October 2006: Health Briefs from Baylor Health Care System

Should You be Tested for the Breast Cancer Gene Mutation?

It's Breast Cancer Awareness Month and one of the biggest advances in the prevention and treatment of the disease has been the discovery of certain gene mutations that dramatically increase a patient's risk. But there's still much debate about who should get tested for the gene mutation and what should be done if the test results are positive.

"If we can identify someone at an elevated risk of getting breast cancer then there are some things that we potentially could offer them that could reduce their risk of getting cancer, maybe even eliminate it completely," says Michael Grant, M.D., breast surgeon on the medical staff at Baylor University Medical Center at Dallas.

Dr. Grant also says that the vast majority of patients who test positive for the gene consider prophylactic surgery.

"Some patients will have their breasts removed not because they have cancer now, but because they want to reduce the risk of getting cancer in the future," adds Dr. Grant.

Since the breast cancer gene mutation also significantly increases a woman's chances of ovarian cancer-it's also becoming more common for some to have their ovaries removed as well.

"And that can be a decision that's hard for them to make, especially if they're not in the place in their life when they've already had their family," says Dr. Grant.

So who exactly should be tested for the gene mutation? Specialists recommend those women over 18 years-old who have a mother, grandmother or sister who developed breast or ovarian cancer before the age of 40 should investigate.

"We usually recommend going to visit with a genetic counselor," says Dr. Grant. "We have some mathematical models that we can put patients through to examine their family history and let them understand what their risk is of having a gene mutation. If that risk is high enough, then they can decide if they want to go through with the testing."

While it is critical to breast cancer prevention that women understand their risk for the disease and find out if they carry the gene mutation, it's still important to note that the majority of breast cancer patients do not have the gene mutation-so all women need to be screened regularly-that may include a mammogram, self-breast exam and clinical exam performed by a physician.

Can Diet Prevent Breast Cancer?

There may now be another reason to drink your milk. Recent research indicates that getting enough in your early years could help ward off breast cancer.

"Diet is just another piece in the puzzle of why some women are predisposed to breast cancer," says John Pippen, M.D., oncologist on the medical staff at Baylor University Medical Center at Dallas. "Research has shown that there are certain things such as vitamins in dairy products that perhaps may be beneficial when taken in the teen years and into the 20's."

So what's in milk that may provide the cancer-fighting benefit?

"Milk is a good source of Vitamin D which also has some antioxidant properties which may be important," adds Dr. Pippen.

In fact the researchers found that those women in their teens and 20's who consume at least nine glasses of milk a week seem to reduce their risk of later developing breast cancer by as much as 35 percent.

"People don't usually think of diet with breast cancer, but it could be that the lack of certain things such as Vitamin D at certain critical development times could be important so Vitamin D as a part of a healthy lifestyle could produce some benefits in the future," adds Dr. Pippen.

In fact, previous research studies have linked Vitamin D deficiencies with an increased risk of breast cancer.

Baylor Researchers Studying New Screening Method for Breast Cancer

Researchers at Baylor University Medical Center at Dallas are studying a possible new screening method for breast cancer that may become the latest breakthrough in early detection of the disease.

The study is designed to find yet another tool to identify a marker that breast cancer may be developing, says Chad Tate, M.D., breast surgeon on the medical staff at Baylor University Medical Center at Dallas.

The researchers are testing a new diagnostic procedure called 'ductal lavage' in which fluid is taken from a woman's breast ducts and then examined for changes or abnormalities.

"Breast cancers progress from cells that are atypical -- on the way to becoming a cancer cell. In the study we are working to find those cells early in the process, before they can be detected by a mammogram," explains Dr. Tate.

Another goal of the five-year study is discovering protocols for patients who have these atypical cells.

"What we hope to learn is whether or not these atypical cells will progress to cancer and if we can suppress that process with medication like tamoxifen," says Dr. Tate.

Dr. Tate also adds that ductal lavage is not designed to be a replacement for other screening methods, such as mammograms and monthly self exams, but rather an additional screening tool.

Skin Changes are Common with Radiation Therapy- Tips to Help Prevent Irritation

Skin changes are one of the most common side effects of radiation treatment for cancer patients and if not treated properly they can be mildly uncomfortable.

"Usually, after the first couple of weeks, a patient will say that their skin is getting a little red and feels like a mild sunburn," says Scott Cheek, M.D., radiation oncologist on the medical staff at Baylor University Medical Center at Dallas. "That description is pretty accurate."

Those kinds of symptoms are normal and easily treated with over-the-counter lotions like aloe vera, but if not taken care of appropriately the irritation can worsen.

"If not watched carefully, the irritation can progress into the top layer of the skin coming off, a condition called dry desquamation," explains Dr. Cheek. "To minimize the skin changes, radiation patients can take simple precautions like only using mild soaps, keeping skin moist and avoiding scratchy clothing."

"The interesting thing about radiation therapy is that the skin reaction doesn't just stop when you're done," adds Dr. Cheek. "Patients need to remember that the area of skin that received radiation could always be more sensitive and should not be exposed-without protection-to the sun."

But Dr. Cheek adds while about 50 percent of radiation patients will report some temporary skin changes, the chances of permanent scarring is very low.

New Method for Determining Spread of Breast Cancer Safer and More Effective

Long-term research from Baylor University Medical Center at Dallas now shows a new method, known as sentinel node biopsy, for determining the spread of breast cancer, is safer and more accurate than the traditional approach.

"The sentinel node biopsy allows us to check to see if there's been any spread to the lymph nodes much more accurately than with removal of all the nodes," says Joseph Kuhn, M.D., surgical oncologist on the medical staff at Baylor University Medical Center at Dallas.

Traditionally, all 20 or so lymph nodes under the arm were removed and dissected. With removal of just the sentinel node, the first node that cancer spreads to, the pathologist is able to spend more time dissecting and analyzing it which means a more accurate diagnosis.

"With sentinel node biopsy, we look at the lymph node more thoroughly and it's also safer because it avoids the risk of chronic arm swelling, fluid collection under the arm and chronic pain," explains Dr. Kuhn.

Dr. Kuhn also adds that research shows that sentinel node biopsy is a safe procedure, is accurate and with long-term follow up, the incidence of reoccurrence is very low.

However, for those breast cancer patients with large tumors sentinel node biopsy is not recommended.