at assessing implant rupture or other degradation that may not be evident by mammogram.

Are You Too Old for a Mammogram?

Kelly Biggs, MD

When should women stop getting mammograms? The answer depends mostly on your physical condition and attitude toward treatment.

The American Cancer Society and many other institutions recommend that women age 40 and older have a screening mammogram every year. Mammography is a critical tool in the fight against cancer, commonly associated with a 30% reduction in breast cancer deaths.

The current guidelines for annual screening mammography were originally derived from several large studies conducted in the 1970s and 1980s, which unequivocally demonstrated a significant health benefit to screening. But these studies were based on women up to age 70. While mammograms find many breast cancers in women over 70, women in these age groups also begin to die of heart disease and other common ailments associated with growing older.

It’s easy to demonstrate the benefit to an 80 year old woman who has a potentially lethal breast cancer surgically removed following early detection by mammogram. But because of the other lethal diseases that affect older women, it’s very difficult to prove in a research study that mammograms prolong life for a large number of women over 70.

That said, the risk of developing breast cancer generally increases with age, and mammograms are routinely finding breast cancers in older women that can be safely removed, effectively saving lives. So long as you are in good health and are willing to undergo surgery to have a tumor removed, you should continue to get mammograms.

Is Breast Pain Something to Worry About?

David R Arbutina, MD, FACS

Breast pain is very common and experienced by most women at some time in their life. Women with breast pain often fear it is a symptom of breast cancer. On the contrary, breast cancer is usually painless. Breast pain can occur in women of all ages and can range from mild tenderness, tingling or discomfort, to severe pain. It can be present in one or both breasts and has many causes. Inflammation from fibrocystic change is the most common cause of breast pain but other causes include: hormonal changes, trauma, breast surgery, certain medications, breast size, water retention, stress, pregnancy, or from an ill fitting bra. Since there are so many potential causes of breast pain, it can be challenging to treat.

 
Generally, breast pain is categorized as either cyclical or noncyclical. Cyclical breast pain is most common, and is associated with a woman’s menstrual cycle. Noncyclical breast pain is less common and usually occurs in postmenopausal women. Causes of noncyclical breast pain may include trauma to the breast or arthritic pain in the chest cavity. Rarely, cancer can cause a persistent breast pain. Treatment for breast pain can vary from addressing infection or cysts to simple lifestyle modifications such as wearing a proper fitting bra, using over the counter or prescribed medications to clear inflammation, stress reduction, and dietary modifications to name a few. Taking these few simple steps may relieve breast pain, however, if it persists consult your physician.

Breast Infection

 

Typically when we hear the word infection, we usually do not think of a breast infection. Breast infection is also referred to as a mastitis. Mastitis is an infection that occurs in the tissue of the breast and often occurs in women who are breastfeeding. Mastitis symptoms may include: redness, pain, swelling, the breast may feel warm to touch, fever, flu-like symptoms, and chills. Causes of mastitis may be a blocked milk duct, or as a result of harmful bacteria, viruses, parasites, or fungi that can enter the breast through a cracked nipple, pimple, or wound. Mastitis must be treated by a physician and antibiotics. If left untreated, a mastitis may lead to an abscess in the breast tissue that may require surgery to be drained. Risk factors associated with mastitis include, but not limited to: breast feeding, sore or cracked nipples, stress, fatigue, poor nutrition, only using one position to breast feed, tight fitting bras, or previous episodes of mastitis.

Prevention of mastitis includes fully draining your breasts while breast feeding, rotating positions from one feeding to the next, getting adequate rest, and eating a healthy diet. It is also very important to perform self-breast assessments on a regular basis. Breast abnormalities can include a new lump, increased breast pain, nipple discharge, dimpling, puckering, or inversion of the nipple, redness of the breast, breast rash, or swelling of the breast. Always report any breast abnormalities to your physician for evaluation and treatment. If you would like additional information, please feel free to call our office.

Screening for Lung Cancer with Low Dose CT

Kelly Biggs, MD and Kelly O’Donovan, PA-C

Screening for lung cancer with low dose computed tomography (CT) is a new approach to fighting lung cancer.  If you are a current or former smoker between the age of 55 and 77 and have smoked 1 pack per day for 30 years or more, you may be eligible for this annual screening program.

Results from the National Lung Cancer Screening Trial published in 2011, a large study involving over 50,000 smokers, demonstrated lung cancer deaths are decreased by 20 percent for those who participate.  Because lung cancer kills over 150,000 people in the United States every year, screening CT has the potential to save tens of thousands of lives.

CT is a widely available technology that rapidly acquires a 3 dimensional detailed picture of the inside of the human body.  Chest CT can detect small lung cancers in very early stage.  Thanks to modern surgical techniques, these cancers can be completely removed much more safely than in the past.  Doctors are using a special protocol to obtain images with less than one third of the radiation dose of a standard chest CT.

Lung cancer screening is not for everyone.  Patients must be in good enough health that, should a cancer be detected, they are willing and able to undergo curative surgery.  And while the benefits of screening CT are real, they are not a substitute for the far greater benefit of quitting smoking altogether!  Talk to your healthcare provider to learn more about this new service.

Genetics of Breast Cancer

David Arbutina, M.D., FACS

Family history or genetics are among the risk factors for breast cancer.  According to the National Cancer Institute, an estimated 5% to 10% of breast cancers are thought to be inherited making some women genetically predisposed to developing breast cancer.

The average woman in the United States has a 12%-13% chance of developing breast cancer.  Women who are genetically predisposed, with a BRCA gene mutation, have up to an 85% chance of developing the disease.  Genetic testing is used to determine if you are predisposed to breast cancer.  Your physician will determine the need for genetic testing.

Who needs to be tested?  Women who develop aggressive breast cancers prior to age 45 should be tested.  If a woman develops breast cancer and has two first degree relatives (mother, sister or daughter) with breast cancer they should also be tested.   If you develop breast cancer at age 55 and have 3 aunts who had breast cancer in their sixties, you don’t need tested.  However, if a family member is BRCA positive, every family member, both male and female, must be tested because there is a 50% chance of having a deleterious gene.  Knowing and acting on a positive test is lifesaving.

Remember, most women are not genetically predisposed to breast cancer.  However, it is important to know if you are in that small group of women who are at high risk because of your genetics.  Talk to your doctor about your unique breast health circumstances and follow your physician’s recommendations about the need for testing.

An Inspiration to all

Lannette Johnston M.S., R.N.

A positive attitude is exactly what Diane Colpetzer has when she talks about her fight through breast cancer.  Although Diane has been fighting since 2007, she has not let it dampen her spirits.  She continues to be such an incredibly strong and inspirational woman.  When first diagnosed she went to a doctor that barely knew her name.  She felt scared and unsure of what was happening.  A few years into her diagnosis she had the great fortune of meeting Dr. David Arbutina from the Breast Cancer & Women’s Health Institute located in Tyrone.  It was then that she knew she would finally be more than just a number.

“I truly believe things would have been different with my journey if I would have had Dr. Arbutina from the start,” explains Diane.  Dr. Arbutina is quick to learn and understand his patient’s wants and needs.  As of today, Diane has been fighting cancer for 2,992 days.  Join her in her campaign to spread the word of this incredible institute by liking the Breast Cancer & Women’s Health Institute’s Facebook Page.  Her goal is to get as many likes for the page as days that she has been fighting.

Although Diane is still fighting, she is an inspiration to us all.   Diane is a huge advocate for mammograms.  “It’s not as painful to have a mammogram as going through some of things you have to go through if you don’t,” exclaims Diane!   Remember if you are 40 years or older, it is time to get a mammogram, it might just save your life.  To learn more about Diane’s story watch her video on the Breast Cancer & Women’s Health Institute website at www.thebreastcancerinstitute.org.

MRI and Breast Disease

Kelly Biggs, M.D.

MRI is a supplemental imaging tool for detecting breast disease.  When intravenous contrast is given to a patient, MRI is extremely sensitive in detecting enhancing breast lesions that may be cancer.  For this reason MRI is valuable in problem solving when mammography and ultrasound fail to provide a definite answer for an abnormality.  Some surgeons use MRI to determine the extent of disease in women who have already been diagnosed with breast cancer.  MRI is an acceptable screening tool for women who are at a greater than average risk for developing breast cancer due to gene mutations, certain medical syndromes, or prior therapeutic radiation treatment.  MRI is the imaging tool of choice for evaluating the integrity of silicone breast implants.

MRI does have limitations, and it should not be considered superior or even comparable to other types of imaging.  Cancers enhance when contrast is given, but so do many other benign breast structures.  Thus, if used as a screening tool for all women, the number of false positive benign biopsies would increase dramatically.  Moreover, MRI is currently too expensive and too time consuming to be an effective screening tool for everyone.  While a mammogram may take just a few minutes to complete, an MRI is usually a 30-60 minute process.

It’s important to be aware of breast MRI, but most women will never need one.  Most routine breast cancer screening can be performed effectively with mammography, and most diagnostic imaging (to address a specific abnormality) can be achieved with mammography and ultrasound.