Breast Cancer Fears And Facts

SELF WENT TO A TOP DOCTOR FOR NEWS EVERY WOMAN SHOULD KNOW NOW.

If you're like us, you want to know all you can about staying healthy. SELF sat down with Larry Norton, M.D., division head of solid tumor oncology at Memorial Sloan-Kettering Cancer Center in New York City, and fired away with every question we could think of. His answers may mean all the difference to your breast health—and life.

Q: Mammography guidelines say that a woman shouldn't get her first test until she's 40. What should younger women do?

Exercise, maintain a healthy weight and limit alcohol. And know your family history—it's remarkable how many people don't. Cancer, especially for older generations, used to be a secret. Nobody talked about it, especially if it was in the breast.

I also think it's a good idea to get a mammogram between the ages of 35 and 40 to see how well your breasts can be imaged. Younger women's breasts tend to be too dense for mammography to be useful, but calcifications will show up at any age if the ratio of breast tissue to fat tissue is advantageous. There is no screen for women in their 20s, but we're working on better ways of imaging the breast and even blood tests that will tell who is at risk for cancer. Early diagnosis is important at any age, and mammograms clearly save lives by finding smaller cancers than physical examination can. But even though the American Cancer Society has softened its stance on breast self-exams, I still think they're a good idea—it's common for women to find their own cancers.

Q: Some say ductal carcinoma in situ, in which cancer cells are still in the milk ducts, is not important because, if untreated, many cases wouldn't become invasive. Are they right?

No. Is a bullet a problem before it hits your head? True, breast cancer is not a problem as long as it stays in the breast. In autopsy studies of people who have died of other things, we find that many women have some changes toward breast cancer, even though the cells have not become invasive. Some cases of DCIS won't progress, but right now we can't tell which ones will.

Q: So does this mean that some cases of DCIS are treated unnecessarily?

Any case of DCIS has to be taken seriously. It will never disappear on its own. It's better to treat all cases because unnecessary treatment is not life-threatening, while failure to treat might be. Most patients with DCIS can have it totally removed with a lumpectomy; radiation and medications can decrease the chances of a recurrence. But DCIS is a problem with enormous variability—treatment will depend on many factors, including age, personal history and preferences. I had a patient who could have had a lumpectomy but chose mastectomy because she would miss a career-making project if she underwent radiation for six weeks. So she had a mastectomy, did her project and then had an excellent reconstruction.

Q: Isn't mastectomy an extreme treatment for DCIS?

Mastectomy means different things to different women. With a good reconstruction, you almost always have a very acceptable cosmetic result. To some women, it was just skin and doesn't mean anything. But reconstruction does not restore sensation, which can have tremendous sexual implications. Something my patients have taught me is that, after bilateral mastectomy, cuddling doesn't feel the same. One patient told me she feels like there is something between her and her husband when they hug. So how can you have a standard of care when these kinds of considerations come into it? Still, most patients with DCIS now choose lumpectomy.

Q: Can soy or vitamins reduce your risk for breast cancer?

Highly refined soy products scare me. Consuming soybeans in their natural form is one thing, but we don't know how much phytoestrogen is in soymilk and soy powders, and we can't be sure that high doses don't stimulate cancer cells that have estrogen receptors. With vitamins, I want to see evidence that they are not harmful. The best way to get vitamins is by eating healthy foods, but a lot of what we eat is supplemented and it's easy to get into an overdose situation. For instance, cancer cells need vitamin C. How do we know that large doses don't feed cancer? And how do we know what vitamins in pill form may leave out? I guarantee you, God put more good things in an apple than I know about.

Q: How should a woman who has been diagnosed with breast cancer of any kind choose what to do?