10 Breast Cancer Myths
As you undergo clinical breast exams, it's important to remember you know your body better than any doctor. If you've heard any of the following comments from your doctor, consider seeking a second opinion -- or another physician.
1. Too young "You're too young to have breast cancer." According to the American Cancer Society, about 75 percent of women who get breast cancer are age fifty or older. But it's estimated that 9,000 American women, aged forty and younger, will be diagnosed with breast cancer each year. Doctors recommend that all women begin breast self-exams at age twenty. In 1998, the American Cancer Society (ACS) revised its guidelines and made forty the age when women should begin having annual mammograms. But recent Swedish studies found a 30 percent decrease in breast-cancer deaths on average when women in their forties have annual mammograms.
2. No history "You don't have a family history of breast cancer, so you're not at risk."Not true. Hereditary breast cancer is the exception, not the rule. It accounts for only about 10 percent of cases. In the other 90 percent, cells become cancerous spontaneously with no known cause. A good doctor will carefully review your family history to find out if you might have inherited a genetic mutation that indicates a higher risk. The biggest clue: numerous close relatives who had the disease, especially at young ages. "People concentrate on mothers and sisters, but it's important to look at the whole family," say doctors. "Breast cancer can be passed down from the father'sside."
3. Mother had cancer "If your mother developed breast cancer after menopause, that doesn't increase your risk."You're still at risk. However, the risk would be even higher if your mother had developed the disease when she was younger. Here's why: When a woman inherits a mutation in the breast-cancer gene, most doctors agree that the disease will probably emerge before menopause (if she develops it -- and not all do). That's why, if your mother had early breast cancer, you have twice the average risk of developing it. If your mother gets breast cancer after menopause, the chance that her disease has a genetic component is reduced. Still, in a small percentage of cases, postmenopausal breast cancers do have genetic roots. So, even if your mother's late-onset breast cancer is the only known case in your family, your own risk of developing the disease is 1.4 times higher than average.The bottom line: Tell your doctor about family members with breast and other cancers -- no matter when the disease was diagnosed. She may recommend having a baseline mammogram in your twenties or thirties, with follow-up tests every year.
4. Get tested "Your strong family history means you should get tested for mutations in BRCA1 and BRCA2, the genes linked to breast cancer."It's not that simple. This blood test raises difficult questions about everything from family relationships to employment discrimination and insurance coverage."It's absolutely essential to have genetic counseling before deciding to undergo testing," says one expert. Prior to testing, the counselor takes a detailed family history, assesses your genetic risk and helps plan your response to results. If the genetic mutation is discovered, some patients choose to screen more vigilantly; others opt to surgically remove healthy breasts in a controversial procedure called prophylactic mastectomy. Studies are currently under way to determine whether taking the drug tamoxifen can decrease breast-cancer risk in carriers of the BRCA1 and BRCA2 gene mutations.
5. Mammography facilities "It doesn't matter where you go to get your mammogram done."When your doctor prescribes a mammogram, get information on mammography centers he recommends. "The more barriers a doctor can remove for the patient-cost, location or even providing the phone number-the easier it is for the patient to comply with his instructions," say some experts. The 1992 Mammography Quality Standards Act (MQSA) states that all mammography facilities in the United States must be certified by the Food and Drug Administration. To get certification, a center must produce films that are clear enough to reveal even small cancers, have X-ray equipment that uses a low level of radiation and employ radiologists who read a minimum of 480 mammograms a year and continue required courses in the field.
6. Self exams "We found a lump -- haven't you been doing self-exams?"This is no time for blame. Preliminary results of a recent large-scale study conducted in China found that women who were taught to do self-exams were more likely to get lumps checked out. But those who were diagnosed with cancer survived no longer than women who had cancer but had not done self-exams.However, finding tumors early is linked to survival. And, in the absence of a test that detects precancerous cells (as the Pap test does for cervical cancer), mammography is the best method of early detection."By the time you can feel a tumor, it's about two centimeters in diameter and it may have been there for as long as eight to ten years," says one doctor.
7. Watch and wait "That lump is nothing to worry about. We'll just watch it and wait."Most lumps are not cancer, but your doctor should be able to pinpoint exactly what it is. Cysts, fibroadenomas, pseudolumps and even premenstrual lumpiness are a few possible explanations. Make sure the appropriate tests are done to confirm a diagnosis. If there's any doubt, ask for a biopsy.When your doctor is vague, or if his diagnosis leaves you dissatisfied, seek another opinion. Don't be reluctant to press the issue: The number-one cause of medical malpractice suits in this country is the delayed diagnosis of breast cancer.
8. Communications glitch "We'll have your biopsy results at the end of the week. Call my office."This comment may seem harmless, but "when a woman's waiting for the results of her biopsy, she's in incredible distress," says a doctor. To avoid communication glitches, you must ask specific questions in advance: If I have the test today, when will you get the results? If you're not available, who else can give me the results? Should I call your office or make an appointment? Can we plan a telephone call at a specific time? Keep in mind that test results may be delayed for legitimate medical reasons; sometimes the pathologist needs a little more time.
9. No second opinion "You don't need a second opinion.""When a doctor says that, you're in the wrong place," says one expert. "It's a real no-no, especially for breast cancer or any other life-threatening illness."Don't be intimidated. A good doctor will expect -- and even encourage -- you to seek another opinion. A second opinion can be deeply empowering for patients. When it confirms your original diagnosis, you'll begin your treatment feeling confident. And, if it turns up new information, you and your doctor will gain insight into your case.However, your doctors may well disagree on treatment options. This is especially common when you consult doctors from different specialties, such as a radiologist, breast surgeon, pathologist and oncologist. You may end up with an overwhelming amount of information, but you don't need to digest it alone. Insist that the various doctors handling your case discuss your treatment. This type of team approach helps patients get the best possible care.
10. Too much information "You've been reading (or been on the Internet) too much.""A good doctor will welcome informed questions from well-read patients," says a doctor. "But there are still doctors who say patients should not have access to the kind of medical information found on the Internet." Remember that books can become outdated quickly, and Web sites may be inaccurate. Look for information that is timely and sources that are reputable.Keep in mind: If you're obsessively triple-checking every word your doctor utters, maybe you should look for a physician who inspires a greater level of trust.
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Khorsheed.com – Nov, Dec 2003
