Why shouldn't I get a breast ultrasound?

"Although use of ultrasound rather than MRI as a supplement to mammographic screening in intermediate-risk women with dense breasts might seem appealing, the authors point out that low reimbursement rates and the shortage of qualified breast sonographers could make this strategy difficult to implement."

— Andrew M. Kaunitz, MD

This quote from the April 4 JAMA http://jama.ama-assn.org/content/307/13.toc was recently sent to me.  

Numerous studies (see  http://drwinsett.blogspot.com/2012/01/more-about-whole-breast-ultrasound-and.html) have demonstrated that supplemental whole breast ultrasound finds breast cancers that mammograms miss, including the study in this same journal where women had supplemental whole breast ultrasound if they had dense breast tissue and one other risk factor.  But that was the comment published in the journal.


So, if you find a willing and experienced doctor who is qualified to do the breast ultrasound, wouldn't you get one if you were at increased risk?  


Together we can prevent 75,000 breast cancer cases each year.

So, You DON'T want a hot flash!

Goes without saying, doesn't it?


Despite the fact that 80% of menopausal women experience them, we really don't know what causes hot flashes.  We know that typically they are like a blast furnace door that suddenly opened (so you could be engulfed in intense heat) and then two minutes later closed so you could be cold, but I don't have to tell you that.  They may happen once a day or once an hour, but I don't have to tell you that.  They may go on for several months or in a few, for years, but I don't have to tell you that.  In the Study of Women's Health Across the Nation (SWAN) 20% of premenopausal women reported hot flashes.


Physiologic studies point to thermoregulatory dysfunction.  Well, yes.  Note that we use big words to restate the issue when we don't know much about it.  What we do know is that core body temperature is normal at the beginning of a hot flash and falls below normal afterwards.  We know there is abnormal peripheral vasodilatation and increased blood flow in the skin.  We also know that the thermoneutral zone (range of temperatures that you "feel" ok) narrows at menopause.  We know about physiological changes, but not what causes them.


We also know that hot flashes are associated with:

• decreased endogenous estrogen levels
• a pulse of luteinizing hormone
• increased follicle stimulating hormone (FSH)
• different sleep stage (REM suppresses hot flashes)
• decrease in normal heart rate variability 
• decreased endogenous brain opioid activity

We know that vasomotor symptoms (hot flashes) are worse for:

• obese women (despite higher endogenous estrone)
• smokers
• sedentary women
• women who are hyperthyroid

And may be triggered by:

• hot drinks
• alcohol
• anxiety
• many drugs, particularly SSRIs
• rare diseases, such as carcinoid

So many observations, but no true cause and effect found, but we can help.

Studies have shown decrease in number, duration or magnitude of hot flashes in women treated with everything from estrogen replacement to breathing "right".

Studies of women with hot flashes show that estrogen replacement is the most effective treatment, orally or transdermal.  Find out more at http://www.endo-society.org/journals/scientificstatements/upload/jc-2009-2509v1.pdf from the Endocrine Society Scientific Statement.  We have previously blogged about the risks of estrogen replacement from deep vein thrombosis to increased breast cancer.  There are almost too many studies for other attempted hot flash treatments to mention (from SSRIs and SNRIs to Vitamin E); almost as many options as those with hot flashes!  No drug or supplement has been shown to be overwhelmingly effective, but there is help.

Imagine the medicine that could treat hot flashes, increase bone density and not cause any bad side effects like breast cancer or maybe even prevent cancer.

Yes, you are right, that medicine is already available: 

• BE LEAN
• BE ACTIVE
• REGULARLY EXERCISE
• LIMIT ALCOHOL

Together we can prevent 75,000 cases of breast cancer each year!

Can my husband get breast cancer?

I am sorry to say, "yes".


Breast cancer is far less common in men, but does happen at the rate of 1:1000 men.  That means about 1 man with breast cancer for each 10 women with breast cancer.  That translates to around 2000 men affected this year.  Just like in women the incidence has been increasing, but is still <1% of cancers affecting males.


More are inherited: 4% BRCA 1 and 15% BRCA 2 (total BRCA 1 & 2 for women only 7%).  Some argue that every male with breast cancer should have the BRCA 1 & 2 test.


90% are estrogen receptor positive (women 75%) and the average age is 66 years (older than for women).


The presentation is most often a painless firm or hard mass, with workup including mammogram, sonogram and needle biopsy.  In most studies there are more advanced cases at presentation than for women.


Treatment parallels that for women, but in most series is treated by total mastectomy and sentinel lymph node biopsy.  In many cases anti estrogen treatment is then offered.


Risk factors are similar to those in women such as higher estrogen exposure and prevention measures are the similar, such as, weight control, activity, exercise, etc.  Remember men should have all breast lumps checked out!






Together we can prevent 75,000 breast cancer cases each year.

You can come to see me even if you don't have a breast lump!

Recently, I was told "I wanted to come see you, but I didn't think I could get in to see you without a breast lump".


As part of "reader question week" I am responding to concerned comments.


I do many things for patients besides reacting to the breast lump or abnormal mammogram.  Indeed, that is a great part of what I have to offer, but we can have an impact even before the lump!  I now spend the majority of my time discussing how to reduce your personal risk for breast cancer, which tests to do (and when) to learn all about personal risk for breast cancer and then what to do about it.  We continue to do many whole breast ultrasounds for those with dense breast tissue even without a known lump.


Early detection is key, but prevention is even better!


There are also many breast concerns, like infection, or other breast-related concerns like hormone replacement that we help with every day.


Please, don't hesitate to call with any concern or question.




Together we can prevent 75,000 breast cancer cases each year!

Three more informative food websites.

In addition to the two sites noted in the last blog, there are three others that I would mention.


The first, http://www.choosemyplate.gov/food-groups/ gives information about food groups and much more.  This takes the place of "my pyramid" type food teaching that you may remember from that "mention" of healthy eating in school.


Next, I recommend http://nutritiondata.self.com/ for detailed nutrition information for just about any food you can imagine.  Type in banana, raw, select medium (7") and get at least 100 nutrition facts from vitamins to omega fatty acids.  Our medium banana contains 105 calories with 27g carbohydrates and 422mg potassium.  There is also a summary, called "the good":  low in saturated fats, cholesterol and sodium, high in dietary fiber, manganese, potassium, Vitamin C and B6.  And the "bad": almost all calories are sugars.  These "good" and "bad" ratings may help you personalize your diet.  For instance, a diabetic might want to know which foods have sugar calories or hypertensives might want to know how much sodium.


Lastly, I recommend for your perusal http://www.webmd.com/diet/ for healthy eating and dieting ideas.


These may be useful sources of nutritional and dietary information and may help you achieve your goal of heathy eating.  Each offers its own authority and validation for your review, but is intended as information and not personal medical advice.  Remember, ask your doctor questions.




Together we can prevent 75,000 breast cancer cases each year!

Who knows about foods that prevent breast cancer?

There are two websites everyone interested in findings about how food, nutrition and physical activity can prevent breast cancer should view regularly.


The first is Sponsored by the World Cancer Research Fund (WCRF) and the American Institute of Cancer Research (AICR) found at http://www.dietandcancerreport.org/.  


On this site, one can find who is reviewing the research, why and what is recommended and even preventable estimates for breast cancer and many others.  It is an easy to navigate site with a wealth of cancer preventive data and information.


The second site is http://www.aicr.org/foods-that-fight-cancer/ and provides specific information about which food, how much, how to cook it, best recipes and even more.  Can you name all the cruciforms?  


Each site is updated continuously and even allows you to sign-up for email notifications.  Just click on each link above to find out more.




Together we can prevent 75,000 breast cancer cases each year!




If you prefer to receive these blogs, each time published, as an email, sign-up in the upper right hand corner at "Follow by email".

Does Vitamin E prevent or cause cancer?

Interesting question.  Some reports demonstrate cancer prevention, but some show a lack of cancer prevention.  Many human and animal studies have demonstrated an association with dietary Vitamin E and fewer cancers.  BUT, a recent report from the SELECT Trial (Selenium and Vitamin E Cancer Prevention Trial) showed an increase in prostate cancers in men supplementing their diet with Vitamin E, and which one, alpha-Tocopherol.  


Therein may lie the answer.  Vitamin E is a group of essential fat soluble vitamins: 4 tocopherols and several tocotrienols.  The tocopherols are the major source of Vitamin E in the US diet, they are all antioxidants but they are not all the same.  Recent research from Rutgers University http://news.rutgers.edu/medrel/news-releases/2012/04/rutgers-study-vitami-20120420 may have the answer.  


The simple answer to quote Dr. Chung S Yang, "Our message is that Vitamin E in the form of gamma-tocopherols...and delta-tocopherols...are beneficial in preventing cancers while the form of Vitamin E, alpha-tocopherol...has no such benefit".


Why is this important and how do we make this work for us?  The gamma and delta forms we get from our diet: plant seeds, avocados, nuts and oils (sunflower, sesame, cottonseed and canola), whole grains.  The supplement Vitamin E you buy at the health food store is almost always alpha-tocopherol.  So, if you buy a Vitamin E supplement make sure it provides a mixture of gamma and delta tocopherols similar to our diet.  The gamma and delta forms are cancer preventers in animal models of lung, colon, breast and prostate cancers.  Hopefully more research will show that they are cancer preventers in humans.  




Together we can prevent 75,000 breast cancer cases each year!




This content is informational and not personal medical advice.


Comments and questions at www.thedoctor@owenwinsettmd.com.