Category Archives: Breast Cancer

Flaxseed: What is it and Can it Keep you Healthy?

Breast Cancer, Diet, Habits, & Other Behaviors, Other Cancers, Ovarian Cancer
Carla Bozzolo, Cancer Prevention and Treatment Fund

1024px-Brown_Flax_SeedsSuddenly, everyone is talking about adding flaxseed to your diet.  What is flaxseed and how can eating it make you healthier?

What is Flaxseed?

Flaxseed is the seed of the flax plant and can be eaten as whole seeds, ground into a powder (flaxseed meal), or the oil can be taken in liquid or pill form.[1] There is evidence that it is a great way to incorporate dietary fiber, antioxidants, and omega-3 fatty acids into your diet.

Flaxseed has been shown to lower cholesterol in some people and it may even reduce the risk of breast cancer. People take flaxseed to help with many digestive conditions, including chronic constipation, diarrhea, diverticulitis (inflammation of the lining of the large intestine), irritable bowel syndrome (IBS), ulcerative colitis (sores in the lining of the large intestine), gastritis (inflammation of the lining of the stomach), and enteritis (inflammation of the small intestine). According to the National Institutes of Health (NIH), more study is needed to prove that flaxseed benefits people who have these conditions.[2]

What’s in This Miracle Seed?

Omega-3 essential fatty acids

Flaxseed is the richest source of omega-3 fatty acids,3 which is good for our hearts, brains, and normal growth and development.4 Omega-3 fatty acid can also be found in fish, plants, nuts, and oils made from nuts. No matter how you consume flaxseed—whole, ground or the oil—you will increase your intake of omega-3 fatty acids.

Lignans

Lignans are a type of plant estrogen that may help slow down certain cancers—cancers that depend on hormones to grow. Lignans also work as an antioxidant, which means they protect cells from the damage that comes with aging. Antioxidants—found in berries and many other foods—may help fight certain cancers. Lignans are concentrated in the coat of the seed so when flaxseed is expressed into oil, the anti-cancer and antioxidant benefits of the lignans are lost.

Dietary fiber

Dietary fiber helps regulate the digestive system and can lower bad cholesterol. Dietary fiber in flaxseed is only found in whole and ground flaxseeds, not in flax oil.

Flaxseed and Breast Cancer

For women who have gone through menopause, a small daily serving of flaxseed (just over half a teaspoon) was enough to lower breast cancer risk. While more research is needed, some studies suggest that for younger women who have not yet gone through menopause flaxseed reduces the risk of breast cancer and slows down the progress of certain breast cancers and other cancers that need estrogen to grow. A study published in 2013 found that eating flaxseed decreased a woman’s chance of getting breast cancer by 82%.

Flaxseed and Cholesterol

Flaxseed (but not flax oil) seems to decrease bad cholesterol among people who have relatively high cholesterol. Once again, women who already went through menopause seemed to benefit most: their “bad” cholesterol dropped more than the bad cholesterol of men or younger women. This is important for older women, because bad cholesterol tends to increase after menopause, as estrogen levels decline.

Who Benefits the Most?

Flaxseed has the potential to benefit everyone as a great source of dietary fiber with almost no side effects.  People with high levels of bad cholesterol and women who are post-menopausal benefit the most.

Different Ways to Eat It

Flaxseed is sold as whole seeds, ground seeds (flaxseed meal), liquid oil, and oil in a pill form. It can easily be added to cereal, baked goods, salad, yogurt, and many other types of food.  Since whole seeds tend to go through the body undigested, ground seeds are considered to be more beneficial.  Flaxseed oil delivers essential fatty acids but it doesn’t have fiber or lignans. If you want to get all the benefits of flaxseed—omega-3 fatty acids, fiber, anti-oxidant and cancer-fighting properties—choose ground flaxseed.  

Cautions

Few side effects have been reported from flaxseed. When taken to reduce constipation, it should be taken with plenty of water.

The fiber in the flaxseed may also lower the body’s ability to absorb medications that are taken by mouth, so it should not be taken at the same time of day that you take pills or dietary supplements.

The Bottom Line

Flaxseeds are a great source of dietary fiber and omega-3 essential fatty acids for men and women of all ages. They don’t have any known serious side effects, and ground flaxseeds are easy to include in the foods you eat every day.

References:

  1. National Institutes of Health. National Center for Complimentary Medicine. Herbs At A Glance: Flaxseed and Flaxseed Oil. April 2012: http://nccam.nih.gov/health/flaxseed/ataglance.htm
  2. National Institutes of Health. National Library of Medicine. Flaxseed: MedlinePlus Supplements. August 2011. http://www.nlm.nih.gov/medlineplus/druginfo/natural/991.html
  3. National Institutes of Health. National Cancer Institute. Antioxidants and Cancer Prevention: Fact Sheet. July 2004. href=”http://www.cancer.gov/cancertopics/factsheet/prevention/antioxidants”>http://www.cancer.gov/cancertopics/factsheet/prevention/antioxidants  ▲
  4. Brown L, Rosner B, Willett W, and Sacks F. Cholesterol-lowering effects of dietary fiber: a meta-analysis. American Journal of Clinical Nutrition. 1999; 69:30-42.  ▲
  5. Cotterchio M, Boucher BA, Kreiger N, Mills CA, & Thompson LU. Dietary phytoestrogen intake–lignans and isoflavones–and breast cancer risk (Canada). Cancer Causes Control.2008; 19:259–272  ▲
  6. Buck K, Zaineddin AK, Vrieling A, Linseisen J, & Chang-Claude J. Meta-analyses of lignans and enterolignans in relation to breast cancer risk. American Journal of Clinical Nutrition. 2010; 92:141–15  ▲
  7. Velentzis LS, Cantwell MM, Cardwell C, Keshtgar MR, Leathem AJ, & Woodside JV.Lignans and breast cancer risk in pre and post-menopausal women: meta-analyses of observational studies. British Journal of Cancer. 2009; 100:1492–1498  ▲
  8. Lowcock E, Cotterchio M, & Boucher B. Consumption of flaxseed, a rich source of lignans, is associated with reduced breast cancer risk. Cancer Causes Control. 2013. E-publicaton ahead of print. Retrieved from href=”http://www.ncbi.nlm.nih.gov/pubmed/23354422″>http://www.ncbi.nlm.nih.gov/pubmed/23354422.  ▲
  9. Pan A, Yu D, Demark-Wahnefried W, Franco O, and Lin X. Meta-analysis of the effects of flaxseed interventions on blood lipids. American Journal of Clinical Nutrition. 2009; 90:288-297.  ▲
  10. Fukami K, Koike K, Hirota K, Yoshikawa H, and Miyake A. Perimenopausal changes in serum lipids and lipoproteins: a 7-year longitudinal study. Maturitas. 1995; 22:193-197.  ▲

 

Angelina Jolie’s Decision

Breast Cancer, Breast Cancer, In the News, News Stories & Editorials
Diana Zuckerman, PhD, Huffington Post: May 16, 2013

When I read about Angelina Jolie’s announcement this week, I cringed.

I have greatly admired her willingness to speak out on important issues over the years. Her public announcement about her mastectomies will certainly reassure some women that losing a breast to breast cancer isn’t quite as frightening as it had once seemed. But Ms. Jolie is a powerful role model to millions of women. What are the unintended consequences of the role she is modeling regarding breast cancer?

Is breast cancer so frightening that it is better for a woman to remove her breasts before she is even diagnosed? Obviously, that isn’t what Ms. Jolie is saying. She has one of the breast cancer genes (BRCA1), and that greatly increases her chances of getting breast cancer.

However, the extremely high risk that she quoted from her doctor (87 percent chance of getting breast cancer) was based on old, small studies. Newer studies have found that the risk of getting breast cancer for an average woman with BRCA1 is 65 percent. Since being overweight and smoking increase the risk and exercising and breastfeeding lower the risk, Ms. Jolie’s risk of breast cancer, even with the BRCA1 gene, could be considerably lower.

Of course, the lifetime risk of breast cancer would still be high, but it wouldn’t be nearly as high a risk during the next 10 years or even 20 years. According to experts, a 40-year-old woman with the BRCA1 gene has a 14 percent chance of getting breast cancer before she turns 50. That’s not nearly as frightening, and with regular screening and all the progress in breast cancer treatments, the survival rate from breast cancer is higher than ever. Many breast cancer patients live long and healthy lives. And, it is possible that by the time Ms. Jolie (or any other woman with BRCA1) got breast cancer in the future–if she ever did–the treatments available would be even more effective than they are today.

Thanks to mammograms, women are getting diagnosed with breast cancer at much earlier stages, making it safe to undergo a lumpectomy (which removes just the cancer) rather than a mastectomy (which removes the entire breast). And yet, American women are undergoing mastectomies at a higher rate than women in other countries–many of them medically unnecessary. Breast cancer experts believe that many women undergoing mastectomies don’t need them and are getting them out of fear, not because of the real risks.

As an actress whose appeal has focused on her beauty, surgically removing both her breasts when she didn’t have cancer was a very gutsy thing to do. But if we care about women’s health, we need to stop thinking of mastectomy as the “brave” choice and understand that the risks and benefits of mastectomy are different for every woman with cancer or the risk of cancer. In breast cancer, any reasonable treatment choice is the brave choice.

Nobody can second-guess Angelina Jolie’s choice–it’s hers alone to make. Fortunately for her, she has access to the best reconstructive surgeons in the country, and they will keep her breasts looking as natural and beautiful as possible, an advantage that most implant patients don’t have. If she has any of the common problems with her breast implants, she can afford to get those problems surgically fixed whenever she wants to. She can also afford breast MRIs every other year ($2,000 each), which the Food and Drug Administration recommends as a way to make sure that the silicone from the implants is not leaking into the lymph nodes.

Angelina Jolie is not in any way an average woman, and what felt right for Angelina Jolie might not be right for most women who are afraid of getting breast cancer, and not even for most women with the BRCA1 or BRCA2 gene.

I thank Ms. Jolie for speaking up about her decision, and I thank the many cancer experts who are doing their best this week to explain why double mastectomies are not the best choice for most women. Let’s use this teachable moment to have a frank discussion of the treatment choices for breast cancer and to encourage women to make decisions based on their own situations, not on the choice of a celebrity, however admirable she is. For each woman, it’s important to weigh her own risk of cancer–in the next few years, and not just over her lifetime–and the risks of various treatments, and to make the decision that is best for her.

To see original article, click here

Airport Security and Radiation

Brain Cancer, Breast Cancer, Diet, Habits, & Other Behaviors, Environmental Exposures, Skin Cancer
Laura Covarrubias, Cancer Prevention and Treatment Fund

Following the September 11th attacks in 2001, the Transportation Security Administration (TSA) was created and given responsibility for protecting the public from security threats in transportation systems, such as airports. Although metal detectors were once the main security devices used at American airports, the TSA introduced new technologies after terror attempts were made using hidden explosives (in shoes and underwear, for example). These backscatter and millimeter scanners have begun replacing metal detectors and are designed to scan a person to determine what weapons or explosives they may have beneath their clothing. Currently, there are about 250 backscatter and 264 millimeter wave scanners in the United States. The TSA hopes to have 1,800 scanners of either type installed by the end of 2014 – which would mean that nearly every airport in the country will have one.

Backscatter scanners look like two large blue boxes. People raise their arms and stand sideways between these two boxes when they are scanned.

In contrast, millimeter wave scanners look like circular glass phone booths, and the person being scanned stands with their arms raised while part of the scanner rotates around them:

If you are not sure which scanner is in use at your airport, ask a TSA official at the security checkpoint.

Privacy

When a millimeter scan is used, the machine determines if the person has any potentially harmful items on his or her body. If so, only the outline of a standard human body is shown with potentially dangerous objects highlighted in yellow. If no dangerous objects are detected, the security officer will only see an empty green screen. The security official does not see an image of the actual individual when the millimeter scan is used.

In contrast, when a backscatter scan is used, a blurred, colorless image of the individual (without clothing) is produced. A security officer views the image and determines if further screening is necessary. In an effort to increase passenger privacy, the TSA updated the software on backscatter machines to make it harder to see details in the images. Still, some people argue that both types of machines violate their privacy.

Radiation

While metal detectors and millimeter scans both use non-ionizing radiation, which until recently was assumed to be safe (see our article Can Cell Phones Harm our Health?), backscatter scans use ionizing radiation, which is used in x-rays and known to potentially increase the risk of cancer. Backscatter scans work a little differently from x-rays. X-rays work by sending high-energy radiation to the body and recording the radiation that passes through the body. Dense parts of the body (like bones) block some of the radiation, resulting in lighter areas on the recorded image.  Backscatter scanners also send radiation toward the body, but at much lower energy than an x-ray. Because it is not as strong as the radiation used in x-rays, the radiation does not pass through the body. Instead, the outer layers of the body “scatter” the radiation, which bounces off the body and back toward the machine. Most of the radiation that is absorbed by the body is deposited in the outer layers (like the skin and ribs), although a 2012 study showed that radiation from these scans may penetrate to other organs.[1] Because the radiation is concentrated in the skin, there are concerns that this could cause skin cancer.

All data on backscatter scans are provided by TSA, a government agency that does not allow independent researchers to examine the machines they use.[2] Researchers must therefore make educated guesses using data provided by the TSA, or they must make models of the scanners based on information that the agency releases.

Scientists differ in their opinions regarding whether small doses of radiation increases the risk of cancer.[3] Some scientists think that very small doses-like those received during backscatter scans-pose zero risk to the individual. Other scientists think that there isn’t enough research on the effects of such low doses of radiation to be able to say how it will affect a person’s cancer risk. However, radiation risk accumulates during a person’s lifetime. This means that even though a single exposure may be very small, it is “added” to every other exposure the person has ever encountered.

The TSA states that backscatter scans use such low doses of radiation that estimating the potential effects of the scan is extremely difficult. [4] 2011 report using information from the TSA found that these backscatter scans expose people to the same amount of radiation that they receive from 3 to 9 minutes of normal daily life or from 1 to 3 minutes of flight. To put this into perspective, we would expect only 6 of the 100 million airline passengers each year to develop a cancer in their entire lives due to the backscatter scans.

Dr. David Brenner, a researcher at Columbia University, produced a different estimate based on the risk that the scanners are to the entire population, not just to an individual. Dr. Brenner multiplied the risk associated with one scan by the number of scans conducted each year to estimate the number of people who may develop cancer in one year because of the scanners. Because up to one billion scans may be performed each year, Brenner estimated that each year 100 people would develop cancer because of their exposure.

In April 2010, a group of scientists from the University of California, San Francisco wrote a letter of concern to Dr. John Holdren, the Assistant to President Obama for Science and Technology, about the backscatter scans. These researchers pointed out that because backscatter scans only penetrate outer layers of the body, it is possible that these layers receive a higher concentration of radiation than previously believed. Because of this, conventional estimates would be inaccurate.[5] This higher concentration of radiation could pose particular risk to certain groups such as:

  • The elderly (due to their susceptibility to skin cancer)
  • Women who have the BRCA gene mutation
  • People with weakened immune systems (such as those with HIV or cancer)
  • Children and adolescents (who have smaller bodies but receive the same amount of radiation as adults with larger bodies)5

The scientists also expressed concern that sperm may mutate because the testicles are close to the surface of the skin and are exposed to radiation during these backscatter scans. In addition, they noted that the effects of radiation on the cornea (the outer surface of the eye) and the thymus (a part of the immune system located in the chest) have not been studied. While this letter only outlined concerns of the scientists and did not present new data, it called for further testing of backscatter scans. The scientists called for more rigorous and independent studies to ensure that the scans are safe for the entire population, as well as for all parts of the body. When Dr. Holdren received the letter, he sent it along to the Food and Drug Administration (FDA). The Food and Drug Administration does not have authority to regulate backscatter scanners because the devices are classified as electronic devices, not medical devices. However, the FDA has experience in regulating radiation-emitting devices used in medicine, such as mammography devices. In a joint reply with the TSA, the FDA stated that the radiation exposures from the backscatter scans were within established legal limits, even for frequent fliers.[6] In reply to the scientists’ concerns that the radiation dose to the skin would be higher, the FDA wrote that their calculations showed that a person would have to pass through the scanner 1000 times in a year in order to begin to absorb the annual limit of what is considered safe.[7]

Not everyone agrees with the FDA, and some people have pointed out that TSA agents operating the scanners may improperly manage the devices or that mechanical errors may occur, either of which could cause the machines to emit more radiation than they are supposed to. From May 2010 to May 2011, there were 3,778 calls for mechanical problems on backscatter machines, but only 2% of those machines were evaluated for radiation safety. Anyone who is concerned about the radiation from the scanners has the legal right to refuse to undergo a scan, as long as they agree to a full-body pat-down by a security officer.

For more information on other types of radiation, see our article Everything You Wanted to Know About Radiation and Cancer, But Were Afraid to Ask.

References:

  1. Schmidt T, Hoppe M. Estimation of organ and effective dose due to Compton backscatter security scans. Medical Physics. 2012;39(3396).
  2. Mehta P, Smith-Bindman R. Airport full-body screening: what is the risk? Archives of internal medicine. 2011;171(12):1112-5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21444831. Accessed March 17, 2012.
  3. Brenner DJ. Are x-ray backscatter scanners safe for airport passenger screening? For most individuals, probably yes, but a billion scans per year raises long-term public health concerns. Radiology. 2011;259(1):6-10. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21436091
  4. Cerra F. Assessment of the Rapiscan Secure 1000 Body Scanner for Conformance with Radiological Safety Standards. 2006. Available at: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Assessment+of+the+Rapiscan+Secure+1000+Body+Scanner+for+Conformance+with+Radiological+Safety+Standards#0. Accessed June 18, 2012.
  5. Sedat J, Agard D, Shuman M, Stroud R. Letter to Dr. John P. Holdren. 2010.
  6. Rabin R.C.. X-Ray Scans at Airports Leave Lingering Worries. The New York Times. August 6, 2012. Available at http://well.blogs.nytimes.com/2012/08/06/x-ray-scans-at-airports-leave-lingering-worries/. Accessed August 7, 2012.
  7. McCrohan J, Shelton Waters K. Letter to Dr. John P. Holdren. 2010.

 

Physician Groups Make Recommendations to Reduce Healthcare Costs

Breast Cancer, Cervical Cancer & HPV, Other Cancers, Prostate Cancer
Nyedra W. Booker, PharmD, MPH, Cancer Prevention and Treatment Fund
  • Does an 18-year-old girl need a pap smear?
  • Should a patient with a mild sinus infection be given antibiotics?

You might be surprised that the answer to both questions is NO according to leading physicians.

In an effort to improve medical care in the U.S. and save healthcare dollars at the same time, each of nine U.S. medical groups recently proposed a list of Five Things Physicians and Patients Should Question. This is a bold move by medical groups who collectively represent almost 375,000 physicians.  Currently, doctors are paid more for ordering more tests and diagnostic procedures, so these recommendations  are not financially beneficial to the physicians involved, but have the potential for reducing the cost of medical care for patients, health insurance companies, and government health programs such as Medicare, Medicaid, and Veterans healthcare.

The medical groups represent a wide range of medical care.  The nine groups include the American Academy of Allergy, Asthma & Immunology; American Academy of Family Physicians; American College of Cardiology; American College of Physicians; American College of Radiology; American Gastroenterological Association; American Society of Clinical Oncology; American Society of Nephrology and the American Society of Nuclear Cardiology.

Recommendations

Here are just a few of the groups’ recommendations:

Hives – Routine diagnostic testing (such as immunoglobulin E (IgE), a skin prick or blood test for allergies) is not recommended for patients with chronic hives, because such testing is usually ineffective at identifying the cause. [American Academy of Allergy, Asthma & Immunology]

Pap Smears – Routine pap smears to screen for cervical cancer are not recommended for women under the age of 21. [American Academy of Family Physicians]

Cardiac Stress Test – Cardiac stress test imaging (a procedure where dye is inserted into the blood stream and images show how well the blood is flowing through the heart) is not recommended for cardiac patients at their annual check-ups unless symptoms are present. [American College of Cardiology]

X-Rays and MRIs for Back Pain – Imaging (X-rays, MRIs) is not recommended for a patient with lower back pain unless a specific cause has been identified. [American College of Physicians]

MRIs and CCTs of the Brain – Imaging of the brain, including MRIs and CCTs (cranial computed tomography), is not recommended for a patient with a headache unless specific risk factors have been identified. [American College of Radiology]

Colorectal Cancer Screening– Colorectal cancer screening by any method (including flexible sigmoidoscopy, computed tomography colonography, double-contrast barium enema test) should be repeated every 10 years in low to average-risk patients who received a normal result at their last colonoscopy screening.  This is less frequently than previous recommendations.  It is recommended that people get their first colonoscopy at age 50. [American Gastroenterological Association]

Breast Cancer Testing – Imaging (PET, CT and radionuclide bone scans) is not recommended for patients with early-stage breast cancer at low risk for metastasis (cancer spreading to other parts of the body). [American Society of Clinical Oncology]

Cancer Screening – Routine cancer screenings (including colonoscopy, mammography and pap smears) are not recommended for patients on dialysis who have a short life expectancy, unless specific signs and symptoms are present. [American Society of Nephrology]

Chest Pains – Routine cardiac imaging including a stress echocardiogram (which  uses ultrasound to show how well the heart is pumping blood) is not recommended for a patient with chest pains who is at low risk for a heart attack or cardiac-related death, is able to exercise, and has a normal electrocardiogram (EKG).[American Society of Nuclear Cardiology][1]

A complete list of all 45 recommendations is available at: http://choosingwisely.org

How Will This Help?

Healthcare spending in the United States reached almost $2.6 trillion in 2010 and is expected to rise to around $4.6 trillion by 2020 unless major changes are made to eliminate unnecessary procedures, according to the Centers for Medicare & Medicaid Services.[2] An increase in the number of people living with chronic illnesses, rising prescription drug prices, and the high administrative costs of managing healthcare programs will contribute to increasing costs. While many continue to debate the exact reasons why healthcare spending is out of control, most agree that something needs to be done immediately.

In 2011, the American Board of Internal Medicine Foundation (ABIM) announced the Choosing Wisely campaign, and the National Physicians Alliance helped develop a multi-year initiative that would promote discussion among physicians, patients and consumer groups, aimed at decreasing healthcare costs by reducing unnecessary tests and procedures. Each participating group of physicians was asked to develop a list of five recommendations based on evidence from research findings. These recommendations were specific to their respective medical fields.

While many doctors and health experts understand that more medical care, and more expensive medical care, is not necessarily better medical care, studies show that the American public is wary of health care guidelines, even when they’re based on strong evidence. Patients and consumers tend to assume that running more tests and relying on newer, more costly technologies translate into health improvements (see Is Newer and More Expensive Care Better?).  As for doctors, the need to pay for expensive new imaging devices by charging for their use, the desire to give patients a clear diagnosis, and concerns about harming a patient by missing a diagnosis can all contribute to ordering unnecessary imaging and other tests.

Given this divide, it’s not surprising that Choosing Wisely has generated praise and concern. While many are praising the initiative as a step in the right direction to reduce the staggering cost of healthcare in the U.S., others question whether these cost-cutting strategies will come at the expense of good patient care.

Next Steps

The American Board of Internal Medicine Foundation and the National Physicians Alliance will continue to work with the nine medical specialty groups and several partnering organizations, including Consumer Reports and the American Association of Retired Persons (AARP), to develop tools and resources to help physicians discuss healthcare decisions with their patients. There will also be at least eight additional medical specialty groups joining the initiative and releasing their recommendations in the fall of 2012.

References:

  1. Choosing Wisely: An Initiative of the ABIM Foundation. Accessed April 04, 2012. http://choosingwisely.org/?page_id=13.
  2. Centers for Medicare & Medicaid Services. “National Health Expenditure Projections 2010-2020.” Accessed April 09, 2012. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/proj2010.pdf

 

Breast Thermography Cannot Replace Mammograms

Breast Cancer, Prevention
Dana Casciotti, PhD, Cancer Prevention and Treatment Fund

In June 2011 the Food and Drug Administration (FDA) issued a warning to women who undergo breast cancer screening:  Do not replace mammograms with thermograms.

Thermograms are pictures of the breast made with a special type of camera (an infrared camera) that shows patterns of heat and blood flow near the surface of the breast.  Supporters of thermography say that these pictures can help doctors see new blood vessel growth, the very earliest sign that a tumor could develop.  Supporters also claim the pictures help identify very early tumors that are not big enough to find with other screening tests.  Thermograms are less painful than mammograms because they do not require squeezing the breast, and they also don’t expose the breast to radiation.  This sounds great, but does it really work?

Early detection of breast cancer is very important because it can save lives and reduce the need for mastectomy (surgery to remove the breast) or chemotherapy.  However, the FDA said there is currently not any “valid scientific data to show that thermographic devices, when used on their own, are an effective screening tool for any medical condition including the early detection of breast cancer or other breast disease.”[1]

Some research shows that thermography might be useful in combination with mammography, especially for women with dense breasts.[2,3] With mammography, dense breast tissue looks white and so does a cancerous tumor, so it is often hard to detect cancer.  Younger women tend to have denser breasts, so mammography in combination with thermography might be more accurate, especially for young women at high risk of breast cancer because of close relatives with breast cancer. Breast cancer screening is not recommended for young women with an average risk of breast cancer.[1]

More research on thermography should be done to determine whether it is truly useful for early detection.  As mentioned above, thermography can identify the earliest signs of tumor growth.  However, these early signs do not necessarily mean breast cancer will develop and they are generally too early to require treatment. Even though it is an easy procedure that simply takes a picture of the breast, its risks might outweigh the benefits if it results in unnecessary follow-up and treatment. That’s why more research is needed to determine if thermography can replace mammography for breast cancer screening.

The FDA is worried that ads for thermography facilities, web sites, and mobile units are misleading women. For example, here is an ad that calls breast thermography “the safe alternative to mammography.” That is not true. Thermography may be a safer test since it does not expose women to radiation, but there is not enough evidence that it is effective and can be used alone for breast cancer screening.

References:

  1. U.S. Food and Drug Administration. Thermographic Imaging Systems for Breast Cancer Screening: FDA Safety Communication. June 2, 2011.  Accessed on 6/8/11 http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm257707.htm.
  2. Arora N, Martins D, Ruggerio D, et al. (2008).  Effectiveness of a noninvasive digital infrared thermal imaging system in the detection of breast cancer. Am J Surg. Oct;196(4):523-6.
  3. Kennedy DA, Lee T, Seely D (2009). A comparative review of thermography as a breast cancer screening technique. Integr Cancer Ther. Mar;8(1):9-16.

Breastfeeding: the Finest Food for your Infant Isn’t Sold in any Store

Breast Cancer, Diet, Habits, & Other Behaviors, Ovarian Cancer
Margaret Aker, Cancer Prevention and Treatment Fund

For years evidence has been mounting about the health advantages of breastfeeding for both mother and child. From a reduced risk of obesity to an increased resistance to disease, study after study shows that breast milk is the ideal food for your newborn child. Can you believe it? Our own bodies produce the best food we can give our children? And for free!

How is Infant Formula Different from Breast Milk?

Infant formula is an imitation of human breast milk. It is made by blending various dairy substitutes. Formula, however, can never exactly duplicate a mother’s breast milk. Formula is more difficult for a baby to digest, it lacks antibodies that help infants fight off diseases and infections, and it doesn’t change to accommodate a growing baby’s nutritional needs the way natural breast milk does.

What are the Health Benefits of Breastfeeding?

Breastfeeding has significant health benefits for you and your child. Exclusive breastfeeding (meaning no formula or other food) during at least the first three months offers the greatest benefits, although some breastfeeding is better than none.

Benefits for your Child

Protection from Disease: Breastfed infants have lower rates of allergies, infections, and respiratory disorders, such as asthma. They also have lower rates of diseases such as diabetes and leukemia.

  • Antibodies that protect infants from disease are transferred from a mother to her child through breast milk.
  • Infant formula can’t provide these antibodies. Breast milk is the first example of “personalized medicine.”

Defense against Obesity: Breastfeeding decreases the likelihood that an infant will become overweight or obese.[1]

  • Breastfeeding is better for teaching infants how to stop eating when they are full. While parents sometimes find it reassuring that they can tell by looking at the bottle how much food their baby has consumed, they also tend to overfeed when bottle-feeding. Instead of looking for cues from their baby showing that he or she is full, parents look at whether the bottle is empty or not.
  • Breast milk contains the flavors of the food the mother is eating. It therefore exposes infants to a wider range of tastes at an early age. This may lead the infant to later accept a well-balanced diet containing a wide variety of foods.

Benefits for You

Protection from Disease: Breastfeeding reduces the mother’s risk of certain types of cancers.

  • Women who breastfed for 18 months or longer are much less likely to develop ovarian cancer than women who never breastfed.[2]
  • The risk of breast cancer decreases the longer a woman breastfeeds her child. Research now shows that this decreased risk has less to do with the number of children a woman breastfeeds and more to do with the length of time she spent breastfeeding each child.[3]
  • Many experts believe these benefits are the result of the delayed return of a woman’s period while she is breastfeeding. Other factors may play a part as well.

Weight loss after Pregnancy and Childbirth:

  • Breastfeeding helps women return to their pre-pregnancy weight. Exclusively breastfeeding is said to burn up to 600 calories a day![4] That’s about the same number of calories burned by running 6 miles or doing the Stair Master for about an hour. (Of course, breastfeeding will only help you lose weight if you don’t eat 600 calories more each day.)
  • Breastfeeding may help to delay the return of your period. The hormones that trigger the production of breast milk may also delay the release of hormones that bring on your period. This does not always happen, however, so if you don’t want to have another child anytime soon you should not be rely on breastfeeding as a form of contraception. For more information about safe contraceptives to use while breastfeeding check out our “Guide to Selecting Safe Medical Contraception.”

Benefits for you Both: Building a Close Relationship Between Mother and Child.

  • Women who breastfeed often have more physical contact (skin-to-skin) with their babies than women who bottle feed. This kind of close contact promotes closeness between mother and child. With breastfeeding, nothing comes between a baby and mother.
  • Feeding-whether by breast or bottle-is an important demonstration of love and an opportunity for bonding. One of the advantages of bottle-feeding is that others can participate in the duty and pleasure of feeding, but that can sometimes be a drawback. Because it is easy to pass the baby to someone else for feedings, and even to teach the infant to hold the bottle and feed himself, a mother who is rushing to get everything done may miss out on some of the time she would otherwise spend bonding with her child.

The Health Benefits of Breast Milk are Unmatched by Baby Formula. So Why Would any Mother not Breastfeed?

Given the multiple benefits mentioned above, there are many reasons why it is a good idea for you to breastfeed your child. It is important to keep in mind, however, that there are also many reasons why a mother might not be able to or might choose not to breastfeed. Every mother’s situation is different. It does not make you a bad mother if you don’t breastfeed your child.

In addition to the physical inability of some women to produce sufficient milk, some reasons that women may be unable or unwilling to breastfeed include:

  • Cost: Breast milk is free, but most newborn babies request around 8-12 feedings each day. So, committing to exclusively breastfeed may entail taking paid-time off work to stay at home with the child, go home for feeding breaks, or pump breast milk. While this type of commitment may be feasible for women whose employers offer great maternity-leave benefits or who do not work, for many it isn’t.
  • Disease: Many women are concerned about breastfeeding when they are sick, have an infection, or are taking a medication. For most illnesses and many medications, it is safe for the mother to continue to breastfeed as normal. Women infected with HIV/AIDS, active tuberculosis, or undergoing certain medical treatments, however, may be required to stop breastfeeding temporarily or permanently. The best thing to do if you are concerned about whether or not breastfeeding is safe for you and your child is to ask your doctor.
  • Food Habits: You are what you eat, and breast milk is essentially what a mother eats. It is important, therefore, that a breastfeeding mother eat well in order to provide good nutrition to her child. Mothers who are not likely to eat a balanced diet or limit their intake of caffeine and alcohol might find it in the best interest of their child to refrain from breastfeeding. No mother using illegal drugs should breastfeed. Talk to your doctor if you have any questions about whether your lifestyle is compatible with breastfeeding your child.
  • Discomfort: Some women simply do not enjoy breastfeeding. They may find it uncomfortable or frustrating. This is not a reflection on the type of mother that you are. Since the pain and difficulty almost always goes away, women are encouraged to try breastfeeding for at least 14 days before giving up.[5] A mother who is having trouble should consider asking her doctor where she can get free advice or help on breastfeeding. However, it is important that each mother considers her own needs when deciding whether to breastfeed. If a mother finds the breastfeeding experience incredibly unpleasant, it will only get in the way of mother-child bonding. Try to be patient, but don’t be a martyr.

When it is possible, breastfeeding is the ideal way to feed your child. Breast milk is naturally manufactured to protect and nourish a growing infant, as well as to help your body bounce back from pregnancy-and, it does a great job at both of these tasks. It is amazing that women’s bodies have outdone the efforts of thousands of scientists and food manufacturers to create the perfect food for infants!

Breastfeeding is not a feasible option for every mother. The multiple benefits of breastfeeding for you and your child, however, make it worthwhile to try to make breastfeeding work. And remember, if you need to supplement breastfeeding with bottles while you’re at work or sometimes in the middle of the night so you can get more sleep, that kind of compromise will still give you and your baby most of the benefits of breastfeeding.

In the end, each mother must personally decide the best way to feed her child. While the health benefits of breast milk are great, there are many other factors that will determine if breastfeeding is right for you and your family.

References:

  1. Breastfeeding: The First Defense Against Obesity. California WIC Association and the UC Davis Human Lactation Center. (2006 March). http://www.calwic.org/docs/reports/bf_paper1.pdf.
  2. Danforth K, Tworoger S, Hecht J, Rosner B, Colditz G, and Hankinson S. Breastfeeding and Risk of Ovarian Cancer in Two Perspective Cohorts. Cancer Causes & Control. Vol. 18, No. 5 (2007 June), pp. 517-523.
  3. Chang-Claude J, Eby N, Kiechle M, Bastert G, and Becher H. Breastfeeding and Breast Cancer Risk by Age 50 among Women in Germany. Cancer Causes & Control. Vol. 11, No. 8 (2000 Sept), pp. 687-695.
  4. Kramer F. Breastfeeding reduces maternal lower body fat. Journal of American Dietician Association. (1993), pp. 429-33.
  5. Love S, Lindsey K. Dr. Susan Love’s Breast Book. Perseus Publishing. 3rd Ed, (2000), pp. 33-50.

Tips for Preventing a Recurrence of Breast Cancer

Breast Cancer, Breast Cancer
Heidi Mallis, Cancer Prevention and Treatment Fund

Women (and men) who are diagnosed with breast cancer usually focus on treatment to destroy the cancer, and many don’t consider what changes they can make to prevent the cancer from returning. They may wish they had taken better care of themselves, but think it is too late to prevent cancer. It isn’t. It’s not just the surgery, radiation, or chemo that can keep you safe after a cancer diagnosis; there is growing evidence that there are a lot of other things you can also do that will help keep cancer from coming back.

Dr. Christopher Li at the Fred Hutchinson Cancer Research Center in Seattle found that female breast cancer survivors who were obese, had a history of smoking, and drank more than seven alcoholic beverages per week, were at an increased risk of developing a second primary breast cancer (“primary cancer” refers to the place where the cancer starts).[1] For patients diagnosed with breast cancer, recurrence most commonly occurs in the opposite breast (referred to as contralateral breast cancer), not the same breast where the cancer was initially treated.[2] It is estimated that one in 25 breast cancer survivors will develop a second primary breast cancer at least six months after their initial diagnosis.[3]

Li and his colleagues found that women who were obese, had a history of smoking, and drank heavily were seven times more likely to develop contralateral breast cancer than women with a non-obese body mass index (BMI), who did not smoke, and consumed less than seven alcoholic beverages per week.[4]

If you are wondering if you or someone you love is obese, it is possible to calculate BMI using the following formula:

[Weight (lbs)/height (in)2] x 703
Say, for example, that you wanted to calculate the BMI for a person who is 5’9” and weighs 200 lbs.

Weight = 200 lbs, Height = 5’9” (69”),
Calculation = [200/(69)2] x 703 = 29.5

The resulting BMI of 29.5 could be plugged in to the standard BMI reference table to determine the weight status of a particular individual. The Centers for Disease Control and Prevention (CDC) provides the following BMI guidelines:

BMI Weight Status
Below 18.5
Underweight
18.5 – 24.9
Normal
25.0 – 29.9
Overweight
30.0 and Above
Obese

From this table, you can see that 29.5 would be considered “obese.”

The Bottom Line

Maintaining a healthy weight through diet and exercise can prevent breast cancer, and can also prevent breast cancer from returning. Breast cancer survivors have a much higher risks—two to six times greater risk—of developing a second breast cancer than women in the general population have of developing a first breast cancer. The study by Dr. Li and his colleagues shows very clearly that many women can reduce that risk by quitting smoking, maintaining a healthy weight or losing weight, and avoiding excessive consumption of alcoholic beverages.

References:

  1. National Cancer Institute (2004). Metastatic cancer: Questions and answers. U.S. National Institutes of Health. September 1, 2004. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/metastatic. (Accessed September 25, 2009).
  2. Wedam SB, Swain SM (2005). Contralateral breast cancer: Where does it all begin? Journal of Clinical Oncology, July 2005; 23(21): 4585-4587.
  3. Kurian AW, McClure LA, John EM, Horn-Ross PL, Ford JM, Clarke CA (2009). Second primary breast cancer occurrence according to hormone receptor status. Journal of the National Cancer Institute, August 5, 2009; 101(15):1058-1065.
  4. CI, Daling JR, Porter PL, Tang MT, Malone KE (2009). Relationship between potentially modifiable lifestyle factors and risk of second primary contralateral breast cancer among women diagnosed with estrogen receptor-positive invasive breast cancer. Journal of Clinical Oncology, September 8, 2009. http://jco.ascopubs.org/cgi/content/abstract/JCO.2009.23.1597v1 (Accessed September 16, 2009).

Do women with non-cancerous breast conditions eventually get cancer?

Breast Cancer
Susan Dudley, PhD, Cancer Prevention and Treatment Fund

In addition to the more than 200,000 women who are diagnosed with breast cancer in the U.S. every year, even more women are told they have an abnormal breast condition that is not cancer.

These conditions may be discovered by the woman herself, by a doctor’s examination, or by a mammogram. Sometimes it is not possible to make an accurate diagnosis until a biopsy is done to remove a tissue sample that can be examined in a laboratory.

Lumps that are not cancer include 1) cysts that are filled with fluid, or 2) fibroadenomas, which are smooth, and hard, often feeling like a marble under the skin. There can also be thickened but harmless areas called pseudo-lumps. White spots that show up on a mammogram are called microcalcification, and may also require a biopsy. Since only 1 in 12 breast lumps is cancerous, and only 20% of microcalcifications are related to cancer, most women get good news after a breast biopsy.

Doctors know that the overall risk for breast cancer increases with age. For a woman in her 20’s in the United States, the risk is very low. By the time she reaches her 70’s, her chance of breast cancer is 1 in 7. But does having one of these non-cancerous conditions change those odds?

Some of them may – but doctors have not known how much risk one of these abnormal conditions adds. Now, a study by Dr. Lynn Hartmann and her colleagues, published in the New England Journal of Medicine can help women and their doctors understand which specific breast conditions add to a woman’s risk, and which ones don’t.[1]

The study included more than 9,000 women who had biopsies for suspicious breast conditions that turned out not to be cancer. Afterward, the researchers monitored their health for approximately 15 years. In that time, 8% of the women developed breast cancer. It turned out that specific changes in breast cells that could be seen in the first non-cancerous biopsy could help predict which women were most likely to get breast cancer.

  • The biopsies from about two-thirds of the women showed that the cells were growing and reproducing at a normal rate, and were changing in ways that are not dangerous. This is called nonproliferative fibrocystic change. The risk of developing breast cancer in the next 15 years was not increased for these women unless their mother, sister, or daughter had the disease.
  • Similar predictable cell changes were found in the biopsies from another 30% of the women. But in this group, the cells were growing and reproducing too fast. This is called proliferative fibrocystic change. In this group, the risk of developing breast cancer over the next 15 years increased from about 5 cases in 100 women with normal cells, to about 9 cases of breast cancer in 100 women with proliferative fibrocystic changes.
  • Less than 4% of the women with non-cancerous biopsies had changes in their breast cells that were very abnormal and cells that were growing and reproducing too fast. This is called proliferative fibrocyctic change with atypia. Their risk of developing breast cancer in the next 15 years increased from about 5 in 100 to about 19 in 100.

For all these groups, the risks are higher if the non-cancerous condition occurred when the woman was very young – in her thirties or forties. A strong family history of breast cancer can also increase the risks for later developing the disease.

Almost all of the women in this study were white, so we can’t be sure that the risks are the same for other racial groups. Still, the results will help women and their doctors decide whether they need to get more frequent breast cancer screening or to take other preventive measures after they have had non-cancerous breast disease.

References:

  1. Hartmann, LC, et al. (2005). Benign Breast Diesease and the Risk of Breast Cancer. New England Journal of Medicine, July 21, 2005, pages 229-237