Study: Mammograms haven’t cut rate of advanced breast cancer

BOSTON, Massachusetts –
A new report raises fresh questions about the value of mammograms. The rate of cancers that have already spread far beyond the breast when they are discovered has stayed stable for decades, suggesting that screening and early detection are not preventing the most dangerous forms of the disease.

The report, in Thursday’s New England Journal of Medicine, is by three prominent cancer specialists and is based on federal statistics going back to the 1970s.

It comes a week after the American Cancer Society scaled back its mammography advice, saying most women should start annual screening at age 45, not 40, and switch to every other year at 55. A government task force recommends even less – every other year starting at 50.

“We’re undergoing what I think for the public is a very confusing debate” about screening, but it’s really “a course correction” prompted by more awareness of its risks and benefits to various groups of women, said Dr. H. Gilbert Welch, a health policy expert at Dartmouth Medical School. “All they heard for years was, ‘there are only benefits.’”

He is the lead author of the report, co-written with Dr. David Gorski of Wayne State University School of Medicine in Detroit and Dr. Peter Albertsen of the University of Connecticut Health Center in Farmington.

“Screening offers hope that cancer can be detected in an early, localized phase when it’s more amenable to treatment,” they write, but that assumes that cancer starts in one place, grows and then spreads. If that was always true, screening would reduce the rate of advanced cancers.

And that has not happened. The rate of breast cancers detected at an advanced stage has been stable since 1975, despite wide use of mammography since the 1980s. The average age of women diagnosed with cancer also has remained around 63, another sign cancers are not being found sooner.

The trends suggest that some breast cancers are already “systemic” or widely spread from the start, and that finding them sooner has limited impact.

“Screening mammography has been unable to identify those bad cancers, destined to become metastatic, at an earlier stage. That doesn’t say mammography doesn’t help less aggressive cancers,” but those are less likely to prove deadly, Welch said.

Dr. Barnett Kramer, a screening expert at the National Cancer Institute, said the report shows the limitations of mammography.

“I wouldn’t want to say it has had no effect but it certainly has not lived up to the anticipated effect,” he said. For every tumor detected early because of mammography, “you would hope to see … an equal reduction in metastatic disease, and that has not occurred.”

The situation is very different with prostate cancer. The rate of advanced cases of that disease has been cut in half since screening with PSA blood tests came into wide use around 1988, and the average age at which men are diagnosed has fallen – from 72 to 70, the authors write.

However, this does not prove PSA testing is good. Shifting the stage at which a disease is diagnosed is “only the first step for successful screening,” which also has to save lives to be worthwhile, Welch said. “Just because you find something earlier doesn’t mean you can change its course.”

Again, Kramer agreed. Prostate screening, “when put to a definitive test, did not show a clear reduction in prostate cancer mortality” in large, rigorously done trials, he said.

The government task force recommends against PSA testing, and says its risks outweigh its benefits for most men.

“Screening is a close call,” Welch said. “My guess is few people are helped” by prostate or breast cancer screening while many are harmed by false alarms that trigger unnecessary tests and treatments, he said.

Recovering from breast cancer: What next?

When a woman is undergoing breast cancer therapies, she is usually focused on dealing with side effects and just getting through the treatment process. But once treatment ends, she may find herself overwhelmed with questions and concerns about the future.

Knowing what to expect during recovery may help with the transition.
Physical health

Women who have been treated for breast cancer will continue to see their oncologists (cancer physicians) on a regular basis — initially every three to six months.

It is important to keep these appointments so that your physician can monitor your health closely. Sometimes there are lingering or even new side effects associated with breast cancer treatment, such as skin that is red and sore from radiation, or lymphedema — the build-up of fluid that results in swelling of the arm and hand. (If axillary lymph nodes were radiated or removed during surgery, lymphedema may occur anytime during or even years after treatment.)

It’s important not only to be aware of common side effects, but to share any questions or concerns with your physician so that issues can be resolved as quickly as possible.

Following cancer treatment, women often report ongoing fatigue, extreme tiredness and exhaustion that doesn’t go away with rest. You will need to listen to your body and balance activity with relaxation. Often women find they can slowly build up their stamina through an exercise routine. This may initially involve short walks and progress to more rigorous activity. Though exercising may be your last concern, it will help you to feel better physically, emotionally and psychologically. Just start out slowly and build your stamina gradually.
Emotional and psychological health

Breast cancer not only affects a woman’s physical health, but also her emotional, psychological and spiritual health and that of her family and friends.

Many women find it hard not to worry about the cancer coming back. This is a very common concern, and it may take some time for those fears to lesson. If you have not joined a support group — either in person or online — this is an ideal time to form that relationship. Dealing with cancer can be a lonely experience, and the benefits of being able to share concerns, questions and experiences with others who can relate to your situation cannot be overstated.

Your relationship with your spouse or significant other, as well as family and friends, may have changed or may still be evolving. Recognize that this is a common occurrence for individuals dealing with a variety of traumatic experiences, and give yourself and members of your support system time to adjust. Most importantly, don’t hesitate to seek help from your physician, a counselor, a pastor and other professionals who may have resources for you.

The American Cancer Society website has a wealth of information and links to resources. If you haven’t visited the ACS site (www.cancer.org), it is a great place to begin your recovery journey.

During the month of October, CRMC is encouraging women to schedule their mammogram by making calls to women who are overdue for their mammograms to remind them that it is time for this important screening. Women will be able to make appointments at the time of the call at convenient hours and locations to meet their needs. Why wait for a phone call? If you haven’t scheduled your mammogram, please consult your care provider or call us at 717-245-5244

Carlisle Regional Medical Center raised over $20,000 in 2014 in support of Relay for Life, the PA Breast Cancer Coalition and Making Strides.

Julia Blum M.D. is a Pennsylvania native. After graduating magna cum laude with a bachelor of science in engineering from the University of Pittsburgh she attended Washington University School of Medicine in St. Louis. She completed her residency at Johns Hopkins University and is board certified in Radiation Oncology. She has been practicing in the central Pennsylvania region for the past 14 years and is pleased to join the Carlisle Regional Cancer Center providing comprehensive treatments.

October is National Breast Cancer Awareness Month. This is the last article in a three-part series written to help women understand more about this disease. Previous articles focused on early detection of breast cancer and treatment options.

Disclaimer: Remember that this information is not intended to replace the advice of your doctor, but rather to increase awareness and help equip patients with information and facilitate conversations with your physician that will benefit your health.

Local tattoo artist aids in breast cancer recovery

Getting diagnosed with breast cancer and undergoing treatment is traumatic enough, but for some women who have had mastectomies to remove the cancerous cells, the effects are devastating.

One area tattoo artist has found a way to help alleviate some of the stress and depression these women suffer after surgery.

Becky Olson of Oak Grove has a shop on King Road, The Body Shop Ink LLC, where she does paramedical tattoos. This includes eyebrows and eyelashes for those who have lost their hair during chemotherapy, as well as areola tattoos for those who have had mastectomies.

“I started doing tattoos back in 2003,” Olson said. “I learned to do it in Baton Rouge at the Permanent Cosmetic Institute, then did an internship in Ocean Springs for nine months at the Permanent Make Up Clinic.

“I did have to get a special certification to do paramedical tattoos, but I knew this was something I needed to do because it is the last step in the recovery process (from breast cancer).”

Breast cancer survivor Dawn Gillis, 69, of Hattiesburg said getting the areola tattoos changed her life.

“It is unbelievable what this did for my self-esteem,” Gillis said. “It made me feel whole again. Like nothing was missing from me anymore.”

Her husband, John Gillis, 72, agreed the tattoos helped Dawn regain self-confidence.

“I could tell it affected her and she really felt conscious about it because she didn’t feel quite complete,” John Gillis said. “So when she got the tattoos done, it did a ton of good for her.”

Dawn Gillis, who was diagnosed with breast cancer in 1997, had previously gone through breast reconstruction. It was her doctor who recommended getting the tattoos.

“The doctor I went to recommended doing the 3-D tattoo because it would cost less and take less time,” Dawn Gillis said. “It used to be you could get the reconstruction covered by your health insurance but now you can’t, so that’s an incentive to do the 3-D tattoo, and that’s how I met Becky.”

Dr. Mike Cheng, a radiation oncologist who practices at the Forrest General Cancer Center, said areola tattoos can enhance breast reconstruction.

“When you get a mastectomy they remove the whole breast, so even if you get a breast reconstruction, it is just a mound of flesh on your chest,” he said.

Dawn Gillis said the reconstruction process is long and expensive.

“When you go through reconstruction, the nipple tattooing is the last part,” she said. “What they do is take some tissue from your leg to reconstruct the nipple and then they tattoo the skin to resemble the natural color of a nipple and areola. I went through the whole thing roughly two years after I had my mastectomy. It took months of appointments and thousands of dollars to get through.”

Olson said areola tattoos cost around $600.

Breast reconstruction can sometimes cause other problems, Olson said.

“Even when you do the reconstruction, what they created can necrotize (the tissue will die), so anyway you are back to square one,” she said. “What I do is just do a tattoo on the skin to make it look like there was a reconstruction.

“A session takes about an hour and 20 minutes, and the only difference between what I do and a normal tattoo is that I use a local anesthetic.”

Olson has plenty of experience with paramedical tattoos. She worked with the Hattiesburg Plastic Surgery Center and Hattiesburg Clinic, where Gillis was one of her first clients.

She opened her own shop in March and still receives referrals from area doctors.

“As of today, I’m sure I’ve done over 100 tattoos,” Olson said. “I know I do roughly 14-16 a year, and I’ve been doing this for 10 years, so you do the math.”

Her work looks realistic enough to pass inspection.

“I’ve seen some of the work and it does look real from a distance,” Cheng said. “I think it’s good work.”

Even the patients are satisfied with Olson’s work.

“When I saw it I thought it was real,” Gillis said. “I was so excited to show my husband, who thought it looked real as well. When I went for my appointment to see my gynecologist, even he said it looked real, and he already knew what I had gone through with all of my procedures.”

John Gillis said he could see the difference the tattoos made in his wife’s life.

“Doctors don’t realize the impact going through all of that has on a woman,” he said. “It’s a horrible process, so Becky being able to do this for Dawn made a world of difference.”

Olson said she hopes to continue her work for the foreseeable future, and is training fellow tattoo artist Joey Boone to do paramedical tattoos, because she does not know of many others in the Pine Belt who can do them.

“The thing is that breast cancer does not discriminate,” Olson said. “You can get it at any age, no matter your lifestyle or background or even your gender. They are still not sure what actually causes breast cancer, unlike other cancers you can get.

“When going through a mastectomy, you take away a woman’s femininity. She doesn’t feel whole or like herself, and all she can see is what she has lost. Building the confidence in these women means more to me than anything, even more than the money.”

Dawn Gillis knows that firsthand.

“A procedure like what I went through really affects women who are not strong within themselves,” she said. “There have been cases of husbands leaving wives based on mastectomies, so this could really help the women who have to go through this.”

Using physical therapy to recover after breast cancer surgery

BILLINGS -Chemotherapy and radiation therapy are treatments many are familiar with because of breast cancer. But two treatments that often go unheard of until someone is diagnosed are lymphedema therapy and physical therapy.

Women at all stages of a breast cancer diagnosis find themselves in the hands of therapist, guiding them through the exercises. Jennifer Gilbertson, 44 of Billings, is a breast cancer survivor on the road to recovery following her 2014 diagnosis.

“It’s been kind of a rocky road. Kind of a rollercoaster is what I would call it,” Gilbertson said.

Gilbertson has been through a laundry list of breast cancer treatments, including chemotherapy, radiation and surgery. ”I’m on the back end of it and doing really well and had a lot of positive support from everyone around me, family and friends,” she said.

A new, unexpected yet welcomed part of that support group is Jennifer Haarr, a physical therapist and certified lymphedema specialist at Billings Clinic. ”Oftentimes they come to see me and they don’t really understand why they’re seeing a physical therapist for breast cancer,” Haarr said.

The reason is scar tissue builds up and muscles get tense following radiation and surgery. With sessions on and off for the past year, Gilbertson is undergoing yet another round of therapy following her recent surgery.

“I’ll be going back to see her again to do some continuing stretching and range of motion, which is very important because it helps in everyday activities,” Gilbertson said.

“My hope is that she feels like she is better and she is recovering more quickly because of it,” Haarr said.

Depending on the severity of each patient’s case, therapy visits can be as few as two but as constant as once a week for several months.

For Haarr, now on her eleventh year of working side-by-side with women like Gilbertson, guiding patients through the movements has become a labor of love as she tries to get them back to doing the activities they enjoy the most.

“I feel like I’m right where I need to be and I feel like I walk away stronger and better for the people I get to work with,” Haarr said.

Strength can also be found in the bonds she creates while working with patients at their most vulnerable moments.

“They get to know you personally, everything you’ve been through. You can laugh together, cry together, and it’s such a great experience to have that. It really is,” Gilbertson said.

Reach to Recovery Program Helping Breast Cancer Patients

The American Cancer Society Reach to Recovery program is helping cancer patients get support from cancer survivors.

TALLAHASSEE – More 290,000 women will be diagnosed with breast cancer this year. It means making big decisions about treatment plans and so many other things. That’s why emotional support is another important part of getting better.

A breast cancer diagnosis doesn’t just affect the person with the disease; it also changes their family and friends.

While their support is necessary, sometimes a patient needs a different kind of shoulder to lean on— someone who’s been there and survived.

That’s what the American Cancer Society’s Reach to Recovery program is all about.

Jackie Batchelor was diagnosed two years ago with stage zero breast cancer.

“There’s no cancer history in my family whatsoever and we’re all girls so I thought they got it wrong,” Jackie says.

At 47-years-old, Jackie chose to have a bilateral mastectomy.

“I didn’t want to have that worry in the back of my head every year to be screened again: oh my god…did it come back.”

During that time, her surgeon asked if she wanted to talk to someone.

“I said absolutely. I think I need that because it’s different…your family’s there…they love you, they cry with you and I needed something more.”

That ‘something more’ turned out to be Thersha Cowley and Reach to Recovery.

Breast cancer survivor Thersha Cowley says, “We are there to provide emotional and practical support to women who’ve been diagnosed or are living with cancer.”

The reason Thersha and others volunteer with Reach to Recovery, is that they know about breast cancer first-hand.

“This year will be my ten year anniversary,” Thersha says.

The first time Thersha called, Jackie says it felt like they’d known each other for years.

“She gave me that support. Things I didn’t even think about, questions I didn’t even… I didn’t even know. She was helping me get to the other side to recover,” Jackie says.

For Jackie and Thersha, what started out as a shoulder to lean on, quickly turned into a friend to laugh with.

“You have a connection with every patient in that: I know how you feel, I know your fears. I understand the uncertainty. When you meet someone like Jackie, it goes beyond that. It is so exciting that we can do these things together,” Thersha says.

That now includes Reach to Recovery.

A 2-year survivor, Jackie just finished her training to become a volunteer.

“Knowing what Thersha did for me, the way she is, the resources she provided to me. I knew I had to give back,” Jackie says.

Now they both are. Showing other women who are going through breast cancer that they can come out on the other side as a smiling survivor.

To become a Reach to Recovery volunteer, a person must be one year out from their treatments, that way they can be emotionally ready to support others. They also have to go through training and a lengthy interview process.

If you would like to be connected to a Reach to Recovery volunteer, call the American Cancer Society at 1-800-227-2345.