Tag Archive | Cancer

Part 2 – The Hidden Truth about NOT MISSING the Diagnosis of Breast Cancer in Women

Dr. with woman 

What are some cold hard facts about breast cancer that women must truly know?

  •  What was the reason that from the 1980s until 1994 there was an increase in breast cancer rates?  With the increase in use of screening mammography, more breast cancer was diagnosed.
  • And how was the diagnosis made?  It was made by an abnormal screening study or breast exam either performed by the patient or a clinician.
  • How far advanced were these cancers that were diagnosed between the 1980s until the mid 1990s?  Most were considered early stage or in situ (which means that it is bordering on developing into an actual cancer but it is contained. 
  • Why is it that there was a sharp decline in breast cancer starting in 2003?  It was at this time that women were avoiding post-menopausal hormone therapy (pharmaceutical brand).  There was a Women’s Health Initiative report in 2002 that created alarm on the role of these pharmaceutical based hormones with shown association with increased breast cancer rates.

What do women need to know about the different imaging studies for screening breast cancer?

  •  What is the most well studied type of imaging study?  Film mammography, which has been extensively studied has undergone a number of randomized controlled trials which showed a critical step in diagnosing and potentially reducing the mortality of breast cancer in women.  The larger argument is the proven age of screening and frequency of screening.  It has clearly been shown that for women 50 and older, that breast cancer diagnosis is unquestionably justified.  And emerging data shows that in women 40 and older, the use of film mammography decreases breast cancer mortality as well.
  • What about newer digital mammography?  There are advantages, especially in women with more dense breasts and women less than 50 years of age when using digital mammography.  One disadvantage is that digital mammography may have a higher false positive (in other words normal breast but an abnormal result) in this group of women.
  • What about using computers to help read mammogram patterns?  Overall use of computer aided detection helps pick up breast cancer but may also increase the recall rate.
  • What about the use of an advanced technique such as MRI (Magnetic Resonance Imaging)?  Aside from the increased cost, screening breast MRI may be more sensitive for the detection of invasive cancers in women at high risk for breast cancer.  As far as picking up cancers, it may do better than mammography.  However, it may do worse when trying to exclude truly normal breasts.  And what this may mean is increased alarm and biopsies for women who would not be at high risk.  Therefore the combination of MRI and mammograms is recommended in women who have a high risk of breast cancer, which means greater than 20% lifetime risk. 
  • What about thermography?  Even though the FDA gave breast thermography approval because of safety, but not necessarily efficacy, thermography centers have sprouted all across the country.  Unfortunately, it is difficult to use it as a screening tool because even if it may pick up true breast cancer, it is difficult to exclude normal breast tissue based on breast skin temperature alone.  What is known about thermography is that it has a high false positive rate of 25% which would mean that 1 in 4 women who had normal breasts would be given alarm that they might have cancer.

 And so what is the take home message for women?

  •  Having breast imaging study by way of mammogram has lowered breast cancer mortality which is a hard fact to argue with.  No one can entirely take the place of the doctor who is seeing the woman for making an individual choice on breast cancer screening and so therefore the final decision is deferred to the physician and patient relationship.  Care must be taken not to recommend advanced imaging techniques which may create more alarm and unnecessary biopsies or further tests and also not recommend technologies that have not shown good reproducible characteristics that are valuable as a screening tool.
  • And so what about the hormonal therapies that have been pharmaceutical based as well as compounding pharmacy based with regard to breast cancer risk?   None of the creams, patches and pills have ever been shown, either by the pharmaceutical or bio identical compounding pharmacies to not increase risk of breast cancer.  What is known, and I will show you at your next visit, is the only known hormone, when given in a special way, that actually decreases the proliferation (growth) of breast tissues, which explains why there is no known increase incident when this hormone is used in the right way.
  • And so why do we think that overall breast cancer mortality is decreasing?  It is not entirely clear whether better and earlier screening, or better treatment modalities based on the type of breast cancer cells is the main reason.  The bottom line is “get in touch with a doctor that handles breast cancer imaging screening so that you do not miss any of the hidden truths about missing the diagnosis of breast cancer. 

Dedicated to your Body Hormone Transformation,

George F Moricz, MD

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Should All Women Be Tested For Hereditary Breast Cancer – Like Angelina Jolie?

Dr. with woman

The spotlight is on preventive mastectomy (removal of breasts), which was recently highlighted by Angelina Jolie.  After testing for the genetic breast cancer gene and  her mother’s history of breast cancer from which she died at age 56, Angelina has brought much needed attention to the QUESTION – Should all women be tested for hereditary breast cancer? 

First, a word or two about breast cancer.  Every year 207,000 invasive breast cancer cases are diagnosed in the United States.  40,000 women are reported to die from breast cancer every year.  Risks include age, genetics and use of estrogens with synthetic progestin.  85% of cases are found in women age 50 and above.

With all the attention on breast cancer cases, it is well documented that most are spontaneous cases – which means that they arise on their own.  Women have a 12% risk of developing breast cancer throughout their lifetime, if they do not have the genes for breast cancer.  This can be as high as 60% if they have the breast cancer gene.  Women who have a family history, but no evidence of the genetic cancer gene, have an elevated risk over twice that of the normal population.

Since over 90% of the cases are spontaneous (occur on their own and are not related to breast cancer genes) and 6% of cases are related to genetic breast cancer genes like BRCA1 and BRCA2, this calls into question whether everyone should be tested.  There has been a breast cancer model that is designed to predict risk of breast cancer but has many limitations.  And then there is the reality that many women, regardless of family history, do not get tested in time, if at all, for breast cancer.

So, today, I will do an overview of these issues and in a following discussion look at breast cancer screening itself.  As a start, it is well known that there are different ways to screen for breast cancer and most societies recommend starting at age 40 unless there are histories that would require earlier screening.  Follow up tests when the initial screening mammogram is abnormal can involve ultrasound or more detailed imaging studies like MRI.  There has been much debate on the frequency of testing with mammograms, with arguments as to whether it is needed every year or every 2 years.  Clinical experience by doctors like myself has seen people become diagnosed within a year of having a normal mammogram.  So in our next discussion, we’ll look in a more detailed way at the way mammograms as the current mainstay compared to other imaging modalities that have their own unique set of advantages and disadvantages.

So with all the attention on Angelina’s decision to have her breasts removed because of the breast cancer gene, the takeaway message is that breast cancer screening is still recommended for people without known family history or breast cancer genes.  And more importantly, because this is a cancer that strikes middle aged women, complications of breast cancer are highly preventable and manageable with implemented screening.  Ultimately, the decision for reducing breast cancer complications comes down to the relationship of the woman and her physician.  A good start would be a frank discussion about concerns of breast cancer screening and reasons that a woman would not want to do it at a certain time in her life.  Oftentimes having a mammogram every 1 – 2 years after age 40 becomes the issue and often presents with newly diagnosed cases outside of that window when a woman decides not to have regular follow up screening mammograms.

So as a great deal of attention is being directed toward the breast cancer gene, which for a select group of people is very, very devastating and may increase not only breast cancer but ovarian cancer risk, many women never get to undergo proper screening and may needlessly be diagnosed with invasive breast cancer and die from this disease.  In the next few discussions, we’ll not only discuss the advantages and disadvantages of different types of breast imaging, but also look at the prevention and screening for ovarian cancer as well.

Dedicated to Excellence in Women’s Health,

George F. Moricz, MD

Diplomat of American Board of Obstetrics and Gynecology

 

P.S.  Also, I almost forgot to mention that we have added new services to benefit women in the Arklatex even more.  Please remind us when you come in to see us.

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