Breast Cancer Archive

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%).

Although vitamin D is essential to bone health, a controlled clinical trial published online by JAMA Internal Medicine on Aug. 3, 2015, found that vitamin D supplements didn't build bone in postmenopausal women with blood levels of vitamin D below the 30-ng/mL threshold generally considered necessary for good health. Researchers at the University of Wisconsin randomly assigned 230 women to three groups: one got 800 IU of vitamin D daily and a placebo twice a month; one got a placebo daily and 50,000 IU of vitamin D twice a month; the third got placebos both daily and twice a month. The study lasted a year. The researchers found that neither dose of vitamin D had a significant effect on bone mass, falls, or fractures.

The Wisconsin study may not have used the right doses of vitamin D or lasted long enough to show an effect. One ongoing study, The Vitamin D and Omega-3 Trial (VITAL), is large enough to demonstrate even small-to-moderate benefits of vitamin D supplementation. VITAL is evaluating a 2,000-IU daily dose for five years in 26,000 women and men. The results are expected in 2017. Until then, it's still important to get the recommended daily dose of vitamin D: 600 IU for adults through age 70 and 800 IU for people ages 71 or older

Q. Some of my friends take saw palmetto supplements to reduce urinary problems caused by an overgrown prostate, which I was recently diagnosed with. My friends swear by it, but is there any good evidence this stuff helps? Is saw palmetto safe?

A. The short answer is that we don't have great scientific evidence that taking saw palmetto truly reduces male urinary problems. On the other hand, it doesn't appear to cause major side effects either.

Q. I am currently receiving annual chest CT scans to check for hidden lung cancer (I used to be a heavy smoker). Should I be concerned about the cumulative effects of radiation exposure?

A. Radiation from medical scans can cause cancer, but the level of exposure considered potentially dangerous appears to be many times greater than the average CT scan. In addition, cancer from medical scans takes decades to develop, which makes it less of a concern for men being screened for lung cancer, which is currently only recommended for current or former smokers ages 55 and older. Radiation from CT scans is a bigger concern for children and young adults, who have more time to develop cancer after exposure to medical x-rays.

You may drink coffee because it tastes good or helps you wake up. But the popular brew is also associated with health benefits, such as reducing the risk for heart disease, stroke, and type 2 diabetes. Now a study from Harvard-affiliated Dana-Farber Cancer Institute published Aug. 17, 2015, in the Journal of Clinical Oncology suggests that regular consumption of caffeinated coffee may be associated with a reduced recurrence of colon cancer, and even a reduced risk of death. The study included nearly 1,000 people with stage 3 colon cancer. They filled out questionnaires about their dietary patterns during chemotherapy, and then again six months after treatment was completed. People who drank four or more cups of coffee per day were 42% less likely to have cancer return than non-coffee drinkers, and were 34% less likely to die from cancer or any other cause.

This type of study doesn't prove that coffee drinking caused the lower chance of cancer recurrence and death. A randomized trial is needed to show cause and effect. But researchers are encouraged by the results. "Regular coffee intake has been associated with a reduced risk of type 2 diabetes, and it may be that through a similar mechanism, coffee may also improve outcomes for people with advanced colon cancer," says Dr. Charles Fuchs, senior author on the paper.

Ask the doctor

Q. I'm 62 years old, and my last menstrual period was at age 51. My doctor told me that my hot flashes would end after "about three to five years," but I still have them. Am I unusual, and what can I do?

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.

Urinary tract infections (UTIs) occur in women of all ages. Physical and hormonal changes can leave women at midlife particularly vulnerable. No woman should have to put up with the inconvenience and discomfort of recurrent UTIs. Self-help measures can be effective, but if they don’t do the trick, see your doctor. He or she can identify and treat any underlying problems and recommend other strategies to keep UTIs at bay.

Treatment decisions are complicated for men with low-risk prostate cancer that grows slowly. These cancers may never become deadly during a man’s expected lifespan. And there is no conclusive evidence showing that treatment in these cases extends survival. So cancer specialists have been leaning toward monitoring low-risk prostate cancer carefully and starting treatment only when it begins to spread. This approach was once used only in academic cancer centers, but new research suggests that this strategy is becoming more common in urology practices throughout the United States and other countries as well.