When it comes to the consumption of alcohol, the message has been decidedly mixed. Some studies show that moderate consumption might offer some health benefits, especially for the heart; other studies show an increased risk for certain cancers, especially breast cancer, with even the consumption of a very small amount of alcohol. What’s a woman to do?
Archives for posts tagged ‘breast cancer’
Monday, 6 February 2012
Thursday, 12 January 2012
The Los Angeles Times ”Booster Shots” blog reports that “increased carbohydrate intake was associated with a higher rate of breast cancer recurrence in survivors of the disease,” according to a study presented at the 2011 San Antonio Breast Cancer Conference.
Thursday, 29 December 2011
The Los Angeles Times “Booster Shots” blog reports that “a Canadian task force recommends” that women in their 40s should not undergo “routine mammograms.”
Tuesday, 6 December 2011
In a blog earlier today, “Even low levels of alcohol increase breast cancer risk,” I told you, “Less than a drink a day even a glass of wine with dinner, could change the risk of breast cancer.” So, what am I telling my patients?
Tuesday, 6 December 2011
A study linking alcohol consumption to breast cancer risk garnered a significant amount of coverage, with all three national news broadcasts covering the story recently. The story received more coverage than any other on the national broadcasts, with regard to time. The story was also covered extensively by wires and print media.
Sunday, 13 November 2011
A number of media sources discussed a new study suggesting that annual mammogram screening may lead to a high false positive rate.
Monday, 31 October 2011
USA Today ran a number of articles discussing breast cancer, focusing in particular on the role of inflammation. The great news here is that doing something that is highly healthy (increasing exercise) seems to reduce breast cancer risk.
Wednesday, 3 August 2011
There’s been a lot of conflicting advice about when women should start getting regular mammograms. Now the American College of Obstetricians and Gynecologists has issued its new guidelines: Annual mammograms starting at age 40, and self-exams for women at high risk for breast cancer. This organization joins a long list of other professional groups who disagree with a government panel’s suggestion to wait until age 50.
Wednesday, 3 August 2011
Mammography screening reduces breast cancer deaths even more than most experts have long believed, according to a new, large-scale Swedish trial. In the study, with a follow-up of nearly three decades, the longest ever, the researchers found that the benefits of the screenings become clearer as the decades roll on.
Wednesday, 6 July 2011
HealthDay reported, “Treatment with hormone replacement therapy (HRT), if tailored to an individual woman’s needs, appears to be safe during menopause, according to a report released at the World Congress on Menopause.”
Tuesday, 28 June 2011
The FDA is warning “women NOT to substitute a type of imaging known as breast thermography for traditional mammography.”
Monday, 30 May 2011
After a long holiday weekend, some of you may need to have an extra cup of coffee to get this short week started. Well, good news, if you do. Women who “drink a substantial amount of coffee each day may lower their risk for developing a particular type of breast cancer,” according to a study in Breast Cancer Research.
Wednesday, 6 April 2011
Readers of this blog over the last year, have seen many of my posts on the plethora of studies and recommendations about vitamin D. Now there’s some new data I think you’ll be interested in.
Saturday, 19 March 2011
In a recent blog, “Scalp cooling may help patients undergoing chemotherapy save their hair,” I told you about women undergoing chemotherapy for breast cancer who are trying to save their hair by wearing “a gel-filled helmet.” Several of you wanted more details on where to find one.
Wednesday, 2 February 2011
It’s not rare for my female patients who are in menopause to ask whether postmenopausal estrogen plus progestin therapy increases breast cancer risk. We used to think that women could take estrogen plus progestin (Prempro, etc) for 5 years without increasing breast cancer risk. Then this was shortened to just 2 to 3 years … and now some experts say there is NO safe period.
New evidence also suggests that estrogen plus progestin increases the risk of ADVANCED breast cancer … and almost doubles MORTALITY.
But, and this is CRITICAL, this explains only the RELATIVE risk. The increase in ABSOLUTE risk is very small … about 1 or 2 more breast cancer deaths for every 10,000 women taking Prempro for one year.
In other words, the risk of breast cancer mortality does DOUBLE, but only from less than 1 per 10,000 to 1-2 per 10,000. So, the RELATIVE RISK almost doubles, but the ABSOLUTE RISK is very, very, very low.
The experts at the Prescribers Letter tell healthcare professionals, “Tell women on estrogen ALONE that this DOESN’T apply to them. Taking Premarin for about 7 years doesn’t increase breast cancer risk … but this is only appropriate for women without a uterus.”
Save hormone therapy for moderate to severe menopausal symptoms. Continue to use the lowest effective dose for the shortest duration.
For just vaginal symptoms, try vaginal lubricants, moisturizers, or vaginal estrogen therapy (Vagifem, Estring, etc).
Wednesday, 12 January 2011
The current “Mammography Saves Lives” campaign in the United States and previous campaigns promoting screening for breast cancer are not providing balanced information, because they underreport, or don’t mention at all, potential harms from the procedure, say critics.
One expert says the advertising for a screening mammogram should say something like this:
MAMMOGRAPY HAS BOTH BENEFITS AND HARMS … THAT’S WHY IT’S A PERSONAL DECISION. Screening mammography may help you avoid a cancer death or may lead you to be treated for cancer unnecessarily. But both are rare; most often mammography will do neither.
That’s why screening is a choice.
Women who want to do everything possible to avoid a breast cancer death should feel good about getting mammograms (every year if they wish).
Women who don’t like the procedure or the prospect of unnecessary testing and treatment should feel equally good about not getting mammograms (or getting them less often or starting them later in life).
You can see a sample of the ad in another post of mine, New Evidence-Based Mammography Ad Suggested. Here are the details behind the ad:
Some experts now estimate that a 10-year course of screening mammography for 2500 women 50 years of age would save the life of 1 woman from breast cancer.
At the same time, up to 1000 women would have had a “false alarm,” about half of those would undergo biopsy, and breast cancer will have been overdiagnosed in 5 to 15 women, who would have been treated needlessly with surgery, radiation, or chemotherapy, alone or in combination.
In other words, over a decade of annual testing of 2500 women at 50 years of age, there would be one life saved and 1000 women harmed (1000 false alarms or false positives). And, 5 to 15 women would be the most harmed by having cancer overdiagnosed.
Here are more details about this concerning story in a report from Medscape Medical News:
This campaign slogan is 1-sided, several critics told Medscape Medical News , and it oversells the benefits of mammography.
When asked for a more accurate headline, H. Gilbert Welch MD, MPH, from the Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, New Hampshire, had the following tongue-in-cheek suggestions: “Mammography could save your life, but it’s a long shot” and “Chances are it won’t, but mammography could save your life.”
Dr. Welch recently wrote an editorial in the New England Journal of Medicine discussing the benefits and harms of screening mammography, in which he reviews new data from Norway that — he says — confirm that “the decision about whether to undergo screening mammography is, in fact, a close call.”
Public information campaigns about mammography should reflect this, he told Medscape Medical News.
Another critic of the promotional campaign is John D. Keen, MD, MBA, from the Cook County John H. Stroger Jr. Hospital in Chicago, Illinois. Explaining to Medscape Medical News that he is a diagnostic radiographer and breast imager with no conflicts of interest and no axe to grind, he said he is very concerned about physicians getting a balanced picture of mammography screening for breast cancer.
In a recent communication in the Journal of the American Board of Family Medicine , Dr. Keen writes that “the premise of a near universal life-saving benefit from finding presymptomatic breast cancer through mammography is false.”
Statistically, there is only a 5% chance that a mammogram will save a woman’s life, he points out. And that chance has to be balanced against potential harms, which vary with age, Dr. Keen continues. For instance, women who are 40 to 50 years of age are “10 times more likely to experience overdiagnosis and overtreatment than to have their lives saved by mammography,” he writes.
Dr. Keen told Medscape Medical News that he is concerned that much of the ongoing debate about mammography has been dominated by screening advocates, but pointed out that many of these experts have professional and financial interests in mammography. He is concerned that they are promoting screening without presenting the whole story.
This point has also been raised by others, including the authors of a recent article published in the New England Journal of Medicine entitled “Lessons From the Mammography Wars.”
There is no regulation of marketing in healthcare, they point out — “the same group that provides a service also tells us how valuable that service is and how much of it we need, as when the Society of Breast Imaging sets the recommendations for mammography.”
New Campaign in the United States
The new Mammography Saves Lives campaign is produced by the American College of Radiology, the Society of Breast Imaging, and the American Society of Breast Disease. It is currently running on television and radio across the United States, and features testimonials from several women who report that mammography saved their lives.
“In fact, there is no way of knowing if an individual was indeed ‘saved’,” Karsten Juhl Jorgensen, MD, from the Nordic Cochrane Center in Copenhagen, Denmark, told Medscape Medical News.
The Nordic Cochrane Center group, which includes Peter Gøtzsche, PhD, has developed an evidence-based outline of the harms and benefits of mammography. They have been very vocal in criticizing information sent out to the general public in national campaigns for breast screening in many countries in Europe, and in Australia, New Zealand, and Canada.
The leaflets sent out to invite women for mammography screening in these countries have not contained adequate descriptions of the harms and benefits, they argue; their fierce criticism led to a very public controversy in the United Kingdom last year when a government-produced leaflet was withdrawn and redesigned.
“The situation in the United States is different, in that there is no national screening program to set a common standard for information at invitation,” Dr. Jorgensen said. “It is much harder to tease out what information is given in the United States, as this may vary considerably across health plans and physicians,” he told Medscape Medical News.
“There is no doubt that screening mammography has generally been oversold” in invitations to screening and in campaigns from cancer societies and other interest groups everywhere in the world where this has been studied, Dr. Jorgensen said.
The result is that women “trust screening to reduce their risk of dying from breast cancer to an extent that is in no way scientifically justified,” he continued.
We would all like to believe that a woman’s life will be saved by mammography “if a cancer that she did not know about is detected at screening,” he said. “But in fact, the likelihood that the woman in question will be diagnosed with breast cancer unnecessarily is 10 times greater.”
“There is no way of knowing if the symptom-free cancer she was diagnosed with would ever have developed into clinical disease. And if it was destined to do so, we cannot know if the screen-detection changed the prognosis in her particular case. She may very well have survived her disease without screening or died from relapsing breast cancer 10 years later,” he said.
Estimates of Harm Not Universally Accepted
However, a leading advocate of mammography, Carol Lee, MD, chair of the American College of Radiology Breast Imaging Commission, who is quoted on the MammographySavesLives.org Web site, suggested that the estimates of harms used by Dr. Keen and Dr. Jorgensen are not universally accepted, and have been questioned by others in the field.
Some of the numbers used are “very debatable,” Dr. Lee said in an interview with Medscape Medical News. The view from the Nordic Cochrane Group is well known to be at the extreme end of a very polarized debate, she added. “We all have different perspectives and different ways of looking at data,” she said.
Dr. Lee emphasized that there is absolutely no doubt that screening reduces breast cancer mortality. In the United States, there has been a nearly 30% reduction in breast cancer mortality since the introduction of widespread mammography screening in the mid-1980s. Although there have been improvements in treatment during this time, she “cannot believe that at least part of this reduction is not due to screening.”
“Screening is not perfect,” she noted. “There are harms; there are harms with every test,” Dr. Lee acknowledged. But the discussion of benefit and harm is a very complex one. It is different for each individual woman, and the place for that discussion is in the doctor’s office, Dr. Lee insisted. Every person needs to have that discussion with their healthcare provider whenever any tests is ordered, she emphasized.
“The Mammography Saves Lives campaign does tell women to talk to their doctor,” she said, “but the bottom line is that mammography does save lives and we need to get this message out, because mammography can’t save lives if women don’t utilize it.”
The message needs to be clear, she continued. “We can’t say you might do it, or you might not’,” she said. And the proposition that “if you are 40 years old you should have a discussion but if you are 50 years old you should have a mammogram doesn’t make sense to me.”
Dr. Lee was referring to last year’s recommendation from the US Preventive Services Task Force (USPSTF) that made that age distinction, sparking outrage from screening advocates.
That USPSTF recommendation has been generally interpreted as questioning the efficacy of mammograms, Dr. Lee explained, adding that she has heard women around the world saying that the US government thinks that mammograms are not worthwhile. “This is very frustrating to me,” she said, because “here we have a public health measure that works.”
One of the stated aims of the new campaign is “to clear confusion.”
The message has to be clear or it will just create more confusion, Dr. Lee emphasized. Something along the lines of “mammography saves lives but it may not be a good thing for you individually” would just add to the confusion that is already out there, she argued. The campaign emphasizes the point that screening does reduce breast cancer mortality, but whether it is right for each individual woman is for her to discuss with her healthcare provider, she said.
Better Than Previous Campaigns, But Still Unbalanced
The current campaign is better than some of the previous campaigns promoting breast cancer screening, said Dr. Welch.
Both he and Dr. Jorgensen were critical of the American Cancer Society’s campaign in the 1980s, which declared: “If you haven’t had a mammogram, you need more than your breasts examined.”
This is an example of a 1-sided campaign — it mentions nothing about the harms of screening, Dr. Jorgensen pointed out. “The truth is that mammography screening today has marginal benefits and serious harms, and that a decision not to get screened can be as sensible and responsible as the decision to get screened.”
Dr. Welch echoed this sentiment in his recent editorial, entitled “Screening Mammography — A Long Run for a Short Slide?”. It was prompted by new data from Norway that appeared in the same issue, which highlighted the fact that the mortality benefit from mammography is modest.
The benefit seen was smaller than that previously reported in clinical trials, he explained to Medscape Medical News, but in the meantime, there have been improvements in the treatment of clinical detected breast cancer, and an increasing awareness among women to report any breast abnormalities. “There is no debate about the value of diagnostic mammography in these circumstances,” Dr. Welch emphasized, but there are questions about the value of screening mammography in healthy women.
“These new data from Norway are probably the best representation we have of effectiveness in clinical practice,” Dr. Welch said. They confirm the view that “the decision about whether to undergo screening mammography is, in fact, a close call.”
There is “a delicate balance between modest benefit and modest harm,” Dr. Welch wrote in his editorial, using data from the Norwegian study to illustrate his point.
Dr. Welch estimated that a 10-year course of screening mammography for 2500 women 50 years of age would save the life of 1 woman from breast cancer. At the same time, up to 1000 women would have had a “false alarm,” about half of those would undergo biopsy, and breast cancer will have been overdiagnosed in 5 to 15 women, who would have been treated needlessly with surgery, radiation, or chemotherapy, alone or in combination.
“Although the current campaign doesn’t suggest that women who forgo mammography need their head examined, it remains 1-sided,” Dr. Welch told Medscape Medical News. It still focuses only on the benefit of mammography, which is why he suggested alternative tongue-in-cheek slogans, such as “Mammography could save your life, but it’s a long shot.”
“What we really need to do is develop a more balanced campaign that respects the fact that different women can make different choices,” he explained. “Since there is no single ‘right answer’ about screening mammography, our goal should be to encourage women to feel good about the answer that’s right for them,” he said. To that end, Dr. Welch suggested that the promotion of screening mammography should reflect this, and offered the following as an example of the way in which the message could be publicized.
Wednesday, 12 January 2011
There’s a new ad being touted for mammogram screening for breast cancer that I think is fair, balanced, and accurate:
You can read the debate about this ad in another post of mine, “‘Mammography Saves Lives’ Slogan Doesn’t Tell Full Story and May Mislead Many Women.”
Monday, 3 January 2011
For years the National Cancer Institute (NCI) has denied a link between abortion and breast cancer. But NCI may soon have to apologize to the women it has misled—because one of its own researchers is starting to acknowledge the link. Here are the details from my friend, attorney Bill Saunders:
In the last 18 months alone, five studies have demonstrated an increased risk of breast cancer following abortion. One of those studies, co-authored by Louise Briton, a NCI branch chief, found a statistically significant 40 percent increased risk of breast cancer following abortion.
The study also acknowledged that its findings were “consistent with the effects observed in previous studies on younger women. Specifically, older age, family history of breast cancer, earlier menarche age, induced abortion, and oral contraceptive use were associated with an increased risk for breast cancer.”
Have these findings caused NCI to reverse course? Not yet, anyway. On its website, NCI still blatantly states that “having an abortion… does not increase a woman’s subsequent risk of developing breast cancer”—a errant conclusion made during a 2003 workshop organized by Ms. Briton herself.
It is time for NCI to stop ignoring the facts.
This failure of NCI to protect women highlights the need for state legislatures to take action. Women must be informed that induced abortion increases their breast cancer risk. To date, 31 states require that women receive some kind of information before abortion. However, only three states—Minnesota, Mississippi, and Texas—explicitly require physicians to inform women seeking abortion of the link between abortion and breast cancer. Two other states—Alaska and West Virginia—include information about the link in the state-mandated educational materials that women must receive prior to abortion.
According to the Guttmacher Institute, there have been more than 45 million legal abortions since the U.S. Supreme Court decided Roe v. Wade in 1973. That’s 45 million women who likely unknowingly accepted a greater risk of subsequent breast cancer when they obtained their abortions—proving once again that abortion has two victims: the child and the mother.
Here are some of my other blogs on this terribly important topic in women’s health:
- Breast Cancer Surgeon Explains How Abortion Elevates Risk for Women
- Abortion Boosts Breast Cancer Risk 193%: Study
- Microbiologist: Hundreds of Studies Reported to Confirm Abortion-Breast Cancer Link
- Study: Elective Abortion More Than Triples Breast Cancer Risk
- National Cancer Institute Researcher Admits Abortion-Breast Cancer Link True
- New Study Finds 66 Percent Increased Breast Cancer Risk After Abortion
- J.M. Dolle et al., Risk Factors for Triple-Negative Breast Cancer in Women Under the Age of 45 Years, Cancer Epidemiol Biomarkers Rev. 18(4):1157, 1158 (Apr. 2009), available here.
- Id. at 1162-63.
- National Cancer Institute, Abortion, Miscarriage, and Breast Cancer Risk (reviewed 2010), available here.
- Guttmacher Institute, Facts on Induced Abortion in the United States (July 2008), available here.
Wednesday, 8 December 2010
As breast cancer awareness increases among women, one leading breast cancer surgeon and professor has written a full explanation of one of the risks women need to keep in mind when talking with friends and family about the deadly disease — abortion.
Dr. Angela Lanfranchi is a Clinical Assistant Professor of Surgery at Robert Wood Johnson Medical School in New Jersey. She is a surgeon who, as the co-director of the Sanofi-aventis Breast Care Program at the Steeplechase Cancer Center, has treated countless women facing a breast cancer diagnosis. Lanfranchi was named a 2010 Castle Connolly NY Metro Area “Top Doc” in breast surgery.
In an article she wrote for the medical journal Linacre Quarterly, Lanfranchi talks about why abortion presents women problems and increases their breast cancer risk. Here are some of the details from a report in LifeNews.com:
A growing amount of evidence from quality studies suggests that induced abortion, but not spontaneous abortion or miscarriage, increases risk of breast cancer.
Of course, induced abortion is not the only risk factor for breast cancer. Most women diagnosed with breast cancer have never had an abortion. Most women who have had an induced abortion will not get breast cancer. Like a family history of breast cancer, which is involved in about 15 percent of all breast cancer cases, induced abortion is just another risk factor.
Cigarette smoke is a carcinogen. While only 15% of cigarette smokers get lung cancer, the risk has been well acknowledged. In comparison, induced abortion as a risk factor for breast cancer is somehow not as widely publicized.
Induced abortion boosts breast cancer risk because it stops the normal physiological changes in the breast that occur during a full term pregnancy and that lower a mother’s breast cancer risk. A woman who has a full term pregnancy at 20 has a 90% lower risk of breast cancer than a woman who waits until age 30.
Breast tissue after puberty and before a term pregnancy is immature and cancer-vulnerable. Seventy five percent of this tissue is Type 1 lobules where ductal cancers start and 25 percent is Type 2 lobules where lobular cancers start. Ductal cancers account for 85% of all breast cancers while lobular cancers account for 12-15% of breast cancers.
As soon as a woman conceives, the embryo secretes human chorionic gonadotrophin or hCG, the hormone we check for in pregnancy tests.
HCG causes the mother’s ovaries to increase the levels of estrogen and progesterone in her body resulting in a doubling of the amount of breast tissue she has; in effect, she then has more Type 1 and 2 lobules where cancers start.
After mid pregnancy at 20 weeks, the fetus/placenta makes hPL, another hormone that starts maturing her breast tissue so that it can make milk. It is only after 32 weeks that she has made enough of the mature Type 4 lobules that are cancer resistant so that she lowers her risk of breast cancer.
Induced abortion before 32 weeks leaves the mother’s breast with more vulnerable tissue for cancer to start. It is also why any premature birth before 32 weeks, not just induced abortion, increases or doubles breast cancer risk.
By the end of her pregnancy, 85% of her breast tissue is cancer resistant. Each pregnancy thereafter decreases her risk a further 10%.
Spontaneous abortions in the first trimester on the other hand don’t increase breast cancer risk because there is something wrong with the embryo, so hCG levels are low. Another possibility is that something is wrong with the mother’s ovaries and the estrogen and progesterone levels are low. When those hormones are low, the mother’s breasts do not grow and change.
A woman can use this information to make an informed decision about her pregnancy. If she chooses to abort her pregnancy for whatever reason, she should start breast screening about 8-10 years later so that if she does develop a cancer, it can be found early and treated early for a better outcome.
If she doesn’t have the resources to raise a child or is not ready to be a mother, there are millions of couples waiting to adopt any child, even one with disabilities.
Women need to understand their own bodies so that they can make the best decision for themselves.
Friday, 3 December 2010
One of my most read blogs in recent months is this one: “Nurse practitioner writes about her decision to stop getting mammograms.” Now, for a fitting follow-up, there’s an even more stunning opinion piece in the Los Angeles Times by physician H. Gilbert Welch of the Dartmouth Institute for Health Policy and Clinical Practice. Dr. Welch has put into print what many women’s health professionals have been discussing behind closed doors recently.
He says that he’s concerned that the National Breast Cancer Awareness Month “has led women to be more fearful of breast cancer than they need be: the ’1 in 8′ or ’1 in 9′ statistic, in particular, serves as a poster child for how to exaggerate risk.”
He is also “equally troubled” by the “relentless promotion of screening mammography as the solution” and the fact that the “campaign’s principal founder is a manufacturer of breast cancer drugs.”
Dr. Welch goes on to list the issues women should “be aware of,” including the continuing mammography debate, improved treatment options, and that “too much disease awareness may not be good for your health.” Here are the details from the LA Times report:
1. Breast cancer is an important cancer.
If nonsmoking women want to worry about any cancer, breast cancer is the one to worry about. The reason is simple: It’s the cancer they are most likely to die from. But this risk should be kept in perspective: A woman’s chance of dying from breast cancer in the next 10 years is in the range of two per 1,000 (if you are age 40) to 10 per 1,000 (if you are age 75). And always consider the flip-side of these statistics: The chances of not dying from breast cancer in the next 10 years are 990 per 1,000 — or better.
If you are a woman who smokes, worry about lung cancer instead, and heart disease.
2. There is a serious debate about the value of screening mammography.
You know this. But what you might not know is that this debate persists despite 50 years of research involving more than 600,000 women in 10 randomized trials, each involving about 10 years of follow-up. No screening test has been more exhaustively studied.
That the debate persists in the face of this wealth of data tells you something: Screening mammography must be a close call. (Note that doctors don’t debate about the value of treating really high blood pressure; that issue was settled more than 40 years ago with a trial of less than 200 men in less than two years).
The reason screening mammography is a close call is simple: It produces both benefit and harm. The combination of heightened awareness and increased screening has undoubtedly led to more breast cancer diagnosis. And a very few women have benefitted by avoiding a breast cancer death. More, however, have been harmed by unneeded surgery, radiation and chemotherapy for small “cancers” that would not have been found without the mammogram and would never have caused problems. Many more have been caught in cycles of testing, abnormal results, biopsies and worry.
3. Screening mammography is your decision, not your physician’s.
Although it’s hard to know how widespread the problem is, a number of women have shared with me that they have been frightened (“Don’t you want to live?”) or guilted (“Don’t you care about your family?”) into being screened. And it gets worse. One told me that her doctor said she could no longer be a patient if she didn’t accept screening. (Imagine my mechanic saying he would no longer work on my car if I wasn’t willing to have him check my coolant system for leaks.)
To be fair to my primary care colleagues, such coercive practices may not reflect their own beliefs but rather that they too are being coerced. Ensuring that all women are screened has become one of the most prominent metrics in healthcare “report cards.” There are practical reasons for this: It is easy to measure, easy to understand and hard to argue against. So regardless of what informed women want, it gets done (remember, we doctors got into medical school because of our ability to get good grades).
Screening is a choice. Those who like mammography and want to do everything possible to avoid a breast cancer death should feel good about doing it every year if they wish. Those who don’t like the procedure or the prospect of being turned into a patient unnecessarily should feel equally good about not doing it or doing it less often or starting it later in life.
4. Unlike screening mammography, there’s no debate about diagnostic mammography.
Doctors agree about what to do when a women (like my wife) notices she has a new breast lump: Get a mammogram. Diagnostic mammography is the technology we use to figure out what the lump is. That’s not screening; that’s diagnosis. And no one argues about it.
5. There have been real improvements in breast cancer treatment.
Its odd how much we hear about breast cancer detection, when the real question is how well we can treat it. All the focus on screening has overshadowed a more important story: Breast cancer treatment has improved over the last 50 years. Breast cancer surgery has gotten a whole lot more sane. Radical mastectomy is largely gone, and more women are given a choice between simple mastectomy and breast-conserving surgery.
But arguably the biggest improvement involves adjuvant therapy, the chemotherapy and hormonal therapy that follows surgery. After summarizing 194 randomized trials, the international collaboration of Early Breast Cancer Trialists concluded that the addition of adjuvant therapy cuts the breast cancer death rate in half. That’s huge.
6. Too much disease awareness may not be good for your health.
Breast Cancer Awareness Month serves as a prototype for “disease awareness” campaigns. Too often these morph into campaigns to find things wrong with healthy people. Our medical care system is extremely capable in this regard. We can detect miniscule abnormalities in the body’s anatomy and its chemical milieu. And, as if that’s not enough, we increasingly change the rules to narrow the definition of “normal”: Lower blood pressures have become hypertension, lower blood sugars have become diabetes.
Many interests are served by this behavior. But that may not include yours. That’s because health means more than the absence of abnormality. Health is also about how people feel; it’s also a state of mind. And it’s hard to feel good when things are constantly being found wrong. Pursuing health, ironically, may require that we not pay too much attention to it.
Friday, 3 December 2010
The CBS Evening News recently reported, “For women going through menopause, the decision about whether to take hormone replacement therapy has been controversial and confusing.” In 2009, “40 million prescriptions for hormones were filled here in the US, but there’s new evidence tonight that this treatment may be even riskier than previously thought.”
ABC World News also covered the story, reporting, “The Women’s Health Initiative reports today that among post-menopausal women, the use of estrogen and progestin is not only linked to an increased risk of breast cancer, but the kind that kind of cancers that have higher fatality rates. The safety of more hormone replacement therapy was first questioned in 2002.”
NBC Nightly News, not to be outdone, reported, “Our lead story tonight has to do with an emotional and perplexing topic for millions of American women — hormone replacement therapy; specifically, its relationship to breast cancer.” Chief science reporter Robert Bazell explained that a new study published in the Journal of the American Medical Association “suggests that hormone replacement therapy, estrogen plus progestin, once the most commonly prescribed medication for women 50 and older, not only increases the risk of aggressive breast cancer, but increases the risk that cancers will be more advanced and deadly.”
In a follow-on piece, NBC Nightly News reported, “Some big questions come out of this. What does this all mean?” Dr. Beth Dupree, medical director of the Breast Health Program at Holy Redeemer Health System in Pennsylvania, explained to viewers that women who are using or considering taking hormone replacement therapy to manage the symptoms of menopause need to “weigh the risks and benefits” in the light of severity of symptoms and discuss them with their physicians. Dr. Dupree also added that the “study shows women are dying at a higher frequency and those hormones probably played a role in that.”
On its front page, the New York Times reports, “Hormone treatment after menopause, already known to increase the risk of breast cancer, also makes it more likely that the cancer will be advanced and deadly,” the study found.
Specifically, “women who took hormones and developed breast cancer were more likely to have cancerous lymph nodes, a sign of more advanced disease, and were more likely to die from the disease than were breast cancer patients who had never taken hormones.” Notably, “the treatment studied was the most commonly prescribed hormone replacement pill, Prempro [conjugated estrogens and medroxyprogesterone], which contains estrogens from horse urine and a synthetic relative of the hormone progesterone.”
According to the coverage by the Washington Post, “The study of more than 12,000 women who were followed for about 11 years produced powerful evidence that deaths from breast cancer were more common among hormone-users, apparently because their cancers had already started to spread.”
The Post notes that “for years, doctors recommended that women take hormones to alleviate hot flashes and other symptoms of menopause to protect their hearts and generally remain more youthful. But eight years ago, the federally funded Women’s Health Initiative revealed that hormones’ benefits were outweighed by risks, including heart disease and breast cancer.”
Bloomberg News reports that the present study’s “findings conflict with previous studies showing breast cancers in women taking hormone therapy had a lower risk of death, said Christopher Loder, a spokesman for New York-based Pfizer, in a statement yesterday.” Pfizer is the manufacturer of Prempro. Loder stated, “We stand behind the current, science-based guidance in Prempro’s label, which advises doctors to prescribe the medicine at the lowest effective dose and for the shortest duration.” He suggested that “women should talk to their doctors about how long they should be on the therapy.”
The Los Angeles Times “Booster Shots” blog noted, “As of now, doctors recommend hormone therapy only for women who have severe menopausal symptoms — such as hot flashes — and only for a year or two.”
However, “a study on whether even one or two years of hormone therapy increases the risk of breast cancer is needed, Dr. Peter B. Bach, of Memorial Sloan-Kettering Cancer Center, in New York, said in an editorial accompanying the study.” Bach wrote, “Clinicians who prescribe brief courses of hormone therapy for relief of menopausal symptoms should be aware that this approach has not been proven in rigorous clinical trials and that the downstream negative consequences for their patients are of uncertain magnitude.”
Friday, 19 November 2010
Researchers in Iran have published the results of a new study showing women who have an abortion face a 193% increased risk of breast cancer. On the other hand, women who carry a pregnancy to term find a lowered breast cancer risk compared with women who have never been pregnant. Here are the details in a report from LifeNews.com:
The study follows on the heels of new reports indicating Komen for the Cure gave $7.5 million to the Planned Parenthood abortion business in 2009. The findings were reported in the journal Medical Oncology but are coming to the public’s attention only now.
Hajian-Tilaki K.O. and Kaveh-Ahangar T. from Babol University of Medical Sciences compared 100 cases of women who were newly diagnosed with breast cancer compared with 200 age-matched controls to review several reproductive factors.
The researchers discovered abortion significantly elevated breast cancer risks. Also, having a first pregnancy at an older age increases the breast cancer risk by 310 percent – which has implications for women who have relied on birth control and delayed a first pregnancy until later in life.
The Iranian scientists also confirmed what other studies have found, namely that increasing parity or the number of births reduces the breast cancer risk significantly.
Reporting on the study, the FoodConsumer web site indicated women with parity equal to or greater than 5 reduced their breast cancer risk by 91 percent compared with women who had never been pregnant and not given birth. Each additional birth also reduced the breast cancer risk by 50 percent.
The Iranian study came just before another research study conducted by scientists in Sri Lanka, which found women who had an abortion in the past were 242 percent more likely to contract breast cancer. That study was published in the journal Cancer Epidemiology and found a 3.42 odds ratio against women having abortions compared with those who kept their baby.
Abortion was the most significant factor in the study on breast cancer risk and researchers found a significantly reduced risk associated with prolonged duration of breastfeeding a newborn. Malintha De Silva and colleagues from the University of Colombo led the study.
In the one from the United States, Louise Brinton, a NCI branch chief, served as co-author. She and her colleagues admitted that “… induced abortion and oral contraceptive use were associated with increased risk of breast cancer.” The authors cited a statistically significant 40% increased risk of breast cancer following an abortion.
“It’s becoming increasingly difficult for the NCI to keep its fingers and toes in the dike,” said Malec, “especially since many researchers in other parts of the world do not depend on the agency for grants.”
See related articles:
Wednesday, 17 November 2010
Last week I blogged on the topic “Mammography Screening for Breast Cancer: What’s a Woman to Do?” That blog was somewhat technical — although I think it presented both the benefits and the risks of mammography — and the fact that this is routine mammography is NOT by any means an easy decision to make. Now, a far more intimate and personal look at the topic is featured in a special report in the Washington Post where Veneta Masson, a nurse practitioner and writer living in Washington, explained the reasons for her decision to stop getting mammograms:
Masson cited a 2008 report by the Nordic Cochrane Center in Denmark, which noted that “if 2,000 women are screened regularly for ten years, one will benefit from the screening, as she will avoid dying from breast cancer.” At “the same time, ten healthy women will … become cancer patients and will be treated unnecessarily. …
“Furthermore, about 200 healthy women will experience a false alarm.” The “psychological strain until one knows whether or not it was cancer, and even afterward, can be severe.”
In other words, for every 2,000 women who choose mammogram screening, one life will be saved, and 210 women will be harmed. That leaves 1789 who will be relieved.
Masson, 56 years old, last had her mammogram 10 years ago. But, unlike her, virtually all of the women in my practice are still choosing to be screened.
Friday, 12 November 2010
There’s been a lot of debate about mammograms for breast cancer screening, but an even more important health promotion exercise would be for women to everything they can to prevent breast cancer. And now experts are reporting that women can do three things to dramatically reduce their risk of getting breast cancer — especially if they have a strong family history of breast cancer:
- Exercise (20 minutes of heart-rate raising exercise at least five times a week),
- Maintain a healthy weight (BMI of 18.5 to under 25), and
- Watch alcohol intake (fewer than seven drinks per week).
Here are the details in a report from HealthDay News:
Women who maintain certain “breast-healthy” habits can lower their risk of breast cancer, even if a close relative has had the disease, a new study finds.
Engaging in regular physical activity, maintaining a healthy weight and drinking alcohol in moderation, if at all, was shown in a large study to help protect against breast cancer in postmenopausal women, the researchers said.
“Whether or not you have a family history, the risk of breast cancer was lower for women engaged in these three sets of behavior compared to women who were not,” said study leader Dr. Robert Gramling, associate professor of family medicine at the University of Rochester Medical Center in New York. The study was published in the journal Breast Cancer Research.
Gramling wanted to look at the effects of lifestyle habits on breast cancer risk because he suspects some women with a family history may believe their risk is out of their control.
He analyzed data on U.S. women aged 50 to 79 from the Women’s Health Initiative study starting in 1993. During 5.4 years of follow-up, 1,997 women were diagnosed with invasive breast cancer.
Gramling excluded women with a personal history of breast cancer or with a family history of early-onset cancer (diagnosed before age 45), then observed the impact of the healthy habits.
Excluding those with an early-onset family history makes sense, because a stronger genetic (versus environmental) component is thought to play a role in early-onset, experts say.
Following all three habits reduced the risk of breast cancer for women with and without a late-onset family history. “For women who had a family history and adhered to all these behaviors, about six of every 1,000 women got breast cancer over a year’s time,” he said.
In comparison, about seven of every 1,000 women developed breast cancer each year if they had a late-onset family history and followed none of the behaviors.
Among women without a family history who followed all three habits, about 3.5 of every 1,000 were diagnosed with breast cancer annually, compared to about 4.6 per 1,000 per year for those without a family history who followed none of the habits.
For his study, Gramling considered regular physical activity to be 20 minutes of heart-rate raising exercise at least five times a week. Moderate alcohol intake was defined as fewer than seven drinks a week. A healthy body weight was defined in the standard way, having a body mass index, or BMI, of 18.5 to under 25.
Gramling hopes his research will reverse the thinking of women whose mother or sister had breast cancer who sometimes believe they are doomed to develop the disease, too.
The findings echo what other experts have known, said Dr. Susan Gapstur, vice president of the epidemiology research program at the American Cancer Society, who reviewed the study findings.
“The results of this study show that both women with a family history [late-onset] and without will benefit from maintaining a healthy weight and exercising, and consuming lower amounts of alcohol, limiting their alcohol consumption,” she said.
The American Cancer Society guidelines for reducing breast cancer risk include limiting alcohol to no more than a drink a day, maintaining a healthy weight and engaging in 45 to 60 minutes of “intentional physical activity” five or more days a week.
The risk reduction effects found in the Gramling study may actually increase if women follow the more intense exercise guidelines of the ACS, Gapstur said.
To learn more about breast cancer risk factors, visit the American Cancer Society web site here.
Friday, 12 November 2010
As I’ve discussed in a previous blog, there has been so much controversy and argument over the last few months about when women should begin mammograms and how often women should have them. The whole thing is very controversial. But, here’s an editorial from experts at American Family Physician that I think does one of the best jobs I’ve seen of clearing up the fog for both physicians and our patients. If you’re just interested in the “bottom line,” then scroll down the page to find the recommendations for your age group:
The November 2009 U.S. Preventive Services Task Force (USPSTF) recommendation for breast cancer screening,(1) while sparking much controversy, was not a radical departure from their previous 2002 recommendation.(2) The USPSTF approached the recommendation update with the basic questions of what ages to start and stop screening, what screening test to use, and how often to screen.
When should we start screening?
The 2002 recommendation endorsing mammography encompassed the age range of 40 to 70 years, but stated that “for women aged 40 to 49, the evidence that screening mammography reduces mortality from breast cancer is weaker, and the absolute benefit of mammography is smaller … [It is] difficult to determine the incremental benefit of beginning screening at age 40 rather than at age 50.”(2) The 2002 recommendation endorsed a screening interval of every one to two years.
New evidence, including information from two randomized controlled trials involving breast cancer screening in women 40 to 49 years of age,(3,4, the first paper found here and the second here)allowed the USPSTF to answer the fundamental questions with greater certainty.
The National Institutes of Health’s Cancer Intervention and Surveillance Modeling Network also provided analyses projecting the expected outcomes of different screening strategies.(5)
The incremental reduction of breast cancer mortality that accrues from starting screening at 40 years of age compared with 50 years of age is small, and the false-positive test rate and risk of unnecessary biopsies are highest in this age group. Furthermore, during these 10 years of screening, more than one half of women can expect a false-positive test result.
The proportion of lesions discovered by mammography that are ductal carcinoma in situ (for which the natural history and benefits of treatment are unknown) is largest in this age group.
Although the radiation exposure from a single mammography screening is not large, the cumulative effects of a lifetime of mammography examinations, particularly in the context of other medical imaging, cannot be assumed to be benign.
Some cancers detected and treated would never have progressed to cause harm in a woman’s lifetime (i.e., overdiagnosis).
Given these concerns, in its 2009 update, the USPSTF recommended that “the decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.”(1)
So when should we stop screening?
The USPSTF extended the upper age for which the evidence was sufficient to make a recommendation to 74 years of age. Although no randomized controlled trial data exist to support mammography after 70 years of age, the modeling data strongly support continued benefit, and the USPSTF believed it was prudent to extend the upper age for its recommendation.
At 75 years and older, the uncertainty about net benefit or harm does not support a recommendation for or against screening.
How often should we screen?
Most of the benefit of annual mammography can be achieved with a biennial interval, with a substantial reduction in the number of lifetime mammography examinations and the associated risk. The USPSTF believes that the balance of benefits and harms is best served by a biennial interval.
There is more agreement than disagreement about the value of mammography for breast cancer screening.(6) Mammography does reduce breast cancer mortality, albeit to a lesser extent than many assume, and although imperfect, it is the best screening tool we have.
Controversy about the value of mammography for women in their 40s has long existed,(7) and others have reached similar conclusions to those of the USPSTF.(8)
How can practicing family physicians incorporate this guideline into clinical practice?
Discuss at 40 years of age, encourage at 50 years of age, strongly encourage at 60 years of age, and individualize at 75 years of age.
For women under 40 years of age.
- No screening recommended.
For women 40 to 49 years of age.
- Advise women that if we follow 1,000 women beginning at 40 years of age until death from all causes, about 30 women will ultimately die from breast cancer without mammography screening.
- If we screen women every other year from 50 to 75 years of age, we can reduce the number of deaths to about 23.
- Beginning screening at 40 years of age will decrease the number of deaths further, but by no more than one.
- Describe to patients the drawbacks of beginning screening in their 40s, including unnecessary testing and treatment, discomfort, the potential hazard of the cumulative exposure to radiation, and the risk of the diagnosis and treatment of cancers that would never be detected in their lifetime without screening.
For women 50 to 59 years of age.
- Encourage women to begin mammography screening, because the benefits outweigh the risks.
- The evidence suggests most of the benefit of annual mammography screening is derived by screening every two years, with fewer false-positive screening results, less radiation, and less unnecessary invasive testing.
For women 60 to 74 years of age.
- Many women who begin screening at 40 years of age grow weary of screening by 60 years of age.
- This is unfortunate, because this is the beginning of the age range for which the benefits most clearly and significantly outweigh the risks.
- Strongly encourage women in this age group to undergo screening every two years.
For women 75 years to 84 years of age.
- We have limited evidence to guide us beyond 75 years of age.
- Healthy women with minimal or no comorbidity may continue to benefit from mammography.
For women 85 years of age or older.
- By 85 years of age, limited life expectancy makes it very unlikely that mammography will reduce morbidity or mortality.
- U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement [published correction appears in Ann Intern Med. 2010;152(3):199–200]. Ann Intern Med. 2009;151(10):716–726.
- U.S. Preventive Services Task Force. Screening for breast cancer: recommendations and rationale. Ann Intern Med. 2002;137(5 pt 1):344–346.
- Moss SM, Cuckle H, Evans A, Johns L, Waller M, Bobrow L; Trial Management Group. Effect of mammographic screening from age 40 years on breast cancer mortality at 10 years’ follow-up: a randomised controlled trial. Lancet. 2006;368(9552):2053–2060.
- Bjurstam N, Björneld L, Warwick J, et al. The Gothenburg Breast Screening Trial. Cancer. 2003;97(10):2387–2396.
- Mandelblatt JS, Cronin KA, Bailey S, et al.; Breast Cancer Working Group of the Cancer Intervention and Surveillance Modeling Network. Effects of mammography screening under different screening schedules: model estimates of potential benefits and harms. Ann Intern Med. 2009;151(10):738–747.
- Partridge AH, Winer EP. On mammography—more agreement than disagreement. N Engl J Med. 2009;361(26):2499–2501.
- Fletcher SW. Whither scientific deliberation in health policy recommendations? Alice in the wonderland of breast-cancer screening. N Engl J Med. 1997;336(16):1180–1183.
- Qaseem A, Snow V, Sherif K, Aronson M, Weiss K, Owens DK; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Screening mammography for women 40 to 49 years of age: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2007;146(7):511–515.
Friday, 5 November 2010
Good news! Aging does not have to equal weight gain. Women do tend to put on a pound a year in their 40s and 50s, but it’s more likely due to a drop in activity rather than hormones. However, hormonal changes can shift your body composition, so any pounds you do gain tend to land in your middle. Here are some tips from Rachel Meltzer Warren, MS, RD, that were first published on Health.com:
Here are some ways to stay slim, reduce menopausal symptoms, and cut the health risks that can rise after menopause.
1) Go fish
Heart disease risk is likely to rise after menopause, so you should try to eat at least two servings of fish per week (preferably those with healthy fats like salmon or trout).
“Women may want to give [fish oil] supplements a try if having two servings of fish a week is problematic,” says JoAnn Manson, MD, chief of preventive medicine at Brigham and Women’s Hospital, in Boston.
Preliminary research suggests that fish oil may also help prevent breast cancer.
Aim for two servings of fish a week—and talk to your doctor about whether or not you should try a supplement.
2) Slim down
If you’re overweight you can minimize menopausal symptoms and reduce the long-term risks of declining hormones by losing weight, says Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine, in New Haven, Conn.
Slimming down not only reduces the risks of heart disease and breast cancer, both of which go up after menopause, says Dr. Minkin, but new research shows that it may also help obese or overweight women cut down on hot flashes.
3) Bone up on calcium
Your calcium needs go up after age 50, from 1,000 milligrams per day to 1,200 mg. “With less estrogen on board, your bones don’t absorb calcium as well,” says Dr. Minkin.
If you have a cup of low-fat milk, one latte, and one 8-ounce yogurt, you’re getting around 1,100 mg calcium. This means you need to take only an additional 100 mg of supplements a day—less than one caplet’s worth—to make up the difference.
If you’re eating dairy, choose low-fat products. These have roughly the same amount of calcium as their full-fat counterparts, but with fewer calories.
4) Ease bloating
“About 100% of my patients going through menopause complain of bloating,” says Dr. Minkin. Although the reasons aren’t clear, fluctuating hormones during perimenopause may play a role.
Dr. Minkin recommends cutting the amount of salt and processed carbohydrates in your diet, as they can make you retain water. But don’t skimp on whole grains, which are rich in heart-healthy fiber, as well as fruits and vegetables.
If healthy food, such as apples and broccoli, make you feel bloated, Dr. Minkin suggests taking Mylanta or Gas-X to combat gas buildup.
5) Rethink that drink
Red wine gets a lot of press for its impact on heart health, but for menopausal women the drawbacks of alcohol might outweigh the benefits.
“One drink a day has been linked to an increased risk of breast cancer,” says Dr. Manson. “So while it has been linked to a reduced risk of heart disease, it really is a trade-off for women.”
If you enjoy a glass of Pinot, try watering it down with seltzer to make a spritzer (you’ll cut calories too). Also keep in mind that red wine and other drinks may bring on hot flashes as a result of the increase in blood-vessel dilation caused by alcohol.
6) Say yes to soy
Soy contains plant estrogens, so many women think it can increase their breast cancer risk, says Dr. Minkin. However, there is little data to support this. The misconception likely comes from studies of high-dose soy supplements, which may stimulate the growth of estrogen-sensitive tumors.
Soy foods like tofu, soy nuts, and soy milk may offer relief from mild hot flashes and are not thought to increase breast cancer risk. “Women in Japan have the highest soy intake and the lowest risk of breast cancer, but Japanese women who move to the U.S. and eat less soy have a higher risk,” adds Dr. Minkin.
7) Try iced herbal tea
A warm cup of joe might be as much a part of your a.m. routine as brushing your teeth. Still, starting your day with a piping-hot drink may not be the best idea during menopause.
“In general, warm beverages seem to trigger hot flashes,” says Dr. Manson. “And the caffeine in coffee and tea could also be having an effect.”
Cover your bases by swapping your morning cup with something cool and decaffeinated—like a Tazo Shaken Iced Passion Tea at Starbucks or a decaf iced coffee.
8) Find a diet that fits
If you need to shed pounds, weight loss is no different during menopause than before it. “If you take in less calories than you burn for a long period of time, you’re going to lose weight,” says Dr. Minkin.
Any balanced diet that cuts calories—and that you can stick with in the long run—will do the job.
However, one study found that postmenopausal women who were on a diet that was low in fat and high in carbohydrates from vegetables, fruits, and grain were less likely to gain weight than women who ate more fat. Consider the new CarbLovers Diet which is rich in whole grains and other figure-friendly foods.
Monday, 1 November 2010
A microbiologist says there are so many published studies confirming the link between induced abortion and breast cancer that he plans to publish one every day on his blog until he’s mentioned them all. It will take Dr. Gerard Nadal so many weeks to cover them all, the blogging will continue until early next year. Here are the details from a report from LifeNews.com:
Dr. Gerard Nadal, who has a has a PhD in Molecular Microbiology from St John’s University in New York, has spent 16 years teaching science, most recently at Manhattan College.
He will report on one abortion-breast cancer study daily until he has exhausted all of the abortion-breast cancer studies and he anticipates he may be reporting on these studies as late as January or February of 2011.
“Today begins the inexorable presentation of the scientific literature on the abortion/breast cancer link,” Nadal writes. “Women’s lives depend on us getting the truth out to them. In short order we’ll generate plenty of pros armed with the simple truth of science!”
His first article reviewed a 1997 epidemiological study by Julie Palmer, Lynn Rosenberg and their colleagues, “Induced and spontaneous abortion in relation to breast cancer,” published in the journal, Cancer Causes and Control.
Palmer and Rosenberg are not unbiased researchers, which makes their findings even more relevant for women. Instead, they are abortion advocates who have testified as expert witnesses on behalf of abortion businesses in lawsuits challenging the states of Alaska and Florida because of their parental notice or consent laws.
Their study, supported by U.S. National Cancer Institute grants, examined 1,835 women ages 25-64 years with pathologically confirmed, invasive breast cancer and 4,289 women aged 25-64 admitted for nonmalignant or malignant conditions.
Nadal says the study found women who had never had children and who had one case of an induced abortion raised their abortion breast cancer risk by 40 percent.
“So in plain English, women who had one induced abortion, regardless of ever having had a child, had a 40% increased risk of developing breast cancer over women the same age, with the same parity status who never had abortions, and the authors are 95% certain that there is no other explanation,” he said.
Nadal says the study further showed that for women who had a child previously, “there is a 30% increased risk of cancer” and it “may well be explained by additional stimulation of the lobules by estrogen in the aborted pregnancy, without the benefit of lactogen at the end.”
Nadal says observers of the debate about the abortion and breast cancer link should pay attention to another part of the study where the authors attempt to undermine their own results in an effort to downplay the abortion-breast cancer link.
The authors claim their own study suffers from a form of recall bias – despite their assertion that they were 95% certain that the results could not be due to chance. The authors believe women with breast cancer are less likely to hide their abortion from the health questioners compiling the data than women without breast cancer.
“They offer no proof of this phenomenon other than the same assertions made by other breast cancer researchers with similar data. In other words, the phenomenon is a baseless assertion reverberating in the pro-abortion echo chamber,” Nadal writes.
“Are we really to believe that breast cancer brings women closer to telling the truth of their previous abortions? Why the acuity of memory in a breast cancer patient vs. the control patients? The abortion question was just one in a long, detailed history taken during the study,” Nadal continues. “There is no rational basis for believing that women with breast cancer are more apt to recall and report an abortion than any other women.”
Despite that, the authors conclude in their study: “The small elevations in risk observed in the present study and in previous studies are compatible with what would be expected if there were differential underreporting by cases and controls.”
Nadal says that doesn’t pass the scientific straight face test.
“If I had pulled that crap during my dissertation defense, my committee would have laughed me out of the room,” he said.
However, as Nadal blogs about the abortion-breast cancer studies, he says this is a recurring theme.
“But, as we shall see over and over on a daily basis for months to come, this is what happens when ideology (and not physiology) becomes the prism through which data are filtered,” he says.
Tuesday, 7 September 2010
Jenn Giroux, RN, new Executive Director of HLI America, a new program of Human Life International founded to educate on the physical, emotional, and spiritual harms of contraception. I thought my readers, particularly women taking or considering the birth control pill, might find a recent article of hers, “Crazy is the New Normal,” to be both scary and enlightening:
Who would have ever guessed that contraception would move center stage in the women’s health and the political arena in 2010?
The New York Post reported that a “Wicked” actress sued Bayer pharmaceutical company claiming the popular birth control Yaz caused her to have a stroke at age 27.
Also woman who have used the pill are now showing up in their 30’s with breast cancer (prior to the pill breast cancer was a post-menopausal women’s disease).
Next time you are at the pharmacy ask for the insert information inside the very box that is provided to the consumer when they purchase a contraceptive … risks associated with the drug include blood clots, strokes, heart attacks, high blood pressure, heart disease, gallbladder disease, liver tumors, and cancer of the reproductive organs and breasts.
How many doctors are telling women who go in for contraceptives these stunning statistics?
Women who use hormonal contraceptives for a minimum of 4 years prior to their first full term pregnancy have a 52% higher risk of developing breast cancer (Mayo Clinic Proceedings).
Women who use a hormonal contraceptive for more then 5 yrs are 4 times more likely to develop cervical cancer (International Agency of Research on Cancer).
Instead many doctors convince married and single woman to go on contraceptives when they go into the office.
Natural Family Planning (NFP) is a highly reliable form of not only spacing children but helping couples to conceive. Recent studies have shown it to be 99% effective. It’s amazing more doctors aren’t encouraging their patients to effectively use NFP that has no risks associated.
Now, as the undeniable medical evidence mounts, which confirms the damage contraceptives have and continue to do to women’s health one may ask why for years mainstream and even pro-life organizations have ignored this.
In addition, it has been revealed that our elected official are trying to force our tax dollars to pay for birth control under “preventative” medicine that tax payers and insurers will be forced to pay under the Affordable Care Act.
It is time that every pro-life organization stands up and resist with all our might.
Not only are these contraceptives damaging to women’s health, but these class A-1 carcinogens are also causing chemical abortions (in excess of 250 million since the 1960′s).
For every U.S. child born an estimated 2 children are killed in the womb from surgical abortion and abortifacient contraceptives (National Center for Health Statistics Division of CDC, 2003; International Pharmacists for Life, 2003).
It’s clear that it is time for expansive and comprehensive education against contraception use.
The very life and health of women and the country depend on it.
As we watch this all play out it is easy to think that “Crazy is the New Normal”… sex outside of marriage, doctors prescribing class A1 carcinogens and women, through hormonal contraceptives, chemically aborting possibly one baby every month.
That’s definitely CRAZY. But it will never be normal.
I’ve written extensively on this topic. Here are some of my publications on the topic:
- Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent. Published in the Archives of Family Medicine in 2000.
- The Growing Debate About the Abortifacient Effect of the Birth Control Pill and the Principle of the Double Effect. Published in the journal Ethics and Medicine in 2000.
- Why I Stopped Prescribing the Pill. Published in the Archives of Family Medicine in 2000.
- Postfertilization Effect of Hormonal Emergency Contraception. Published in the Annals of Pharmacotherapy in 2002.
Here are some of my blogs on the topic:
- Did you know the birth control pill can cause abortions?
- American Society of Reproductive Medicine Statement Confirms the Pill Causes Abortion
- The Abortifacient Effect of the Birth Control Pill (A Reading List)
- New documentary features Dr. Walt and exposes abortifacient qualities of the birth control pill
- Dr. Walt in an Online Documentary Revealing Abortifacient Effects of the Pill
Friday, 13 August 2010
A study out of Sri Lanka has found that women who had abortions more than tripled their risk of breast cancer. The study focused on analyzing the association between the duration of breastfeeding and the risk of breast cancer. But the researchers also reported other “significant” risk factors for breast cancer, such as passive smoking and being post-menopausal. The highest of the reported risk factors was abortion.
The study, entitled “Prolonged breastfeeding reduces risk of breast cancer in Sri Lankan women: A case-control study,” was led by Malintha De Silva and colleagues from the University of Colombo.
Here are some of the details from Life Site News: The researchers found that among women who breastfed for between 12-23 months there was a 66.3% risk reduction in comparison to those who had never breastfed and those who breastfed for between 0 and 11 months. The risk reduction climbed to 87.4% for those who breastfed for 24-35 months and 94% among women who breastfed for 36-47 months.
Dr. Joel Brind, an epidemiologist at the City University of New York, cautioned that the researchers do not clearly indicate whether they are referring specifically to induced abortions, as opposed to spontaneous abortions (miscarriage). Requests for clarification have not yet been answered.
However, in the study the researchers compare their findings with other studies that focused on induced abortions, seeming to suggest that induced abortion was their focus.
According to Dr. Brind, an expert on the association of abortion and breast cancer, the findings are consistent with studies from other populations where abortion rates are low. He explained that in epidemiology, risk factors are best analyzed in places where the particular factor is less prevalent. Once most people have that factor, however, it is much more difficult to study its influence, since it is difficult to find anyone with whom to compare.
“This study is consistent with the kind of data we used to see in China and Japan when abortion had a very low prevalence,” he said. But in China, where abortion has become rampant, research is now showing a higher risk of breast cancer following abortion.
Dr. Brind said that the study’s raw data supports the conclusion about the abortion-breast cancer link. But he criticized the paper about the study, which he said “has some errors in it which should have been corrected on peer review.”
Most significantly, he highlighted the researchers’ claim that a late age at first pregnancy strongly decreased the risk of breast cancer, which goes against all the other research over the last 50 years. “This is not a valid finding,” he said, because the researchers “actually miscalculated their own raw data.”
Karen Malec, president of the Coalition on Abortion/Breast Cancer, said that the study shows that “women who abort forfeit the protective effect of breastfeeding.”
“The loss of that protective effect is incurred in addition to the effect of abortion leaving the breasts with more places for cancers to start.”
Malec said that given the lack of routine mammograms in Sri Lanka, “health professionals must focus on disease prevention,” which would involve publicizing the link between abortion and breast cancer.
“It is criminal that the U.S. National Cancer Institute (NCI) has covered up this risk for over a half century,” she said.
However, she continued, “It’s becoming increasingly difficult for the NCI to keep its fingers and toes in the dike,” in large part because “many researchers in other parts of the world do not depend on the agency for grants.”
Louise Brinton, a NCI branch chief, served as co-author in the U.S. study in which she and her colleagues admitted that “…induced abortion and oral contraceptive use were associated with increased risk of breast cancer.” The authors cited a statistically significant 40% increased risk.
If you are a woman who has had an abortion, this information means that you need to consider a couple of actions:
- Learn everything you can about how your can significantly lower your risk of breast cancer by proper diet, exercise, and sleep,
- Be sure to discuss breast cancer screening with our primary care physician, and
- Strongly consider seeing a post-abortion counselor. You can find one through your nearest Crisis Pregnancy Center or by contacting CareNet here.
Here are some of my other posts on the topic:
- The Dark Side of Breast Cancer Awareness Month
- Surgeon Reports Abortion Ups Breast Cancer Risk
- New Study Finds 66 Percent Increased Breast Cancer Risk After Abortion
Related web sites:
Friday, 6 August 2010
CNN/Health.com reported, “Millions of Americans already take fish oil to keep their hearts healthy and to treat ailments ranging from arthritis to depression.”
Now a new study appearing in Cancer Epidemiology, Biomarkers & Prevention suggests that fish oil “supplements may also help women lower their risk of breast cancer.”
In fact, “postmenopausal women between the ages of 50 and 76 who took fish oil were … less likely to develop certain types of breast cancer than women who didn’t,” researchers at the Fred Hutchinson Cancer Research Center found.
However, consider this information very preliminary. My friends at the Natural Medicines Comprehensive database say this:
You can read more about the study here.
You can also read my blog on how to take the right kind and amount of fish oil here.