Breast cancer browsing by tag


The Importance of Breast Self-Exams

Monday, December 2nd, 2013

Breast cancer is a major topic of interest these days, partly because so many women will eventually get it, and partly because education can make such a huge difference in a given woman’s prognosis. According to the National Cancer Institute, the 5-year survival rate ranges from 98% when the cancer is caught early and has not metastasized to around 24% when it not found until after it has already spread to other parts of the body. This is precisely why screening measures such as breast self-exam, clinical exams by a doctor, and regular mammograms after age 40 are so important.

Breast Self-Exam

Self-exam is the most important and most effective screening method available to women younger than 40 years of age. It is free, takes very little time, and saves thousands of lives every year. No one is as familiar with your own unique breasts as you are, so you can often find changes, thickening, lumps, or skin changes that other people might not notice during an examination.

Examine your breasts during the same time each month – for example, ten days after your period starts. If that is too hard to keep track of, then do the exam on the last day of your period. Before or during your period is not a great time because your breasts may be enlarged, making it hard to determine what you are feeling.

Look at your breasts in the mirror, checking for symmetry. If one of your breasts has always been slightly larger than the other, then this is nothing to worry about. However, if one of your breasts has newly become larger than the other, this is something to get checked out. Look for any changes in the skin, such as dimpling, pitting (like an orange peel), or redness. Look for any retraction of the skin that occurs when you raise your arms above your head.

To feel for lumps or changes inside your breasts, the best place is in the shower because your hands slide more easily over wet, soapy skin. Use your fingers to make concentric circles all over your breast, working your way in toward the nipple, and checking for any unusual lumps and also squeezing the nipple to check for any discharge (there should be none unless you are lactating). Don’t forget to check your armpit for lumps as well. After your shower, repeat this exam lying on your back with your arm raised above your head and lotion or baby oil on your skin.

Why Is Breast Self-Exam Important?

In just a few minutes once a month, you could very well save your own life. Women have many reasons for not performing self-exams. They may be afraid of what they will find (ironically, breast self-exams keep women much safer). They may not think it necessary, since their doctors examine their breasts (but a tumor can do a lot of spreading in a year’s time). Or they may forget or not think about it for months at a time. However, the statistics show the importance of making an effort to remember this.

Clinical screening methods are also important and can catch things that a woman might not be able to feel or see in her own breasts. An annual exam by your gynecologist as well as regular mammograms are important screening tools that save many lives – but neither is as effective or as important as being familiar enough with your own breasts to be aware of a change the moment it happens. If you do feel or see a change in one of your breasts, but your doctor seems to think it’s nothing, don’t worry – he or she is probably right – but do insist on following up with a mammogram to take another look. No one knows your body like you do. You are the expert on your unique body, you are the one responsible for your own well-being, and you are the one in charge of watching for signs of breast cancer and getting medical attention immediately if they do appear.

If you are older than 40 years of age, then a mammogram is the preferred approach to evaluation of your breast (perhaps with an adjunctive sonogram for dense breasts).  A Canadian Task Force concluded that breast self-examination in older women (40-69 years) )should not be performed due to increased anxiety and unnecessary biopsies for benign disease.  However, as I have stated in my women’s health book, “Inside Information for Women”, I believe that breast self-examination has the potential to detect breast cancer that you can feel and still should be recommended.

– Yvonne S. Thornton, M. D., M. P. H.

Researchers Suggesting There is No “One-Size-Fits-All” Approach to Breast Screenings

Monday, July 29th, 2013

Mammograms are universally accepted as the most effective way of screening for breast cancer; however, is this really true? Many women may be surprised to learn that there is more than one method for detecting potentially life-threatening masses in the breasts, and these varying procedures are being used in an increasing number of women in the population.  This is not to say that mammograms are not important or valuable as a detection tool in screening for breast cancers – however, in many cases it may not be effective when used alone, and as new screening technologies are developed and become more widespread an increasing number of women will need to work with their doctors to develop a more personalized approach to breast screenings.

According to a new report in the June issue of the American Journal of Medicine, for many years, mammography has been the sole imaging test recommended for breast cancer screening, and remains the only test proven to reduce breast cancer-related mortality. However, the widespread application of mammography in population-based screening remains controversial, owing to decreased sensitivity in women with dense breast tissue, radiation concerns, and a high rate of false-positive studies, leading to excessive breast biopsies.  Those who image the breasts are adapting to these challenges with the development of new technologies. Low-dose mammography can reduce radiation risk to the breast. Contrast-enhanced mammography can evaluate blood flow in the breast, similar to MRI. Tomosynthesis produces multiple mammographic slices through the breast, similar to computerized tomography (CT scan), and has significant potential to lower recall rates and increase specificity.

The article goes on to say that both whole-breast ultrasound and MRI have been shown to detect additional cancers in certain high-risk populations and will likely be increasingly used in screening women with dense breasts. MRI studies are very expensive and have a high false positive rate, i.e., they have difficulty in identifying a negative on the image as a true negative (without disease) in the patient.  However, a decrease in mortality has not been proven using these modalities.  Molecular imaging in the form of BSGI and PEM of the breast is widely available. Positron emission mammography (PEM) and breast-specific gamma imaging (BSGI) use molecular imaging to increase specificity in cancer detection by demonstrating increased metabolic activity.  However,  due to relatively large whole-body radiation doses (equivalent to 20-30 mammograms), they are not currently suitable for annual screening.

The reason that the same method will not work with every woman is because every woman’s body is different. Variations in the structure of a woman’s breast, the density of her breast tissue, or even the existence of implants may affect the ability of the standard mammogram to fully detect any underlying lumps or irregularities in her breast tissue. Simply put, every woman’s breasts are different, and so too must the screening for every woman be different.

While these advances are encouraging, it is improbable that any of the new technologies will replace mammography for population-based screening programs, because all have significant limitations.  Furthermore, given the heterogeneity of the human population, a “perfect” imaging technology for breast cancer screening will likely never be found.  However, women who feel as if they have different needs should consult with their doctor and ask whether or not there may be special considerations they should make as a part of screening for cancers. However, ultimately the main thing that older women should do is to continue receiving their mammograms regularly as well as younger women (less than 35 years of age) conducting breast self-examinations on a regular basis within the comfort of their own home. In coming years it is likely that the plan of action for women will begin to change depending on individual women’s needs, but the existence of different technologies is still no substitute for the screening methods that are commonly accepted and readily available.

– Yvonne S. Thornton, M. D., M. P. H.

Angelina Jolie News Raises BRCA Awareness

Monday, June 10th, 2013

Celebrity gossip is usually centered on unimportant things, and as busy as I am I rarely pay attention to any of it. However, I was forced to take pause with the recent news of Angelina Jolie’s double mastectomy, which she decided to undergo after making discovery that she was a carrier of the BRCA1 gene. For once, celebrity gossip might be doing more good than harm. In the past few weeks, talk about the BRCA 1 and 2 genes has gained a lot of momentum.

An increasing number of women are realizing how important it is to receive this screening procedure, especially if they have a family history of breast and ovarian cancers. Many women had certainly not heard about BRCA 1 and 2 screenings until Jolie’s frank discussion of the issue—something which is astonishing, as studies have already shown that testing for the BRCA gene increases awareness in women, leading them to higher rates of surveillance with regular self-checks and mammograms, as well as to a higher rate of preventative operations to reduce their cancer risks, such as Jolie’s double-mastectomy.

In short, the Angelina Jolie story is one piece of celebrity news that I can get behind. It might be a little distressing to think that some women are only learning about such an important topic through gossip magazines, rather than through their doctors, but sometimes it is best to appreciate any help you can get. In this case, if a larger number of women receive genetic testing to determine whether or not they are a carrier of the BRCA 1 or 2 gene as a result of a celebrity news story, then at least it can be said that perhaps our celebrity culture has done something right for once.

Angeline Jolie should, of course, be commended for her strength in speaking so publicly about such an important issue. The fact that she was willing to open up about her experiences in hopes of raising awareness may help many women prevent breast and ovarian cancers.

– Yvonne S. Thornton, M. D., M. P. H.

Do We Need to Talk More About Mammograms?

Monday, May 13th, 2013

It seems like a no-brainer that women should receive screening for breast cancer with a mammogram. It is recommended by most doctors that women, starting between the ages of thirty and forty, begin to schedule their mammograms every two years. It is at about this time that breast cancer becomes a serious risk to most women, and it will remain a risk to most women until well after menopause. However, as serious as this issue is, there are still a lot of women who decide not to get mammograms. Why is that?

For patients, there is a real fear associated with mammograms. They can be uncomfortable, and there are always stories getting out about false diagnoses of breast cancer being made. In fact, it is likely that a lot of women will need to undergo a biopsy to determine whether a spot found in a mammogram is cancerous or not—however, the benefits of a potential diagnosis early on, before cancer has a chance to grow and spread, far outweighs the potential downside of having to undergo a biopsy when no cancer is present.

In addition, there are unfortunately still many women out there who treat the age of 70 as a magical cut-off point when they no longer need breast cancer screenings. However, most women who get breast cancer are over 50, and a large number of these are over 70. Senior women are not being told how important it is to receive a regular mammogram, as this study indicates.  A large number of younger women are also unaware of the importance of checking their breasts regularly with home examinations. It is important for women of all ages to be aware of the fact that they are at risk, no matter what their age, background, or current health.


– Yvonne S. Thornton, M. D., M. P. H.

Are Hormones Giving You Breast Cancer?

Thursday, April 18th, 2013

When we are young and fertile, we take hormones for birth control.  As we age and go through menopause, we take hormones to control our bodies in other ways.  It seems as women, we are never happy with the natural course our bodies take, and so we constantly manipulate them with hormones. Although for most of us this method works, there are side effects, and sometimes, they can be deadly.

If you’ve been involved in any kind of female hormone therapy, you know that the two main ingredients are estrogen and progestin.  This kind of treatment can balance older women out so they don’t have to deal with hot flashes, mood swings, and other symptoms of menopause, but it can also lead to dangerous imbalances that lead to illnesses like cancer.  An observational study by the Los Angeles Biomedical Research Institute found that women who initiated hormone therapy involving estrogen plus progestin has a higher incidence of breast cancer than in women who did not use such therapies.  Additionally, they found that the closer to menopause hormone therapy was used, the higher the risk.  Estrogen plus progestin also increased the mortality rate in women who developed breast cancer.

If menopause is making you miserable, obviously you need to find some form of relief.  Instead of jumping into hormone therapy though, talk to your physician about all of your options.  There are many lifestyle changes you can make to reduce your symptoms that have to do with diet, exercise, and routines.  For instance, hot flashes may be reduced by avoiding spicy foods, caffeine, and alcohol.  Sleeplessness may be remedied by regular workouts, a strict sleep schedule, and stress reduction.  Mood swings could be controlled by the same diet and exercise strategies or even therapy.  Your physician may also be able to administer less extreme medications for only your most severe symptoms instead of taking the wide-scale approach of hormone therapy.

For women who absolutely must go on a hormone therapy regimen that involves estrogen plus progestin, make sure you start out on the lowest dose possible.  Your physician can always increase it if needed, but there’s no sense getting more than you need.  Also, as soon as symptoms are under control and hormone therapy is no longer needed, get off of it.


– Yvonne S. Thornton, M. D., M. P. H.


Vitamin D Helps Prevent Breast Cancer in Black Women

Thursday, December 13th, 2012

As if breast cancer wasn’t frightening and deadly enough, research shows that black women are 41% more likely to die from it. Though they are less likely to get it in the first place, the results are more often fatal when they do. Of course, no one wants to get breast cancer. No matter your race or background, it’s extremely dangerous. However, these findings should be a wake up call for black women to be especially diligent in being tested for breast cancer early on and also to take as many preventative measures as possible. Believe it or not, increased exposure to vitamin D will help.

A recent study explored the link between vitamin D and breast cancer in black women.  According to this case-control study, for black women, it is more difficult for the body to extract vitamin D from its most natural source—sunlight—because the pigmentation in the skin prevents it. However, the results of the study showed that women who had more vitamin D in their systems from external sources were less likely to get breast cancer. External sources include both sunlight and vitamin supplements. Though vitamin D is produced in the body sometimes, that type of vitamin is not the one that protects against breast cancer.  I am somewhat skeptical of this study because it does not consider any confounding variables, such as genetic predisposition and health care disparities in the management of breast cancer in Black women.  The patients were from the Northeast and there were no patients from the Caribbean or southern locales.  However, it is a start and a randomized clinical trial needs to be conducted to confirm their results in African-American women in the Sun Belt compared to those living in areas with less daily sunlight.

If you are of African American descent, it’s important that you start getting mammograms, as recommended, i.e., every one –two years between age 40 and 49 and then annually at 50 years of age.  Early detection is the best way to save yourself from the disease.  Too much sun exposure can be dangerous for the skin, but you should find out how much will allow vitamin D to be processed and utilized in cancer prevention. A supplement containing the vitamin is another good way to reap the benefits of it, and many women’s vitamins do contain small amounts.

In many cases, breast cancer is totally unpredictable and random. It might strike you no matter how you live your life. However, we should consider the results of this study because even if it doesn’t help, it certainly can’t hurt.

– Yvonne S. Thornton, M. D., M. P. H.

Found a Lump? Stay Calm.

Monday, October 15th, 2012

October is breast cancer awareness month, and it reminds us every year to practice good breast health and receive regular mammograms to protect ourselves. Early detection is always best when it comes to any type of cancer, and a simple mammogram is all we need to detect cancer in our breasts. All women are also encouraged to perform regular self-examinations to look for irregularities. If you find something unusual during one of these self-examinations or even just by chance when you look in the mirror, you’ll probably automatically assume it’s breast cancer. The truth is, it could be a number of different things, so don’t panic.

Don’t get me wrong – any changes in your breasts should be examined by your doctor immediately. However, there is no reason to get worked up over breast pain, nipple discharge, or even a palpable bump. Yes, any of these symptoms could be caused by breast cancer, but you won’t know for sure until you’ve had a diagnostic mammogram, physical exam, and ultrasound. Until then, remember that our breasts are complex and unpredictable organs.

Surprisingly, the Canadian Task Force on Preventive Health Carefound fair evidence that breast self-examination had no benefit and good evidence that it was harmful because it increased anxiety, physician visits and resulted in higher breast biopsies for benign disease. This group concluded that among women aged 40-69 years, routine teaching of breast self-examination should be excluded from breast cancer screening. However, I believe that breast self-examination has the potential to detect breast cancer that you can feel and still should be recommended.

It’s easy to forget that breasts are not simply sitting on our chest unchanging. They are constantly active, and they are easily affected by our body’s hormonal changes at any given moment. Your breasts will change during your menstrual cycle, during pregnancy, and even during menopause.

Especially in women younger than 40 years of age, changes in your breasts could be caused by benign cysts, mastitis, abscesses, breast hematoma, or a wide variety of non-cancerous tumors that can form in the many areas of such a complex organ. Breast tissue changes will always be alarming, but you should try to stay calm until the results of the test come back. Breast cancer can be fatal, but the many other possible conditions are harmless and will sometimes even go away on their own.

When you notice any changes in your breast, your reaction should should not be to panic and apathy will only kill you. You should certainly call your doctor and set up an appointment right away, but you should not start calling your family members frantically without knowing the entire story. Breast cancer awareness month should remind you to stay on top of your breast health, but it should also remind you to be grateful for all of the time you’ve remained happy and healthy.

 – Yvonne S. Thornton, M. D., M. P. H.

Scalp-Cooling Cap Freezes Chemo Hair Loss

Thursday, August 9th, 2012

Breast cancer, or any kind of cancer for that matter, is scary and stressful, and it doesn’t help that the treatment can cause hair loss.  Then, not only must you brave the disease, but also the beacon that your bald head becomes, proclaiming to everyone that you have cancer.  Recent experiments though show that a hat could stop or slow hair loss due to chemotherapy.

When you go through chemotherapy, its intent is to attack the rapidly dividing cancer cells.  Unfortunately, the drugs can’t always tell which rapidly-dividing cells are harmless.  Because your hair follicles divide quickly too, they often get attacked by the drugs.  These effects vary depending on the type of chemotherapy drugs you’re using, the regimen you’re on, and of course, the rate at which your hair follicle cells divide.  That’s why some people do not experience hair loss, while others experience it temporarily or even permanently.  Researchers at Laval University in Quebec sought a way to prevent or slow hair loss during chemotherapy.  They found, that by using a scalp-cooling cap, they could constrict the blood vessels around the follicles, preventing some of the chemotherapy drugs from giving their full dose to those areas.  When tested on a small, preliminary group, they found that the cap did show promise.  The cap was used for 20 minutes before the treatment and for an hour or more after the treatment.  Overall, their results showed 69% of women who tried it saw hair loss at the “not at all,” “a little,” or “moderate” levels.

If further trials test the cap and find it successful, it may be another option to add to your chemo treatment down the road.  That could mean a lot longer stays at the clinic, but it could also make for a slightly less stressful road to recovery in the end.  A scalp-cooling cap that freezes chemo hair loss in its tracks could be one more thing breast cancer survivors have to be thankful for.


– Yvonne S. Thornton, M. D., M. P. H.

Breast Cancer Works the Night Shift

Thursday, June 28th, 2012

Cancer of all kinds have plagued humanity for some time, which is why researchers are working so hard to determine risk factors, treatments, and possible cures.  Breast cancer in particular has received a lot of attention because of its devastating effects on women.  Now, it seems that working the night shift may add one more risk factor for women when it comes to developing breast cancer.

Currently, breast cancer kills more women than any other cause and more than 1.3 million women are diagnosed with it each year.  Researchers have discovered possible risk factors like genetic mutations, late first pregnancies, and hormone therapy.  Environmental and lifestyle causes are also being explored, but have not yet been specifically identified.  In France though, a study by the Center for Research in Epidemiology and Population Health looked at the careers of 3000 women and compared their breast cancer rates.  Shockingly, they found that women who worked the night shift were 30% more likely to develop breast cancer.  They believe this may be due to the disruption of the sleep cycle and circadian rhythms.  These processes, when disturbed, can negatively affect the nocturnal melatonin surge and its anti-carcinogenic effects, functioning of the biological clock genes that control cell proliferation, and/or the immune system.  Women who worked swing shift, switching on and off of at least three days of night shifts at a time, were even more likely to develop breast cancer than those who worked all night hours for each work night.

At a time when so many women suffer from breast cancer and when night work is on the rise, this study shows us yet again how important quality sleep is on a regular basis.  If you do have to work the night shift, make sure you have at least eight hours of time in a dark room to rest, where light does not disrupt your melatonin release.  It is imperative that we all take the time to recharge our bodies and minds, even if we feel we should be up and interacting with our families while they are awake.  When you work at night, both you and your family need to understand the health risks of not allowing yourself that sleep.  If you can sleep, you will enjoy many more healthy years with your family in the future than if you deny yourself that rest now.


– Yvonne S. Thornton, M. D., M. P. H.

Three ways to lower breast cancer risk

Thursday, October 14th, 2010

The conventional wisdom has been that, if you have a genetic predisposition to breast cancer, lifestyle changes, that might benefit other women, won’t help you. Your genes rule, so the thinking has gone until now, and there isn’t much you can do about it.

Now, I’m happy to report, new research in the journal Breast Cancer Research suggests that you don’t have to be a hostage to your genes. The study,  by researcher Dr. Robert Gramling of the University of Rochester in New York, followed approximately 85,000 post-menopausal women for more than five years. And while it was true that women with a family history of breast cancer were at greater risk to get the disease, he discovered something very promising. Women who:

  • exercised moderately (20 minutes per day for five days a week);
  • maintained normal body weight;
  • and drank no more than one alcoholic beverage per day

… lowered their risk of breast cancer. Yes, even those who had a family history of the disease.

Among those with a family history who followed the above guidelines and developed breast cancer, the rate was six in one thousand, compared to seven in one thousand among those who failed to follow the guidelines.

As I’ve been telling my patients and readers for years, there are so many benefits to maintaining a healthy weight. This study adds one more.

For your own health and the sake of those who love you, take good care of your body and it should take care of you for a very long time.

– Yvonne S. Thornton, MD, MPH