Women have more options than ever for fighting breast cancer. But many aren't getting the best screening and care, resulting in missed cancers, over-aggressive treatment and other serious mistakes. Being informed is the best defense. In recognition of Breast Cancer Awareness Month, find out which questions to ask, how to choose a mammography facility and surgical options...
Breast cancer. For many women, these are two of the most dreaded words in the English language. And no wonder: More than 180,000 women this year will receive the diagnosis, plunging them into a world of complicated decisions and difficult treatment.
But there’s good news too. More women are diagnosed early, when the odds of beating the disease are as high as 98%. And thanks to genetic tests and new drugs, prevention and treatment are getting personalized.
At every step, from deciding where to schedule a mammogram to determining the best treatment, women have options that were unimaginable just a few years ago. But research shows that many aren’t getting the best tests and treatments, resulting in missed cancers, overaggressive surgery and other serious mistakes.
The challenge: Breast cancer is a complex disease — some researchers believe it’s at least five genetically distinct conditions. And no approach to tests and treatments is right for everyone. Here’s how to make sure you get the care you need.
Know Your Risk
Although chances for getting breast cancer increase for all women as they age, other factors can make certain women especially vulnerable, according to the National Cancer Institute.
These include:
If you’ve had breast cancer in the past
A close blood relative — female or male — who has had the disease
Early onset of menstruation (before age 12)
Menopause after age 55
Having no children or giving birth to your first child after age 30
Being overweight
Certain genetic changes (including the presence of BCRA1 or BCRA2, gene mutations associated with breast cancer susceptibility)
Learn the Warning Signs
Most doctors no longer recommend the monthly breast self-exam, because it showed little benefit in saving lives. However, if you notice changes in your breast, see your doctor right away.
Pay attention to these warning signs:
A lump or hard knot
Swelling or redness
Puckering of the skin
A nipple rash, sore or discharge
Change in the size and shape of the breast
To be alert to subtle changes, you need to know how your breasts normally look and feel. The Breast Awareness Interactive Tool, from Susan G. Komen for the Cure, is a good place to start.
Know Where and When to Get a Mammogram
Getting regular mammograms is the best way to find breast cancers early. But there are conflicting recommendations about whether to start screenings at 40 or 50.
One Swedish study sides with testing younger: The study found that beginning mammogram screening at 40, rather than 50, reduced the risk of dying from breast cancer by 26%. The findings are consistent with the recommendations of leading cancer organizations in this country.
The American Cancer Society advises annual mammograms starting at 40 and urges women at high risk to talk with their doctors about starting younger. The National Cancer Institute recommends screening every year or two for women in their 40s. And experts agree that if you’re over 50, regular mammograms are a must.
Deciding where to get your mammogram is as important as figuring out when. Some facilities are more accurate than others.
Mammograms are more likely to be interpreted correctly at facilities with a breast-imaging specialist – a doctor who spends at least half his or her time doing breast screening – according to a 2008 NCI study, which reviewed nearly a half-million mammograms.
When you call for an appointment, ask if there’s one on staff.
Follow Up on a Worrisome Test
If a lump is found on a routine mammogram or in an exam, the next step is often a diagnostic mammogram, which takes close-up X-rays of the suspicious region of the breast. But as with screening mammograms, the facility you choose can affect the accuracy of results.
A 2007 study of 123 radiologists by Group Health Cooperative, published in the Journal of the National Cancer Institute, found that on average they missed 21% of cancers on these critical tests, with the worst performers wrong in 73% of cases.
Such mistakes almost guarantee delays in treatment, which can have dangerous consequences.
In the study, radiologists who spent at least a day each week doing breast imaging had a better record on diagnostic mammograms than those who spent less. Doctors affiliated with academic medical centers had the best results of all.
If you need a diagnostic mammogram, go to a breast-imaging specialist. Unless you live in a rural area, you should be able to find one no more than an hour or two away.
“Even if you don’t live near one, it would be worth the drive,’’ says Diana Miglioretti, Ph.D., the Seattle researcher who led the study.
Make an Informed Choice About Surgery
Many women diagnosed with breast cancer face a choice between two procedures that have been shown to be equally effective at saving lives: mastectomy (removing the breast) or lumpectomy, taking out only the tumor and surrounding tissue, followed by radiation.
Treatment guidelines developed by leading experts favor lumpectomy because it’s less invasive. But, believe it or not, whether women get it often depends on where they live.
Women in the Northeast are much more likely to have breast-saving surgery than women in the South, with those in the West and Midwest falling between, according to Jack Sariego, M.D., a Temple University professor of surgery, who reviewed 800,000 patients’ records in a 2008 study.
The doctor’s age is also a factor: Earlier University of North Carolina research found that women treated by younger doctors — those who trained after 1981 — were more likely to undergo lumpectomy than patients who saw older ones.
Your decision can have significant long-term effects, emotionally and cosmetically. So know the risks and benefits of any procedure your surgeon recommends.
The top question to ask: “Am I a candidate for breast-conservation surgery [lumpectomy or partial mastectomy], and if not, why not?’’ Sariego says.
Get a Second Opinion
Surgeons who treat a lot of breast cancer and those who work in cancer centers or university-affiliated hospitals are more likely than general community surgeons to recommend lumpectomy, according to a study in the journal Cancer in 2005.
Researchers presented sample cases to 45 surgeons: 87% of high-volume breast surgeons favored breast-conserving surgery, compared with 60% of surgeons who operate on breasts less frequently.
But most breast cancer patients go to general community surgeons. The study doesn’t suggest they aren’t skilled at treating the disease, but breast-conserving surgery, like many medical innovations, has been slow to filter from academic medical centers to local hospitals.
Physician training, habits and biases may limit your options, so get a second opinion, says Steven Katz, M.D., professor of medicine and health management at the University of Michigan and the study’s leader.
Ask the first surgeon you see to recommend others. Or find a specialist by talking to other patients and scouring the Web. Breast cancer patients who do independent research are more likely to get treatment by experienced surgeons in hospitals with cancer programs, compared with women who rely on referrals from their doctor or health plan, Katz has found.
Take the Full Course of Treatment
Lumpectomy is as effective as mastectomy only if it’s followed by radiation; a course of treatment is generally five days a week for six weeks.
Yet only 75% of women who get a lumpectomy go on for radiation, Columbia University researchers reported in 2007 in the Journal of the National Cancer Institute. This raises the risk of a dangerous cancer recurrence.
Before you decide on your surgery, talk to a radiation oncologist (the specialist responsible for radiation treatments). Ask about side effects and the likely effects on your energy level. Will you have to take off time from work?
Don’t feel pressured to make a hasty decision.
“One of the biggest problems is that breast cancer is treated as a medical emergency when it’s not,” Katz says.
Ask About Breast Reconstruction
If a lumpectomy isn’t right for you, a mastectomy followed by reconstruction may be an option — but you might have to bring up the subject of restoring the breast.
Only a third of patients discuss reconstruction with their doctors before choosing between mastectomy and lumpectomy. Only 54% of doctors regularly send breast cancer patients for a plastic surgery consultation, University of Michigan researchers reported in the journal Cancer in 2007.
Both procedures alter your appearance, though in different ways. Ask your surgeon how your breast will look and feel, and how your clothing will fit. These may seem like minor issues when you’re first diagnosed, terrified and focused solely on getting healthy, but they’ll probably become important when you’re well again.
Lumpectomy sometimes changes the breast more than women expect, so you might want to talk with a plastic surgeon even if you’re going that route. Or you may want to find a surgeon experienced in oncoplasty, surgery that removes tumors and reshapes tissue around it to improve the breast’s look.
What’s Your Breast Cancer Risk?
The biggest risk factor for developing breast cancer is simply being a woman, though a small percentage of men develop it, too. Fortunately, with better screening processes for early detection, breast cancer doesn't have to be fatal.
No comments:
Post a Comment