Better Breast Health
As the daughter of a breast cancer survivor, I ought to know better. But for the life of me, I never remember to do a monthly breast self-exam, forcing me to confess at yet another annual checkup that, no, I haven’t been monitoring myself regularly, and yes, I know I should. And then, of course, I forget about it all over again. Luckily, it turns out that as blunders go, mine is not the worst. Doing a monthly self-exam is advisable, but because I get regular yearly checkups, I’m covered, according to the American Cancer Society. Several common missteps, however, can be more costly to your health. Whether you’re trying to catch something suspicious as early as possible or remain in remission, these medical mistakes are ones you can’t afford to make.
Mistake: Not Acting Your Age
You may look and feel younger than you are, but there’s no denying the ultimate truth: Age is the most significant risk factor for developing breast cancer. The chance of being diagnosed when you’re under 40 is truly a long shot: one in 209. But as you move into your 40s and 50s, that number spikes to one in 24 (that’s about four percent) who will be diagnosed with breast cancer before they reach 60. Those aren’t odds you want to play. Take your chronological age seriously and, when you hit 40, be religious about getting annual mammograms and clinical exams. The American Cancer Society and the American College of Radiology, among others, recommend that women begin regular mammogram screening at 40. And while the American College of Physicians advises doctors to avoid false positives and overinvasive testing by weighing each patient’s individual risk, our experts call this bad advice. Says Daniel B. Kopans, MD, professor of radiology at Harvard Medical School, "The analysts who have suggested that screening has no benefit until age 50 are wrong. The evidence clearly shows the death rate goes down when screening begins at the age of 40."
Mistake: Putting Off Your Annual Mammogram
The percentage of women getting a mammogram slipped from 70 percent to 66 percent from 2000 to 2005, according to research from the National Cancer Institute. "No one likes having a mammogram," Kopans concedes. "But, since 1990, the death rate from breast cancer has decreased by 25 percent, and mammography screening is mostly the reason." Schedule mammograms exactly a year apart. Even a few months’ lag can give an aggressive cancer the time to thrive. If your doctor doesn’t send out reminders, jot the appointment down or schedule it on your mother’s birthday or another date that you’ll remember.
Mistake: Not Demanding an MRI
A breast MRI can detect cancers much earlier than a mammogram, especially in dense breasts, because an injected dye is used to track abnormal blood flow to and from tumors. Together with a mammogram, it’s a powerful screening tool. The American Cancer Society recommends that MRIs be used in women with a strong family history or diagnosed genetic mutation. Some studies also support the use of MRI to check the other breast in someone just diagnosed with cancer. "Women need to query their physician, ‘There are new standards of care, so why would I not have this done?’" says Christy A. Russell, MD, an oncologist at the breast center at the University of Southern California Norris Cancer Hospital. Make sure your doctor refers you to a center that is equipped to follow up any abnormal results with an MRI-guided biopsy — only half currently are.
Mistake: Losing Track of Your Records
If you move or change doctors, make sure you hang on to a copy of your previous mammograms so you can give them to your new doctor. Comparing a new mammogram with an old one can reduce the number of false positives by as much as 44 percent. That’s because if a spot on your mammogram looks borderline, a radiologist can refer to those old records. "If there’s a finding on a mammogram and it has ‘probably benign’ characteristics and has been stable for two or more years, it’s benign," Kopans explains. If your films are being mailed from your previous office, allow at least a few weeks for the records to reach the radiologist before you show up for your appointment — many offices won’t even look at this year’s mammogram until you give them last year’s to compare it with.
Mistake: Not Considering a Second Opinion
You’ve been diagnosed and feel a sense of urgency. But before you race off for surgery, consider this: According to a recent study, when women diagnosed with cancer got a second opinion from a team of cancer experts, more than half the time their treatment plan changed significantly. A second set of eyes on the film or slide sample often results in a reevaluation of initial findings, sometimes diagnosing a more invasive cancer or even a second lump — and sometimes determining that the patient does not have cancer after all. "The mistake is rushing into surgery or letting a doctor talk you out of a second opinion," says study author Michael S. Sabel, MD, a surgical oncologist at the University of Michigan Comprehensive Cancer Center, in Ann Arbor. "Patients have time — a couple of weeks — to seek out a second opinion." The one situation that definitely warrants a second look: when the doctors who initially read your mammogram and pathology reports aren’t dedicated breast specialists. This could be the case if your primary care doctor refers you to a local hospital where the radiologists read all types of film.
Mistake: Not Picking the Right Surgeon or Hospital
Women who chose a breast surgeon based on their doctor’s recommendation were less likely to go to a top cancer center, while women who did research were twice as likely to end up with an experienced specialist and to be treated at a dedicated center (typically, an American College of Surgeons-approved cancer program or a National Cancer Institute-designated cancer center). "Our study showed that referral by a primary care physician was the least common way to get to a specialized center," says Monica Morrow, MD, a surgical oncologist at Fox Chase Cancer Center, in Philadelphia. "As a patient, you need to say that you want to consult a doctor who is a specialist." Studies of cancer surgery have repeatedly found better results for those who are treated by experienced surgeons at dedicated centers. "Doctors who devote their entire career to breast cancer are more likely to know which treatment is cutting edge," Morrow says.
To find a center near you that meets the criteria, go to the state-by-state listing at:
Mistake: Not Investigating Clinical Trials
Before your treatment plan is set, ask your doctor if you qualify for any clinical trials. Although patient care costs may not be covered by insurance, the trade-off is getting therapy that may offer a better survival rate or have fewer side effects while you are receiving high-quality medical care. Being put in the placebo group does not mean you’ll get a sugar pill — you’ll simply get the current gold standard in cancer treatment. "If your own doctor isn’t running such a study or seems reluctant to recommend one, don’t take no for an answer," says Charles M. Balch, MD, an oncologist at the Johns Hopkins Medical Center, in Baltimore.
To find out what trials might be available in your area, go to the following Web sites:
Mistake: Not Enlisting an Advocate
If you are called back for some not-so-good news, it’s a smart idea to bring along another set of ears: "Once I say, ‘All your hair is going to fall out,’ they don’t take in another word," oncologist Russell says. That’s why it’s crucial that you have a more clearheaded advocate, someone who can act as your note taker, strategist, even diplomat, when necessary. Recruit your spouse, a sibling, a close friend, but think twice about bringing an adult child along. Chances are good that you’ll try to protect them from bad news and won’t really hear what the doctor is telling you.
Mistake: Skipping Support
Will being in a support group save your life? Probably not. But avoiding one may cost you in other ways. Researchers have found benefits to joining up, from reducing your pain to improving your sex life. Women who have and maintain a rich support network — a group, a spouse, friends, a religious affiliation — may also have an easier time returning to their daily lives compared with isolated women, who also report less energy and more anxiety and depression, according to a study published in the Journal of Psychosomatic Research. "Support groups are invaluable," says Linette Atwood, a survivor and creator of The Patient Resource Cancer Guide. "To reach out to others who have gone before you gives you renewed strength to fight back."
Mistake: Not Keeping Tabs on Your Weight
There’s no clear consensus on what you should eat to better your odds. Some studies have shown that a low-fat diet can slightly reduce the risk of recurrence and that a high-fat diet slightly increases the risk of relapse. "However, studies haven’t been consistent, making it very frustrating for survivors," says Sandra Norman, PhD, a research associate professor of epidemiology at the University of Pennsylvania School of Medicine. But the greatest danger, Norman says, may simply be gaining weight. Higher weight before diagnosis and weight gain after diagnosis are associated with both higher recurrence and mortality rates.
Mistake: Avoiding Exercise
After treatment, it’s more important than ever that you stay active. "When we say to exercise, it doesn’t mean running a marathon," explains Wendy Chen, MD, an oncologist at the Dana- Farber Cancer Institute, in Boston. Women who exercise (the equivalent of walking one to three hours a week at a moderate pace) have a 50 percent lower risk of dying from breast cancer compared with those who don’t.
Physical activity may also ward off breast cancer by reducing estrogen levels or by simply helping to avoid weight gain, another known risk factor. And it’s also good for your mental health: Women who weight-trained twice a week following treatment reported feeling more confident and stronger. New research has shown that strength training does not trigger or aggravate lymphedema — a painful condition that causes swelling in the arm and torso in up to 50 percent of survivors. "Women should have appropriate professional supervision to begin weight training after breast cancer," says study leader Kathryn Schmitz, PhD, MPH, an exercise physiologist at the University of Pennsylvania Abramson Cancer Center in Philadelphia. "If you can’t afford a personal trainer, I’d go with a physical therapist [which may be covered by your insurance.]"
Mistake: Quitting Your Medications Too Soon
Tired of the pill popping, the co-pays, the side effects, or the daily reminder of their cancer battle, many women discontinue their medications prematurely. One study shows that just over a third of survivors stop taking tamoxifen well before the recommended five years. Don’t. Research indicates that tamoxifen and aromatase inhibitors can cut the risk of cancer relapse by as much as 50 percent. "Talk to your doctor about why you don’t want to continue taking it," urges Ann Partridge, MD, an oncologist at the Dana-Farber Cancer Institute. Often, your physician can prescribe something to manage the side effects or find a way to defray costs.
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