BREAST CANCER LINKS


WEBSITES

There are many websites for breast cancer, some good, some not so good.  Below find some of what I feel are the better ones.  The internet is a wonderful resource, but as there is no editorial control, anyone and anything can be on the internet.  Please be careful as you search the internet.  If you have questions about websites you have found please email me at lkrause@lakeshoresurgicalassociates.com.  If they are good I will be happy to add them to my list, if not I will give you my opinion.

American Cancer Society:  www.cancer.org
National Cancer Institute:  www.cancer.gov
National Library of Medicine:  www.nlm.nih.gov
National Surgery Adjuvant Breast and Bowel Project:  www.nsabp.pitt.edu
Cancer Wellness Center:  www.cancerwellness.org
MedlinePlus:  www.medlineplus.gov

A surgicenter I work at in the downtown Chicago area:  www.900northsurgical.com

Below is a nice article on lymphedema with some links:
http://www.cancer.net/patient/Library/Cancer.Net+Features/Living+With+Cancer/After+Treatment+for+Breast+Cancer:+Preventing+Lymphedema?cpsextcurrchannel=1#
  


 


NEWSWORTHY

One of the most common questions I get asked is what type of breast imaging should I get.  There are 3 options today, a mammogram, either analog or digital, a breast ultrasound, or a breast MRI.  I will mention thermagrams and Miraluma scans only to tell you that they have not not been shown to be useful.

  Mammograms are clearly still the best screening test we have.  I recommend a baseline mammogram between 35-40 and then yearly after 40.  Under special circumstances, such as a significant family history of breast cancer, we may get them earlier but that is not common.  Mammograms tend to not be very accurate in young breasts.  The big question today is should I get digital or analog(film screen) mammograms.  Most studies have not shown a significant difference between them, but a recent large study may have different information.  They gave both types of mammograms to patients and compared the reliability of them. When they looked at the whole study there was no difference. But when they looked at the subset of young patients with dense breasts, they found that the digital mammograms were more accurate.  That study was on the news and stirred a whole debate on what is the best mammogram to get.  For woman who are postmenopausal it probably does not make a difference.  For pre- menopausal woman who have dense breasts, perhaps there is a difference.  My concern is that the study was done under study conditions where they were reviewing the mammograms very intensely and playing with the computer controls to seek out abnormalities.  Is that the real world?  Only time will tell.  To me the most important issue is to get your mammogram at a good facility with good radiologists.

Breast ultrasound is a great diagnostic study but probably not a great screening tool. What do I mean by that?  A diagnostic study is using the technology to look at an area of the breast that either by mammogram or exam is concerning.  A screening exam is looking at a patient who has no issues on exam or mammogram and seeing if we can see a problem on ultrasound.  By today's techniques screening ultrasounds are not recommended.

Breast MRI is an interesting issue.  Studies have shown that breast MRI is probably more accurate in high risk woman than any other study we do.  So why don't we do breast MRI on everybody?  First of all breast MRI is very expensive, about $3000 per study as opposed to a mammogram, which is usually less than $200.  Second, breast MRI tend to be overly sensitive and often pick up things that are nothing, but end up getting extra xrays and even biopsies.  Thirdly, most insurance companies will not cover breast MRI except in certain circumstances. Lastly most MRI units cannot do breast MRI as they require more modern machines with special hardware and software and also a radiologist who is trained in reading them. So the bottom line is breast MRI is not for everybody but in certain situations both as a diagnostic and screening test they have a place.  Your breast surgeon is the best person to know if this is a good test for you.


BREAST MRI INFORMATION PACKAGE

The link below has an information package about breast MRI that can be sent to your insurance company with the letter I have sent you regarding breast MRI for high risk women.  The package contains an excerpt from the Blue Cross website, as well as an editorial from both JAMA and the NEJM showing the utility of breast MRI in high risk women.  I recommend making a copy of this information, as well as the letter before you submit it to your insurance company in case it gets lost.  In addition there is an article below with breast cancer screening guidelines from The American Cancer Society which you can also include to help your case.  Good Luck


Document

EVISTA

Evista or Raloxifene has been in the news lately.  Unfortunately the study that has looked at this medication still has not been published.  As I have had so many questions about it though, I thought I would at least give some information until the formal study is released and I have a chance to review it in detail.  Evista or Raloxifene is in the same class of drugs as Tamoxifen, the SERM's or selective estrogen receptor modulators.  Tamoxifen has been used for many years to treat breast cancer.  In the studies using Tamoxifen it was seen that in addition to treating the cancer that the drug was given for, it was noted that Tamoxifen also reduced the risk of new breast cancers.  So a number of years ago a study was done in high risk women.  Tamoxifen was studied against a placebo for breast cancer prevention.  The study showed an across the board 50% reduction of breast cancer in high risk women.  Unfortunately it was noted in the study that in postmenopausal women there was a small but real risk of both uterine cancer and blood clots.  Shortly after that another drug in the same class as Tamoxifen, called Evista or Raloxifene, was developed and tested for the treatment of osteoporosis in postmenopausal women.  It has been known that Tamoxifen also protected against osteoporosis.  In the study of Evista it was shown to protect against osteoporosis and it was also noted that it seemed to reduce the risk of breast cancer in the women taking it, with fewer episodes of uterine cancer and blood clots than Tamoxifen.  So the next study was to compare Tamoxifen to Evista in high risk, postmenopausal women, for the prevention of breast cancer.  This was called the STAR trial and is the study that has been in the news lately.  From what I can see the study showed that both drugs were effective in reducing invasive breast cancers.  Tamoxifen was better than Evista in reducing non-invasive breast cancers.  Evista seemed to also have a lower incidence of both uterine cancer and blood clots than Tamoxifen although it probably was more than in the general population. So it appears that Evista, in addition to helping osteoporosis, also reduces the risk of breast cancer with a fairly low incidence of side effects.  So will Evista become the next drug to prevent breast cancer in postmenopausal women?  Will a woman who has osteoporosis be able to take Evista and treat her osteporosis as well as decrease her risk of breast cancer?  From the early data it seems that this may be the way to go.  I wait for the formal study to be released for more information.  I hope this has been helpful for you. Two websites of interest are:  http://www.cancer.gov/star/ and http://www.breastcancerprevention.org/.

LMK

 

An addendum to the above note.  After reviewing the data, what I said about Evista stands.  It appears to prevent invasive breast cancers as well as Tamoxifen.  It helps with osteoporosis.  There is not an appreciable increase in blood clots or uterine cancer as was seen with Tamoxifen.  It appears to be a good drug for high risk, postmenopausal women to help with osteoporosis as well as reduce the risk of breast cancer.

 

LMK


2-1-07

Two items in the recent news:

First:  For the first time in a long time there has been a drop in the incidence of breast cancer in 2003.  The drop was noted mainly in postmenopausal women and in hormone responsive tumors.  This drop corresponded to the  data from the Women's Health Initiative Study(WHI) that had shown an increase in breast cancer with the combination(an estrogen and progesterone) hormone replacement therapy.  Shortly after that announcement many women stopped taking hormones leading investigators to suggest that this drop may have been related to women stopping the hormones.  Now it is very difficult to show cause and effect and this drop does seem to happen quite soon after this WHI announcement, but it is certainly food for thought.  I am hopeful more information will come out about this as the data is studied more extensively.

Second:  A recent study in the New England Journal of Medicine was in the news talking about the increased risk of breast cancer associated with breast density as measured on a mammogram.  Now this is not new information as this association has been known for many years.  What is also known is that dense breasts are much harder to evaluate on mammogram and exam making the pickup of breast cancers more difficult.  Unfortunately breast density is more genetically controlled  than environmental, so there is not much a woman can do about the density.  It is just one more of the issues your breast surgeon needs to take into account in your screening.

LMK
 

AMERICAN CANCER SOCIETY BREAST CANCER SCREENING GUIDELINES-2007

The American Cancer Society has recently published guidelines for breast cancer screening which includes breast MRI for the appropriate groups. As always these recommendations need to be reviewed with your breast surgeon to be sure if indeed this test is reasonable for you.  The attached article reviews the information and may be helpful to include with information you are sending to your insurance company to be pre-certified for the test if it is appropriate for you.  It is in PDF format so you will need a PDF reader to see it.  Click on the PDF link below to view or print out the article.

LMK


So the American Cancer society in Illinois has a website where they offer many cancer related items such as help for wigs, etc.  The web address is IllinoisCancerHelp.org check it out


lmk