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Breast Density: What it is and what it means to you

 
There are several steps that women can take to reduce their breast cancer risk. From following a healthy diet, having an active lifestyle, to limiting alcohol and using safe beauty products, there are a number of opportunities for women to take charge of their breast health.

But one significant risk factor that women can’t control? Breast density.

Breast density, a term that some women who have had mammograms may be familiar with, refers to the percentage of different tissues that make up a woman’s breasts—fat tissue, glandular tissue and connective tissue. While some women’s breasts are comprised primarily of fat tissue, nearly 40 percent of women have breasts with mostly glandular and connective tissue, a characteristic commonly referred to as dense breasts that can make breast cancer more difficult to detect.

“Dense breast tissue appears white on a mammogram, and so do tumors and other abnormalities, which makes it easier for tumors to hide. Although mammograms can still be effective for women with dense breasts, detecting calcifications for example, this camouflaging does make it more difficult to detect some cancers,” explains John Stassi, MD, radiologist with The Barbara Brodsky Comprehensive Breast Center at Bryn Mawr Hospital, part of Main Line Health.

Not only do dense breasts make breast cancer more difficult to detect, they also make it a more likely occurrence. Studies have linked breast density with a higher risk for breast cancer.

Previously, women were not made aware of their breast density but thanks to new regulations in nearly half of the states across the country, including the 2013 Pennsylvania Breast Density Notification Act, physicians are now required to alert women when a mammography exam shows dense breasts.

“For women, this news can be concerning. However, by telling our patients whether or not they have dense breasts and then educating women about how to manage that risk, we will hopefully be able to reduce the number of undetected or hidden cancers in our patients with dense breasts,” says Dr. Stassi.

Even if they learn they have dense breasts, Dr. Stassi encourages women to continue to schedule their annual mammogram. Some of the earliest signs of cancer, such as calcifications, are still easily detected even in dense tissue. The use of 3D mammography throughout Main Line Health has already improved breast cancer detection in our patients with dense breast tissue.” says Dr. Stassi. Learn more about 3D mammography at Main Line Health.

If you learn that you have dense breasts, talk with your primary physician or gynecologist, or a breast center nurse navigator about your lifetime breast cancer risk. A risk assessment will take into account your family history and many other factors and if it indicates that you are at a higher lifetime risk for breast cancer, they can help you determine what supplemental screenings are best for you. If additional testing is necessary, your physician may recommend breast MRI, or breast ultrasound, all of which have been shown to increase cancer detection in dense breasts.

“The earlier we can begin education and awareness, the better. We are making efforts to educate women and their physicians not only about the significance of having dense breasts, but how to manage the associated risk,” says Dr. Stassi.

More Evidence Tamoxifen, Other Meds Help Limit Breast Cancer Spread

6-year study finds follow-up therapy cuts survivors’ risk for cancer in the other breast

By Robert Preidt

Thursday, October 6, 2016

HealthDay news imageTHURSDAY, Oct. 6, 2016 (HealthDay News) — Treatment with tamoxifen or another class of drugs called aromatase inhibitors does cut breast cancer patients’ risk of developing cancer in their other breast, a new study finds.

Some breast cancers rely on estrogen to help them grow, and drugs like tamoxifen or the aromatase inhibitors (which include anastrozole) have long been prescribed to certain breast cancer survivors.

Tamoxifen blocks estrogen receptors in the breast cells to hamper cancer growth. Anastrozole stops estrogen production in fat tissue, which makes small amounts of the hormone.

According to background information in the new study, about 5 percent of breast cancer patients develop cancer in their other breast (contralateral breast cancer) within 10 years after their initial breast cancer diagnosis. Prior clinical trials had concluded that tamoxifen and aromatase inhibitors reduce this risk, but their impact on actual patient treatment was unclear.

The new study was led by Gretchen Gierach, of the U.S. National Institutes of Health, and involved almost 7,500 women diagnosed with invasive breast cancer between 1990 and 2008.

Most of the patients were white and their average age at diagnosis was nearly 61. Tamoxifen was used by 52 percent of the patients for an average of just over three years.

Aromatase inhibitors were used by nearly 26 percent of the patients. About half of this group took aromatase inhibitors with tamoxifen for a median of 2.2 years, and about half took aromatase inhibitors alone for a median of almost three years.

During just over six years of follow-up, 248 of the patients in the study were diagnosed with a cancer appearing in the previously unaffected breast.

However, the risk of this happening declined the longer patients took tamoxifen, Gierach’s team found. Compared to those who did not take the drug, current users had a 66 percent lower risk after four years of taking tamoxifen. Risk reductions were smaller but still significant at least five years after stopping tamoxifen therapy, the study authors noted in a news release.

Use of aromatase inhibitors without tamoxifen was also associated with reduced risk of cancer in the previously unaffected breast, the findings showed.

Overall, for every 100 patients who’d survived at least five years, using tamoxifen for at least four years was estimated to prevent three cases of tumors spreading to the previously unaffected breast over a decade, the researchers said. That finding was specific to women with what are known as estrogen receptor-positive tumors, where the cancer is sensitive to the hormone.

Gierach’s team believes the findings support recommendations that breast cancer survivors “complete the full course” of whichever medication (tamoxifen or aromatase inhibitor) they’ve been prescribed.

Two oncologists each called the new findings “reassuring.”

One is Dr. Stephanie Bernik, who is chief of surgical oncology at Lenox Hill Hospital in New York City. She believes that tamoxifen and aromatase inhibitors are potentially life-saving, so the new findings are welcome.

“Many women have side effects from the drugs and although these side effects are often minor, they need encouragement to continue using the drug,” Bernik explained. “With more evidence showing that in real-life settings tamoxifen and aromatase inhibitors help prevent recurrences, more women will continue to take the drug for longer periods of time.”

Dr. Nina D’Abreo directs the Breast Health Program at Winthrop-University Hospital in Mineola, N.Y. She believes the NIH trial confirms the benefits of the drugs as evidenced in prior studies, and may help dissuade some women from deciding to have the unaffected breast removed for preventive purposes.

D’Abreo said the study “also affirms that the duration of therapy matters, but even shorter use has benefits for the ‘real-world patient’ who cannot comply with the recommended five to 10 years.”

The findings were published online Oct. 6 in the journal JAMA Oncology.

SOURCES: Stephanie Bernik, M.D., chief, surgical oncology, Lenox Hill Hospital, New York City; Nina D’Abreo, M.D., medical director, Breast Health Program, and attending physician, department of oncology and hematology, Winthrop-University Hospital, Mineola, N.Y.; JAMA Oncology, news release, Oct. 6, 2016

Main Line Health Breast Cancer Awareness Month Events

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Join Main Line Health this October for a series of educational seminars devoted to breast health. These events are free, but registration is requested.
Think pink, live green: protecting your daughter’s breast health
Friends’ Central School in Wynnewood | October 6 | 7:00–9:00 pm
Make everyday choices to reduce breast cancer risk with Marisa C. Weiss, MD, director of breast health outreach and breast radiation oncology, Lankenau Medical Center; and founder and president, breastcancer.org.

Unconventional breast cancer care: the alternative approach
Paoli Hospital | October 11 | 6:00–7:00 pm
Learn about applying wellness therapies to complement traditional treatments with Sharon A. Marshall, MD, radiologist, Paoli Hospital and Kathleen Sacharian, MSN, CRNP, oncology nurse practitioner, Cancer Center of Paoli Hospital.

Understanding breast density and why it matters
Ludington Library in Bryn Mawr | October 12 | 6:00–7:00 pm
Learn about your breast density and what this mammogram finding means with W. Bradford Carter, MD, breast surgeon, Bryn Mawr Hospital.

Sidestep breast cancer: ways to beat the risks
Main Line Health Center in Newtown Square | October 17 | 7:00–8:00 pm
Learn about hereditary and lifestyle risk factors as well as actions to prevent disease with Amy L. Curran, MD, hematologist/oncologist, Bryn Mawr Hospital.

Heart health after breast cancer: making the connection
Paoli Hospital | October 18 | 6:00–7:00 pm
Understand and minimize your risk for heart disease after breast cancer treatment with Won S. Chang, MD, radiation oncologist, Paoli Hospital and Donald V. Ferrari, DO, cardiologist, Lankenau Heart Institute at Paoli Hospital.

Managing breast cancer-associated lymphedema
Main Line Health Center at Newtown Square | October 26 | 6:00–7:00 pm
Learn more about risk reduction, recognition and treatment for this lesser-known side effect of treatment with Tabitha Muracco, PT, MSPT, CLT, physical therapist, Main Line Health.

Mammogram misconceptions: clearing up the myths
Riddle Hospital | October 27 | 6:00–7:00 pm
Know when to get your mammogram—and why—with Tina R. Stein, MD, imaging and diagnostic radiologist, Riddle Hospital.

Call 1.866.CALL.MLH or register online and view more upcoming events.

 

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BREAST CANCER AWARENESS MONTH

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Good Samaritans are lending a hand…
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BREAST CANCER AWARENESS MONTH BRINGS OUT THE BEST!

WOW!!

Linda Creed Breast Cancer. Org is proud to showcase our supporters!

Starting tomorrow, October 1, Linda Creed Breast Cancer will be front and center with great supporters volunteering their time, talent, and financial help. Here’s what’s happening now!

Philadelphia International Dragon Boat Festival – Tomorrow at Boat House Row!

Big thanks to PECO Power Paddlers and Friends of Linda Creed. They’ve been training hard these last few weeks and they’re going for the goal. First heat is 8:45 AM. If you’re in the area and want to cheer them on stop by tents 88 & 89.

All month long…

Blo/Out Salons at 7th & Chestnut and 18th & Chestnut in Philadelphia will be giving every client the opportunity to donate a $1 to Linda Creed Breast Cancer with their wash and blow dry.

Soap Bucket Skincare & Candles in Oxford,PA, has designed a special candle with proceeds going to Linda Creed Breast Cancer. They are being joined by their fellow business associates. Come out and support these generous Oxford businesses during October.

And more coming…

Chubb Insurance hosting a Corn Hole Business Meeting.

Aquatic Fitness Center in Jenkintown (215-887-8787) is holding a spinning challenge on Saturday, October 16 led by the master spinner herself, Donna Belote. Go Spinners!!

Univ of the Sciences is hosting a fun evening, Pinkathon!, at the Athletic Recreation Center on Friday evening into early Saturday, 9 pm – 2 am. Tickets can be purchased on campus or through Linda Creed’s website.

LaFortuleza Rehab, 133 W. Hunting Park Ave, Philadelphia, (215-455-5370) supporters will be dancing to the music during their Zumbathon on Saturday, October 22! Come join in the fun!

Showtime Charities will be belting out the songs on Monday, October 24.

Standby…More to follow.

Copyright © | 2016 | Linda Creed Breast Cancer. Org |, All rights reserved.
Our mailing address is:
| 614 South 8th St. – #277 | Philadelphia, PA 19147 | (215) 564-3700
http://www.lindacreed.org

 

Tamoxifen OK for Breast Cancer Patients without Uterine Abnormalities

By Mary Elizabeth Dallas

Thursday, September 22, 2016

THURSDAY, Sept. 22, 2016 (HealthDay News) — For most women, taking the breast cancer drug tamoxifen doesn’t increase their risk of uterine cancer, a new study suggests.

For women who don’t already have precancerous abnormalities in the uterine lining (endometrium), the risk is small, according to the Loyola Medicine study. The researchers said a pretreatment ultrasound may ease women’s concerns.

“Many women who would benefit from taking tamoxifen fail to do so because they fear getting endometrial cancer,” first author Dr. Ronald Potkul said in a Loyola news release. “Our study found that for women who did not have endometrial abnormalities when they began taking tamoxifen, there was a very low rate of developing pre-malignant conditions.”

Potkul is chairman of obstetrics and gynecology and director of gynecologic oncology for the Loyola University Health System in Maywood, Ill.

The study, funded by the U.S. National Cancer Institute, involved nearly 300 postmenopausal women. All had a type of early stage breast cancer known as estrogen receptor-positive cancer. That means cancer cells get signals from estrogen that spur them to grow.

The women, whose average age was 59, were randomly selected to take tamoxifen, either alone or along with the hormone progestin.

Tamoxifen is a highly effective drug used to treat breast cancer and to help prevent it in women at high risk for the disease, the researchers said.

The study authors theorized that taking progestin along with tamoxifen would reduce patients’ odds of developing abnormal changes in the uterine lining that could lead to cancer.

The women had ultrasounds of their uterus when the tamoxifen study began, after two years and again after five years.

Two years in, only 6 percent of the 89 women in the tamoxifen-only group had uterine abnormalities — much lower than the 30 percent that the study authors had projected.

Five abnormalities were found in the tamoxifen-only group, and one in the group taking tamoxifen with progestin, according to the study published in npj Breast Cancer. The authors said that difference is insignificant.

None of the abnormalities was cancerous, and only one more, also not cancerous, was found after five years.

The study authors said their findings could be affected by the fact that all participants had ultrasounds before taking tamoxifen. If they showed a set level of thickening in the uterine lining, a biopsy was done. Women with abnormal biopsies were not included in the study.

The authors said more study is needed before making broad treatment changes.

SOURCE: Loyola Medicine, news release, Sept. 16, 2016

GUEST POST BY BILL ARON, author and photographer

The Unacknowledged Phase of Cancer

by Bill Aron

I can’t control how long I live, but I can control how I live. Cancer taught me that.

When I was diagnosed with cancer in 1993, my first reaction understandably was fear, which was soon followed by a crushing sense of feeling all alone. I felt alienated and estranged from everyone. It was like I was living in a different universe. Susan Sontag described this feeling well when she wrote that the sick person is transported to another country, separate and distinct from the land of the healthy. Then after treatment, instead of being elated, I felt once again alone and confused.

Over time, I began asking other survivors, several hundred in all, over a 10-year period, about how they felt when their treatment was finished, and many acknowledged similar feelings. One survivor labeled it the ”unacknowledged phase” of cancer, when the frenetic flurry of treatments and doctors’ appointments is replaced with a gaping silence and an uncertainty about what the future holds.

At this point, survivors are left to their own resources as they attempt to move forward. Family and friends expect the survivor to move on. Even the survivor expects life to go back to normal. I instinctively knew this wasn’t right.

I learned a lot from the survivors I spoke with: I discovered that fear, pain and depression do not have to be lasting events, but can be viewed as passages to somewhere and something better.

Some survivors changed careers, some reordered their priorities, some started families, while others simply reaffirmed that the path they had chosen was right for them. They changed in other ways as well, altering their diets and taking up exercise. “No one dies from eating fruits and vegetables or exercising,” one survivor told me. They explored ways to give back to the “cancer community” by raising money, visiting treatment centers, founding survivor organizations, and reaching out to others who had been diagnosed. They believed they could make a difference.

Too often, the words, “You have cancer” are an ending instead of a beginning. In truth, I learned that there are amazing stories to be told of people for whom cancer became an impetus to change their lives for the better. Those stories could comfort thousands of people who felt they alone and scared. Those stories need to be heard.

Towards that end, I interviewed several hundred cancer survivors, which became the basis for the book “NEW BEGINNINGS: The Triumphs of 120 Cancer Survivors” which consists of interviews and portraits of 120 survivors, ages 2 through 99, many cancers.

In conclusion, the most important lesson I learned is that “If you can change how you feel about your life’s possibilities, then the world around you will change.” Learning to live after, and with cancer is a very different mindset – and many need help in figuring out how.

 

“Conquering cancer is really not about cure. It’s about living—living well for as long and as fully as one can.”

The New York Times personal health columnist

Jane E. Brody in her introduction to NEW BEGINNINGS

 

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A Taste of the Images: http://www.billaron.com/new-beginnings-the-triumph-of-120-cancer-survivors.html

AmazonLink: http://goo.gl/FnS5J4

 

 

Cancer Survivor: Chelsea Kaurman with Friends: right to left: Hannah, Daniella, Chelsea, Marissa, Kayla, Sarah, Alana

Cancer Survivor: Chelsea Kaufman with Friends: right to left: Hannah, Daniella, Chelsea, Marissa, Kayla, Sarah, Alana

Chelsea Kaufman and Friends, in Chelsea’s words: “Before I was diagnosed with cancer, I was just another giddy 15-year-old, size-four girl. After six surgeries and six months of chemotherapy, I first had to learn that I needed to allow myself to grieve for all the fear that I experienced, and most important, the loss of my 15th year. Only after the grief could my focus change to moving forward … To live without goals is to exist without celebrating life.”

Just 2 Years of Tamoxifen Ups Breast Cancer Survival

On Thursday, I met with my oncologist Dr David Mintzer at Pennsylvania Hospital for my 4th year check up. He told me there is a symposium coming up in June which will present data for continuing Tamoxifen for 10 years! We will discuss it next year which will be my 5 year mark. Interesting to find this article online which says even 2 years helps survival. It does not suggest skipping the 5 or 10 year protocol if you can take the side effects but, if not, even two years is beneficial.

For premenopausal women with estrogen receptor (ER)-positive breast cancer, 2 years of adjuvant tamoxifen is enough to confer a long-term survival benefit, according to a Swedish study with more than 25 years of follow-up.

The study, by Maria Ekholm, MD, from Lund University in Sweden, and colleagues, was published online May 9 in the Journal of Clinical Oncology.

The finding is not surprising, said Hatem Soliman, MD, from the Moffitt Cancer Center in Tampa, Florida, who was not involved in the study.

Dr Hatem Soliman

“It has been known for quite some time, and previous data have shown that even someone who delays starting their tamoxifen, say a year or two out, still derives benefit,” he told Medscape Medical News.

The South Swedish and South-East Swedish Breast Cancer Groups conducted the randomized phase 3 SBII-2pre trial from 1984 to 1991. Of the 564 premenopausal patients with primary breast cancer, 276 were randomly assigned to 2 years of adjuvant tamoxifen and 288 were assigned to no systemic treatment.

In addition, in the Adjuvant Tamoxifen: Longer Against Shorter (ATLAS) trial, which randomly assigned patients without recurrence after 5 years of tamoxifen to continue tamoxifen for another 5 years or to receive no further treatment, the absolute beneficial effect on breast cancer mortality was 0.2% at year 10 and 2.8% at year 15 (Lancet. 2013;381:805-816).

And results from the Adjuvant Tamoxifen – To Offer More? (aTTom) trial were similar (J Clin Oncol. 2013;31[suppl]:abstr 5), Dr Ekholm and her colleagues note.

More on the Carryover Effect

In their study, Dr Ekholm’s team also saw the carryover effect on mortality.

The reserachers obtained data on date and cause of death from the Swedish Cause of Death Register, so were able to look at cumulative mortality and cumulative breast-cancer-related mortality.

For the 250 patients still alive in April 2014, median follow-up was 26.3 years (range, 22.7 – 29.7 years). Of the 314 deaths, 262 were deemed to be related to breast cancer.

In the 362 patients with ER-positive tumors, tamoxifen was associated with a marginal reduction in mortality (hazard ratio [HR], 0.77; 95% CI, 0.58 – 1.03; P = .075) and a significant reduction in breast-cancer-related mortality (HR, 0.73; 95% CI, 0.53 – 0.99; P = .046).

In the 332 patients with ER-positive, PR-positive tumors, a significant beneficial effect was also seen. For cumulative mortality, the hazard ratio was 0.73 (95% CI, 0.54 – 0.98; P = .034), and for breast-cancer-related mortality, it was 0.70 (95% CI, 0.51 – 0.97; P = .30).

However, in the 153 patients with ER-negative, PR-negative tumors, no such beneficial mortality effects were seen.

Patients with ER-positive tumors who were younger than 40 years derived the most benefit from tamoxifen. For those patients, the hazard ratio for cumulative mortality was 0.45 (95% CI, 0.23 – 0.91), whereas for patients 40 years and older, it was 0.89 (95% CI, 0.65 – 1.23; interaction P = .061).

Results were similar for cumulative breast cancer-related mortality. For patients younger than 40 years, the hazard ratio was 0.37 (95% CI, 0.17 – 0.82), whereas for patients 40 years and older, it was 0.87 (95% CI, 0.61 – 1.22; interaction P = .044).

The researchers assessed the effect of tamoxifen at three different time periods in patients with ER-positive tumors: years 0 to 5, years 5 to 15, and beyond 15 years.

The hazard ratios for mortality and breast-cancer-related mortality increased to a peak at 6 years in both the tamoxifen and control groups, but declined thereafter.

Dr Mateusz Opyrchal

The data from this trial reflect data from other studies looking into adjuvant endocrine treatments, said Mateusz Opyrchal, MD, PhD, from the Roswell Park Cancer Institute in Buffalo, New York.

“Interestingly, we continue to see the effect of treatment even after 15 years of follow-up, demonstrating the difficulty in treating and studying breast cancer, as disease recurrence can happen many years and even decades after the initial diagnosis,” he told Medscape Medical News.

The researchers showed “that even shorter treatment with endocrine therapy is better than no treatment at all,” he pointed out. “These results will not affect the current guidelines, which recommend 5 to 10 years of adjuvant endocrine therapy, but they might help patients and their oncologists make informed decisions for women with relatively low-risk cancers who have intolerable toxicities from their endocrine therapies,” he said.

That just 2 years of tamoxifen shows a survival benefit “speaks quite a bit to the ability of tamoxifen to reduce breast-cancer-specific mortality,” noted Dr Soliman.

“The impact of these data right now is that we can probably counsel our patients that some tamoxifen is better than nothing, even if they are not able to hang in for the full 5- to 10-year period currently recommended. So, when patients ask us if a couple of years of tamoxifen is going to do anything for them, we can at least potentially point to this study and say there are some data that even 2 years is better than nothing, but it’s probably not ideal,” he said.