Breast Cancer The Facts

carol anne riddell: i'mcarol anne riddell. from the newest research questions aboutmammograms and diagnosis to cutting edge technology, we'vegot the very latest updates on breast cancer treatment.science & u! starts now. ♪ [theme music] ♪ dr. max gomez: i'm dr. maxgomez. an unusual controversy has broken out amongst breastcancer doctors. it's over whether everything that's beingcalled breast cancer really is cancer. in other words, isbreast cancer being

over-diagnosed leading topotentially harmful intervention and treatment, notto mention the psychological stress that cancer diagnosisleads to. here's what you need to know. you only haveto ask a few women on the street to realize how emotional an issue breast cancer is for women. female 1: i've got two kids,and i'd want to live as long as i could, so i'd take careof it, probably have a double mastectomyif that's what it took.

female 2: i would dowhatever it took, and again, just thinking of my family,to be around is much more important to me than aminimalist approach. dr. max gomez: one thingthat has helped to ease women's fear of breast cancer isearly detection, the assurance that finding a cancer at itsearliest and smallest stage vastly improves the odds forcure, and breast cancer survival statistics havein fact improved as screening mammograms have becomeincreasingly common. but what

if a lot of what doctors havebeen calling breast cancer really isn't cancer? dr. dawn hershman: there is no doubt that we are over-diagnosing and overtreating breast cancer. as our screeningtechnology has improved, the problem is that we find alot of things that probably have no biologic significance. dr. max gomez: that's notan isolated opinion. a viewpoint just published in the journalof the american medical

association by a group ofexperts advising the national cancer institute recommendschanging the definition of a number of cancers and eveneliminating the word cancer from some common diagnoses. near the top of their over-diagnosis and name-changelist is ductal carcinoma in situ or dcis, stage zero. dr. dawn hershman: we run a realrisk by telling patients with dcis that they have cancerbecause they think of themselves as being at higherrisk than they really are.

really these patients areat risk for developing cancer. dr. max gomez: in fact,years ago, gynecologists changed what they call abnormalcells found in a pap smear. dr. steven goldstein: we usedto talk about different levels of dysplasia and supersevere dysplasia had this name "carcinoma in situ," scaredpatients because it's got that "cancer" word in it. yearsago we changed the nomenclature in gynecology. wenow talk about cin, cervical intraepithelialneoplasia 1, 2, 3, but no longer

use that "carcinoma" wordbecause it wasn't truly cancer. dr. max gomez: in other words,dcis stage zero in the breast is abnormal cells that are arisk factor for cancer and may never become cancer.the fly in the ointment is being able to predict withcertainty what those abnormal cells are going to do. dr. larry norton: the problem is that right now we, just by looking at it, withall the molecular tests we have and looking at theappearance of the microscope,

we can't say with assurancethat what we're looking at is going to be benign or is goingto be indolent, so at the present time, we have totreat everything as potentially dangerous until we get betterat finding out how come some things are dangerousand some things aren't. dr. max gomez: still manyexperts argue that what you call something has animpact on treatment. dr. steven goldstein: it hasmade all the difference in the world for the patients. whenyou told the patient she had

carcinoma in situ, she wantedto do anything yesterday to get rid of it. if you tellsomeone they have cin 3, and we're going to treatthat with a certain kind of treatment, she's not nearly asafraid because it doesn't have that cancer word in it. dr. max gomez: othersargue, "why not be safe and treat all dcis as cancer". thetrouble with that approach is that carries some real risks too. dr. dawn hershman: imean there is no doubt that,

in the world of medicine, bad things happen. you have to be very cautiousabout the unanticipated complications of surgery,radiation, hormonal therapy, of everything that we do becausethings don't always work out exactly as planned. dr. max gomez: and that'sthe concern here that many women may be having treatmentsthat have side effects, both physical and emotional,that are actually worse than the abnormal cells themselves,but until science can figure

out which abnormal cells aregoing to become invasive cancer down the road, womenneed to have a very serious discussion with their doctors,realizing that dcis doesn't necessarily mean cancer. i'm dr. max gomez forscience & u! carol anne riddell: i'm carolanne riddell. breast cancer, it can be a devastating andoverwhelming diagnosis for patients and their families,but as cutting-edge research shows, knowledge is a powerfulweapon against the disease.

breast cancer survivor marjorieschwartz knows exactly what it feels like in thosedays following diagnosis. marjorie schwartz: my own cancerwas found on a sonogram. i did not know what to do, likealmost every other woman. i was totally overwhelmed. carol anne riddell: that was eight years ago. now marjorie works with otherwomen through the support organization share. sheencourages them to do their research because so much haschanged when it comes to

treating breast cancer. marjorie schwartz: they feellike a bomb has been dropped into their lives, and of coursea bomb has been dropped into their lives, but we urge themto take the time to figure out their diagnosis and not act tooquickly so that they do the right thing. each womanreally has to figure out her own pathology with her doctorand chart a course that's very individualized, much more sothan it has ever been in the past.

carol anne riddell: heathermcarthur, a breast cancer doctor at memorial sloan-kettering cancer center, explains why an individualizedapproach is so important. breast cancer is nota single disease. dr. heather mcarthur: just asthough each individual on planet earth is unique anddifferent, each tumor is unique and different. carol anne riddell: dr. mcarthuris working on cutting-edge research here in immunotherapy.the goal: to train a patient's

own immune system to recognizeand fight cancer cells so that, after the patient'sbreast cancer is cured, it doesn't come back. dr. heather mcarthur: whatwe're doing is combining freezing of the tumor tissueto create tiny little tumor fragments that are moredigestible to the immune system because a big lump of tumortissue is difficult for the immune system to process, buttiny little tumor pieces are much more digestible, so wefreeze the tumor with a process

called cryoablation, which isjust a medical term for freezing, and then administeran immune-boosting drug so that an individual can developa robust immune response to all those individual tumorfragments. in other words, you're not just focusingon one specific feature. you're allowing the thousandsif not millions of features to present themselves to the immunesystem with the hope that, at a later date, if the bodywere presented with that information again in the formof a reoccurrence, that your

own immune system wouldrecognize that because it had developed memory, and wouldtherefore attack any cells that had that information. carol anne riddell: it almostsounds like the stuff of science fiction, our own bodiestaught to recognize and attack our own specific cancer. dr.mcarthur says that the work is part of an ongoing clinicaltrial and experimental at this point, but she believes in thepromise of immunotherapy. dr. heather mcarthur: my dreamis that this becomes standard

of care. the only way that wemake any advancement in this field, the only way that we movethis field forward is through research. carol anne riddell: the goodnews, experts are learning more about breast cancer all thetime, so for patients that means more potentialto beat the disease. i'm carol anne riddellfor science & u! tinabeth pina: hi, i'm tinabethpina. now, while the benefits of a mammogram are notdisputed, there are still

questions behind what age tostart regular screenings. dr. jiyon lee: what we knowis that annual screening mammography starting at age 40has been shown to decrease breast cancer-related mortality.now it's not going to save every life. there are lots ofreasons for that but people's chances of surviving breastcancer are extremely high if they're getting the annualscreen mammography than if they're not. tinabeth pina: dr. jiyon lee isamong those in the medical

community who concur withthe latest data that encourages average-risk women to starttheir baseline mammograms at 40. the harvard universitystudy of 7,300 breast cancer patients found that more thantwo-thirds of breast cancer deaths occurred in younger womenwith no history of mammography or with intervals of two yearsor more between screenings. unscreened women accountedfor 71% of breast cancer deaths over an 18-year period, and themedian age with a fatal diagnosis was 49.

dr. jiyon lee: this is just thelatest of many, many, many studies that have been goingback to reinforce the very same thing. we know for a factthat a good 20-25% of breast cancer diagnoses are womenin their 40s, and this is one of the reasons why we feel sopassionate about making sure we don't give up thisfight, but i also want to make sure that people understandthat when they're under 40, there's nothing protectiveabout that necessarily. it's just that the odds areless, so women in under 40 age

group probably comprise about5% of the cancer diagnoses, so that's not 0, so that's whyit's important for people to still be doing things likechecking themselves, being aware of changes in their body, makingsure that they're getting regular physical exams withtheir physician, and if it means coming in for a mammogrambecause that's part of the evaluation for anything,then absolutely we're happy to see them. tinabeth pina: accordingto a controversial study

released four years ago by theu.s. preventative services taskforce, women were toldthat they could wait until they were 50 before getting regularmammograms, and could get them every other year. dr. jiyon lee: since then, ithink the only really silver lining around this dark cloudis the fact that now there's been such a proliferationof new research that has specifically looked at thosecriticisms, and further validated and reinforced whatwe still believe are the right

recommendations toput forth all along. tinabeth pina: accordingto the american cancer society, the earliest breast cancersare detected by mammograms, and they decrease breast cancerdeaths by 30%. cancers detected in early stages have a 98% curerate. nevertheless, mammograms do have their limitations. dr. otis brawley: womenalso should be told of the limitations of mammography at this time, that is that women who get mammograms, some willbe called back because they

have abnormalities that turn outnot to be cancer. another important limitationis some cancers will be missed by mammography and clinicalbreast exam. dr. jiyon lee: breast densityis the main limitation, and we know that. that's not somethingthat anybody has ever kept a secret, so we know that aboutbreast density, and we know that about mammography, but wealso know that mammography, not only all the strength andthe volume of the data behind it, but because it's still thebest test for looking for

calcium deposits which are oftenfrequently a sign of an early breast cancer. it doesn'thave to be. a lot of calcium is benign, but it can bethe early sign that we see, even in a dense mammogram. dr. otis brawley: we'reactually hoping that medicine and indeed engineering isgoing to give us some better tests, something much betterthan mammography to help us identify breast cancer. dr. jiyon lee: something calledtomosynthesis, some people

refer to it as 3d mammography,but it's a way of using the same low-dose x-ray technologyto go thin section by thin section through the breast usingequipment we already have, and that'll allow us to getthrough the dense breast tissue layer by layer to help us findthings that could otherwise be obscured, so that issomething, that is a version of mammography doing even betterwith the technology that's already standard of care.the screening mammography was designed to be annual for areason. it's so that it can do

its best job picking up truechanges that really turn out to be cancer, but otherwise nothaving to worry about all kinds of other little things that turnout not to be. tinabeth pina: the bottom lineis you need to get a mammogram but it's up to you and yourphysician to figure out a screening plan basedon your personal risk. for science & u!,i'm tinabeth pina. magalie laguerre-wilkinson: i'mmagalie leguerre-wilkinson. we're here at memorial sloan-kettering cancer center's

department of clinical genetics.we'll talk to an expert about the now known brca1 and 2 genemutations. the term brca1 and brca2 gene mutations,also known as brca1 and brca2 became somewhat familiara few months ago when the actress angelina jolie wentpublic with a very private decision, a preventive doublemastectomy. she's not alone, though, in that decision. manywomen in the united states who carry that same genemutation have done what

the hollywood star feltwas her only option. dr. noah kauff is the directorof ovarian cancer screening and prevention in the clinicalgenetics and gynecology services at memorialsloan-kettering cancer center. dr. noah kauff: i think asyou're putting into context whether or not risk reductionstrategies are drastic, i think you have to understandthat the risks are quite substantial and very real,and that given the magnitude of the risk, that moreaggressive risk reduction

strategies arelikely warranted. magalie laguerre-wilkinson:according to the american cancer society, breast canceris the second leading cause of death in women, lungcancer being the first; and while women who arenon-carriers of the brca1 and 2 gene mutations havea 2% chance of developing breast cancer by age 50, carriersof the gene mutation are at greater risk. dr. noah kauff: for women withmutations in brca1 or brca2,

rather than having a 2% chanceof developing breast cancer by age 50, their risk is26%-39%, so anywhere from a 1-in-3 to a 1-in-4 chanceas opposed to 1-in-50 for women in the general population. magalie laguerre-wilkinson:brca1 and brca2 were identified in 1994 and 1995, and sincethen, it has been the hope of geneticists and researchersalike to identify the gene mutation in its early stages. dr. noah kauff: there are anumber of things, a number

of red flags which would suggestyou should have an evaluation by a cancer geneticsprofessional. those would include if you have a familyhistory of breast cancer prior to age 50, and that would be notjust in yourself but close relatives on either yourmother or your father's side of the family. magalie laguerre-wilkinson:while preventive mastectomy can be a radical choice againstdeveloping breast cancer and often a very difficult decisionfor women, dr. kauff says there

are methods beyond a regularmammogram they need to be aware of to aid in preventionand earlier detection. dr. noah kauff: we actuallyknow that mammography alone in women with brca1 or brca2mutations will miss over 60% of the cancers, and given thatboth the american cancer society and the nationalcomprehensive cancer network recommend screeningwith a combination of both mammography and mristarting no later than age 30 in the setting of a womanwith a brca1 or brca2.

additionally, one of thecornerstones of prevention of breast cancer in women withbrca1 or brca2 mutations is actually removing the ovariesafter childbearing is complete but before menopause. doingthis will reduce the risk of breast cancer in women withthese mutations by 40%-70%. magalie laguerre-wilkinson:experts do say that as treatment and research evolve,preventive surgery may no longer be the onlylife-saving option. i'm magalie laguerre-wilkinsonfor science & u!

donna hanover: i'm donnahanover. the number of young women being diagnosed withbreast cancer each year has been increasing. that raisesquestions about why the numbers are going up, how wefind breast cancer, and what these young women face. mabel harrison: thereis zero cancer in my family. kira goldberg: they even called while i was at this appointment, and i said "hi" andpretended i wasn't sitting in a breast surgeon'soffice in a hospital gown.

marlena ortiz: when hesaid i was going to lose my hair, that's when i waslike, "oh no, no, no, no. it's not going to work. idon't think so." millet lopez: even today at fiveyears out, i'm constantly thinking about recurrence. donna hanover: as a youngmother, what was going through your mind? anna solomou: that iwas going to die and leave my child without a mother.

donna hanover: columbiadoctorsmidtown breast cancer surgeon, dr. margaret chen, says althoughpreviously only 5% of breast cancers appeared in women under 40, the number is dramatically increasing. dr. margaret chen: the notionthat young women do not get breast cancer, that is amyth, that is not true. there was a recent report in thejournal of american medical association that found therate of breast cancer in these young women between the agesof 25-39 has actually doubled in

the past 34 years. donna hanover: at a recentgathering, several women who were diagnosed with breastcancer in their 20s and 30s revealed a common problem. theyor their doctors delayed taking action when they found alump. mabel harrison, who's a registered nurse, delayedbecause 10 years prior she had a cyst. mabel harrison: so flashforward to let's say last year around this time, i noticed a lump on the left breast,

and i thought, "oh, it's a cyst,i'm not going to worry about it." i promptly delayed forfive months until i noticed the nipple itself was not asreactive as the right side, and being a nurse, i knewthen that it was not a cyst. donna hanover: marlena ortiz didgo to the doctor right away. marlena ortiz: she just touched it and told me it was a fibroid and to come back in six months. donna hanover: delay is abig problem because, when breast cancer occurs in womenunder 40, it's often more

aggressive and faster growingthan in older women. it also raises issues offertility, which kira goldberg says her doctors failed tomention. kira goldberg: you can't havekids while you're on tamoxifen anyway because it causes birth defects because it deprives your body of estrogen.they just said, "here, take this for five years," so i'mtold it shouldn't be a problem, but in reality who knows what atleast five years of estrogen deprivation will do to a20-something.

donna hanover: some young women,especially if they'll have chemo, do go through thecomplex process of harvesting their eggs. marlena ortiz: it wascrazy expensive, so on top of cancer being so expensive.my parents pushed for it more so i did it. donna hanover: anna solomou made a different choice. anna solomou: i was reallyworried about my life and just saving my life, to be therefor the 8 year old that i had,

and i didn't want to leaveanother baby behind if something happened,god forbid. donna hanover: besidesgetting treatment, many young women want to do more tofight back. millet lopez, a partner at squeaky wheelmedia, gave information for the new book getting things offmy chest by melanie young. millet also createdan award-winning website called ihadcancer.com. millet lopez: it was builtso that anyone who's been

affected by cancer canconnect with others who've been through a similarsituation. donna hanover: marlena alsocreated a website beatingcancerinheels.org thatincludes beauty advice like dressing with a mastectomy,drawing eyebrows, and styling head wraps. in studying thereasons more women this age are getting breast cancer,researchers have found an increase in estrogenreceptor-positive cancers, meaning they seem tobe fed by hormones.

dr. margaret chen: we thinkthat this is probably related to lifestyle factors andhormonal factors, so things such as less breast feeding,such as women having children when they're older, older thanthe age of 30, having fewer children, being on hormones. donna hanover: likebirth control pills. dr. margaret chen: right,exactly, and being less active in their lifestyle, eating moreof a meat and sweet diet. donna hanover: in any case,many of these women find

strength in full-out facing thereality of the moment. anna solomou: being baldwas very liberating. mabel harrison: i just stoppedwearing my head wraps and hats and stuff and just startedrocking the henna, and people were funny. you know, likeon subways, before they would never say anything withthe headscarf, but now they're, "i love what you did," "areyou a survivor?" and i hear a lot of people, "i wish i haddone that." well, "you know, you can still shave your head"is usually what i tell them,

and they're like "no." donna hanover: but it's a wayof taking your self back. mabel harrison: taking controland a little bit of "dammit, cancer took my hair but i'mgoing to take my beauty back." donna hanover: as many youngwomen with breast cancer have discovered, sticking togetherto find information about treatments, facilitate research,and discuss the choices they have to make gives themstrength in facing the future. i'm donna hanover for science & u!

mike gilliam: i'm mike gilliamfor science & u! breast cancer is devastatingin minority communities, and the mortality ratesare even higher in poor, underserved neighborhoods,but one organization is bridging that gap. projectrenewal is running something called the scanvan. for the last 27 years,mary soloman has been running the scanvan.she's been bringing mammograms to women who areuninsured or who live in

underserved communities. mary soloman: scanvanis a wonderful program. what we're able to do iswe're able to provide women, regardless of whether or notthey're insured, uninsured, we're able to provide them witha screening mammography, a clinical breast exam, and,in the case of the uninsured, we're also able to providethem with free pap testing, cervical screening testing,as well as free colorectal screening testing as well.

mike gilliam: now, you'reserving communities that are underserved. why isthat important? mary soloman: there's a bigdisparity between the, shall i say, haves and thehave-nots. we know that part of the problem is it's moredifficult for the underserved not only to be screenedbut to be provided with timely follow-up and timely treatmentand consistent treatment. mike gilliam: and, while thereare more cases in white women, the mortality rate among africanamerican women is greater

and is declining at a slowerpace than their white counterparts. rates for latinasand asians are generally lower. follow-up care is a problem. mary soloman: part of theproblem is the system. it's an unwieldy system, verydifficult sometimes for patients to navigate, especiallyif they don't speak the language, especially if theyperceive that this was going to cost them a lot of money.these problems are also rooted in just the way patientslive their lives, the amount

of responsibilities they havearound their homes, their jobs, just putting food on the tableis an effort. now we're just piling on with this additionalneed to perhaps go to a hospital every day for treatment. thisis a huge barrier or this a huge problem for a lot ofpatients. mike gilliam: the scanvan goesout every week to various community centers and healthcenters where they conduct mammographies. female 3: this is very excellentfor the community and for

low-income people and forelderly that cannot travel. mike gilliam: mira sulamagreavywas screened at a scanvan, and she says it savedher life. her son david was two-and-a-half years old,and she had just stopped breastfeeding when she noticed alump on her breast. mira sulamagreavy: i didn'treally pay any attention to it. one day i just said, you knowwhat, i'd better try to get this free mammogram because ididn't have health insurance, and i'm glad that i did thatbecause, if i hadn't done it,

i would have never found outthat the lump that i had was not a buildup of milk, but itwas actually breast cancer. i totally felt horrible becauseall i could think of was who's going to take care of david?who's going to take care of lloyd? mike gilliam: but treatmentsaved her and her family, leading to thisheartwarming moment. david: thank you for my mommy. mira sulamagreavy:: i am sothankful for life. there's no

such thing as a bad day becauseevery day that you have breath in your lungs,it's a good day. mike gilliam: mary says thescanvan screens about 5,000 women a year. it allstarted when her mother realized something was wrong with mary'sgrandmother. mary soloman: she wasdiagnosed with a very early stage breast cancer, thankgoodness, simply because my mother stumbled uponit. she was treated, and my grandmother lived to 93 anddied of a stroke,

not of breast cancer. mike gilliam: that incidentprompted mary's mother, diana trulio, to found thewomen's outreach network, the first modern mammographyvan in the city in a very long time. that was back in 1983.her mother did some research and eventually contacted dr.phillip strax, who had run mobile vans and conducteda study into mammography years earlier. a short timelater, mary joined her mother on the van and has been helpingwomen ever since.

mary soloman: i joined mymother in 1987, and together we were screening women forseveral years together, and in 1999, my mother's breast cancerwas found during a routine screen onboard one of ourscanvans, and my mother today is 80 years old, and she'swell, and she's well because her breast cancer was foundat the very earliest of stages, and she was treated, and shewill remain well, and she will be cancer-free for the restof her life only because of screening mammography.

mike gilliam: and she has amessage for all women. mary soloman: i don't wantto hear the excuse, "it's not in my family." i don't want to hearthe excuse, "i can't afford it." if you have not had amammogram in the past year, and you are 40 years or older,you need to have a mammogram, every year, and we stand hereready to provide it to you if you have no insurance or ifyou don't know how to access a mammographer in your area. mike gilliam: so the bottomline is follow the advice of

health professionals and getthose mammograms. they will allow you to livea longer, healthier life. i'm mike gilliamfor science & u! carol anne riddell: that'sour show for today. i'm carol ann riddell.we'll see you next time on science & u!