What You Should Know About Older Women and Breast Cancer

It's Breast Cancer Awareness Month, and I had a question from one of my clients about why should she worry about breast cancer "at her age?" We devote a lot of press to mothers and daughters and sisters and spouses, but what about grandmothers and great-grandmothers? What I am going to share with you in this posting may seem a bit of a surprise, because we tend to focus a lot of our attention on women who are in their prime when we think about breast cancer. We may even think that older - and very post-menopausal - women need not be as concerned about a medical risk often associated with hormonal activity.

There has been research at Memorial Sloan-Kettering that basically says that regular testing works as well if not better for older patients as it does for younger patients, because if the cancer is caught early - and therefore small - these women have a very favorable prognosis. In other research at Beth Israel Deaconess Medical Center in Boston doctors followed about 65,000 women who had been diagnosed with breast cancer using Medicare data alongside women without breast cancer who numbered 170,000. Women over 65 who were diagnosed in this group with what is called ductal cell carcinoma in situ and stage I cancer - what they refer to as DCIS - were just as likely to survive for the study period of eight years as those without this diagnosis. Now, this is the amazing part. The women who were diagnosed before 80 years of age actually lived a bit longer than women who did not have breast cancer.

Treatment decisions can be complicated for older patients. And it is mostly because older patients tend to have other medical issues going on which providers refer to as co-morbidities. As we get older, we may also have high blood pressure, diabetes, or something else. In other research physicians have found that more conservative, non-surgical, non-radiation, even non-chemotherapy can be effective. But again, it comes down to early detection to avoid the complications of a more aggressive cancer.

Even if we just come out and say women who got breast exams were just taking better care of themselves, early detection seems to be working better for older women than their younger counterparts. And, of course, we should take the larger lesson that early diagnosis and treatment are incredibly important for any elder for whom we are caregivers. When I first looked into breast cancer and older patients I actually thought I was going to find professionals suggesting it is not as essential to have breast exams as patients get older. The research seems to be saying that doctors ought to be talking to their female patients at every age, because stage II and stage III patients did not fair as well. Talk to your provider to see what is optimal for the age of the elder for whom you care.

Charlotte Bishop is a Geriatric Care Manager and founder of Creative Case Management, certified professionals who are geriatric advocates, resources, counselors and friends to older adults and their families. Please email your questions to Charlotte Bishop.

Original article

What Boomer Women Should Know About Breast Cancer

The American Cancer Society expects that 230,480 new cases of invasive breast cancer will be diagnosed in 2011, 57,650 new cases of CIS (the non-invasive form of breast cancer), and that about 39,520 women will die from breast cancer. That's too many! What should Boomer women know about prevention?

There has been much publicity about Vitamin D of late. Now studies have shown that the mighty vitamin D can also help protect all of us Baby Boomer women against breast cancer.

I encourage every woman to check her vitamin D level regularly and keep it in the optimal range. Based upon the outdated requirements for this important vitamin, which have recently been increased, "normal" is not the same as optimal. Many of us have been told by our physician for years that our vitamin D levels are normal. It's time to get them checked against the newer "optimal" standards.

Most docs today now recommend supplementing with 2,000 IUs of vitamin D3 per day, as well as getting as much from your diet as you can. I know it's hard to get all you need from food. Fatty fish like Salmon, herring, catfish and halibut are good sources, but if you don't like fish it can be difficult to find high levels of this important vitamin in other foods.

There is another easy way to optimize our vitamin D. Make sure you are getting plenty of regular, safe, sun exposure. Believe it or not, the sun is actually the best source of vitamin D. The sun's UVB rays help our bodies manufacture vitamin D in the fat layer under the skin. Our own body can make all the vitamin D we need from regular sun exposure. We should spend about fifteen minutes showing some skin before we put on our sunscreen; exposing the skin is good for us as long as we don't burn.

There is also evidence that Vitamin K not only helps activate proteins that are involved in the structuring of bone mass, which is good news for all of us Baby Boomer women, but recent studies show it also has an anti-cancer effect; vitamin K has been used in the treatment of several different cancers, including breast cancer. You can get your vitamin K in swiss chard, kale, parsley and spinach, broccoli and cauliflower, brussels sprouts, liver, soybean oil and wheat bran. Many more choices here than with vitamin D, however, supplements are also available if you'd prefer.

Dietand Exercise are hugely important in preventing breast cancer. A study published in the " Journal of Clinical Oncology " reinforces previous findings that women with breast cancer greatly reduce their risk of recurrence by eating a healthy, plant-based diet rich in fruits and vegetables, and exercising regularly. This study, conducted by researchers at the University of California, San Diego, tracked dietary patterns and exercise habits of nearly 1,500 women who were diagnosed with early-stage breast cancer. Researchers found that the death rate for women who consumed a high-fiber diet rich in fruits and vegetables, and practiced good exercise habits, was 44% lower than the rate for women who exercised little and ate few plant-based foods. Almost half the risk, wow!

So, as my dear ol'gram used to say: "take your vities, eat all your veggies, and get plenty of fresh air!"

Best of Health,

Kathi

Kathi Casey, The Healthy Boomer Body Expert provides weight loss tips, relief from Menopause Symptoms, Sciatic Nerve Pain Remedies and more: http://www.healthyboomerbody.com/

Original article

Breast Cancer - Should You Worry?

Breast cancer is one of the top cancers in women today. Most of us would know someone who has, or has had breast cancer, and with the ongoing media coverage of the condition, women are becoming increasingly aware of the condition. National breast screening programmes, dedicated breast clinics, advances in modern treatment methods together with ongoing research, all play their part in the early detection and successful treatment.

What is Cancer?

Cells throughout the body are continually being lost and replaced, occuring in a state of balance. If, for some reason, the control mechanisms ensuring this balance become disrupted, a cell may start multiplying out of control - a tumour is then born.

Tumours are classified into whether they are benign or malignant. Benign tumours are those which, whilst growing in a uncontrolled manner, do not spread beyond the confines of their anatomical boundaries. Malignant tumours, on the other hand, are those which have the ability to invade structures and thereby enabling them to spread beyond their anatomical boundaries. They are also able to spread to distant parts of the body by invading the blood and lymphatic systems. The characteristic feature shared by all cancers is that this usual balance between cell loss and cell multiplication is disrupted.

What are the Risk Factors for developing Breast Cancer?

Some women with one, or even a few risk factors, never go on to develop breast cancer, whilst there are many women with breast cancer who have no apparent risk factors.

The Following are known risk factors:

• Having had cancer in one breast: this increases 3 to 4 fold, the risk of developing a new breast cancer, unrelated to the first, in the other breast, or in another part of the same breast.

• Getting older: the risk of breast cancer increases with age, the peak incidence occurring in the 55 to 59 age group. Whilst breast cancer predominantly affects older women, it can occur in women under 30 years of age.

• Family history of breast cancer: having a first degree relative (mother, sister or daughter) with breast cancer increases your risk of having breast cancer yourself.

• Predisposing breast conditions: history of certain breast conditions, such as atypical lobular or ductal hyperplasia, and lobar carcinoma in-situ, increases the risk of developing breast cancer.

• Genetics: carriers of alterations of the BRCA1 or BRCA2 genes are at higher risk of developing breast cancer. Women suspected to have genetic risk for breast cancer should undergo genetic risk assessment by a specialist (ideally in a cancer genetics clinic). Women with this BRCA mutation have about a 5 - 10 times increased risk for developing breast cancer compared to women without this mutation. They also tend to present with breast cancer at a much earlier age.

• Being Overweight

• Alcohol intake

• Race: caucasian women have been found to be at slightly higher risk of developing breast cancer than their African-American, Hispanic, Native American and Asian counterparts.

• Presence of other cancers in the family: a positive family history of cancers of the ovaries, uterus, cervix or colon increases the risk of you developing breast cancer.

• Excessive exposure to radiation

• Hormone Replacement Therapy (HRT): long term use of combined oestrogen and progesterone increases the risk of breast cancer.

• Late childbirth: having your first child after the age of 35 or never having children increases your risk of breast cancer.

• Early menarche: if you had your first period before the age of 12 years, your risk is increased.

• Late menopause: if you reach menopause very late, this would also increase your risk of breast cancer.

What are the Symptoms?

Breast cancer, in its early stages, usually has no symptoms. As the tumour grows, some of the following symptoms may be noticed:

• Lump in the breast or underarm that does not change in size with your mensus. Lumps due to breast cancer are typically painless.
• Changes in the colour or skin of the breast, areola or nipple (e.g. puckering, dimpling or scaling)
• Change in the nipple, such as retraction (pulled in nipple), itching or burning sensation, or discharge from the nipple.
• A marble-like hardened area under the skin of the breast.
• Change in the size or shape of the breast

What Can Help Decrease the Risk of Developing Breast Cancer?

A healthy balanced diet, regular exercise, maintaining a healthy weight, and avoiding over-consumption of alcohol, will help decrease the chances of developing breast cancer, along with a host of other diseases. Minimizing the use of Hormone Replacement Therapy to as short a time as possible will also minimize risk.

Having regular screening mammograms will not decrease the risk of developing breast cancer, but it enables the best chance of early detection, where treatment is generally more successful.

How is Breast Cancer Diagnosed?

Many women present to their doctors with breast symptoms which do not turn out to be due to cancer. Common benign conditions of the breast include fibroadenomas and fibrocystic disease of the breast. However, all new breast changes should be evaluated by a doctor.

Doctors generally make the diagnosis of breast cancer by employing what is commonly known as the "Triple Test". As its name suggests, there are three parts to it:

(i) Clinical Examination
(ii) Imaging of the Breast
(iii) Breast Biopsy

1. Clinical Examination

Breast examination by a doctor involves inspecting and palpation of all 4 quadrants (the breast is typically categorized into 4 parts) of both breasts, the area under the nipples, and under both arms to feel for lymph node enlargement.

2. Imaging of the Breast

Mammography is the commonest test used to detect breast cancer. In younger women who tend to have much denser breast tissue, mammograms may be difficult to read and doctors may request for other imaging methods instead.

Benign breast lumps are typically rounded with smooth edges. Cancers, by contrast, usually appear denser with an irregular edge. The surrounding tissue may also be distorted by invading cancer cells. Cancers may also be associated clusters of calcium flecks which show up on mammograms as bright white dots.

Ultrasound of the breast is a good way to focus on areas of the breast which are of particular concern, such as in a region where a lump is felt. It is also frequently done in younger women with denser breast tissue in whom mammograms may not be suitable.

MRIs are sometimes used to assist in the screening of women at high risk of breast cancer, obtaining more detailed assessment of an area of particular concern found on mammogram or ultrasound, as well as in the monitoring for recurrence after treatment.

3. Breast Biopsy

Fine-Needle Aspiration

Fine-needle aspiration (FNA) involves collecting a small sample of breast tissue using a long, thin needle and a syringe. FNAs are done under local anaesthesia. Mammograms or ultrasounds are often used to help locate the area of concern. Cells aspirated are then sent to a pathology laboratory for staining and interpretation.

Core / Mammotome Biopsy

This is similar to the FNA, however, in this case a much larger needle is used to obtain a "worm" of breast tissue rather than just some cells as in that obtained by an FNA. The core biopsy is also done under local anaesthesia and it gives doctors more breast tissue to work on, increasing the accuracy of diagnosis.

Open Surgical Biopsy

This requires a cut in the skin, in order to remove a sample of the lump, or sometimes, the entire lump. This method, whilst being the most accurate method of differentiating benign from cancerous lesions, is a lot more invasive than the previously discussed methods.

Your breast surgeon will advise you on the most appropriate method for obtaining a biopsy sample for you.

Factors Which Affect Prognosis:

Several factors are know to affect the likelihood of successful treatment and the risk of recurrence.

These would include the following:

• The stage of the cancer (size of tumour, whether it has spread to the lymph nodes or to other parts of the body)
• The type of breast cancer (eg. tubular, mucinous, papillary)
• Whether the tumour is hormone receptor (estrogen/progesterone receptors) positive or negative
• Histological grade
• Human epidermal growth factor type 2 receptor (HER2) gene amplification and/or overexpression
• Whether the tumour is a new one or a recurrence
• The age, menopausal status and general health of the woman

Treatment:

Surgery is considered to be the primary treatment of breast cancer and many patients with early breast cancer are cured by surgery alone. Surgery aims to completely remove the tumour, as well as to achieve clear resection margins, in order to reduce the risk of tumour recurrence. Several types of surgery are performed (eg. mastectomy, lumpectomy) but these will not be discussed in this article.

Adjuvant therapy is designed to treat micrometastatic disease (cancer cells which have escaped the breast and regional lymph nodes, and which have not yet had an established identifiable metastatic focus). It is given after primary therapy to increase the long-term disease-free survival.

Types of adjuvant therapy include chemotherapy, hormonal therapy, radiation therapy and targeted therapy with monoclonal antibodies.

Dr Ang C.D. has been in medical practice for over 12 years. He graduated with an M.B.B.S. degree from the National University of Singapore in 1997 and subsequently completed his post-graduate diploma in Family Medicine.

He has had training in Emergency Medicine, Internal Medicine, Geriatric Medicine, Orthopaedic Surgery, Obstetrics & Gynaecology, Neurosurgery, General Surgery, Colorectal Surgery and Urology.

Dr Ang currently practices in a family clinic in Singapore, seeing a good mix of paediatric, adult and geriatric patients.

With the goal of providing local and international patients with a resource for specialist care in Singapore, Dr Ang has founded SingaporeDoc.com, a Web Directory of Specialists in Private Practice in Singapore.

http://www.singaporedoc.com/

Original article