All in the Family: breast cancer and genetic testing

A recent episode of The Today Show featured three sisters with a rare similarity:  they all have breast cancer and were diagnosed in the same year. All three have the genetic mutation that increases risk for breast cancer and have a family history of breast cancer. 

Because family history and genetics can play a role in a woman’s risk for breast cancer, we asked Teresa Helsten, MD, assistant clinical professor in the UC San Diego School of Medicine Division of Hematology-Oncology at Moores Cancer Center three questions about if and when a woman should receive genetic testing for breast cancer.

Question: How can a woman know if she should be tested for this genetic mutation?

Answer: Above all, any woman (or man, in the case of breast cancer) who is concerned about the possibility of carrying a genetic mutation for breast/ovarian cancer should consult with her physician. Physicians may provide counseling or refer patients to trained genetic counselors for evaluation.

Things that might make a woman think about her risks include the following:

  • A family history of breast and other cancers: Think about both sides of the family (mother’s and father’s sides) and think about family members up to and including two generations away (up to and including grandparents or grandchildren). Any family that has two or more members with breast cancer or breast and ovarian cancer on the same side of the family, particularly if anyone has had breast cancer when younger than 50 years old, or has had two separate breast cancers. Any men with breast cancer.  Breast cancer and one of the following cancers on the same side of the family: thyroid cancer, sarcoma, adrenal cancer, uterine (endometrial cancer), stomach (gastric) cancer, and leukemia/lymphoma.
  • Being from a population at risk: People of Ashkenazi Jewish descent have a higher risk of carrying a BRCA1/2 mutation.  Women who are Ashkenazi Jewish may not need to have as strong a family history of breast and other cancers to be considered for testing. However, women of Ashkenazi Jewish descent with no personal or family history of breast cancer are probably not at risk.

Q: Once tested and the gene is present, what are a woman’s options?

A: If a woman is found to carry a genetic mutation that increases her risks of breast and ovarian cancer, there are several things to think about:

  • What about screening for other family members? A trained genetic counselor or physician can counsel as to who should consider testing and how. When in doubt, other family members can discuss with their own physicians.
  • Does she want to do anything to reduce her risks of developing breast and ovarian cancer? If so, she will need to discuss carefully with her physician to help make the right decision for her as every case is unique. Options include increased surveillance (which doesn’t lower the risk of cancer, but increases chances of detection); taking risk-reducing medications (e.g., tamoxifen); and surgical removal of breasts and/or ovaries. For example, removal of both breasts by mastectomy reduces the risk of breast cancer by approximately 90-95 percent. These decisions can be very personal and very difficult, but the good news is that they almost never need to be made in a rush. It is worth taking the time to get informed in order to make a decision that is fits the individual.

Q:  Does having the genetic mutation for breast cancer mean breast cancer is inevitable?

A: No, cancer is not inevitable, but the risks are usually quite high. Depending on the specific mutations discovered, the lifetime risks of breast cancer for BRCA1/2 carriers are estimated to be 56-84 percent. For ovarian cancer, the lifetime risks are a bit lower. They are estimated to be 36-46 percent for BRCA1 and 10-27 percent for BRCA2 mutation carriers.

Embryonic Development Protein Active in Cancer Growth

Silencing it impairs tumor growth, making ROR1 a potential therapeutic target

A team of scientists at the University of California, San Diego Moores Cancer Center has identified a novel protein expressed by breast cancer cells – but not normal adult tissues – that could provide a new target for future anti-cancer drugs and treatments.

Led by Thomas J. Kipps, MD, PhD, Evelyn and Edwin Tasch Chair in Cancer Research and Interim Director of the UC San Diego Moores Cancer Center, the scientists found that the tumor cells of patients with breast cancer frequently express the Receptor-tyrosine-kinase-like Orphan Receptor 1, or ROR1.  They found that silencing expression of ROR1 impaired the growth and survival of human breast cancer cells.  The findings are published in the March 5 online issue of PLoS One.

ROR1 was first identified in the early 1990s and labeled an orphan receptor because its purpose was unknown. Subsequent work found that ROR1 is expressed at high levels during embryogenesis, during which time it plays an important role in regulating embryonic muscle and skeletal development. During fetal development, however, the expression of this protein is turned off.  Normal cells and tissues in adults do not typically express ROR1.

Cancer cells, however, are a different matter.

“Cancer cells tend to acquire features of less differentiated cells,” said Kipps, interim director of the UC San Diego Moores Cancer Center and a professor of medicine in the UC San Diego School of Medicine. “They often can be found to have features of embryonic cells.”

In recent years, Kipps and others have become increasingly interested in the role of ROR1 plays in the growth of cancer – and whether the protein might provide new options for stopping development of the disease. In 2008, for example, Kipps and colleagues reported that patients with leukemia treated with whole-cell vaccines could generate antibodies that reacted with their leukemia cells and the leukemia cells of other patients, but not with normal cells.  They identified that such antibodies could target ROR1, accounting for the specificity of these antibodies in reacting with cancer cells.  They identified another protein that could interact with ROR1 to stimulate the growth and/or survival of leukemia cells and that antibodies generated against ROR1 could block this function.

The discovery that ROR1 functions similarly in breast cancer heightens hopes. When the protein was silenced in human breast cancer cells, the cancer cells had slower rates of growth in the laboratory and in animal studies.

More here

Too Young For This: young survivors of breast cancer

While cancer affects a person’s quality of life at any age, a recent study in The Journal of the National Cancer Institute reports that women under the age of 50 who survive breast cancer are more adversely affected psychologically and physically.  The study noted that, “these women suffer from severe psychological distress, infertility, premature menopause, a decrease in physical activity and weight gain.” 

Of the estimated 288,130 new cases of breast cancer in 2011, five percent were women under 50 years of age.  Because these women are more adversely affected, we asked Wayne Bardwell, PhD, president of the American Psychosocial Oncology Society and director of Patient & Family Support Service at Moores Cancer Center three questions about addressing these patients’ psychological needs.

Question: When does psychological counseling become part of the treatment for breast cancer or does it?

Answer: There are various points in the cancer trajectory where psychological counseling can be helpful. These include the time of diagnosis, the time during active treatment, and during the transition from treatment to “survivorship.” Receiving a cancer diagnosis can be a shocking experience for many patients. The process of treatment, while greatly improved over treatments in the past, can still be an arduous process that may result in fatigue, insomnia, anxiety, pain and other symptoms. Psychotherapy can be helpful in coping with treatment and its side effects. At the completion of treatment, it is not uncommon for a patient’s support system to “breathe a collective sigh of relief” and go back their usual lives. During treatment, many patients use a certain amount of denial to cope (“I’m going to beat this; treatment will not be difficult for me”). Once treatment is over, it is not uncommon for patients to experience a variety of feelings that have been held at bay only to find that their support system is no longer mobilized.  

Q: Anxiety and stress are cited as a negative contributing factor in a diagnosis, especially in young women. Why does stress have a more negative effect on younger patients?

A: Cancer strikes younger patients at times in their lives where they may be seeking a partner, raising a family or in the midst of a budding career. Thus, they may have much on their plates and much that they are looking forward to in their lives. For some patients, cancer may present the major adversity that they have faced. Older patients, by virtue of having lived longer, have likely faced more difficulties along the way than a younger patient. Facing and surmounting challenges teaches us coping strategies that are helpful in meeting future challenges. 

Q: How can friends and family help improve a patient’s outlook?

A:  Friends and family are key in the support system for any patient dealing with cancer. Support can take several forms. The best emotional support involves listening to and accepting the patient as they are in the moment. While an optimistic outlook can be helpful, patients don’t always feel positive, and it is not uncommon for them to feel guilty about this. They may sometimes feel sad, anxious, fearful or angry. Rather than trying to change the patient’s feelings, it is best to convey some sense of understanding why they are experiencing whatever feeling they may express. Tangible support involves helping with logistical issues (e.g., childcare, housecleaning, rides to appointments). I often encourage patients to make a list of things that need to be done. If someone asks “How can I help,” they can be directed to the list and encouraged to sign up for a task. And sometimes, the patient wants to hang out with a good friend and achieve as much normalcy as possible. 

Setting the Record Straight: Why Mammograms Remain the Gold Standard in Breast Cancer Detection If there is only one thing you take away from reading this blog, here it is: in the fight against breast cancer, mammograms are the standard diagnostic tool – known to detect even the smallest cancers more than five years before they can be felt.  Women over 40 are encouraged to be tested yearly.  Period. A recent article in The Atlantic reported that, for women with dense breasts, mammograms aren’t as effective, only detecting cancer 40 to 50 percent of the time and that breast ultrasound (US) should be added as a diagnostic tool.  One of our experts disagrees and cites the fact that this recommendation is based on a single study.  “This article shows a lack of understanding regarding the details of the ACRIN 6666 trial: this study focused on women who had dense breasts and who were already considered ‘high-risk’ for breast cancer,” explained Haydee Ojeda-Fournier, MD, assistant professor of clinical radiology and medical director of breast imaging. “ACRIN 6666 also showed an unacceptable number of false negative biopsies which were expensive, had associated complications, and that ultrasound is more expensive and time consuming than a mammogram. On average, ultrasound took 40 minutes per case whereas a typical mammogram takes eight minutes.” We asked Dr. Ojeda-Fournier three questions about sonograms, dense breasts and why mammograms remain the standard diagnostic tool for detecting breast cancers. Question: Why should women over 40 have yearly mammograms? Answer: Eight large, randomized clinical trials have shown mortality due to breast cancer decreases as much as 30 percent as a result of mammographic screening.  It’s important to note that these studies cannot be repeated because it would be unethical to deprive woman from this life saving study and it would be expensive and untimely (women have been followed for 30 years on these clinical trials).  We also know that digital mammograms, which were not available prior to 2005, are more sensitive in detecting cancer in women with dense breasts.  UC San Diego Health System is fully digital. Q: What defines a dense breast and, if a woman has dense breasts, should she request a sonogram or US each time she has a mammogram? A: We cannot truly classify breast density because we do not perform volumetric imaging of the breast.  Rather, we look at an image and then decide if it is fatty, scattered, dense or extremely dense, depending on how much ‘white’ we see.  The white areas indicate the glandular tissue; dark gray being fatty tissue. Q: Are their drawbacks to adding US as another diagnostic tool? A: ACRIN 6666, which showed whole breast ultrasound to be detrimental in screening evaluation of the breast, lead to too many unnecessary biopsies, and this study targeted high-risk woman with dense breasts (i.e. the highest risk women).  For now, the role of ultrasound in breast cancer is in differentiating cysts versus solids lesions and/or to guide biopsies.
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Setting the Record Straight: Why Mammograms Remain the Gold Standard in Breast Cancer Detection

If there is only one thing you take away from reading this blog, here it is: in the fight against breast cancer, mammograms are the standard diagnostic tool – known to detect even the smallest cancers more than five years before they can be felt.  Women over 40 are encouraged to be tested yearly.  Period.

A recent article in The Atlantic reported that, for women with dense breasts, mammograms aren’t as effective, only detecting cancer 40 to 50 percent of the time and that breast ultrasound (US) should be added as a diagnostic tool. 

One of our experts disagrees and cites the fact that this recommendation is based on a single study. 

“This article shows a lack of understanding regarding the details of the ACRIN 6666 trial: this study focused on women who had dense breasts and who were already considered ‘high-risk’ for breast cancer,” explained Haydee Ojeda-Fournier, MD, assistant professor of clinical radiology and medical director of breast imaging. “ACRIN 6666 also showed an unacceptable number of false negative biopsies which were expensive, had associated complications, and that ultrasound is more expensive and time consuming than a mammogram. On average, ultrasound took 40 minutes per case whereas a typical mammogram takes eight minutes.”

We asked Dr. Ojeda-Fournier three questions about sonograms, dense breasts and why mammograms remain the standard diagnostic tool for detecting breast cancers.

Question: Why should women over 40 have yearly mammograms?

Answer: Eight large, randomized clinical trials have shown mortality due to breast cancer decreases as much as 30 percent as a result of mammographic screening.  It’s important to note that these studies cannot be repeated because it would be unethical to deprive woman from this life saving study and it would be expensive and untimely (women have been followed for 30 years on these clinical trials). 
We also know that digital mammograms, which were not available prior to 2005, are more sensitive in detecting cancer in women with dense breasts.  UC San Diego Health System is fully digital.

Q: What defines a dense breast and, if a woman has dense breasts, should she request a sonogram or US each time she has a mammogram?

A: We cannot truly classify breast density because we do not perform volumetric imaging of the breast.  Rather, we look at an image and then decide if it is fatty, scattered, dense or extremely dense, depending on how much ‘white’ we see.  The white areas indicate the glandular tissue; dark gray being fatty tissue.

Q: Are their drawbacks to adding US as another diagnostic tool?

A: ACRIN 6666, which showed whole breast ultrasound to be detrimental in screening evaluation of the breast, lead to too many unnecessary biopsies, and this study targeted high-risk woman with dense breasts (i.e. the highest risk women).  For now, the role of ultrasound in breast cancer is in differentiating cysts versus solids lesions and/or to guide biopsies.

Moores Cancer Center Recruiting for Four Breast Cancer Clinical Trials

The ENERGY Study – Exercise and Nutrition to Enhance Recovery and Good Health for You – explores the role of diet and exercise in female breast cancer survivors who are at risk for recurrence.

  • 4-year study
  • 21 years of age or older
  • Overweight
  • Diagnosed with Stage I-III breast cancer within the previous 5 years and have completed their initial treatment
  • Willing and able to attend group meetings and maintain contact with investigators for two years
  • Able to be physically active
  • NOT currently enrolled in another nutrition or weight loss study

For more Information on ENERGY, please contact 858-822-2779 or hbarkai@ucsd.edu or visit http://energytrial.ucsd.edu

The REACH FOR HEALTH Study is testing how the treatments of lifestyle intervention and the drug called metformin, which is used to treat diabetes, affect breast cancer survival.

  • 6-month study
  • Overweight
  • Diagnosed with Stage I-IIIA
  • Not scheduled for or currently undergoing chemotherapy
  • Able to communicate dietary and physical activity data via telephone
  • If taking statins, tamoxifen, or aromatase inhibitors; able and willing to remain on treatment for 6-month study period

For more detailed information on participating in REACH FOR HEALTH, call 858-822-6799 or contact Jesica Oratowski Coleman at joratowski@ucsd.edu.

STUDY DETAILS for THOSE ‘AT RISK’ (never had breast cancer)

The HELP Study – Health Eating & Living Program for Weight Control – aims to reduce breast cancer risk in postmenopausal women through lifestyle change, using Internet-enhanced telephone counseling intervention.

  • 2-year study
  • Women between the ages of 45 to 70
  • Overweight
  • Want to increase their physical activity and improve their diet
  • Must have high-speed Internet access

For more information on participating in the HELP Study, contact 858-822-2895, healthyeating@ucsd.edu or visit http://www.healthyeatingucsd.org

The MENU Study – Metabolism, Exercise and Nutrition – examining the difference between three diets of differing composition on weight loss and cancer biomarkers.

  • 1-year study
  • Healthy, overweight women 
  • Over 21 years of age
  • BMI (body mass index) higher than 30, less than 40
  • Willing and able to participate in clinic visits, group sessions, and telephone and Internet communications at specified intervals
  • Able to provide data through questionnaires and by telephone
  • Willing to allow blood collections
  • No known allergy to tree nuts
  • Able to be physically active

For more information on the MENU study please contact Elizabeth Quitana, MS, RD at 858-822-6162, elquintana@ucsd.edu

Thinking about drinking A new study out of Harvard Medical School, published this week in the Journal of the American Medical Association, raises new questions about how much alcohol consumption increases the risk of breast cancer. As in previous studies, the Harvard researchers found that women who consumed two or more drinks per day were 51 percent more likely to develop breast cancer in their lifetime than women who didn’t consume alcohol at all. What’s grabbing headlines is the authors’ analysis that even light drinking – three to six glasses of wine per week – could boost a woman’s lifetime risk of breast cancer by 15 percent. Clearly, if the findings hold up, any level of alcohol consumption appears to be a risk factor for breast cancer. Does this mean women should abstain from drinking entirely? There is no simple answer. Clarity remains harder to find than a good claret. On average, one in 8 American women will develop breast cancer over their lifetimes. That’s the baseline risk. Numerous other elements impact that number. Aging is major risk factor. Two out of every three invasive breast cancers are found in women 55 years and older. Genetic predisposition is another. Women who have inherited certain mutations in the BRCA1 and BRCA2 genes have a fivefold increased risk, and changes in other genes have been implicated. Ethnicity, tissue density, menstrual history and other particulars also play a role. You can read a fuller list here. What’s so confounding about effects of alcohol consumption, though, is that it also seems to provide some measurable health benefits. Moderate alcohol drinking has been shown to raise levels of HDL, the good cholesterol, and other substances that promote cardiovascular health. It’s also been linked to a decrease in middle-aged and older adults. And in 2008, researchers at UC San Diego challenged conventional thinking that alcohol consumption was bad for the liver with a study that found modest consumption (one glass of wine a day) might actually decrease the prevalence of Non-Alcoholic Fatty Liver Disease. So what’s the answer? Right now, it seems the best course is to individually weigh the trade-offs. Cardiovascular disease is far more prevalent than breast cancer, so maybe the heart health benefits of modest alcohol consumption outweigh the small increased risk of breast cancer. On the other hand, a woman with known, elevated cancer risk probably should shun drinking altogether. It remains a personal decision, one best made after serious, sober consideration.
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Thinking about drinking

A new study out of Harvard Medical School, published this week in the Journal of the American Medical Association, raises new questions about how much alcohol consumption increases the risk of breast cancer.

As in previous studies, the Harvard researchers found that women who consumed two or more drinks per day were 51 percent more likely to develop breast cancer in their lifetime than women who didn’t consume alcohol at all. What’s grabbing headlines is the authors’ analysis that even light drinking – three to six glasses of wine per week – could boost a woman’s lifetime risk of breast cancer by 15 percent.

Clearly, if the findings hold up, any level of alcohol consumption appears to be a risk factor for breast cancer. Does this mean women should abstain from drinking entirely? There is no simple answer. Clarity remains harder to find than a good claret.

On average, one in 8 American women will develop breast cancer over their lifetimes. That’s the baseline risk. Numerous other elements impact that number. Aging is major risk factor. Two out of every three invasive breast cancers are found in women 55 years and older. Genetic predisposition is another. Women who have inherited certain mutations in the BRCA1 and BRCA2 genes have a fivefold increased risk, and changes in other genes have been implicated. Ethnicity, tissue density, menstrual history and other particulars also play a role. You can read a fuller list here.

What’s so confounding about effects of alcohol consumption, though, is that it also seems to provide some measurable health benefits. Moderate alcohol drinking has been shown to raise levels of HDL, the good cholesterol, and other substances that promote cardiovascular health. It’s also been linked to a decrease in middle-aged and older adults. And in 2008, researchers at UC San Diego challenged conventional thinking that alcohol consumption was bad for the liver with a study that found modest consumption (one glass of wine a day) might actually decrease the prevalence of Non-Alcoholic Fatty Liver Disease.

So what’s the answer? Right now, it seems the best course is to individually weigh the trade-offs. Cardiovascular disease is far more prevalent than breast cancer, so maybe the heart health benefits of modest alcohol consumption outweigh the small increased risk of breast cancer. On the other hand, a woman with known, elevated cancer risk probably should shun drinking altogether.

It remains a personal decision, one best made after serious, sober consideration.

“A Crucial Catch” for Breast Cancer

October 2 was a big win for our Health System as well as for the Chargers. As the official sponsor of the Chargers “A crucial catch” Breast Cancer Awareness game, football fans received Moores Cancer Center pink breast cancer awareness beads and saw our name and messages on the scoreboard, as well as banners displayed in the stadium.

There was a pre-game ceremony featuring four Moores Cancer Center survivors displaying a giant pink ribbon in recognition of National Breast Cancer Awareness Month. Our very own Lightning Ladies fan club members received hot pink rally towels at the Chargers’ Power Party. Our “Ask the Experts” Anne Wallace, MD, and Barbara Parker, MD, talked to fans at the Moores Cancer Center booth while staff distributed brochures on cancer programs and services. To see more photos, visit us on Facebook.

Look for our Health System booth at San Diego Chargers home games in the Power Party tailgate area, located between parking areas F3 and E3. Come join us at the November 6 game!

When Zero Cancer is a NegativeA Q&A with Dr. Sarah Blair of the UC San Diego Moores Cancer Center Comedian and actress Wanda Sykes recently announced that she underwent a double mastectomy after surgery for breast reduction revealed she had a ductal carcinoma in situ, or DCIS.  During an episode of The Ellen DeGeneres Show she told the host she was “very, very lucky, because DCIS is basically stage zero cancer.”  Despite having an early stage of breast cancer, Ms. Sykes decided to have a radical mastectomy as there is a history of breast cancer in her mother’s family. Is it possible to have “stage zero” breast cancer? Yes.  According to The American Cancer Society’s website there are five stages: from the carcinoma in situ (stage 0) to stage IV. Each stage denotes the size and spread of the tumor, if the cancer has spread to lymph nodes, and if it has metastasized. While many people may have a vague idea about what it means to have stage I breast cancer versus stage IV (the higher the number, the worse the prognosis) one would assume that stage 0 meant just that, zero cancer.  We asked Sarah Blair, MD, associate professor of Surgery at the UC San Diego Moores Cancer Center, three questions about stage 0 breast cancer to shed some light on this little known stage. Question: First things first, are patients surprised to learn that there is a stage 0 breast cancer? Answer: Yes, many patients are not familiar with stage 0.  When I counsel my patients, I show them a picture to demonstrate the difference.  Basically these tumors start in the duct which is a tube that drains milk when you breast feed.  Tumors that are stage 0 are confined inside the duct and cannot spread outside to other parts of the body.  However, if the tumor is left alone they can eventually break through the duct and become invasive.  Early treatment prevents spread of the tumor. Q:  Wanda Sykes decided to have a radical mastectomy based on her family history of breast cancer.  Is this typical for stage 0? A: Most Women are good candidates for breast conservation, which is removal of that area of the breast or lumpectomy plus radiation.  I would also recommend the drug Tamoxifen for women with estrogen sensitive tumors.  This drug treats the tumor itself and helps prevent future tumors.  However, some women do not want to take Tamoxifen because of its side effects.  For the average woman with stage 0 their lifetime risk of developing a second cancer in either breast is 20 percent. Some women with a strong family history of breast cancer, i.e. multiple relatives with breast cancer, may have a higher risk of a second cancer, particularly if they are diagnosed at a young age.  These women may consider more aggressive surgical treatment to prevent future cancers.  Typically, most women do not have radical surgery but those that do have much better cosmetic outcomes than in the past. Q:  Does a diagnosis of stage 0 mean that the cancer is 100 percent curable? A: Unfortunately, nothing is 100 percent in medicine but there is a high likelihood of being cured.  The chance of being cured depends on the size of the tumor and its appearance under the microscope or grade.  In general the chance of being cured is greater than 90 percent.
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When Zero Cancer is a Negative
A Q&A with Dr. Sarah Blair of the UC San Diego Moores Cancer Center

Comedian and actress Wanda Sykes recently announced that she underwent a double mastectomy after surgery for breast reduction revealed she had a ductal carcinoma in situ, or DCIS.  During an episode of The Ellen DeGeneres Show she told the host she was “very, very lucky, because DCIS is basically stage zero cancer.”  Despite having an early stage of breast cancer, Ms. Sykes decided to have a radical mastectomy as there is a history of breast cancer in her mother’s family.

Is it possible to have “stage zero” breast cancer? Yes.  According to The American Cancer Society’s website there are five stages: from the carcinoma in situ (stage 0) to stage IV. Each stage denotes the size and spread of the tumor, if the cancer has spread to lymph nodes, and if it has metastasized. While many people may have a vague idea about what it means to have stage I breast cancer versus stage IV (the higher the number, the worse the prognosis) one would assume that stage 0 meant just that, zero cancer. 

We asked Sarah Blair, MD, associate professor of Surgery at the UC San Diego Moores Cancer Center, three questions about stage 0 breast cancer to shed some light on this little known stage.

Question: First things first, are patients surprised to learn that there is a stage 0 breast cancer?

Answer: Yes, many patients are not familiar with stage 0.  When I counsel my patients, I show them a picture to demonstrate the difference.  Basically these tumors start in the duct which is a tube that drains milk when you breast feed.  Tumors that are stage 0 are confined inside the duct and cannot spread outside to other parts of the body.  However, if the tumor is left alone they can eventually break through the duct and become invasive.  Early treatment prevents spread of the tumor.

Q:  Wanda Sykes decided to have a radical mastectomy based on her family history of breast cancer.  Is this typical for stage 0?

A: Most Women are good candidates for breast conservation, which is removal of that area of the breast or lumpectomy plus radiation.  I would also recommend the drug Tamoxifen for women with estrogen sensitive tumors.  This drug treats the tumor itself and helps prevent future tumors.  However, some women do not want to take Tamoxifen because of its side effects.  For the average woman with stage 0 their lifetime risk of developing a second cancer in either breast is 20 percent. Some women with a strong family history of breast cancer, i.e. multiple relatives with breast cancer, may have a higher risk of a second cancer, particularly if they are diagnosed at a young age.  These women may consider more aggressive surgical treatment to prevent future cancers.  Typically, most women do not have radical surgery but those that do have much better cosmetic outcomes than in the past.

Q:  Does a diagnosis of stage 0 mean that the cancer is 100 percent curable?

A: Unfortunately, nothing is 100 percent in medicine but there is a high likelihood of being cured.  The chance of being cured depends on the size of the tumor and its appearance under the microscope or grade.  In general the chance of being cured is greater than 90 percent.

Yearly Mammograms Beginning at Age 40 Still the Standard of Care

October is National Breast Cancer Awareness Month (NBCAM) which celebrates 26 years of raising awareness through education and access to yearly mammograms.  Although recent studies have disagreed on the extent of benefit, mammograms remain a key part of breast health recommendations from most major health care institutions.

Except for skin cancers, breast cancer is the most common cancer among American women.  According to the American Cancer Society, nearly 230,480 women in the United States will be diagnosed with invasive breast cancer this year. 

Here are three things every woman needs to know about breast cancer:

  1. All women over 40 need mammograms every year
  2. Early detection is the key! Regular mammograms beginning at the age of 40 can help detect even tiny cancers three to five years before they can be felt.
  3. 75% of women diagnosed with breast cancer have no family history of breast cancer or other major risk factors.

For more information on this and other types of cancers, visit the UC San Diego Moores Cancer Center