Breast cancer myths and realities

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A recent study researched and reported by a major Federal advisory panel, The Institute of Medicine, should give both comfort and concern to women and their families about breast cancer. and

The IOM was called upon by the Susan G. Komen for the Cure advocacy organization to investigate the evidence about the real causes of breast cancer. Happily, along the way, the report also issued some news that should bring relief to many women concerned about non-factors involved in breast cancer causation.

It has long been known that certain factors do play a role in increasing a woman s chances of getting breast cancer. These include:
*early-onset of menses
*never having been pregnant
*post-menopausal obesity
*strong family history of breast cancer, especially at younger ages
*having the BRCA-1 or BRCA-2 mutations: the strongest factor of all

Except for the last factor, all the others increase risk only minimally: most cases of breast cancer have no specific precursor, and this lack of predictability is one of the reasons it inspires such anxiety and fear among women. A more recent addition to this list is having dense breasts, detected on mammograms. The density both increases the risk of the disease, and also makes it more difficult to detect on a mammogram. Women with especially dense breast are often advised to have special studies done, such as ultrasound or even MRI in addition to the routine X-Ray mammogram.

Getting back to the IOM report: The panel evaluated a wide spectrum of environmental (meaning non-genetic) exposures, which had been thought to contribute to increasing breast cancer risk. The good news is that none of the suspected chemicals some groups accuse of causing the disease were shown to do so. Exonerated by the IOM: DDT, BPA, phthalate plasticizers, benzene, and other industrial chemicals and pesticides.

On the other hand, the scientific panel cautioned women about the increased risk they felt might be a result of excessive exposure to ionizing radiation in the form of CT scans. In fact, that was the only exogenous (non-genetic) factor they expressed caution about, except for long-term hormone replacement therapy. As a breast-cancer advisory report, they advised avoiding unnecessary CT scans to reduce that specific risk. My organization, The American Council on Science and Health, weighed in on this important issue at that time:

However, that advice makes sense for everyone, doctors and patients alike, since medical science does not know how much (or how little) X-Ray exposure can lead to cancer. The trick of course is deciding which CT scan or X-Ray test is unnecessary. It s fairly easy to make that determination after the fact, but in the heat of a potentially serious condition where immediate diagnostic imaging is required, a woman is unlikely to demand justification for a scan if the doctor orders one.

But often, the situation is not so urgent, and the doctor may want to get one more test, just to be sure. This is often done to protect the doctor not the patient out of fear of being sued later. In those cases, it s perfectly appropriate for a woman to ask a few simple questions:
*Is this scan really necessary to help you diagnose my condition?
*Can another test be done instead without radiation say, a sonogram?
Of course, the real risk of inducing a cancer from one (or even a few) CT scans is quite remote, so a wise patient would comply if the ordering physician sticks to his or her guns. Discretion is the better part of valor in that circumstance.