As a relatively common yet mysterious disease, breast cancer can be a confusing and fearful topic to understand. Doctors on Rockdale Medical Center's breast cancer treatment team held a panel discussion Oct. 2 to demystify treatments, debunk some myths, and offer the latest information.

About 1 in 8 women in the U.S. will be diagnosed with breast cancer at some point in their lives. The good news is that there are more treatment options than ever, and survival rates are climbing. And, despite some recent debates, that annual mammogram for women 40 and older is still important, the doctors said.
The panel included Dr. Leslie Holmes (radiology/oncology), Dr. Kathleen Lambert (hematology/oncology), Dr. April Speed (breast surgery ) and Dr. Richard Stiles (radiology).

Prevention

What causes breast cancer and what can women do to avoid it? That's the main thing everyone wants to know. But in the vast majority of cases, doctors have no idea.

Some breast cancer comes from genetic factors, but in about 80 percent of cases, the patients have no known risk factors.

"[Breast cancer is] a very frustrating disease that happens for reasons we don't understand," said Stiles. "We just don't know how to prevent it as well as we'd like to."

The doctors recommended exercise and healthy eating-which are great benefits no matter what-but those are no guarantees against cancer. Stiles said he often has patients who are frustrated that they lived healthy lifestyles and developed breast cancer.

Some of the apparent biggest risk factors are difficult or impossible to control, such as the time of a woman's first period or menopause.

Speed and Lambert discussed some studies that have loosely linked breast cancer to alcohol or tobacco use, or to parabens and phthalates-chemicals used in cosmetics and plastics. But there is no proof that any of those substances cause breast cancer. Likewise, there is no proof that consuming soy products affects the risk one way or another.

Screening

With the causes of breast cancer largely unknown, regular examinations to catch any cancer early are very important. Breast cancer is usually curable when caught early.

"Early detection beats prevention every day," Stiles said.

There are three basic screenings every woman should do: a monthly breast self-exam; an annual breast physical exam; and for older women, an annual mammogram.

Many women are familiar with the self-exam as the classic "checking for lumps." But, Speed explained, the idea of that exam is changing. Doctors now advise women about the concept of "breast self-awareness." That means to think about the big picture of the breast's overall condition, not just lumps or the mechanics of the exam. Any type of change, such as skin color or nipple discharge-could be a cancer symptom. It is also important to check under the arm, not just the front of the breast.

The annual mammogram has been under fire in recent years, with some widely reported studies saying they are unnecessary. Stiles explained that there is some validity to the criticisms, but he expressed concerns that media reports oversimplify the debate. His opinion is that annual mammograms are still crucial for life-saving early detection.

Mammogram screening rates are dropping, Stiles said, and his big fear is that primary care doctors are advising women to skip them.

Various studies have questioned whether mammograms are effective at reducing cancer death rates, and whether they lead to "over-treatment" of disorders that are not cancerous. Stiles acknowledged that mammograms create a lot of false-positive results-about 80 percent of time, when an abnormality is found, it turns out not to be cancer. But other studies report that mammograms are a crucial front line in catching cancer early.

Both sides in the debate have "bias," Stiles said.
Some researchers are more focused on individual patients, some on overall public health. And money comes into play-either saving health care funds or spending them. But both sides are also honestly trying to figure out a complicated scientific subject, he said. For the general public, he said, it's important to remember that no single study tells the whole story-even though the media often report it that way.

Mammograms are now more financially accessible than ever. The new federal Affordable Care Act requires insurance companies to cover the screening mammogram, Stiles told the News that also shows that many health experts believe it's a crucial preventative measure.

Treatments

For women diagnosed with breast cancer, the treatments themselves often trigger fears, with full mastectomy and chemotherapy being well-known options.

But, Speed said, "it's no longer one-size-fits-all...We're realizing your breast cancer is as unique as you are as an individual."

Full mastectomy-the total removal of the breast-used to be the only option. But today, depending on the form of the cancer, the surgery can be more targeted. There are also more cosmetic surgery options for reconstructing the breast.

Some of the stereotypical side effects of chemotherapy, such as nausea and vomiting, today can be prevented or controlled, Lambert said. Others may still appear, with the biggest common ones including hair loss and fatigue. She emphasized that chemotherapy just means drug therapy, which comes in many forms depending on the exact type of breast cancer.

Holmes explained radiation treatment as sounding more frightening than it really is. The treatment works by directing a beam of particles that damage breast tissue cells. Healthy cells will heal themselves, but cancer cells will die. Radiation treatment is also customized to the individual patient, and Holmes emphasized that RMC performs it with a team of friendly doctors and assistants who draw up the treatment plan.