Well, new in the last 30 years. Selective Estrogen Receptor Modulators (SERM) do prevent breast cancer! This finding has been reconfirmed in a recent Lancet publication http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60140-3/abstract.
These investigators, led by Dr Jack Cuzick at the Center for Cancer Prevention at Queen Mary University London, performed a meta-analysis of data from 9 breast cancer prevention trials using 4 SERMS (some call these estrogen [receptor] blockers), looking at breast cancer incidence at a median follow-up of 65 months. Two of the SERM's may be familiar to you: tamoxifen and raloxifene(Evista); but studies with arzoxifene and lasoxifene were also included.
They analyzed data from 83,399 women in 306,617 women-years of follow-up! Overall they report a 38% reduction in breast cancer incidence. 38% did not get breast cancer! We know the drugs work, so now the key is to find out who would benefit and what is the risk.
Today, there are general guidelines, which differ by country, which basically state that those of higher risk should be offered the medicine. Interestingly, in the US the "break-point" for recommendation falls around 20% life-time risk (population life-time risk for breast cancer risk is 12%) and in the UK, at 30% risk.
Several drugs may be used in postmenopausal women but only tamoxifen is approved for use in the premenopausal woman. Each has unique side effects and risks and at least one is approved for another beneficial use (maintaining bone health).
Now the exciting part; just as cardiologists can tell whether a statin drug may be "working" by following cholesterol levels, we now may have a biomarker for efficacy of a SERM. Imagine, giving the medicine only to those who benefit most! Personalized medicine! Basing your decision to continue the medicine on information about its efficacy in you and not just the population at large, statistical, benefit!
The first biomarker discovered is breast density. We will discuss the effect of breast density on breast cancer risk and the change in breast density on the effectiveness of the SERM's next week! Then how the SERM's work and finally how to individualize the prescription, weighing benefits vs risks. Check back!
Together we can prevent 86,000 breast cancer cases this year.
This is general content and not personal medical advice.
Friday, May 10, 2013
Wednesday, May 8, 2013
A New Way of Thinking...Exercise to prevent recurrence!
I know everyone wants to know another benefit of regular exercise! How about, exercise to prevent breast cancer recurrence? YES, it does!
Today, we will look at studies of women who, unfortunately, have been diagnosed with breast cancer. But there is good news. Many studies have demonstrated significantly better outcomes for women who regularly exercise.
For example, we look to another cohort from the Nurses' Health Study. This time JAMA reports http://jama.jamanetwork.com/article.aspx?articleid=200955 on almost 3000 women who were diagnosed with breast cancer (stages I, II or III) and followed at least 4 years.
When compared to non-exercisers (<1hour/week), those women who walked at an average pace (2-2.9mph), or did the equivalent, at least 3 hours per week, did significantly better: 50% fewer recurrences, 50% fewer deaths from breast cancer and 50% fewer deaths from any cause!
Another group that should get an exercise prescription!
Together we can prevent 86,000 breast cancer cases this year and help those who have been diagnosed. If you want to help a friend who has been diagnosed, tell her about this information and have her check with her doctor for an exercise prescription!
This content is general and not personal medical advice, but if you know someone who might benefit, call me 512-451-5788.
Today, we will look at studies of women who, unfortunately, have been diagnosed with breast cancer. But there is good news. Many studies have demonstrated significantly better outcomes for women who regularly exercise.
For example, we look to another cohort from the Nurses' Health Study. This time JAMA reports http://jama.jamanetwork.com/article.aspx?articleid=200955 on almost 3000 women who were diagnosed with breast cancer (stages I, II or III) and followed at least 4 years.
When compared to non-exercisers (<1hour/week), those women who walked at an average pace (2-2.9mph), or did the equivalent, at least 3 hours per week, did significantly better: 50% fewer recurrences, 50% fewer deaths from breast cancer and 50% fewer deaths from any cause!
Another group that should get an exercise prescription!
Together we can prevent 86,000 breast cancer cases this year and help those who have been diagnosed. If you want to help a friend who has been diagnosed, tell her about this information and have her check with her doctor for an exercise prescription!
This content is general and not personal medical advice, but if you know someone who might benefit, call me 512-451-5788.
Monday, May 6, 2013
A new way of thinking? Exercise prescription!
Didn't we talk about this? Yes, we did http://drwinsett.blogspot.com/2012/08/should-we-doctors-treat-inactivity.html.
The Canadians are doing it http://www.cbc.ca/news/health/story/2013/05/03/exercise-prescription.html and its working!
Since the US Center for Disease Control (CDC) says 79% of americans are not meeting guidelines for exercise, maybe we doctors should write more exercise prescriptions. See http://www.usatoday.com/story/news/nation/2013/05/02/physical-activity-guidelines/2128971/?cid=xrs_rss-nd%3C.
For those of you who need a jump-start to your exercise and be active program, would that work?
If it would work for you, call your doctor or call me 512-451-5788 to get your personalized exercise prescription. Remember, over 75 studies have shown that those who regularly exercise have fewer breast cancers http://drwinsett.blogspot.com/2012/06/maybe-youve-heard-exercise-reduces.html.
Together we can prevent 86,000 breast cancers this year!
This is general content and not personal medical advice, but if you know someone who needs an exercise prescription, have them call me at 512-451-5788.
The Canadians are doing it http://www.cbc.ca/news/health/story/2013/05/03/exercise-prescription.html and its working!
Since the US Center for Disease Control (CDC) says 79% of americans are not meeting guidelines for exercise, maybe we doctors should write more exercise prescriptions. See http://www.usatoday.com/story/news/nation/2013/05/02/physical-activity-guidelines/2128971/?cid=xrs_rss-nd%3C.
For those of you who need a jump-start to your exercise and be active program, would that work?
If it would work for you, call your doctor or call me 512-451-5788 to get your personalized exercise prescription. Remember, over 75 studies have shown that those who regularly exercise have fewer breast cancers http://drwinsett.blogspot.com/2012/06/maybe-youve-heard-exercise-reduces.html.
Together we can prevent 86,000 breast cancers this year!
This is general content and not personal medical advice, but if you know someone who needs an exercise prescription, have them call me at 512-451-5788.
Friday, May 3, 2013
A new way of thinking...about breast cancer screening
Screening is a test offered to a group of people to find a disease. In the our business, usually an imaging test to find a potentially deadly disease: breast cancer.
The problems with screening are many: financial cost, emotional cost (worry about result and false negative findings), ethics (to whom to recommend the test) and what to do with the positive result (as so many like to write about now: over treatment).
To look at mammography, specifically, lives are saved (see earlier blog posts) so the test works. But, apparently, according to some experts, we are learning more about to whom to recommend the test. Let's look at just one issue today. One group recommends routine mammography beginning at age 40 and others at age 50 years.
I offer one solution: the BREVAGen Risk Assessment Test. This test, combining your genetics (cheek swab) with features of your clinical history, gives the clearest picture we have today of your risk, so that you may decide about screening. See http://drwinsett.blogspot.com/2012/04/more-personalized-breast-cancer.html.
Ask your doctor, if the test is right for you or ask us 512-451-5788. If you have had the test, then tell a friend.
In the meantime, keep walking, jogging, swimming or biking, etc, to lower your risk for breast cancer! And think about how long to do one of these to offset the calories in that latte you just had!
Together we can prevent 86,000 breast cancers this year!
This is general content and not personal medical advice.
The problems with screening are many: financial cost, emotional cost (worry about result and false negative findings), ethics (to whom to recommend the test) and what to do with the positive result (as so many like to write about now: over treatment).
To look at mammography, specifically, lives are saved (see earlier blog posts) so the test works. But, apparently, according to some experts, we are learning more about to whom to recommend the test. Let's look at just one issue today. One group recommends routine mammography beginning at age 40 and others at age 50 years.
I offer one solution: the BREVAGen Risk Assessment Test. This test, combining your genetics (cheek swab) with features of your clinical history, gives the clearest picture we have today of your risk, so that you may decide about screening. See http://drwinsett.blogspot.com/2012/04/more-personalized-breast-cancer.html.
Ask your doctor, if the test is right for you or ask us 512-451-5788. If you have had the test, then tell a friend.
In the meantime, keep walking, jogging, swimming or biking, etc, to lower your risk for breast cancer! And think about how long to do one of these to offset the calories in that latte you just had!
Together we can prevent 86,000 breast cancers this year!
This is general content and not personal medical advice.
Tuesday, April 30, 2013
A new way of thinking!
And apparently it works!
How about labels that read: you need to take a brisk walk of __ minutes to burn off the calories in this sandwich?
Researchers from TCU (just the the north of us) did just that and the exercise-needed-to-burn-off label had more of an impact on what food was selected than the calorie, fat, protein, salt, etc label. In a paper presented at a recent meeting we are given the results http://www.eurekalert.org/pub_releases/2013-04/foas-mld041813.php.
They divided 300 men and women, 18-30 years, into three groups and studied response to the menu info and amount of calories eaten. One group got the usual label with fat, sugar, etc that we all see at chain restaurants (by law now), one group no label info, and the last group got only the time of a brisk walk needed to burn off the calories in the item eaten on the label.
The label with the "exercise needed" to burn off the calories in this item had the most impact!
In this study, there was no difference in consumption between the calories label and no label groups!
Maybe we should be thinking in terms of how far do I need to walk to burn off this egg, toast, jam and coffee with sugar and cream, and not just how much sugar, fat and carbs in each! You may look up calories burned per exercise many places, but one example is myfitnesspal at http://www.myfitnesspal.com.
As the authors note, for some an eye-opener: a 30 minute brisk walk without hills, like Ft Worth, burns around 150 calories; but with hills, like in Austin, burns about 200 calories!
Since we know that not being lean, independent of other factors, is implicated in at least 20% of all breast cancers, maybe we should change to this way of thinking.
Together we can prevent 86,000 breast cancers this year!
This content is general and not personal medical advice, but if you need a jump start to your next "brisk walk" call me 512-451-5788.
How about labels that read: you need to take a brisk walk of __ minutes to burn off the calories in this sandwich?
Researchers from TCU (just the the north of us) did just that and the exercise-needed-to-burn-off label had more of an impact on what food was selected than the calorie, fat, protein, salt, etc label. In a paper presented at a recent meeting we are given the results http://www.eurekalert.org/pub_releases/2013-04/foas-mld041813.php.
They divided 300 men and women, 18-30 years, into three groups and studied response to the menu info and amount of calories eaten. One group got the usual label with fat, sugar, etc that we all see at chain restaurants (by law now), one group no label info, and the last group got only the time of a brisk walk needed to burn off the calories in the item eaten on the label.
The label with the "exercise needed" to burn off the calories in this item had the most impact!
In this study, there was no difference in consumption between the calories label and no label groups!
Maybe we should be thinking in terms of how far do I need to walk to burn off this egg, toast, jam and coffee with sugar and cream, and not just how much sugar, fat and carbs in each! You may look up calories burned per exercise many places, but one example is myfitnesspal at http://www.myfitnesspal.com.
As the authors note, for some an eye-opener: a 30 minute brisk walk without hills, like Ft Worth, burns around 150 calories; but with hills, like in Austin, burns about 200 calories!
Since we know that not being lean, independent of other factors, is implicated in at least 20% of all breast cancers, maybe we should change to this way of thinking.
Together we can prevent 86,000 breast cancers this year!
This content is general and not personal medical advice, but if you need a jump start to your next "brisk walk" call me 512-451-5788.
Tuesday, March 26, 2013
Why screen for breast cancer?
Because it works!
Enough said? Numerous studies have demonstrated lives saved by screening mammography (See previous blog posts by typing in mammography in the search box at the right)! But the guidelines are for the general population at risk and now we can refine the recommendation, by taking your clinical and genetic uniqueness into account and refine the screening plan to make it just right for you!
The screening plan that is modified to your risk!
Imagine! More cancers uncovered and less stress of false positive (finding something that look like cancer but isn't). For some that may mean a breast MRI, for some another type of breast imaging, but for most whole breast ultrasound (see previous blog posts)! For some women, more often (six month exams) for some less often (maybe even even 2 years as the paper sited in yesterday's blog suggested).
How do we arrive at individualized screening?
- BRACAnalysis
- BREVGen Risk Assessment
- HALO Breast Pap Test
- Breast density on mammogram
We begin with the above results, but each one test may not apply to everyone, but one or more of them may be right for you. Each one will be the subject of upcoming posts, so come back tomorrow!
Remember the only thing better than early detection is prevention, so do something today to lower your risk for breast cancer like being active: get up and walk 5 minutes out of every hour you sit at our desk, or try a standing desk or exercise ball or park far away from the door!
Together we can prevent at least 86,000 breast cancers this year!
This is general content and not personal medical advice, but if you can't wait to find out which test might be right for you call us 512-451-5788.
Monday, March 25, 2013
Making sense of Breast Cancer Screening
You have probably been reading a lot about screening mammography recently, notably http://archinte.jamanetwork.com/article.aspx?articleID=1669103, Outcomes of Screening Mammography by Frequency, Breast Density, and Postmenopausal Hormone Therapy. So now, add this article to the many others showing the benefits of screening mammograms and try to make sense of them all.
The importance of the article was missed by most news reporting: that screening in young women (40-49 years) does, in the authors' words, "minimize their risk of advanced-stage disease". Further, they point out that more mammograms mean more false positives at any age; the price of routine screening mammography.
But, in this blog, we have been talking about personalized medicine: which screening is the right choice for which woman? Personal screening recommendation fit for her personal risk. And now Dr Otis Brawley, chief medical officer of the American Cancer Society recommends "There may be some women who need to be screened every six months and others every two years depending on breast density, family history and genetic testing" (http://www.reuters.com/article/2013/03/19/us-cancer-breast-mammograms-idUSBRE92I00720130319 see, in particular, paragraph five and six).
There are "guidelines" for screening for breast cancer, including one of the most powerful tools we have, mammography.
BUT, they are just guidelines. Find out which screening plan is best for you, based on your personal history, family history and genetics.
We have the tools to enable personalized breast cancer screening for each woman and will discuss these, this week and the next.
For now, do something to lower your risk for breast cancer, because prevention is even better than early detection! GO FOR A WALK! And tune in tomorrow for more.
Together we can prevent at least 86,000 breast cancer cases this year!
This is general content and not personal medical advice, so check with your breast doctor.
The importance of the article was missed by most news reporting: that screening in young women (40-49 years) does, in the authors' words, "minimize their risk of advanced-stage disease". Further, they point out that more mammograms mean more false positives at any age; the price of routine screening mammography.
But, in this blog, we have been talking about personalized medicine: which screening is the right choice for which woman? Personal screening recommendation fit for her personal risk. And now Dr Otis Brawley, chief medical officer of the American Cancer Society recommends "There may be some women who need to be screened every six months and others every two years depending on breast density, family history and genetic testing" (http://www.reuters.com/article/2013/03/19/us-cancer-breast-mammograms-idUSBRE92I00720130319 see, in particular, paragraph five and six).
There are "guidelines" for screening for breast cancer, including one of the most powerful tools we have, mammography.
BUT, they are just guidelines. Find out which screening plan is best for you, based on your personal history, family history and genetics.
We have the tools to enable personalized breast cancer screening for each woman and will discuss these, this week and the next.
For now, do something to lower your risk for breast cancer, because prevention is even better than early detection! GO FOR A WALK! And tune in tomorrow for more.
Together we can prevent at least 86,000 breast cancer cases this year!
This is general content and not personal medical advice, so check with your breast doctor.
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