Cancer Prevention Archives - Page 2 of 3 - Screening for Better Health

Why family history can increase risk of breast cancer

May 26, 2016 by drjaffer

All cancer (not just breast cancer) is the result of a mutation in the cells. Sometimes this mutation is passed down from parents to their children in their genes. Other times, this mutation arises over the course of a person’s life – for example, from exposure to common carcinogens, like cigarette smoke. While one of the pillars of preventive medicine is avoiding disease-causing agents such as carcinogens, there is nothing we can do to modify the genetics we received from our parents. As a result, when mutations may have been passed down to us, it is important we practice proper screening techniques in order to determine how how our risk might be and to catch any potential diseases early, while they still may be treatable.

Breast cancer is common enough that about 1 in 8 women will develop some form of it in their lifetimes. It is a disease that all women need to be aware of and should be screened for at the appropriate age. Even men can develop breast cancer; we all share some amount of risk.

But of these women, between 5 and 10% of them are thought to develop breast cancer as a result of hereditary mutations in their genes. This might seem like a relatively small number, but still impacts thousands of women each year. And some of these mutations result in cancer a very high rate – as much as 80% of women with the well-known BRCA1 may develop breast cancer over their lifetimes. And while other relatively common mutations may have lower rates of cancer, many of these cancers tend to develop in both breasts, or at earlier ages, during periods of women’s lives when they would not normally be tested for cancers. As a result, these cancers may go undetected for long periods of time, leading to much greater mortality. Last but not least, these mutations often go hand-in-hand with other forms of cancer, such as ovarian cancer, making them even more dangerous if undetected.

The reason it is important to be highlight these genetic risk factors is not to scare or upset you – it’s to help you understand the importance of your family medical history. The best defense (in fact, the only defense) against these genetic factors is being aware of any family history of breast cancer or other cancers, and knowing when it’s right to bring this information to your doctor. At that point, the two of you can work together to form a screening and prevention strategy that is right for your particular case. Through early detection and proper preventive techniques, we can take the fight to breast cancer, instead of letting it come to us.

For a detailed chart of “red flags” in your family history that can help you know when to alert your doctor, take a look at this breast cancer family history infographic.

When Mammograms are Wrong: False-Positives and False-Negatives

April 26, 2016 by drjaffer

First and foremost, let’s get this out of the way: Mammograms are often wrong. In fact, some estimates show that up to 90% of “positive” results (those that have detected abnormalities) are actually “false-positives”, meaning that there was no cancer despite the reading. And up to 20% of “negative” results are estimated to be “false-negatives,” meaning there actually was cancer present but it wasn’t detected.

Any screening test has a chance for false-negatives: it’s impossible to detect anything with 100% accuracy. Getting that percentage of false-negatives as low as possible is one of the reasons procedures are constantly re-evaluated and refined. But I want to focus today on the false-positive tests, because the impact of getting a false-positive on your mammography is a little less understood.

False-Positives

This number – up to 90% – may seem unacceptable at first glance. Getting something wrong 90% of the time is usually considered a deal-breaker elsewhere in life, after all!

According to the National Cancer Institute, false-positives are most common in young women, women who have had previous biopsies on their breasts, those with a family history of breast cancer, and women taken estrogen supplements.

Mammograms can also sometimes detect something known as localized ductal cancer. This is the finding of breast cancer that is localized to the ducts of the breasts known as ductal carcinoma in situ. The concern is that many women with ductal cancers may never die of breast cancer that was diagnosed with the screening mammography. These women may be are subjected to unnecessary breast surgery, radiation therapy and even chemotherapy in older age, leading to health problems and costs that were not truly contributing to their long-term survival.

False-positive tests can result in unnecessary procedures, stress, medical costs, lost time, and additional risks. Believing you have life-threatening breast cancer when you do not can be a tremendously disruptive, life-altering experience in the short term with long-term consequences. So how are you supposed to rely on a mammogram with such accuracy rates?

Using Mammograms the Right Way

It all comes down to how mammograms are utilized. The most important thing to understand is that an initial positive test does not necessarily mean you have cancer. In fact, odds are you do not! But follow-up tests will be needed to learn more information and get to the truth behind the positive result. Additional mammograms, ultrasounds, and surgery followed by biopsy are the typical followups, depending on what is found. It is important not to panic at this stage, and to understand that more information is needed before a complete diagnosis can be made.

Another important factor in using mammograms the right way is understanding when they should be conducted. Young women are much more likely to experience false-positive (and false-negative) results: as a result, for average-risk women the American Cancer Society recommends screening starting at age 45, while the United States Preventive Services Task Force recommends screening start at age 50. Screening in young women has not been shown to conclusively help prevent deaths from breast cancer, and may cause more harm than good in many cases. If you are at higher risk or want to begin screening earlier than these guidelines, you should discuss it with your doctor and understand some of the limitations inherent to mammograms.

As women reach their late years, the benefits of mammograms becomes difficult to determine. Women age 75 and older can still develop breast cancer, but in some cases their remaining life span may be less than the period required for breast cancer to become fatal. For women that are still healthy and likely have a number of years remaining, screening may be a good practice. For others, screening may cause more harm than help. It is recommended that you speak with your doctor and try to determine a plan that is right for you and your health as there are no set, agreed-upon guidelines.

Mammograms are still the best tool we have

For all their limitations, mammograms are the best tool for detecting early breast cancer and saving lives. Breast cancer is a fatal disease that takes the lives of about 40,000 women a year. If allowed to develop and spread to other parts of the body, it can be too late to save someone with breast cancer. By staying vigilant and following proper guidelines, it is possible to detect this dangerous disease early and save lives. Be sure to speak with your doctor and schedule the right tests at the right times for you!

The Stool Test: How a fecal test can help detect colon cancer, and where it falls short

March 31, 2016 by drjaffer

nci-vol-9888-72 — Colorectal Cancer Cells. Source: NCI Center for Cancer Research

The Stool Test, also known as a Fecal Occult Test, is sometimes given to patients for aid in screening for colon cancer. While it can help aid in detecting colon cancer, it is important to understand why it, and other tests like it, are only supplemental tests and not a replacement for more accurate and rigorous screening procedures – in this case, colonoscopy.

The reasons for a stool test are simple: it is easy and quick enough to conduct at home, and much less invasive than a colonoscopy. You receive a simple card kit, and you smear a fecal sample on each card before returning them to your doctor. The most up-to-date versions of the test are designed to successfully detect tiny, microscopic bits of blood in the stool. Since this is one of the major warning signs of colon cancer, this can help give early warning to patients who will then need to get a full colonoscopy as a follow-up.

The downsides, however, are very real. Stool tests are not very accurate, and have a high chance for either a false positive (where blood is present but does not come from colon cancer or pre-cancerous polyps) or false negative (where no blood is detected, but colon cancer is present). In the case of the false positive, you’re still going to need to undergo a full colonoscopy to confirm the presence of cancer or polyps. And in the case of a false negative, you may have been able to detect the cancer early if you had undergone a colonoscopy instead of the quicker and easier stool test.

Like many screening tests that have issues with accuracy, the recommendations for taking the stool test vary depending on the organization. The CDC lists it as a “recommended” test, saying you should take it once a year. The American Cancer Society specifically recommends the more modern, accurate version of the test. And the USPSTF gives the test an “Inconclusive” rating, meaning there is not enough evidence to recommend the test as a primary screening tool.

The good news is that tests like this are always been improved, and newer versions of the stool test have shown more and more promise in accurate detecting colon cancer. It is possible that in the coming years, we may see an accurate enough version of the stool test that it replaces regular colonoscopies as the primary means of early detection in patients. But for now, it’s important you talk to your doctor about when to schedule your first colonoscopy – remember, if you catch it early, colon cancer is a beatable disease!

A look at Lung Cancer: When Prevention is the Only Cure

March 31, 2016 by drjaffer

Lung Cancer is an unusual disease in that it was once incredibly rare, so much so that many doctors would never see a case in their lifetimes, and is now a leading cause of death almost entirely due to a single, controllable factor – which just happens to be tobacco smoking. It is also one of the most visible diseases, and is relatively well-understood by the public. We know what causes it, we know it is a fatal disease, and there’s not much debate over these points any more.

Smoking causes lung cancer, and other than a small percentage of cases that arise from industrial and environmental carcinogens, in general exposure to tobacco smoke is the one controllable risk factor for lung cancer. Smokers have ten times the risk of nonsmokers to develop lung cancer, and that’s not including the #2 risk factor, which just happens to be second-hand smoke.

And while there are screening tests for detecting early signs of lung cancer, these tests are limited in ability to help and can carry sizable risks. Screening, while critical in treating some otherwise fatal diseases, cannot keep you safe from lung cancer. In this case, the only realistic solution is abstaining from smoking, or quitting if you already smoke. The earlier you quit, the higher your expected life span and the less likely you are to get cancer, but quitting at any stage of life has a dramatic increase on your life expectancy.

Most people understand the relationship between smoking and lung cancer. They understand that it is an extremely fatal disease that can be prevented in a very straightforward manner, even if it may be hard to do so. But it’s important to also look at the big picture with regards to prevention as a means of achieving better health and preventing fatal diseases.

There are many diseases where prevention, before the fact, is the most reasonable “cure”. Type 2 Diabetes, for example, can be prevented in many people by exercising, avoiding obesity, and eating in a healthy manner. While there are treatments and techniques for managing the disease once it has been acquired, the only safe option is not developing it in the first place! Even better, these same lifestyle choices can help prevent Heart Disease and Strokes, which are among the most deadly and frequent killers of Americans. Cervical Cancer is one of many diseases that can be largely prevented with proper vaccination at an early age. Esophagal Cancer can be prevented by proper treatment of chronic acid reflux disease before it develops into something more.

Remember, you have the ability to manage your own health better than any doctor can. You might not be a medical professional, but you control what goes into your body, when you exercise, and how often you visit the doctor’s office. You have a great deal of power. It’s important to take your role of caretaker of your body seriously!

When Screening Might be a Mistake: Prostate Cancer

March 27, 2016 by drjaffer

Prostate Cancer is the most common internal organ malignancy in men in the United States. Every year, over 30,000 men die from complications of prostate cancer, making it the second leading cause of cancer death after lung cancer in men. All signs point to it being one of the most important cancers for doctors to discuss with their patients and to catch early.

And yet the American Cancer Society (ACS) and the United States Preventive Services Task Force (USPSTF) do not recommend routine blood testing for prostate cancer screening – even though it is effective at detecting cancer early. Why would these groups not recommend screening, in that case? It would seem to be a “common-sense” issue to most patients that an early catch equals an early cure. However, with prostate cancer, the situation is much more complicated.

An early American study published recently found that annual use of blood testing and digital exams (where a doctor physically searches for abnormalities with a finger) detected prostate cancer early, but did not lower the death rate from this malignancy. And while a recent large, well-structured study from Europe found a small benefit of blood testing, on the other hand a preliminary result of a large prostate cancer screening trial published in the New England Journal of Medicine in March 2009 showed no survival benefit from screening.

What this means is that while we don’t have much evidence that catching early prostate cancer allows us to do much about it. Furthermore, there is controversy over whether screening in older men, who might die other natural causes before the cancer took its toll, is actually improving quality of lives or simply encouraging them to undergo difficult treatment that is unlikely to extend their lifespan.

Most doctors still believe that catching early prostate cancer can save lives, and most will tell patients this if asked. Nearly every health organization recommends discussing screening options with your doctor, and knowing the warning signs of prostate cancer in order to make better decisions. But this controversy serves as a reminder that screening, even when it is effective at detecting a disease, is not always the answer for finding a cure.