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What’s the Latest News About Breast Cancer?

An Update from the Miami International Breast Conference.

Conference notes from Dr. Richard MacDowell, Albany Medical Center

Breast Cancer conferences are filled with talks about chemotherapies and protocols. Also discussed this year were current issues relating to treatment options. Many were discussed in detail and deserve some further explanation.

(Published in the To Life! Spring 2016 Newsletter)

Lumpectomy or Mastectomy? Currently, breast conserving surgery (lumpectomy followed by radiation therapy), is the more common approach to treating breast cancers. But, requests for mastectomy, including bilateral mastectomy have been increasing, especially among younger women. Some describe this as the “Angelina Jolie effect” due to her much publicized bilateral mastectomy and reconstruction surgery. This treatment is indicated in some patients, particularly those with increased risk of breast cancer because of gene mutations. But most patients opting to have the second breast removed do not fall into this high risk category. Instead, many patients indicate the wish to avoid years of follow-up by mammogram and possible future biopsies. Some note that the cancer risk is lessened following mastectomy, though with close follow-up, these cancers are rarely fatal. There is no clear answer but this decision is significant and not to be made without a thorough understanding of the pros and cons of both surgical techniques. Consensus is emerging that we are misdirected in doing more mastectomies and prophylactic mastectomies. We know that, absent a markedly elevated genetic risk, there is minimal, if any, surgical advantage to removal of the second breast. It should also be noted that there is now data to suggest a survival advantage to breast conserving therapy (lumpectomy plus radiation) over mastectomy.

Do we overtreat DCIS? Much is written about noninvasive breast cancers such as DCIS (ductal carcinoma in situ). Historically, this was seen as a definite precursor to invasive cancer and treated aggressively. Some now claim that we treat DCIS too aggressively given that many of these cancers are unlikely to spread thus not needing aggressive therapy. A technique called genomic profiling is available to identify DCIS patients who can be monitored, rather than
aggressively treated. Genomic profiling is analysis of biopsied breast tissue to predict which tumors are likely to be aggressive and which are likely to be indolent. Studies show that many such tumors can be treated with minimal therapy and close follow-up. It is likely that this will lead to fewer patients receiving radiation therapy, particularly older patients. Breast Density Many patients having mammograms recently have gotten letters from the radiologist about the density of their breasts. This is new in the last few years and has caused confusion. For many years, radiologists in New York State have been required to notify patients if their mammograms indicated any problems. Now radiologists must also indicate if the scan indicated significant breast density. Breasts are considered “dense” when they have more fibroglandular tissue than fatty tissue. In that case, it can be harder to see a mass or a lump on the mammogram, meaning that it might be missed. It is left to the physician and patient to determine what to do with this information. Some medical practices routinely recommend screening ultrasounds for patients with dense breast tissue while others use 3-D mammography, or rely on close observation. The number of additional breast cancers found due to this change is small but significant. Breast density is a finding that many women will need to consider. It is important to talk to your physician about the significance of dense tissue and what follow-up is needed.

To Screen or Not to Screen? There has been much discussion and debate about mammography timing and frequency of late. This largely concerns patients with no obvious risk factors for breast cancer. Those with abnormal gene mutations or a strong family history likely need to start having mammograms sooner, more often, and for a longer time. We know that 75-80% of breast cancers occur in individuals who do NOT have abnormal genes, a strong family history or other significant risk factors. This average person sees a variety of very different recommendations, causing understandable confusion. The American Cancer Society now recommends screening to begin at age 45 with annual screening thereafter. However, the United States Preventative Services Task Force recommends starting screening at age 50 and continuing every two years. Both organizations agree that women should have the choice to begin screening as early as age 40. This may
be appropriate for those wanting to take every step in the interest of early detection, but others are concerned about false positive findings generating unnecessary biopsies and radiation exposure. For them, starting screening at age 50 may be appropriate. This is a point to be reviewed with your physician.

A Compelling Account The conference keynote speaker was Amy Robach of Good Morning America. She is the reporter who was persuaded to have her first mammogram at age 40, on live television. She didn’t want to but was convinced that her participation would save lives. Little did she know that the life she saved would be her own. Robach had no risk factors but her live TV mammogram showed an invasive and aggressive breast cancer with positive lymph nodes - potentially fatal without early detection. Over many years I have heard survivors tell their stories, but rarely been so moved as I was listening to this professional commentator and young mother describe her experience. Screening recommendations address the broadest general audience but allow for individual differences. Clearly Robach is an advocate for early mammography but again, this is something that needs to be discussed between physician and patient to determine when best for her to begin her mammography screenings. This should not be determined by governments or others.

Well known breast and general surgeon, Dr. Richard MacDowell practices at Albany Medical Center. He attended the Miami Breast Cancer Conference and shared his impressions with To Life!

FAQs on How to Choose and Buy a Breast Prosthesis and Mastectomy Bra

One of the services offered at To Life! is the proper fitting of breast prostheses (also called breast forms).After breast cancer surgery, a woman can take control of her appearance and boost her self-esteem with the proper fit of a breast prosthesis.This can make a big difference in a woman’s self-image. Read more for  some frequently asked questions and answers concerning breast forms:

“Why should I have a ‘proper fit’?”

A properly fitting breast prosthesis will balance your appearance, prevent your bra from moving around, keep your spine in alignment and balance weight on your shoulders. They are designed to mimic the weight and shape of your natural breast.It is our goal at To Life! to find a prosthesis that is the right size and shape for you and your lifestyle.

“When should I have my first fitting?”

After surgery, your surgeon will recommend the appropriate time for you to start wearing a breast prosthesis. This largely depends upon the post-operative healing process and the type of mastectomy that was performed.While we appreciate that many women in the post-mastectomy phase of recovery are quickly ready to get back to normal or at least establish a “new normal”, it is a good idea to wait at least five to six weeks post-surgery to ensure all swelling has gone down.Your measurements will not be accurate if you are swollen.

“What should I wear to a fitting?”

You should wear what you normally wear in your everyday life.Part of the fitting is seeing how your clothes fit and look when you are wearing the prosthesis.A snug-fitting, design-free top will offer you the best idea of how proportional and symmetrical the breast prosthesis is to your body.

“How are prostheses sized?”

Breast prostheses are available in different shapes, sizes and skin tones.You will be fit to a shape that best conforms to your body shape and matches your existing breast (for unilateral patients).The forms are not sized like a bra so you can't count on getting a form that fits by referencing your bra size.Our fitters can help you find a style and size that works best for you.

“What do they look like?”

Some forms are symmetrical, so they can be used on either side, and some forms are designed to be asymmetrical (used only on your right or left side).

“What are they made of?”

Some are made of silicone and some are made of fiberfill. A silicone breast prosthesis is closest to imitating breast tissue in weight and drape.A good prosthesis will also have some movement similar to your real breast.Some silicone breast prostheses are designed to be worn in the pocket of a mastectomy bra and some are designed to adhere directly to the chest wall.

A fiberfill breast form is very light weight, although some do come “weighted.”It is a good idea to ask your fitter about the pros and cons of a fiberfill breast form.These forms may not be the best option for some women because they may be too light.Fiberfill breast forms are designed to be worn in the pocket of a mastectomy bra.

To Life! has a wide variety of breast prostheses and breast forms and our fitters are knowledgeable in what each form has to offer.The fitters will help you find a prosthesis that's the proper shape, size and weight for your lifestyle and your body.

“Is it comfortable to wear a prosthesis?”

Fit and comfort of a prosthesis is very individual.The prosthesis is designed to mimic the weight of the existing breast and the existing breast can be surprisingly heavy.The industry has come a long way in offering silicone prostheses that are lighter weight and cooler.Our fitters can show you the latest in lightweight silicone prostheses.

“How do I take care of my prosthesis?”

Simply washing them with a mild soap, towel drying them and putting them in their box when they are not being worn is all the care and maintenance they need.

“Will my insurance cover the cost of my prosthesis?”

Insurance companies typically provide coverage for one prosthesis every two years for unilateral patients or two prostheses every two years for bilateral patients.Because of that two-year limit, it is very important to be sized correctly.If you are sized incorrectly, you will not be eligible to re-submit for the correctly sized prosthesis for two years.That is why we recommend waiting until all of your swelling has gone down.

“Do I need a prescription?”

Your doctor will need to write a prescription for “mastectomy bras” and a “breast prosthesis” if you plan to submit these products to your insurance company.

“When do I get the mastectomy bra?”

Your fitting for the breast prosthesis will include a mastectomy bra fitting.The fitter will measure you to determine your bra band size and your cup size.If you have had bilateral surgery, you will tell the fitter the cup size you want to be.To Life! offers many options for mastectomy bras including seamed, seamless, molded cup, camisole bras, and sports bras.

Our goal at To Life! is to ensure your breast prosthesis and mastectomy bra needs are met properly and in a stress-free manner.A proper fitting at the right time is the best way to attain that goal.

“How Much Does a Prosthesis Cost?”

Fitting services at To Life! are complimentary, provided by certified mastectomy fitters. There are costs associated with product. We participate with some insurance companies, including Medicare. However, should we not participate with your insurance company, please know that we have options for supporting your needs and will not turn anyone away. Please feel free to contact us for more detailed information on how we may best serve you.

Our goal at To Life! is to ensure your breast prosthesis and mastectomy bra needs are met properly and in a stress-free manner. A proper fitting at the right time is the best way to attain that goal. Please feel free to contact our fitters with any questions you may have.

Please feel free to contact our fitters with any questions you may have.

Delmar Boutique:Ann Rose (518) 439-5975

Saratoga Boutique:Melanie Murphy (518) 587-3820

Radical surgery just one option

Actress Jolie's double mastectomy puts focus on gene tests

Victoria O'Donnell wishes she got tested for a gene that shows an increased risk of breast cancer after her sister, Valerie Grugan, was diagnosed and had a double mastectomy three years ago.

The 46-year-old Greene County resident considered the test at the time, but figured she didn't need it. She got annual mammograms. She felt good.

Read more

Quyen Nguyen: Color-Coded Surgery

Surgeons are taught from textbooks which conveniently color-code the types of tissues, but that's not what it looks like in real life -- until now. At TEDMED, Quyen Nguyen demonstrates how a molecular marker can make tumors light up in neon green, showing surgeons exactly where to cut.

For Latinas, Patient Navigation Can Speed Breast Cancer Diagnosis

It’s not uncommon for Latinas who have an abnormal mammogram test to not follow up and get the medical treatment that can need. But a little extra support can make the difference.

SAN ANTONIO, TEXAS — It’s not uncommon for Latinas who have an abnormal mammogram test to not follow up and get the medical treatment that can need. But a little extra support from helpers called “patient navigators” can make the difference.

Facing a possible diagnosis of breast cancer can be tough for anyone to process. But for whatever reason Hispanic women need a little extra help to get them back to the doctor.

“It can be fear, it can be economics, it can be language issues, it can be not knowing the medical system and what are the next steps required to get complete follow-through," said Amelie Ramirez of the University of Texas Health Science Center.

Ramirez is the author of a new study published in the journal Cancer that found assigning a “patient navigator” to Latinas who have abnormal breast cancer scans improves their health care.

“They help them set up their appointments. If the woman says 'I can’t come in because I don’t have anyone to help me with child care, I don’t have transportation,' our patient navigator assists them with these barriers," Ramirez said.

In the study, on average, women received a diagnosis more than 40 days sooner if they worked with a patient navigator.

This can save lives and health care dollars. Ramirez said they are looking for ways to make having a patient navigator on staff as a standard part of a successful health care model.

Vitamin D and Breast Cancer

New Research & Recommendations

Dr. JoEllen Welsh, Professor at University at Albany's Cancer Research Center, presented on the topic of Vitamin D at our recent Beat the Odds event. She answered a number of questions from the audience. The following article highlights her findings (Click for full length presentation PDF)

The recommendations are confusing, partly because there are two things to consider (but they are related):

How much vitamin D do I need (ie, from diet or pills)?

What is the optimal blood level of vitamin D?

The optimal blood levels are determined by measurement of 25-hydroxyvitamin D. This is the test a Dr can/will order, and it will be flagged as “low” if the measurement is below 32ng/ml. It measures both forms of vitamin D (D2 and D3). Some of the data on blood levels and chronic disease is shown in different units (nmole/l), 32ng/ml is equivalent to 80nmole/l. Therefore the minimum level of 80nmole/l is the same as 32ng/ml. From what we know now, this is the level which seems to be associated with best protection against chronic diseases. We do not have evidence that levels higher than this are better.

If the value is found to be low, then a prescription form of vitamin D may be given – this is a very large dose of D2 (50,000 units per pill) and is usually taken once a week for 6-8 weeks, then the blood level is re-tested.

If the blood test is OK, then you can assume your vitamin D pools are sufficient.

The recommended minimum intake is 600 units per day but this is for healthy persons and assumes some sun exposure. Not everyone will have a normal blood test at this level, so it is absolutely essential to have the test done to see where you are. The upper limit has been set at 4000 units per day (although this is conservative).

Wellness Therapies

To Life! offers Reiki and Healing Touch at no charge to patients, survivors, and caregivers by appointment.
Each of these therapies promotes relaxation and healing, and clients leave our doors with a sense of calm and positivity.

As one client stated,

"I really enjoyed my [Healing Touch] experience with Shirley.  I left in peace and calm.  The feeling continues today. Oddly for me, tears flowed during the session; I wonder where they came from.  Hmmmm. I haven't cried in years, but it sure felt good!! 

I strongly recommend a session with Shirley for everybody.  The healing touch made the rest of my day pleasant and enjoyable; I was able to relax and enjoy the simple wonders of nature that surround me that I don't notice very often, like the smell of  flowers in my garden, the birds chirping, the magnificient sky.  Truly a magical experience.  It dawned on me that I might just be depressed and Shirley's healing hands greatly affected my mind, body and spirit.  Amazing!!"

--Ruth, Breast Cancer Survivor

To learn more about how Reiki can help manage chronic pain, visit this article: How can Reiki help you?


Breast Cancer Surgery Rules Are Called Unclear

A recent article published in the New York Times cites a study that indicates guidelines for lumpectomies (the most common breast cancer surgery) are unclear and not necessarily agreed upon...

A recent article published in the New York Times cites a study that indicates guidelines for lumpectomies (the most common breast cancer surgery) are unclear and not necessarily agreed upon. The study, performed by Dr. Laurence E. McCahill of Lacks Cancer Center in Grand Rapids, MI, was published online  by The Journal of the American Medical Association.

According to Dr. McCahill, nearly half of women who have undergone lumpectomies had second opertaions that weren't needed, while others are missing out on additional surgery that could benefit them. Ths study found that rates of repeat surgery can vary widely by doctor, from zero percent to 70 percent. This is due to lack of agreement on guidelines amongst the surgeons who perform these surgeries.

Read more here.