<![CDATA[Breast Cancer]]> en daily 1 <![CDATA[Breast Cancer Risk and Estrogen Alternatives]]>
hormone therapy (HT), which may increase your risk of breast cancer. If you can, consider nondrug remedies first, says JoAnn Manson, MD, a professor of medicine at Harvard Medical School and the author of Hot Flashes, Hormones & Your Health.

Dr. Manson has several suggestions for managing hot flashes and night sweats:




  • Wear layered clothing.
  • Lower the thermostat.
  • Use portable fans.
  • Avoid dietary triggers such as caffeine, spicy foods, and alcohol.
  • Avoid tobacco.
  • Increase your intake of soy-based foods.
  • Consider trying the herb black cohosh.
A low dose of a selective serotonin-reuptake inhibitor (SSRI) or the antiseizure medication gabapentin may also be useful, according to Kala Visvanathan, MBBS, assistant professor of epidemiology and oncology at Johns Hopkins Bloomberg School of Public Health, in Baltimore.

"If a woman has only vaginal dryness and discomfort with intercourse and no other symptoms, she can use a topical estrogen or a vaginal estrogen ring, which have a much lower absorption of estrogen," adds Dr. Manson, who notes that relaxation and breathing techniques have worked for some women as well. "I would encourage women to try lifestyle modifications before going with estrogen, especially if they have mild symptoms," she says.

Dr. Visvanathan agrees: "You definitely want to try simple things first, then go to [HT] if you need to. It used to be that hormones were the first thing you tried, but the paradigm is changing because we’ve determined the long-term breast cancer and cardiovascular risk associated with HT, and because the benefits of HT have been shown to be less effective than previously thought. Women with modest menopausal symptoms can often treat their symptoms effectively with nonmedical therapies."

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If you end up needing estrogen or combination HT, though, and you want to keep your breast cancer risk low while still keeping menopause symptoms in check, ask your doctor about transdermal patches, gels, and sprays, which deliver low doses of estrogen through the skin and may have fewer risks than pills. "Transdermal estrogen may be less likely to cause blood clots and gallbladder disease," Dr. Manson explains. "And lower doses may be less likely to increase the risk of breast cancer or other cancers."

The bottom line: Consider alternative approaches to see if one or several together can control your menopause symptoms before turning to oral estrogen or combination HT.
]]> Taking estrogen may increase a woman's risk of getting breast cancer. (ISTOCKPHOTO/HEALTH) <![CDATA[Estrogen and Your Breast Cancer Risk]]>

• Combination hormone therapy (HT): If you’re considering taking estrogen and progestin (a synthetic form of the hormone progesterone) to give you relief from annoying menopause symptoms like hot flashes and night sweats, be sure to limit the time you’re on the drugs. That’s because over time your breast cancer risk climbs, says JoAnn Manson, MD, professor of medicine at Harvard Medical School and author of Hot Flashes, Hormones & Your Health.

"In the Women’s Health Initiative (WHI) trial, when women got seven years of estrogen alone, there was no increased risk of breast cancer, but after four to five years on combined hormone therapy, the risk emerges," she says. In fact, over time, estrogen plus progestin can raise a woman’s risk for breast cancer by 24%; even if you take estrogen on its own for more than 10 to 15 years, your risk may still go up.

Dr. Manson was a coauthor on a March 2008 study in the Journal of the American Medical Association that followed up on the WHI trial. It showed that even after the women stopped taking combination HT, their breast cancer risk remained elevated. "The risk of breast cancer does decline after stopping hormone therapy," she stresses, "but if a tumor has formed while a woman is on hormones it’s very likely to come to light even after she stops hormones, so there is some residual risk. Stopping drug therapy doesn’t mean a tumor evaporates, but the risk gradually declines."

• HT and early diagnosis of breast cancer: If you have no family history of the disease, you’ve probably been encouraged to get your first mammogram by age 40 and every one to two years after that to help ensure that any tumor is caught early, when it’s most treatable. That’s good advice, but taking HT may complicate things. "Estrogen-and-progestin HT can lead to increased mammographic density"—denser breast tissue—"that can obscure breast tumors and delay diagnosis," says Dr. Manson. Denser breasts are believed to be an independent risk factor for breast cancer, but they also make it harder to accurately read a mammogram and that "can lead to abnormal mammograms that may require extensive follow-up and anxiety about repeat testing and even unnecessary biopsies," Dr. Manson adds.

• HT and risk for benign breast disease: In April 2008, the Journal of the National Cancer Institute found that postmenopausal women who’d taken estrogen on its own doubled their risk of a noncancerous type of breast disease, but one that’s associated with a higher risk of breast cancer. A September 2008 study led by the same author, Thomas E. Rohan, MD, PhD, an epidemiologist at the Albert Einstein College of Medicine, in New York City, found similarly disturbing evidence in a study of women taking estrogen and progestin: Combined HT raised a woman’s risk of benign breast disease by 74%.


Next Page: Estrogen, testosterone, and breast cancer risk
• Estrogen, testosterone, and breast cancer risk: Low sexual desire and vaginal dryness are two common—not to mention very unpleasant—hallmarks of menopause for many women. Estrogen can help ease the latter and researchers have looked at whether adding testosterone—another hormone that’s crucial to libido, even in women—into the mix might help. The extent to which testosterone will perk up your love life is uncertain, but combining estrogen and testosterone may increase your breast cancer risk. A 2006 study collected data from more than 121,000 women who were part of the Nurses' Health Study and found that for the women who'd taken estrogen and testosterone, the risk of developing breast cancer went up 17% for every year they took the combo, compared to those who’d never taken hormones for menopause symptoms.

The bottom line: "The recommendation for hormone therapy is for the lowest effective dose for the shortest duration, to minimize the risk of breast cancer and to minimize risk overall," sums up Dr. Manson.

Talk to your doctor about whether HT is right for you in the first place and, if it is, annually revisit the decision to stay on hormones. "If they develop hot flashes or irregular periods, women don’t automatically go on hormones for their lifetimes anymore; they go on them if they have symptoms that are severe and aren’t controlled by other approaches," explains Kala Visvanathan, MBBS, assistant professor of epidemiology and oncology at Johns Hopkins Bloomberg School of Public Health, in Baltimore. "After a period of time you can reduce the dose and see if you’re still getting symptoms. Rethink it on a yearly basis, asking your doctor, 'Should I continue on it, do I need it?'"

Dr. Manson suggests trying to limit combination HT to two to three years, and to no more than five years, if possible. If you have dense breasts (your doctor can tell whether you do), ask about ways to lower your cancer risk and make sure your annual mammogram and clinical breast exams are thorough and regular. You may also want to consider alternatives to HT and/or switch to a lower dose. Skip the supplemental testosterone too.

If you’re in treatment for breast cancer
To keep breast cancer from coming back, your oncologist will want to keep the level of natural estrogen in your body at an all-time low; it’s unlikely he’ll OK either estrogen or combination HT while you’re still in treatment. "It’s very controversial and I would try to avoid it," Dr. Manson says. Instead, you’re more likely to be put on medications that do just the opposite—deplete the estrogen you do have in order to prevent a recurrence. If you’re prescribed raloxifene (Evista) or tamoxifen, these not only block estrogen receptors to stop a tumor from growing, but they can also do a lot to stave off another cancer. Aromatase inhibitors such as Arimidex and Femara—mainly used by postmenopausal women—keep your body from making the hormone in the first place, significantly lowering the chances that breast cancer will return.

The bottom line: If at all possible, pass up HT while you’re still in treatment. If your symptoms are still poor after treatment, reevaluate the decision with your doctor.

If you’re at increased risk of breast cancer
If your odds of getting breast cancer are higher than average—because you have a family history or because you carry a mutation of the BRCA-1 or BRCA-2 genes (which puts you at a much higher risk)—you’re bound to wonder whether taking hormones to relieve menopause symptoms is worth it.

"If a woman is at very high risk for breast cancer, I’ll try to avoid using HT," says Dr. Manson. "But if she doesn’t respond to other treatments and she’s highly symptomatic—disrupted sleep, severe hot flashes, vaginal dryness—and she’s not getting adequate relief, a short course of hormones for two to three years should not really increase her risk." Talk to your doctor about what’s right for you; you may be able to find nonhormonal relief before turning to drugs. Dr. Visvanathan notes that if you’ve had your uterus removed, your physician may suggest estrogen alone, which is associated with lower odds for breast cancer as are other alternatives to HT.

Keep in mind too that when it comes to breast cancer risk and hormones, researchers definitely don’t have all the answers. An October 2008 Journal of the National Cancer Institute study of postmenopausal women who’d taken hormones actually offered reassuring news, at least for BRCA-1 carriers: The researchers found that the BRCA-1 women who’d taken estrogen alone or combined estrogen and progesterone actually had a decreased risk of breast cancer compared with those who hadn’t had HT. Why? That’s not clear, says Steven Narod, MD, one of the study’s authors and director of the familial breast cancer research unit at the Women’s College Research Institute in Toronto.

The bottom line: Skip or postpone HT, if possible, or talk to your doctor about a short course of hormones while menopause symptoms are at their worst.
]]> Taking estrogen may increase a woman's risk of getting breast cancer. (GETTY IMAGES/HEALTH) <![CDATA[Products That May Reduce Your Risk of Breast Cancer]]>
breast cancer and household products, whether they be soap or water bottles. But many consumers, activists, and experts are concerned that a variety of goods contain hormone disruptors, chemicals that when absorbed into the body can mimic or interfere with hormones such as estrogen. Some researchers believe that chemicals with estrogenic characteristics can cause normal breast cells to divide.

"Each time they divide, they have the risk of copying DNA incorrectly and creating mutations in key genes, which may lead to increased breast cancer risk," says Suzanne Snedeker, PhD, the associate director for translational research for the Program on Breast Cancer and Environmental Risk Factors at Cornell University. Chemicals that mimic estrogen might also enable an existing breast tumor to keep growing, because most tumors depend on estrogen to grow.

Individual products contain only small amounts of these questionable chemicals, if they do at all. But there is growing concern that the ubiquity of such agents in cosmetics, household products, and certain plastics, may have a cumulative estrogenic effect. "We are not saying if you use a certain product with estrogenic ingredients it will cause breast cancer," Snedeker says. "But the science suggests your risk may be reduced if you avoid these ingredients." Here are a few ways to play it safe.

View the slideshow
]]> (GETTY IMAGES) <![CDATA[Breast Cancer During Pregnancy: What You Need to Know]]>
Australian runner, age 41, who died Monday from breast cancer that spread to her liver and brain. Sadly, about 1.3 million women will be diagnosed with breast cancer worldwide this year, and 465,000 women will die from it—McCann is just one of many. The twist on the story is that she discovered her breast lump while pregnant, and initially she thought it was nothing.

Breasts can do all sorts of strange things during pregnancy: They blow up, they get tender and lumpy, they squirt mysterious substances. For many women, pregnancy boobs are a downright strange experience. When I was pregnant, it was the first time I had a generous bosom, and I poked my boobs every now and then to see if they were real. What I didn't do was check them to make sure they were healthy.

Like McCann, I figured breast changes during pregnancy were normal. And they usually are. Breast cancer during pregnancy is quite rare. In the United States, just 1 in 3,000 pregnant women is diagnosed with breast cancer.

But you still need to be vigilant. That means doing routine breast self-exams and reporting anything suspicious to your doctor immediately. Breast tenderness is normal during pregnancy, but hard lumps are not. It's really important to take action quickly: The average reported delay in reporting a lump or other symptom detected during pregnancy is 5 to 15 months, a factor that may contribute to less promising outcomes.

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If you and your doctor do find an abnormality, there are ways to perform diagnostic tests, such as ultrasound and mammography, without exposing the fetus to radiation. Sometimes babies are induced early (as was the case with Kerryn McCann's baby) so that the mother can start chemotherapy or another treatment as soon as possible.

There are lots of lessons to take away from Kerryn McCann: She was an inspirational athlete and mother of three and, whether you are pregnant or not, her story is a call to check your breasts—now.

Read Anne's previous posts:
How Blogging Is Good for Your Breasts
Good News: My Migraines May Be Good for My Breasts
The Survivor Files: Amazing Women Share Their Breast Cancer Journeys
]]> (GETTY IMAGES) <![CDATA[How Blogging Is Good for Your Breasts]]>
expressive writing and talk therapy can help women with breast cancer feel better. It follows, then, that the electronic equivalent of such things, i.e., blogging, would also be good for your health. In fact, more than one group is investigating the notion that online unloading—connecting with others who know what you're going through—may actually improve coping skills and help you live longer and better. Well, duh. We bloggers knew that, didn't we?

Proof is nice, however: One study has already reported the benefits of breast cancer patients using online resources, and other researchers—such as Alice Flaherty, MD, a neuroscientist at Harvard University, and Nancy Morgan, the director of Georgetown University's Lombardi Comprehensive Cancer Center's Arts and Humanities Program—are interested in how blogging might have mental and physical benefits.

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It may be that blogging about stressful experiences such as breast cancer acts as a placebo to dull pain, just like in-person complaining does, says Dr. Flaherty, who is the author of The Midnight Disease: The Drive to Write, Writer's Block, and the Creative Brain. Or, it could be that sharing personal stories triggers the release of feel-good dopamine.

Some hospitals have started hosting patient blogs on their websites as docs begin to recognize the therapeutic value, Morgan told the Scientific American. Unlike a journal, blogging offers the added benefit of receptive readers in similar situations, she says. Morgan is hoping to conduct more research on expressive writing studies that include blogs.


Next Page: Some of my favorite blogs
While the researchers do their thing, women with breast cancer are doing theirs: They're talking and sharing and finding comfort where they can in the blogosphere. Here, some of my favorite blogs.

Mothers With Cancer
More than 20 moms who have or have had various kinds of cancer (including breast cancer) and are parenting kids of all ages share their experiences here. Their posts, from how to position a prosthesis in a mastectomy bra to trying to make sense of their most recent doctor visit, are heartfelt and helpful.

Two Hands
Jeanette Vagnozzi is the 44-year-old star of this moving blog about a California woman waging her second fight with breast cancer. Jeanette started the blog almost five years ago when she was first diagnosed, and gives full details of her treatment and reconstruction.

Toddler Planet
Inflammatory breast cancer doesn't show up on a mammogram, as blogger Susan Neibur found out. She writes about her diagnosis, treatment, and recovery, as well as her crazy-busy life as a working mom with two toddlers.

If you have a favorite good-for-your-breasts blog, please let me know.

Read Anne's previous posts:
Good News: My Migraines May Be Good for My Breasts
The Survivor Files: Amazing Women Share Their Breast Cancer Journeys
Could Where I Live Raise My Risk of Breast Cancer?
]]> Going online may not only make you feel better, but it may also help you get better. (GETTY IMAGES) <![CDATA[Cosmetics and Breast Cancer: Should Teens Ditch the Makeup?]]>

A controversial new report highlights teen girls' extra vulnerability to environmental contaminants during their crucial adolescent years, and revisits an unsettled debate over whether cosmetics are part of the problem.

So-called hormone disrupters are the toxic troublemakers at the center of this discussion.

These chemicals—found not just in cosmetics but also in pesticides, plastics, and drugs—are thought to mimic hormones such as estrogen when they’re absorbed by the human body. And high, sustained levels of estrogen are linked to the development of breast cancer.

The question is: How to navigate the largely self-regulated cosmetics industry as a conscientious shopper? Is there something you should be doing to help protect your daughters and granddaughters from the world around them?

Teenage bodies burdened with chemicals
The debate over the safety of cosmetic ingredients was reignited in September when the Environmental Working Group (EWG), a Washington, D.C.–based nonprofit, published a report on the subject.

EWG found that teenage girls' bodies contained the same potentially hormone-altering chemicals found in many cosmetics and its report references earlier studies that link those chemicals to health risks, including cancer, in lab animals. Of particular concern is a chemical family known as phthalates, used in some nail polishes and fragrances.

"We're concerned that these hormone-disrupting chemicals could start to play a role in how growth and development plays out in the teen body and therefore how it might be linked to health effects later in life," says Rebecca Sutton, PhD, author of the report and a senior scientist at EWG.

But don't liquidate your cosmetics shelf just yet. The authors of the EWG report, which looked at 20 girls ages 14 to 19, did not show a direct link between the girls' makeup habits and what was found in their bodies. The chemicals could have come from any number of other sources.

"The phthalates in the plastic water bottles these girls drink from, or the microwave containers they eat out of, may be far more likely to get into their system than cosmetic use, and as of now, no one has banned these things," says M. William Audeh, MD, an oncologist who works in cancer risk assessment at the Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center in Los Angeles.

"I agree that the general environment in which we grow up and live is far too full of unnatural, possibly harmful chemicals," says Dr. Audeh. "But I think that to say that cosmetics are an important source, and then blame diseases on them, is going much too far."


Next Page: Activists demand cleaner cosmetics
Activists demand cleaner cosmetics
Stacy Malkan, a cofounder of the advocacy group Campaign for Safe Cosmetics and author of Not Just a Pretty Face: The Ugly Side of the Beauty Industry, says cosmetics need extra scrutiny because they are often a direct source of exposure to so many different chemicals. Cosmetics are rubbed right into the skin, inhaled (think perfumes and other sprays), or swallowed (as with lipsticks)—and often on a daily basis.

To some cancer experts, pinpointing the exact source of these chemicals is not as important as the age of the girls exposed—not just to cosmetics and household and industrial products, but also to cigarette smoke, radiation, and even fatty foods.

"What is known is that when developing breast tissue is exposed to toxic chemicals, it has more effect and impact," says Julia A. Smith, MD, PhD, director of the NYU Cancer Institute's breast cancer screening and prevention program and director of the Lynne Cohen breast cancer preventive care program at New York University.

Dr. Smith also finds it disconcerting that younger girls appear to be using more cosmetic and personal care products than adult women. The EWG’s teenage survey participants used an average of 17 personal care products every day, containing an estimated 174 different ingredients, compared to the roughly 12 products and 168 different chemicals they previously found that adult women each used daily.

Advocates say the problem is serious, and they suggest playing it safe by avoiding chemical-laden cosmetics—and argue that it isn't difficult to do so. Hair sprays and lip liners aren’t exactly essential (although many a junior-high student would disagree).

"While we may not be able to control the carcinogens we breathe from the air or drink from the water, we don't need to be putting these chemicals directly on our skin," says Malkan.

Eventually, she says, there should be no cosmetics that contain hormone-disrupters on the market. "Taking these chemicals out of personal care products should be a no-brainer. It's an easy way, relatively speaking, to reduce the toxic load in the world."

Malkan, who confesses to having been "obsessed with beauty products" in her teenage years, would like to see more research into the effects of cosmetic ingredients on teenagers and children, as well as studies tracking repeated exposures over long periods of time.


Next Page: Unnecessary panic?
Unnecessary panic?
A cosmetics industry representative interviewed for this story pointed out that the EWG report "lacks many of the rigors that you would normally associate with a real scientific report," such as a large study population and control or placebo groups.

"They're presenting some very alarming assertions that are not supported by the methodology they used," says John Bailey, PhD, chief scientist of the Personal Care Products Council.

As for the EWG–referenced studies suggesting the dangers of cosmetic ingredients, Bailey says, "Many of these studies involve cell cultures where you take cells out of the body and you expose them to very high concentrations of a material." That’s not the same, he says, as looking at "real use and actual exposure [in which] products are applied to the skin at low levels."

Dr. Audeh is also worried about the public reaction to findings such as the EWG’s. He says such reports can result in "unnecessary panic aimed at what may be a minor or relatively unimportant source of chemical exposure."

The science is certainly preliminary in this field. Even if cosmetics ingredients do prove harmful in further studies, scientists also have yet to pinpoint the exact mechanism by which hormone-disrupting chemicals may affect breast health.

Is there a direct impact when you paint your nails with polish containing phthalates, for instance? Or do the chemicals amplify preexisting risk factors for breast cancer—such as family history or genetic predisposition?

"Not everyone who's exposed to a given environmental influence reacts the same way," explains Dr. Smith. "But our experience shows us that there's an interaction between the environment and one's underlying biology and genetics. Teasing out the exact effects is going to take time."

Research on men and boys
Much of current research into hormone-disrupting agents focuses on men and boys, and some of it is alarming. A recent study in the New England Journal of Medicine, for instance, suggested that lavender and tea tree oils caused several prepubescent boys to develop breasts.

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But experts agree that more research is needed on hormone disrupters picked up from various sources and the risks they may pose to adolescent females.

"Cancer occurs only when a cancer-causing agent has occurred in a very specific window of development," says Irma H. Russo, MD, chief of the molecular endocrinology section of the Breast Cancer Research Laboratory at Fox Chase Cancer Center, in Philadelphia, and a researcher into the impact of hormone disrupters on female development. And that "window of susceptibility," as Dr. Russo calls it, extends from a girl's prepubescent years all the way back to her in utero development.

"If anything, looking at girls between the ages of 14 to 19 may be a little bit late because sometimes the damage occurs much earlier," she says.


Next Page: How to be an educated consumer
How to be an educated consumer
Until research sways (or doesn’t sway) more minds and brings stricter control over the sorts of chemicals in question, cosmetics activists such as Malkan urge consumers to press for more regulation of the industry.

Although the U.S. Food and Drug Administration has some authority over beauty products, the cosmetics industry is a largely self-regulating and self-testing one, with a focus on weeding out products that pose immediate and obvious health risks, such as allergic reactions or skin irritation.

Malkan advises women to serve as their own regulators: "The government is not protecting us and the companies are not protecting us, so we have to protect ourselves."

To that end, she offers some tips for sorting through the maze of makeup, lotions, potions, creams, and gels out there.

• Choose products with fewer ingredients and fewer chemicals.

• Before buying, think to yourself, "Do I really need this product?" and consider whether you can cut it from your daily routine.

• For more on cosmetics ingredients, visit the EWG's cosmetics database, Skin Deep. (The Personal Care Products Council also offers a website, Cosmeticsinfo.org, with information about ingredients and regulation.)

Dr. Audeh has his own list of toxic products that teenage girls should avoid to make sure they’re not increasing their breast cancer risk—it includes cigarette smoke, high-fat diets, and diets with lots of red meat—but he doesn’t believe soaps and makeup belong at the top of it.

"I am not claiming that exposure to estrogenic chemicals from cosmetics are totally without health risks," says Dr. Audeh. "But it is hard to argue that of all these things, cosmetics are the most important."
]]> A new report found teenage girls' bodies contained the same potentially hormone-altering chemicals found in many cosmetics. (FOTOLIA) <![CDATA[Prophylactic Mastectomy: How I Weighed My Cancer Risk and Had My Breasts Removed at Age 33]]>
Will I get breast cancer?
My mother had breast cancer about 10 years ago, and my sister Beth got diagnosed in 2004. She tested positive for the BRCA gene mutation, so she ended up getting a double mastectomy.

I’m one of three girls, so Beth’s test results gave me and my other sister, Carolyn, a 50% chance of having the gene mutation.

At first I didn’t do anything with that information. I felt like I was too young to worry at just 32. Also, why would I get tested? I would never get surgery, so what was the point of knowing?

Carolyn got tested right away, and she was negative. My parents both got tested too, and it turned out that even though my mother had had breast cancer, my father was the breast cancer gene carrier.

Eventually I started getting really scared of chemotherapy—more than cancer. I started hearing how damaging chemo could be, that it could cause infertility.

I became an emotional wreck and spent a couple of months deciding if I wanted to get tested—and face the possibility of a double mastectomy.

It was a catch–22: If I’m positive, how am I going to live with this information? But if I don’t find out I’m positive, I’m still living in fear.


Next Page: Will men find me attractive?
Will men find me attractive?
When I tested positive for the BRCA gene mutation in April 2005, I was devastated. I felt like I’d just gotten a life sentence. But I still was not ready for a mastectomy.

I think the worst part was that I was single and dating. It’s hard enough to meet somebody as it is. How am I going to meet somebody if I have scars all over? Will men really be able to accept this and love me and find me attractive?

What I really needed was to talk to other women who had done the surgery to see actual results. I really only wanted to talk to single women, but it was virtually impossible to find them.

I got hooked up with a support group but a lot of these women had had oophorectomies (the removal of ovaries), and they were talking about how they lost their sex drive, how their hormones were crazy. That actually made me feel worse. I was just trying to wrap my head around maybe losing my breasts!

Strong reactions
It was interesting but I found that the men in my life—like my father and my brothers-in-law—were more worried than I was, like they didn’t know if men could really handle that.

My parents kind of kept to themselves and ended up telling me after the fact that they really didn’t think that I should have done it—because of how men would react.

But none of my friends thought it was unreasonable to consider a double mastectomy or that it was too drastic or a mistake. I know a lot of other women who had people in their lives say they were crazy for doing this.

I made the final decision to have the surgery in August 2005. I think the last piece that nailed it down for me was when I met with a plastic surgeon and she explained that they can do skin sparing, and I saw her photos of all the patients she had done. It was amazing.


Next Page: Saying good-bye to my breasts
Saying good-bye to my breasts...
I saw a therapist who suggested I formally look in the mirror and say good-bye to my breasts and make an emotional connection with them. My friend did a photo shoot for me. And I definitely had those mirror moments where I was looking straight on and saying good-bye to the images of them, and the touch.

I think I went through such a healthy process. I didn’t rush into it. I really was at peace by the time I made the decision. And during that time I was also training for the Avon walk—I was getting in shape and feeling connected to the cause.

But there was definitely a feeling of a countdown, especially in the last couple of weeks. 20 days, 19 days…I was ticking off the days. It did feel like doomsday but I was confident in my decision.

…and going under the knife
In a skin-sparing mastectomy, they cut around the nipple, and all the skin stays, except for your nipple. They scoop out all the breast tissue through the hole that they make in each breast. They also put tissue expanders under the muscles of the chest wall to start stretching the skin for implants.

My surgery was a lot less scary than I thought it was going to be because I had breasts when I woke up. And it wasn’t gory. It was so clean looking!

I thought it was going to be all bruised and bloody, but it looked exactly like before but with some gauze over the center.

The recovery was painful. And you have drains coming out of you, which are kind of gross. Each time you go to the plastic surgeon to have your expanders stretched, it’s painful all over again until your body gets adjusted.

In January I had my exchange surgery where they put in the implants, and that was a walk in the park.

Then I got the nipples in March. The nipples are really just flesh at the center of my breast; they sew it in a way that protrudes like a nipple. But the coloring’s not there. So after that heals, you get a tattoo that’s the color of a nipple.


Next Page: I like the way my breasts look
I like the way my breasts look
So now it’s two and a half years since the reconstruction was finished, and I feel great. I feel so relieved.

I actually like the way my breasts look. I like them better than the way they looked before. And it has not affected my relationships with men at all. I’ve been with a few men since. And some didn’t even know and I didn’t bother to tell them.

I think I’m one of the fortunate ones because my breasts were not my biggest asset and not something that I identified with my beauty.

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Now I help other women going through it. I give comfort and support to women who are scared out of their minds. Because I’m so at peace, I’m able to pass on some kind of security to other people.

In fact, I would say this is the best thing that ever happened to me. It kind of changed my outlook on a lot of things. It made me stronger and gave me perspective about what’s really important.

There was never anything I was really passionate about in my life before, and now I found something.
]]> <![CDATA[Good News: My Migraines May Be Good for My Breasts]]>
migraine on Saturday, July 13, 1985. I had fled to the rooftop of my apartment building to escape the Live Aid concert that my husband was blaring full blast from the TV. Thirty minutes later I ran back down and told him I thought I was having a stroke. My head hurt terribly and there was a squiggly shiny thing vibrating in my eyes.

A neurologist diagnosed me with a migraine, and I have suffered several of the nasty headaches with auras (light disturbances) since. I can’t think of the word migraine without also thinking about Bob Geldof (the organizer of Live Aid). And the next thought I have is what poor taste he has to name his children Fifi, Peaches, and Pixie. But I digress.

Now I get to add a much better association: healthy breasts. Unbelievably, recent research reveals that women who get migraines (even just once) may be less likely to get some kinds of breast cancer. This is huge and such an unexpected gift—kind of like finding out that cheese and eggs are good for your heart.

The news came from cancer epidemiologist Christopher Li, MD, and his colleagues at Fred Hutchinson Cancer Research Center in Seattle, who surveyed 3,500 postmenopausal women, 2,000 of whom had breast cancer and 1,500 who didn’t. They discovered that the women with migraines had a 30% lower risk of developing breast cancer.

How could the pain in my head have anything to do with sickness in my boobs? Researchers speculate that estrogen could be the key. Higher estrogen levels have been linked to breast cancer, and migraines sometimes occur during estrogen fluctuations—when it drops during menstruation, for example.

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Of course, the breast cancer benefit could come from the drugs that migraine sufferers take, typically nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, of which I am a very big fan. After years of experimentation, I’ve found I can usually "cure" a migraine within a few hours by chugging two cans of Diet Coke and swallowing four Advil. Together, they work a lot better than many of the drugs I’ve been prescribed, and now I know the caffeine and meds may be good for my girls too! A Harvard study found a "a weak inverse association between caffeine-containing beverages and risk of postmenopausal breast cancer."

So, the next time I get a migraine and pop that first can of Diet Coke, I'll drink to my girls' health and to the pain passing quickly.

Read Anne's previous posts:
It's Breast Cancer Awareness Month. Should You Think Before You Pink?

Christina Applegate Chose Breast Reconstruction, So How Come Other Women Don't?

The Survivor Files: Amazing Women Share Their Breast Cancer Journeys

Could Where I Live Raise My Risk of Breast Cancer?

Breast-Cancer Scares: Bras, Abortion, Deodorant. Fact or Fiction?
]]> Horrible head pain may have a very silver lining. (GETTY IMAGES) <![CDATA[Stress-Reduction Therapy May Hike Breast Cancer Survival Rates]]>
breast cancer diagnosis and stress—you can pretty much count on the two going hand in hand. Now, a new study is raising hopes about the effects of group therapy and relaxation techniques on the well-being and survival rates of women with breast cancer. Learning how to handle the stress of a diagnosis and treatment in the first year may help such women live better and longer, researchers said today.

The Ohio State University randomized clinical trial looked at 227 women with stage II or stage III breast cancer over 11 years. About half took part in what researchers call intervention—26 small therapy groups led by psychologists in the first year—and half did not.

The result: That one year of therapy and stress reduction (weekly sessions for four months and monthly sessions for eight months) was linked to improved survival 11 years later in the intervention group, the researchers write in the December 15 issue of Cancer, an American Cancer Society journal. In fact, breast cancer patients who had the group therapy were 45% less likely to have a recurrence of breast cancer and 56% less likely to die of breast cancer than those who did not.

Interestingly, breast cancer patients in the intervention group who were open to the idea that stress reduction could make a difference and who practiced progressive muscle relaxation techniques daily had the greatest reductions in distress and physical symptoms.

Progressive muscle relaxation involves slowly tensing and relaxing each muscle group (you can watch a video here). The technique, along with guided imagery, has been studied as a way to reduce anxiety in patients being treated for breast cancer. But this was the first study to link the technique to increased immunity and breast cancer survival.

Next Page: The results

The pro-intervention results of this study are a boost for those who believe that psychological therapy, such as talking with a psychologist, improving diet and exercise habits, and learning new coping skills and relaxation techniques, can provide big benefits—from increased immunity to better survival rates—in cancer patients. Past studies on the role of group therapy have been controversial and sometimes have yielded conflicting results.

That's why Michael Stefanek, PhD, vice president of behavioral research and director of the Behavioral Research Center at the American Cancer Society, is only cautiously optimistic. "Psychological interventions have been found in the majority of well-controlled studies to enhance quality of life and reduce distress," he said in a statement. Patients may learn healthy lifestyle habits and strategies that enhance their quality of life and communication skills, he said, but "it would not be reasonable for patients to participate in psychological interventions with the goal of extending survival."

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It's understandable that experts don't want to falsely raise hopes of survival. But the authors of the new study do link stress-reduction techniques with improved immunity: "Added immune control of disease processes, particularly early—when patients were recovering from surgery and receiving adjuvant cancer therapies—may have occurred with the declining stress."

And they hypothesize that psychological interventions that reduce stress may also interrupt the inflammatory process, which has been linked to tumor growth and disease progression.

The fact is, the patients who received therapy had a reduced risk of death from all causes, not just breast cancer. Wrap this research up with 30 years of hundreds of psychological intervention trials, the study authors say, and you have a good case for promoting group therapy and stress reduction as a survival technique.

Indeed, policy makers and oncology professionals in the United States and around the world recommend treating those diagnosed with breast cancer for their psychological distress. The researchers hope their study results are a step toward making that goal a reality.

Read Anne's previous posts:
Good News: My Migraines May Be Good for My Breasts

It's Breast Cancer Awareness Month. Should You Think Before You Pink?

Christina Applegate Chose Breast Reconstruction, So How Come Other Women Don't?

The Survivor Files: Amazing Women Share Their Breast Cancer Journeys

Could Where I Live Raise My Risk of Breast Cancer?

]]> Group therapy may improve breast cancer survival. (ISTOCKPHOTO/HEALTH) <![CDATA[Breast Cancer Screening Advice from Julia A. Smith, MD]]>
Julia A. Smith, MD, PhD, is the director of the NYU Cancer Institute's breast cancer screening and prevention program and director of the Lynne Cohen breast cancer preventive care program at New York University in New York City.

Q: Do you recommend that all women perform breast self-exams and have clinical exams and mammograms?

A: Yes, I do. I recommend getting a baseline mammogram between the ages of 35 and 40 (to compare against tests later in life). Anyone over the age of 40 should have a mammogram every one to two years, and over the age of 50 yearly. Women should also see a doctor for a physical (or “clinical”) breast exam at least once a year. You should check your own breasts monthly. If you're premenopausal, check them as soon as your period ends.

Q: How important are breast self-exams?

A: Breast self-exams have never actually been shown in studies to decrease the number of women who die of breast cancer. However, I do advise women to check themselves because as they get familiar with their own breasts, they are more able to detect things that seem unusual.

Q: Do mammograms catch every cancerous tumor?

A: The main concern with mammograms is that they tend to produce false negatives, meaning that they will sometimes miss a lump. That happens in around 20% of mammograms. A mammogram will catch most cancers, though—and those are typically the cancers that would not have been caught by clinical breast exams or self-exams.

Q: Should more women get mammograms?

A: Yes, more women should. But unfortunately, the rate of women getting mammograms in recent years has been declining. It’s not known why this is. It doesn't appear that doctors are recommending mammograms less, and it doesn't appear that women are not being properly referred. It seems that women are simply not showing up. Depending on the situation, these women are either skeptical, complacent, or scared.

Q: Should I be afraid of the radiation that mammograms produce by using X-rays? Could it give me cancer, maybe even breast cancer itself?

A: Studies have shown no increased risk of problems from mammograms, and the dose of radiation is lower than it used to be. The benefits far outweigh any risk.


Next Page: How do I know if I need a breast MRI?
Q: How do I know if I need a breast MRI?

A: Magnetic resonance imaging (MRI), which uses a magnetic field and radio waves to take pictures of the breast, is especially useful to get a closer look at patients who have a diagnosis of breast cancer. But MRIs are also often recommended for women who are at high risk for breast cancer, such as women with a family history of the disease, BRCA gene mutations, or previous personal experience with breast cancer.

Q: Are there any downsides to having a breast MRI?

A: While a mammogram can give a false negative, a breast MRI can result in a false positive. It's so sensitive that it can pick up things that turn out not to be cancer. If that leads to an unnecessary biopsy, it can be upsetting for the patient, not to mention the financial burden—or the fact that repeat biopsies may make future mammograms harder to read.

That being said, the breast MRI is a very valuable tool in both screening and diagnosis, and when applied correctly, the benefits of the procedure far outweigh the potential risks.

Q: How do I know if I need an ultrasound?

A: After a suspicious clinical exam or a mammogram, you may have an ultrasound, which uses sound waves to make a picture of the tissues inside the breast. The procedure can also be useful as part of standard annual screening for women with very dense breasts or at high risk for breast cancer.

Q: What should I do if there are no breast cancer screening facilities where I live?

A: Talk to a trusted family doctor or health professional and let them recommend someone. Keep in mind, however, that your mammogram needs to take place in a radiology setting and not in an oncologist's or general practitioner's office, because the reading of the mammogram and the upkeep of the mammogram machine have to conform to American College of Radiology standards. In very remote areas, the alternative may be a traveling mammogram van.

Q: How is mammography changing?

A: The technology has improved so that each mammogram X-ray delivers less radiation than before, further lowering the already low cancer risk. And there’s been a standardization of the way mammograms are read and the way radiologists and technicians are certified. Another improvement is the advent of digital mammograms, which are not available everywhere yet, but they may be more accurate and easier to read for women who have very dense breasts or are very young.

Q: When are digital mammograms helpful?

A: If a doctor sees something suspicious on your regular mammogram, following up with a digital image may provide a clearer and more accurate look at the breast, in the same way a patient may benefit from an ultrasound or an MRI.

Q: What does the future of breast cancer screening look like?

A: We hope to be able to better identify each patient’s level of risk and then tailor screening procedures more to that level. This involves looking more closely at family history, using genetic testing, understanding ancestry and hormonal history, and factoring in personal breast history, such as whether there have been biopsies in the past and what they have shown.

]]> (JULIA SMITH)