Last week, the United States Preventive Services Task Force released new mammogram recommendations for American women. While nothing has changed here in Canada – in fact, the new U.S. recommendations mirror the Canadian Cancer Society’s current guidelines (clinical breast exams at least every two years for women 40 and older; mammograms every two years for women 50 and older) – a lot of confusion still exists about breast cancer screening. Today I interviewed Dr. Lavina Lickley, an MD who has conducted extensive research on breast cancer prevention. To boot, she’s also a survivor of the disease. Dr. Lickley expertly answered every mammography question I could think of – believe me, I had plenty – and you can read our interview in the February 2010 issue of Chatelaine (it’ll be on newsstands before you know it). But, I wanted to tell you today about the single best piece of advice she has for women who aren’t at higher risk for breast cancer, when it comes to getting a mammogram:
“Never till 35, always at 50; in between 35 and 50, any reason is a good reason.”
Sound advice from a very smart woman.
Yesterday, the United Services Preventive Services Task Force released new guidelines recommending that women start regular breast screening at 50, not 40. They also recommend that women between the ages of 50 and 74 have mammograms every second year as opposed to annually, and that doctors stop teaching their patients to perform breast self-examinations (BSEs).
The reason behind these reversals? The task force says “there is moderate certainty” that the net benefit of bi-annual screening for women under the age of 50 is small and that false-positive test results – more common for women aged 40 to 49 – can cause unnecessary distress (no doubt). They also state that “adequate evidence suggests that teaching BSE does not reduce breast cancer mortality.”
So what does this mean for those of us south of the border? In a nutshell, not a lot. The new U.S. recommendations for mammograms mirror the current recommendations of the Canadian Cancer Society: Women older than 40 should receive clinical breast exams from a health care provider at least every two years; women aged 50 to 69 should have a mammogram every two years. And the Canadian Breast Cancer Foundation notes that our own Canadian Task Force on Preventive Health concluded back in 2001 that there was not enough evidence to conclude that BSEs were an effective early screening tool. (That said, I’m a fan of the breast aware approach advocated by both the Canadian Breast Cancer Foundation and the Canadian Cancer Society).
While our own breast screening recommendations may sound straightforward, mammography programs vary by province and women at greater risk for the disease need to talk to their doctors about whether they should start screening earlier. Look for more on this crucial health issue in the February 2010 issue of Chatelaine.
A friend of mine recently told me that when I talk about cancer, she gets a little lost in all the medical terminology and references to different kinds of treatments. It’s a slippery slope, and I can see now that I have slid it. To make amends for my spouting of esoteric mumbo jumbo, herewith, a Cancer Primer:
Cancer Strong contender for Most Terrifying Word in the English language; also known as the C-Word, the Darth Vadar of disease, and “the little word with the big stink.” Meaning: A disease that involves abnormal or uncontrolled cell division. Basically your good cells get overtaken and/or crowded out by bad cells. This doesn’t happen because you did something wrong, no matter what anyone including that nasty little voice in your head tries to tell you.
Metastatic Breast Cancer (Also, “mets” in cancer-lingo.) The scary, hairy, foul-breathed boogeyman of breast cancer. It means your breast cancer has spread to other parts of your body. But it is still called “breast cancer” no matter where it goes (bones, organs, lymph nodes…) Imagine you are Turkish, and you visit Newfoundland for some whale watching or, God forbid, turbot-fishing. You are still Turkish. You are not considered Canadian just because you came to Canada for the fish. OK, so perhaps this analogy is a bit obscure. What I’m saying is, it’s not that your breasts have travelled to your liver, but that the invading cells are the offspring of the original trouble-makers. When this happens, they just add the M-Word to the C-Word and voila! Your C-Word gets cranked up a few stages (see “Staging” below.)
Biopsy This is when they physically extract suspicious cells from your body and send them to a lab for questioning under a microscope. They have lots of different kinds of biopsies, some of which are less unpleasant than others, but eventually you’ll get an answer. Oh yes, you’ll talk, little cells… You’ll sing like little cancerous canaries…
Pathology The specific nature of your disease as defined by the characteristics of your cancer cells. Some breast cancers are related to hormones, some are not; some breast cancer cells have certain proteins on them, others do not. The lab identifies exactly what the cells are made of so the oncologists know whether to use the medical equivalent of numchucks or molotov cocktails. All breast cancer cells are stupid jerks, you don’t need a microscope to see that.
Radiation I think everyone has a basic idea of what happens with radiation – you nuke the cancer. In a localized, laser-beam sort of way. Check out “radiation” in the tags for more details.
Chemotherapy Ah, notorious chemo: the bald-making, sick-making, cancer-killing drug therapy. Actually, not all chemotherapies make you bald and many are much improved in the sick-making department too. They’ve come a long way, baby. And they’re not all administered by IV drip, either – some (like my capecitabine) are pills. Think of chemo like an army that goes in and wipes out everything good along with everything bad, with the intention of rebuilding the good stuff later (this usually works better in chemotherapy than in Bush Administration foreign policy.) The somewhat arbitrary attack plan explains hair loss; if chemo drugs are designed to attack fast-reproducing cells – like cancer cells – they’ll knock out hair cells too. Hair loss can be an incredibly devastating, psychologically debilitating, massive downer. You look in the mirror and see “cancer” looking back. On the upside, people will give you their seat on the bus and eventually, the hair grows back.
Targeted Therapies These newer cancer treatments are less arbitrary than chemo, and more targeted to the specific cellular stuff happening with certain cancers. For example, they may work in conjunction with chemotherapy to deliver the toxic drugs directly to the cancer cells (smart-bombing) or they may be designed to prevent the tumour from developing the blood vessels it needs to feed itself and grow. Let’s all just take a moment here and be collectively creeped out that tumours develop blood vessels and feed themselves. Seriously. It’s gross. It’s like something from a Ridley Scott movie.
Staging This is when they measure your cancer and kind of rank how bad it is. Not that anyone ever says “it’s somewhat bad,” or “it’s extremely bad.” They will just talk about how much it has spread, how big the tumour is, where it is in proximity to organs, etc. Stage 0 cancer is called “in situ” and means it hasn’t moved one little bit, and Stage IV is the big M. People sometimes also talk about “high grade” and “low grade” cancer. This is another measure of the likelihood of the cancer to move around or otherwise become a greater pain in the a**. In addition, you’ll hear about things like “triple positive” or “double negative” cancers – this isn’t a measure of the extent of the cancer but of its nature (estrogen, progesterone or HER-2 positive or negative) so don’t let it freak you out.
There are many more terms in the cancer lexicon – far, far too many – but that, I think, is enough cancer talk for one day.
This morning, at media gathering about cancer research at Princess Margaret Hospital in Toronto, I was lucky enough to hear the scientist Tak Mak speak a bit about his work. Mak is the director of the hospital’s breast cancer centre — but you might know him as one of Chatelaine’s “Men We Love,” from our November issue last year.
To explain how our understanding of breast cancer has advanced over the years, Mak used this analogy:
“Imagine a big bowl of fruit. That’s what breast cancer is like. We didn’t know that before — that’s what research has taught us. We now know that there isn’t just one type of breast cancer; instead, there are apples and oranges and bananas and pineapples. In the past, we used the same drugs for everyone, and we didn’t understand that a treatment might do an excellent job with oranges, but nothing to bananas.”
Mak went on to say that researchers have come a long way in understanding that the aggressive breast cancer that hits younger women behaves completely differently than the type that typically affects older women. He described the newest treatments for breast cancer as “sharp-shooter drugs” — drugs that target the specific cells, instead of just killing (or removing) everything in sight. An example of these “sharp-shooter drugs”? Herceptin, which our formidable blogger Leanne Coppen wrote about this week.
One-hundred percent of the proceeds benefit research into ovarian cancer (a notoriously difficult-to-detect cancer that’s also the fifth most deadly cancer for women).
I’ve also always been a fan of War Child’s holiday cards, designed by musicians such as Leonard Cohen, Joni Mitchell, Sarah McLachlin, Finger Eleven, Feist, Tragically Hip and Avril Lavigne. The proceeds help fund humanitarian programs for children in war-torn countries.
These pretty holidays cards from Global Exchange are fair trade and they’re tree-free — made from recycled cotton rag embroidered by artisans in Indian:
When you give the gift of a donation to Rethink Breast Cancer this holiday, you can send the lucky recipient this hilarious e-card: