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Women’s Cancer Q&A: Advances in Care

WebMD’s women's cancer expert, Harold J. Burstein, talks to WebMD's chief medical editor about treatment advances, research breakthroughs, and the prognosis for the future.

Women hear a lot about the benefits of a low-fat diet and exercise, and popular rumors advocate avoiding chemicals such as those in antiperspirants. What’s your take on breast cancer prevention strategies? continued...

However, the one risk factor that’s different is heredity. It’s clear that women who have a strong family history of breast or ovarian cancer have a greater risk of developing breast cancer themselves.

And we know now that there are at least two specific genes associated with both cancers: BRCA1 and BRCA2.

Common sense suggests that habits such as getting more cardiovascular exercise and eating more fruits and vegetables are good for everyone’s overall health. But it’s not clear that avoiding red meat, going on an all-vegetarian diet, drinking red wine, eating soy or avoiding soy, or similar actions will lower the chances of being diagnosed with breast cancer.

You mentioned genes earlier, and certainly BRCA1 and BRCA2 are in the news. Also, I see the occasional study looking at other genes that may or may not predispose women to breast cancer, or that may point to their getting a more aggressive type. Given this, should women seek out genetic testing or be more proactive in learning about their own genetic profile?

Not really, because breast cancer’s hereditary risk factors probably account for only 5% to 10% of cases. However, genetic counseling may be useful for women who do have several relatives who have had breast or ovarian cancer; or women from families where breast cancer strikes at a very early age, typically younger than 40; or women who have had breast and ovarian cancers -- these all could signal a possible hereditary risk.

What about mammograms? Experts say they are the best detection we have, although not everyone agrees on how effective they are.

Mammography is a remarkably effective tool. That said, it is not a perfect tool, and that’s where the controversy lies. Even though it’s the best screening tool we have, it can still miss breast cancers in some women. And in other women mammograms may indicate something abnormal, but further testing shows there’s nothing to worry about. So some women undergo what some consider to be unnecessary testing, including a possible biopsy.

There is also debate about which women might need something more than a mammogram. For example, some women have dense breast tissue, which makes it more difficult to detect a tumor with a mammogram screening.

Even so, my view is that there’s no question women should get mammograms on a regular basis starting at age 40. There’s no question that the last decade’s decrease in breast cancer death rates in the United States and Western Europe is due in large part to public health programs such as widespread mammography.

The news on the screening front right now is trying to figure out who needs extra testing and what tests we should give. The most commonly discussed “other test” is the MRI, a very sensitive technique that allows a radiologist to look in more detail at breast tissue, to pick up smaller abnormalities that may be difficult to see or may be hidden on a mammogram.

Still, while our threshold for ordering an MRI has gotten lower, not every woman needs an MRI.

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