Chemoprevention, Discussions

You may have heard the term “chemoprevention” in conversations about breast cancer or had it mentioned by a doctor during a visit. The word is, as its two parts imply, the use of chemotherapy as a preventative technique against cancer. In breast cancer, it’s a way to delay the development of cancer by utilizing chemical therapies such as medicines, vitamins and diet to slow the progress of or delay the development of breast cancer.

The most well-known drug for this is tamoxifen, the first chemoprevention drug to be approved by the Food and Drug Administration (FDA) for this purpose. Studies have shown that it can reduce chances of breast cancer development by half in high risk women.

As with any therapy, however, there are benefits and draw backs. If chemoprevention worked without side effects or risks, then all physicians would recommend it to all women all of the time. Since it does have risks, however, it’s only prescribed in specific cases of need. The U.S. Preventive Services Task Force (USPSTF) has recommended against using tamoxifen or relaxifene (another chemopreventive) for breast cancer prevention except in women who are at high risk.

Women at high risk for breast cancer such as those with a family history of the disease, an inherited genetic mutation (such as BRCA), are obese, high risk lesions and family history, etc. will possibly be recommended for chemoprevention. In most cases, women who do not have a risk factor over 20% will not benefit from this option.

BSGI: Is It Ready for Prime Time?

Breast-Specific Gamma Imaging, Discussions

Breast-Specific Gamma Imaging (BSGI) is a new technology from Dilon Diagnostics that involves a pharmaceutical tracing agent that emits low levels of gamma radiation for a short period of time. The patient is given this tracer and then images of the breast are taken using a special tool for detecting that gamma radiation.

The theory behind BSGI is that cancerous tissues have a higher metabolic rate than surrounding tissues, which means they’ll tend to gather these gamma tracers more quickly than the surrounding healthy tissues will. On a scan, this would then show up as a “hot spot” that should be further tested (usually through biopsy) for cancer.

Early clinical trials in multiple facilities have shown that BSGI has a good rate of success and so it is beginning to appear to be useful tool in the breast cancer detection field. The controversy around the technology is not in its efficacy, however, it’s in the gamma radiation it uses.

Considered benign for most people, it is still radiation and thus carries a risk. Most doctors do not use BSGI as a regular detection tool, but as a secondary or follow-up tool when a standard mammogram does not show enough evidence to warrant an MRI scan.

The BSGI test is cheaper than an MRI and usually much faster to schedule and get results from. Further, it is often easier to get insurance coverage for a BSGI than it is for a more expensive MRI. So many doctors use it as a more accessible tool for breast cancer screening when a mammogram is unclear or the patient is at higher risk and more conclusive checks need to be made. Often, a positive BSGI can convince the doctor and insurers that an MRI is warranted.

Another use of BSGI is when a PEM (positron emission mammography) cannot be done, usually because the patient may have blood glucose complications. In rare cases, patients with a fear of MRI scans (usually claustrophobia) will be given a BSGI instead.

For now, the technology appears ready for prime time in specific roles, but should not be considered the primary or “go-to” breast screen for cancer. In most patients, the risk associated with the radiation is just not warranted.

Alcohol Increases Breast Cancer Risk

Alcohol, Breast Cancer, Discussions

Recently, a study gained wide publicity for highlighting that alcohol, even in moderate amounts, increases breast cancer risk in women. This is the latest in a long string of such studies, all of which have generally agreed that alcohol consumption increases breast cancer risk.

Does this mean you should never drink again? No.

This and previous studies equating alcohol consumption with breast cancer risk have shown a general trend towards amounts being important. While frequency is not considered a factor, according to this latest study, the amount of alcohol consumed is a factor.

The study specifically equates 10g per day of alcohol increases breast cancer risk by about 10%. The number is taken as an average weekly consumption, so a woman who drinks 70 grams on Saturday in a binge had 10g average for the week and is considered the same as the woman who drank 30g on Monday, 10g on Wednesday, 20g on Friday, and 10g on Saturday. Clearly one woman is drinking in moderation while the other is not. Most doctors would agree that the woman drinking in moderation is likely to be much healthier in general than is the woman who binge drinks on the weekends.

While moderate alcohol use can increase your breast cancer risk, other studies have shown that moderate alcohol consumption can lower heart disease risks. This poses an obvious conundrum for many women.

The trick here is in weighing options versus benefits. The average woman in America has a 1 in 7 chance of getting breast cancer. The average woman in America has a 1 in 2 chance of being diagnosed with heart disease. In fact, heart disease kills more women in the U.S. than all forms of cancer combined. Does this mean you should choose drinking over reduced breast cancer risk?

Not necessarily. The trick here is understanding risks. A discussion with your doctor should include weighing these risks and lifestyle choices. For example, a woman who has a family history of cancer and little history of heart disease and who is under 55 years of age, the risks will likely weigh in favor of giving up alcohol. Flipping that, a woman over age 55 has a much higher chance of heart disease than she does of being diagnosed with breast cancer and if she also has a family history of cardiovascular issues, then obviously moderate alcohol consumption could be beneficial.

As with most things, the trick is to understand moderation, benefits and downsides, and open discussions with your doctor about them is the best course of action in all things regarding your health.

3D Mammogram

3D Mammogram, Discussions

Since its announcement late last year, many people have been wondering about this new 3-dimensional mammogram technology being tested at Massachusetts General. With 40 million mammograms conducted in the U.S. every year and with growing concern and reportage of the false-positives and errors that can be made in the process, women are rightly interested in any new technology that could improve their screening.

A 3D mammogram works in the same way as a regular digital mammogram with one exception: it takes multiple images from various angles to capture a 3-D image of the breast. There are good and bad points to this approach. The good side is that it allows for a better image that is more easily viewed and studied by the screener. The bad side is that it involves much more exposure to radiation for the patient.

In a normal mammogram scenario, the process works like this: the patient comes to the hospital or clinic to have the exam. The images are taken and the patient goes home. After study of the images, a doctor or trained specialist will either give the patient the all-clear or will find something they aren’t sure about and order another mammogram be taken for further analysis. In the latter case, the patient is brought back for another screening ñ creating understandable worry for the patient since ìinconclusiveî to many means ìI must have itî instead. The new mammogram is taken and the patient is either given the all-clear or brought in for more tests. If something is found, it’s often given to a second opinion through another mammogram. All taking a toll on the patient.

With 3-D mammogram imaging, the number of call-backs for retest are expected to be lowered dramatically. So the patient would be less likely to be asked to return should there be an anomaly because of the way a 2-D mammogram is viewed. The idea is that many former questions on 2-dimensional mammograms may be resolved through looking at the breast in a 3-dimensional way. By rotating, many anomalies can be explained as natural such as tissues overlapping, which gives the look of a ìmassî on a 2-D image but is seen for what it is on a 3-D shot.

Still, 3D mammogram imaging is very much in its infancy. Until it’s been used and tested and found to be better than the standard variety, it’s not going to become nationally adopted. 3D Mammograms are available in Aventura, Hollywood Memorial, and at DCA (diagnostic centers of america) in both Boca Raton and Boynton Beach.