Hunt
for Pink October
Pink ribbon medallions will be placed in secret locations in the community,
with clues to their locations being given out on HANK-FM and right here on this page. Individuals who find the pink ribbon medallions get to participate in an event at Clarian West on Thursday, November 6th at 6:00pm where each contestant will win one of nine exciting pink prize packages or a stay at the Pink Shell Resort and Spa in Marco Island, Florida, courtesy of NWA World Vacations!
Individuals who solve the clue and go to the proper location, but find that the medallion has already been retrieved will receive a free pink ribbon “Post-It” pen, which can be used to fill out an entry to win a “second chance” pink ribbon medallion to be drawn at the end of October. 3M will donate part of the proceeds from the pink ribbon pens to breast cancer research. Only one
winning medallion may be claimed per person.
• Week Five Clue:
For trucks that are built "tough" and mustangs with zip, visit the dealership in the town where purple's always hip. The Hunt For Pink October ends where quality is job one, solve this clue in a hurry. A single medallion left to be won.
Roundtrip
Airfare for two valued at up to $800!
Prize courtesy of NWA World Vacations offering great deals on vacation packages to Florida and around the world.. Contact your local travel agent or online at nwaworldvacations.com.
Roundtrip Airfare for two valued at up to $800, Hotel accomodations
valued at up to $1000, Expires 10/31/09, Total Value up to $1800.
NWA World Vacations offers great deals on vacation packages to Florida
and around the world! Visit nwaworldvacations.com or contact your travel agent for details.
Ask Dr. Robert Goulet
Ask Dr. Robert Goulet Answers by Dr. Robert Goulet, one of the nations best-known and most respected breast cancer surgeons and researchers. He is the medical director of the Clarian West Breast Care and Research Center, and of the Indiana University Breast Care and Research Center.
Q: Nationally, how many women are diagnosed with breast cancer each year? According to the American Cancer Society (Ca Cancer J Clin 2008; 58:71-96), breast cancer leads the list at 26% of all newly diagnosed cancers in women. In real numbers 182,460 new breast cancer cases were diagnosed in 2007; about 1% or 1,990 of which occurred in men. Last year 3660 new breast cancer cases were identified in Indiana.
Q: Who has the highest risk of developing cancer? Statistically speaking, if you are a white woman living in the United States you have the highest incidence of breast cancer in the world. The risk of developing breast cancer increases with age reaching a peak around the mid-seventh decade of life. While the incidence is substantially lower in younger women, even women in their 20’s and early 30’s develop breast cancer.
Q: What are the risk factors for developing breast cancer? In my patient discussions, I divide breast cancer risk factors into three major categories: 1. familial risks, 2. estrogen exposure, and 3. environmental exposure.
A person’s family history weighs heavily in breast cancer risk assessment. The number of first-degree relatives with breast, ovarian or uterine cancer is significant. This is particularly important if that relative was premenopausal at the time of the diagnosis, if two or more of these tumors occurred in the same patient, if the disease affected both breasts, or if the relative with breast cancer was a male. Ethnicity also figures into this area with certain ethnic groups having substantially higher rates of hereditary forms of breast cancer (ie. certain eastern European Jews). If a person has a suspicious family history, then genetic testing may be indicated and in that situation I recommend a consultation with a certified genetic counselor or medical geneticist. I also include a patient’s own past medical history in this category. Included are the number of previous breast biopsies and the documented evidence of predisposing or premalignant breast lesions like atypical ductal or lobular hyperplasia (ADH/ALH) or lobular carcinoma in situ (LCIS).
The exposure to estrogen has been shown to increase the risk of breast cancer. Therefore women who start their menses below the age of 12 or who continue to have periods after age 50 are at increased risk. If a woman never carries a full-term pregnancy or if she delays her first full-term pregnancy until later in life her risk is increased. Women who take hormone replacement therapy combining estrogen and progesterone are at increased risk. There is no clear evidence that oral contraceptives increase the risk of breast cancer. The role of plant estrogens (phytoestrogens) in breast cancer risk remains poorly defined.
Environmental risk factors cover a wide range of exposures. Previous medical
therapy, such as radiation therapy for a childhood malignancy, may increase the subsequent risk of breast cancer. Exposure to carcinogens in the workplace may also play a significant role in the development of breast cancer. Cigarette smoke, both primary and second-hand, increases a woman’s risk. Certain dietary factors like high concentrated fats and excessive alcohol intake have also been implicated in breast cancer risk.
Q: What are the different types of breast cancer? In most cases breast cancer can be divided into either “intraductal” or “invasive” malignancies. In many cases both elements can be identified within a single tumor. An intraductal breast cancer is one in which the tumor cells are incapable of breaking through the walls of the milk ducts and therefore are incapable of accessing the bloodstream or lymphatic vessels that surround the affected ducts. The disease is therefore local or one that is limited to the breast. With the wider application of mammography screening the number of women diagnosed with intraductal cancers has dramatically increased in the recent past. Invasive cancers, on the other hand, have the capacity to disrupt the wall of the milk duct and subsequently gain access to other areas of the body after entering the circulation. Invasive and intraductal cancers can be subdivided based on their presentation or appearance under a microscope.
Breast tumors can be further subdivided based on the presence of certain markers on the surface of the tumor cells. Examples of this are the receptors for the sex hormones estrogen and progesterone. Estrogen receptor can be viewed like a switch on the surface of breast cancer cells. If the hormone is present the switch is on and the tumor cells are stimulated to multiply. If the hormone is removed or prevented from interacting with the receptor the switch is off and the tumor cells do not multiply and in some cases die. A tumor cell without the estrogen receptor on its surface multiplies with or without estrogen receptor. Its switch is stuck in the on position constantly. In general, estrogen receptor positive tumors behave better and have a more favorable prognosis. Younger women are less likely to have breast cancers that are estrogen receptor positive when compared to women beyond menopause. Another tumor marker which helps in differentiating breast cancers is the protein her HER2/neu. Roughly 20% of breast cancers produce this protein. Tumors that are positive for HER2/neu tend behave more aggressively. Fortunately there is a very effective therapy that specifically targets HER2/neu positive breast cancer cells. The field of tumor markers represents one of the most exciting areas of breast cancer research today.
Q: How does the type of breast cancer affect the survival rate once diagnosed? In general, the earlier a breast cancer is diagnosed the better the prognosis. Women with intraductal cancers, appropriately treated, have a 98% chance of never dealing with a recurrent breast cancer. Providing a prognosis for women with invasive breast cancer is an area that has undergone monumental changes in the past several years. Based on information drawn from the definition of the human genome, new tools have been developed that provide clinicians with a prognostic report tailored to each individual patient. Armed with this tool, clinicians can confidently predict the risk of metastases at ten years, which women will and will not benefit from chemotherapy, and who will require hormonal therapy. This breakthrough has revolutionized the care of women with invasive breast cancer and the technology is only at its infancy.
A separate group of patients that require separate attention are those that present with the variant known as inflammatory breast cancer. These tumors seemingly develop over night; often with dramatic enlargement and swelling of the breast with a characteristic redness of the skin. The process is usually very uncomfortable but not painful. In this situation the patient is treated aggressively with chemotherapy to start followed by a modified radical mastectomy and finally radiation therapy. The prognosis in this situation is guarded with an overall 5-year survival of 25%. The good news is that newer therapies and new combinations of old therapies are being evaluated in clinical trials that show promise for these patients.
Q: What are the warning signs and symptoms that a woman should look for? Despite the fact that the American Cancer Society and National Breast Cancer Coalition have withdrawn their support for monthly breast self exam, I continue to encourage my patients to become familiar with their bodies. Beginning with observation, a woman should stand in front of a mirror with her hands at her sides and look at her breasts from the front and then side-to-side. She should focus on changes in the size, shape and symmetry of the breasts. Look at the contour of the nipples for changes and skin for changes in color, swelling or retraction. This should be repeated with the arms raised above the head. This maneuver may accentuate more subtle changes.
Next, palpate the breasts. This can be done in the erect position or while lying down. I teach my medical students to use the triple touch technique recommended by the American Cancer Society. Using the technique requires gentle pressure to each are of the breast starting with a light touch, then moderate touch and then deep touch. Normal breast tissue is compressible, while abnormal tissue will hold its shape under this pressure and requires more focused evaluation. You cannot differentiate between a cyst and a solid mass of the breast on palpation.
Nipple discharge can be disconcerting. May women will have some element of nipple discharge and in most cases, it is innocent. There are two reasons to pursue nipple discharge. The first is if the discharge occurs spontaneously and second is if the discharge appears bloody. In either case, further evaluation is necessary.
The most ominous changes of the breast are associated with inflammatory breast cancer. The breast undergoes a rapid increase in size (usually over a week to 10 days). The patient complains that the breast feels heavier and her bra no longer fits properly. There is swelling of the skin, which is marked by small pitting across the surface of the breast and there is a distinct redness which progresses. Although patients complain of discomfort to the area, the pain is not typically intense. There is no associated temperature elevation or shaking chills typically seen in the context of a breast abscess.
Any change that last for more than 30 days, should be brought to the attention of your health care professional.
Q: What is the best way of ensuring early detection and prevention? Detection and prevention are two very different topics. Early detection is the key to success in treating breast cancer. Although breast self-examination has not proven effective in improving breast cancer outcome, I continue to encourage my patients to perform monthly self-exams in an effort to increase awareness of their bodies and emphasize their responsibility as caretakers. For women with no special risk factors, the American Cancer Society recommends annual clinical examination by your health care provider beginning in early adulthood and annual mammogram beginning at age 40. For women with a first degree relative with a history of breast cancer, the screening should begin 10 years before the onset of the relative’s disease. If you mother was diagnosed with breast cancer at age 40, you should begin your annual screening mammograms at age 30. There is ample data that supports the use of screening MRI in women who are at high risk and have dense breast tissue noted on mammography. Breast ultrasonography is an excellent adjunct to mammography and clinical examination, but is not a screening tool. If an abnormality is detected on screening, then diagnostic studies should follow and if necessary, a biopsy of the breast tissue should be performed. Most breast biopsies can be performed using a needle. Surgical biopsies should be reserved for extraordinary cases only.
In breast cancer prevention, the first step is to clearly identify ones risk status. This requires a careful evaluation of the factors that were outlined previously. In some cases, genetic testing is performed that can identify an inherited abnormality that significantly increases the danger of breast cancer. There is an evolving group of breast cancer subspecialties with a focused interest in this area. Breast cancer prevention has been a reality since 1998 when researchers, evaluating a group of women facing increased threat of breast cancer due to a variety of factors, reduced the risk of developing a malignancy by 50% overall with the prophylactic administration of a drug, tamoxifen, for five years. Since then, other medications have been tested and found effective in risk reduction and new medications are currently being evaluated in their role as preventative agents. In some cases, particularly in women with documented genetic defects, prophylactic surgery may be recommended, which may included removal of the ovaries and fallopian tubes, in addition to mastectomies. Although surgical intervention results in dramatic risk reduction, it does not eliminate the possibility of breast or ovarian cancer and continued surveillance is necessary.
Q: What early detection measures are available to me? These have been outlined above. They include: 1) clinical examination, 2) mammography (preferably digital), 3) ultrasonography, 4) breast MRI. All of these modalities must be applied rationally and in a responsible manner. The combination of clinical examination and mammography remains the gold standard for detection. Breast ultrasonography compliments physical examination and mammography, but cannot substitute for them. Breast MRI is emerging as a highly effective tool in breast evaluation. The indications for the study are specific and not everyone is a candidate.
Q: What lifestyle changes will help reduce the risks for developing breast cancer? Surprisingly, there is little reliable information regarding risk reduction through lifestyle changes. Obesity, particularly post-menopausal, increases the hazard of breast cancer. The consumption of a diet high in saturated fats is related to this. Excessive alcohol consumption also increases a woman’s risk of breast cancer. Exercise, for as little as 30 minutes three times a week, results in breast cancer risk reduction. If you smoke, stop! Women who smoke have an increased risk of a variety of associated health problems, including breast cancer. Vigilance of ones body and health is a lifestyle characteristic that will serve you well. If there is a change that persists for more than 30 days, consult your health care provider. If you have adopted risky behaviors (i.e.; smoking, overeating), deal with them. This may require professional help to be successfully.
Q: Where can women go to find more information and resources? There are a large number of options for women seeking information related to breast health. The first stop should be your primary care provider. If they do not have the information you need, they aught to be able to direct you to someone who does. In this regard, it is never “improper” to ask for a second opinion. You would not renovate your home without consulting with several individuals. Why should you be any less vigilant with something as precious as your health?
Some of my favorite external information resources include:
The Young Survivors Coalition
The American Cancer Society
The Little Red Door Cancer Agency
The National Cancer Institute
The Wellness Community
