Tag Archives: Breast cancer

Breast Cancer Treatment Options

Introduction

breast cancer treatment remedies

The next to last post in this series on breast cancer focuses on breast cancer treatment. Of course, there is no universal treatment of every breast cancer diagnosis. Everything is based on the specific type of breast cancer and the extent of progression upon diagnosis. Management usually involves a team approach in order to balance multiple considerations. As a result, this often leads to different treatment modalities being used together.

Breast Cancer Treatment Options

Breast-Cancer-Treatment-Diagram1
My goal today is to give you a general understanding for the different components of treatment, not to get into the nuances of individual treatment regimens. I certainly recommend you engage your personal physician and resources such as the CDC and the American Cancer Society. These will provide you with any and all additional, up-to-date details you may desire.

We treat breast cancer in several complementary ways. These include surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. Let’s review the basics of each.

breast cancer treatment sx

  • Surgery: Sometimes, the cancer advances to a level where it can only be removed surgically. Surgical options include cutting out the area affected by the cancer (a lumpectomy), removing the entire breast (a mastectomy), and/or removing the areas where the cancer will drain and spread to other parts of the body (lymph node biopsy/resection). Of course, options aren’t actually quite this simple. Efforts to spare skin and tissue and to retain a cosmetic appearance are important considerations. If the risk of breast cancer in that breast is sufficiently high, sometimes the other breast is removed. Additional surgical considerations include breast reconstruction after surgery, which may include one’s own tissue or a synthetic breast implant. These are options to be discussed with a plastic surgeon prior to breast cancer surgery.

BREAST CANCER TREATMENT chemo

  • Chemotherapy: Chemotherapy is the use of medication to kill or reduce the cancer. Chemotherapy may be given via an IV (into the veins) or by pills. Typically, it is given before surgery to reduce tumor size, after surgery or with other therapy to reduce the risk of recurrence, or as a primary treatment option.

Breast Cancer Myths_Button

  • Radiotherapy (radiation therapy): High energy rays can be aimed at the cancer cells in an effort to kill them. Alternatively, radioactive material can be placed in the body.

breast cancer treatment hormonal tx

Additional Breast Cancer Treatment Options

  • Hormonal therapy: As mentioned in this post, certain cancer cells are stimulated by hormones to grow. Hormonal therapy blocks cancer cells from getting the specific hormones that assist growth. Different drugs in this class act in a variety of different ways, both direct and indirect, with the same end result of diminishing the ability of hormones to stimulate tumor growth. Yes, this treatment option would be better named hormonal blocking therapy. Hormonal therapy also can be used as a primary treatment option or after other treatment options to reduce the chance of recurrence.
  • Biological therapy: Biological therapy serves to boost the body’s immune system to better help it fight the cancer. It also is of assistance in addressing immune-reducing side effects other cancer treatments may create.
  • Targeted drugs: An additional treatment modality is the use of targeted drugs, which attack specific abnormalities within cancer cells. The most notable example of such an abnormality is the presence of a human growth factor receptor 2 (HER2), a protein that helps breast cancer cells grow and survive..

Complications and Side Effects

Complications and side effects of breast cancer treatment are plentiful. These vary based on the treatment given. For example, surgery carries a risk of bleeding and infection. Risks of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Also, breast tissue may be altered in texture and may appear swollen. Rarely, damage to the heart or lungs may occur. Common side effects of chemotherapy include hair loss, nausea, vomiting, fatigue and an increased risk of developing infection. Finally, rare side effects can include premature menopause, damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.

Your Decision Making Team

breast cancer treatment decision making team

The teams of medical, radiological and surgical cancer specialists who treat breast and other cancers do phenomenal work. Accordingly, you can do your part in reducing your risks and engaging in practices (breast self-exam and mammograms). This will allow for early detection. Remember, the days of increasing rates of breast cancer are behind us. Thankfully, breast cancer survivors abound! There are approximately 2.8 million survivors in the US. You now have the tools to be included in those numbers should (heaven forbid) you find yourself afflicted by breast cancer.

breast cancer survivor

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Breast Cancer Risk Factors

Introduction

breast cancer 1 in 8

A concerning reality is breast cancer risk factors tell the story of acquiring breast cancer. Even as a physician, I am left to think about the horror of risk factors. Most notably, simply being a woman brings a lifetime risk of acquiring breast cancer that’s 1 in 8. The only thing I can think of off-hand and relate to similarly is the risk for trauma being an inner-city minority kid. This risk of breast cancer is compounded by the reality that there is no way to prevent it. Thus, this must be emphasized early and often. Risk factor identification and reduction, coupled with early evaluation, detection and treatment are absolutely vital.

breast cancer incidence

The Reach of Breast Cancer

Breast cancer is the second most common cancer contracted by American women (after skin cancer). It is the second most common cause of death from cancer (after lung cancer). More than a quarter of a million new cases will be diagnosed in women yearly. Approximately 40,000 women will die from complications of breast cancer annually, representing over 100 deaths every day.

In the event the previous information seemed like too much gloom and doom, understand that the tide has been stemmed. After more than two decades of increase, rates of new cases of breast cancer began dropping in 2000 and have stabilized. This is largely thought to be due to declining rates of post-menopausal hormone use. As you may know, such hormone use has been shown to increase the risk of both breast cancer and heart disease.

Breast Cancer Risk Factors

avoidable breast cancer risk factors

Speaking of risks, I don’t especially like this part of the conversation because it always comes across as if everything is a risk factor. There are still controversies about what is or isn’t a risk. As a result, patients end up confused and paralyzed into inaction. Therefore, I’ll mention just enough for you to understand and work with. If you have specific questions on what you’ve heard that I haven’t already addressed in the breast cancer myth posts (Parts I and II), feel free to ask.

alcohol and breast cancer risk factors

There are risk factors you can’t change, like aging, family history and being a woman. Having these risk factors simply means you need to be more diligent in performing self exams. Also, it especially means you must seek early care for suspicious findings. Now, there are other risk factors you can minimize and are under your control. These include the following:

  • Alcohol use
  • Choosing not to breast feed
  • Obesity
  • Oral contraceptive use
  • Postmenopausal hormonal therapy

avoidable breast cancer diagram

The bottom line is your risk factors don’t cause cancer, and the absence of risk factors doesn’t ensure you won’t have breast cancer. For example, men contract breast cancer as well. What it all comes down to is you must be diligent in performing exams and getting evaluated and treated if something abnormal is discovered. We’ll discuss some of that next.

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Even More Breast Cancer Myths!

Introduction

We’re continuing from the earlier post with more breast cancer myths, well because you have so many questions!  In fact, I’m doubling up on what you received earlier in Part I of Breast Cancer Myths.  

More Breast Cancer Myths

6. “Breast cancer is preventable.”

  • Unfortunately, this is not true.  All of our efforts are geared toward lowering risks, early detection and effective treatment.

7. “Obesity doesn’t affect my risk of getting breast cancer.”

  • Not true. Post-menopausal women with weight gain are at especially increased risk.

8. African-American women have an increased risk due to hair straighteners and relaxers.Breast Cancer Myths_Button

  • This myth was taken head on and debunked by the National Cancer Institute in a large 2007 study including women with significant use over a 20-year period.

9. Caffeine causes breast cancer.

  • Not according to the evidence. There’s even evidence suggesting a benefit, but the data on this is just as inconclusive as that suggesting a link to breast cancer.

10. Mammograms increase breast cancer risk due to the radiation load.

breast cancer mammogram risk

  • The risks of radiation are so relatively insignificant that they’re mentioned as an afterthought compared to the benefits received from early and frequent evaluation.

Even More Breast Cancer Myths!

11. “Tight clothes and underwire bras will make me get breast cancer.”

  • Not true. Neither has any connection to breast cancer.

12. “Small breasts give me less of a chance of having cancer!”

  • Not true. Larger breasts are sometimes more difficult to evaluate, but that’s not the same as saying the risk of cancer is increased in women with larger breasts.

13. “These lumps I have are ok because I’m breastfeeding.”even more breast cancer myth logo

  • The fact you can discover normal changes in your breast tissue doesn’t mean that all lumps discovered while breastfeeding are normal. Get evaluated.

14. “Deodorant and tanning cause breast cancer, don’t they?”

  • No. Cell phones don’t either. Tanning does increase the risk of skin cancer, but that’s a topic for another day.

15. “I heard having a baby when I’m older increases my risk of breast cancer.”

  • Well, not just any baby, but having one’s first baby later in life is a significant consideration. Women who give birth for the first time after age 35 are 40 percent more likely to get breast cancer than women who have their first child before age 20.

16. “Breast cancer is a death sentence.”

more breast cancer myths death sentence

  • Most women survive breast cancer. Give yourself the best opportunity to do so by reducing your risks, learning the principles of early detection and getting prompt treatment if ever diagnosed. We’ll focus on these considerations in the next posts.

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Five Breast Cancer Myths

Introduction

breast-cancer-myths

Breast cancer myths: are you afraid of them? Before I get into the details of what you need to know about breast cancer, it’s important to clear the table of some of the persistent breast cancer myths and fears that exist. The disease is tough enough as it is without the fear factor impeding our ability to fight back. Please be patient with me here. If you find these myths ridiculous, then good for you, as it indicates that you’re informed on the matter. Just understand that these are real questions that other physicians and I hear often. Remember, knowledge is power.

breast cancer myth 3

Breast Cancer Myths

1. “If a family member of mine has breast cancer, that means I’ll get it too.”

  • It is only true to say that women who have a family history of breast cancer have a higher risk of developing it. Overall, only approximately 10% of women diagnosed with breast cancer have a family cancer, and most women with breast cancer have no family history. In other words, a family member with breast cancer isn’t a life sentence for you, and it shouldn’t stop your efforts to lower your other risks and focus on early detection and treatment.

2. “All lumps in my breast are breast cancer.”

  • There are two important points for you to remember. First, any persistent change in the breast or armpit (axilla) should not be ignored. Remember, I will be stressing the importance of early evaluation for the purposes of detection. That said, only a small percentage of breast changes represent cancer (about 80% of lumps are benign). The really good news is if you learn and perform consistent breast exams, you will detect these changes earlier than anyone else and very often early enough to make a difference.

bustingthemyths

3. “Men don’t get breast cancer.”

  • Unfortunately, I know this not to be the case within my family. Annually, there are over 400 breast cancer deaths among men from over 2000 new cases being diagnosed. Men should pay attention just as women do because unfortunately, in part due to the delayed detection, the death rate of breast cancer in men is higher than in women.

4. “I heard breast implants cause cancer.”

  • No. There’s no increased risk with breast implants and breast cancer. However, you can legitimately say implants sometimes obscure the view of possible cancer on a mammogram.

5. “The risk of breast cancer is always 1 in 8.”

  • Actually it’s 1 in 8 during a woman’s lifetime. However, the important distinction is the risk increases as one ages, from 1 in 233 in a woman’s 30s up to 1 in 8 across the board by age 85.

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Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

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How to Perform the Breast Self-Exam

 

Introduction

Beginning in their 20s, women should be aware of the benefits and limitations of breast self-exam (BSE) as a screening tool for breast cancer. Women should know how their breasts normally look and feel. It is extremely important to report any new breast changes to a health professional as soon as they are found. Still, finding a breast change does not necessarily mean there is a cancer.

Breast Self Exam

A woman can notice changes by being aware of how her breasts normally look and feel. Feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (with a BSE) also helps. Similarly, using a specific schedule to examine breasts maintains a heightened awareness of normalcy.

If you choose to do BSE, the information below is a step-by-step approach for the exam.

Special considerations

The best time for a woman to examine her breasts is when they are not tender or swollen. Women who examine their breasts should have their technique reviewed during periodic health exams by their health care professional.

Women with breast implants can do BSE, too. It’s helpful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that implants push out the breast tissue; this may actually make it easier to examine. Women who are pregnant or breastfeeding can also choose to examine their breasts regularly.

It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts. Not performing BSE makes it especially important to immediately report any changes to your doctor.

How to perform the breast self-exam

Breast-Self-Exam

Horizontal positioning

  • Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
  • Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Make overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
  • Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

breast self exam movement

  • Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
  • There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
  • Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

breast-self exam-5

Standing position

  • While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
  • Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

breast-self-examination lying down

Summary

This procedure for doing breast self-exam is different from some previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman’s ability to find abnormal areas.

I need to acknowledge and thank the multiple sources that continue to compile and disseminate information to the public. These include the Centers for Disease Control and Prevention, the American Cancer Society and the Susan G. Komen Foundation. We highly recommend them should you need additional or more thorough information. I welcome your questions and comments.

Feel free to ask your SMA expert consultant any questions you may have on this topic.

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October is Breast Cancer Awareness Month

Introduction

breast-cancer-awareness

How’s your breast cancer awareness? Breast cancer affects so many of us. If it doesn’t affect you or your family as well, I hope it’s not because you haven’t been paying attention. Sadly, one in eight women will be diagnosed with breast cancer in their lifetime. It’s more likely than not that every single one of us has been affected by this, either directly or through a friend or family member.

breast cancer awareness 1-8

Breast Cancer is Different

All cancer is devastating, but something about breast cancer is different. We’ve found the way to eradicate certain cancers and have made remarkable progress on others. Aside from the hereditary component, breast cancer seems so…random, so dehumanizing and so debilitating to so many.

Unlike so many of the things I address as an emergency physician, breast cancer isn’t like trauma, STDs and many other conditions, where one is often directly suffering the consequences of their behavior. It is vital that you appreciate the need and value for early detection to give yourself the best possible chance for the best possible outcomes. I’ll be discussing all these considerations in detail throughout the week.

breast cancer awareness gilda

Breast Cancer Awareness

I appreciate the sentiment behind a National Breast Cancer Awareness Month, but if I could offer you anything on this, it would be a plea to be ‘aware’ every month, and use this month as a (re)commitment to take basic steps that will reduce your risk, a charge to maintain steps for early evaluation and a prod to point you toward prompt treatment if and when needed.

In fact, those three areas will be the topics of my next few posts. In the meantime, please share this or other information about breast cancer with any and all females in your life. I also hope you choose to engage your family, friends and others in conversations geared to improving breast cancer awareness. Odds are many of them have been or will be affected by breast cancer.

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Ask your SMA expert consultant any questions you may have on this topic. Also, take the #72HoursChallenge, and join the community. Additionally, as a thank you, we’re offering you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!

Order your copy of Dr. Sterling’s books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.jeffreysterlingbooks.com. Another free benefit to our readers is introductory pricing with multiple orders and bundles!

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Straight, No Chaser: Breast Cancer in Men

breast cancer risk

I won’t overstate the case, but you should be aware that breast cancer occurs in men. That said it occurs at a much lower rate than it does in women. I know what you may be thinking, but it’s not that obvious. Both males and females have breast tissue. The big difference is women come equipped with a much greater support of certain hormones that stimulate development of breast tissue. You know this to be true because there are circumstances in which males, either through natural occurrence of abnormally high levels of those hormone levels or by stimulation (such as occurs with certain medicines), can develop noticeable sized breasts (called gynecomastia in non-cancerous circumstances and also present in breast cancer). This Straight, No Chaser offers information you should know to avoid a higher risk of developing breast cancer.

male breast cancer data

How often does breast cancer occur in males?

  • It is estimated that in 2014, approximately 2500 men are expected to be diagnosed with breast cancer.
  • Less than 1% of all breast cancers develop in men.

What are the risk factors for breast cancer in men?

male_breast_cancer_button

  • Age: Increases in age correspond to an increased risk. In fact, age in the greatest risk for men. In fact, the average age of men diagnosed with breast cancer is about 68.
  • High estrogen levels: Estrogen stimulates growth of breasts, both in normal and abnormal circumstances. The following are circumstances that can produce high estrogen levels in men.
    • Obesity increases estrogen production.
    • Certain conditions or treatment with hormonal medicines that include estrogen.
    • Heavy alcohol use can damage the liver, which can result in a diminished ability of the liver to regulate estrogen levels.
    • Similarly, other causes of liver disease also result in higher estrogen levels.
    • You can also get significant estrogen exposure if hormones are used in the beef cattle you eat.

Gynecomastia

  • Klinefelter syndrome is a genetic disorder involving the presence of additional X chromosomes (the “female” chromosome). Men with this syndrome have lower levels of male hormones (androgens) and higher levels of female hormones (estrogen), resulting in a higher risk of developing gynecomastia and breast cancer.
  • Radiation exposure: Receiving radiation therapy to the chest before age 30 (such as occurs with treatment of Hodgkin’s disease) may increase the risk of developing breast cancer.

BC risk Table

  • A family history of breast cancer or genetic alterations: Other men in one’s family with breast cancer, or a breast cancer gene abnormality also increases the risk of breast cancer. Men identified as having certain abnormal genes, including BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer of 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. The message here is if you have a family history of breast cancer, consider getting checked for the presence of these genes.

If you are a male with significant risks, your next step is to have a conversation with your physician. In case you haven’t seen the rest of the Straight, No Chaser series on breast cancer, use the following links for information on the rest of the story.

breast self exam male


Straight, No Chaser: 
Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors
Straight, No Chaser: This is How You Self-Assess For Breast Cancer, Part 1
Straight, No Chaser: How to Perform the Breast Self-Exam
Straight, No Chaser: Signs, Symptoms and Prognosis of Breast Cancer
Straight, No Chaser: Breast Cancer Treatment Options
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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Straight, No Chaser: Breast Cancer Treatment Options

breast cancer treatment remedies

The next to last post in this series on breast cancer is on management. Of course, there is no universal treatment of ‘breast cancer’; everything is based on the specific type of breast cancer and the extent of progression upon diagnosis. Management usually involves a team approach in order to balance multiple considerations, which often leads to different treatment modalities being used together.
Breast-Cancer-Treatment-Diagram1
My goal today is to offer an understanding for the different components of treatment, not to get into the nuances of individual treatment regimens. I certainly recommend you engage your personal physician and resources such as the Center for Disease Control and Prevention and the American Cancer Society, which will provide you with any and all additional details you may desire.
Breast cancer is treated in several ways, including surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. Let’s review the basics of each.

breast cancer treatment sx

  • Surgery: Under certain circumstances, the cancer has only advanced to a level where it can be surgically removed. Surgical options include cutting out the area affected by the cancer (a lumpectomy), removing the entire breast (a mastectomy), and/or removing the areas where the cancer will drain and spread to other parts of the body (lymph node biopsy/resection). Of course, options aren’t actually quite this simple. Efforts to spare skin and tissue and to retain a cosmetic appearance are important considerations. Sometimes decisions to remove the other breast is made if the risk of breast cancer in that breast is sufficiently high. Additional surgical considerations include breast reconstruction after surgery, which may include one’s own tissue or a synthetic breast implant. These are options to be discussed with a plastic surgeon prior to breast cancer surgery.

BREAST CANCER TREATMENT chemo

  • Chemotherapy: Chemotherapy is the use of medication to kill or reduce the cancer. Chemotherapy may be given via an IV (into the veins) or by pills. Chemotherapy may be given before surgery to reduce tumor size, after surgery or with other therapy to reduce the risk of recurrence, or as a primary treatment option.

Breast Cancer Myths_Button

  • Radiotherapy (radiation therapy): High energy rays can be aimed at the cancer cells in an effort to kill them. Alternatively, radioactive material can be placed in the body.

breast cancer treatment hormonal tx

  • Hormonal therapy: As mentioned in this post, certain cancer cells are stimulated by hormones to grow. Hormonal therapy blocks cancer cells from getting the specific hormones that assist growth. Different drugs in this class act in a variety of different ways, both direct and indirect, with the same end result of diminishing the ability of hormones to stimulate tumor growth. Yes, this treatment option would be better named hormonal blocking therapy. Hormonal therapy also can be used as a primary treatment option or after other treatment options to reduce the chance of recurrence.
  • Biological therapy: Biological therapy serves to boost the body’s immune system to better help it fight the cancer. It also is of assistance in addressing immune-reducing side effects other cancer treatments may create.
  • Targeted drugs: An additional treatment modality is the use of targeted drugs, which attack specific abnormalities within cancer cells. The most notable example of such an abnormality is the presence of a human growth factor receptor 2 (HER2), a protein that helps breast cancer cells grow and survive..

Complications and side effects of breast cancer treatment are plentiful, and they vary based on the treatment given. Surgery carries a risk of bleeding and infection. Risks of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may be altered in texture and may appear swollen. Rarely, damage to the heart or lungs may occur. Common side effects of chemotherapy include hair loss, nausea, vomiting, fatigue and an increased risk of developing infection. Rare side effects can include premature menopause, damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.

breast cancer treatment decision making team

The teams of medical, radiological and surgical cancer specialists who treat breast and other cancers do phenomenal work. Do your part in reducing your risks and engaging in practices (breast self-exam and mammograms) that allow for early detection. Remember, the days of increasing rates of breast cancer are behind us, and breast cancer survivors abound, with approximately 2.8 million survivors in the US. You now have the tools to be included in those numbers should (heaven forbid) you find yourself afflicted by breast cancer.

breast cancer survivor

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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Straight, No Chaser: How to Perform the Breast Self-Exam

breast self exam

Beginning in their 20s, women should be aware of the benefits and limitations of breast self-exam (BSE). Women should know how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer.

Breast Self Exam

A woman can notice changes by being aware of how her breasts normally look and feel and by feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (with a BSE) and using a specific schedule to examine her breasts.
If you choose to do BSE, the information below is a step-by-step approach for the exam. The best time for a woman to examine her breasts is when they are not tender or swollen. Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.
Women with breast implants can do BSE, too. It may be helpful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that the implants push out the breast tissue and may actually make it easier to examine. Women who are pregnant or breastfeeding can also choose to examine their breasts regularly.
It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts and report any changes to their doctor right away.

How to examine your breasts

Breast-Self-Exam

  • Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
  • Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
  • Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

breast self exam movement

  • Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
  • There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
  • Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

breast-self exam-5

  • While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
  • Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

breast-self-examination lying down

This procedure for doing breast self-exam is different from some previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman’s ability to find abnormal areas.
I need to acknowledge and thank the multiple sources that continue to compile and disseminate information to the public, including the Centers for Disease Control and Prevention, the American Cancer Society and the Susan G. Komen Foundation. I have used these and other sources over the course of the week to integrate my practices and have distilled their information in many cases. I highly recommend them should you need additional or more thorough information. I welcome your questions and comments.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
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Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors

breast cancer 1 in 8

Even as a physician, I am left to think about the horror of being a woman with a lifetime risk of acquiring breast cancer that’s 1 in 8. The only thing I can think of off-hand and relate to similarly is the risk for trauma being an inner-city minority kid. This risk of breast cancer is compounded by the reality that there is no way to prevent it. Thus, it must be emphasized early and often: risk factor identification and reduction, coupled with early evaluation, detection and treatment are absolutely vital.

breast cancer incidence

Breast cancer is the second most common cancer contracted by American women (after skin cancer), and it is the second most common cause of death from cancer (after lung cancer). More than a quarter of a million new cases will be diagnosed in women yearly, and approximately 40,000 women will die from complications of breast cancer annually (that’s over 100 deaths every day).
In the event the previous information seemed like too much gloom and doom, understand that the tide has been stemmed. After more than two decades of increase, rates of new cases of breast cancer began dropping in 2000 and have stabilized. This is largely thought to be due to declining rates of post-menopausal hormone use in response to results of major research projects. As you may know, such hormone use has been shown to increase the risk of both breast cancer and heart disease.

breast cancer risks

Speaking of risks, I don’t especially like this part of the conversation because it always comes across as if everything is a risk factor, and there are still controversies about what is or isn’t a risk. As a result, patients end up confused and paralyzed into inaction. Therefore, I’ll mention just enough for you to understand and work with; if you have specific questions on what you’ve heard that I haven’t already addressed in the breast cancer myth posts (Parts I and II), feel free to ask.

breast-cancer-risk-factors-infographic

There are risk factors you can’t change, like aging, family history and being a woman. Having these risk factors simply means you need to be more diligent in performing self exams and seeking early care for suspicious findings. Now, there are other risk factors you can minimize and are under your control, including the following:

  • Alcohol use
  • Choosing not to breast feed
  • Obesity
  • Oral contraceptive use
  • Postmenopausal hormonal therapy

breast-cancer-diagram

The bottom line is your risk factors don’t cause cancer, and the absence of risk factors doesn’t ensure you won’t have breast cancer. For example, men contract breast cancer as well. What it all comes down to is you must be diligent in performing exams and getting evaluated and treated if something abnormal is discovered. We’ll discuss some of that next.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Even More Myths Regarding Breast Cancer

Breast-Cancer-Myths2

Continuing from the earlier post with additional myths, well because you have so many questions!  In fact, I’m doubling up on what you received earlier in Part I of Breast Cancer Myths.  
6. “Breast cancer is preventable.”

  • Unfortunately, this is not true.  All of our efforts are geared toward lowering risks, early detection and effective treatment.

7. The risk of breast cancer isn’t affected by obesity.

  • Not true. The risk is particularly increased in post-menopausal women with weight gain.

8. African-American women have an increased risk due to hair straighteners and relaxers.
Breast Cancer Myths_Button

  • This myth was taken head on and debunked by the National Cancer Institute in a large 2007 study including women with significant use over a 20-year period.

9. Caffeine causes breast cancer.

  • Not according to the evidence. There’s even evidence suggesting a benefit, but the data on this is just as inconclusive as that suggesting a link to breast cancer.

10. Mammograms increase breast cancer risk due to the radiation load.

breast cancer mammogram risk

  • The risks of radiation are so relatively insignificant that they’re mentioned as an afterthought compared to the benefits received from early and frequent evaluation.

11. “Tight clothes and underwire bras will make me get breast cancer.”

  • Not true. Neither has any connection to breast cancer.

12. “I was told small breasts give me less of a chance of having cancer!”

  • Not true. Larger breasts are sometimes more difficult to evaluate, but that’s not the same as saying the risk of cancer is increased in women with larger breasts.

13. “These lumps I have are ok because I’m breastfeeding.”
breast cancer myth logo

  • The fact you can discover normal changes in your breast tissue doesn’t mean that all lumps discovered while breastfeeding are normal. Get evaluated.

14. “Deodorant and tanning cause breast cancer, don’t they?”

  • No. Cell phones don’t either. Tanning does increase the risk of skin cancer, but that’s a topic for another day.

15. “I heard having a baby when I’m older increases my risk of breast cancer.”

  • Well, not just any baby, but having one’s first baby later in life is a significant consideration. Women who give birth for the first time after age 35 are 40 percent more likely to get breast cancer than women who have their first child before age 20.

16. “Breast cancer is a death sentence.”

breast cancer myth death sentence

  • Most women survive breast cancer. Give yourself the best opportunity to do so by reducing your risks, learning the principles of early detection and getting prompt treatment if ever diagnosed. We’ll focus on these considerations in the next posts.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Five Myths Surrounding Breast Cancer

breast-cancer-myths

Before I get into the details of what you need to know about breast cancer, it’s important to clear the table of some of the persistent myths and fears that exist. The disease is tough enough as it is without the fear factor impeding our ability to fight back. Please be patient with me here. If you find these myths ridiculous, then good for you, as it indicates that you’re informed on the matter. Just understand that these are real questions that other physicians and I hear often. Remember, knowledge is power.

breast cancer myth 3

1. “If a family member of mine has breast cancer, that means I’ll get it too.”

  • It is only true to say that women who have a family history of breast cancer have a higher risk of developing it. Overall, only approximately 10% of women diagnosed with breast cancer have a family cancer, and most women with breast cancer have no family history. In other words, a family member with breast cancer isn’t a life sentence for you, and it shouldn’t stop your efforts to lower your other risks and focus on early detection and treatment.

2. “All lumps in my breast are breast cancer.”

  • There are two important points for you to remember. First, any persistent change in the breast or armpit (axilla) should not be ignored. Remember, I will be stressing the importance of early evaluation for the purposes of detection. That said, only a small percentage of breast changes represent cancer (about 80% of lumps are benign). The really good news is if you learn and perform consistent breast exams, you will detect these changes earlier than anyone else and very often early enough to make a difference.

bustingthemyths

3. “Men don’t get breast cancer.”

  • Unfortunately, I know this not to be the case within my family. Annually, there are over 400 breast cancer deaths among men from over 2000 new cases being diagnosed. Men should pay attention just as women do because unfortunately, in part due to the delayed detection, the death rate of breast cancer in men is higher than in women.

4. “I heard breast implants cause cancer.”

  • No. There’s no increased risk with breast implants and breast cancer. However, you can legitimately say implants sometimes obscure the view of possible cancer on a mammogram.

5. “The risk of breast cancer is always 1 in 8.”

  • Actually it’s 1 in 8 during a woman’s lifetime. The important distinction is the risk increases as one ages, from 1 in 233 in a woman’s 30s up to 1 in 8 across the board by age 85.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: October is Breast Cancer Awareness Month

breast-cancer-awareness

Breast cancer disturbs me deeply, and if it doesn’t affect you as well, you haven’t been paying attention. One in eight women will be diagnosed with breast cancer in their lifetime. It’s more likely than not that every single one of us has been affected by this, either directly or through a friend or family member.

breast cancer awareness 1-8

Breast cancer is different. We’ve found the way to eradicate certain cancers and have made remarkable progress on others. Aside from the hereditary component, breast cancer seems so…random, so dehumanizing and so debilitating to so many. Unlike so many of the things I address as an emergency physician, breast cancer isn’t like trauma, STDs and many other conditions, where one is often directly suffering the consequences of their behavior. It is vital that you appreciate the need and value for early detection to give yourself the best possible chance for the best possible outcomes. I’ll be discussing all these considerations in detail throughout the week.

breast cancer awareness gilda

I appreciate the sentiment behind a National Breast Cancer Awareness Month, but if I could offer you anything on this, it would be a plea to be ‘aware’ every month, and use this month as a (re)commitment to take basic steps that will reduce your risk, a charge to maintain steps for early evaluation and a prod to point you toward prompt treatment if and when needed. In fact, those three areas will be the topics of my next few posts. In the meantime, please share this or other information about breast cancer with any and all females in your life. I also hope you choose to engage your family, friends and others in conversations geared to improving breast cancer awareness. Odds are many of them have been or will be affected by breast cancer.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Take the #72HoursChallenge, and join the community. As a thank you for being a valued subscriber to Straight, No Chaser, we’d like to offer you a complimentary 30-day membership at www.72hourslife.com. Just use the code #NoChaser, and yes, it’s ok if you share!
Order your copy of Dr. Sterling’s new books There are 72 Hours in a Day: Using Efficiency to Better Enjoy Every Part of Your Life and The 72 Hours in a Day Workbook: The Journey to The 72 Hours Life in 72 Days at Amazon or at www.72hourslife.com. Receive introductory pricing with orders!
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Breast Cancer in Men

breast cancer risk

I won’t overstate the case, but you should be aware that breast cancer occurs in men. That said it occurs at a much lower rate than it does in women. I know what you may be thinking, but it’s not that obvious. Both males and females have breast tissue. The big difference is women come equipped with a much greater support of certain hormones that stimulate development of breast tissue. You know this to be true because there are circumstances in which males, either through natural occurrence of abnormally high levels of those hormone levels or by stimulation (such as occurs with certain medicines), can develop noticeable sized breasts (called gynecomastia in non-cancerous circumstances and also present in breast cancer). This Straight, No Chaser offers information you should know to avoid a higher risk of developing breast cancer.

male breast cancer data

How often does breast cancer occur in males?

  • It is estimated that in 2014, approximately 2500 men are expected to be diagnosed with breast cancer.
  • Less than 1% of all breast cancers develop in men.

What are the risk factors for breast cancer in men?

male_breast_cancer_button

  • Age: Increases in age correspond to an increased risk. In fact, age in the greatest risk for men. In fact, the average age of men diagnosed with breast cancer is about 68.
  • High estrogen levels: Estrogen stimulates growth of breasts, both in normal and abnormal circumstances. The following are circumstances that can produce high estrogen levels in men.
    • Obesity increases estrogen production.
    • Certain conditions or treatment with hormonal medicines that include estrogen.
    • Heavy alcohol use can damage the liver, which can result in a diminished ability of the liver to regulate estrogen levels.
    • Similarly, other causes of liver disease also result in higher estrogen levels.
    • You can also get significant estrogen exposure if hormones are used in the beef cattle you eat.

Gynecomastia

  • Klinefelter syndrome is a genetic disorder involving the presence of additional X chromosomes (the “female” chromosome). Men with this syndrome have lower levels of male hormones (androgens) and higher levels of female hormones (estrogen), resulting in a higher risk of developing gynecomastia and breast cancer.
  • Radiation exposure: Receiving radiation therapy to the chest before age 30 (such as occurs with treatment of Hodgkin’s disease) may increase the risk of developing breast cancer.

BC risk Table

  • A family history of breast cancer or genetic alterations: Other men in one’s family with breast cancer, or a breast cancer gene abnormality also increases the risk of breast cancer. Men identified as having certain abnormal genes, including BRCA1 or BRCA2 genes (BR stands for BReast, and CA stands for CAncer) have an increased risk for male breast cancer of 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities. The message here is if you have a family history of breast cancer, consider getting checked for the presence of these genes.

If you are a male with significant risks, your next step is to have a conversation with your physician. In case you haven’t seen the rest of the Straight, No Chaser series on breast cancer, use the following links for information on the rest of the story.

breast self exam male


Straight, No Chaser: 
Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors
Straight, No Chaser: This is How You Self-Assess For Breast Cancer, Part 1
Straight, No Chaser: How to Perform the Breast Self-Exam
Straight, No Chaser: Signs, Symptoms and Prognosis of Breast Cancer
Straight, No Chaser: Breast Cancer Treatment Options
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Breast Cancer Treatment Options

breast cancer treatment remedies

The next to last post in this series on breast cancer is on management. Of course, there is no universal treatment of ‘breast cancer’; everything is based on the specific type of breast cancer and the extent of progression upon diagnosis. Management usually involves a team approach in order to balance multiple considerations, which often leads to different treatment modalities being used together.
Breast-Cancer-Treatment-Diagram1
My goal today is to offer an understanding for the different components of treatment, not to get into the nuances of individual treatment regimens. I certainly recommend you engage your personal physician and resources such as the Center for Disease Control and Prevention and the American Cancer Society, which will provide you with any and all additional details you may desire.
Breast cancer is treated in several ways, including surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. Let’s review the basics of each.

breast cancer treatment sx

  • Surgery: Under certain circumstances, the cancer has only advanced to a level where it can be surgically removed. Surgical options include cutting out the area affected by the cancer (a lumpectomy), removing the entire breast (a mastectomy), and/or removing the areas where the cancer will drain and spread to other parts of the body (lymph node biopsy/resection). Of course, options aren’t actually quite this simple. Efforts to spare skin and tissue and to retain a cosmetic appearance are important considerations. Sometimes decisions to remove the other breast is made if the risk of breast cancer in that breast is sufficiently high. Additional surgical considerations include breast reconstruction after surgery, which may include one’s own tissue or a synthetic breast implant. These are options to be discussed with a plastic surgeon prior to breast cancer surgery.

BREAST CANCER TREATMENT chemo

  • Chemotherapy: Chemotherapy is the use of medication to kill or reduce the cancer. Chemotherapy may be given via an IV (into the veins) or by pills. Chemotherapy may be given before surgery to reduce tumor size, after surgery or with other therapy to reduce the risk of recurrence, or as a primary treatment option.

Breast Cancer Myths_Button

  • Radiotherapy (radiation therapy): High energy rays can be aimed at the cancer cells in an effort to kill them. Alternatively, radioactive material can be placed in the body.

breast cancer treatment hormonal tx

  • Hormonal therapy: As mentioned in this post, certain cancer cells are stimulated by hormones to grow. Hormonal therapy blocks cancer cells from getting the specific hormones that assist growth. Different drugs in this class act in a variety of different ways, both direct and indirect, with the same end result of diminishing the ability of hormones to stimulate tumor growth. Yes, this treatment option would be better named hormonal blocking therapy. Hormonal therapy also can be used as a primary treatment option or after other treatment options to reduce the chance of recurrence.
  • Biological therapy: Biological therapy serves to boost the body’s immune system to better help it fight the cancer. It also is of assistance in addressing immune-reducing side effects other cancer treatments may create.
  • Targeted drugs: An additional treatment modality is the use of targeted drugs, which attack specific abnormalities within cancer cells. The most notable example of such an abnormality is the presence of a human growth factor receptor 2 (HER2), a protein that helps breast cancer cells grow and survive..

Complications and side effects of breast cancer treatment are plentiful, and they vary based on the treatment given. Surgery carries a risk of bleeding and infection. Risks of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may be altered in texture and may appear swollen. Rarely, damage to the heart or lungs may occur. Common side effects of chemotherapy include hair loss, nausea, vomiting, fatigue and an increased risk of developing infection. Rare side effects can include premature menopause, damage to the heart and kidneys, nerve damage, and, very rarely, blood cell cancer.

breast cancer treatment decision making team

The teams of medical, radiological and surgical cancer specialists who treat breast and other cancers do phenomenal work. Do your part in reducing your risks and engaging in practices (breast self-exam and mammograms) that allow for early detection. Remember, the days of increasing rates of breast cancer are behind us, and breast cancer survivors abound, with approximately 2.8 million survivors in the US. You now have the tools to be included in those numbers should (heaven forbid) you find yourself afflicted by breast cancer.

breast cancer survivor

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Signs, Symptoms and Prognosis of Breast Cancer

stage-2-breast-cancer

So, after all we’ve discussed this week, this is what it comes down to: the one in eight lifetime risk has landed at your doorstep. What happens next is very important. The ability to recognize and obtain early treatment for breast cancer (or not) will determine the length and quality of the rest of your life. Remember, most women survive breast cancer; there are approximately 3 million breast cancer survivors in the U.S. That said, also remember that there are about 40,000 annual deaths from breast cancer. The combination of breast self-exams and widespread use of screening mammograms has increased the number of breast cancers found before they cause any symptoms. Unfortunately, many others go undetected because of the limitations or failure to engage those two modalities.

breast cancer symptoms

I really want you to become familiar with your bodies (in this instance, your breasts). The most common symptom of breast cancer is a new lump, but you should be in tune with any new change or irregularity, including pain, swelling, redness, irritation, nipple inversion or other irregularity. Remember, breast tissue extends into the armpit (axilla), and you may find swollen and tender lymph nodes in the axilla or near the collarbone (clavicle). My bottom line: you be responsible for diligently assessing any abnormalities, and your healthcare team will determine the cause and if it’s cancer.

Breast-Cancer detection

One more pitch for early detection: if breast cancer is detected prior to spread to the lymph nodes, the 5-year survival rate (with appropriate treatment) is as high as 98%. If it’s reached the lymph nodes, that drops to approximately 84%, and if it has spread to other body parts (e.g. the lungs, liver and bone – this is called metastatic cancer or carcinoma), the average 5-year survival rate drops to 23%.
This represents a drop in mortality rates by about 25% since 1990. Unfortunately, survivors must live with the uncertainties of possible recurrent cancer and some risk for complications from the treatment itself. That said, recurrences of cancer usually develop within 5 years of treatment. About 25% of recurrences and 50% of new cancers in the opposite breast occur after 5 years.

breast Cancer_biomarker_figure

Many of you have asked about tumor ‘predictors’. I’ll end this post with a look at three considerations, although there are many others:
1. Breast cancer cells may contain binding sites for hormones (estrogen and progesterone). When that’s the case, these cells are called hormone receptor-positive; if not, they’re called hormone receptor negative. When cancer cells are hormone receptor positive, they are responsive to certain medications (such as tamoxifen and others). This improves prognosis. These types of cells also happen to grow more slowly, which also helps. On the other hand, hormone receptor-negative cells only respond to chemotherapy.
2. Tumor markers are proteins released from cancer cells that are able to be identified during the disease. They are notable for demonstrating (or predicting) how aggressive one’s cancer may be. The one I will mention (yes, there are others) is the HER2 marker, which is especially quick-growing and aggressive. The American Cancer Society recommends all newly diagnosed women be tested for this. Fortunately, only 20% women with invasive breast cancer are positive for HER2.
3. Curiously, tumor location within the breast has proven to be an important predictor. Tumors in the middle of the breast are most serious than those toward the outside.

breast cancer survivor

I wish all of you breast cancer survivors or those with family members affected all the best with this. I hope these posts have again pointed out the importance of lowering your risk profile and early detection and treatment. This is another illustration of the shortcomings of our typical approach to health care; relying on medical care is not the same as comprehensive healthcare. The time to engage the fight against breast cancer is not in the midst of advanced disease.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: How to Perform the Breast Self-Exam

breast self exam

Beginning in their 20s, women should be aware of the benefits and limitations of breast self-exam (BSE). Women should know how their breasts normally look and feel and report any new breast changes to a health professional as soon as they are found. Finding a breast change does not necessarily mean there is a cancer.

Breast Self Exam

A woman can notice changes by being aware of how her breasts normally look and feel and by feeling her breasts for changes (breast awareness), or by choosing to use a step-by-step approach (with a BSE) and using a specific schedule to examine her breasts.
If you choose to do BSE, the information below is a step-by-step approach for the exam. The best time for a woman to examine her breasts is when they are not tender or swollen. Women who examine their breasts should have their technique reviewed during their periodic health exams by their health care professional.
Women with breast implants can do BSE, too. It may be helpful to have the surgeon help identify the edges of the implant so that you know what you are feeling. There is some thought that the implants push out the breast tissue and may actually make it easier to examine. Women who are pregnant or breastfeeding can also choose to examine their breasts regularly.
It is acceptable for women to choose not to do BSE or to do BSE once in a while. Women who choose not to do BSE should still be aware of the normal look and feel of their breasts and report any changes to their doctor right away.

How to examine your breasts

Breast-Self-Exam

  • Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.
  • Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
  • Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

breast self exam movement

  • Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).
  • There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.
  • Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

breast-self exam-5

  • While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)
  • Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

breast-self-examination lying down

This procedure for doing breast self-exam is different from some previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman’s ability to find abnormal areas.
I need to acknowledge and thank the multiple sources that continue to compile and disseminate information to the public, including the Centers for Disease Control and Prevention, the American Cancer Society and the Susan G. Komen Foundation. I have used these and other sources over the course of the week to integrate my practices and have distilled their information in many cases. I highly recommend them should you need additional or more thorough information. I welcome your questions and comments.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: The Reach of Breast Cancer and Your Risk Factors

breast cancer 1 in 8

Even as a physician, I am left to think about the horror of being a woman with a lifetime risk of acquiring breast cancer that’s 1 in 8. The only thing I can think of off-hand and relate to similarly is the risk for trauma being an inner-city minority kid. This risk of breast cancer is compounded by the reality that there is no way to prevent it. Thus, it must be emphasized early and often: risk factor identification and reduction, coupled with early evaluation, detection and treatment are absolutely vital.

breast cancer incidence

Breast cancer is the second most common cancer contracted by American women (after skin cancer), and it is the second most common cause of death from cancer (after lung cancer). More than a quarter of a million new cases will be diagnosed in women yearly, and approximately 40,000 women will die from complications of breast cancer annually (that’s over 100 deaths every day).
In the event the previous information seemed like too much gloom and doom, understand that the tide has been stemmed. After more than two decades of increase, rates of new cases of breast cancer began dropping in 2000 and have stabilized. This is largely thought to be due to declining rates of post-menopausal hormone use in response to results of major research projects. As you may know, such hormone use has been shown to increase the risk of both breast cancer and heart disease.

breast cancer risks

Speaking of risks, I don’t especially like this part of the conversation because it always comes across as if everything is a risk factor, and there are still controversies about what is or isn’t a risk. As a result, patients end up confused and paralyzed into inaction. Therefore, I’ll mention just enough for you to understand and work with; if you have specific questions on what you’ve heard that I haven’t already addressed in the breast cancer myth posts (Parts I and II), feel free to ask.

breast-cancer-risk-factors-infographic

There are risk factors you can’t change, like aging, family history and being a woman. Having these risk factors simply means you need to be more diligent in performing self exams and seeking early care for suspicious findings. Now, there are other risk factors you can minimize and are under your control, including the following:

  • Alcohol use
  • Choosing not to breast feed
  • Obesity
  • Oral contraceptive use
  • Postmenopausal hormonal therapy

breast-cancer-diagram

The bottom line is your risk factors don’t cause cancer, and the absence of risk factors doesn’t ensure you won’t have breast cancer. For example, men contract breast cancer as well. What it all comes down to is you must be diligent in performing exams and getting evaluated and treated if something abnormal is discovered. We’ll discuss some of that next.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
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Straight, No Chaser: Even More Myths Regarding Breast Cancer

Breast-Cancer-Myths2

Continuing from the earlier post with additional myths, well because you have so many questions!  In fact, I’m doubling up on what you received earlier in Part I of Breast Cancer Myths.  
6. “Breast cancer is preventable.”

  • Unfortunately, this is not true.  All of our efforts are geared toward lowering risks, early detection and effective treatment.

7. The risk of breast cancer isn’t affected by obesity.

  • Not true. The risk is particularly increased in post-menopausal women with weight gain.

8. African-American women have an increased risk due to hair straighteners and relaxers.
Breast Cancer Myths_Button

  • This myth was taken head on and debunked by the National Cancer Institute in a large 2007 study including women with significant use over a 20-year period.

9. Caffeine causes breast cancer.

  • Not according to the evidence. There’s even evidence suggesting a benefit, but the data on this is just as inconclusive as that suggesting a link to breast cancer.

10. Mammograms increase breast cancer risk due to the radiation load.

breast cancer mammogram risk

  • The risks of radiation are so relatively insignificant that they’re mentioned as an afterthought compared to the benefits received from early and frequent evaluation.

11. “Tight clothes and underwire bras will make me get breast cancer.”

  • Not true. Neither has any connection to breast cancer.

12. “I was told small breasts give me less of a chance of having cancer!”

  • Not true. Larger breasts are sometimes more difficult to evaluate, but that’s not the same as saying the risk of cancer is increased in women with larger breasts.

13. “These lumps I have are ok because I’m breastfeeding.”
breast cancer myth logo

  • The fact you can discover normal changes in your breast tissue doesn’t mean that all lumps discovered while breastfeeding are normal. Get evaluated.

14. “Deodorant and tanning cause breast cancer, don’t they?”

  • No. Cell phones don’t either. Tanning does increase the risk of skin cancer, but that’s a topic for another day.

15. “I heard having a baby when I’m older increases my risk of breast cancer.”

  • Well, not just any baby, but having one’s first baby later in life is a significant consideration. Women who give birth for the first time after age 35 are 40 percent more likely to get breast cancer than women who have their first child before age 20.

16. “Breast cancer is a death sentence.”

breast cancer myth death sentence

  • Most women survive breast cancer. Give yourself the best opportunity to do so by reducing your risks, learning the principles of early detection and getting prompt treatment if ever diagnosed. We’ll focus on these considerations in the next posts.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

Straight, No Chaser: Five Myths Surrounding Breast Cancer

breast-cancer-myths

Before I get into the details of what you need to know about breast cancer, it’s important to clear the table of some of the persistent myths and fears that exist. The disease is tough enough as it is without the fear factor impeding our ability to fight back. Please be patient with me here. If you find these myths ridiculous, then good for you, as it indicates that you’re informed on the matter. Just understand that these are real questions that other physicians and I hear often. Remember, knowledge is power.

breast cancer myth 3

1. “If a family member of mine has breast cancer, that means I’ll get it too.”

  • It is only true to say that women who have a family history of breast cancer have a higher risk of developing it. Overall, only approximately 10% of women diagnosed with breast cancer have a family cancer, and most women with breast cancer have no family history. In other words, a family member with breast cancer isn’t a life sentence for you, and it shouldn’t stop your efforts to lower your other risks and focus on early detection and treatment.

2. “All lumps in my breast are breast cancer.”

  • There are two important points for you to remember. First, any persistent change in the breast or armpit (axilla) should not be ignored. Remember, I will be stressing the importance of early evaluation for the purposes of detection. That said, only a small percentage of breast changes represent cancer (about 80% of lumps are benign). The really good news is if you learn and perform consistent breast exams, you will detect these changes earlier than anyone else and very often early enough to make a difference.

bustingthemyths

3. “Men don’t get breast cancer.”

  • Unfortunately, I know this not to be the case within my family. Annually, there are over 400 breast cancer deaths among men from over 2000 new cases being diagnosed. Men should pay attention just as women do because unfortunately, in part due to the delayed detection, the death rate of breast cancer in men is higher than in women.

4. “I heard breast implants cause cancer.”

  • No. There’s no increased risk with breast implants and breast cancer. However, you can legitimately say implants sometimes obscure the view of possible cancer on a mammogram.

5. “The risk of breast cancer is always 1 in 8.”

  • Actually it’s 1 in 8 during a woman’s lifetime. The important distinction is the risk increases as one ages, from 1 in 233 in a woman’s 30s up to 1 in 8 across the board by age 85.

Feel free to ask your SMA expert consultant any questions you may have on this topic.
Order your copy of Dr. Sterling’s new book Behind The Curtain: A Peek at Life from within the ER at jeffreysterlingbooks.com, iTunes, Amazon, Barnes and Nobles and wherever books are sold.
Thanks for liking and following Straight, No Chaser! This public service provides a sample of what http://www.SterlingMedicalAdvice.com (SMA) and 844-SMA-TALK offers. Please share our page with your friends on WordPress, like us on Facebook SterlingMedicalAdvice.com and follow us on Twitter at @asksterlingmd.
Copyright © 2016 · Sterling Initiatives, LLC · Powered by WordPress

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