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Posts with tag dense

What tests do we really need?

Wouldn't it be great if we could receive full-body scans every year to check for early signs of cancer and other disease? Even if possible and affordable -- right now, scans cost about $900 -- it still wouldn't be such a great idea.

Full-body scans often result in false alarms. People with harmless abnormalities may end up facing more tests, more risks, and more worry in order to rule out illness. The scan itself can present health hazards too. It exposes patients to more radiation than a chest X-ray and could slightly increase the risk of cancer, especially for those scanned every year.

How do we know, then, if something has gone awry in our bodies? Well, we can do our self-exams -- breast exams, testicular exams, skin exams -- and we can report for annual check-ups. We can respond to symptoms we experience -- if headaches are bothersome and persistent, your doctor may prescribe a head scan -- and we can pursue tests and screening that we really need for cancer prevention and early detection. Here are just a few:

Continue reading What tests do we really need?

Still unknown but not so significant

The doctor who read my mammogram and ultrasound results today is the same doctor who detected in my recent MRI something of unknown significance. Today, the unknown remains. But the significance is not so significant.

This doctor saw an unusual pattern of tissue in my right breast when she viewed my Friday MRI results, some sort of enhancement she didn't see in the left breast or on the MRI I had a year ago. But today's mammogram looked good and today's ultrasound did too. So I guess if three different imaging tests don't turn up anything truly suspicious and there doesn't appear to be anything to biopsy, then all is well. For now.

All that must be determined now is when I will report back for more screening to chart the state of the dense breast tissue that keeps me on my toes.

Another bullet dodged. Another day in the life of a worried breast cancer girl.

Sunday Seven: Seven fears left by breast cancer

Cancer-related fear once consumed my mind. Now it sits lodged in the back of my brain and only presents itself on rare occasions.

I handle my fears so much better now than when cancer was new and fresh and raw. My fears hardly ever cause me real anxiety, they don't cripple my mental functioning anymore, and more than ever, they serve to focus my efforts in life. When fear strikes, it's usually a wake-up call of sorts, a reminder to leave no stone unturned, a summons to keep on living.

Although so much less threatening than they once were, my fears still exist. And I like to review them once in awhile, lose myself in a little emotional housekeeping, tidy up some of the mess cancer made. I always feel better when things are in order -- fears included.
  • I fear a breast cancer recurrence, the return of a tumor that rises to the surface of my skin and presents itself again underneath my fingertips -- or in my worst-case scenario is lost among dense breast tissue, undetected by self-exam, and caught too late by some combination of mammogram, ultrasound, and MRI.
  • I fear more than anything another cancer -- something entirely different from breast cancer, something buried in my body and not as responsive as breast cancer to treatment. I am prepared for a second visit from breast cancer because I know how to proceed, know I will succumb to treatment that is familiar, know I will remove both breasts in the most radical of life-saving approaches. But cancer in my lungs, brain, bones, blood, ovaries is out of my realm. And these cancers -- among many others -- really scare me.
  • I fear that my mom and my sister -- my first-degree female relatives -- will one day follow in my breast cancer footsteps. I once thought family history trickled down from above, from older family members. Now I know the disease can start with anyone. I am the anyone in my family. I am the reason my mom and sister are closely watched and monitored and tested. I am the one that put the fear of cancer into their hearts and minds -- and into mine.
  • I fear having another baby. I fear the return of cancer during pregnancy, leaving me with difficult choices regarding my health and my baby's health. I fear cancer returning after a baby is born, leaving me with one more child and more treatment to manage. I fear another cancer would lead to a decreased chance of survival and another baby would leave my husband feeling stranded should I die too soon. And I fear having a baby girl who would inherit the very real chance of developing breast cancer at some time during her life.
  • I fear not having another baby. I fear the regret I may feel one day, perhaps 50 years from now when I am healthy and cancer-free and without the child I longed for. I fear I am being overly cautious, too tentative, a bit selfish. A fellow cancer survivor once wrote me, "I learned that my family continues, even if I do not. I also learned that they are at least as tough as I am so will cope with the genes I pass to them and their own cancer battles if needed. Finally, I learned they look out for each other just as I looked out for them. No matter what your future, you will never regret giving another child a place in your family." I fear this man may be right.
  • I fear the potential long-term effects of treatment. I fear the chemotherapy that saved my life in the short-term may come to haunt me in the long run. I fear the radiation that zapped my breast and a piece of my lung and part of my ribs and possibly my heart will cause me problems in the future. I fear the effects of Herceptin -- the drug that dripped into my veins for one whole year with the purpose of keeping cancer at bay -- and worry my heart my fail me when I am old and gray because of the toxicity of this drug.
  • I fear dying at a young age. I fear leaving my children before they are grown. I fear leaving my husband a single parent, my mom someone who has lost a child, and my sister an only child. I have been told over and over again that my chances of survival are great, fantastic even. I have a 93 percent chance of not dying from breast cancer. This does seem great -- until I take into account that this percentage is good for only five years. My five years will expire when I am 39 years old. What happens then, I am not sure. The only thing I am sure about is that five years is not enough time. I want more, need more, demand more. Yet I fear my days may be numbered.
These are the fears that keep me focused. And while they are sometimes not-so-pleasant, I am in no hurry to resolve any of them. I am thankful really to have these fears swirling in my head -- because it means I am alive. And for me, being alive with fears is better than not being alive at all.

Dense breasts riskier than fatty breasts

I have dense breasts. And ever since the surgeon who performed my breast reduction surgery more than 10 years ago told me about the composition of my breast tissue, I have been a bit obsessed with how my breasts feel. Good thing -- because I ended up with breast cancer two years ago as a result of my own at-home monitoring. And now I wonder if my cancer was influenced by the density characterizing the tissue that fills my breasts.

Canadian researchers are reporting in a groundbreaking study that women with dense breasts, like me, are five times more likely to develop breast cancer than whose whose breasts have a lot of fatty tissue. It's long been knows that dense breasts inhibit the effectiveness of X-ray mammograms -- and perhaps delay diagnosis -- but now it's clear that breast density is a risk factor all on its own.

"Breast density is an 'extremely important' factor that accounts for up to one-third of all cases," says lead investigator Norman Boyd of the Campbell Family Institute for Breast Cancer Research at Princess Margaret Hospital in Toronto

Dr. Boyd says breast size has no bearing on density, and women cannot determine their degree of density on their own.

Density is the percentage of breast tissue not clearly visible on X-ray mammography. While fat shows up dark on mammograms, dense tissue appears light -- making it difficult to spot tumors.

This is not all bad news, say the authors of the study who report that density decreases with age. This research opens up a whole new avenue of prevention because the factors that affect density -- hormones, diet, exercise, environmental exposures -- can hopefully be altered. Also, this is very important news for women because it provides them with new and better information. And now, women who know they have dense breasts can insist on more frequent screening.

This research is published in Thursday's edition of the New England Journal of Medicine.

Timing of treatment works for and against us

My new breast cancer friend recently sat through her second infusion of Adriamycin and Cytoxan -- the long-time traditional chemotherapy combination for breast cancer -- and all the while, listened to another breast cancer survivor share her thoughts on these two drugs.

This woman told my friend she opted to stray from these chemotherapy agents because of their toxic side effects, because of their combined potential for causing other cancers, like leukemia. She instead took another drug route and was happy for her decision. My friend, however, was scared.

My friend returned home from her treatment and found herself reading a Cancer Blog post reporting that Adriamycin and Cytoxan may no longer be the gold standard treatment for breast cancer, that Taxotere and Cytoxan may become the preferred, safer option.

Fear and panic set in, and my friend e-mailed me, in search of perspective from a recipient of the drugs she was starting to believe are both ineffective and cancer-causing.

I am not a doctor. I am not an expert. I am not qualified in any way to represent the facts about medical research. But I am surviving breast cancer. And I did spend eight difficult weeks under the influence of Adriamycin and Cytoxan, given every two weeks in a dose-dense fashion. So I have an opinion about these drugs -- and about most things breast cancer related.

I shared my opinion with my friend, who has since decided to proceed with her prescribed treatment plan. I told her that in rare cases, chemotherapy can cause a second cancer, like leukemia. But this is not common, and the unlikely risk does not outweigh the benefit of receiving chemotherapy to address the cancer at hand.

I also shared with my friend that we can only benefit from therapies that are available and effective at the time of our treatment. Studies prove that Adriamycin and Cytoxan work -- that's why so many women are treated with this accepted method. Drugs in the research pipeline may one day definitively replace what is available today. But we must be OK with what we receive -- because we have no control over what lies ahead. We must live in the here and now -- with the knowledge that should our cancers return, bigger and better options may await us.

Consider Herceptin. Once not even an option for women with aggressive HER2 positive breast cancer, this targeted drug may be the magic bullet in an attack against this disease. I received Herceptin. My friend will receive Herceptin. Timing was on our side for this medical breakthrough.

Timing may not have been on our side should a new gold-standard drug treatment emerge and replace Adriamycin and Cytoxan. But we can still trust these two drugs will do their jobs, will prevent a recurrence of a disease that is so much more treatable today than it was years ago. Lucky for us.

Dose-dense chemotherapy better for breast cancer

More evidence shows that dose-dense chemotherapy is better than conventional treatment in early breast cancer. The results were presented at the 2006 San Antonio Breast Cancer Symposium (SABCS).

Chemotherapy for breast cancer given at shorter intervals between doses can increase survival rates. The researchers want to keep evaluating this method of treatment to see if there are any long term side effects.

A Phase III trial conducted in Germany studied 1284 patients under the age of 65 who had at least four lymph nodes containing metastatic cancer. Patients were assigned to receive either dose-dense chemotherapy or conventional treatment.

At five years the relapse-free survival was 70 percent in the dose-dense arm, compared with 62 percent in the conventional-dose arm. Patients did seem to have a lower quality of life with the dose-dense method of treatment but recovered after a few months.

Researchers concluded that updated results continue to demonstrate better efficacy with dose-dense chemotherapy than with conventional therapy in early breast cancer.

A lump in my breast

I still can't believe I got breast cancer. I really can't believe it's been two years since my whole journey began.

I found a lump in my breast on November 16, 2004. It took eight days of doctoring and worry before the mystery that lingered beneath the skin of my left breast unfolded.

Ever since that November day, I have been documenting my struggles and triumphs with a disease that turned my life upside down.

It all started exactly like this.

On November 16, 2004, I felt a lump in my left breast while taking a shower. I have always been aware of what my breasts feel like. I have a lot of dense tissue -- so dense that the surgeon who performed my breast reduction had trouble separating the tissue to take some out and leave some in.

My breasts always seem lumpy to me and I never knew if I'd be able to tell the difference between normal and abnormal tissue. Four years ago I had a mammogram because of something I felt. It all turned out fine -- it was just the dense tissue. All of my annual GYN visits have revealed nothing abnormal. But I've always been aware and curious which is why I found something in the shower. I knew it was not normal.

It was hard and felt like a small green pea. It moved around and for the first few days, I had a hard time locating it. Once I became obsessed with it, I could find it immediately.

Digital mammography detects hard-to-catch cancers

Technology has come a long way over the years -- and now the technology behind digital mammography is allowing life-saving screenings for the toughest patients to diagnose with breast cancer.

This is no small technological breakthough. It is a critical component for lowering the breast cancer death rate the American Cancer Society reports has declined 2.3 percent each year between 1990 and 2002. Since breast cancer is a treatable disease if caught early, digital mammography will up the odds of survival for women with this disease.

Digital mammography operates according to a computer-based technique that allows for digital manipulation of a breast X-ray. It exceeds the capability of film mammography -- and is much like the comparison between digital photography versus film photography. Both work. But one works better.

Studies show digital mammograms have a lot to offer. They detect tumors better in young women with dense breast tissue, for example. They allow for ease of storage and retrieval of images. And they can easily become part of a woman's electronic medical record.

There are still benefits of traditional mammography and women are still urged to use this less expensive option. They are also urged to conduct self-breast exams and to report for clinical exams with physicians. It's the whole package that contributes to comprehensive breast health, not just one isolated test. When used in combination with all other screening methods, digital mammography makes for a more accurate overall picture.

Breast cancer chemotherapy tougher on young women

Just before my chemotherapy for breast cancer started -- when I was fantastically frightened by the toxic drugs that were about to drip into my veins -- I was told by doctors, nurses, survivors, friends that I would be just fine. I was young and strong and tough. I would easily tolerate the beating my body was about to take. This is what I was told and actually came to believe myself. I had no other choice really than to approach chemotherapy with a fighter mentality. And so I did. And I did pretty well for my first three doses of Adriamycin and Cytoxan -- given every two weeks instead of three in a dose-dense fashion -- followed by one injection of Neulasta 24 hours later to maintain normal blood counts. And then something happened. And I did not end up tolerating the chemotherapy my gut told me was a scary endeavor.

Continue reading Breast cancer chemotherapy tougher on young women

Birth control options limited for survivors of breast cancer

In November 2004, my husband I and decided to try to have a third child. But instead of getting pregnant, I got breast cancer. And with the aggressive treatment I would receive -- surgery, dose-dense chemotherapy, radiation, and Herceptin therapy -- becoming pregnant was not an option. Birth control became my only option -- an option that has many limits for premenopausal women surviving breast cancer.

Continue reading Birth control options limited for survivors of breast cancer

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