We are now learning that a breast sonogram (or ultrasound) has potential as a screening tool. Traditionally, breast sonograms have been used to further evaluate a palpable mass or mammographic abnormality, but now more women are asking for a sonogram as a screening test in addition to a mammogram and with good reason. Mammograms do save lives and are the best breast cancer screening test we have, but do not find all breast cancers.
In published studies reviewed by The Society of Breast Imaging (http://www.sbi-online.org/displaycommon.cfm?an=1&subarticlenbr=7) the results for breast sonograms are promising. In over 42,000 whole breast ultrasounds in addition to mammograms, more cancers were found than by mammograms alone. Importantly, over 90% of these were in dense breasts. By definition these are breasts over 50% dense. The density is categorized as "heterogeneously dense" at 51-75% density or "dense" (>75% dense) and called by some Type 3 or 4. It is on the mammogram report and now in Texas you will be told about your density as required by Henda's Law. Thanks to one of our readers, you may find more about "The Negative Mammogram Myth" at http://www.theatlantic.com/health/archive/2012/01/the-negative-mammogram-myth/252020/.
More importantly, those cancers found by ultrasound were small, averaging 10mm and 91% were node negative! So more treatment options, including lumpectomies and avoiding chemotherapy, were available to these women.
In addition to finding more invasive cancers in dense breast tissue, there were also more found in those with a personal history of breast cancer or a family history of breast cancer.
Furthermore, the whole breast ultrasound is well tolerated, requires no preparation, has no x-ray risk (because it is safe sound waves), is easily accessible and relatively inexpensive.
In figuring out the risk/benefit ratio, the cons have to be considered as well. The exam is operator dependent and may produce false positives, which are abnormalities that look like they might be malignant, but eventually prove not to be. In such a case, there are two options, sonographically guided Fine Needle Aspiration (FNA) (a tiny needle with local anesthesia) or close follow-up.
So, a woman with one of the two denser categories of breast tissue by mammogram, a personal history of breast cancer or a family history of breast cancer should consider whole breast ultrasound as an additional screening test.
Monday, January 30, 2012
Friday, January 27, 2012
Evista: might it be right for you?
Evista (raloxifene) is a powerful drug with two benefits: helps your bones and decreases the risk for breast cancer.
I will discuss the benefits as well as safety information for this drug. This blog is intended to educate and provoke a discussion with your doctor. It might be the right prescription for you.
Evista is a selective estrogen receptor modulator(SERM) like tamoxifen. Basically a SERM "turns down" the estrogen receptors in the breast leading to fewer breast cancers in those taking the drug and "turns up" the estrogen receptors in the bones leading to increased bone mineral density and reduced risk for vertebral fractures. It is one of the most studied drugs; in multiple trials of almost 40,000 women. Over 64 million prescriptions have been written.
Who should consider Evista?
It is indicated only for postmenopausal women (whose ovaries either don't make estrogen or have been removed) to:
When I talk about Evista I am obliged to remind everyone that I am a Faculty Resource for the Lilly Lecture Bureau (the company that makes the drug).
I will discuss the benefits as well as safety information for this drug. This blog is intended to educate and provoke a discussion with your doctor. It might be the right prescription for you.
Evista is a selective estrogen receptor modulator(SERM) like tamoxifen. Basically a SERM "turns down" the estrogen receptors in the breast leading to fewer breast cancers in those taking the drug and "turns up" the estrogen receptors in the bones leading to increased bone mineral density and reduced risk for vertebral fractures. It is one of the most studied drugs; in multiple trials of almost 40,000 women. Over 64 million prescriptions have been written.
Who should consider Evista?
It is indicated only for postmenopausal women (whose ovaries either don't make estrogen or have been removed) to:
- treat and prevent osteoporosis
- decrease the risk of invasive breast cancer in women with osteoporosis
- decrease the risk of invasive breast cancer in women who are high risk.
The bone part is easy to assess: history of fracture and bone mineral density.
The high risk for breast cancer requires more consideration, the kind we discuss at almost every visit. The factors that I consider are:
- family history (mother, daughter, sister increase the risk the most)
- previous breast biopsies, particularly finding atypical cells
- lobular carcinoma in-situ
- late (particularly >30 yo) or no full term pregnancy
- early first menstrual cycle (<11 years)
- prolonged use of combined estrogen and progesterone hormones
- greater than average breast density
- age (the risk continues to climb the further you get from 20 yo).
If you have any of these, you should consider Evista with your doctor.
What about side effects? Although the safety has been demonstrated in several trials Evista isn't for everyone. The most important safety information is in the Boxed Warning: increased risk of venous thomboembolism (a clot in the leg that may then break off and go the lung) and death from a stroke in women with coronary artery disease. If you have had deep vein thrombosis, you should not take it. If you have coronary artery disease, then you need to consider risk/benefit value with your doctor.
The major adverse reactions are hot flashes and leg cramps. We have options to help with these that are non hormonal and non prescription.
In summary, Evista is powerful medicine and one of the drugs that I use to prevent breast cancer. Check with your doctor to find out if it is right for you. Learn more at http://www.evista.com/Pages/index.aspx.
Together, we can prevent 75,000 breast cancer cases per year!
When I talk about Evista I am obliged to remind everyone that I am a Faculty Resource for the Lilly Lecture Bureau (the company that makes the drug).
Wednesday, January 25, 2012
Maybe you should tell your boss to take a hike!
Do you have a supervisor that is giving you a hard time? Maybe you should tell her or him to go take a hike: 30 minutes at least twice a week.
According to recent research published yesterday online http://www.springer.com/about+springer/media/springer+select?SGWID=0-11001-6-1336221-0 that is exactly what you should do if supervisor stress is hard on you!
In the study, 98 employees and their supervisors completed questionnaires about the work place. The employees rated their perceptions about how abusive the current supervisor was and the supervisors described their exercise patterns.
The researchers found that when the supervisors were stressed that the employees felt more victimized. This was not surprising, but when the same stressed bosses began to exercise, the employees reported lower levels of abusive behavior!
They conclude that "the simple act of exercising minimizes the negative effects of supervisor workplace stress on employees".
So, now add stress reduction to the list of benefits of regular exercise which begins with FEWER BREAST CANCERS.
Tuesday, January 24, 2012
Exercise to make you feel good? Yes. There's data!
I have been extolling the virtues of exercise (fewer breast cancers and weight control) for sometime and now I have another one to help those who might be reluctant to start.
WORRY LESS with exercise!
A research group at U of Georgia recently published their positive results from a study of sedentary women with generalized anxiety disorder(GAD) treated by exercise. This disorder characterized by excessive and often uncontrollable worries also includes physical symptoms of fatigue, irritability and sleep disorder. Find the study online at http://www.ncbi.nlm.nih.gov/pubmed/22116310?dopt=Abstract.
These 30 women, aged 18-37, who were sedentary, were randomly allocated to lower body weight lifting, cycling (equivalent body region, work load and time) or nothing. The workouts were only twice weekly.
The groups were evaluated by psychologists blinded to the activity and in all exercise groups there was a significant reduction in worry and great improvements in other symptoms, such as tension, irritability and fatigue.
Some 90,000 Americans suffer from GAD and could be helped by exercise. Just imagine how the rest of us benefit from the positive effect of exercise on anxiety!
SO, WORRY LESS, FEEL BETTER AND GET FEWER BREAST CANCERS WITH EXERCISE!!!
WORRY LESS with exercise!
A research group at U of Georgia recently published their positive results from a study of sedentary women with generalized anxiety disorder(GAD) treated by exercise. This disorder characterized by excessive and often uncontrollable worries also includes physical symptoms of fatigue, irritability and sleep disorder. Find the study online at http://www.ncbi.nlm.nih.gov/pubmed/22116310?dopt=Abstract.
These 30 women, aged 18-37, who were sedentary, were randomly allocated to lower body weight lifting, cycling (equivalent body region, work load and time) or nothing. The workouts were only twice weekly.
The groups were evaluated by psychologists blinded to the activity and in all exercise groups there was a significant reduction in worry and great improvements in other symptoms, such as tension, irritability and fatigue.
Some 90,000 Americans suffer from GAD and could be helped by exercise. Just imagine how the rest of us benefit from the positive effect of exercise on anxiety!
SO, WORRY LESS, FEEL BETTER AND GET FEWER BREAST CANCERS WITH EXERCISE!!!
Monday, January 23, 2012
Do you want to know your personal risk for breast cancer?
We all know that if you have a family history of breast cancer that you personally may be at increased risk for breast cancer. BUT only 30% of women have any family history of breast cancer and only 7% will have one of the breast cancer genes. Now we have a test for everyone else.
This test, called The BREVAGen Breast Cancer Risk Assessment Test, is the first of its kind for breast cancer. The test combines clinical data about family history, breast biopsies, and reproductive history with your genetics.
We fill out the short answers to seven questions and then swab the inside of each cheek. The results are usually returned in about three weeks.
The results give two scores: the risk for developing breast cancer in the next 5 years and a lifetime risk. These two numbers provide us with information to make recommendations for everything from screening to prevention strategies. The results are based on the actual rate of breast cancer for women in large clinical trials.
So who might consider the test?
Consider this simple in-office test to help you formulate your plan of action.
I want to see more women who will not get breast cancer and I want to start with you!
This test, called The BREVAGen Breast Cancer Risk Assessment Test, is the first of its kind for breast cancer. The test combines clinical data about family history, breast biopsies, and reproductive history with your genetics.
We fill out the short answers to seven questions and then swab the inside of each cheek. The results are usually returned in about three weeks.
The results give two scores: the risk for developing breast cancer in the next 5 years and a lifetime risk. These two numbers provide us with information to make recommendations for everything from screening to prevention strategies. The results are based on the actual rate of breast cancer for women in large clinical trials.
So who might consider the test?
- Anyone who wants to know her personal risk
- Family history, but no a close relative
- Close family history and a negative BRCA 1 & 2 test.
- History of breast biopsy
- History of breast cyst aspiration
- Anyone considering hormone replacement
- Anyone who thinks she might benefit from prevention strategies
Consider this simple in-office test to help you formulate your plan of action.
I want to see more women who will not get breast cancer and I want to start with you!
Friday, January 20, 2012
Now is the time for weekly email newsletters
My email newsletters have grown in popularity, so now I am going to begin sending them every week. Each newsletter will contain a preview of the week's blogs. I will have a schedule of 3 per week.
With your help we can prevent 75,000 breast cancer cases per year.
- The first part of the week will be devoted to breast cancer symptoms, diagnosis and tests.
- Midweek blogs will cover the latest science news about breast disease.
- In the last blog of the week, I will discuss breast cancer prevention.
With your help we can prevent 75,000 breast cancer cases per year.
Wednesday, January 18, 2012
Foods that have been linked to fewer breast cancers
The most comprehensive list that I have been able to find for cancer fighting foods can be found at http://www.aicr.org/foods-that-fight-cancer/.
The list is regularly updated and gives information for cancers other than breast.
Remember, with everyone spreading the word, we can prevent 75,000 cases of breast cancer each year!
The list is regularly updated and gives information for cancers other than breast.
Remember, with everyone spreading the word, we can prevent 75,000 cases of breast cancer each year!
Tuesday, January 17, 2012
A new mechanism for the some of the benefits of exercise.
We know some of the many benefits of regular exercise, but now we know at least one more mechanism. Researches at Dana-Farber Cancer Institute and Harvard Medical School published online in the journal Nature last week the results of a new study involving humans and mice.
They have discovered a new hormone made in exercising muscles that sends good signals to the rest of the body. This messenger hormone is aptly names Irisin after the Greek Messenger Goddess Iris.
They identified at least two important functions of Irisin, which is increased by exercising. One effect is elevated Irisin is turning conventional "white" fat (what we think of as fat and mostly central as we age) to "brown" fat which burns more calories, primarily to keep us warm. The second effect is to make the body more sensitive to glucose.
They found the effect lasted several hours after the exercise in both animals and humans. Then they injected Irisin in amounts equal to that produced at strenuous exercise into obese pre-diabetic mice and found the beneficial results of increased energy expenditure (weight loss and glucose sensitivity) with no change in diet or exercise and apparently no ill effects.
They caution that the "exercise in a pill" won't have all the benefits of going to the gym, for instance building muscle, but might help ward of diabetes.
For now, I recommend a walk, a run, a bike ride or the gym to get your Irisin "risin"!
They have discovered a new hormone made in exercising muscles that sends good signals to the rest of the body. This messenger hormone is aptly names Irisin after the Greek Messenger Goddess Iris.
They identified at least two important functions of Irisin, which is increased by exercising. One effect is elevated Irisin is turning conventional "white" fat (what we think of as fat and mostly central as we age) to "brown" fat which burns more calories, primarily to keep us warm. The second effect is to make the body more sensitive to glucose.
They found the effect lasted several hours after the exercise in both animals and humans. Then they injected Irisin in amounts equal to that produced at strenuous exercise into obese pre-diabetic mice and found the beneficial results of increased energy expenditure (weight loss and glucose sensitivity) with no change in diet or exercise and apparently no ill effects.
They caution that the "exercise in a pill" won't have all the benefits of going to the gym, for instance building muscle, but might help ward of diabetes.
For now, I recommend a walk, a run, a bike ride or the gym to get your Irisin "risin"!
Friday, January 13, 2012
Make the Calorie your friend!
Check out this excellent piece from ABC News.
http://abcnews.go.com/blogs/health/2012/01/12/the-calorie-your-weight-loss-best-friend/#.TxBQpZXwbew.email
http://abcnews.go.com/blogs/health/2012/01/12/the-calorie-your-weight-loss-best-friend/#.TxBQpZXwbew.email
Wednesday, January 11, 2012
Did you read that RED WINE research was falsified?
The next day. Wow! Just after I had blogged about the benefits of RED WINE for breast cancer, CBS news ran a story about RED WINE, but this time how one lab at the University of Connecticut had falsified data about the benefits of red wine for the heart, specifically resveratrol in red wine.
No change in the data presented yesterday, from multiple studies, with plausible mechanism from numerous unconnected laboratories and in many different peer reviewed journals. RED WINE does have a breast cancer risk reduction benefit and it's probably not the resveratrol, but other polyphenols.
One lab that has reported extensively on heart benefits has been investigated and there are signs of not as robust data for heart benefits of resveratrol in red wine as reported.
We will have to wait for the dust to clear to find out how much if any of the heart data is good.
It is important to remember that the risk attributed to wine drinkers (white vs red) for breast cancer in this country only applies to 2% of women.
The benefits of BEING LEAN, MOVING MORE AND REGULAR EXERCISE are not limited to 2%, but can apply to all! Let's each continue to do these things and encourage our friends and family to do likewise so we can prevent 75,000 new cases of breast cancer this year!
No change in the data presented yesterday, from multiple studies, with plausible mechanism from numerous unconnected laboratories and in many different peer reviewed journals. RED WINE does have a breast cancer risk reduction benefit and it's probably not the resveratrol, but other polyphenols.
One lab that has reported extensively on heart benefits has been investigated and there are signs of not as robust data for heart benefits of resveratrol in red wine as reported.
We will have to wait for the dust to clear to find out how much if any of the heart data is good.
It is important to remember that the risk attributed to wine drinkers (white vs red) for breast cancer in this country only applies to 2% of women.
The benefits of BEING LEAN, MOVING MORE AND REGULAR EXERCISE are not limited to 2%, but can apply to all! Let's each continue to do these things and encourage our friends and family to do likewise so we can prevent 75,000 new cases of breast cancer this year!
Tuesday, January 10, 2012
Did you read that RED WINE was good for you?
You may have seen in the news a recent report from www.cedars-sinai.edu that "Moderate red wine drinking may help cut women's breast cancer risk" and I thought we should look at the issue of alcohol and breast cancer.
Many studies have demonstrated a link between too much alcohol of any kind and breast cancers. A literature review suggests that 3 or more drinks (45 gms of alcohol which translates to 15 oz of wine www.pubs.niaaa.nih.gov/publications) significantly increases the risk for breast cancer and perhaps having a wreck, among other things. Furthermore, a large observational study, published last year (jama.ama-assn.org/content/306/17/1884) of 100,000 women in the Nurses Health Study suggests that anyone drinking over 3-6 drinks per week begins to show an increase in breast cancers. A review of the article reveals that the "drinking group" had other risks like increased tobacco use, more hormone replacement use and more with a family history of breast cancer, suggesting that alcohol in moderation may not be the only difference between the groups. The mechanism may be that alcohol changes the hormonal balance (estrogen, progesterone and testosterone) to favor breast cancer development and when added to other risks may enhance them.
Subgroup analysis of this study and two other studies found that folate or folic acid intake mitigates this effect of alcohol even at a dose of 300mcg per day.
So what about the newest study? Red grape skin contains polyphenol compounds, some of which have antioxidant properties to help prevent breast cancer and the hypothesis is that the protection of the red is greater than any putative risk, particularly at a "moderate" dose. The researchers in the Cedars Sinai study said the change in hormonal pattern suggested that RED WINE may stop the growth of cancer cells, not like other kinds of alcohol, particularly white wine.
So how many breast cancers are we talking about here. Of course there is geographical and national variation, but an article in Cancer Causes and Control reviewing nutritional data and cancer statistics noted that the population attributable risk in the US is only 2% of all breast cancers. Clearly being lean, moving around and exercise have more impact in the population as a whole.
Moderate alcohol use has been shown in multiple studies to prevent coronary artery disease, ischemic stroke and diabetes. For those at risk moderate alcohol use has been shown to have a substantial survival benefit. Factoring in these studies and pending a longterm randomized trial of alcohol on overall clinical outcome, I have some recommendations:
Many studies have demonstrated a link between too much alcohol of any kind and breast cancers. A literature review suggests that 3 or more drinks (45 gms of alcohol which translates to 15 oz of wine www.pubs.niaaa.nih.gov/publications) significantly increases the risk for breast cancer and perhaps having a wreck, among other things. Furthermore, a large observational study, published last year (jama.ama-assn.org/content/306/17/1884) of 100,000 women in the Nurses Health Study suggests that anyone drinking over 3-6 drinks per week begins to show an increase in breast cancers. A review of the article reveals that the "drinking group" had other risks like increased tobacco use, more hormone replacement use and more with a family history of breast cancer, suggesting that alcohol in moderation may not be the only difference between the groups. The mechanism may be that alcohol changes the hormonal balance (estrogen, progesterone and testosterone) to favor breast cancer development and when added to other risks may enhance them.
Subgroup analysis of this study and two other studies found that folate or folic acid intake mitigates this effect of alcohol even at a dose of 300mcg per day.
So what about the newest study? Red grape skin contains polyphenol compounds, some of which have antioxidant properties to help prevent breast cancer and the hypothesis is that the protection of the red is greater than any putative risk, particularly at a "moderate" dose. The researchers in the Cedars Sinai study said the change in hormonal pattern suggested that RED WINE may stop the growth of cancer cells, not like other kinds of alcohol, particularly white wine.
So how many breast cancers are we talking about here. Of course there is geographical and national variation, but an article in Cancer Causes and Control reviewing nutritional data and cancer statistics noted that the population attributable risk in the US is only 2% of all breast cancers. Clearly being lean, moving around and exercise have more impact in the population as a whole.
Moderate alcohol use has been shown in multiple studies to prevent coronary artery disease, ischemic stroke and diabetes. For those at risk moderate alcohol use has been shown to have a substantial survival benefit. Factoring in these studies and pending a longterm randomized trial of alcohol on overall clinical outcome, I have some recommendations:
- If you don't drink, think twice before you start.
- If you drink, make certain your multivitamin has 400mcg folate.
- If you drink white wine, you might consider the benefits of RED.
- And the amount? Most experts define "moderate" as 1-2 glasses (<8 oz).
Wednesday, January 4, 2012
Why test for breast cancer risk?
Happy New Year and welcome 2012!
70% of breast cancers occur in women with no family history and another 23% have a family history but did not inherit the known breast cancer gene BRCA 1 or 2. That means 93% of women may not have a good idea of personal breast cancer risk at all.
We now have a validated risk assessment tool for women 35 years or older that integrates clinical features with genetic markers. This BREVAGen test includes clinical factors related to estrogen exposure and breast health with genetic information obtained from a cheek swab.
The test result then allows us to more clearly identify individual risk and set up a personal plan for screening and risk reduction.
You can know your breast cancer risk and confidently take charge of your screening program!
If you want to know your hidden breast cancer risk, then this is the test for you!
Find out more at www.brevagen.com or call us at 512-826-4480.
70% of breast cancers occur in women with no family history and another 23% have a family history but did not inherit the known breast cancer gene BRCA 1 or 2. That means 93% of women may not have a good idea of personal breast cancer risk at all.
We now have a validated risk assessment tool for women 35 years or older that integrates clinical features with genetic markers. This BREVAGen test includes clinical factors related to estrogen exposure and breast health with genetic information obtained from a cheek swab.
The test result then allows us to more clearly identify individual risk and set up a personal plan for screening and risk reduction.
You can know your breast cancer risk and confidently take charge of your screening program!
If you want to know your hidden breast cancer risk, then this is the test for you!
Find out more at www.brevagen.com or call us at 512-826-4480.
Monday, January 2, 2012
If you are told you have DENSE BREAST TISSUE
Henda's law took effect today in Texas. The mammography facility is now required to tell you if you have dense breast tissue so that you my talk to your doctor about whether you may benefit from supplemental screening.
For many of you, this means full breast screening ultrasound. While not everyone is prepared to do this examination, we are, and have reserved time each day for the procedure.
I urge you to be proactive!
Please feel free to call to schedule the exam or email me with questions.
Owen Winsett, MD
512-451-5788
thedoctor@owenwinsettmd.com
For many of you, this means full breast screening ultrasound. While not everyone is prepared to do this examination, we are, and have reserved time each day for the procedure.
I urge you to be proactive!
Please feel free to call to schedule the exam or email me with questions.
Owen Winsett, MD
512-451-5788
thedoctor@owenwinsettmd.com
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