Breast Cancer Archive

The release of new guidelines on mammography never fails to renew the heated controversy over the potential benefits and harms of this procedure. The latest draft guidelines from the U.S. Preventive Services Task Force (USPSTF) are no exception. The USPSTF recommends that women begin having mammograms at age 50 and stop at age 75. (The American Cancer Society and other medical organizations recommend that women begin getting regular mammograms at age 40.) The draft recommendations say there isn’t enough evidence to recommend or discourage the use of a new technique called 3-D mammography for screening, and also say there isn’t enough evidence to recommend that women with dense breasts, who are at higher risk of breast cancer, should have an ultrasound or MRI in addition to screening mammography. Comments can be made on the USPSTF draft until 8:00 pm Easter Time today. A final version of the recommendations is expected to be released in the fall of 2015.

Although the chance of developing breast cancer increases after age 60, the likelihood of dying from it is low.

If you're like most women, you consider the possibility of learning you have breast cancer every time you have a mammogram. But breast cancer probably doesn't seem as scary as it did when you were younger, because there has been so much good news about breast cancer in the last 20 years—improvements in mammography, advances in surgery and reconstruction, and drugs that are more effective and less toxic.

Although research suggests that women over 70 with early-stage breast cancer can skip radiation treatment, nearly two-thirds of women in that age group continue to receive it, according to findings published online Dec. 2, 2014, by the journal Cancer.

Researchers from Duke University sought to determine whether evidence from a large, randomized clinical trial published in 2004 had influenced treatment for early breast cancer. That study showed that adding radiation therapy to surgery plus tamoxifen does not reduce five-year recurrence rates or prolong survival in older women with early-stage tumors.

Although more than 80% of women with breast cancer use alternative therapies to relieve the side effects of treatment, there has been no scientific consensus on which ones are safe and effective. Researchers from several major cancer centers have analyzed data on over 80 such therapies and created a set of guidelines to help women with breast cancer and their oncologists. The results were published online in Journal of the National Cancer Institute Monographs on Oct. 27, 2014.

Only a few therapies were deemed to have enough evidence to justify recommendation—meditation, yoga, and relaxation with imagery for anxiety, stress, depression, and fatigue, and acupuncture for controlling nausea and vomiting from chemotherapy. Acetyl-L-carnitine, a supplement used to ease nerve pain, was found to increase nerve damage instead.

New evidence shows the tests may benefit women older than age 75.

Just as it is for younger women, routine breast cancer screening for older women is debated. The U.S. Preventive Services Task Force (USPSTF) recommends against routine mammograms for women 75 and older at average risk of breast cancer. But the American Cancer Society and other health agencies recommend that screenings continue annually as long as women are in good health. "That's because the best data we have for mammography is for women between the ages of 40 and 75. That doesn't mean mammography won't reduce the death rate from breast cancer after age 75; it's just never been studied in randomized controlled trials," says Dr. Phoebe Freer, a radiologist at Harvard-affiliated Massachusetts General Hospital.

Q. I had radiation and chemotherapy treatments for breast cancer. My cancer doctor sent me to a cardiologist for an ultrasound. Are there cardiac risks to cancer treatments?

A. Radiation to the chest can harm the heart muscle, arteries, and valves. In women who have had breast radiation, the lifetime risk of having a heart attack or another major cardiac event goes up approximately 3%. Women who have radiation to the left breast, which is nearer the heart, have a higher chance of problems, but the overall dose of radiation also plays a role. Radiation-related heart effects can emerge as soon as five years after treatment, so women who have breast cancer at a younger age may develop heart problems earlier than would otherwise be expected.

The mammogram remains the foundation of breast cancer screening, but variations on this test can improve detection for some women.

The mammogram isn't a perfect test, but it's the best one we have right now for identifying breast cancers early, which is why it remains the cornerstone of breast cancer detection. "For the woman at average risk for breast cancer, it is the only proven screening test," says Dr. Robyn Birdwell, associate professor of radiology at Harvard Medical School and section head in the Division of Breast Imaging at Brigham and Women's Hospital.

Breast pain after menopause can come in many forms

Menopause has come and gone. Why do I still have breast pain?

In most cases, breast pain is a by-product of reproductive life: Like breast swelling, it waxes and wanes during the menstrual cycle, and it's one of the first symptoms of pregnancy. Many women expect breast pain to go away after menopause. When it doesn't, they may fear they have breast cancer. Fortunately, breast pain is rarely a symptom of cancer, regardless of age. Still, that possibility should be considered, along with a number of noncancerous conditions that affect the breasts.

The drug anastrozole (Arimidex) reduced the chance of developing breast cancer by 53% in postmenopausal women at high risk for the disease (40 women developed breast cancer in the anastrozole group, compared with 85 women in the placebo group), according to a study published online December 12 in The Lancet. Anastrozole works by lowering the amount of estrogen in the body, which some breast cancers need to grow. This medication belongs to the class of breast cancer drugs called aromatase inhibitors. In this study, anastrozole was more effective than older breast cancer drugs called selective estrogen receptor modulators (SERMs), which include tamoxifen (Nolvadex) and raloxifene (Evista). However, it was similar in effectiveness to another aromatase inhibitor, exemestane (Aromasin). An editorial in the same issue stresses that researchers still need to determine whether breast cancer prevention drugs actually reduce deaths from the disease, which studies have not yet shown.

Many women who could benefit from breast cancer prevention drugs aren't taking them.