Breast Cancer Myths
Ask the Doctor: Breast Cancer Myths
Dr. Jon Strasser
From the October 2011 Newsletter
Myth: Breast cancer doesn’t run in my family so I don’t have to get a mammogram every year.
While some forms of breast cancer are due to genetic mutations, the vast majority of breast cancers are not related to mutations. The average woman has a 1 in 8 lifetime chance of getting breast cancer. Mammograms are the most effective screening test to detect breast cancer. Annual mammograms over the age of 40 can help catch many breast cancers in their early, most treatable form, leading to a better chance of beating the disease, and reduced mortality. Women who skip annual mammograms tend to have cancers detected at later stages of disease.
Myth: Your father’s family history of breast cancer doesn’t affect your risk as much as your mother’s.
The two main mutations that cause breast cancer – BRCA1 and BRCA2–can be inherited from either your mother or your father. If either parent harbors either of these mutations and passes it on to their children, they will be at a high risk of developing a breast cancer. Hence it is important when looking at family history to not only look at the mother’s family history, but also the father’s family history to see if there is any indication that there is a higher prevalence of breast cancer, suggesting a mutation. In addition, you need to look primarily at the women on your father’s side; while men do get breast cancer, women are more vulnerable to it.
Myth: Annual mammograms expose you to so much radiation that they increase your risk of cancer.
Mammography is a special type of x-ray imaging that uses low dose x-rays, high contrast, high-resolution film, and an x-ray system designed specifically for getting detailed images of the breast. Mammograms have been performed since the 1920s and modern mammography in use since the 1970s uses extremely low doses of radiation to get a good image of the breast. Since the early 2000s, with the advent of digital mammograms, the dose has been even further reduced.
To put this in comparison, the dose received by one CT scan of the chest, abdomen, and pelvis is equivalent to about fifty mammograms. In addition, the dose from one mammogram is equivalent to 7 weeks of normal background radiation that we receive daily from natural sources.
The benefits of mammogram far exceed the extremely low risk of mammograms.
Myth: Knowing you have changes in the BRCA1 or BRCA2 gene can help you prevent breast cancer.
While only 5-10% of all breast cancers are associated with known genetic mutations, both BRCA1 and BRCA2 gene mutations are associated with a greater than 80% lifetime risk of breast cancer, and possibly other malignancies, such as ovarian cancer. Approximately 30% of women also inherit other familial causes of breast cancer potentially putting them at a higher lifetime risk of breast cancer as well. Women who have the mutation are recommended to have more aggressive screening from an earlier age, and are also candidates for chemoprevention strategies or bilateral prophylactic mastectomies, and sometimes oophorectomy (ovary removal). These can help to minimize the risk of developing breast cancer in known carriers of the gene mutation. Read more about genetic risks here: http://debreastcancer.org/information/risk_genetic.
Myth: I was called back for “extra views” after my mammogram. That must mean I have cancer.
Mammograms can often detect architectural changes in the breast that may or may not be real (for example a fold of the breast tissue). Extra views, such as compression views or magnification views, may be needed to help determine if these areas are real or not. The majority of call backs actually prove that there is not a concerning finding on the imaging.
Myth: Mammograms are painful.
In order to get the best image quality from a mammogram, the breast needs to be compressed, to flatten out folds of tissue to prevent a false reading. The majority of mammograms are not painful, however, there can be some occasional discomfort that only lasts a short time during the examination. A small amount of discomfort is worth the benefit of a mammogram. Read more about mammograms here: http://debreastcancer.org/information/mammograms.
Myth: Radiation therapy is dangerous and will affect other parts of my body.
Radiation is indeed a scary word to people and has many connotations of danger – most people always equate radiation to a nuclear power plant.
However, modern radiation therapy is a widely used modality in all cancers, is an effective tool in fighting cancer, and extremely safe. In this day and age, radiation therapy is planned 3-Dimensionally to carefully identify the area of the cancer and also the normal adjacent tissues that need to be spared. Radiation can then be delivered with very precise shaping to confine the radiation to the area that needs to be treated, with minimal dose to the adjacent tissues. It is a safe modality and the long term risks are very low.
Myth: Participating in a clinical trial is good for others but not for me.
Clinical trials are an important tool to allow us to learn how we can improve our treatments to be less toxic and to improve on outcomes with newer medicines or treatment. The goal of a clinical trial is to test whether a new treatment is better than the current standard of care. As a worst case scenario, a patient would receive a standard treatment, and maybe even a newer treatment that could be more beneficial than the standard treatment. While an individual may not directly benefit from a clinical trial, they will likely help the countless number of women who will get cancer in the future. As a patient, this is your way to help future women who will be diagnosed with breast cancer.
Myth: If I don’t feel a lump, I don’t need to go for my mammogram.
While some cancers can be present with a breast lump, the majority of breast cancers are detected before a lump is felt due to the use of mammograms. Annual mammograms allow doctors to detect changes in the breast architecture that may be associated with breast cancer, thereby allowing the cancer to be diagnosed early, where it can be successfully treated. In addition, lumps are often not associated with breast cancer - roughly 80% of breast lumps are caused by benign changes (cysts, fibroadenomas). If you feel a lump you should see your PCP or gynecologist to determine if further evaluation is warranted.
Myth: Birth control pills cause breast cancer.
The effect of oral contraceptives pills (OCPs) on breast cancer is an area of controversy, but probably not associated with a significant risk of breast cancer. While one large analysis in 1996 from the Collaborative Group on Hormonal Factors in Breast Cancer demonstrated a slight elevation of developing breast cancer after the use of OCPs, the Women’s Contraceptive and Reproductive Experiences study published in 2002 in the New England Journal of Medicine did not show any increase in risk in breast cancer in those women who have used oral contraceptives.
Young women with BRCA1 or BRCA 2 mutations, or who have a strong family history of breast cancer who have used oral contraceptives may have an increased risk of breast cancer. This may or may not actually be caused by the oral contraceptive given these patients high lifetime risk of breast cancer.
I would recommend talking to your gynecologist to further discuss your particular situation.
Myth: Drinking from a plastic water bottle causes cancer.
There is no evidence that plastic bottled water causes breast cancer. This is purely a theoretical concern, as BPA (the plastic material in bottles) is a synthetic estrogen and breast cancer can be stimulated by estrogen. However, there has never been any study that has conclusively shown a risk.
Myth: There is nothing you can do to reduce the risk of getting breast cancer. If it is going to happen, it will happen.
A woman’s chance of being diagnosed with breast cancer is about 1 in 8 by the time she reaches 85. While there are some known causes of breast cancer (such as known genetics mutations, prior chest radiation for Hodgkin’s disease), the majority of breast cancers are sporadic without a known cause.
There is a lot that average risk women can do to lower their risk of breast cancer, including losing weight if they are obese, getting regular exercise, lowering alcohol consumption and having regular clinical breast examinations and annual mammograms. Smoking cessation is also a good strategy (and also reduces your chance of lung cancer).
There is active research on prevention strategies, and for some women at extremely high risk, there is data on anti-estrogen drugs such as raloxifene or tamoxifen that show a preventive benefit. For very high risk women, the option of prophylactic mastectomy can reduce their risk by 90%.
If you feel you may be at high risk, I would recommend talking with an expert who can evaluate your situation and discuss your options.
Read more about risk factors here.