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Myths and Facts About Breast Cancer

Breast cancer is the disease that women fear most, according to many surveys—and the subject of scores of magazine articles, TV shows, websites, and books. Women trying to keep up have to weed through a pile of information, misleading and confusing statements, and deliberate misinformation (such as the Internet rumors that antiperspirants and underwire bras cause breast cancer: they don't). Here's what people are saying, and asking.

Stress and breast cancer: cause and effect?

There's no evidence that emotional upset or severe stress (temporary or chronic) causes breast cancer, or causes it to recur after treatment. Or indeed that personality or attitude has any relation to breast cancer. This is a myth—and a heavily promoted myth. True or not, a recent study in Psycho-Oncology reports that a high percentage (42%) of women who had survived breast cancer by at least two years believed stress was to blame for the cancer. About 26% blamed genetics (a better guess), and 25% the environment (surprisingly little is known about this).

The researchers concluded that doctors should ask their patients what they think about the causes of breast cancer. It might be comforting for a woman to learn that her emotions did not "give" her breast cancer.

Women whose cancer had not recurred were asked what they thought had kept them healthy. An even higher proportion (60%) attributed their survival to a positive attitude. They cited good diets, exercise, stress reduction, luck, and taking tamoxifen, among other things. Indeed, doctors do think that what's called a "fighting spirit" can boost a woman's chances of survival.

In other words, you don't give yourself breast cancer. But a positive attitude, including a willingness to comply with treatment, may indeed help you get well.

Mammograms: outmoded?

In spite of what you may have read, mammography is still the gold standard for detecting breast cancer, and it's likely to remain the gold standard for some time. This comes from a new detailed report from the Institute of Medicine, part of the National Academy of Sciences. A committee appointed by the Institute and headed by Dr. Joyce Lashof (Associate Chair of our Editorial Board) reviewed the evidence and found that mammograms have reduced the mortality rate from breast cancer by one third in women aged 55 to 70.

And a subsequent study in the journal Cancer claimed even greater benefits. In Sweden, where 85% of women age 40 to 69 get the test, the death rate from breast cancer among women having mammograms was two-thirds less than that of women who didn't get screened. This was not a controlled study, and may have over-estimated the benefit. Still, it adds support for mammograms. While they don't prevent breast cancer, they can detect it at early, treatable stages, which is why the mortality rate has dropped.

Many expert recommendations still hold: all women should begin having annual mammograms at age 50. Women at higher risk for breast cancer, in consultation with their physicians, may need to start mammography at 40.

New screening tests are also coming into use. Here are three that may one day be widely used in addition to conventional mammography:

Full-field digital mammography: a very similar process for the woman, but it uses electronic detectors and produces digital images that can be easily stored. So far it doesn't look any more accurate than regular mammograms, and it's more costly. But it may prove to be a better tool for women with dense breasts.

Magnetic resonance imaging (MRI): widely used already, but not to detect breast cancer. MRI, which uses a magnetic field to create an image, may be useful for detecting less common forms of breast cancer, and for women with dense breasts. As the technology improves, its usefulness for detecting breast cancer may also improve.

Ductal lavage: a very thin catheter is inserted into the milk ducts, where most cancers originate, and cells are extracted. It's FDA-approved as an adjunct to mammography and already in use for high-risk women. It might one day be useful for detecting precancerous cells and thus allow for preventive treatment—in much the same way that a Pap test can detect potential cancers of the cervix. But ductal lavage has drawbacks—in particular, too many false positives—and is not ready for wide use.

Other methods are already in use: ultrasound is a useful adjunct to mammography; and genetic testing can help some high-risk women make treatment decisions. Some new scanning techniques are still in the developmental stage. And new biological knowledge (that is, understanding of the nature of tumors and potential markers that may reveal the presence of tumors) will help in diagnosis as well as treatment.

While mammography is not perfect, it is still the best of the tests. And don't forget regular breast exams by a professional, as well as the monthly breast exams you do yourself.

Older women: not at risk?

The idea that breast cancer is a young woman's disease is untrue, and may have arisen from many articles in women's magazines about young women with breast cancer. In fact, breast cancer risk rises dramatically with age. A recent study of Canadian women aged 50 to 75 found, however, that women aged 70 to 75 were less likely to get mammograms. The reasons for this were complex: fear of the test and of results played a role, but so did the mistaken idea that older women are less susceptible to breast cancer. Fatalism stopped some women: "If I get it, I get it—no point worrying." This is not a constructive way to think about your health.

Women who get regular blood pressure checks, exercise, and don't smoke are more likely to get mammograms, whatever their age, according to research. It makes sense to take good care of yourself in all the ways you can—which includes getting regular mammograms—into your seventies and eighties and beyond.

Breast cancer prevention: exercise and diet?

If you're keen on taking care of yourself, you want to know how to prevent breast cancer. Will a good diet help? Exercise? Avoiding alcohol? Unfortunately, it's been hard to pinpoint any way to prevent breast cancer.

High-fat diets were long suspected of raising breast cancer risk, and this link has been much studied. But there seems to be no connection, although a diet high in animal fats is harmful in other ways. Surely, scientists thought, eating lots of fruits and vegetables protects against breast cancer. But while such a diet is a very good idea, there's no certainty it protects against breast cancer.

As for exercise, there is some indication that getting regular exercise over a lifetime is protective—but the evidence is not strong. Perhaps exercise is beneficial because it helps control weight (obesity increases the risk of breast cancer). Like eating fruits and vegetables, getting regular exercise is an excellent idea for other reasons, whatever its effect on breast cancer risk.

Some studies have found that alcohol increases the risk of breast cancer—but others have found no increased risk except in heavy drinkers. It's far from certain. Moderate drinking—one drink a day for women—does lower the risk of heart disease.

Remember this: The causes of breast cancer remain essentially unknown. Genetics and estrogen levels over a lifetime no doubt play the major roles.


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