SalemNews.com, Salem, MA

October 26, 2010

Doctor shares the facts on breast cancer

By Will Broaddus
Staff Writer

In recognition of Breast Cancer Awareness Month this October, The Salem News asked Karen Krag, medical oncologist at Massachusetts General North Shore Cancer Center in Danvers, some questions about breast cancer prevention, treatment and screening.

Is breast cancer a worsening problem?

It is an increasing problem. About 200,000 cases have been diagnosed in 2010. It's increasing for a multitude of reasons. First among these are changes in reproductive patterns: Women are having fewer children and having them later. Also, girls are having their periods earlier, which exposes them to cycling hormones longer.

The second thing tied to it is that, 100 years ago, the life expectancy of women was 40 years. Now it's 80 years. Breast cancer in young women is actually not increasing, although those cases are reported often in the news. It occurs almost exclusively in post-menopausal women.

Any other factors?

Breast-feeding plays a role. Very few women exclusively breast-feed. If you exclusively breast-feed, you suppress the menstrual period, and if you do that, you have a decreased risk. So although breast-feeding is increasing, and is becoming more prevalent, it's still at less than 10 percent at 6 months.

Are there things women can do to decrease their risk for getting breast cancer?

We can make an enormous impact. The lifestyle stuff is extraordinarily important. Obesity, drinking — more than five alcoholic drinks a week — and lack of exercise all increase risk. Each of these factors is also independent of the other, so even if you weigh 300 pounds, if you exercise, it will decrease risk.

Who's at risk for breast cancer?

Everybody. All women are at risk.

When should women get mammograms?

Screening should start at 40.

How often should mammograms be performed?

Once a year, and they should continue as long as you're in good health.

Controversial recommendations were made last year by the U.S. Preventive Services Task Force regarding screening. What do you think of them?

The recommendation of this panel last year was: If you have a woman at average risk, you shouldn't screen until 50, because there are false positives in the 40-to-50 age group that lead to lots of anxiety without a huge medical benefit, statistically speaking. But statistics don't help the individual who does test positive. The panel would limit screening in the 40-to-50 age group to women at high risk. But since most breast cancer is diagnosed in women of average risk, limiting screening to identified high-risk women makes no sense. Besides, there isn't a medical downside to screening.

What is the fatality rate from breast cancer?

The death rate is decreasing. There were less than 40,000 deaths from breast cancer in 2010, and that number has gone down over the last 20 years. That's because of screening, finding it earlier when it was treatable. Also, our treatments are better, and we're getting better at figuring out who needs what.

The vast majority of women who have a cancer diagnosed by mammogram will be cured of their cancer. The majority of breast cancer deaths occur in women who were diagnosed because of something they felt. A lot of those are unscreened, or have cancers that grow rapidly between mammograms.

What if there is a family history of breast cancer?

Mammograms should begin at 40, unless there is a family history, in which case they should start 10 years earlier than the age of the youngest family member who was diagnosed.