Breast Cancer FAQs
Until there's a cure for breast cancer, we will have questions that need answers. We asked Clifford A. Hudis, M.D., chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center in New York, to address iVillagers' ongoing concerns about prevention, risk, treatment and the prevailing myths about this disease.
Reducing Your Risk
Q: What can I do to reduce my risk of breast cancer?
Q: How much do healthy habits help to lower our risk?
Q: Are women becoming unnecessarily worried about breast cancer?
Q: Does the Pill increase my risk?
Q: Does having an abortion or miscarriage increase a woman's risk of developing breast cancer?
Screening for Breast Cancer
Q: Do you recommend breast self-exams?
Q: What other screening techniques are being developed?
Q: Should young women who are concerned about breast cancer get mammograms?
Q: If I have been on HRT for five years, does this mean I should get more frequent mammograms?
Diagnosing and Treating
Breast Cancer
Q: Are the rates of breast cancer increasing or decreasing?
Q: Does having a mastectomy relieve you completely from any further worries of breast cancer on "that side"?
Q: Is it true that breast cancer patients tend to gain weight on chemotherapy?
Q:How close is a "cure"?
Reducing Your Risk
Q: What can I do to reduce my risk of breast cancer?
A: On average, women who have a late first period and early first pregnancy have a lower risk. But those are things you can't control. Thinner women who exercise more and maybe eat a lower-fat diet may have a lower risk, but those effects are modest. The number one risk factor for breast cancer is age. There is also one drug, tamoxifen, that has been shown to lower the risk of breast cancer for women with high risk. The studies of this drug have been limited to women over age 35. Younger women would be unlikely to take it.
Q: What about reducing stress or taking vitamins? How much do these healthy habits help to lower our risk?
A: These healthy habits make you feel better, but they do not have a direct link to breast cancer. It's also a burden sometimes to tell people to reduce stress. People may have cancer because they have a gene that causes it. It's not because of stress. How you cope with your cancer may affect your outcome, but generally speaking, stress does not have a direct link to breast cancer. On the other hand, a low-fat diet with restricted calories has been linked to lower risks of many kinds of cancer, and everyone should strive to follow such a diet for a variety of reasons.
Q: Do you think the effort to raise awareness of breast cancer has gone too far? Are women becoming unnecessarily worried about breast cancer?
A: I don't know. I can't speak for all women. I think women should be aware of their health risks. We have had modest and continuing success with breast cancer, and this has to be in part because of the awareness and demystification of the disease. Plus, now women are no longer afraid to talk about it and seek treatment. These are all good things. The problem is not awareness. The problem is that women are still dying of breast cancer.
Q: I've been taking birth control pills for years. Do they increase my risk for developing breast cancer?
A: As with other hormones, there could be a small risk. But birth control pills may also protect against ovarian cancer.
Q: I have heard that having an induced abortion or miscarriage can increase a woman's risk of developing breast cancer later in life. Is that true?
A: There is no link. That is a myth.
Screening for Breast Cancer
Q: According to a study by the Fred Hutchinson Research Center in Seattle, breast self-exams are not effective in predicting cancer deaths. Do you still recommend that women perform them?
A: There was a large study done in China with factory workers that failed to show a benefit for breast self-exam. This is upsetting news to women who think breast self-exams are effective. It was a well-done study but there is also room to criticize the study scientifically. The death rate for breast cancer has been falling, the size of breast cancers detected has been going down and the absolute number of cancers detected is going up. This may not be just from mammography, so we believe that there may be a benefit from self-examination. Also, being aware of your body can lead to a downstream of events that are beneficial, and therefore we continue to strongly recommend breast self-exams. We certainly don't want to lose the momentum of the success in the past decades in finding breast cancers.
Q: Are there other effective screening techniques being developed?
A: In addition to breast self-exam and mammography (both conventional and digital) there are also other technologies being developed, such as MRI screenings and devices that detect heat in the breast. There is no perfect screening method available but we will see more and more high-tech approaches in the future. There are limits and benefits to all screening techniques. And there is also a dilemma with screening: People believe that screening tests are definitive. The truth is that you find more cancer than you would have found without the test, but unfortunately no screening test can find every cancer. That is the motive to develop better tests.
Q: Women are advised that they don't need a mammogram until they are 40. But what about young women who are concerned about breast cancer? What should we do?
A: If you are from a family where there is clearly a high risk of breast cancer, the recommendation is to get one at 40 years old, or 10 years before the age at which your mother got breast cancer. The caveat, however, is that this first mammogram has to be evaluated to see if it's even interpretable, because some younger women have dense breasts that can make it harder to find abnormalities. There are also breast self-exams and ultrasound tests that can be done. For young women with no family history, there is no recommendation for routine mammograms before the age of 40 unless you personally have a special risk, such as a prior history of radiation treatment to the chest.
Q: If I have been on HRT for five years, does this mean I should get more frequent mammograms?
A: There is no evidence that more frequent mammograms are beneficial. A woman in this situation needs to discuss the use of hormone therapy with her doctor.
Diagnosing and Treating
Breast Cancer
Q: Are the rates of breast cancer increasing or decreasing?
A: In ballpark figures, there are around 200,000 cases a year in the U.S. and 40,000 deaths. The rate of death is declining, but incidence is going up. Over the last 15 years, average age of women has increased. And the number of cancer discoveries has gone up. But the average size of those cancers has gone down. We have more cancer, we have older women, but we have fewer deaths. That is why we are cautiously optimistic that something good is happening.
Q: Does having a mastectomy relieve you completely from any further worries of breast cancer on "that side"?
A: No. Breast cancer can rarely return in the skin where the breast had been. However, mastectomy does lower the risk. On the other hand, women treated with mastectomy have no greater chance of survival than do women treated with lumpectomy and radiation therapy. So the decision regarding the type of surgery should be made in collaboration with a surgeon, taking into account the patient's desires but without assuming that one is more "curative" than another for most patients.
Q: My oncologist said when I first started chemo that for some reason breast cancer patients tend to gain weight as compared to most cancer patients, who lose weight. Is this true?
A: Yes. Patients receiving post-operative chemotherapy do often gain weight. The reasons for this are not well understood.
Q: How close is a "cure"?
A: I think the answer to this question is very complicated. Breast cancer should not be understood to be one disease, both scientifically and by the public. Because we think of it as one disease, we think there is one single treatment for it. The problem with breast cancer is that we call it "breast cancer," but there are really many different types. There is breast cancer that is invasive, breast cancer that is noninvasive and breast cancer that never spreads. The range of outcomes is as wide as it can be for any cancer. How do you call that one disease? We would be better off understanding breast cancer when we recognize the subtypes and describe them. When doctors give a diagnosis, they don't say Miss Jones has leukemia. They describe the leukemia as chronic or acute and describe a subtype. There may also be drugs out there for one subtype, but that don't work for another. Until we break breast cancer down to much smaller types and develop drugs for each individual type, we will be somewhat frustrated. The description of the human genome may get us closer to being able to identify types of breast cancer and develop specific treatments for these subtypes.
