Breast Cancer Archive

Ask the doctor

Q. I have been smashed, squashed, pulled, and tugged annually for 25 years. Why isn't there a better way to take a mammogram?

A. We hear you! Compression mammography has been the "gold standard" for decades for one reason — it works. Flattening the breast makes ductal tissue easier to distinguish and reduces the amount of radiation required to do so. Studies have demonstrated that it is the most effective approach to breast cancer screening.

Research we're watching

Ductal carcinoma in situ (DCIS) differs from breast cancer because it is noninvasive, so it cannot spread to other parts of the body. However, it can progress to an invasive breast cancer, which can be life-threatening. Researchers from the Netherlands Cancer Institute wanted to determine how DCIS affected long-term survival.

The team studied almost 10,000 postmenopausal women who were diagnosed with DCIS between 1989 and 2004. They tracked the patients over an average of 10 years and compared their death rates with the expected mortality rates of the general population. They found that women who had been treated for DCIS had a 2.5% risk of dying of breast cancer over 10 years and a 4% risk at 15 years — rates that were higher than in the general population. But they also found that DCIS survivors had a 10% lower risk of dying from any cause compared with the general population. They presented their results Jan. 27, 2017, at the European Cancer Congress.

Women with early cancer in one breast may opt to remove the other, healthy breast because they overestimate their risk of a second cancer.

Electroacupuncture may be an effective alternative to medication for relieving hot flashes causing sleep disturbances in postmenopausal women.

Once you've completed treatment, adjusting to a "new normal" can be challenging.

Image: RuslaGuzov/ Thinkstock

Completing cancer therapy can feel like a graduation. You've done some hard work, it's paid off, and you may be ready to celebrate. But saying goodbye to treatment can arouse many of the emotions and uncertainties associated with beginning a new chapter in life.

Dr. Larissa Nekhlyudov is a general internist who works with cancer survivors at two Harvard affiliates, Brigham and Women's Hospital and Dana-Farber Cancer Institute. She acknowledges that cancer survivors have a lot to deal with. "Once you've had your final chemotherapy infusion or swallowed the last pill, you may find yourself facing a new set of challenges—monitoring yourself for signs of recurrence, getting recommended follow-up care, adjusting to the long-term effects of treatment, psychologically adapting to normal life, and working to stay in good health," Dr. Nekhlyudov says.

Letters notifying women that they have dense breasts are difficult to understand. Women receiving them should contact their doctors.

Researchers have wondered for a long time whether there might be a link between excess thyroid hormone and an increased risk of breast cancer. High levels of thyroid hormone have been shown to mimic estrogen, which fuels many breast cancers. A new study has suggested that there may indeed be a link — but it’s important to put the results into context.

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A research letter published online Jan. 21, 2016, in JAMA Oncology suggests that many older adults are getting unnecessary cancer screenings. Researchers looked at questionnaire answers from about 150,000 seniors (ages 65 or older) across the country, and found that about half had received prostate-specific antigen (PSA) testing or mammography in the past year. But a third of those screened did not have a 10-year life expectancy, a major guideline for screening. Unnecessary screening rates varied by state—for example, 11% in Colorado and about 20% in Georgia. "Undergoing a screening test may actually cause more harm than good, especially with older patients or those with significant medical conditions," says Dr. Marc Garnick, an oncologist at Beth Israel Deaconess Medical Center and editor in chief of Harvard's Annual Report on Prostate Diseases. So talk to your doctor about the guidelines. Both the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF) recommend routine mammograms every two years for women ages 55 to 74. The ACS does not recommend mammograms in this age group if a woman has a life expectancy of less than 10 years.

For all men, the USPSTF recommends against routine PSA testing. The ACS suggests that men 50 or older (at average risk for prostate cancer) make the decision about screening with their doctor, but only if they have a life expectancy of at least 10 years, and only if they have been advised about the uncertainties, risks, and potential benefits of prostate cancer screening.

Personalizing breast cancer diagnosis and treatment has resulted in therapies that are more effective and less toxic than in the past.

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The federal government's "Cancer Moonshot," with the expressed goal of curing cancer, is getting a lot of press lately. While the initiative's stated goal may be overly ambitious because cancer is actually 200 or more individual diseases, it promises to increase research funding and speed the availability of new treatments.

Amid the excitement, it's easy to overlook the fact that there has already been great progress in treating many cancers. Patients are enduring fewer side effects and living longer. Breast cancer is a prime example. "There's no question that breast cancer treatment is improving," says Dr. Ann Partridge, senior physician at the Susan F. Smith Center for Women's Cancers at Harvard-affiliated Dana-Farber Cancer Institute.

Ask the doctor

Q. In your discussions of breast cancer screening, you never mention ultrasound. Is it an alternative to mammography?

A. No. Although the FDA has approved an automated breast ultrasound system to be used in addition to mammography for asymptomatic women with dense breasts, there are not enough published data about its effectiveness in screening to support its use. Moreover, ultrasound alone is not an alternative to mammography for routine breast cancer screening because ultrasound cannot pick up the small deposits of calcium (microcalcifications) that can be a sign of breast cancer.