Journal News writer Bill Cary tackles the myths surrounding breast cancer in this week’s Sunday Life cover story as part of our ongoing coverage of Breast Cancer Awareness Month. Here’s the story as it appeared in print:
Everyone seems to know someone touched by breast cancer. It’s a disease that will be diagnosed in one in eight women during their lifetimes, according to the American Cancer Society, but it reaches far deeper into families and friendships, as loved ones and acquaintances often come face to face with cancer for the first time.
Along with that awareness, however, comes lots of second-hand information and anecdotes about how best to prevent breast cancer, plus a steady and often contradictory stream of information in the media about the latest advances in medicine and treatments.
Add in the inherent dangers of turning to the Internet for medical advice and you’re bound to get a wealth of sort-of truths and outright misinformation.
To help separate fact from myth, we asked local doctors and breast cancer experts to address 10 myths that are among the most prevalent misconceptions they hear from their patients. Their answers, after the jump.
Myth: Only women get breast cancer
As expected, women account for the vast majority of breast cancer cases, but men do get it.
“Men account for less than 1 percent of all the breast cancer cases in the U.S.,” says Dr. Andrew Ashikari, a surgical oncologist affiliated with the Ashikari Breast Center in the Dobbs Ferry Pavilion of St. John’s Riverside Hospital and the Ashikari Breast Center at Hudson Valley Hospital Center in Cortlandt Manor.
He notes that the cancer is most often found in men as an abnormal mass in the breast — and that it often comes with a strong family history.
“Male breast cancer is associated with a higher incidence of a genetic cause of their cancers,” he says, and he recommends that “all families with male breast cancers should be considered for genetic testing.”
Adds Dr. Nancy Mills, an oncologist with the Memorial Sloan-Kettering Cancer Center in Sleepy Hollow: “Interestingly, if I see a man with breast cancer, the first thing I think of is some sort of genetic family predisposition.”
And she notes that the men with breast cancer in her practice “tend to be in later stages because we usually don’t screen men for breast cancer.”
Myth: Most women with breast cancer have a family history of the disease
Not true, all experts say, and this is one of the most common myths local doctors say they see in their practices.
“The vast majority of of breast cancer is what we call sporadic, meaning it just happens,” Mills says.
“Only 10 percent of women who get breast cancer have a family history,” says Dr. Helen Pass, an assistant professor of clinical surgery at Columbia University and director of breast care at the Center for Advanced Surgery at Bronxville’s Lawrence Hospital. “I tell my patients that they’re not protected by virtue of their family history.”
Myth: Mammograms do more harm than good
Ashikari says this is a common misconception, especially when it comes to the amount of radiation a patient is exposed to during the process.
“Yes, there is radiation associated with mammography, but there are guidelines set to limit the radiation exposure, and the current guidelines have not been associated with any known harm,” he says.
Pass acknowledges that many women find mammograms uncomfortable, painful and difficult to go through, but they “are still the best screening test we have.”
For her patients, she likens the amount of radiation you get from a current mammogram to what you would get from flying from New York to California, or just walking around for three months. You get a certain amount of radiation just from existing on the planet, and exposure is greater at higher altitudes because the atmosphere is thinner.
Most of all, mammograms save lives.
Dr. Anthony Cahan, chief of breast surgical services at Northern Westchester Hospital in Mount Kisco, says that mammography “remains one of the most effective tools for decreasing the mortality of breast cancer. Studies consistently demonstrate a 20 to 30 percent reduction in breast cancer mortality in screened versus nonscreened populations.”
Myth: I’m too old to get breast cancer
Not true, all experts say.
“Young women with breast cancer get a lot of the attention, but the reality is that the incidence of breast cancer increases with age,” Mills says. “The older you are the more likely you are to get it. Older people just tend to get all cancers, period. Older women should get mammograms forever, basically.”
For the most part, breast cancer primarily affects postmenopausal women, with 80 percent of the cases occurring in women over 50, Ashikari says.
In fact, the incidence of breast cancer for each decade of life keeps increasing, he says, with the highest incidence of the disease in patients in their seventies. They account for 24 percent of breast cancer cases.
And women in their eighties may have to go through the same treatment as women half their age.
“Some 80-year-olds end up getting the full surgery, radiation and chemotherapy,” Pass says. “We can’t promise they won’t.”
Myth: I’m too young to get it
“You’re never too young to get breast cancer,” says Dr. Roseanne Newell, a surgeon and the director of the Solomon Katz Breast Center at Sound Shore Medical Center in New Rochelle, noting that the youngest patient she has ever seen was 22.
Of all breast cancer patients, 20 percent are premenopausal women under 50, Ashikari says. Most of these women — about 15 percent — are in their forties, “but there is about a 5 percent incidence in patients in their thirties and a rare — 1 percent — incidence in women in their twenties.”
Unfortunately, breast cancer in these younger women is more aggressive, he adds, “and requires more aggressive treatment, almost always chemotherapy.”
Ashikari notes that he, like other breast specialists, tends to see more of these premenopausal women as patients because these women know that their cases are unusual and are more likely to seek out specialized care.
Pass, who has seen a patient as young as 16, has this diagnostic advice for all young women: “You need to get used to the size, shape and texture of your breast when you are in your twenties.”
That way, you can quickly determine when abnormalities show up and seek medical advice.
Myth: I have to go to New York City for quality care
A generation ago, suburban women wanting top-notch treatment faced dozens of trips into Manhattan for breast cancer surgery and treatment at nationally renowned institutions like Memorial Sloan-Kettering Cancer Center. That’s no longer the case, as high-quality breast centers have spread across the Lower Hudson Valley — and more and more talented medical personnel have decided to practice and live in the suburbs.
“Due to the quality of life that Westchester offers, many of the finest physicians, trained at the most prestigious institutions, move and practice here,” Cahan says.
“I’m a Columbia surgeon and yet I feel very comfortable doing all my surgery at Lawrence Hospital,” says Pass, who lives in Bronxville and has two children in the Bronxville school district.
“Some people need to be in the big bricks-and-mortar places, and that’s fine,” she adds.
And it may be particularly good medical advice for rare breast cancers, Newell says. “Some of the seldom seen cancers, especially some of the sarcomas and the ways they are treated, would benefit from a visit to Memorial,” she says.
Another option for those newly diagnosed in the suburbs is to have the surgery in a big-name medical center in the city, with all follow-up care and treatment at a facility closer to home.
“Surgery is a one-time deal, whereas chemotherapy can be pretty intensive in terms of the number of treatments and complications you might have,” Mills says.
If post-surgery radiation is advised, that can mean daily therapy for five or six weeks, she adds. “That’s a lot of visits if you’re talking about schlepping into Manhattan — that’s a lot of time and inconvenience. If you can do it in your own back yard, that makes it so much easier for patients.”
Myth: I know women with breast cancer whose mammogram didn’t detect the disease. So why bother with getting one every year?
“Unfortunately, no imaging test available is 100 percent accurate in detecting breast cancer,” says Dr. Patricia Joseph, director of Breast and Women’s Health Prevention Services at Nyack Hospital. “Mammography, ultrasound and breast MRI can all miss breast cancers, but that does not mean that none of the tests are useful. Mammography is still the best in being able to detect cancer at an early stage when it is most curable.”
“It saves lives,” adds Dr. Abraham Mittelman, a medical oncologist with Northern Westchester Hospital, Phelps Memorial Hospital Center and NY Medical College. “If you look at the American Cancer Society statistics over the past 10 years, there’s been an improvement, or decrease in death rates from breast cancer, because we find it earlier.”
And that’s because of annual mammograms for all women starting at age 40, as recommended by the vast majority of medical experts.
“Basically, mammograms save lives,” says Mills, of Memorial Sloan-Kettering Cancer Center in Sleepy Hollow. “That’s the gold standard.”
Myth: MRIs and sonograms (ultrasound) are better than mammograms because they find more cancer
Many women hear that these other diagnostic tests are more sensitive and find more cancers, so that’s what they ask for from their doctors.
MRI (magnetic resonance imaging) is a procedure that uses a magnet, radio waves and a computer to make a series of detailed pictures of areas inside the body. Mammograms use x-rays to image the breast; MRIs do not.
Ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The resulting echoes form a picture of body tissues called a sonogram.
“MRIs are never a replacement for mammograms,” Mills says, and they have not been shown to be advantageous in routine breast cancer screening.
They can also lead to unnecessary, painful procedures.
“MRIs are limited by the fact that they generate a lot of false positives — areas with abnormal enhancement — leading to a lot of unnecessary biopsies that are negative,” Newell says.
MRIs are also a lot more expensive than mammograms, and most insurers balk at paying for them unless the patient has a strong family history of the disease.
Sonograms are sometimes used, in conjunction with mammograms, particularly in younger women with dense breast tissue. They are not sensitive enough to be used as a substitute for mammograms, Cahan says.
Myth: In terms of long-term survival rates, removing the entire breast is better than removing just the cancer.
Wrong again. “This has been definitively disproven,” Ashikari says.
“I start by telling my patients that we now have 30 years of data, going back to the very first trials,” says Pass, the surgeon at Lawrence Hospital. “The survival rates are absolutely the same between women who had a lumpectomy and women who had a mastectomy.”
Still, some women persist in the belief that in the long run they’re better off going with a complete mastectomy instead of a breast-conserving lumpectomy.
“The use of mastectomy is determined not by the stage or aggressiveness of the cancer but by the extent of the disease in the breast,” Ashikari explains. “If too much of the breast is involved with cancer then a mastectomy is needed to remove the whole cancer.”
Myth: Once diagnosed, breast cancer decisions need to be made very quickly
Actually, most breast cancers are fairly slow growing.
“I tell people it’s an emotional emergency, not a biologic emergency,” Pass says.
“For a lump to show up on a mammogram, it is believed that it takes five years, and to grow into a lump you can feel (it takes) eight years,” Pass says.
She urges patients to “take a couple of weeks” to think through where and how they want to be treated after they get a cancer diagnosis.
“You certainly have a month,” Newell says. “Any longer — say two to three months — you’re increasing your chance of its spreading to lymph nodes.”
Adds Dr. Joseph, of Nyack Hospital: “Taking time to fully evaluate the situation and plan the best treatment once the diagnosis has been made has not been shown to have an adverse impact on outcome or survival.”
On the other hand, you do have cancer, and you can’t keep going from doctor to doctor, getting additional consultations.
“We do see patients who delay a little too long,” Mills says. “There’s a little bit of denial going on.”