25 Jul CoP Roundtable Q&A
During our CoP Roundtable event in late February we received some questions that unfortunately the experts could not get to. In order to insure that no one was left unanswered we have compiled the list of questions and answers here.
Q: How can breast cancer affect breastfeeding mommies?
A: Breastfeeding isn’t recommended if the mother is getting chemo, hormone, or targeted therapy. Many chemo, hormone, and targeted therapy drugs can enter breast milk and be passed on to the baby.
If you have questions, such as when it might be safe to start breastfeeding, be sure to talk with your health care team. If you plan to start back after you’ve stopped breastfeeding for a while, you will want to plan ahead. You may need extra help from breastfeeding experts.
Q: I am an Ashkenazi Jew. Why do we have higher rate of breast cancer? (Relatively closed gene pool?)
A: In the U.S., breast cancer risk is slightly higher among Jewish women than among other women. This increased risk is likely due to the high prevalence of BRCA1 and BRCA2 gene mutations in Jewish women of Eastern European descent (Ashkenazi Jews). You can find more information about gene mutations related to breast cancer and Ashkenazi Jewish heritage here.
Q: Do drugs like the depo shot increase or decrease cancer chances?
A: Findings on Depo Provera have shown no impact on breast cancer risk overall. However, a possible increase in risk has been found among current, longer-term users compared to women who never used Depo Provera. Before using Depo Provera or another type of birth control with hormones (or if you are currently using one and haven’t done so already), talk with your health care provider about its benefits and risks.
Q: What is the survival rate of a woman after going through chemotherapy and has been diagnosed with Stage 4 breast cancer?
A: Survival for Stage IV (or metastatic) breast cancer varies greatly from person to person. It is important to note survival data are based on women diagnosed before some of the newer treatments for metastatic breast cancer were available. Modern treatments for both early-stage and metastatic breast cancer have improved survival for women diagnosed today. Survival and prognosis for each individual should be discussed with the individual’s health care team.
You can find more information regarding Treatment, support groups, assistance and quality of life for patients with Stave IV metastatic Breast Cancer here.
Q: There were actually numerous questions about breast screening recommendations. To best address everyone’s concerns, please see the following:
A: Screening recommendations for women with a higher risk of breast cancer vary. The best decision in every situation is to discuss your family history and personal risk with your doctor or care provider and make a decision on your screening planned based on your personal needs.
Susan G. Komen believes all women should have access to regular screening mammograms when they and their health care providers decide it is best based on their personal risk of breast cancer. In addition, screening should be covered by insurance companies, government programs and other third-party payers. Read more from our press release.
Minimum Age to Start
|American Congress of Obstetricians and Gynecologists||
|American College of Radiology/Society of Breast Imaging||
|American Medical Association||
|National Comprehensive Cancer Network||
|American Cancer Society||
Every Year (45-54)
Every 1-2 Years (55-on)
|U.S. Preventative Services Task Force||
Every 2 Year (50-74)
Q: Does the 3D mammogram allow for longer periods of time between mammograms? (For instance, every 2 years instead of every year)
A: No. Although 3D mammography (like the kind used on the Komen San Diego mobile mammography coach) is a more accurate mammogram that detects 41% more invasive cancers and reduces callbacks by 40% versus 2D mammography alone, it is still recommended for women over 40 to get screened every year.
Q: Does joining a breast cancer support group increase survival rate?
A: Support groups are an important resource for breast cancer survivors. They are designed to increase the support network of the people in the group.
At this time, however, it is unclear whether social support can improve survival or reduce the risk of breast cancer recurrence. Randomized controlled trials do not show a survival benefit from support groups among breast cancer survivors (although other quality of life benefits have been shown). However, prospective cohort studies suggest that survivors with more social support have better survival.
The differences in results may be due to the types of social support studied. Cohort studies have mostly studied the social support people get from existing social networks, such as friends and family. In contrast, randomized trials have mostly studied social support from strangers, such as cancer survivor support groups. More studies are needed to determine whether there is a difference between these two kinds of social support and breast cancer survival.
Q: Can you please talk about when other screening methods are necessary and/or recommended? (MRI, ultrasound, etc)
A: Studies show breast ultrasound alone is not a good breast cancer screening tool and has many false and false negative results.
Breast ultrasound exams are most often performed with a hand-held ultrasound device (see image above), so the quality of the image can vary greatly depending on the skill and experience of the person doing the exam. Automated breast ultrasound may help improve image quality and is under active study. However, at this time, it is not widely available or routinely used.
At this time, breast MRI is mostly used in breast cancer diagnosis and staging however, it is also used in breast cancer screening for women at higher risk, such as women with:
- A BRCA1or BRCA2 mutation
- A first degree relativewith a BRCA1/2 mutation, but personally have not been tested for BRCA1/2 mutations
- Radiation treatmentto the chest area between ages 10 and 30
- Li-Fraumeni, Cowden or Bannayan-Riley-Ruvalcaba syndrome (or a p53orPTEN gene mutation)
- An ATM, CHEK2or PALB2 gene mutation
- A greater than 20 percent lifetime risk of invasive breast cancer based mainly on family history (Estimate your lifetime riskor learn more about risk.)
Talk with your health care provider about breast cancer screening. Together, you can make a screening plan that is right for you.
Q: How much does birth control increase breast cancer risk?
A: Birth control and breast cancer risk depends on the type of birth control used and the types of hormones in the birth control. Current or recent use of birth control pills (oral contraceptives) slightly increases the risk of breast cancer. Studies show that while women are taking birth control pills (and shortly after), they have a 20 to 30 percent higher risk of breast cancer than women who have never used the pill. This extra risk, though, is quite small because the risk of breast cancer for most young women is low. So, even with a slight increase in risk, they are still unlikely to get breast cancer. Once women stop taking the pill, their risk begins to decrease and after about 10 years, returns to that of women who have never taken the pill. In most studies to date, women were taking older, higher-dose forms of the pill.
One area still under study is how today’s lower-dose pills affect breast cancer risk. Some types of newer birth control pills lower the number of periods a woman has during a year. Others contain progestin, but no estrogen (often called “mini-pills”). The impact on breast cancer risk appears to vary by type of lower-dose birth control pill. Mini-pills may not increase risk at all. Early findings show that other types of lower-dose birth control pills may increase breast cancer risk, but less so than the higher-dose pills of the past . These topics are still under study.
Depo Provera and hormone-releasing IUDs contain progestin alone, while the birth control patch and the vaginal ring contain both estrogen and progestin. At this time, data on a potential link between these products and breast cancer risk are limited.
Before making any decisions about using birth control pills (or if you are currently taking them and haven’t done so already), talk with your health care provider about the benefits and risks.
Q: Does having a lot of children affect breast cancer risk?
A: Studies show that the more children a woman has given birth to, the lower her risk of breast cancer tends to be. After a first child, each childbirth lowers risk. Women who have never given birth (called nulliparous) have a slightly higher risk of breast cancer compared to women who have had more than one child. However, women who give birth only once at age 35 or older have a slightly higher risk compared to nulliparous women. This is because the excess risk of having only one child at an older age never quite goes away.
Q: How does smoking increase risk [of breast cancer?] What about second hand/third hand?
A: In recent years, more studies have shown that heavy smoking over a long-time is linked to a higher risk of breast cancer. In some studies, the risk was highest in certain groups, such as women who started smoking before they had their first child. The 2014 US Surgeon General’s report on smoking concluded that there is “suggestive but not sufficient” evidence that smoking increases the risk of breast cancer.
Researchers are also looking at whether secondhand smoke increases the risk of breast cancer. Both mainstream and secondhand smoke contain chemicals that, in high concentrations, cause breast cancer in rodents. Studies have shown that chemicals in tobacco smoke reach breast tissue and are found in breast milk of rodents.
In human studies, the evidence on secondhand smoke and breast cancer risk is not clear, at least in part because the link between smoking and breast cancer is also not clear. One reason for this might be that tobacco smoke may have different effects on breast cancer risk in smokers compared with those who are just exposed to secondhand smoke.
Q: Can you talk about the different stages of breast cancer?
A: The stage of breast cancer describes the extent of the cancer within the body (learn more here). Knowing the stage of your breast cancer helps plan your treatment. Breast cancer stage is the most important factor for prognosis. In general, the earlier the stage, the better the prognosis will be, which is why early detection through regular and timely screenings is so important. Pathologic staging (the standard way to stage breast cancer) is based on a pathologist’s study of the tumor tissue and any lymph nodes removed during surgery.
Although there are a few ways to classify stage, the most widely used is the TNM system. TNM stands for:
- T= Tumor size
- N= Lymph Node status (the number and location of lymph nodes with cancer)
- M= Metastases (whether or not the cancer has spread to other areas of the body)
Click here to view a table that lists the TNM classifications for each stage of breast cancer.
The most common staging consists of the following:
- Stage 0: Ductal carcinoma in situ (DCIS) — non-invasive breast cancer wherethe abnormal cells have not left the milk ducts to invade nearby breast tissue.
- Stage I (a or b): early breast cancer— smaller than 2 centimeters and have not spread to thelymph nodes in the armpit (axillary nodes).
- Stage II (a or b): either larger than 2 centimeters or have spread to the axillary nodes.
- Stage III (a, b, or c): locally advanced breast cancer.
- Stage IV: any cancer with metastases, no matter the size of the tumor or the lymph node status.
Q: How can we become advocates for breast cancer screenings in our daily lives? How do we encourage and create dialogue to encourage/support women?
A: Stay educated and share your knowledge! It is currently the law, and it is your right to get an annual mammogram after 40. Sign up to be part of the Circle of Promise to get updates about breast health and events in San Diego here.
Starting a dialogue is a great first step. If you or a loved one have been diagnosed, share your experience with others and empower them to seek assistance from Komen and its partners. Encourage friends and family members to practice breast self-awareness, get regular check- ups, and mammograms. Early detection is critical.
By sharing our own experience, strength and hope with other women who have been diagnosed or had a family or friend who has been diagnosed, we can create an environment that encourages them to engage in dialogue about their own experiences. Start with your own circle of friends and family to start a conversation about the importance of breast health. By opening this door, others may feel empowered to continue the conversation and share their experience with others, and the conversation will carry well past your circle.
Q: What about early awareness? We seem to have a reactive culture in ethnic minority populations but just like Sex Education is in the classroom, can more be done about cancer education? Everyone is required to be in school for a period in life – let’s catch them there! e.g., Self Breast exam coaching classes/video targeted at school-aged kids.
A: Many sexual education courses do include breast and self-exam (BSE) guidelines, however, although it seemed promising when it was first introduced, studies have shown BSE does not offer the early detection and survival benefits of other screening tests. Currently, breast self-exam is not recommended for breast cancer screening, although it is important to become familiar with the way your breasts normally look and feel. Knowing what is normal for you may help you see or feel changes in your breasts. Breast self-awareness is an important part of Komen’s 4 Keys to Life.
Q: How do we break cultural and dietary habits? E.g., celebrity chefs can work on cultural menus with lovely people like you and devise food that we can enjoy.
A: There are many tools available to help guide you through cooking for breast cancer patients and survivors. Komen offers a recipe search tool that lets you search by cuisine, ingredients, cook time, special diets and many other filters. Once you make your selections, a complete list of recipes that meet your search criteria will appear. You can search for recipes and get more healthy eating tips here.
UCSD Moores Cancer Center offers their Healthy Eating Program which provides UC San Diego Health patients, staff, research participants, and the community with resources, monthly nutrition seminars and cooking classes focusing on the benefits of nutrition and cancer prevention. Learn more online at http://cancer.ucsd.edu/coping/diet-nutrition/healthy-eating-program/
Q: Are carbs our Achilles heel?
A: The American Cancer Society recommends that you limit intake of refined carbohydrate foods, including pastries, candy, sugar-sweetened breakfast cereal, and other high-sugar foods, and choose whole-grain breads, pasta and cereal (such as oats and barley) instead of breads, cereals, and pasta made from refined grains, and brown rice instead of white rice.
Q: Touching on starting this education early, there are few under 40 in this room. How can we advocate a 20-30 cancer free movement?
A: Breast cancer is rare in younger women. Fewer than five percent of all breast cancers diagnosed in the U.S. occur in women under 40. Even so, if you are a woman in your 20s or 30s, you may worry about your risk of breast cancer now and in the future. Most factors that increase breast cancer risk in older women (such as drinking alcohol) also increase risk in younger women. And, most factors that lower risk in older women (such as ever having breastfed) also lower risk in younger women. Read our recent blog post on breast cancer in younger women. We don’t know what causes breast cancer to develop in any one woman, no matter her age. However, a few factors are especially important to breast cancer risk in younger women. These include inherited gene mutations and African American ethnicity.
Q: Genetic testing – why can’t this be done early and free? I am British African and in Africa we do tests at birth to determine blood type for sickle cell trait, in the UK other tests are done. If cancer is tied to genetics, can we not push for this earlier so lifestyle choices are made in time and disciplined by parents/guardians?
A: Because harmful BRCA1 and BRCA2 gene mutations are relatively rare in the general population, most experts agree that mutation testing of individuals who do not have cancer should be performed only when the person’s individual or family history suggests the possible presence of a harmful mutation in BRCA1 or BRCA2.
Professional societies do not recommend that children, even those with a family history suggestive of a harmful BRCA1 or BRCA2 mutation, undergo genetic testing for BRCA1 orBRCA2. This is because no risk-reduction strategies exist for children, and children’s risks of developing a cancer type associated with a BRCA1 or BRCA2 mutation are extremely low. After children with a family history suggestive of a harmful BRCA1 or BRCA2 mutation become adults, however, they may want to obtain genetic counseling about whether or not to undergoing genetic testing.