Breast Cancer Archive

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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.

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.

Research we're watching

A study published Oct. 15, 2015, in the International Journal of Cancer adds to evidence that the risk of breast cancer increases—but not very much—with every drink a woman takes. Researchers from five Spanish universities followed 334,850 women, ages 35 to 70, from 10 European countries. During an 11-year period, 11,576 were diagnosed with breast cancer.

When the researchers compared alcohol intake among women who developed breast cancer and those who didn't, they found women who averaged two drinks a day had a 4% higher risk than those who limited their consumption to one daily drink. Those who averaged three drinks a day had a 6% higher breast cancer risk.

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Women can devise their own breast cancer screening schedules based on their risk and preferences.

If you tend to "go by the book" for preventive health care, you probably get a flu shot each fall, have a colonoscopy every 10 years, and generally follow the experts' recommendations. But what do you do about mammograms? For decades, the two most influential expert groups—the American Cancer Society (ACS) and the U.S. Preventive Services Task Force (USPSTF)—haven't agreed about when to start having mammograms, how often to have them, or how long to keep on having them. Although the two groups come a little closer together with their most recent guidelines, they still disagree about breast cancer screening for women ages 45 through 54.

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News briefs

The guidelines for routine breast cancer screenings are changing again. The American Cancer Society (ACS) published its new recommendations Oct. 20, 2015, in The Journal of the American Medical Association, suggesting that women at average risk for breast cancer now wait until age 45 to begin getting yearly mammograms (it had been age 40) and then get yearly mammograms until age 54. After that, the ACS now recommends that average-risk women ages 55 to 74 transition to screening every other year (instead of annually). It's a big shift for the ACS, and the recommendations are now more in line with the guidelines that came from the U.S. Preventive Services Task Force (USPSTF) in 2009, which recommended mammograms every two years for average-risk women ages 50 to 74 and advise against routine screening before age 50 in these women. The USPSTF guidelines have been controversial since they came out. But no one is saying that women at increased risk for breast cancer should wait to get a mammogram; it's a decision that must be made by a woman and her doctor, based on her risk factors. One other big change to the ACS guidelines: that women continue screening mammography only if they have a life expectancy of 10 years or longer.

Ask the doctor

Q. I'm a 48-year-old woman, and I've never had a mammogram. Different guidelines seem to say different things. What do you recommend?

A. You're right, there are several different guidelines. Probably the two most often consulted by doctors are those of the U.S. Preventive Services Task Force (USPSTF) and the American Cancer Society (ACS). Recent changes by the ACS bring its recommendations nearer to those of USPSTF. They disagree slightly about you. ACS says you should have a mammogram (because you are over 45), but USPSTF says to begin at age 50. Both expert committees stress that these recommendations apply only to women who are not at extra risk of breast cancer (extra risk includes, for example, having a parent, sibling, or child who's had breast cancer). If a woman is at extra risk, she should start getting mammograms earlier.

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Research we're watching

A preliminary study published Sept. 14, 2015, in JAMA Internal Medicine reported that older women in Spain who ate a traditional Mediterranean diet enhanced with extra-virgin olive oil were less likely to be diagnosed with breast cancer. The study was part of a large Spanish clinical trial, Prevención con Dieta Mediterránea (PREDIMED).

PREDIMED looked at three different groups of women. One followed the Mediterranean diet plus extra servings of olive oil. A second followed the diet plus extra servings of nuts. Those in the third group were ad-vised to reduce their fat intake. The study followed about 4,300 women ages 60 to 80 for five years.

The purpose of treating ductal carcinoma in situ (DCIS)—the earliest, noninvasive form of breast cancer (often called "precancer")—is to prevent those lesions from becoming invasive and thereby greatly reduce the risk of dying from breast cancer. As mammography has become more precise, it has detected more DCIS, and more women get treatment with surgery and often radiation as well. An analysis published online by JAMA Oncology on Aug. 20, 2015, adds to increasing questions about the best way to manage DCIS in most women diagnosed with it.

Canadian researchers analyzed 20 years of data from 108,000 women with DCIS in a database maintained by the National Cancer Institute. Most women were treated with lumpectomy, often followed by radiation, or mastectomy. The researchers found that treatment with radiation or mastectomy did not lower the overall breast cancer death rate in women with DCIS. It remained at 3.3%—the average death rate from all breast cancers. However there were some groups—including African American women and women under 40—in whom the death rate was higher (7% to 8%).

Among 400 postmenopausal women who were previously inactive, those who did 300 minutes per week of moderate or high intensity exercise had more success at reducing total fat after one year than those who exercised for 150 minutes per week.

The PREDIMED study showed that the Mediterranean diet can statistically lower a person’s risk for cardiovascular disease, including heart attacks, strokes, and death from heart-related causes. The data also suggest that a Mediterranean diet is associated with a reduced chance of getting breast cancer. This small analysis has some limitations, but provides another reason to consider this already healthful way of eating.