Breaking the News About Breast Cancer

(HealthDay News) -- Shelley Volz, now 59, got the news about her breast cancer diagnosis 10 years ago, right before she was headed from San Francisco to New York for the wedding of her younger brother.

After much thought, she decided to tell only her mother before the wedding and to hold off telling other family members. "My mother had a typical mother's reaction, tears and hugs, and we moved on," Volz said. "She really appreciated the fact that I didn't want to steal the limelight there."

Volz waited until after the wedding celebration to calmly tell others. Ten years later, after successful treatment, she is doing fine.

While she says she doesn't think she found it as difficult as many people to disclose the diagnosis, she did think about others' reactions.

In that sense, she is typical, according to a new study. "Even when women are facing a breast cancer diagnosis, they are still concerned about caring for everyone else, especially the emotions of others," said study author Grace J. Yoo, a medical sociologist at San Francisco State University's Biobehavioral Research Center.

She presented the findings Monday at the American Sociological Association annual meeting, in Boston. The research is especially timely, given the recent news that actress Christina Applegate, 36, is being treated for early breast cancer.

Yoo and her team interviewed 164 San Francisco-area breast cancer survivors, average age 57, of different ethnicities to evaluate the "emotion work" involved in telling others about the diagnosis.

In interviews with the researchers, the women talked about their feelings and actions after getting the diagnosis.

"Even telling someone, 'I have breast cancer,' it's well thought out," Yoo said. "They know the statement, to some, can overwhelm." Women react in different ways -- stifling their own emotions so they don't appear vulnerable, paying attention to the timing of their news, or sometimes letting it all out, she said.

Women find it somewhat easier to tell friends than family members, she found. "Women are trying to protect older, aging parents and younger children and even their spouses, even during illness. Women are socialized to care about others."

Ideally, Yoo said, women should do less of that at this time. "It's a time they should be caring about themselves, what decisions they should be making about breast cancer. They shouldn't emotionally burn themselves out by caring for others' emotions."

One woman, for instance, told the interviewer that she didn't tell her mother about her breast cancer until after the surgery, because she knew her mother would worry. Many women said once they were told about the diagnosis, they were surprised about the outpouring of help, even from acquaintances. But some feared that if they told, people may not care enough to help.

The findings ring true with what another expert has seen in clinical practice. This has "documented what we have known instinctively," said Lori Worden, an oncology social worker in Grants Pass, Ore.

Her advice to women? "You don't need to tell people today." Feel free to process it yourself first. Practicing what you will say, by saying it out loud to yourself or writing it down, can help, she said.

Yoo's advice: "We tell women to seek out other breast cancer survivors, other women who understand, to increase their resources." And focus more on getting emotional support than giving it.

More information
To learn more about how to tell others about your diagnosis, visit the Lance Armstrong Foundation.

The Reality of Mammograms and Breast Cancer False Alarms

Better technology means more scares, but if you have breasts like mine, you have to believe it's worth it
by Sally Chew

On my way into St. Vincent's Comprehensive Cancer Center recently to get my annual mammogram, I happened to read in the paper that the greater accuracy of the new digital mammograms means more false alarms—more scares, more visits.

I don't know if it was technical improvements that sped me through the masher more quickly than usual that day. More likely, it was the usual exasperation with the dense tissue of my ultra-fibrocystic breasts.

Digital mammograms are intended for women with dense breasts, but mine would defy even Superman’s powerful stare—or so I've been told. Radiologists dutifully study my "films" each year but rarely expect to see what's really going on till I lay back, down the hall, for a cool, sticky ultrasound.

Which is where I was dispatched last week so they could snap these:

The shadowy globes at the top of each image above are cysts, among a dozen or so I carry around from year to year. We track them every spring like so many migrating whales.

I crane my neck to see the screen while a technician punches measurements into her computer with one hand and drags that chilly wand around my breasts with the other.

Actually, she's more interested in those white, wispy "calcifications" and any brand-new dark shapes—like the pebble that prompted an open biopsy a few years back on that very same hall.

At the time, it seemed like pure luck that I emerged from surgery with a benign diagnosis (and a pretty scar). I hadn't yet experienced enough bump-by-bump monitoring to understand the benefits of the false alarm.

I get it now, though. As long as the statistics continue to be in my favor—did you know that 80% of biopsies are benign?—and the folks manning the machines actually seem to be paying attention, count me in for the extra whale-watching.

Drinking May Raise Breast Cancer Risk

(HealthDay News) -- Alcohol, consumed even in small amounts, increases the risk of breast cancer and particularly estrogen-receptor and progesterone-receptor positive breast cancer, a new study shows.

The findings, expected to be presented Sunday at the annual meeting of the American Association for Cancer Research, in San Diego, are followed by a second study that found an association between breast cancer risk and two genes involved in alcohol metabolism.

Previous data has suggested that consuming alcohol ups the risk of breast cancer, although the precise mechanisms have not been clarified.

In some forms of breast cancer, malignant cells have receptors that render them sensitive to hormones such as estrogen. The first study aimed to see if the hormone receptor status of the tumor influenced the relationship between alcohol consumption and breast cancer risk.

In the study, a team led by Dr. Jasmine Lew of the U.S. National Cancer Institute followed more than 184,000 postmenopausal women for an average of seven years.

Those who had less than one drink a day had a 7 percent increased risk of breast cancer compared to teetotalers, the team reported. Women who drank one to two drinks a day had a 32 percent increased risk, and those who had three or more glasses of alcohol a day had up to a 51 percent increased risk.

But the risk was seen mostly in those 70 percent of tumors classified as estrogen receptor- and progesterone receptor-positive. Researchers suspect that alcohol may have an effect on breast cancer via an effect on estrogen.

The risk was similar whether women consumed primarily beer, wine or spirits, the NCI team noted.

The second study dug deeper into other possible mechanism by which alcohol consumption increases breast cancer risk.

"For years, we've known that there's an association between alcohol drinking and breast cancer risk, but nobody knows yet what the underlying biological mechanisms are," said Dr. Catalin Marian, lead author of the study and a research instructor in oncology at the Lombardi Comprehensive Cancer Center at Georgetown University in Washington, D.C. "The logical step was to begin analyzing the alcohol metabolizing genes."

And indeed, two of these genes -- ADH1B and ADH1C -- were associated with a two-fold increase in breast cancer risk.

But the study does not prove a definite cause-and-effect link. "This is an association," Marian said. "This type of study is good for generating hypotheses. It's not a definite conclusion. It needs to be replicated by other studies to say for sure that what we found is there."

Another researcher urged caution in interpreting the results of both studies.

"These studies are too early for use in a clinical setting or to advance a public health message," said Dr. Peter Shields, co-author of the genetics study and deputy director of the Lombardi Comprehensive Cancer Center.

However, he added that the findings "really do advance science, and, with proper replication in other studies, then they may be highly clinically significant."

More information
There's more on breast cancer at the U.S. National Cancer Institute.

Environmental Toxins, Radiation May Be Tied to Breast Cancer

(HealthDay News) -- In the decades following World War II, both breast cancer rates and the use of synthetic chemicals soared in the United States -- and a new report contends there's a strong connection between the two.

Produced by the Breast Cancer Fund, a non-profit group whose mission is to identify environmental links to breast cancer, The State of the Evidence: 2008 concludes toxic chemicals in the environment, along with increased radiation exposure, are the main culprits in the sharp rise of breast cancer incidence.

The report cautions that "in-utero" [in the womb] and early childhood exposure to carcinogens through plasticizers, estrogen-mimicking substances and other chemicals may increase the risk of breast cancer in adult life.

"As we looked at the research comprehensively, the themes of interactions of timing and mixtures of chemical exposures and also radiation exposure as risks emerged. In bringing this broad focus to environmental causes of breast cancer, we hope to find ways to lower the future incidence of breast cancer not only for adults but, most importantly, for our children and grandchildren," said Dr. Janet Gray, an endocrinology researcher at Vassar College, who edited the report.

However, some public health experts say there's no scientific proof establishing a link between environmental contaminants and breast cancer.

Based on a review of more than 400 breast cancer studies, The State of the Evidence noted that more than 80,000 synthetic chemicals are currently used in the United States, although complete toxicological screening data are available for only 7 percent of them. Many of these substances are known to remain in the environment for many years and accumulate in body fat and breast tissue.

One group of chemicals -- phthalates, which the Breast Cancer Fund report identifies as a breast cancer risk -- was in the news last week when the U.S. Senate passed legislation strengthening the Consumer Product Safety Commission with an amendment requiring all children's toys and child-care products to be free of these hormone system disruptors. A study by Fox Chase Cancer Center in Philadelphia last year found that phthalates accelerated breast development and genetic changes in newborn female lab rats, a condition that might predispose the animals to breast cancer later in life.

Exposure to chemicals that mimic estrogens in the body, called xenoestrogens, is thought to be the reason more girls are entering puberty at younger ages, according to Jeanne Rizzo, executive director of the Breast Cancer Fund.

In addition to phthalates, the new report lists other endocrine-disrupting compounds that the study authors say have been shown to affect the risk for breast cancer in humans, or the risk of mammary cancer in animals. Those compounds, according to the report, include:

• Pesticides such as DDT, dieldrin, aldrin and heptachlor; triazine herbicides
• Bisphenol, a chemical used to make plastics, epoxy resins and dental sealants
• Polyaromatic hydrocarbons (byproducts of combustion)
• Tobacco smoke
• Dioxins
• Alkyphenols (industrial chemicals used in cleaning products)
• Metals including copper, cobalt, nickel and lead
• Parabens (anti-microbials used in personal care products)
• Food additives such as compounds given to cattle and sheep to enhance growth

The report also cites environmental factors that may exert cancer-causing effects without hormone disruption. Those factors include exposure to the petrochemical solvent benzene; organic solvents used in the computer, furniture and textile industries; polyvinyl chloride (PVC) used in a variety of appliances, food packages and medical products; 1,3-butadiene, a byproduct of petroleum refining and vehicle exhaust; ethylene oxide, used in medicine and some cosmetics; and aromatic amines, byproducts of manufacturing plastics and dyes. Both ionizing and non-ionizing radiation are also listed as suspected cancer-causing agents, the report stated.

"The conclusions of the surveyed research show us we need to look earlier and earlier at the impact of chemical exposure in utero and early life and how toxins, radiation, genetic predisposition, diet, exercise and all those things interact together to increase breast cancer risk. The results of this study compel us to look at the need for broad public health policy reform and more federally funded research," Rizzo said.

In response to the report, Tiffany Harrington, public affairs director with the American Chemistry Council, said the chemical industry is seeking to better understand the complex relationship between modern chemistry and human health.

"The chemistry industry has contributed to endocrine research by supporting applied scientific studies focused on developing the datasets needed to evaluate the reliability of endocrine screening methods," she said.

Meanwhile, environmental medicine expert Dr. Jonathan Borak, an associate clinical professor of medicine at Yale University's School of Medicine, said a host of studies have found no clear link between specific toxins and breast cancer.

"So far, I have not seen any compelling evidence of a link between any environmental contaminants and breast cancer," he said.

More information
For more on breast cancer, visit the American Cancer Society.

Health Tip: Get Screened for Cancer

(HealthDay News) -- Early detection, by way of regular screening, is one of the best ways to beat cancer.

The American Cancer Society offers these guidelines for cancer screenings:

• Women, starting at age 40, should get an annual mammogram to screen for breast cancer.
• Breast exams should start at age 20. An annual exam is recommended at age 40. Before that, women at normal risk should be examined about every three years.
• Beginning at age 50, women and men need regular screening for colorectal cancer. People at an increased risk for colorectal cancer should be tested earlier.
• Women need regular Pap smears to screen for cervical cancer. Pap smears should be given within three years of starting intercourse, or by age 21, whichever is earlier.
• Men 50 and older should get the prostate-specific antigen (PSA) test and a digital rectal examination annually. Men at higher risk should begin testing at age 45.

Estrogen Levels in Blood Predict Breast Cancer's Return

(HealthDay News) -- New research shows that women who experienced a recurrence of their breast cancer had almost twice as much estrogen in their blood as women who remained cancer-free after treatment.

This indicates that circulating estrogen levels contribute to a recurrence as much as the initial malignancy does.

That information is not entirely new, said Dr. Jennifer Wu, an obstetrician/gynecologist at Lenox Hill Hospital in New York City. "That's the reason we use drugs that help to lower estrogen levels. Estrogen causes increased cell division; we think it can perhaps start breast cancer," she said. "But this is a good study in that it has a lot of patients and proves that they have a demonstrable increase in estrogen levels over patients who don't have a recurrence."

Where there's a problem, there's also often a solution.

"Anti-estrogen drugs can only have so much impact," said study author Cheryl Rock, a professor of family and preventive medicine at the University of California, San Diego, School of Medicine. "There are two things apart from these drugs that can help to lower estrogen, or we believe it can, because it can in the general population. One is moderate to vigorous exercise, and the other is healthy weight management, achieving an ideal weight."

The hormone estrogen is produced not only by the ovaries, but also by fat tissue.
Previous research has shown that estrogen contributes to the risk of primary breast cancer in postmenopausal women, but there has been less evidence of the role of estrogen in cancer recurrence.

"The relationship between circulating estrogen and risk for primary breast cancer is very well-established, but there were surprisingly few studies in which estrogen levels have been measured in breast cancer survivors," Rock explained.

This study, published in the March issue of Cancer Epidemiology, Biomarkers & Prevention, followed 153 pairs of women who had had breast cancer (one in each pair experienced a recurrence, while one did not) for more than seven years.

Two-thirds of the participants were using tamoxifen, a drug which interferes with estrogen's activity in the body.

In the end, women with more circulating estrogen were more likely to have a recurrence.
There may be other factors at play also, Rock said. For instance, sex hormone-binding globulin basically makes estrogen available to get into tissue. "If estrogen is bound to that protein, it's not going to float right over to the cell," Rock said. "When people are overweight, they have higher blood levels of insulin, which suppresses synthesis of that protein, so exercise not only is related to actually helping weight management but, because it lowers insulin, it might make the hormonal situation look better."

And don't rule out existing anti-estrogen drugs, experts added.

"This study justifies the use of drugs that help decrease estrogen levels like tamoxifen and aromatase inhibitors," Wu said. "[In the future], we may want to titrate different levels of anti-estrogen medications. Right now, we have a standard dosage for everyone, whereas women who are heavier or other women who may have higher estrogen levels for one reason or another may need larger doses."

More information
Visit the National Cancer Institute for more on breast cancer.

Vitamin E Supplements May Raise Lung Cancer Risk

(HealthDay News) -- Vitamin supplements won't protect people against lung cancer and taking vitamin E may even heighten the risk, a new study finds.

The survey covered the supplement-taking habits and lung cancer incidence of almost 78,000 adults in the state of Washington over a four-year period.

"Our study of supplemental multivitamins, vitamin C, vitamin E and folate did not show any evidence for a decreased risk of lung cancer," study author Dr. Christopher G. Slatore, a fellow in the division of pulmonary and critical care medicine at the University of Washington, said in a statement. "Indeed, increasing intake of supplemental vitamin E was associated with a slightly increased risk of lung cancer."

As reported in the March issue of the American Journal of Respiratory and Critical Care Medicine, the research focused on men and women aged 50 to 76 taking part in the four-year VITAmins and Lifestyle (VITAL) study. Lung cancer was diagnosed in 521 participants surveyed.

In addition to the expected association with smoking, family history and other lung cancer risk factors, there was a slight but statistically significant association with vitamin E supplementation and incidence of the disease, the researchers found.

Every increase in vitamin E of 100 milligrams per day was associated with a 7 percent rise in lung cancer risk -- translating into a 28 percent increase in risk over 10 years for someone taking 400 milligrams of vitamin E daily.

"This provides additional evidence that taking vitamin supplements does not help prevent lung cancer," said Eric Jacobs, strategic director of pharmacoepidemiology at the American Cancer Society.

The society does not currently recommend use of any vitamin supplement to prevent malignancy, Jacobs said. However, "our dietary guidelines do recommend eating five or more servings of a variety of vegetables each day," he noted.

A representative of the supplements industry called the study results "not all that surprising."
"Vitamins are essential nutrients that act to maintain health and prevent vitamin deficiency," Pamela Mason, spokeswoman for the London-based Health Supplements Information Service, said in a statement. "They were never intended to be used to prevent chronic disease such as cancer. Indeed, it would be asking a lot of a vitamin pill to expect it to prevent cancer."

Since the primary cause of lung cancer is smoking, the best preventive measure is simply not to smoke, Jacobs said. Nutrients can play an auxiliary role, he noted. Anyone who cannot quit should avoid taking beta-carotene supplements, because studies have linked them to an increased risk of lung cancer, Jacobs said.

On the other hand, "for former smokers, there is some evidence that vegetables high in carotinoids, such as carrots and sweet peas, decrease the risk," he said.

Some vitamins have been linked to a reduced risk of other cancers, added Edward Gorham, an associate professor of family and preventive medicine at the University of California at San Diego.

"We have worked with vitamin D, and we found a protective effect of vitamin D on colon cancer, breast cancer and ovarian cancer, and recently a modest effect on lung cancer," Gorham said.
But that effect came not from supplements but from sunlight, which causes vitamin D to be formed in the human body, he said.

"These results with multivitamins dont surprise me because there is so little vitamin D in multi-supplements, 100 or 200 International Units," Gorham said. "To achieve the effect, it takes 2,000 IU. If youre in the tropics, that amounts to 10 or 15 minutes in the sun. In southern California, it takes 10 or 15 minutes in the summer and longer in the winter because the sun angle is so low."

One study has also associated vitamin D supplements with a decreased risk of colon and breast cancer in women, Gorham said.

More information
There's more on nutrition and cancer prevention at the American Cancer Society.