Chapter List

• Introduction to Total Health for Women
• Acne
• Alcoholism
• Allergies
• Anemia
• Angina
• Appendicitis
• Arthritis
• Asthma
• Back Pain
• Bladder Infections
• Breast Cancer
• Breast Implant Complications
• Breast Lumpiness
• Bronchitis
• Cervical Cancer
• Cesarean Section
• Chronic Fatigue
• Colds and Flu
• Cold Sores
• Colorectal Cancer
• Constipation
• Depression
• Dermatitis
• Diabetes
• Diarrhea
• Eating Disorders
• Eczema
• Endometrial Cancer
• Endometriosis
• Fatigue
• Fibroids
• Fibromyalgia
• Food Allergies
• Foot Pain
• Gallstones
• Gender Discrimination
• Gum Disease
• Hair Loss
• Headache
• Hearing Loss
• Heartburn
• Heart Disease
• Heart Palpitations
• Hemorrhoids
• Hepatitis
• High Blood Pressure
• High Cholesterol
• Hiv and Aids
• Hysterectomy
• Incontinence
• Infertility
• Inflammatory Bowel Disease
• Inhibited Sexual Desire
• Insomnia
• Irritable Bowel Syndrome
• Lactose Intolerance
• Laryngitis
• Lung Cancer
• Lupus
• Menopausal Changes
• Menstrual Problems
• Motion Sickness
• Muscle Cramps
• Neck and Shoulder Pain
• Oral Cancer
• Osteoporosis
• Ovarian Cancer
• Overweight
• Painful Intercourse
• Panic Attacks
• Pelvic Inflammatory Disease
• Phlebitis
• Physical and Emotional Abuse
• Pneumonia
• Post-Pregnancy Problems
• Post-Traumatic Stress Disorder
• Premenstrual Syndrome
• Psoriasis
• Raynauds Disease
• Repetitive Strain Injury
• Rosacea
• Sexually Transmitted Diseases
• Sinusitis
• Skin Cancer
• Smoking
• Stress
• Stroke
• Temporomandibular Disorder
• Tendinitis and Bursitis
• Thyroid Disease
• Ulcers
• Unwanted Hair
• Vaginal Infections
• Varicose Veins
• Vision Problems
• Water Retention
• Yeast Infections

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Breast Cancer

Breast Cancer

Fighting a Fearsome Disease

You see the posters on buses. You hear the ads on the radio. Even while shopping in your favorite drugstore, you're likely to hear a piped-in celebrity voice from an overhead speaker: "See your doctor today. You have a one-in-eight chance of getting breast cancer."

But do you?

Probably not. Nearly 80 percent of all breast cancers occur in women over 50. And only women over 85 have a 1-in-8 chance of getting it. For the rest of us, the risk is considerably less. By age 30, it's 1 chance in 2,426. By age 40, it's 1 in 222. And by age 45, it's 1 in 96.

Still, one chance in however-many is one chance too many for a disease that strikes 182,000 American women every year and kills 40 percent of them within a decade. And some scientists believe that breast cancer among premenopausal women is increasing.

"Many experts believe there has been a real increase in the incidence of breast cancer," says Richard Love, M.D., professor of clinical oncology at the University of Wisconsin at Madison. "The causes of much of the real increase are not known." Among the risk factors that scientists have been able to identify so far are a family history of breast cancer and various factors related to a woman's hormones.

The Enemy Within

It's hard to accept the idea that your own body produces a substance that can encourage tiny breast cells to form cancerous clusters. But "there's overwhelming evidence that the female hormone estrogen plays a central role in causing breast cancer," says Ronald Ross, M.D., professor of preventive medicine at the University of Southern California School of Medicine in Los Angeles.

No one has figured out all the hows and whys, but some studies have found that breast cancer risk is reduced 5 to 15 percent for every year that the onset of menstruation is delayed. Other studies have found that women who experience natural menopause before age 45 have only half the breast cancer risk of women who experience menopause ten years later. Still other studies have found that women who have artificial menopause--when their ovaries are surgically removed, for example--have even less breast cancer risk than women who experience natural menopause.

The common denominator among all these studies seems to be that the less exposure a woman has to her own reproductive hormones, estrogen and progesterone, the lower her risk of developing breast cancer, says Dr. Ross.

That's why pregnancy, breastfeeding, physical activity and a low-fat diet with plenty of plant fiber and little alcohol all decrease a woman's risk of breast cancer: They all reduce the amount of estrogen circulating through her body.

"Any strategy that alters estrogen is going to have an effect on breast cancer risk," says Dr. Ross. Here are strategies that doctors suggest to reduce your risk.

Adjust fat and fiber. "In countries where women eat a low-fat, high-fiber diet, they have lower estrogen levels and lower breast cancer risk," says Sherwood L. Gorbach, M.D., professor of community health and medicine at Tufts University School of Medicine in Boston. A controversy rages over exactly how much fat you should cut to lower your risk, he adds, but a diet that gets between 20 and 25 percent of its calories from fat is a wise choice until the scientific dust settles.

But fiber may have even more of an impact on estrogen than fat. So as you cut back on fat, start increasing fiber as well, says Dr. Gorbach. You need to get 40 grams of fiber a day to lower estrogen levels.

To accomplish both, cut out processed meats and cheeses, eat red meat no more than three times a week, remove the skin from poultry and eat plenty of whole grains, fruits and vegetables every day.

Eat soy. "We're particularly interested in soy fiber," says Dr. Gorbach. "We think that there are substances in soy (plant estrogens) that are related to natural estrogens." In animal studies, plant estrogens seem to block the estrogen involved in breast cancer and actually prevent the disease, he says.

Although these plant estrogens are found in their highest concentration in soy products such as tofu, other sources include alfalfa, apples, barley, carrots, cherries, green beans, licorice, oats, parsley, peas, potatoes, red beans, rice, sprouts and wheat.

Load up on fruits and vegetables. In Harvard University's Nurses' Health Study, which included 89,000 women, researchers found that women who generally ate two or more servings of vegetables a day reduced their risk of breast cancer 17 percent.

No one really knows why, says Dr. Love, but "some studies indicate that intake of adequate vitamin A is important." When women in the Nurses' Health Study who normally didn't get much vitamin A from food took supplements containing 10,000 international units every day, they had half the risk of women who didn't take supplements.

Avoid alcohol. "Reducing the consumption of alcoholic beverages appears to reduce breast cancer risk," says Dr. Love. A study of 34 women between the ages of 21 and 40 conducted by researchers at the National Cancer Institute in Bethesda, Maryland, and the Human Nutrition Research Center in Beltsville, Maryland, found that just two drinks a day significantly elevated total estrogen levels.

Get up and go. A joint study that was conducted by the National Cancer Institute and the Shanghai Cancer Institute in China found that women whose jobs involved moving around rather than sitting reduced their risk of breast cancer somewhere between 30 and 45 percent. In fact, the more physical activity women experienced on the job, the less likely they were to get breast cancer. The difference, researchers concluded, may be explained by the effect that physical activity has on estrogen.

Breastfeed. "Lactation is protective against breast cancer in younger women," Dr. Love says. "Longer periods of lactation of at least six to eight months appear to provide maximal protection. It seems as though the hormones released during lactation cause a permanent, physical change in breast cells that protects them from the potentially cancer-inducing effects of estrogen."

Put your ovaries in hibernation. Researchers at the University of Southern California are at work on a pill to inactivate the ovaries. "I have no doubt that if you shut down the ovaries, the risk of breast cancer will go down," says Dr. Ross. He and his colleagues estimate that giving a woman medication to suppress ovulation for 5 years will reduce her risk of breast cancer by 38 percent. Suppressing ovulation for 15 years will reduce her risk by 80 percent. While this dramatic method would appear to be only for women with a high risk of breast cancer, Dr. Ross says that the option may someday be available to all women.

What Are Your Odds? Your age is still the single biggest risk factor for breast cancer. Here's how the National Cancer Institute and the American Cancer Society assess your risk. By age 25: 1 in 21,441 By age 30: 1 in 2,426 By age 35: 1 in 622 By age 40: 1 in 222 By age 45: 1 in 96 By age 50: 1 in 52 By age 55: 1 in 34 By age 60: 1 in 24 By age 65: 1 in 18 By age 70: 1 in 14 By age 75: 1 in 12 By age 80: 1 in 10 By age 85: 1 in 9 Lifetime: 1 in 8

The Art of Detection

Breast self-examinations and mammograms are the two best methods for detecting breast cancer. In fact, 90 percent of lumps are found by patients examining themselves.

While many women would rather not do self-exams, doctors emphasize that they're quick and simple to perform, and the effort is certainly worthwhile. Here's what to do.

First put your hands high over your head and look in the mirror for any dimpling, nipple changes or obvious lumps. Then put your hands on your hips and check the mirror again.

Then, if nothing shows up, put the hand on the side you want to examine behind your head. Then check the breast using one of three patterns: Gently use your fingertips to trace concentric circles around your breast, examine the breast in vertical strips from above the breast to below it, or pretend the breast is a pie and gently push on one "slice" at a time.

It's not important which method you choose, or even if you use your own particular variation. What is important, doctors agree, is that you check your breast in the same way and at the same time every month--preferably a week or so after your period.

Finally, put your other hand behind your head and check the other breast.

Most women aren't wild about mammograms, and some are so worried about how they'll feel that they're afraid to get them.

Questions to Ask Your Doctor You've found the lump. Your doctor's confirmed its presence. And you've heard the words that nobody ever wants to hear: "It might be cancer. We need to check it out." So now--shocked and frightened as you may be--you need to make some decisions. And to help you make those decisions, here are some pertinent questions to ask your doctor, from women who've been in exactly the same position. * Do you think it's malignant? * Will you do a needle biopsy or a surgical biopsy? * How accurate is the biopsy you intend to do? * Will you phone me with the results as soon as you have them? How long until I'll hear from you? * If the biopsy is positive, do I meet the surgical criteria for a lumpectomy and radiation? If the answer is yes, you do have breast cancer, here's what else you'll want to ask. * Is the breast cancer spreading? * Is the cancer sensitive to hormones and will it respond to hormone treatment? * What lab tests were run and what are their results? * How will you use this information to recommend further tests or treatments? * Which treatment options do you recommend and why? * Do you recommend any follow-up hormonal therapy? * What are the survival statistics after these procedures? * What are the complications associated with each procedure? * What type of anesthesia is used? * How long do I have to stay in the hospital? * Is the surgeon you're recommending a breast surgeon? * Is she board-certified? * How many of the procedures that you recommend has she done? * How will I know if the surgeon got all the cancer? * What are the chances that some of the cancer cells have escaped the breast and are now somewhere else in my body? * How will my breast look after the surgery? * Am I a candidate for any type of breast reconstruction? * Should I have it done immediately following the surgery? * How long will it take me to recover my normal energy level and get my life back on track?

But a mammogram is nothing more than a high-tech x-ray of your breast. Your breast is placed between two clear plastic plates, x-rays are shot through the breast to a photographic plate beneath, and you're free to go. It takes only a minute and is just slightly uncomfortable.

The advantage of a mammogram is that it can sometimes detect cancer a good two years before you can feel a lump--which gives you an opportunity to get earlier treatment.

When should you have a mammogram? "That varies a little depending on whom you ask," says Kathleen Mayzel, M.D., director of the Faulkner Breast Centre and assistant clinical professor of surgery at Tufts University School of Medicine.

Some doctors feel that there's no reason to get a mammogram until after menopause unless it's to investigate a lump. The American Cancer Society recommends that a regular screening program begin by age 40.

The Mammogram Missed It Matuschka is a sculptor and photographer who lives in New York City. She had been sculpting and photographing a series of torso self-portraits for several years when, at the age of 37, she discovered a lump in her right breast. After a mastectomy, she decided to continue her torso studies. Her provocative work has been exhibited in museums and photography shows around the world. This is her story. The mammograms never showed my tumor. I had been going to a breast surgeon and having my breasts checked for ten years because my mother died of breast cancer. But in 1991 I started having a very eerie feeling that I was beginning to look like my mother when she had breast cancer. I had just had my breasts checked six months earlier, but I didn't like the way I was looking or feeling. So I decided to go to a lecture at a local hospital. One of the things they showed me was how to examine my breasts lying down--I had been doing it standing in the shower. So I went home, followed their instructions and--boom!--I felt a small stone. I called my breast surgeon, but he said he was too busy to see me, so I went to my physician, my regular GP. He said, "I don't know what this is, but it's not a cyst. You should go get a mammogram and get checked out by a specialist." The next day, I went for the mammogram. A clinician examined me. She said, "This is nothing, it's noncancerous." I said, "How do you know? Do you have x-ray vision?" She said, "No, but it's soft and it moves, and cancer doesn't move." I asked to see the expert on call and he said, "I don't think this is anything to worry about, but you should see if it can be aspirated--if any fluid can be drawn out. And if it can't, you should have a biopsy." The next day I went to his office. It didn't aspirate. I called my breast surgeon, who had been seeing me for ten years, and insisted that he see me now. And when he felt the suspicious lump he said, "This is nothing to worry about, Matuschka. It's definitely not cancer." All the doctors I had seen implied it was nothing.They based their judgment on the feel of the lump. The surgeon even said I could go do a show of my work in Helsinki and come back three months later. I said, "No, I'll have this out immediately." So I had a biopsy. But because the surgeon didn't think I had breast cancer, he chose to be very cosmetic when he went in to do it. He decided, "Why scar the breast for something that's not cancer?" When he found out it was cancer, he realized he'd made a mistake. And when the pathology report came back, he recommended a mastectomy. I didn't know more than he did, so I agreed. I assumed that if you took the breast off, you reduced the chance of having cancer spread to other parts of the body--and of dying. By removing the breast I thought you removed all of the cancer. A discussion of lumpectomy never occurred. The breast surgeon said later that he actually recommended a mastectomy for cosmetic purposes. He said, "I thought you'd get a better cosmetic result." In other words, he said that based on what his aesthetic requirements of what a breast should look like, I should have a mastectomy. After I had the operation, I felt a need to share my experience through the visual arts. The impetus was to help other people. I did public service posters that were created out of my disappointment, sadness, irritation, whatever you want to call it--but not anger, because my work is not compelled by anger--to educate women. It was my way of sharing.

"I generally recommend a baseline mammogram between the ages of 35 and 40," says Dr. Mayzel. "Most doctors feel it can be closer to 40 unless you have a mother or sister who developed premenopausal breast cancer. Then it should be closer to 35."

There's no reason to do it any earlier because cancerous cells are usually hidden--even from mammography equipment--by the dense breast tissue characteristic of women under 35.

"Between the ages of 40 and 50, women should have a mammogram every one to two years, then yearly after the age of 50," Dr. Mayzel says.

Breast Cancer Treatment

There are three basic options in treating breast cancer: Removing just the cancerous lump of cells with a small margin of healthy tissue (lumpectomy), having a lumpectomy followed by local radiation treatments, and amputating the breast (mastectomy).

According to data from the National Cancer Institute, when cancer had not spread to the lymph nodes, 74 percent of women who had a lumpectomy alone were still alive ten years after the surgery. Seventy-five percent of those who had undergone a mastectomy made it to that benchmark.

Even when cancer was found to have spread to the lymph nodes, both procedures were equally effective. The National Cancer Institute found that 51 percent of women who had a lumpectomy alone and 50 percent of women who had a mastectomy survived ten years.

Lumpectomy followed by radiation offered an even better success rate: 78 percent if the cancer had not spread to the lymph nodes, and 58 percent if it had.

"The efficacy of lumpectomy plus radiation has been tested more thoroughly than any other cancer treatment," says Allen Lichter, M.D., chairman of radiation oncology at the University of Michigan in Ann Arbor. "There have been at least six major trials. And every one has demonstrated that women who choose to preserve their breast pay no survival penalty."

What's more, women who choose lumpectomy plus radiation over mastectomy may have a psychological advantage. In a study at the University of Pennsylvania in Philadelphia, women who'd had lumpectomies had a more positive attitude toward their recovery: 87 percent of them felt "cured," while only 36 percent of the women who'd had a mastectomy felt that they were free of cancer.

The missing breast was a source of ongoing anxiety, the researchers concluded, because it was a constant reminder that somehow, somewhere, the women still might have cancer. As a result, 50 percent of the women who had undergone a mastectomy said they regretted their decision. Fifty-five percent said that, given a second chance, they'd have a lumpectomy plus radiation instead.

What's Next?

Once breast surgery is over, your doctor is likely to recommend follow-up treatment.

"Most breast cancers are eight to ten years old by the time you can feel a lump," explains Susan Love, M.D., director of the University of California at Los Angeles Breast Center. "Long before that, cancer cells make their way into the bloodstream and lymphatic system, where they're either killed by the body's own immunity or they begin to establish cancer outposts."

That's why follow-up treatment with either chemotherapy or the estrogen-blocking drug tamoxifen (Nolvadex) is usually recommended by cancer experts. Both these treatments can go after renegade cancer cells and shoot them down.

"Chemotherapy is recommended for premenopausal women with cancerous lymph nodes and occasionally for those with noncancerous nodes as well," says Dr. Mayzel. "The use of tamoxifen in premenopausal women is in clinical trials, although early results suggest that it doesn't work as well as chemotherapy in this group of women. Tamoxifen is recommended for postmenopausal women. It seems to work as well as chemotherapy and has fewer side effects."