Q. A patient recently came in to our center for a routine mammogram and brought a photocopy of a newspaper clipping (source unknown) regarding news that mammograms, in addition to providing early detection for breast cancer, may also detect early heart disease in women. She asked me what I thought.
A. I told her that this was not news to me, and that I found it interesting this information is only being published now. Back in 2000 or 2001, my former partner and I began discussing arterial calcifications on mammograms, with the notion that if women had significant calcifications in their breast, why would they not have similar calcifications in their coronary or other arteries, and further, if they were young, such as under 55, and had significantly more calcifications than we were “used to seeing”, could this be a portend of kidney disease or other systemic medical illness? Even though there was no published research on this at the time, my partner and I decided to report what we thought were significant breast calcifications on mammograms, in an effort to alert that woman’s primary physician to a potential problem.
However, with regard to medical advancements, timing is always critical. Soon after beginning to report breast calcifications on mammograms (for me, around 2000 or 2001), I received several phone calls from primary physicians who were irritated that I was causing them to go on wild goose chases and run up medical bills, so I decided to hold off – only because I did a literature search and could find no scientific evidence at the time, to back up my theory.
There is, however, now research that corroborates the notion that arterial calcifications on a mammogram correlate to risk of having, or developing coronary artery disease. The paper I cite is: Margolies L., Salvatore M., et al.: Digital Mammography and Screening for Coronary Artery Disease. Journal of the American College of Cardiology Imaging 2016; 9(4) 350-360.
This paper indicates that the more breast calcifications a woman has on her mammogram, directly correlates to the amount of coronary artery calcifications she has, and further, it correlates to an increasing risk for her to have heart disease. The paper ends on a cautionary note that this information is preliminary, and needs to be replicated, and I think it will be. So keep your eyes out for new information, and I will also keep you posted here.
Michael J. Ulissey, MD, FACR
Q. How can I reduce my risk of getting breast cancer?
Physicians have known for decades that best way to reduce one’s risk of getting breast cancer (and many other cancers) is with diet and exercise.
A Mediterranean diet, in addition to being heart healthy, can help reduce one’s risk of breast cancer because it is low fat, high fiber, and packed with natural nutrients. http://breastdiagnostic.com/blog-article1/ . Most dietitians and physicians believe that taking vitamins does not really help, and simply gives you expensive urine. It is best to get the nutrients the natural way with real food.
Via many observational studies, physicians have also know that getting regular exercise reduces one’s risk for breast cancer, and a recent study published in a companion journal of the Journal of the American Medical Association continues to support this notion (and also indicates the risk of getting many other cancers will also be reduced).
The good thing about this most recent study is that it shows that one can currently be overweight and still benefit from the cancer risk reduction.
The exercise also does not have to be a marathon. Moderate exercise like regular walking, running, and swimming is great. If you are not in the best shape, begin with a slow walk and over time, as you feel you can, increase your speed. Maybe begin with 15 or 20 minutes a day, five days a week. Work your way up to 45 minutes a day, five days a week, and do this for three months. See how you feel. I will bet you feel great, lose weight, and want to continue this as a regular routine. Over time you will not only gain many tangible health benefits, but you will also be reducing your risk of heart disease and multiple cancers, including breast.
Michael J. Ulissey, MD, FACR
Q. Should I be worried about breast pain?
A. That depends. The type of breast pain that is diffuse and bilateral (involves both sides and relatively all over), is generally not worrisome as long as you are current on getting your yearly mammograms. If you have had a mammogram within the last eleven months, and you don’t feel a lump in your breast on self-exam, then sit tight and mention your breast pain to the doctor or technologist at your next mammogram appointment. If you have not had a mammogram in the last year, then please schedule one and mention your breast pain, just to be safe.
There can be many causes for this type of pain – most are probably hormonal, environmental, or a mix. Monthly hormone cycles can cause breast pain that comes and goes periodically. This type of pain can also be a bit worse around the menopausal years. And even for women who are post menopausal, there are hormones in meat, plant estrogens vitamin supplements, caffeine, and other mimickers of female hormones that can all come in to play. In addition, some women are born with fibrocystic breast tissue, which is more sensitive to these types of stimulants. Most women can live with their breast pain as long as they feel we have checked it out to make sure it is non-cancerous. Other things that might help would be to reduce caffeine (coffee, tea, chocolate), and using over the counter non-steroidal anti-inflammatory agents such as Ibuprofen products (Motrin, Advil, and generics work fine).
Now, if you have new onset breast pain that is focal (just in one place), wait for a month or two, and see if it resolves on its own. If it does not, make an appointment with your doctor and get it checked out. Typically we would begin with a mammogram and an ultrasound exam, just to be safe.
Dr. Mike Ulissey
Breast MRI detects more invasive cancers than mammography in high-risk women
Apr 25, 2016 | John Hocter
Q. My doctor recommends I do periodic breast self examinations, like in the shower once a month, but what I read online is that the government task force does not.
A. I recommend that you do it. Maybe not every month, but every other month or so I think is a good idea.
Both monthly breast self examination and clinical breast examination by a doctor, or qualified alternate clinician, have been controversial. The fancy words are Sensitivity and Specificity. When a test (like a manual breast examination) is sensitive, that means it is very good at picking up a potential abnormality (in this case, a breast cancer). However, often the potential abnormality often does not turn out to be an actual cancer (fancy word = False Positive). When a test is specific, that means that it does not always pick up a potential abnormality, but when it does, it is more likely that it will be a true abnormality (in our example, a breast cancer).
A manual breast self-examination, and even a clinical breast examination by a doctor, are neither sensitive, nor specific, but in my opinion, they are still useful. First of all, no medical test is 100% accurate. By doing a monthly self-exam beginning when you are young, over time your fingertips will remember what your breast tissue feels like. They will learn the various lumps, bumps, and ridges that comprise your normal breast tissue, so that some day, ten or twenty years down the road, you may be doing your exam in the shower and feel something “different”. Women’s intuition is good. If you do feel this and think it is different, get it checked out by your primary doctor, as well as well as a doctor at a full service regional breast center. Most of the time the extra checkup turns out to be normal, but sometimes, just by doing this easy monthly self exam, you might pick up something six months or a year earlier than when your next yearly mammogram is due.
Dr. Mike Ulissey
Q. I think I feel a lump in my breast. What should I do now?Never ignore a lump in your breast. Let’s talk about what it might be, and the steps needed to figure out if it is worrisome or not.
First, you need to decide if you really feel a lump. About half of women have dense breast tissue, which can feel like a lump if it swells due to hormonal changes. So, if you are premenopausal, see if the lump persists through a complete menstrual cycle. If it does, go to your doctor for an evaluation. If you are post-menopausal, and if the lump persists for several days or weeks, go to your doctor for an evaluation. In either case, your doctor is likely to refer you for further evaluation. In our opinion, we feel it is extremely important to make sure you go to a full service regional breast center – one that specializes in breast care and has physicians who focus exclusively in breast diagnosis.
Depending on your age, the initial evaluation at the breast center will usually begin with a mammogram, an ultrasound, and a physical exam by the breast radiologist.
The good news is that most lumps are non-cancerous, but not all, which is why it is important not to ignore them. Harmless possibilities include a cyst, a fibroadenoma, or dense stromal fibrosis. Cysts often come and go on their own so we generally leave them alone because they are otherwise harmless. If they are in any way bothersome or painful, we can easily numb the skin, place a needle in the cyst, and drain it away.
If there is any question about the diagnosis of a lump, the radiologist will perform a biopsy, which is a simple procedure with local anesthesia. After numbing the skin, we will use a special needle to take slivers of tissue from the lump, and then send them to a lab for definitive diagnosis. Turn around time to get lab results should be in the order of 24 – 48 hours.
Look for a full service regional breast center that can do all of procedures necessary to evaluate your lump and do the needle biopsy (if needed) in one day, at one visit, to make it easier on you – one stop shopping so to speak.
Dr. Mike Ulissey
Q. A friend of mine at work was diagnosed with breast cancer. How do I better understand my risk?
Risk assessment is a natural concern to women, especially since breast cancer is being talked about much more openly today than in the 70s or 80s. You never seemed to hear about a neighbor, colleague, or friend developing it, but now it seems commonplace.
The key, however, is not only to find out your risk, but what to do with that information. There are several online tools that are very easy to use on any home computer. One is at the National Cancer Institute (NCI) and can be accessed here: http://www.cancer.gov/bcrisktool/. One of the more widely accepted models by most of the major medical centers is the Tyrer Cuzick risk calculator, because it is one of the most comprehensive. This site requires you to download the tool and it only works on Windows based operating systems: http://www.ems-trials.org/riskevaluator/
Normal Risk is less than 15%, Intermediate Risk is between 15 and 20%, and High Risk is 20% or more. For women at high risk, the American Cancer Society and many other reputable medical organizations recommend adjunct screening with annual breast MRI. For women at intermediate risk, especially for those with dense breast tissue, many full service regional breast centers offer adjunct screening with whole breast ultrasound. Research is beginning to substantiate the notion that this can be a useful added tool for women who want additional peace of mind over mammography.
It is most important to understand that 75% of women who get breast cancer have no risk factors at all, so please remember, friends don’t let friends skip mammograms.
Dr. Mike Ulissey
Q. A patient recently came in and asked why we are not doing Thermography. She showed us a Facebook posting and asked us to comment: http://drjockers.com/thermography-the-new-gold-standard-in-breast-cancer-screening/?utm_content=buffer3cb00&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer
A. If I could pick a test that is absolutely not helpful in the detection or diagnosis of breast cancer it would be Thermography. Thermography has been virtually condemned by medical societies specializing in early detection because it misses so many cancers that at the time of imaging are quite large. In fact, the FDA has refused to approve Thermography for breast cancer screening or diagnosis, so if you do go to a Thermogram center, you might ask them: “Is your machine FDA approved?” If they answer “yes” ask them to see the certificate, or show them this link: http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm257259.htm
When made aware of thermography companies touting their machines, the FDA has gone so far as to issue them warning letters: http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2011/ucm250701.htm
In all fairness to Dr. Jockers, I contacted his office by phone and asked to speak with him, so I could get his side of the story. After putting me on hold to speak with the doctor, his assistant gave me his e-mail address and assured me that he would respond after he finished with his clinic patients. I sent an e-mail with several questions and received no response, so I called back and was not able to get through to the doctor.
My advice is to stick with mammograms, preferably 3D Tomosynthesis ones, and if you are over 40 get them yearly as long as you are in good health.
Dr. Mike Ulissey