I have always individualized the mammogram recommendation depending upon the woman’s risk factors and desires. I’ve also had many patients (and a number of good friends) who avoid mammograms altogether. I have respected this position for more than twenty years, and with today’s data on the limits of mammography, I respect it more than ever now. If you choose this option, let your doctor know that you’re willing to be a partner in your health care and release her (or him) from liability for your decision to avoid mammography. Tell him or her that you’re willing to put this in writing and sign it as a legal release form. Failure to diagnose breast cancer is one of the most frequent reasons for lawsuits against doctors!
The new 2009 guidelines do not apply to women at high risk for breast cancer because of a gene mutation that makes breast cancer more likely or because of previous extensive exposure to radiation. I recommend annual or biennial mammograms and/or sonograms or other screening if you have a positive family history for breast cancer or if you find that getting this screening puts your mind at ease. (Peace of mind produces very positive biochemical changes in the body.) If you have a first-degree relative who got breast cancer before menopause, consider annual screening mammograms starting five years before the age your relative was diagnosed.
In an ideal world, breast health screening would be done via thermography, using the right kind of equipment, and read by a professional who is fully trained in this area and who knows when a mammogram, ultrasound, or MRI would provide more information. I predict that this will be the medicine of the future when it comes to breast health. And it’s all good!
Still undecided about what you should do? Try the National Cancer Institute’s Breast Cancer Risk Assessment Tool (www.cancer.gov/bcrisktool), consisting of seven simple questions. The tool calculates both your risk of getting invasive breast cancer in the next five years as well as your lifetime risk, and it compares each to the risk for the average U.S. woman of the same age and race or ethnicity. This can be useful in helping you decide if mammograms are right for you, and how often you want to have them.
If You Find a Breast Lump
~ IF YOU FIND A LUMP, GET A DIAGNOSIS. It’s important to see a practitioner who can help you through the process of finding out whether your breast lump is benign or cancerous. Waiting and imagining the worst are obviously not healthy. Dr. Dixie Mills says, “Many women who come to see me have already reviewed their wills.”
~ ALWAYS TAKE SOMEONE WITH YOU. Many women who have found a breast lump are too frightened and overwhelmed to ask questions and explore all their options with their doctor or other medical professional. Having a companion can help you focus; if he or she takes notes, you can review them together later.
~ DON’T LET ANYONE RUSH YOUR DECISION. Many options are available for the diagnosis and treatment of breast lumps, ranging from breast cyst aspiration to needle biopsy to open biopsy. Most breast lumps or thickenings actually turn out to be benign. Many are simply fluid-filled cysts, which can be aspirated right in the office. If the fluid is clear, you have both your diagnosis and treatment at the same time. Nothing further needs to be done. Oftentimes breast lumps or thickenings are the result of hormonal stimulation and will go away after you get your period. This is particularly true during perimenopause, when estrogen overstimulation of breasts is so common. One of my patients developed large, painful lumps in both of her breasts throughout her perimenopause. This really scared her and also made it difficult to tell what was really going on in her breasts. After she finally had her last period, however, her breasts returned to their normal consistency, and her lumps went away for good.
~ GET A SECOND OPINION IF YOU’RE NOT COMPLETELY COMFORTABLE WITH THE FIRST. Even if you do have cancer, in the vast majority of cases your treatment will not be compromised if you take a couple of weeks or even months to find a doctor you trust and feel comfortable with.
IF YOU HAVE BEEN DIAGNOSED WITH
BREAST CANCER
Join a breast cancer or other support group in your area. Studies have shown that support groups characterized by open and honest sharing are associated with increased longevity and decreased rate of tumor recurrence. Besides, a support group is a very safe place to learn how to ask for what you need—or even discover those needs in the first place.
The following books and other resources provide powerful support for your inner wisdom during this time, as well as a wealth of practical information.
Sacred Choices: The Gentle Art of Disarming a Disease and Reclaiming Your Joy, by Judie Chiappone (Holistic Reflections, 2000).
My Healing from Breast Cancer, by Barbara Joseph, M.D. (Keats Publishing, 1996).
Breast Cancer Survivor’s Club, by Lillie Shockney, R.N. (Windsor House Publishing Group, 1996).
The Cancer Report: The Latest Research in Psychoneuroimmunology (How Thousands Are Achieving Permanent Recoveries), by John Voell and Cynthia Chatfield (Change Your World Press, 2005). For more information on this research, visit www.cancer-report.com.
The Moss Reports by Ralph W. Moss, Ph.D., at www.cancerdecisions.com.
Dixie Mills, M.D., maintains an excellent breast health website (www.drdixiemills.com).
PUTTING BREAST CANCER RISK IN PERSPECTIVE
Most women grossly overestimate their risk for breast cancer. Recent surveys of women between the ages of forty-five and sixty-four show that 61 percent feared cancer (predominantly breast cancer) more than any other disease. Only 9 percent feared heart disease the most, despite the fact that it is the leading cause of death in women, claiming more women’s lives each year than the next fourteen causes combined.89 Breast cancer isn’t even the leading cause of death from cancer in women. That distinction goes to lung cancer.
Though every one of us probably knows a woman with breast cancer, and though breast cancer is the most common cancer among North American women, the lifetime risk for breast cancer—the widely touted one-in-eight (or one-in-seven for Caucasian women) figure90—applies only if you live beyond the age of eighty-five.91 The one woman in eight who does develop breast cancer has a 50 percent chance of receiving the diagnosis after the age of sixty-five and a 60 percent chance of dying from another cause.
Kelly-Anne Phillips and her colleagues at Princess Margaret Hospital in Toronto, Ontario, Canada, have constructed a very helpful chart based on the 1995 incidence and mortality rates in the Ontario Cancer Registry. Here’s what it shows.
Out of 1,000 females born healthy and alive:
~ Ages 35–39: 986 will be alive. Of these, 1 will get breast cancer, 0 will die from it, and 2 will die of other causes.
~ Ages 40–44: 983 will be alive. Of these, 5 will get breast cancer, 1 will die from it, and 4 will die of other causes.
~ Ages 45–49: 977 will be alive. Of these, 8 will get breast cancer, 2 will die from it, and 6 will die of other causes.
~ Ages 50–54: 968 will be alive. Of these, 11 will get breast cancer, 3 will die from it, and 11 will die of other causes.92
The irrational fear of breast cancer creates a great deal of suffering for women and prevents many from enjoying the benefits of perimenopausal treatments—such as high-dose soy, bioidentical progesterone, low-dose bioidentical estrogen, and testosterone—that can relieve symptoms and help prevent diseases that are far more apt to be a threat to longevity or quality of life.
THE BREAST CANCER GENE:
SHOULD YOU BE TESTED?
Fully 95 percent of all breast cancers have little or nothing to do with genetics. The rest are associated with inherited mutations in two different genes: BRCA1 and BRCA2. Women who inherit a BRCA1 mutation have a higher risk than those with a BRCA2 mutation. They have a 56 percent lifetime risk of breast cancer and also an estimated 15 percent risk of developing ovarian cancer by the age of seventy. Though less is known about the BRCA2 mutation, it is estimated that it will account for an additional 40 percent of hereditary breast cancers.93
The true frequency and implications of breast cancer gene mut
ations are still uncertain, in part because the BRCA1 gene is very large and many different mutations have been found within it. One particular BRCA1 mutation has now been detected in approximately 1 percent of Jews of Eastern European descent. Different mutations have been found in other populations. In addition, there are other gene pathways besides those governed by BRCA1 and BRCA2 mutations that may lead to breast cancer. When you add to this the technical problems of sequencing an entire gene, it is clear that genetic testing for breast cancer risk is an incomplete science. A negative test for the gene may have little meaning in a setting of a strong family history of breast and ovarian cancer.94 On the other hand, if there is only one individual in the family with breast or ovarian cancer, the chances of this cancer occurring due to a mutation in either BRCA1 or BRCA2 is quite small.
Francis Collins, M.D., Ph.D., formerly of the National Center for Human Genome Research in Bethesda, Maryland, summarized the current dilemma associated with testing positive for the breast cancer gene.
We are still profoundly uncertain about the appropriate medical care of women with these mutations. Despite the general usefulness of mammograms for the early detection of breast cancer in women over the age of 50, there are no data to instill confidence that regular mammography at a younger age, in concert with self-examination and examination by doctors or nurses, will reduce the risk of death from metastatic breast cancer among very-high-risk women with BRCA1 mutations. We do not yet know the appropriate use of more drastic measures, such as prophylactic mastectomy, especially given the anecdotal evidence that cancer can still occasionally arise in the small amount of epithelial tissues remaining after surgery…. Clinical research is urgently needed to address all these uncertainties.95
Though federal legislation is in progress to protect those who test positive, testing also raises the potential for health insurance discrimination, life and disability insurance discrimination, and discrimination in employment.96
EPIGENETICS: THE SCIENCE OF THE FUTURE
In the documentary The Living Matrix—The Science of Healing (www.thelivingmatrixmovie.com), leading-edge scientists, physicians, and physicists, including Bruce Lipton, Ph.D., former Apollo astronaut Edgar Mitchell, D.Sc., and Lynne McTaggart, convincingly demonstrate that we are far more than biochemical machines—and, most important, that there are energetic and electromagnetic force fields (which are related to thoughts and emotions) that profoundly affect our health and healing. These quantum fields of energy and information heavily influence our states of health and determine the environment in which a gene functions and how it gets expressed. Dr. Lipton cites data, for instance, that demonstrates that a baby who is adopted into a family in which many members get cancer will end up with the same risk of cancer as her adopted family, despite very different genes. The reason has to do with epigenetics—the science of how genes and the environment interact. It turns out that it is the cell membrane that is the brain of the cell, telling it what to do and what to let in. The genes in a cell, which reside in the nucleus, are more like gonads. They simply help the cell divide. The environment is what actually tells the cell what to do. Hence, even those with positive breast cancer genes (or any other genetic condition) need to realize that they are not mere victims of their genes—and that they have far more impact on their genes than they realize.
Here’s the bottom line: genetic testing has great limitations and should be approached very cautiously. Though a negative test for the breast cancer gene can be a great relief for an individual with a positive family history for breast cancer, it’s not a guarantee against getting breast cancer. I do not recommend being tested unless you have at least two or more close family members who’ve had breast or ovarian cancer.
You should also undergo thorough genetic counseling from a professional with extensive knowledge and training in the field, both before and after getting your test results. If your test is positive, seek medical care from a professional who is actively engaged in research protocols to further our knowledge of these disorders. The National Cancer Institute Cancer Information Service (1-800-4-CANCER) can supply information about genetic services at cancer centers supported by the institute.
A third option: genomic testing done by a physician skilled in nutritional and functional medicine may help you decrease your risks further through targeted lifestyle changes. (See www.functionalmedicine.org.) It’s also crucial to remember that many, many women have healed their lives—and their cancers—through lifestyle changes, which include updating old, outmoded, self-destructive childhood programming!
THE EFFECT OF HT ON BREAST HEALTH
Despite the fact that most women, with or without supplemental hormones, will not get breast cancer, the documented link between hormones and breast cancer is worrisome for everyone concerned. Nearly every woman asks, “What is the effect of hormones on my risk for breast cancer?” The answer depends on which hormones she is taking, what her dosage is, and what her inherent risk factors are to begin with. These issues were raised by a letter I received from a man concerned about his wife’s hormone supplementation program.
My wife has recently switched from taking Premarin, which she originally took to quell hot flashes, to taking natural progesterone in the form of a skin cream. As a result, her breast pain and tenderness have gone away and so have her headaches. What’s more, my wife has had almost complete relief from her hot flashes, too. But, as a result of some things I have read about the possible connection between progesterone and breast cancer, I want to be reassured that my wife is on the right track—and that no unscheduled trains will be coming down that track which could cause her harm in the future.
The experience of the woman described in this letter beautifully illustrates the side effects that often result from taking Premarin, until recently the most regularly prescribed estrogen drug for perimenopausal symptoms. Breast pain is one of the most common adverse reactions to estrogen replacement of all kinds, with anywhere from 20 to 35 percent of women complaining of it when given standard, non-individualized doses.97 This is especially frightening for women who have a personal or family history of benign breast disease (also known as fibrocystic breast disease), which, in the past, was felt to be associated with an increased risk for breast cancer. Newer research, however, has failed to show any consistent association between benign breast disease and increased risk of breast cancer.98 And, as already stated, breast pain is often a sign of suboptimal iodine levels (see The Role of Iodine in Thyroid Disease).
Headaches are also a common side effect of taking Premarin, since estrogen can be metabolized into a substance that is similar to adrenaline and can result in pounding temporal headaches. Bioidentical progesterone, on the other hand, has been shown to stop hot flashes and has none of these side effects.
Many people, however, are uncertain about potential long-term health problems resulting from progesterone, because of studies from the National Cancer Institute and the Women’s Health Initiative, both of which documented an increased breast cancer risk for those women on long-term estrogen/progestin hormone therapy. A reanalysis of the WHI data published in 2011 showed that such risk increases only for women who began taking HT either before menopause or within five years of it. Those who started HT five years or more after menopause had no increased risk.99 Furthermore, what most people (including doctors) do not understand is the difference between the synthetic hormones at non-individualized doses used in the NCI and WHI studies and bioidentical estrogen and progesterone used at low, individualized doses.
Here are the facts: the National Cancer Institute study was a large epidemiological study involving 48,355 women who were on both estrogen and progestin for varying periods of time between the years 1980 and 1995. Women of normal weight who took this hormone combination for five years had a 40 percent increased risk for breast cancer compared to those who were not on hormone therapy. (Intriguingly, women who were overweight did not have this increased risk, although overweight women are at
higher risk in any case because body fat makes estrogen.) They also had a greater risk for developing breast cancer than those on estrogen alone.100
The 2002 WHI study showed that out of 10,000 women on Prempro, there would be an additional 8 cases of breast cancer compared to placebo. A 2010 analysis of the data confirmed that after eleven years of follow-up, those who took Prempro who developed breast cancer were diagnosed with more advanced tumors and had higher rates of mortality—yet in terms of absolute rates, the risk of breast cancer mortality was fairly low (2.6 deaths from breast cancer per year per 10,000 women on combination HT compared to 1.3 breast cancer deaths per year per 10,000 women taking placebo—or 1.3 extra deaths from breast cancer per 10,000 women per year attributable to HT).101
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