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I have three important news stories about breast disease. The first relates to hormone therapy. The second reflects on mammograms, and the third describes breast reduction surgery. Contact me if you have any questions about how these articles might effect your own personal situation.
First, the latest news on HRT (hormone replacement therapy).
First, the latest news on HRT (hormone replacement therapy).
Good (Breast Cancer) News for HRT Users
Most Tumors Are Small, Slow-Growing, Treatable
By Jeanie Davis
WebMD Medical News Reviewed By Michael Smith, MD
Sept. 12, 2002 -- Women who take hormone replacement therapy and later develop breast cancer are more likely to have tumors that are smaller, slow-growing, and treatable, a new study shows. In fact, HRT users may not even be more likely to get breast cancer at all.
WebMD Medical News Reviewed By Michael Smith, MD
Sept. 12, 2002 -- Women who take hormone replacement therapy and later develop breast cancer are more likely to have tumors that are smaller, slow-growing, and treatable, a new study shows. In fact, HRT users may not even be more likely to get breast cancer at all.
This summer, a huge clinical trial -- the Women's Health Initiative -- showed that the oral high-dose combination of estrogen and progestin in Prempro increases a woman's risk of breast cancer, heart disease, and stroke. "When that study came out, it really scared a lot of people," says Rodney F. Pommier, MD, associate professor of surgery at Oregon Health & Science University in Portland. He is the lead investigator of a study appearing in the September issue of Archives of Surgery. "We think that a big part of the story wasn't really looked at," Pommier tells WebMD. "We've known for years that taking HRT [hormone replacement therapy] for a few years increased risk of breast cancer slightly. But without HRT, women are deprived of an important survival advantage -- they could get worse tumors. That advantage could be so big that it would outweigh all the disadvantages."
Pommier's study is "one more bit of reassuring information that there's not an enormous downside to HRT regarding breast cancer," says William Wood, MD, chairman of surgery at Emory University School of Medicine in Atlanta. Wood reviewed Pommier's study for WebMD.
In their study, Pommier and colleagues analyzed medical records for 290 women with breast cancer -- half had used HRT at some point in the past and the other half had not. On average, HRT users had been on hormones for 16 years. Contrary to the Prempro study, Pommier found virtually no difference in the frequency of breast cancer between the women who did and did not take HRT.
"In the [Prempro] study, 300 women had breast cancer in a scant five years -- which shows it's a very common disease," he says. "Most of them clearly got it whether they got the hormones or not. Only a few may have gotten it because they took estrogen, but I don't think in five years you can show that." However, the other differences were "very stark," Pommier tells WebMD.
HRT users were more likely to have small, early stage cancers that were not aggressive and had not spread. Plus, HRT users were more likely to have precancerous lesions rather than full-blown cancer.
"Our study is saying that when you take [HRT], you're getting much better cancers, and that needs to be weighed in," he says.
Woods says there are many benefits to estrogen replacement therapy, including the following:
Reducing hot flashes.
Reducing short-term memory loss.
Reducing risk of depression.
Protecting against Alzheimer's disease.
Keeping the vagina young and increasing lubrication.
Protecting the urethra so you don't get vaginitis.
Reducing risk of colon cancer.
Preventing osteoporosis hip and shoulder fractures.
Reducing short-term memory loss.
Reducing risk of depression.
Protecting against Alzheimer's disease.
Keeping the vagina young and increasing lubrication.
Protecting the urethra so you don't get vaginitis.
Reducing risk of colon cancer.
Preventing osteoporosis hip and shoulder fractures.
© 2002 WebMD Inc. All rights reserved.
Now regarding mammograms:
Study Shows Mammograms Lower Breast Cancer Deaths
Screening Saves Lives
Article date: 2002/07/31
Mammography works. That’s the conclusion of a study and an editorial reported in the August 1 issue of the journal Cancer (Vol. 95, No. 3: 458-69, 451-57). The study was conducted by Stephen W. Duffy, MSc, from Cancer Research UK in London, United Kingdom, and 22 other experts from around the world. They looked at deaths from breast cancer in seven counties in Sweden, both before and after community mammography programs began.
Screening Saves Lives
Article date: 2002/07/31
Mammography works. That’s the conclusion of a study and an editorial reported in the August 1 issue of the journal Cancer (Vol. 95, No. 3: 458-69, 451-57). The study was conducted by Stephen W. Duffy, MSc, from Cancer Research UK in London, United Kingdom, and 22 other experts from around the world. They looked at deaths from breast cancer in seven counties in Sweden, both before and after community mammography programs began.
Recently, there have been conflicting reports about the value of mammography, and whether it decreases deaths from breast cancer.
By carefully examining information from the seven Swedish counties before and after community screening programs were started, the study found a large decrease in the number of women dying from breast cancer after screening had been in place for several years.
For the seven counties together, breast cancer deaths decreased 45% in women who actually had a screening mammogram. In one county, where screening had been in place for over 10 years (Dalarna county), deaths from breast cancer decreased 60% compared to death rates before screening.
The authors pointed out that not all of the decrease in breast cancer deaths is due to screening alone. Before mammography was available in these counties, the death rates from breast cancer had been falling by about 1% per year, according to the authors. "This can be considered to be the combined effect of increased public awareness resulting in more rapid reporting of breast symptoms, changes in the availability of diagnostic and treatment facilities, improvements in therapy, and patient management," they said.
But, they said, at the same time, the incidence of breast cancer was increasing in these counties. That means that the majority of the benefit in decreasing breast cancer deaths is related to mammography, the authors reported.
Robert Smith, PhD, one of the study authors and director of screening for the American Cancer Society, emphasized the importance of this study. "This study represents an important new direction for breast cancer screening," said Smith. "There is not likely going to be another trial for mammography. This study measures how screening is performing in the community. We can measure the benefit in women who actually got tested. "These data show that well-organized screening programs can achieve high quality and contribute to a reduction in breast cancer deaths," said Smith.
And last, if you've ever considered breast reduction therapy:
Getting It Off Your Chest
Thu Aug 29, 7:06 PM ET
By Jennifer Thomas
HealthScoutNews Reporter
Thu Aug 29, 7:06 PM ET
By Jennifer Thomas
HealthScoutNews Reporter
THURSDAY, Aug. 29 (HealthScoutNews) -- Most people may think breast size is a matter of personal preference, but for many large-breasted women it can be a medical issue.
April Borry-Black, 47, lived with years of chronic back pain and deep grooves in her shoulders from her bra straps. As she got older, she got tired of having to wear two heavy-duty bras when she went running and dealing with people staring at her breasts rather than her face.
Borry-Black is one of the growing number of women who are opting for breast reduction surgery. Last year, 114,926 women in the United States had surgery to have their breasts made smaller, according to the American Society for Aesthetic Plastic Surgery. Breast reduction surgery is up 28 percent from 2000 and 140 percent from 1997.
Meanwhile, plastic surgeons are trying to get the word out that breast reduction surgery is often done for medical, rather than cosmetic, reasons. "It is a medical procedure," says Dr. Alexander Moya, a plastic surgeon at Geisinger Medical Center in Danville, Pa. "These patients present with low back pain, shoulder pain and even numbness and tingling in their fingers because of nerves that are being compressed by their bra."
Because it's widely considered a cosmetic procedure, insurance companies often won't pay for breast reduction surgery, Moya says. Even among insurance companies that will cover it, there are often strict guidelines for how much breast tissue must be removed for it to be considered a medical procedure.
Doctors usually remove from 2 pounds to 4 pounds of tissue. "That's a huge amount of weight to have off your chest," Moya says.
Of all the procedures he does, women who get breast reduction are among the most pleased with the outcome. "It's amazing," Moya says. "Once you go ahead and perform the surgery, they are so happy. They can wear normal clothing. They can do activities they couldn't do before and not be bothered by any pain."
If you're considering breast reduction surgery, check out the American Society for Aesthetic Plastic Surgery or the American Society of Plastic Surgeons for more information about what to expect or how to find a surgeon.
I hope you've learned something here about breast disease. Until next time. Dr. Rehert
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