Doctor HealthHealth Tips

WASHINGTON — Remember peeking through a View-Master? Scientists are using the same concept behind the classic kids’ toy to try to see mammograms in 3-D.

The goal: A better way to check for breast cancer in women with breasts too dense for today’s mammograms to give a clear picture.

Radiologists donning 3-D glasses isn’t the only potential aid. The Mayo Clinic in Rochester, Minn., is testing a new kind of breast camera that might challenge the images of those far pricer MRI exams now reserved for the most high-risk women, but at a fraction of the price.

Both technologies still are experimental. But the research is being watched closely because the need is so great: Half of women younger than 50 and a third of women over 50 are estimated to have dense breasts.

In addition to a harder time viewing any brewing tumors, women with dense breasts have a higher risk of getting breast cancer, too.

Only a mammogram can tell if your breasts are made up more of dense or easier-to-examine fatty tissue. But if a doctor warns that you have dense breasts, there’s little good advice on how to get a better cancer check today.

“It’s a major issue in the field now, more and more, how to address the imaging needs of women with significant breast density,” says American Cancer Society screening specialist Robert Smith. “We and women and everyone else is kind of left wondering what would be best under what circumstances.”

But, “we can do better than we’re doing,” predicts Dr. Mary S. Newell, assistant breast-imaging chief at Emory University in Atlanta, who is testing the 3-D approach.

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by JOANNE VERN

As women, especially American women, much of our femininity is centered on our breasts. No matter where you look, there are pictures, billboards, commercials, television shows, and movies with women with these beautiful breasts and ample cleavage. The thought of losing one or both breasts, to breast cancer, can be devastating for many of us. Sure, there’s reconstruction, but will it ever really look the same again? Even if you have reconstruction, you’ll never have sensation there again and, for many of us, that definitely affects our sexuality.

I went through two separate mastectomies, for my breast cancer, despite the fact that I wanted them both done at the same time. Two different surgeons told me that wasn’t necessary. They found out, later, that it was, as I had the same breast cancer in both breasts. Through these surgeries, I learned a few things about what to expect, and how to get up and running again, after a mastectomy for breast cancer.

The first thing to realize is that, apart from the emotional aspect of such an operation, this is a simple surgery. The breast is composed, mostly, of fatty tissue and, of course, milk ducts and lobes. The removal of this breast tissue is way easier than operating on an organ, but carries much more emotional impact for most of us. Most surgeons will get as much of the breast tissue out as they can to help alleviate the chance of a recurrence of your breast cancer. You will typically wind up with a horizontal scar about four inches long. The scar may be red for quite a while but, ultimately, should fade to where you can hardly see it anymore.

You want to be sure to take loose-fitting, button-down shirts (raiding your hubby’s closet is helpful) with you, to the hospital, as you won’t be able to raise your arms over your head for a while. You will also need a sports bra and I would highly recommend one that fastens in the front. They will put that on you after your surgery. Typically, you should be able to stay in the hospital for one night. If you’re going to have lymph nodes removed, a small pillow, to slip under that arm, will help make you more comfortable. Check with your local American Cancer Society as they may have small pillows for you. An extra pillow to hold to your chest, if you need to cough, sneeze, or laugh, can help keep your incision from hurting.

When you wake up, you will have a couple of drain tubes for each side you have done. These tubes are important as they allow the excess fluid, which your body will produce, to drain out. If you didn’t have them, the fluid would have to be aspirated with a needle. The drains, even though they’re no fun, are better than that. These drains will have to be emptied a couple of times a day and you will have to write down how much fluid you drain so the doctor will know when you’ve slowed down enough to remove them. You may not know where to put these drains under your clothing. I pinned mine up to the sports bra and that way, they didn’t pull when I moved.

When you get home, plan on having someone there to help you for the first few days. You won’t be allowed to reach into your cabinets and definitely won’t be able to clean house or pick up your children, if you have little ones. You’ll be sent home with pain meds and definitely take them if you need them. Studies show that you will heal faster if you keep yourself out of pain, so don’t be afraid to take them as prescribed.

If you have a recliner, you might consider moving it into the bedroom as you won’t be able to lie flat for a while. You’ll need to sleep in a partial sitting position. If you don’t have one, or don’t have space for it in your bedroom, lots of pillows will work, too. That’s what I used. Just be sure you have enough pillows to keep yourself comfortable propped up.

If you would like someone who’s been there before you to visit with, be sure to call your local American Cancer Society and ask for a Reach 2 Recovery volunteer. This is an American Cancer Society program where they try to match you with one of their volunteers who have as similar experience as you’re facing. This woman will come visit you and will bring you all sorts of brochures and information on conventional treatment. She will also bring you a list of exercises you can start to do to regain your mobility and range of motion.

This is VERY important. It hurts to stretch your arm up, after surgery, but if you haven’t had reconstruction, and you don’t start soon, you will lose that range of motion. I would recommend starting to gently, slowly reach your arm up … let your body be your guide … the day after your surgery. This is ONLY if you have not had reconstruction. If you have, let your plastic surgeon tell you when to start stretching. Push to where it hurts just a little, but do not push too far past that. Little by little, you’ll find yourself able to stretch a little farther every couple of days.

Most of all, allow yourself to heal emotionally, as well as physically. Some of us just can’t look at that incision right away. That’s OK. Take as much time as you need. I know I felt like some kind of freak with no breasts and, even six years later, I still do sometimes. But remind yourself that these scars are your battle scars. They do not make you less of a woman. They make you a warrior.

By Melissa Buhmeyer

hese herbal breast enhancement pills are very quickly becoming the most talked about method of breast enlargement.
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With a breast enlargement pills, you can stop taking it when you reach your desired size. Discover if breast enlargement pills can increase your bust size, or if herbal breast enhancement is the right alternative to cosmetic surgery. Search the internet for breast enlargement and you will find many sites that sell a breast enlargement pills. A quick Internet search on “breast enlargement” comes up with thousands of products, including creams, pills, lotions, exercise devices, and hypnosis tapes. Information about breast enlargement pills, exercises, creams, pumps etc.

This category generally includes pain killers, aphrodisiacs, weight loss solutions, penis enlargement pills, breast enlargement pills, cancer and AIDS cures, etc. Most breast enlargement pills are merely vitamins and herbs, which do little more than give your body nutrients. Most breast enlargement pills contain phytoestrogens which are naturally occurring non- hormonal plant estrogens which stimulate female body to produce new breast tissue growth. Product reviewed range from natural breast enlargement and enhancement pills and products to acne & rosacea remedies.

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by ANCHALEE SAECHIN

Mastitis (inflammation of breast tissue) is a common benign cause of a breast mass. It is commonly seen in women after childbirth while breastfeeding. These masses are often quite painful. Women who are not breastfeeding can also develop mastitis. In healthy women, mastitis is rare. However, women with diabetes, chronic illness, AIDS, or an impaired immune system may be more susceptible.

• Bacteria normally found in a baby’s mouth or on the nipple can enter the milk ducts through small cracks in the skin of the nipple and can multiply rapidly in the breast milk. This can lead to a superficial small area of inflammation (frequently from a streptococcal germ) or a deeper walled-off infection or abscess (frequently from a staphylococcal germ).

• Mild temperature elevations (previously termed milk fever) accompanied by some breast or nipple soreness is usually secondary to engorgement and dehydration immediately (48-72 hours) after delivery and is treated by improved breastfeeding technique. This condition may also occur in women who are not breastfeeding and have not completely suppressed lactation yet.

• About 1-3% of breastfeeding mothers develop mastitis, usually within the first few weeks after delivery. Most breast infections occur within the first or second month after delivery or at the time of weaning. Engorgement and incomplete breast emptying can contribute to the problem and make the symptoms worse.

• Chronic mastitis occurs in women who are not breastfeeding. In postmenopausal women, breast infections may be associated with chronic inflammation of the ducts below the nipple. Hormonal changes in the body cause the milk ducts to become clogged with dead skin cells and debris. These clogged ducts make the breast more open to bacterial infection. Infection tends to come back after treatment with antibiotics.

Mastitis is an infection of the tissue of the breast that occurs most frequently during the time of breastfeeding. This infection causes pain, swelling, redness, and increased temperature of the breast. It can occur when bacteria, often from the baby’s mouth, enter a milk duct through a crack in the nipple. This causes an infection and painful inflammation of the breast.

Breast infections most commonly occur 1-3 months after the delivery of a baby, but they can occur in women who have not recently delivered as well as in women after menopause. Other causes of infection include chronic mastitis and a rare form of cancer called inflammatory carcinoma.

• The breast is composed of several glands and ducts that lead to the nipple and the surrounding colored area called the areola. The milk-carrying ducts extend from the nipple into the underlying breast tissue like the spokes of a wheel. Under the areola are lactiferous ducts. These fill with milk during lactation after a woman has a baby. When a girl reaches puberty, changing hormones cause the ducts to grow and cause fat deposits in the breast tissue to increase. The glands that produce milk (mammary glands) that are connected to the surface of the breast by the lactiferous ducts may extend to the armpit area (axilla).

• A breast infection that leads to an abscess is more serious. If left untreated, an abscess, which is an infection within an enclosed space that forms a collection of pus, can develop in the breast tissue. This type of infection may require surgical drainage.

Getting tested regularly improves your chances for early detection. The screening tests described below can help find cancer early:

• Breast self exam—Can aid in detection of early tumors, particularly those that develop between annual mammograms and clinical breast exams. Monthly self-exams help you become familiar with how your breasts normally look and feel. This can help you recognize changes, such as thickening, lumps, spontaneous nipple discharge, dimpling or puckering.

  Don’t be overly worried if you think you feel a lump. Breast tissue naturally has a lumpy texture, and this lumpiness is more noticeable in some people than in others. If you feel the lumpiness throughout your breast, it is probably just the normal breast tissue and not something to be concerned about. If you discover a new lump that feels different from the rest of your breast—one that is firmer or different from what you have felt before—you should have it checked by your doctor.

• Clinical breast exam—Physical examinations done by physicians, nurse practitioners and other trained medical staff, who check the appearance and feel of the breasts and underarm for changes. The American Cancer Society recommends that women in their 20s and 30s should have a clinical breast exam as part of a routine health exam at least once every three years. Women over the age of 40 should have a yearly clinical breast exam.
• Mammogram—Uses x-rays to create an image of the breast, and may detect tumors that can’t be felt. A mammogram is generally considered to be the best screening method available. It can detect a tumor in an early stage, when it can be most effectively treated. Yearly mammograms are recommended for women 40 years and older.
• Ultrasound—Uses high-frequency sound waves to produce images on a viewing screen. Ultrasound is the best way to find out if an abnormality discovered through physical exam or mammography is solid (a benign fibroadenoma) or fluid-filled (a benign cyst). An ultrasound does not indicate whether a solid lump is cancerous.

In breast cancer, cancer cells in the breast tissue divide and grow in an uncontrolled manner. About 20% of breast cancers originate in the milk-producing glands, also called lobules. About 80% originate in the mammary ducts, the milk passages that connect the lobules and the nipple. Cancerous tumors in the breast usually grow very slowly. By the time one is large enough to be felt as a lump, it may have been growing for as long as ten years.

There are two kinds of breast cancer, invasive breast cancer and non-invasive carcinoma in situ.

Invasive breast cancer
Invasive breast cancer is the more serious of the two types. It occurs when abnormal cells from inside the lobules or ducts spread into the surrounding breast tissue. This enables the cancer to spread to the lymph nodes and, in advanced stages, to areas such as the liver, lungs, and bones.

A previous assumption was that breast cancer started as a very small tumor in the breast tissue and grew bigger. It eventually spread to nearby lymph nodes, and then to distant lymph nodes. Finally, it metastasized in other parts of the body. Now, doctors think that cancer cells can spread from the breast through the blood and lymphatic system at early stages of the disease, even though these spreading cancer cells do not always survive.

A phrase that you may hear from your doctor is the term ‘locally advanced’ breast cancer. This is usually refered to as cancer has not spread to another area in the body. However the following issues may have occurred:

• The cancer in the breast may be bigger than 5 centimetres across
• The cancer may have spread into the skin or muscle of the chest, or
• There may be cancer in the lymph nodes under the arm

Locally advanced breast cancer can be any of the above or all of these issues listed. Locally advanced could mean either stage II or stage III breast cancer.

What are the treatments for breast cancer?

Almost all women with breast cancer will have some type of surgery in the course of their treatment. The purpose of surgery is to remove as much of the cancer as possible, and there are many different ways that the surgery can be carried out. Some women will be candidates for what is called breast conservation therapy (BCT). In BCT, surgeons perform a lumpectomy which means they remove the tumor with a little bit of breast tissue around it but do not remove the entire breast. BCT always needs to be combined with radiation therapy to make it an option for treating breast cancer. At the time of the surgery, the surgeon may also dissect the lymph nodes under the arm so the pathologist can review them for signs of cancer. Some patients will have a sentinel lymph node biopsy procedure first to determine if a formal lymph node dissection is required. Sometimes, the surgeon will remove a larger part (but not the whole breast), and this is called a segmental or partial mastectomy. This needs to be combined with radiation therapy as well. In early stage cancers (like stage I and II), BCT is as effective as removal of the entire breast via mastectomy. Most patients with DCIS that have a lumpectomy are treated with radiation therapy to prevent the local recurrence of DCIS (although some of these DCIS patients may be candidates for close observation after surgery). The advantage of BCT is that the patient will not need a reconstruction or prosthesis to appear like she did before the procedure.

More advanced breast cancers are usually treated with a modified radical mastectomy. Modified radical mastectomy means removing the entire breast and dissecting the lymph nodes under the arm. Patients with DCIS that have a mastectomy do not need to have the lymph nodes removed from under the arm. Some patients are candidates for BCT but choose modified radical mastectomy for personal reasons. Your surgeon can discuss your options and the pros and cons of either procedure. Most women who have modified radical mastectomies choose to undergo a reconstruction. There are many different procedures for creating a new breast mound, and you should talk to your plastic surgeon before your surgery to discuss your options and decide on how you would like to proceed. For more information on breast reconstruction, see Breast Reconstructive Surgery Options.

Chemotherapy

Despite the fact that the tumors are removed by surgery, there is always a risk of recurrence because there may be microscopic cancer cells that have spread to distant sites in the body. In order to decrease a patient’s risk of recurrence, many breast cancer patients are offered chemotherapy. Chemotherapy is the use of anti-cancer drugs that go throughout the entire body. The higher the stage of cancer you have, the more important it is that you receive chemotherapy; however, even stage I patients may benefit from chemotherapy in certain cases. In early stage patients, the risk of recurrence may be small, and thus the benefits of the chemotherapy are even smaller. However, the option to receive chemotherapy should be offered to most patients with breast cancer and they can decide if the potential benefits of chemotherapy outweigh its side effects in their own particular case.

There are many different chemotherapy drugs, and they are usually given in combinations for 3 to 6 months after you receive your surgery. Depending on the type of chemotherapy regimen you receive, you may get medication every 3 or 4 weeks; and you may have to go to a clinic to get the chemotherapy because many of the drugs have to be given through a vein. Two of the most common regimens are AC (doxorubicin and cycolphosphamide) for 3 months or CMF (cyclophosphamide, methotrexate, and fluorouracil) for 6 months. There are advantages and disadvantages to each of the different regimens that your medical oncologist will discuss with you. Based on your own health, your personal values and wishes, and side effects you may wish to avoid, you can work with your doctors to come up with the best regimen for your lifestyle.

Sometimes patients have a recurrence of their cancer, or present in stage IV with disease outside of their breast. These patients will all need chemotherapy, and a variety of different agents may be tried until a response is achieved. Sometimes we give chemotherapy before surgery, and this is called neoadjuvant chemotherapy. This is usually reserved for very advanced cancers that need to be shrunken before they can be operated on.

Radiotherapy

Breast cancer commonly receives radiation therapy. Radiation therapy uses high energy rays (similar to x-rays) to kill cancer cells. It comes from an external source, and it requires patients to come in 5 days a week for up to 6 weeks to a radiation therapy treatment center. The treatment takes just a few minutes, and it is painless. Radiation therapy is used in all patients who receive breast conservation therapy (BCT). It is also recommended for patients after a mastectomy who had large tumors, lymph node involvement, or close/positive margins after the surgery. Radiation is important in reducing the risk of local recurrence and is often offered in more advanced cases to kill tumor cells that may be living in lymph nodes. Your radiation oncologist can answer questions about the utility, process, and side effects of radiation therapy in your particular case.

Hormonal Therapy

When the pathologist examines your tumor specimen, he or she finds out if the tumor is expressing estrogen and progesterone receptors. Patients whose tumors express estrogen receptors are candidates for therapy with an estrogen blocking drug called Tamoxifen. Tamoxifen is taken by pill form for 5 years after your surgery. This drug has been shown to drastically reduce your risk of recurrence if your tumor expresses estrogen receptors. However, there are side effects commonly associated with Tamoxifen including weight gain, hot flashes and vaginal discharge that patients may be bothered by. There are also very uncommon side effects like blood clots, strokes, or uterine cancer that may scare patients from choosing to take it. You need to remember that your chances of having a recurrence of your cancer are usually higher than your chances of having a serious problem with Tamoxifen, but the decision to undergo hormonal therapy is a personal one that you should make with your doctor. There are also newer drugs, called aromatase inhibitors that act by decreasing your body’s supply of estrogen; these drugs are reserved for patients who have already gone through menopause. Talk to your doctors about these new therapies.

Biologic Therapy

The pathologist also examines your tumor for the presence of HER-2/neu overexpression. HER-2/neu is a receptor that some breast cancers express. If your cancer expresses it, you usually have a higher chance of having your tumor recur after surgery. A compound called Herceptin (or Trastuzumab) is a substance that blocks this receptor and helps stop the breast cancer from growing. Some patients are candidates for this medicine. Talk to your medical oncologist to see if Herceptin is right for you.

Follow-up testing

Once a patient has been treated for breast cancer, they need to be closely followed for a recurrence. At first, you will have follow-up visits every 3-4 months. The longer you are free of disease, the less often you will have to go for checkups. After 5 years, you could see your doctor once a year. You should have a mammogram of the treated and untreated breasts every year. Because having had breast cancer is a risk factor for getting it again, having your mammograms done every year is extremely important. If you are taking Tamoxifen, it is important that you get a pelvic exam each year and report any abnormal vaginal bleeding to your doctor.

Clinical trials are extremely important in furthering our knowledge of this disease. It is though clinical trials that we know what we do today, and many exciting new therapies are currently being tested. Talk to your doctor about participating in clinical trials in your area.

Dartmouth researchers Wendy Wells and William Kinlaw are looking into a protein called S14. (Photo by Joseph Mehling ‘69)

William Kinlaw, an associate professor of medicine at Dartmouth Medical School, has been working on a protein called S14 since 1990. Over the past few months, however, the news about S14 has picked up. Through a series of recently published academic studies, Kinlaw and colleagues are ready to pronounce S14 a potential drug target in treating breast cancer.

“Over the past three years, we’ve learned about S14 and its role in communicating information about the nutrient and energy supply to genes mandatory for fat metabolism in breast cancer cells,” says Kinlaw, who is also affiliated with the Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center. “With this knowledge has also come the understanding that most breast cancers have found a mechanism to turn on the S14 gene”.

He explains that these tumors are ‘addicted’ to S14, because it is mandatory for the activation of a group of genes that allow the cancer cells to make fat. Kinlaw and his team have observed that breast cancer cells die if S14 is removed, and their analysis of human breast tumors indicates that S14 is critical for metastasis.

“This makes sense, as fat is a crucial fuel for breast cancers,” he says. “We believe this is particularly so during a tumor cell’s attempt to journey from the breast to other parts of the body, because the normal breast tissue supplies machinery that allows tumor cells to acquire fat from the bloodstream. Our data support the hypothesis that once the cells leave this metabolically friendly breast environment, the ability to manufacture their own fat becomes a make-or-break issue”.

These findings are supported by three recently published articles. First, a few months ago, Kinlaw and his team published a study in the February 1, 2006, issue of Experimental Cell Research that further explored S14’s relationship in driving fat metabolism in breast cancer cells. The scientists discovered that if you inactivate this protein, the cancer cells die. Because of this, Kinlaw explains, S14 may be a new anticancer target for breast cancer patients.

Second, in the July 2006 issue of Breast Cancer Research and Treatment, Kinlaw and fellow Dartmouth scientists Bernard Cole, Peter Morganelli, Gary Schwartz, and Wendy Wells published a study that connected the amount of S14 present in a given clinical breast cancer case to the prediction, with surprising accuracy, of which tumors would recur on long-term follow up. The scientists used a special new antibody made at Norris Cotton Cancer Center in their predictions. Kinlaw says that this study revealed the potential of S14 as a new marker for prognosis in breast cancer, and experiments are now underway to validate this result. Kinlaw has also tapped into the expertise at Dartmouth’s Tuck School of Business, where students formulated this idea as a model business plan for a class project for Gregg Fairbrothers, adjunct professor of business administration and the director of the Dartmouth Entrepreneurial Network.

And finally, the journal Endocrinology invited Kinlaw and his colleagues to review the topic of fat metabolism in breast cancer cells. In the review, which was available online on June 29, the scientists present a new theory of breast cancer metastasis and its relationship to fat metabolism and diet that focuses on S14.

“We’re now working to examine this idea rigorously in cancer-prone mice engineered to lack S14 in the mammary gland, and to find areas on the S14 protein that might be suitable for attack with a drug,” says Kinlaw.