Tag: breast cancer

Breast Cancer Screenings: What’s New and What’s Best?

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Breast cancer

screening guidelines vary with each person. You might wonder why your doctor chooses certain ones over others.




In the WebMD webinar “
Breast Cancer Screenings: What’s New and What’s Best?”
Julia E. McGuinness, MD, discussed the most recent breast cancer screenings. She explained the guidelines and why they should be tailored to each person.


McGuinness is an assistant professor of medicine at the Columbia University Herbert Irving Comprehensive Cancer Center. She specializes in caring for people who have breast cancer and those at high risk of developing it.


“One of the most important things is to learn about your own breast cancer risk factors and your breast density,” she says. “Those things help us determine the best way to screen you for breast cancer. It’ll also empower you to have that discussion with your doctor about what your risk for breast cancer is.”


Poll Questions


It can be tricky deciding which 

breast cancer screening option

is best for you. There are different reasons you may need to follow a certain protocol. McGuinness explained how to choose the best screening for you.


A poll of webinar viewers found 46% help manage their breast cancer risk by talking with their doctor about screening options.



Question: I do this to help choose the best breast cancer screening for me:


  • Talk with my doctor about which guidelines fit me best: 46%


  • Know my risk factors for breast cancer: 29%


  • Know my breast density: 18%


  • Consider my own screening preferences: 7%


Why Is Breast Cancer Screening Necessary?


“Breast cancer is still the most common cancer in women. We estimate that about 1 in 8 women will be diagnosed with breast cancer in their lifetimes,” says McGuinness. “This is why screening is so important. The goal of breast cancer screening applies to any cancer screening: find cancer early.”


Breast cancer screening can:


  • Find cancer before you have symptoms 


  • Boost your chances of a cure 


  • Lower the cost of treatment


  • Allow for treatments that have fewer side effects


Breast Cancer Screenings Aren’t One-Size-Fits-All


There are a few types of breast cancer screening options:


  • Screening mammograms


  • 3D mammograms or digital breast tomosynthesis


  • Breast ultrasound


  • Breast MRI


Continued


Most women should have a
mammogram
every 1-2 years. But if you’re at high risk for breast cancer (which includes having 

dense breast tissue

), consider having extra breast imaging done. This includes a breast ultrasound or breast MRI.


“Talk with your doctor about the best screening options for you based on your risk and the rest of your medical history,” says McGuinness. “But don’t forget to consider your own preferences. You have a voice in how you want to be screened. There’s not just one recommended way to screen for breast cancer.”


Viewer Questions



How can you manage claustrophobia during mammograms?



Can mammograms cause costochondritis?



If you have dense breasts and yearly sonograms, why do you need mammograms?


We deal with
claustrophobia
a lot during breast MRIs. One thing that we use in those situations, because they’re longer exams, are medications to help with claustrophobia.


For mammograms, it’s trickier because they’re shorter exams and they’re more commonly done. We don’t necessarily want to give everyone anxiety medication for each exam. 


Talk with the mammogram technicians or your doctor about what the process is going to look like. That way, you know exactly what you’re going into when you get there. There are different ways that the techs can minimize your pain or discomfort.


Costochondritis
is inflammation in your ribs or the tissues next to your ribs. It can cause chest pain, especially if you’re moving or taking a deep breath. Your breasts are directly over your ribcage. If you’re being squeezed into a mammographic machine, you could be touched by the machine near your ribs.


It’s not common, but every person’s body is different. Some people who are thin and don’t have a lot of excess padding, or fat, to protect them might have a little bit of pain.


If this happens, tell your doctor and the tech next time so they can adjust things.


If you have dense breasts and have sonograms yearly, you still need mammograms. Ultrasounds or sonograms of the breast aren’t very good at detecting breast cancer on their own. Mammograms are more effective at detecting cancer. We never recommend ultrasounds alone.


Continued



Which screenings are best for those at high risk of breast cancer but allergic to MRI contrast dyes?



How do breast screenings apply to people who are transgender?



How do breast implants and breast reduction surgery affect effectiveness and recommendations of breast cancer screenings?


We’d never have a person with such an allergy go through an MRI for screening. If there’s no alternative, we give them medication to help the allergy (if it’s not severe) so they can still go through it. But for screening purposes, we wouldn’t put anyone at risk in that situation. In this case, your alternatives are mammograms and ultrasounds. We’d do a combination, since you can’t get the MRI.


In the future, CAT scans for breast screening might be an option.


There are no specific guidelines in breast cancer screening for
transgender people. For trans men who still have intact breast tissue, they should still continue screening.


On the flip side, it’s a little harder for us to figure out what to do for trans women. They’re receiving a lot of female hormones, like estrogen, which theoretically could boost their risk of breast cancer. But we don’t have good guidelines on what to do yet, since they don’t have the same degree of breast tissue as cisgender women. 


Talk with your doctors. Generally, we suggest that if you were assigned female at birth and have transitioned, you should continue mammograms unless you’ve had bilateral mastectomies where there’s no breast tissue left.


We also recommend women who had breast augmentation surgery (either implants or breast reduction surgery) get annual mammograms.


Having such surgery can leave scar tissue, and that can make it harder for radiologists to fully read your mammograms. We certainly don’t tell people not to get these surgeries for that reason. But you might end up having more false positive results.


There are no guidelines saying that everyone who had these surgeries should get breast MRIs. But those can take a better look at your remaining breast tissue or the breast tissue that’s been pushed up by an implant.


Continued


Make sure you talk with your surgeon and your primary doctors, continue breast cancer screening, and be aware that you might get a lot more false positives.



At what age can someone with normal mammograms and no family history of breast cancer safely stop having mammograms?



Is there a connection between osteoporosis and breast cancer in postmenopausal women?



Do women who’ve never given birth have a higher risk of breast cancer?


With mammograms, it’s all a risk-benefit analysis. The guidelines say age 75. But if people are healthy and living longer, they can continue mammograms after that.


If you’re sick with other medical conditions – like something that’s going to shorten your life span and you’re going through a lot of other treatments — we often stop screening mammograms. Because the likelihood that breast cancer will become a danger to your health is less likely than another medical condition doing so. It’s a tricky balance. Talk to your doctor about what’s right for your specific situation.


Osteoporosis
in postmenopausal people happens because, after menopause, your estrogen levels drop when your ovaries stop producing it. Estrogen supports bone health. But there’s no direct link between osteoporosis and breast cancer risk. 


If you have osteoporosis and have lower estrogen, it doesn’t mean your risk of breast cancer is lower or vice versa.


However, never having children, or having your first child after the age of 30, is a
risk factor
for breast cancer. The reason is that when you go through pregnancy, your body has a break in the typical cycle of estrogen production you have every month when you’re getting a period.


So having that 9-month break in typical estrogen production is what lowers your risk for developing breast cancer. If you have a pregnancy at an earlier age, like in your 20s or even in your teens, that earlier break means you might improve your breast cancer risk. 


We shouldn’t make decisions about children based on our breast cancer risk. But we can incorporate that into our risk calculations. It’s not a large risk factor for breast cancer. But if you have other major risk factors, this small factor can be what bumps you into the high-risk category where you would actually need to be screened differently.




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What to Do When You Find a Lump

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It can be alarming to find a lump in your breast. But understanding the next steps can arm you with important knowledge.




In the WebMD webinar
“What to Do When You Find a Lump,”
Stephanie Bernik, MD, explained the steps you should take. She talked about breast changes that need to be checked, health conditions other than breast cancer that might be the cause, whether breast self-exams are useful, and more. 


Bernik is the chief of breast service at Mount Sinai West in New York and associate professor of surgery at the Icahn School of Medicine at Mount Sinai.


“If you find a mass, don’t panic. There are so many things that can be benign (non-cancerous), especially in people who are menstruating,” says Bernik. “But certainly don’t ignore a finding.”


Poll Questions


Some lifestyle habits can reduce your exposure to estrogen. High levels of estrogen are linked to an increased risk of breast cancer and other health conditions. 


A poll of webinar viewers found that 40% reduce their estrogen exposure with regular exercise. That’s followed by 27% who avoid estrogen-increasing hormone-replacement therapy (HRT). 



Question: I limit my exposure to estrogen by:


  • Getting regular exercise: 40%


  • Avoiding HRT: 27%


  • Reducing fat in my diet: 20%


  • Drinking little or no alcohol: 11%




Another webinar poll asked about known risks for breast cancer. Being female was a breast cancer risk for 41% of viewers, compared to over 30% who have breast cancer in their family history. 



Question: My breast cancer risks include:


  • Being female: 41%


  • Family history: 32%


  • Starting periods early: 13%


  • Being postmenopausal and taking hormone therapy: 7%


  • Starting menopause late: 4%


What’s a Breast Self-Exam?


It’s a way to
check your breasts for changes. While it used to be more popular, doctors now warn against its overuse.


“The problem we have found with self-breast exams is that people tend to feel too much,” says Bernik. 


“That creates a false positive. For example, if you feel something but the doctors don’t see anything, you may have to get surgery to have a tissue diagnosis.”


While it’s important to be aware of any change in your breasts, it’s also good to understand that you’ll feel the fat areas in your breasts during a self-exam as well. These may not be dangerous lumps. Feeling too much can create unneeded anxiousness for you.


“We say you should sweep your breasts in the shower. Make sure you’re not feeling anything obvious. If you do feel something, you can’t ignore it,” she says.


When to See Your Doctor About a Lump


If you find a breast mass and you’ve been through
menopause
, call your doctor and schedule an exam. 


“Most cancers will be in postmenopausal women,” says Bernik. “But just because you’re young, it doesn’t mean you can’t get cancer.”


If you haven’t been through menopause, wait to see if the lump is still there after your next period. If it doesn’t go away, see your doctor.


Viewer Questions



How do breast implants affect breast cancer risk?



What’s the link between stress and breast cancer?



How does breast reduction surgery affect breast cancer risk?


Implants can make some breast tissue unclear when you have a mammogram. With
implants
, even if they’re silicone, it’s suggested you have more mammograms. You should be adding an MRI at least every 3 years in addition to the screening mammogram and/or an ultrasound if you’re 40 or older.


Several years ago, we had textured implants that were mostly silicone. They were used because they really held their shape. While it was rare, they were linked to lymphoma. We don’t use those implants anymore. But we also don’t rush to take them out unless there’s a reason. If there is, then those implants are removed and replaced with different ones.


Stress can increase your risk of breast cancer, as it causes inflammatory reactions in your body. On a microscopic level, those factors affect cells, which raises your risk of cancer. Stress isn’t good for your body, not just in terms of breast cancer, but for every organ system.


You want to lead a healthy lifestyle by eating a nutritious diet, exercising, trying to keep alcohol to a minimum, and lowering your stress. All of these help lower your risk of cancer.


Nothing eliminates your risk of breast cancer. But if you have a genetic risk of it, you might have a prophylactic mastectomy. This is surgery that can remove a lot of your breast tissue. Through that, we can lower your risk by 90%, which is lower than the general population. 




How do you know if you’re a BRCA carrier?



Does having an aunt with breast cancer increase your risk?



Why are women more likely to develop breast cancer as they age?


We screen a lot more people for
BRCA
than we used to because the cost of the genetic tests has gone down. You can do screening for BRCA for about $250. 


Some people get the test just to know if they carry the mutation or not. But in general, the screening is recommended if you have:


  • Triple-negative cancer yourself


  • Male breast cancer in your family


  • A history of breast and ovarian cancer


  • Several relatives who’ve had breast cancer


In terms of your cancer risk related to your family history, we like to do a little probing. We ask about other cancers in your family on your father’s and mother’s side.


Just because you don’t have a first-degree relative with cancer, it doesn’t mean you don’t have a risk. You need to dive more into your genetics. 


Cancers can skip a generation. So you can have a mother who didn’t have breast cancer, but she’s a carrier. She may have three sisters, your aunts, with breast cancer. You have to look at the whole story.


People are more likely to develop breast cancer as they age. That’s because as you age, you’re at a higher risk of all sorts of cancers. This is because your cells are older. 


In your body, you have repair tools. There are always breaks in your DNA, but your body tends to fix those. If your body fails to fix a break in your DNA, that can cause cancer. As you age, there are more of these breaks in your DNA because your cells are older and not functioning as well.



Is there a best or worst time in your cycle to have a mammogram?



Should you get an ultrasound annually with a mammogram if you have dense breasts? 



Should you have mammograms as long as you live?


We don’t usually time
mammograms
to your cycle. But the best time to get a mammogram would probably be on days 7 to 14 of your cycle. It’s hard to predict that because cycles can sometimes have something that throws them off. So people tend to schedule mammograms at any point in their cycle.



If you have dense breasts, your ultrasound and mammogram recommendations will vary a little bit based on what state you’re in. Some states will put a statement on the mammogram if there’s dense breast tissue. Then, you have to speak to your doctor to see if extra screening is needed.


If you have dense breast tissue, some states automatically add an ultrasound. But it does vary, so always read your mammogram. If it says “heterogeneously dense” anywhere on your mammogram, you should ask for an ultrasound as well.


If you’re expected to live more than 5 years, breast surgeons suggest we continue to screen you for breast cancer. Guidelines say you can stop at 75. But people are living much longer than that. These large-scale guidelines look at the general population and not at the person as an individual.


Even if the guidelines say you don’t need screening, you should consider doing it. Even if you’re 85. If you’re still healthy, you should continue getting screened.


Watch a replay of the WebMD webinar

“What to Do When You Find a Lump.”


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Data Point | The gender disparity in healthcare

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The Data Point is a bi-weekly newsletter in which The Hindu’s Data team decodes the numbers behind today’s biggest stories.  

(This article forms a part of the Data Point newsletter curated by The Hindu’s Data team. To get the newsletter in your inbox, subscribe here.)

The difference in the anatomy between various genders implies that diseases and their symptoms may affect them differently. Moreover, some diseases affect certain genders more than others, while a few are gender-specific conditions. Thus, it is imperative to look through a gendered lens for a better understanding of diseases.

Equal representation of genders in clinical trials, and impartiality and unbiasedness in testing and diagnosis help in creating a healthcare system that addresses the needs of all genders.

Yet, various studies conducted in the U.S. reveal that in some fields of medicine such as oncology, psychiatry, neurology and cardiology, the disease burden was higher among women while their share in clinical trials was not proportionate. 

In a study where 1,433 trials were conducted from 0.3 million people in the U.S. between 2016 and 2019, the average share of women was  41.2%. In psychiatry, where women comprised 60% of patients, the share of women participating in clinical trials was 42%. Similarly, the difference was significantly high in the case of cardiovascular diseases (41.9% female participants vs. 49% female patients) and cancer trials (41% female participants vs. 51% female patients)

Gender disparity is also observed in research funding. For instance, according to the National Institutes of Health (NIH) data, the 2023 research funding estimate for substance misuse (a condition more prevalent among men) was $2,583 million while that for depression (a condition more prevalent among women) was $664 million. Similarly, research funding in 2022 for HIV/AIDS, a disease more prominent among men (DALY of 0.361 million in 2015) was $3,294 million, while that for inflammatory bowel disease (IBD), a disease dominant among women (DALY of 0.475 million) was $203 million. (expand DALY somewhere)

To know more about the gender gap in clinical trials and research funding, click here

Women faced the challenge of a gender gap in testing, diagnosis and treatment, which arose from a lack of comprehensive research about conditions dominant among women and biases toward women in healthcare.

In a multicentre observational study published in 2023, it was revealed that the median time taken to diagnose IBD from the onset of a symptom was more prolonged in women than in men. For instance, it took about 12.6 months to diagnose Crohn’s disease (a type of IBD) for women, while it only took 4.5 months for men. Similarly, it took 6.1 months for women and 2.7 months for men, in the case of ulcerative colitis.

NIH data also revealed that funding given for women’s reproductive disorders was significantly lower than that for conditions with a similar disease burden. 

Polycystic ovary syndrome (PCOS) is a common endocrine-metabolic abnormality among women with a worldwide prevalence of up to 21%, depending on diagnostic criteria. Yet, while diseases with equal or lesser disease burden like rheumatoid arthritis, tuberculosis, and systemic lupus erythematosus, were awarded funds worth $454.39 million, $773.77 million, and $609.52 million respectively, the funding for PCOS research between 2006 and 2015 was limited to $215.12 million. 

Thus, a limited understanding of disease further delays diagnosis, especially for diseases affecting women’s reproductive system. 

In the Indian context, the taboo towards menstrual health in society, which extends to the health sector adds to this problem. Endometriosis, a disease that affects roughly 10% (190 million) of women and girls of reproductive age worldwide according to the WHO, is highly underreported in the country. 

Despite persistent visits to multiple gynaecologists over a decade, my journey to obtain a proper diagnosis for endometriosis was marked by significant delays. My experiences of enduring intense menstrual cramps, accompanied by nausea and bowel disorders, were consistently dismissed by doctors who attributed them to natural menstrual processes. Prescription of painkillers became routine without a genuine effort to comprehend the severity of my discomfort or suggest diagnostic scans for underlying issues. Only after my insistence, despite initial reluctance from doctors, did I finally receive a diagnosis. Regrettably, by that time, the lesions within my ovaries had grown larger than the organs themselves.

Even with a diagnosis, treatment options remain limited due to the narrow understanding of this condition. While invasive surgeries like laparoscopic procedures and hormonal medications seem to be the only options, these treatments come with significant side effects and cannot guarantee the complete eradication of recurring lesions.

In an article titled, “Male-centric medicine is affecting women’s health” in The Hindu, the author explains that women are less likely to receive appropriate medications, diagnostic tests and clinical procedures even in developed countries such as Canada and Sweden as the stereotype of the “hysterical woman” continues to haunt women even when they need urgent clinical interventions. 

Therefore, it is crucial to implement appropriate interventions, create awareness within the medical community to mitigate bias and push for gender-sensitive clinical trials and equitable allocation of research funding. These measures are imperative to ensure equal and unbiased healthcare for all individuals, regardless of their gender among other identities.

Fortnightly figures

  • 10.3% was the decrease in India’s merchandise exports in May 2023 at $34.98 billion from $39 billion in May 2022. Imports contracted at a slower 6.6% rate to $57.1 billion, lifting the trade deficit to a five-month high of $22.1 billion. This is the sixth time in the last eight months that goods exports have declined year-on-year, although May’s decline was lower than the 12.6% fall recorded in April.
  • 110 million people have had to flee their homes because of conflict, persecution, or human rights violations, the UN High Commissioner for Refugees (UNHCR) said. The war in Sudan, which has displaced nearly 2 million people since April, is but the latest in a long list of crises that have led to the record-breaking figure. Last year alone, an additional 19 million people were displaced, including more than 11 million who fled Russia’s invasion of Ukraine in the fastest and largest displacement of people since World War II.
  • 1 lakh people were shifted to approximately 1,500 temporary shelters set up as part of the disaster management efforts by the Gujarat State against Cyclone Biparjoy before the cyclone made landfall. Cyclone Biparjoy caused widespread damage in Gujarat’s Kutch-Saurashtra region as it made landfall late on June 15, Thursday. The Gujarat government also shut schools and other educational institutions for the next day as the State received heavy downpours in the aftermath of the cyclonic storm.
  • 4.25% was India’s retail inflation in May from 4.7% in April this year, a 20-month low. The price rise in food items faced by consumers moderated to 2.91%. This is the third successive month that inflation has remained below the Reserve Bank of India’s (RBI’s) upper tolerance limit of 6% after a prolonged streak above it. Base effects from May 2022 when retail inflation was over 7% also played a role in lowering the inflation rate this May.
  • ₹1.13 lakh crore was the third instalment of tax devolution released by the Centre to States, according to the Finance Ministry. This surpasses the normal monthly devolution of  ₹59,140 crore. The additional advance aims to enable expedited capital spending, financing of development/welfare-related expenditure and increased resource availability for projects and schemes of the States.

Thank you for reading this week’s edition of the Data Point newsletter! To subscribe, click here. Please send your feedback to [email protected]

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Breast density changes over time could be linked to breast cancer risk, study finds | CNN

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CNN
 — 

Breast density is known to naturally decrease as a woman ages, and now a study suggests that the more time it takes for breast density to decline, the more likely it is that the woman could develop breast cancer.

Researchers have long known that women with dense breasts have a higher risk of breast cancer. But according to the study, published last week in the journal JAMA Oncology, the rate of breast density changes over time also appears to be associated with the risk of cancer being diagnosed in that breast.

“We know that invasive breast cancer is rarely diagnosed simultaneously in both breasts, thus it is not a surprise that we have observed a much slower decline in the breast that eventually developed breast cancer compared to the natural decline in density with age,” Shu Jiang, an associate professor of surgery at Washington University School of Medicine in St. Louis and first author of the new study, wrote in an email.

Breast density refers to the amount of fibrous and glandular tissue in a person’s breasts compared with the amount of fatty tissue in the breasts – and breast density can be seen on a mammogram.

“Because women have their mammograms taken annually or biennially, the change of breast density over time is naturally available,” Jiang said in the email. “We should make full use of this dynamic information to better inform risk stratification and guide more individualized screening and prevention approaches.”

The researchers, from Washington University School of Medicine in St. Louis and Brigham and Women’s Hospital in Boston, analyzed health data over the course of 10 years among 947 women in the St. Louis region who completed routine mammograms. A mammogram is an X-ray picture of the breast that doctors use to look for early signs of breast cancer.

The women in the study were recruited from November 2008 to April 2012, and they had gotten mammograms through October 2020. The average age of the participants was around 57.

Among the women, there were 289 cases of breast cancer diagnosed, and the researchers found that breast density was higher at the start of the study for the women who later developed breast cancer compared with those who remained cancer-free.

The researchers also found that there was a significant decrease in breast density among all the women over the course of 10 years, regardless of whether they later developed breast cancer, but the rate of density decreasing over time was significantly slower among breasts in which cancer was later diagnosed.

“This study found that evaluating longitudinal changes in breast density from digital mammograms may offer an additional tool for assessing risk of breast cancer and subsequent risk reduction strategies,” the researchers wrote.

Not only is breast density a known risk factor for breast cancer, dense breast tissue can make mammograms more difficult to read.

“There are two issues here. First, breast density can make it more difficult to fully ‘see through’ the breast on a mammogram, like looking through a frosted glass. Thus, it can be harder to detect a breast cancer,” Dr. Hal Burstein, clinical investigator in the Breast Oncology Center at Dana-Farber Cancer Institute, who was not involved in the new study, said in an email. “Secondly, breast density is often thought to reflect the estrogen exposure or estrogen levels in women, and the greater the estrogen exposure, the greater the risk of developing breast cancer.”

In March, the US Food and Drug Administration published updates to its mammography regulations, requiring mammography facilities to notify patients about the density of their breasts.

“Breast density can have a masking effect on mammography, where it can be more difficult to find a breast cancer within an area of dense breast tissue,” Jiang wrote in her email.

“Even when you take away the issue of finding it, breast density is an independent risk factor for developing breast cancer. Although there is lots of data that tell us dense breast tissue is a risk factor, the reason for this is not clear,” she said. “It may be that development of dense tissue and cancer are related to the same biological processes or hormonal influences.”

The findings of the new study demonstrate that breast density serves as a risk factor for breast cancer – but women should be aware of their other risk factors too, said Dr. Maxine Jochelson, chief of the breast imaging service at Memorial Sloan Kettering Cancer Center in New York, who was not involved in the study.

“It makes sense to some extent that the longer your breast stays dense, theoretically, the more likely it is to develop cancer. And so basically, it expands on the data that dense breasts are a risk,” Jochelson said, adding that women with dense breasts should ask for supplemental imaging when they get mammograms.

But other factors that can raise the risk of breast cancer include having a family history of cancer, drinking too much alcohol, having a high-risk lesion biopsied from the breast or having a certain genetic mutation.

For instance, women should know that “density may not affect their risk so much if they have the breast cancer BRCA 1 or 2 mutation because their risk is so high that it may not make it much higher,” Jochelson said.

Some ways to reduce the risk of breast cancer include keeping a healthy weight, being physically active, drinking alcohol in moderation or not at all and, for some people, taking medications such as tamoxifen and breastfeeding your children, if possible.

“Breast density is a modest risk factor. The ‘average’ woman in the US has a 1 in 8 lifetime chance of developing breast cancer. Women with dense breasts have a slightly greater risk, about 1 in 6, or 1 in 7. So the lifetime risk goes up from 12% to 15%. That still means that most women with dense breasts will not develop breast cancer,” Burstein said in his email.

“Sometimes radiologists will recommend additional breast imaging to women with dense breast tissue on mammograms,” he added.

The US Preventive Services Task Force – a group of independent medical experts whose recommendations help guide doctors’ decisions – recommends biennial screening for women starting at age 50. The task force says that a decision to start screening earlier “should be an individual one.” Many medical groups, including the American Cancer Society and Mayo Clinic, emphasize that women have the option to start screening with a mammogram every year starting at age 40.

“It’s also very clear that breast density tends to be highest in younger women, premenopausal women, and for almost all women, it tends to go down with age. However, the risk of breast cancer goes up with age. So these two things are a little bit at odds with each other,” said Dr. Freya Schnabel, director of breast surgery at NYU Langone’s Perlmutter Cancer Center and professor of surgery at NYU Grossman School of Medicine in New York, who was not involved in the new study.

“So if you’re a 40-year-old woman and your breasts are dense, you could think about that as just being really kind of age-appropriate,” she said. “The take-home message that’s very, very practical and pragmatic right now is that if you have dense breasts, whatever your age is, even if you’re postmenopausal – maybe even specifically, if you are postmenopausal – and your breasts are not getting less dense the way the average woman’s does, that it really is a reason to seek out adjunctive imaging in addition to just mammography, to use additional diagnostic tools, like ultrasound or maybe even MRI, if there are other risk factors.”

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New study suggests Black women should be screened earlier for breast cancer | CNN

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CNN
 — 

A new study on breast cancer deaths raises questions around whether Black women should screen at earlier ages.

An international team of researchers wrote in the study, published Wednesday in the journal JAMA Network Open, that clinical trials may be warranted to investigate whether screening guidelines should recommend Black women start screening at younger ages, around 42 instead of 50.

The US Preventive Services Task Force – a group of independent medical experts whose recommendations help guide doctors’ decisions – recommends biennial screening for women starting at age 50. The Task Force says that a decision to start screening prior to 50 “should be an individual one.” Many medical groups, including the American Cancer Society and Mayo Clinic, already emphasize that women have the option to start screening with a mammogram every year starting at age 40.

Even though Black women have a 4% lower incidence rate of breast cancer than White women, they have a 40% higher breast cancer death rate.

“The take-home message for US clinicians and health policy makers is simple. Clinicians and radiologists should consider race and ethnicity when determining the age at which breast cancer screening should begin,” Dr. Mahdi Fallah, an author of the new study and leader of Risk Adapted Cancer Prevention Group at the German Cancer Research Center in Heidelberg, Germany, said in an email.

“Also, health policy makers can consider a risk-adapted approach to breast cancer screening to address racial disparities in breast cancer mortality, especially the mortality before the recommended age of population screening,” said Fallah, who is also a visiting professor at Lund University in Sweden and an adjunct professor at the University of Bern in Switzerland.

Breast cancer screenings are typically performed using a mammogram, which is an X-ray picture taken of the breast that doctors examine to look for early signs of breast cancer developing.

“Guidelines for screening actually already do recommend basing a woman’s time to initiate screening on the risk of developing cancer, though race and ethnicity have not been traditional factors that go into these decisions,” Dr. Rachel Freedman, a breast oncologist at Dana-Farber Cancer Institute, who was not involved in the new study, said in an email.

The American Cancer Society currently recommends that all women consider mammogram screenings for breast cancer risk starting at the age of 40 – and for women 45 to 54, it’s recommended to get mammograms every year. Those 55 and older can switch to screening every other year if they choose.

But “we are in the process of updating our breast cancer screening guidelines, and we are examining the scientific literature for how screening guidelines could differ for women in different racial and ethnic groups, and by other risk factors, in a way that would reduce disparities based on risk and disparities in outcome,” Robert Smith, senior vice president for cancer screening at the American Cancer Society, who was not involved in the new study, said in an email. “We are examining these issues closely.”

The American Cancer Society’s recommendations appear to align with the findings in the new study, as the research highlights how screening guidelines should not be a “one-size-fits-all policy,” but rather help guide conversations that patients and their doctors have together.

“We, here at the American Cancer Society, strongly recommend that all women consider a screening mammogram from the age of 40 onwards, and that means having a discussion with their doctor,” said Dr. Arif Kamal, the American Cancer Society’s chief patient officer, who was not involved in the new study.

“The authors highlight that age 50 can be a little late,” Kamal said about the study’s findings on when to begin breast cancer screening. “We are in agreement with that, particularly for women who may be at slightly higher risk.”

The researchers – from China, Germany, Sweden, Switzerland and Norway – analyzed data on 415,277 women in the United States who died of breast cancer in 2011 to 2020. That data on invasive breast cancer mortality rates came from the National Center for Health Statistics and was analyzed with the National Cancer Institute’s SEER statistical software.

When the researchers examined the data by race, ethnicity and age, they found that the rate of breast cancer deaths among women in their 40s was 27 deaths per 100,000 person-years for Black women compared with 15 deaths per 100,000 in White women and 11 deaths per 100,000 in American Indian, Alaska Native, Hispanic and Asian or Pacific Islander women.

“When the breast cancer mortality rate for Black women in their 40s is 27 deaths per 100,000 person-years, this means 27 out of every 100,000 Black women aged 40-49 in the US die of breast cancer during one year of follow-up. In other words, 0.027% of Black women aged 40-49 die of breast cancer each year,” Fallah said in the email.

In general, for women in the United States, their average risk of dying from breast cancer in the decade after they turn 50, from age 50 to 59, is 0.329%, according to the study.

“However, this risk level is reached at different ages for women from different racial/ethnic groups,” Fallah said. “Black women tend to reach this risk level of 0.329% earlier, at age 42. White women tend to reach it at age 51, American Indian or Alaska Native and Hispanic women at age 57 years, and Asian or Pacific Islander women later, at age 61.”

So, the researchers determined that when recommending breast cancer screening at age 50 for women, Black women should start at age 42.

Yet “the authors didn’t have any information on whether the women included in this study actually had mammographic screening and at what age. For example, it is possible that many women in this study actually had screening during ages 40-49,” Freedman, of the Dana-Farber Cancer Institute, said in her email.

“This study confirms that the age of breast cancer-mortality is younger for Black women, but it doesn’t confirm why and if screening is even the main reason. We have no information about the types of cancers women developed and what treatment they had either, both of which impact mortality from breast cancer,” she said.

The harm of starting mammograms at a younger age is that it raises the risk of a false positive screening result – leading to unnecessary subsequent tests and emotional stress.

But the researchers wrote in their study that “the added risk of false positives from earlier screenings may be balanced by the benefits” linked with earlier breast cancer detection.

They also wrote that health policy makers should pursue equity, not just equality, when it comes to breast cancer screening as a tool to help reduce breast cancer death rates.

Equality in the context of breast cancer screening “means that everyone is screened from the same age regardless of risk level. On the other hand, equity or risk-adapted screening means that everyone is provided screening according to their individual risk level,” the researchers wrote. “We believe that a fair and risk-adapted screening program may also be associated with optimized resource allocation.”

The new study is “timely and relevant,” given the overall higher mortality rate for breast cancer in Black women and that Black women are more likely to be diagnosed at a younger age compared with other ethnic groups, Dr. Kathie-Ann Joseph, surgical oncologist at NYU Langone’s Perlmutter Cancer Center and professor of surgery and population health at the NYU Grossman School of Medicine, said in an email.

“While some may argue that earlier screening may lead to increased recalls and unnecessary biopsies, women get recalled for additional imaging about 10% of the time and biopsies are needed in 1-2% of cases, which is quite low,” said Joseph, who was not involved in the new study.

“This has to be compared to the lives saved from earlier screening mammography,” she said. “I would also like to point out that while we certainly want to prevent deaths, earlier screening can have other benefits by allowing women of all racial and ethnic groups to have less extensive surgery and less chemotherapy which impacts quality of life.”

Breast cancer is the most common cancer among women in the United States, except for skin cancers. This year, it is estimated that about 43,700 women will die from the disease, according to the American Cancer Society, and Black women have the highest death rate from breast cancer.

Even though Black women are 40% more likely than White women to die from the disease, Kamal of the American Cancer Society said that the disparity in deaths is not a result of Black women not following the current mammogram guidelines.

Rather, implicit bias in medicine plays a role.

“In the United States, across the country, there are not differences in mammogram screening rates among Black women and White women. In fact, across the entire country, the number is about 75%. We see about 3 in 4 women – Black, White, Hispanic, and Asian – are on time with their mammograms,” Kamal said.

Yet there are multiple timepoints after a patient is diagnosed with breast cancer where they may not receive the same quality of care or access to care as their peers.

“For example, Black women are less likely to be offered enrollment in a clinical trial. That is not because of a stated difference in interest. In fact, the enrollment rate in clinical trials is equal among Black women and White women, if they’re asked,” Kamal said.

“What we have to understand is where the implicit and systemic biases held by patients and their caregivers and their families may exist – those that are held within health systems and even policies and practices that impede everyone having fair and just access to high quality health care,” he said.

Additionally, Black women have nearly a three-fold increased risk of triple-negative breast cancers. Those particular type of cancers tend to be more common in women younger than 40, grow faster than other types of invasive breast cancer and have fewer treatment options.

Black women also tend to have denser breast tissue than White women. Having dense tissue in the breast can make it more difficult for radiologists to identify breast cancer on a mammogram, and women with dense breast tissue have a higher risk of breast cancer.

But such biological differences among women represent just a small part of a much larger discussion around racial disparities in breast cancer, Kamal said.

“There are systemic issues, access to care issues that really go beyond biology,” he said. “The reality is cancer affects everybody and it does not discriminate. Where the discrimination sometimes occurs is after the diagnosis, and that’s really what we need to focus on.”

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#study #suggests #Black #women #screened #earlier #breast #cancer #CNN

Florida Bill Doing Best To Out-Worst All Other Bans On Gender-Affirming Care

Post By Politics , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

As Yr Wonkette covered yesterday, and as brought to our attention by the invaluable Erin in the Morning, the state of Florida (Motto: “America’s Useless Appendage”) is considering a whole swath of terrible legislation that if passed, would make life even more miserable for LGBTQ+ people there. It’s understandable, really — there are so many Republicans in the state Legislature, and they all want a turn at proving that they can hate LGBTQ+ folks as much or more than their peers.

Read More:

Florida LGBTQ Hate Bills Want Some Bigot To Have ‘Parental Rights’ Over Everybody Else’s Children

Red States About Five Minutes Away From Legalized Lynching Of Trans People

What IS Gender Affirming Health Care For Kids Anyway, Because Texas Is Super F*cking Lying About It Right?

Today, we’ll take a closer look (again, thanks to Erin Reed) at just one of those very bad ideas, Florida HB 1421, which drunkenly tells other states’ bans on gender affirming care for trans youth, “Hold my beer” before jumping on a skateboard and launching itself into the abyss. A Florida House subcommittee yesterday voted to move HB 1421 out of committee. After hearings in a second committee, the bill is likely to be sent to the full House, where it’s likely to pass. It’s Florida, and Republicans have an 85-35 majority of seats.

It’s not only an extremist bill, it’s also so broadly written that in attempting to outlaw gender-affirming care for minors, it also may make mastectomies for breast cancer illegal and ban hormone treatments for menopause. We can’t entirely guarantee that’s a mistake. The bill doesn’t simply ban gender-affirming treatment going forward: It would force detransition on trans youth. All minors currently receiving puberty blockers or hormone replacement therapy would have to end treatment by December 31 of this year. Such forced detransitioning is almost certain to lead to suicides, not that the psycho bigots supporting the bill care.

As ever: If you’re having thoughts of harming yourself, call the national suicide and crisis lifeline at 988.

This being Florida, the bill keeps getting worse. One provision would allow the state to take trans kids from their parents to “protect” them from getting gender-affirming care in another state.

As with several similar bills around the country, the law also forbids insurance plans from covering gender-affirming care for adults, because the bill’s sponsor, the dubiously named Rep. Randy Fine — a former gambling industry executive, not a doctor — says he believes all medical care for trans people is merely “a cosmetic-type procedure, and not necessarily a procedure that would improve their health.” Yes, of course he’s ignoring the consensus among medical organizations that transition is the treatment for gender dysphoria, and that, yes, it saves lives.

Because the bill bans the state from paying for any gender-affirming care, it would also result in forcible detransition for incarcerated trans people. The bill’s sponsor was very clear on that when another state representative asked. Further, the blanket prohibition on puberty blockers and hormone therapy would probably prohibit some treatments for stunted growth in children. Another legislator said that, as she read the bill, it may ban contraception for minors, although Fine said he didn’t think it would.

HB 1421 also prohibits any changes to birth certificates to reflect an adult’s gender identity. State Rep. Kelly Skidmore (D) had questions about why a bill supposedly aimed at “protecting” children would do that; Fine (again, not a doctor) explained that “your biology cannot be changed,” to which Skidmore replied, “Doctors would disagree. […] You can change your biology. That’s the point of gender-affirming care and surgery.”

Fine then muttered something about chromosomes, which kind of ignores the fact that hormone therapy very definitely changes a person’s biology, what with the differences in hair growth, body chemistry, and so on. But not chromosomes!

Fine went on to explain that gender-affirming care for minors is “child abuse,” although he acknowledged that’s his personal opinion, not actually a law. But co-sponsor Rep. Ralph Massullo — who somehow is a doctor — insisted it was just like “If you chop your sons arm off it’s child abuse,” so there’s a doctor who knows his stuff. Massullo also explained, contrary to the medical consensus, that since gender dysphoria is all in trans people’s heads, they should see a therapist and get cured through good old conversion therapy, which doesn’t work.

The most glaringly insane part of the bill is the former gambling executive’s medically muddy definition of “gender clinical interventions,” a term that isn’t actually from medicine. HB 1421 defines such interventions as

procedures or therapies that alter internal or external physical traits.

The term includes, but is not limited to:

1. Sex reassignment surgeries or any other surgical procedures that alter primary or secondary sexual characteristics.

2. Puberty blocking, hormone, and hormone antagonistic therapies.

The bill allows a few exceptions, such as for treatment of infants born with ambiguous genitalia, and of course for treatments to reverse gender-affirming care, but that’s about it; as House Democrats pointed out, the broad prohibitions on altering “primary or secondary sexual characteristics” appears to ban mastectomies, breast reduction or enhancement, maybe prostate surgery, and who knows, maybe even penile implants for treatment of erectile dysfunction.

But wait! Since it only applies to minors, Fine figured that wouldn’t be a problem. During questioning by state Rep. Christine Hunschofsky (D), Fine was surprised to hear that minors can even have breast cancer, though he remained skeptical of that anyway, and mocked what he said was the “pervasive problem of youth breast cancer.” Probably just an excuse to get top surgery, right sir?

Oh yes, and because it’s so sloppily written, the bill would also ban insurance from covering breast cancer mastectomies — for adults too, since the insurance ban is for all “gender clinical interventions,” regardless of the patient’s age.

Will Larkins, an 18-year-old high school student, testified against the bill, telling the committee members that his transgender friends would be directly harmed by the bill, not “protected.” He begged the lawmakers to at least agree to a Democratic amendment that would allow youth who have already begun treatment to continue it.

“That health care has saved their lives. You will kill them. I am telling you right now — look me in the eyes — you will kill them if you pass this bill and you don’t pass this amendment. […] You will kill them if you force them to detransition.”

The committee rejected the amendment, because there are no trans people in Florida, just punching bags to beat up on for the cameras.

This is where we wish we could tell you that HB 1421 is so obviously unconstitutional that there’s no chance it will pass and be signed into law, but you’ve been here for a while and you wouldn’t ever fall for a hopeful lie like that. We don’t even think they’d listen to our new hero, Grace Linn, that wonderful centenarian wonder woman. But who knows? Bet she’d make a trans lives matter quilt if she thought it would help.

[HuffPo / Florida HB 1421 / Erin Reed on Twitter / New Republic / Image generated by DreamStudio Lite AI]

Yr Wonkette is funded entirely by reader donations. If you can, please give $5 or $10 a month so we can keep you up to date on the horror show parts of our nation seem bent on becoming. We can’t let the bastards get away with this.

Do your Amazon shopping through this link, because reasons.



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#Florida #Bill #OutWorst #Bans #GenderAffirming #Care

After Breast Cancer: Fitness and Nutrition Tips

Post By Health , , ,

When you finish treatment for breast cancer, you might have a mix of feelings. Going through treatment is physically and mentally exhausting, with many side effects from chemotherapy, radiation, surgery, and immunotherapy. Once the treatment phase is over, is there anything you can do to boost your odds of staying cancer-free?

The answer is YES. There’s a lot you can do in your everyday life — in addition to taking any meds your doctor prescribes to help prevent recurrence and keeping up with your screenings.

Cancer experts have long advised breast cancer survivors that the same healthy lifestyle habits that have been shown to lower your chance of developing breast cancer in the first place are also likely to cut the risk of breast cancer recurrence. In the past, that advice was based mostly on expert opinion.

But more recently, studies specifically done on breast cancer survivors have added weight to that opinion. These findings suggest that regular physical activity and a healthy diet that is high in vegetables, fruits, whole grains, and beans and low in processed carbohydrates and high in fiber can help guard against breast recurrence and death.

You’ve Got to Move It, Move It

Being physically active has clear benefits.

Women who got regular physical activity before their cancer diagnosis and after treatment are less likely to have their cancer come back or to die compared with those who were inactive. That’s according to a 2020 study from researchers at Roswell Park Comprehensive Cancer Center in Buffalo, NY. 

The study focused on 1,340 women with breast cancer and the Department of Health and Human Services (HHS) physical activity guidelines for adults, which are to get at least 150 minutes of moderate-intensity physical activity and 2 days of muscle-strengthening activity every week. In the study, women who did that were less likely to have their cancer come back than those who were inactive. They also were less likely to die over the 2 years of the study period. Even those who were considered to be “low active,” meaning that they came close to meeting the recommended activity levels but didn’t quite get there, had improved survival, as well. 

Fitness Tips for Breast Cancer Survivors

Your body has been through a lot – from the cancer itself to the treatments for it. No one is expecting you to run a marathon unless you want to. But don’t underestimate the power of regular movement.

 

Start small. Even a daily 15-minute walk has benefits. “You don’t have to do a lot of intense workouts to benefit,” says Karen Basen-Engquist, PhD, the director of the Center for Energy Balance in Cancer Prevention and Survivorship at The University of Texas MD Anderson Cancer Center. “It can be hard to begin exercising when you’re experiencing fatigue related to cancer treatment, but moving just a small amount most days can help you reach the point where you can do more.”

Tell your doctor. You may have glossed over the guidance you often see in fitness magazines: “Consult your doctor before starting any exercise program.” Don’t ignore that advice this time. Check with your treatment team to see how much exercise they feel you can handle at this point in your recovery.

Set realistic expectations. If you were running an 8-minute mile before you started chemotherapy, don’t expect to be able to match that pace 3 or 4 months after your last dose. And that’s OK.

Don’t stress your bones and joints. This is especially important if you’ve had bone loss related to chemotherapy. Instead of running or high-impact aerobics, which could add to your risk of fractures, start with walking. Or try swimming, a no-impact way to work your muscles and your cardiovascular system.

Be aware of your ability to balance. If you have neuropathy (tingling or numbness) in your feet or hands after chemotherapy, that can affect your balance. Be careful about activities where you might risk falling. Instead of running on a treadmill, for example, you might prefer to work out on an exercise bicycle.

Make time for strength training. It can make a difference in your daily life. “While we can’t say whether or not it improves overall survival, the evidence shows that breast cancer survivors who do strength training see improvements in their fatigue, quality of life, and physical functioning,” Basen-Engquist says.

What to Eat: Leafy Greens and Smart Carb Intake

What about food? The good news is that the general principles of healthy eating are also beneficial for breast cancer survivors.

Two recent studies suggest that a healthy diet can help breast cancer survivors live longer. Both studies involve data from about a quarter of a million women who took part in two large observational studies called the Nurses’ Health Studies. The studies followed these women, all of whom were under 55 and cancer-free when they began, for up to 30 years. By 2011, about 9,000 of the study participants had been diagnosed with breast cancer.

The first study found that women who ate the greatest amounts of fruits and vegetables after their breast cancer diagnosis had an overall lower risk of dying during the course of the study compared to those who ate the least amounts. 

When the researchers dug deeper, they found that it was leafy greens and cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts that were driving most of the benefits. Women who ate almost a full serving of cruciferous vegetables daily had a 13% lower risk of dying from any cause during the study, compared to those who ate almost none of these vegetables. And women who ate almost two servings of leafy greens daily were 20% less likely to die, compared to those who ate almost no greens.

Carbs were key in the second study – specifically, what kinds or types of carbs women ate. It found that high glycemic load carbs — those that cause your blood sugar to spike, like sugary beverages, processed foods like chips and doughnuts, and fast food like cheeseburgers and french fries — posed an increased risk. Breast cancer survivors with high glycemic load diets were more likely to die of breast cancer than those who ate lower glycemic load diets. They also found that women who ate high-fiber diets had a lower risk of death than those who ate diets low in fiber.

The bottom line: Eat more fruits, vegetables, and whole grains. 

“Taken together, the research suggests that women diagnosed with breast cancer may benefit from eating a diet high in fruits and vegetables and eating less rapidly digested foods sources, such as whole grains and non-starchy vegetables,” says Nigel Brockton, PhD, vice president of research for the American Institute of Cancer Research (AICR). 

And there was good news for fans of tofu and edamame: Despite past concerns that the estrogen-like properties of soy might contribute to breast cancer, evidence now shows that the opposite is true. “If anything, soy has a beneficial effect and may even reduce the risk of breast cancer recurrence,” Brockton says.

Maintaining a Healthy Weight 

In general, getting regular physical activity and eating a healthy diet can help keep you from gaining too much weight, something that researchers have also found is important after breast cancer. 

“There is strong evidence that a higher body mass index after diagnosis is associated with poorer outcomes in breast cancer,” Brockton says. “Avoiding weight gain and doing your best to stay at a healthy weight is important.”

Overall, Brockton says that the AICR’s recommendations about diet and physical activity for cancer prevention are still wise advice for breast cancer survivors to avoid a recurrence. These include:

  • Maintain a healthy weight.
  • Be physically active.
  • Eat more whole grains, vegetables, fruits, and legumes (like beans).
  • Avoid sugary drinks and limit your intake of fast foods and processed foods high in fats, starches, and sugars.
  • Limit red meats like beef, pork, and lamb.
  • Avoid processed meats and alcohol.

Source link

#Breast #Cancer #Fitness #Nutrition #Tips

After Breast Cancer: Fitness and Nutrition Tips

Post By Health , , ,

When you finish treatment for breast cancer, you might have a mix of feelings. Going through treatment is physically and mentally exhausting, with many side effects from chemotherapy, radiation, surgery, and immunotherapy. Once the treatment phase is over, is there anything you can do to boost your odds of staying cancer-free?

The answer is YES. There’s a lot you can do in your everyday life — in addition to taking any meds your doctor prescribes to help prevent recurrence and keeping up with your screenings.

Cancer experts have long advised breast cancer survivors that the same healthy lifestyle habits that have been shown to lower your chance of developing breast cancer in the first place are also likely to cut the risk of breast cancer recurrence. In the past, that advice was based mostly on expert opinion.

But more recently, studies specifically done on breast cancer survivors have added weight to that opinion. These findings suggest that regular physical activity and a healthy diet that is high in vegetables, fruits, whole grains, and beans and low in processed carbohydrates and high in fiber can help guard against breast recurrence and death.

You’ve Got to Move It, Move It

Being physically active has clear benefits.

Women who got regular physical activity before their cancer diagnosis and after treatment are less likely to have their cancer come back or to die compared with those who were inactive. That’s according to a 2020 study from researchers at Roswell Park Comprehensive Cancer Center in Buffalo, NY. 

The study focused on 1,340 women with breast cancer and the Department of Health and Human Services (HHS) physical activity guidelines for adults, which are to get at least 150 minutes of moderate-intensity physical activity and 2 days of muscle-strengthening activity every week. In the study, women who did that were less likely to have their cancer come back than those who were inactive. They also were less likely to die over the 2 years of the study period. Even those who were considered to be “low active,” meaning that they came close to meeting the recommended activity levels but didn’t quite get there, had improved survival, as well. 

Fitness Tips for Breast Cancer Survivors

Your body has been through a lot – from the cancer itself to the treatments for it. No one is expecting you to run a marathon unless you want to. But don’t underestimate the power of regular movement.

 

Start small. Even a daily 15-minute walk has benefits. “You don’t have to do a lot of intense workouts to benefit,” says Karen Basen-Engquist, PhD, the director of the Center for Energy Balance in Cancer Prevention and Survivorship at The University of Texas MD Anderson Cancer Center. “It can be hard to begin exercising when you’re experiencing fatigue related to cancer treatment, but moving just a small amount most days can help you reach the point where you can do more.”

Tell your doctor. You may have glossed over the guidance you often see in fitness magazines: “Consult your doctor before starting any exercise program.” Don’t ignore that advice this time. Check with your treatment team to see how much exercise they feel you can handle at this point in your recovery.

Set realistic expectations. If you were running an 8-minute mile before you started chemotherapy, don’t expect to be able to match that pace 3 or 4 months after your last dose. And that’s OK.

Don’t stress your bones and joints. This is especially important if you’ve had bone loss related to chemotherapy. Instead of running or high-impact aerobics, which could add to your risk of fractures, start with walking. Or try swimming, a no-impact way to work your muscles and your cardiovascular system.

Be aware of your ability to balance. If you have neuropathy (tingling or numbness) in your feet or hands after chemotherapy, that can affect your balance. Be careful about activities where you might risk falling. Instead of running on a treadmill, for example, you might prefer to work out on an exercise bicycle.

Make time for strength training. It can make a difference in your daily life. “While we can’t say whether or not it improves overall survival, the evidence shows that breast cancer survivors who do strength training see improvements in their fatigue, quality of life, and physical functioning,” Basen-Engquist says.

What to Eat: Leafy Greens and Smart Carb Intake

What about food? The good news is that the general principles of healthy eating are also beneficial for breast cancer survivors.

Two recent studies suggest that a healthy diet can help breast cancer survivors live longer. Both studies involve data from about a quarter of a million women who took part in two large observational studies called the Nurses’ Health Studies. The studies followed these women, all of whom were under 55 and cancer-free when they began, for up to 30 years. By 2011, about 9,000 of the study participants had been diagnosed with breast cancer.

The first study found that women who ate the greatest amounts of fruits and vegetables after their breast cancer diagnosis had an overall lower risk of dying during the course of the study compared to those who ate the least amounts. 

When the researchers dug deeper, they found that it was leafy greens and cruciferous vegetables like broccoli, cauliflower, and Brussels sprouts that were driving most of the benefits. Women who ate almost a full serving of cruciferous vegetables daily had a 13% lower risk of dying from any cause during the study, compared to those who ate almost none of these vegetables. And women who ate almost two servings of leafy greens daily were 20% less likely to die, compared to those who ate almost no greens.

Carbs were key in the second study – specifically, what kinds or types of carbs women ate. It found that high glycemic load carbs — those that cause your blood sugar to spike, like sugary beverages, processed foods like chips and doughnuts, and fast food like cheeseburgers and french fries — posed an increased risk. Breast cancer survivors with high glycemic load diets were more likely to die of breast cancer than those who ate lower glycemic load diets. They also found that women who ate high-fiber diets had a lower risk of death than those who ate diets low in fiber.

The bottom line: Eat more fruits, vegetables, and whole grains. 

“Taken together, the research suggests that women diagnosed with breast cancer may benefit from eating a diet high in fruits and vegetables and eating less rapidly digested foods sources, such as whole grains and non-starchy vegetables,” says Nigel Brockton, PhD, vice president of research for the American Institute of Cancer Research (AICR). 

And there was good news for fans of tofu and edamame: Despite past concerns that the estrogen-like properties of soy might contribute to breast cancer, evidence now shows that the opposite is true. “If anything, soy has a beneficial effect and may even reduce the risk of breast cancer recurrence,” Brockton says.

Maintaining a Healthy Weight 

In general, getting regular physical activity and eating a healthy diet can help keep you from gaining too much weight, something that researchers have also found is important after breast cancer. 

“There is strong evidence that a higher body mass index after diagnosis is associated with poorer outcomes in breast cancer,” Brockton says. “Avoiding weight gain and doing your best to stay at a healthy weight is important.”

Overall, Brockton says that the AICR’s recommendations about diet and physical activity for cancer prevention are still wise advice for breast cancer survivors to avoid a recurrence. These include:

  • Maintain a healthy weight.
  • Be physically active.
  • Eat more whole grains, vegetables, fruits, and legumes (like beans).
  • Avoid sugary drinks and limit your intake of fast foods and processed foods high in fats, starches, and sugars.
  • Limit red meats like beef, pork, and lamb.
  • Avoid processed meats and alcohol.

Source link

#Breast #Cancer #Fitness #Nutrition #Tips

Some experts say more women should consider removing fallopian tubes to reduce cancer risk | CNN

Post By Health , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,



CNN
 — 

“Knowledge is power,” says Samantha Carlucci, 26. The Ravena, New York, resident recently had a hysterectomy that included removing her fallopian tubes – and believes it saved her life.

The Ovarian Cancer Research Alliance is drawing attention to the role of fallopian tubes in many cases of ovarian cancer and now says more women, including those with average risk, should consider having their tubes removed to cut their cancer risk.

About 20,000 women in the US were diagnosed with ovarian cancer in 2022, according to the National Cancer Institute, and nearly 13,000 died.

Experts have not discovered a reliable screening test to detect the early stages of ovarian cancer, leading them to rely on symptom awareness to diagnose patients, according to OCRA.

Unfortunately, symptoms of ovarian cancer often don’t present themselves until the cancer has advanced, causing the disease to go undetected and undiagnosed until it’s progressed to a later stage.

“If we had a test to detect ovarian cancer at early stages, the outcome of patients would be significantly better,” said Dr. Oliver Dorigo, director of the division of gynecologic oncology in the Department of Obstetrics and Gynecology at Stanford University Medical Center.

Until such a test is widely available, some researchers and advocates suggest a different way to reduce the risk: opportunistic salpingectomy, the surgical removal of both fallopian tubes.

Research has found that nearly 70% of ovarian cancer begins in the fallopian tubes, according to the Ovarian Cancer Research Alliance.

Doctors have already been advising more high-risk women to have a salpingectomy. Several factors can raise risk, including genetic mutations, endometriosis or a family history of ovarian or breast cancer, according to the US Centers for Disease Control and Prevention.

If they accept that they won’t be able to get pregnant afterward and if they are already planning on having pelvic surgery, it can be “opportunistic.”

“We are really talking about instances where a surgeon would already be in the abdomen anyway,” such as during a hysterectomy, said Dr. Karen Lu, professor and chair of the Department of Gynecologic Oncology and Reproductive Medicine at MD Anderson Cancer Center.

Although OCRA shifted its recommendation to include women with even an average risk of ovarian cancer, some experts continue to emphasize fallopian tube removal only for women with a high risk. Some are calling for more research on the procedure’s efficacy in women with an average risk.

Fallopian tubes are generally 4 to 5 inches long and about half an inch thick, according to Dorigo. During an opportunistic salpingectomy, both tubes are separated from the uterus and from a thin layer of tissue that extends along them from the uterus to the ovary.

The procedure can be done laparoscopically, with a thin instrument and a small incision, or through an open surgery, which involves a large incision across the abdomen.

The procedure adds roughly 15 minutes to any pelvic surgery, Dorigo said.

Unlike a total hysterectomy, in which a woman’s uterus, ovaries and fallopian tubes are removed, the removal of the tubes themselves does not affect the menstrual cycle and does not initiate menopause.

The risks associated with an opportunistic salpingectomy are also relatively low.

“Any surgery carries risk … so you do not want to enter any surgery without being thoughtful,” Lu said. “The risk of a salpingectomy to someone that is already undergoing surgery, though, I would say is minimal.”

Many women who have had the procedure say the benefit far outweighs the risk.

Carlucci had her fallopian tubes removed in January during a total hysterectomy, after testing positive for a genetic condition called Lynch syndrome that multiplied her risk of many kinds of cancers, including in the ovaries.

Several members of her family have died of colon and ovarian cancer, she said, and it prompted her to look into the available options.

Knowing that she could choose an opportunistic salpingectomy, which greatly decreased her chances of ovarian cancer, gave her hope.

As part of the total hysterectomy, it eliminated her risk of ovarian cancer.

“You can’t change your DNA, and no amount of dieting and exercise or medication is going to change it, and I felt horrible,” Carlucci said. “When I was given the news that this would 100% prevent me from ever having to deal with any ovarian cancer in my body, it was good to hear.”

Carlucci urges any woman with an average to high risk of ovarian cancer to talk to their doctor about the procedure.

“I know it seems scary, but this is something that you should do, or at the very least consider it,” she said. “It can bring so much relief knowing that you made a choice to keep you here for as long as possible.”

Monica Monfre Scantlebury, 45, of St. Paul, Minnesota, had a salpingectomy in March 2021 after witnessing a death related to breast and ovarian cancer in her family.

In 2018, Scantlebury’s sister was diagnosed with stage IV breast cancer at 27 years old.

“She went on to fight breast cancer,” Scantlebury said. “During the beginning of the pandemic, in March of 2020, she actually lost her battle to breast cancer at 29.”

During this period, Scantlebury herself found out that she was positive for BRCA1, a gene mutation that increases a person’s risk of breast cancer by 45% to 85% and the risk of ovarian cancer by 39% to 46%.

After meeting with her doctor and discussing her options, she decided to have a salpingectomy.

Her doctor told her she would remove the fallopian tubes and anything else of concern that she found during the procedure.

“When I woke up from surgery, she said there was something in my left ovary and that she had removed my left ovary and my fallopian tubes,” Scantlebury said.

Her doctor called about a week later and said there had been cancer cells in her left fallopian tube.

The salpingectomy had saved her life, the doctor said.

“We don’t have an easy way to be diagnosed until it is almost too late,” said Scantlebury, who went on to have a full hysterectomy. “This really saved my life and potentially has given me decades back that I might not have had.”

Audra Moran, president and CEO of the Ovarian Cancer Research Alliance, is sending one message to women: Know your risk.

Moran believes that if more women had the power of knowing their risk of ovarian cancer, more lives would be saved.

“Look at your family history. Have you had a history of ovarian cancer, breast cancer, colorectal or uterine in your family? Either side, male or female, father or mother?” Moran said. “If the answer is yes, then I would recommend talking to a doctor or talking to a genetic counselor.”

The alliance offers genetic testing resources on its website. A genetic counselor assess people’s risks for varying cancers based on inherited conditions, according to the US Bureau of Labor Statistics.

Carlucci and Scantlebury agree that understanding risk is key to preventing deaths among women.

“It’s my story. It’s her story. It’s my sister’s story … It is for all women,” Scantlebury said.

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Cancer is striking more people in their 30s and 40s. Here’s what you need to know | CNN

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CNN
 — 

It’s World Cancer Day, and the outlook for winning the war against this deadly disease is both good and bad.

In the United States, deaths from cancer have dropped 33% since 1991, with an estimated 3.8 million lives saved, mostly due to advances in early detection and treatment. Still, 10 million people worldwide lost their lives to cancer in 2020.

“During the last three years, the No. 1 leading leading cause of death in the world was actually cancer, not Covid-19,” said Dr. Arif Kamal, chief patient officer for the American Cancer Society.

Symptoms of cancer can mimic those of many other illnesses, so it can be difficult to tell them apart, experts say. Signs include unexplained weight loss or gain, swelling or lumps in the groin, neck, stomach or underarms and fever and night sweats, according to the National Cancer Institute.

Bladder, bowel, skin and neurological issues may be signs of cancer, such as changes in hearing and vision, seizures, headaches and bleeding or bruising for no reason, the institute said. But most cancers do not cause pain at first, so you can’t rely on that as a sign.

“We tell patients that if they have symptoms that do not get better after a few weeks, they should visit a doctor,” Kamal said. “It doesn’t mean the diagnosis will be cancer, however.”

Rather than wait for symptoms, the key to keeping cancer at bay is prevention, along with screenings to detect the disease in its early stages. That’s critical, experts say, as new cases of cancer are on the rise globally.

A surprising number of new diagnoses are in people under 50, according to a 2022 review of available research by Harvard University scientists.

Cases of breast, colon, esophagus, gallbladder, kidney, liver, pancreas, prostate, stomach and thyroid cancers have been increasing in 50-, 40- and even 30-year-olds since the 1990s.

That’s unusual for a disease that typically strikes people over 60, Kamal said. “Cancer is generally considered an age-related condition, because you’re giving yourself enough time to have sort of a genetic whoopsie.”

Older cells experience decades of wear and tear from environmental toxins and less than favorable lifestyle choices, making them prime candidates for a cancerous mutation.

“We believed it takes time for that to occur, but if someone is 35 when they develop cancer, the question is ‘What could possibly have happened?’” Kamal asked.

No one knows exactly, but smoking, alcohol consumption, air pollution, obesity, a lack of physical activity and a diet with few fruits and vegetables are key risk factors for cancer, according to the World Health Organization.

Add those up, and you’ve got a potential culprit for the advent of early cancers, the Harvard researchers said.

“The increased consumption of highly processed or westernized foods together with changes in lifestyles, the environment … and other factors might all have contributed to such changes in exposures,” the researchers wrote in their 2022 review.

“You don’t need 65 years of eating crispy, charred or processed meat as a main diet, for example,” Kamal added. “What you need is about 20 years, and then you start to see stomach and colorectal cancers, even at young ages.”

So how do you fight back against the big C? Start in your 20s, Kamal said.

Many of the most common cancers, including breast, bowel, stomach and prostate, are genetically based — meaning that if a close relative has been diagnosed, you may have inherited a predisposition to develop that cancer too.

That’s why it’s critical to know your family’s health history. Kamal suggests young people sit down with their grandparents and other close relatives and ask them about their illnesses — and then write it down.

“The average person doesn’t actually know the level of granularity that is helpful in accessing risk,” he said.

“When I talk to patients, what they’ll say is, ‘Oh, yeah, Grandma had cancer.’ There’s two questions I want to know: At what age was the cancer diagnosed, and what specific type of cancer was it? I need to know if she had cancer in her 30s or 60s, because it determines your level of risk. But they often don’t know.”

The same applies to the type of cancer, Kamal said.

“People often say ‘Grandma had bone cancer.’ Well, multiple myeloma and osteosarcoma are bone cancers, but both of them are relatively rare,” he said. “So I don’t think Grandma had bone cancer. I think Grandma had another cancer that went to the bone, and I need to know that.”

Next, doctors need to know what happened to that relative. Was the cancer aggressive? What was the response to treatment?

“If I hear Mom or Grandma was diagnosed with breast cancer at 40 and passed away at 41, then I know that cancer is very aggressive, and that changes my sense of your risk. I may add additional tests that aren’t in the guidelines for your age.”

Cancer screening guidelines are based on population-level assessments, not individual risk, Kamal said. So, if cancer (or other conditions such as heart disease, diabetes, Alzheimer’s, or even migraines) runs in the family, you become a special case and need a personalized plan.

“And I will tell you the entire scientific community is observing this younger age shift for different cancers and is asking itself: ‘Should guidelines be more deliberate and intentional for younger populations to give them some of this advice?”

closeup of a young caucasian doctor man with a pink ribbon for the breast cancer awareness pinned in the flap of his white coat; Shutterstock ID 724387357; Job: CNN Digital

Report: Black women more likely to die from breast cancer

If your family history is clear of cancer, that lowers your risk — but doesn’t remove it. You can decrease the likelihood of cancer by eating a healthy, plant-based diet, getting the recommended amount of exercise and sleep, limiting alcohol consumption and not smoking or vaping, experts say.

Protecting yourself from the sun and tanning beds is key, too, as harmful ultraviolet rays damage DNA in skin cells and are the prime risk factor for melanoma. However, skin cancer can show up even where the sun doesn’t shine, Kamal said.

“There’s been an increase of melanoma that’s showing up in non-sun-exposed areas such as the underarm, the genital area and between the toes,” he said. “So it’s important to check — or have a partner or dermatologist check — your entire body once a year.”

Skin check: Take off all your clothes and look carefully at all of your skin, including the palms, soles of feet, between toes and buttocks and in the genital area. Use the A, B, C, D, E method to analyze any worrisome spots and then see a specialist if you have concerns, the American Academy of Dermatology advised.

Also see a dermatologist if you have any itching, bleeding or see a mole that looks like an “ugly duckling” and stands out from the rest of the spots on your body.

Get vaccinated if you haven’t: Two vaccinations protect against cervical and liver cancers, and others for cancers such as melanoma are in development.

Hepatitis B is transmitted via blood and sexual fluids and can cause liver cancer and cirrhosis, which is a scarred and damaged liver. A series of three shots, starting at birth, is part of the US recommended childhood vaccines schedule. Unvaccinated adults should check with their doctor to see if they are eligible.

The HPV vaccine protects against several strains of human papillomavirus, the most common sexually transmitted infection, according to the US Centers for Disease Control and Prevention.

Human papillomavirus can cause deadly cervical cancer as well as vaginal, anal and penile cancer. It can also cause cancer in the back of the throat, including the tongue and tonsils.

“These HPV-related head and neck cancers are more aggressive than the non-HPV-related cancers,” Kamal said, “so boys as well as girls should be vaccinated.”

Since the vaccine’s approval in 2006 in the US for adolescents ages 11 to 13, cervical cancer rates have declined by 87%. Today, the vaccine can be given through age 45, the CDC said.

Breast self-exams: Breast cancer is the most common type of cancer diagnosed worldwide, according to the WHO, followed by lung, colorectal, prostate, skin and stomach cancers.

Both men and women can get breast cancer, so men with a family history should be aware of the symptoms as well, experts say. These include pain, redness or irritation, dimpling, thickening or swelling of any part of the breast. New lumps, either in the breast or armpit, any pulling in of the nipple and nipple discharge other than breast milk are also worrisome symptoms, the CDC said.

Women should do a self-exam once a month and see a doctor if there are any warning signs, the National Breast Cancer Association advised. Choose a time when the breasts will be less tender and lumpy, which is about seven to 10 days after the beginning of the menstrual flow.

Screenings and tests: At-home exams and vaccinations can save lives, but many cancers can only be detected through laboratory tests, scans or biopsies. The American Cancer Society has a list of recommended screening by ages.

Getting those done in a timely manner increases the chance for early detection and treatment, but it’s still each person’s responsibility to know their risk factors, Kamal said.

“Remember, guidelines are only for people at average risk,” he said. “The only way someone can know whether the guidelines apply to them is to really understand their family history.”

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