October 2007: Health Briefs from Baylor Health Care System

Battling Breast Cancer: What You Need to Know

Thanks to research, new equipment and advanced technology, women have more weapons in their arsenals than ever in the battle against breast cancer. Here are just a few:

Prevention. The results of the Study of Tamoxifen and Raloxifene (STAR) trial are in, and the news is good. Both of these medications can help women reduce their risk of breast cancer.

"It's very exciting because in both groups-tamoxifen and raloxifene-women benefited. Both drugs substantially reduce the risk of breast cancer. Raloxifene had a lower risk of embolic events such as pulmonary embolism or deep vein thrombosis," says Margaret Sunderland, M.D., a medical oncologist on the medical staff at Baylor Medical Center at Irving. Women at high risk-including women over age 60-should consult with their doctors about these medications.

Diagnosis. The new breast MRI machine at Baylor Irving is helping diagnose cancer in certain women.

"MRI is a totally different way of looking at breast tissue. It's not affected by density like mammograms are, so age has no influence on accuracy. Particularly for younger patients, it's really a benefit," says Ed Clifford, M.D., a board-certified general surgeon on the medical staff at Baylor Irving. He says that with breast MRI, several women with breast cancer have had cancer diagnosed in the opposite breast when there was little reason to suspect it based on their mammograms.

Treatment. Standard radiation treatment takes six and a half weeks of sessions every weekday. With MammoSite^® breast radiation therapy, women can get treatment that's just as effective in only five days.

"A catheter is inserted into the space where a lumpectomy was performed and the radiation is placed inside the catheter," explains Dr. Clifford. "It makes a lot of sense-the area of the body that gets the highest radiation dose is right where the tumor was." By administering the radiation in the immediate area, the surrounding, healthy tissue gets a much lower dose than with radiation that's beamed in from outside the body.

There are benefits in lymph node treatment too. When appropriate, doctors are removing fewer lymph nodes following a breast cancer diagnosis, which lowers toxicity, swelling, pain and a patient's risk of lymphedema.

For a referral to a physician on the medical staff at Baylor Irving who can help with breast cancer diagnosis and treatment, call 1-800-4BAYLOR.

Can a Healthy Diet Help Prevent Breast Cancer?

Is there a link between diet and breast cancer? According to some recent studies, there may be. But while none of them have proven beyond a shadow of a doubt that certain foods actually cause or prevent cancer, most agree that eating a healthy diet consisting of foods from each of the five food groups-as well as low-fat and unprocessed foods-is the safest way to reduce the risk of breast cancer. However, an unhealthy diet-one high in fat and calories-can contribute to obesity which has been proven to increase the risk for many types of cancer-including breast cancer.

"Extra body fat actually causes an increase in the body's production of estrogen which is a growth stimulator that may encourage cancer cells to multiply," says Dee Rollins, R.D., Ph.D., clinical dietitian at Baylor Regional Medical Center at Grapevine. "There is a growing body of evidence that suggests some cancers may be attributed to our lifestyle choices such as the food we eat."

It is recommended by the Centers for Disease Control and Prevention that eating five servings of fruits and vegetables a day is beneficial to your health. Why? Because fruits and vegetables are rich in antioxidants, among other vitamins and nutrients.

"Antioxidants can actually prevent cellular damage and keep free radicals in the body under control. There is evidence that free radicals-which promote the growth of abnormal cells-contribute to the development of cancer," explains Dr. Rollins.

There are some risk factors for breast cancer that are beyond your control such as age, gender and genetics, but of the risk factors you can control, diet is at the top of the list.

"A healthy diet can not only help you reduce your risk of developing breast cancer, but it can lower your risk for many other types of cancer as well as heart disease, stroke and diabetes," adds Dr. Rollins.

Dr. Rollins recommends the following guidelines to help reduce your risk of breast cancer and maintain a healthy weight.

• Eat less fat, especially saturated fat.
• If you eat meat, choose lean cuts.
• Choose low-fat dairy.
• Reduce your intake of sugar and starchy carbohydrates.
• Limit alcohol consumption to less than one drink a day.
• Limit the amount of processed foods you eat.
• Increase your intake of fruits and vegetables-about five or more servings per day.

What You Need to Know About Breast Cancer

Early detection, surgery and chemotherapy are helping many women keep their breast cancer at bay.

"The most important thing is detecting it at an early stage. Stage I breast cancer is typically very treatable-people do well," says Rachel Zent, M.D., a breast cancer surgeon on the medical staff at Baylor University Medical Center at Dallas.

That's why it's important to watch for signs of the disease so it can be caught and treated before it's had a chance to spread. Here's how:

Monthly breast self-exams. Check your breasts every month after your menstrual cycle, or on a date you'll remember, such as the first of every month.

Clinical breast exams. Your doctor should examine your breasts every three years up to age 40 and yearly after that, or as recommended based on your risk factors.

Mammograms. Doctors recommend a baseline mammogram between age 35 and 40 and yearly mammograms starting at age 40, or sooner if your risk is higher.

Breast ultrasound. This test can help evaluate abnormalities that show up on mammograms.

Breast MRI. This scan can screen women who are newly diagnosed with cancer and those with a 20% to 25% lifetime risk of the disease.

If you have a suspicious mass, your doctor may recommend a biopsy-taking a sample from the lump to check for signs of cancer.

If your biopsy reveals cancer, doctors will determine how invasive it is and how likely it is to have spread. You'll work with your doctor to develop a treatment plan, which might include chemotherapy before and/or after surgery, radiation therapy, surgical removal of the lump, or surgical removal of some or all of the breast.

While there's no way to prevent breast cancer, there are ways to reduce your risk, and they match the healthy-living advice you hear for just about every condition:

• Maintain a healthy weight.
• Exercise.
• Don't smoke.
• Eat less fat, especially saturated fat.
• If you eat meat, choose lean cuts.

There are also other factors within your control that can decrease your breast cancer risk, such as:

• Having your first child before age 30.
• Reducing your use of birth control pills.
• Avoiding hormone replacement therapy.
• Breastfeeding for one and a half to two years.
• Limiting alcohol to less than one drink a day.

To schedule a mammogram at a Baylor Breast Imaging Center near you or for a referral to a physician on the medical staff at Baylor who can help diagnose and/or treat breast cancer, call 1-800-4BAYLOR.

Don't Neglect Your Annual Mammogram- It Could Save Your Life

Recent studies suggest that fewer women are getting mammograms today than were getting them five years ago, even with breast cancer awareness at an all-time high. That's discouraging news, since doctors stress that the most important thing for women age 40 and older is to have regular mammograms. Why? Because annual mammograms can help detect breast cancer at its earliest stage when it's most treatable, increasing the chances for survival.

"Mammograms can detect 90 to 95% of breast cancers and can reveal breast abnormalities before they present as a lump," says Anita Chow, M.D., breast surgeon on the medical staff at Baylor All Saints Medical Center at Fort Worth. "Some women avoid mammograms out of fear of discomfort, but the entire procedure usually only takes five to 10 minutes-a small amount of time when you consider that it could save your life."

The American Cancer Society recommends the following guidelines:

• Women age 40 and older should have a mammogram every year and should continue to do so as long as they are in good health.
• Women in their 20's and 30's should have a clinical breast exam as part of a regular health exam by a health professional every 3 years.
• In addition to mammograms and clinical breast exams, all women should conduct breast self-exams on a monthly basis.
• Research has also shown that a breast MRI is beneficial for women newly diagnosed with cancer and those with a 20% to 25% lifetime risk of developing it.

"Early detection is critical because by the time symptoms develop, the breast cancer may be larger or might have spread beyond the breast," adds Dr. Chow. "The size of the breast cancer and how far it has spread helps to determine a woman's prognosis for the disease."

The bottom line is mammograms and other forms of breast screening save thousands of lives every year by detecting breast cancer early. Consult with your physician about your risk for developing breast cancer and your options for recommended screenings.

Get the Facts About Common Breast Cancer Myths

Get your pink ribbons out-it's Breast Cancer Awareness Month. And although we know so much more about the disease right now than ever before, experts say there are still several myths about breast cancer many of us believe as truths.

Millions of women turn to the Internet to read about the latest research on breast cancer, but should be cautious about what they find.

"When women turn to the Internet, some of the websites may not give them accurate information so they're getting information that is sometimes false and misleading," says Manish Gupta, M.D., oncologist on the medical staff at Baylor Regional Medical Center at Plano.

Experts say that when it comes to breast cancer there are a number of myths many of us believe are true.

"One of the most common ones I hear is-no one in my family has breast cancer so I'm not at risk for getting breast cancer-which is actually not true," explains Dr. Gupta.

In fact, only 10% of breast cancers are explained by a genetic mutation. Another big myth is that only older women get breast cancer.

"The majority of breast cancers do occur in older women, but even women in their 30's and 40's can develop it and I've seen women in their 20's with breast cancer as well," adds Dr. Gupta.

Many people even believe that breast implants can cause cancer. "There have been studies looking at breast implants causing cancers. There have also been studies that have looked at breast implants causing other rheumatologic disorders and none of them have been shown to cause any cancers or any other medical problems," explains Dr. Gupta.

But probably the most widely believed myth of all is that breast cancer is only a woman's disease.

"In fact, one in 100 breast cancers do occur in men," adds Dr. Gupta.

Here are some other myths you may have heard or read about on the Internet:

• Antiperspirants can cause breast cancer
• Birth control pills can cause breast cancer
• If I have a genetic mutation that predisposes me to breast cancer there is nothing I can do about it. "There are medications you can take to help prevent breast cancer from developing and you can also get prophylactic surgery," says Dr. Gupta.

What about the theory that regular mammograms are the best way to detect breast cancer?

It's true that regular mammograms are critical when it comes to finding most breast cancers, but it's also very important to do monthly self-breast exams. Studies have shown that in young women mammograms can miss up to 40% of breast cancers so it's important to do both.

What You Need to Know About Inflammatory Breast Cancer

Inflammatory breast cancer is a rare and little-known form of breast cancer that produces no lumps and can not usually be detected with a mammogram. Experts say thousands of women develop it each year, but unfortunately, many of them miss the early symptoms.

"Inflammatory breast cancer can develop very quickly and can often be mistaken as an insect bite or infection or inflammation in the breast," says Valerie Gorman, breast surgeon on the medical staff at Baylor Medical Center at Waxahachie. "IBC is very similar to mastitis, a common breast infection, so it is easily mistaken as this. But if antibiotics do not clear up the infection within a week, a biopsy should be performed to rule out breast cancer."

Not only are the symptoms of IBC difficult for patients and sometimes even doctors to recognize, but it's usually not detected primarily by mammograms alone. Why? Unlike most types of breast cancer, IBC does not present as a lump.

According to the National Cancer Institute, symptoms usually develop quickly-over a period of weeks or months. Typical symptoms of IBC include:

• Redness, swelling or warmth in the breast
• A pink, reddish purple or bruised appearance on the skin of the breast
• Ridges that develop on the skin of the breast
• Heaviness, tenderness or an aching or burning sensation in the breast
      • A sudden increase in breast size
      • Swollen lymph nodes under the arm or above the collarbone

"Nearly all women diagnosed with inflammatory breast cancer (IBC) all say the same thing-they never thought the changes in their breast could be breast cancer," says Dr. Gorman. "Early diagnosis is critical because IBC is aggressive and can spread to other parts of the body very quickly," says Dr. Gorman.

Around 4% of the cancers diagnosed each year are IBC, but it's more common in women under 50 and in African-Americans.

If you suspect that you may have inflammatory breast cancer consult with your physician.

Fear A Mammogram? Follow These Tips

Fear of discomfort is one reason women may choose not to have their recommended annual mammogram. Yet, there are a few simple things a woman can do to ease any possible discomfort she may feel during this brief imaging procedure.

Hold off on coffee, tea and soft drinks.
Caffeine has a tendency to make a woman's breasts tender and lumpy, potentially making the mammogram uncomfortable. Avoid drinking coffee and tea, unless it's decaffeinated, for a week prior to a mammogram. Other items containing caffeine include diet drinks, chocolate and even some common over-the-counter (OTC) pain relievers. Be sure to read the label of any OTC medications before you take them prior to a scheduled mammogram.

Steer clear of perfumes and talcum powder.
Deodorant, talcum powder, perfumes and oils may leave a residue that can be picked up by the X-rays, obscuring the mammogram and possibly interfering with the results. Ultimately, this means a woman could need a second mammogram. It is recommended not to use these products on the day of a scheduled mammogram.

"Most women's breasts are naturally tender or slightly swollen during the week prior to their menstrual period," says radiologist Sheri Hockett, M.D., department chair of radiology/pathology on the medical staff at Baylor Medical Center at Garland Breast Center. "Try to avoid scheduling your annual mammogram during this time."

A sensible dressing tip also makes the process a little easier: Wear a two-piece outfit with a blouse or sweater on the day of the appointment. While a woman's choice of outfit will not affect the outcome of her mammogram, most women find it easier and faster to slip off a blouse instead of removing a one-piece dress.

Mammography is a low-dose X-ray of the breast that is the most effective way of finding breast cancer in its earliest and most treatable stages. Any possible discomfort during a mammogram should not prevent women from scheduling this procedure. During the procedure, performed by a female radiologic technologist, a woman's breast is placed on a ledge and gently compressed in order to see all the tissue and any possible abnormalities.

Doctors recommend a baseline mammogram between age 35 and 40, and yearly mammograms starting at age 40 or earlier if a woman has a family history of breast disease. In the U.S. alone, more than 200,000 people are diagnosed with breast cancer every year. But if detected at an early stage, the chances of survival are extremely high.

In addition to the annual mammogram, women should perform a monthly breast self-exam beginning at age 20, and a woman's physician should perform a clinical breast exam every three years up to age 40 and yearly after age 40.

To schedule your mammogram at Baylor Garland, call (972) 487-5293.