The primary goal of the Be Aware Foundation is to inspire women to follow early detection guidelines. As reported in previous issues of Ask the Doctor, starting screening mammography at age 40 years and repeating it annually results in more that 40% reduction in breast cancer mortality. Evolving improvements in screening such as use of digital mammography could lead to further improvements in mortality reduction.

Despite the dramatic success of mammography in detecting early stage breast cancers, there is still room for major improvements. In women whose breasts are primarily made up of fatty tissue, the mammogram is extremely effective in detecting small cancers. The fat provides a black background. Cancers typically show up as white densities or white spots of calcium. Thus, detecting small cancers in fatty breasts is relatively easy.

Detecting small cancers in women with dense breasts is much more challenging. In dense breasts the background is mostly white. Attempting to visualize a small “white” cancer in a dense breast has been compared to the challenge of finding a snowman in a snow storm. Dense breasts are the norm in pre-menopausal women, for example over 70% of women in their 40s have dense breasts. Although dense breasts are less common in post-menopausal women, 54% of women in their 50s and 42% of women in their 60s have dense breasts. The miss rate for detecting small cancers in women with dense breasts approaches 30%.

What are women with dense breasts to do? For most women with dense breasts and no family history, yearly screening with digital mammography is all that is required at the present time. However, for women with strong family histories of breast or ovarian cancer, more aggressive screening must be considered.

One of the biggest breakthroughs in breast cancer screenings was reported in the prestigious NEJM in 2004*. The study compared mammography screening to screening with both mammograms and MRIs. Their findings demonstrated the superiority of the MRI in detecting a greater percentage of early staged breast cancers. Current MRI technology is much superior to what was used in the NEJM study which will undoubtedly lead to even better results.

MRI has both its advantages and disadvantages. Of course, its primary benefit is effectiveness in finding very small cancers. Also, the MRI doses not use radiation. The primary disadvantage of the MRI is cost. In Orange County the cost of a breast MRI can exceed $5,000 dollars. Not surprisingly, insurance companies are reluctant to approve breast MRI because of the obvious concerns of how it would impact skyrocketing health care costs.

At present most insurance companies will cover the cost of an MRI if the physician can provide evidence that the woman’s lifetime risk of getting breast cancer is 20% or more. The lifetime risk can be determined by using established formulas such as the Gail model to determine risk. Unfortunately, the commonly used Gail model underestimates risk for women with multiple family members with breast cancer. Accurate assessment of risk often requires the use of more sophisticated risk assessment tools that are not generally available to most women. Women who want more information on risk assessment can Contact Us.

One additional issue of major concern is that none of the existing models takes into account the important issue of breast density. Breast density is a well-established risk factor for breast cancer, and many states have passed laws requiring mammography programs to inform women with dense breasts that they are at higher risk for getting breast cancer. Similar legislation was recently vetoed by Gov. Jerry Brown who based his decision on the assumption that there is no consensus on what to do with the information on breast density (see reference).

Gov. Brown is correct in stating that there is no consensus on what to do with the information, but women do not necessarily need a consensus to make informed decisions on personal health care issues. Let’s face it, if MRI were less costly, all women with dense breasts would be encouraged to have them. But what Brown and the insurance companies do not take into consideration is that medical costs are dramatically reduced when breast cancers are caught early.

The cost of treatment of early stage breast cancer is in the range of $30,000 dollars, and survival rates approach 100%. In contrast, the initial cost of treatment of more advanced cancers can exceed $50,000 dollars. More importantly, these more advanced cancers are also associated with higher risks of recurrence. The long-term costs for treating patients with metastatic cancer can easily exceed $500,000 dollars. Unfortunately, politicians and insurance companies focus on short term cost-containment solutions, and rarely accept the challenge of understanding the big picture.

So what is a woman to do? Certainly if you have a strong family history, you should encourage your health care provider to do a risk assessment or ask to be referred to a risk assessment program. If your risk is 20 or more, the insurance will likely cover the cost of the MRI. But, what if you have dense breasts and a family history of breast cancer, but a lifetime risk score of less than 20?

Ideally, we would screen all women with dense breasts with an MRI, but at present the out-of-pocket costs are prohibitive for most women. What is urgently needed is to lower the cost of the MRI so that it becomes affordable for most women. We are working on such a program.

*Kriege M, et-al. Efficacy of MRI and Mammography for breast cancer screening in women with a familial or genetic disposition. NEJM. 351:427-437

If you have any questions on the value of screening mammography or other questions on breast care, feel free to Ask The Doctor or contact us.

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The study from the British Medical Journal concluded that for many women the anxieties associated with being called back for additional views and the trauma associated with a negative biopsy result are of such a magnitude, that they may outweigh the potential benefits of screening mammogram. The authors concluded women should be encouraged to assess the risks and benefits of screening mammography and come to their own conclusion about the need for screening.   

Of course studies like these create confusion. Fortunately, two recent studies reported on this year (2011) provide future evidence that screening mammograms are very effective in saving lives and routine yearly screening should start at age 40.

The most impressive study is a recent update of the one done in Sweden. In this study Dr. Tabar reports on a study of 130,000 women who were followed for more than 29 years. This updated recent study reinforces his previous findings that regular screening reduces breast cancer deaths by more than 30%.

 
Another study of more than 1 million women followed for more than 16 years demonstrated a similar 30% mortality reduction in women between 40 and 50 years of age, which is the most challenging group because of the tendency for these women to have dense breasts.

Equally important is the observation that women who consistently do their mammograms on a yearly basis have an even greater breast cancer reduction than women who are less consistent in obtaining their early mammograms.  

 
The issue of harm from a mammogram seems to be grossly overestimated in the study reported in the BMJ. The article refers to the anxiety associated with being called back for additional views as well as the trauma associated with going through a biopsy that proves to be benign (i.e. not cancer). Granted this can be a traumatic experience for many women, but a screening mammogram has the potential to be life saving. The majority of cancers identified on a screening mammogram do not require mastectomies, and in many cases chemotherapy can be avoided.  For the vast majority of women, the benefits far outweigh the risks.   

Unfortunately, the study from the BMJ will give some woman an excuse to forgo a mammogram, and in some of those cases the opportunity for a curative operation will be missed.

If you have any questions on the value of screening mammography or other questions on breast care, feel free to Ask The Doctor or contact us.

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In brief, the study demonstrated a small but statistically significant increased risk for developing breast cancer with the consumption of 3 or more alcoholic drinks per week. The type of alcohol did not seem to make any difference, thus a shot of whisky had the same effect as a 6 ounce glass of wine or one beer. This risk was in large part dependent on the lifetime pattern of alcohol consumption. The study basically concluded that the greater the lifetime exposure to alcohol, the greater the influence on the risk of getting breast cancer.

Just how much the risk is and just what should be done about it is less clear. For the average risk women the benefits of a glass or two of wine per week may overshadow the risks for getting breast cancer, particularly if the woman has a family or personal history of heart disease. However, for the high risk women and women who are very concerned about their personal risk of getting breast cancer, alcohol intake becomes an important risk that can be managed by the individual.

Most risk for breast cancer, such as family history and history of high risk biopsies are fixed. However, risk factors such as lack of exercise and post-menopausal obesity are manageable by the individual. Now that the risks associated with taking more than two ounces of alcohol per week has been established, women can now make more informed personal decisions on what to do when it comes drinking alcoholic beverages.

If you have question regarding the subjects of risk analysis or how alcohol influences risk, feel free to contact us.

¹ Chen WY, Rosner SE, Hankinson GA, et. al. Moderate alcohol consumption during adult life, drinking patterns, and breast cancer risks. JAMA. 2011;3O6:1884-1890.

Of course, the next logical question is: What is a woman to do if she learns she has dense breasts? The ideal next step would be to perform an MRI, but the costs are prohibitive for most people (i.e. ranging from $7k at hospital based imaging centers to a low of $1.5k at some private centers… with no evidence of better quality for the more expensive MRI).

Insurance companies typically do not cover the cost of an MRI unless a woman has other risk factors such as a strong family history of breast cancer. In fact, most insurance companies do not even take breast density into account when determining eligibility. There is no general consensus on how the medical community should respond to this new legislation, if it is signed into law by the Governor. I deal with this challenging problem on a daily basis, and I will briefly outline how I approach it.

The first issue is the type of mammogram. The data definitely supports the use of digital mammography in women with dense breasts. It is also essential that these women have yearly mammography starting at age 40. Patients should insist that the current year’s mammogram be compared with the previous year’s mammogram. Even a subtle change in density on the mammogram or any new symptom requires both additional mammographic views along with an ultra-sound evaluation of the area of concern.

Patients with dense breasts should be aware of other risk factors such as family history, previous high risk biopsy, etc. Many women in this higher risk category will qualify for MRI. Risk assessment programs are now available to determine risk and assist higher risk patients in qualifying for a MRI.

Finally, all women (but especially those with dense breasts) should follow early detection guidelines including monthly breast self-examination (BSE). Learning to do a BSE with confidence provides women with a layer of protection that is free and can be life saving. Any change on BSE should be reported to a physician and appropriate action should be taken. We have recently raised the money to fund a BSE video. We hope that it will help all women to do BSE with confidence.

Any Questions, please Contact Us or Ask The Doctor your question.

Major Risk Factors

Other risk factors:

One of the major goals of the Be Aware Foundation is to educate, motivate and inspire women to identify their personal risks for breast cancer, and to take necessary steps to reduce them. Most breast cancer risks are fixed, and there is nothing a woman can do to reduce them. Examples of fixed risk factors are: family history, breast density, and ethnicity. Other risk factors are modifiable risk factors. Two of the most important modifiable risk factors that relate to every woman are diet and exercise. There is convincing evidence that proper diet and a program of vigorous exercise can lower breast cancer risks.

A major health problem in today’s society is that we eat too much, and we eat the wrong things. In addition, the conveniences of modern society result in lower energy expenditures, i.e. we don’t exercise enough. The goal in this month’s “Ask the Doctor” is to inspire readers to take the challenge to convert to a diet rich in whole grains. In subsequent editions I will explore the issue of exercise in more detail.

A brief review of history will provide insight into how the American diet has evolved. For over 100,000 years grains and seeds were essential dietary components of primitive diets (Click here for source). Survival was a constant challenge and food supplies were unpredictable. Being slightly over-weight may have had a theoretical advantage, at least eating all you could when it was available was an effective strategy for survival before humans learned to store food (Click here for source).

In the past two centuries, major societal changes have taken place. For one thing, food is in abundance, and we do not need to worry about starvation. Furthermore, we can obtain food with limited physical effort.

In addition, there have been major alterations to how food is processed. One important example of the alteration of traditional foods is the processing of grains (such as wheat, rice, and barley). In the refining process the bran, the outer layer, which is a primary source of vitamins, minerals (including omega 3 and 6, anti-oxidants, and fiber) is removed in the milling process. The refining process results in a finer texture, more appealing taste, and longer shelf life, according to MayoClinic.com. However, in addition to removing valuable nutrients, the refining process results in important alterations in how glucose is absorbed which in turn has a major impact on blood sugar and insulin levels.

Eating refined grains (pasta, potatoes, white breads, and most cereals) has much the same influence on blood sugar as does eating candy, honey, or pure sugar. Refined grains are composed primarily of carbohydrates which are rapidly broken down by the intestine to glucose. The glucose is then rapidly absorbed, which in turn leads to a rapid rise in insulin levels. Over time the insulin brings the glucose levels down. When the glucose levels fall, hunger returns.

This problem of rapid absorption associated with refined grains is accentuated by the approach that many overweight individuals take to attempt to lose weight. Rather than respond by eating when they are hungry, they postpone eating as long as tolerated. This restriction of food in response to hunger sends a message to the brain that starvation is pending and that the metabolism should slow down. In addition, the brain sends out signals to convert available glucose to fat in an effort to have adequate energy stores for the future.

The situation is quite the opposite when eating whole grains. The fiber in the bran is essential to slowing the absorption of the carbohydrate component of the grain. As a result of slower absorption, there is a less vigorous insulin response. Blood sugar levels rise more slowly and are sustained longer, allowing for a longer interval between eating and subsequent hunger (Click here for source). Once you are on a high fiber diet you should never go hungry. When you are hungry you are encouraged to eat and most people will eat 6 or more small meals a day. Think about it. You never go hungry, you eat until you are satisfied, and you lose weight and gain energy. Not a bad combination.

Another important consideration from a breast cancer risk perspective is the issue of the elevation of insulin levels. The following is a series of recent quotes from respected research institutions:

• “Higher-than-normal levels of insulin place postmenopausal women at increased risk of breast cancer, researchers at Albert Einstein College of Medicine of Yeshiva University report. Their findings, published in the January 7 issue of the Journal of the National Cancer Institute, suggest that interventions that target insulin and its signaling pathways may decrease breast cancer risk in these women.” (YU.edu, Jan. 2009)

• The Einstein researchers go on to state: “Obesity is a well-established risk factor for postmenopausal breast cancer, but just how obesity and breast cancer are connected is unclear… One such imbalance is elevated levels of insulin, which stimulates the growth of breast cells in tissue culture. The Einstein study is the first to prospectively identify insulin’s role in breast cancer while controlling for estrogen levels.

Researchers from Yale have come to similar conclusions: There is growing evidence that weight and physical activity affect breast cancer outcomes, and our findings suggest that the mechanism linking lifestyle factors and breast cancer may be the insulin pathway,” Irwin said. “Our findings are timely in that therapeutic trials of insulin-lowering medications in women treated for breast cancer are being conducted. Previous research of ours conducted at Yale also showed that a daily brisk walking program decreased insulin levels. Women treated for breast cancer who are overweight or not currently exercising should definitely seek lifestyle counseling and/or talk with their physician about additional therapeutic options.” (Yale.edu, Dec 2010)

A second important issue that complicates the issue of weight control is the issue of dietary enhancements. Some are obvious to the consumer such as super-sized portions, and others go largely unnoticed such as the addition of high fructose corn syrup to an ever increasing proportion of food products (for more detailed and entertaining information see: Omnivores Dilemma). This recent trend to “enhance” produce with HFCS is not only one of the major contributors to childhood obesity, but has the potential to add to the risk of breast cancer and other health care issues. (For more information see: American Journal of Clinical Nutrition, Vol. 79, No. 4, 537-543, April 2004).

What to do? The basic goal for every American should be to have a well balanced diet. Not only is it easy, it is cost effective. Unprocessed grains, seeds, and beans should provide the bulk of calories and are highly nutritional. The U.S. Dietary Guideline recommends at least three servings of whole grains per day totaling 48 grams.

In my first personal attempt to reach 48 grams per day I tried flax seeds. One problem with flax seeds is, as with most seed and grains, they must be ground or soaked before they can be eaten. Also, by the time I reached the 48 grams per day level my foods were starting to taste like sawdust. The advantage of chia sees is that they can be eaten raw or by just adding water, but only need to soak for a few minutes. The following section summarizes some of the recently available medical data on chia seeds. The goal of this discussion is to provide the reader with confidence that chia seeds represent a very easy and inexpensive way to meet or exceed US dietary guidelines.

The Chia seed: Nutritional value

Chia seeds are so rich in vitamins (including higher omega 3 than found in flax seeds), minerals, and anti-oxidants that many food authorities have labeled them as super foods. For a more detailed explanation of the nutritional benefits of chia seeds see: eHow.com

One of the most recent articles describing the value of chia seeds comes from the European Journal of Clinical Nutrition that concluded: ….eating chia helps lower postprandial (after meal) blood sugar levels in people with type 2 diabetes and chia increases satiety (makes you feel fuller). Also, as a possible result of lower blood sugars: blood pressure, blood coagulation and inflammatory markers are improved. V Vuksan, AL Jenkins1, AG Dias, et. al. European Journal of Clinical Nutrition (2010) 64, 436–438.

The following link provides detailed information on the nutritional value of chia seeds: Nutritiondata.self.com

The history of chia seeds is fascinating and is summarized on eHow.com. One quote from this reference is of particular interest: "A major food crop of indigenous peoples, such as the Mayans, Incas, and Aztecs, chia seeds were once so highly valued that they were used as currency. Chia seeds were a vital source of energy and nutrition during long marches, since as little as one to two tablespoons was sufficient to sustain a person through 24 hours of hard exercise. Easily stored and transported chia seeds were also used in the everyday diet, often ground into flour to be used in breads and other recipes, or roasted to be eaten out of hand, or mixed with water to make gruel. However, chia seed production was nearly eradicated during the Spanish Conquest, and the value of this once common food was largely forgotten."

Recent research from the University of Arizona suggests that the chia diet dramatically decreased triacylglycerol levels and increased HDL cholesterol and ω-3 fatty acid contents in rat serum. These findings suggest that α-linoleic-rich chia oil may be an alternative to co-3 sources for vegetarians and people allergic to fish and fish products.

The above outline should convince the most skeptical reader of the potential value of chia seeds. The thing that sets chia seeds apart from most other seeds and grains is that they are so convenient. They can be eaten raw, sprinkled on salads, or combined with water. In Mexico they are combined with fruit juices to create a drink known in Mexico as chia fresca. One recent study form the Journal of the American Dietetic Association found that replacing some oil or eggs in baking cakes with chia gel did not diminish the quality of the cake! In 2009, the European Union approved chia seeds as a novel food, allowing up to 5% of a bread product’s total matter.

Chia seeds can be used as a primary source to achieve the U.S. Dietary Guideline of 48 grams per day. However, by converting to other tasty and readily available whole grain products like bulgur wheat, rye, unprocessed rice, it becomes even easier to meet or exceed these guidelines. As with any “super food,” they work as part of an overall balanced diet that includes a variety of fresh fruits, vegetables, healthy fats and lean protein, not as a replacement for or supplement to a poor diet.

Just a note of caution:

Chia seeds can lower blood pressure. Individuals taking blood pressure meds should consult with their physician. Individuals who have a reaction when eating chia seeds must avoid them completely.

People who take blood thinners like warfarin should also consult their physician since Chia seeds might increase the risk for bleeding. For more information visit Chiaseeds.us

Hopefully, this extended version of Ask the Doctor will help you better understand the problems of the “modern” American diet and more importantly, I hope it will inspire you to introduce some of these concepts into your own diet.

Feel free to Ask The Doctor if you have any questions, or you can contact us.

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In December 2008 I required emergency back fusion for a condition called cauda equine syndrome. In
my case it was a benign growth impinging on the spinal cord causing pain and paralysis to my lower
extremities. After months of rehabilitation I reached a plateau in strength and energy which was
significantly lower than what I was capable of doing before my back condition developed. I did not have
the strength for what I considered to be a proper work out and could barely make it through a busy day
at work. I became depressed thinking that I was just too old to get back to my previous energy levels.

On Christmas in December 2009 my youngest son, Matthew, gave me a copy of the book “Born to
Run”, written by Christopher McDougall, an aging marathon runner whose body was giving out. He
was looking for solutions that would allow him to improve his running. He learned of a group of super
athletes, the Tarahummara Indians, who resided in the Copper Canyons of Mexico. He embarked on
an exciting journey to find them and learn their secrets for success. These Indians were the world’s
greatest distance runners. They started running from early childhood, and by their early teens were
capable of running 50-100 miles at a time.

One of the first things Chris learned about this tribe was their unusual diet habits. One of the main
staples of their diet and something they routinely took with them when on a long distance run were chia
seeds. Yes, it was the same seed that we applied to our chia pet in an effort to allow the ceramic head
to grow hair. The “hair”, of course, was the sprouting from the chia seeds.

At first I was skeptical that diet had much to do with running or their ability to consistently win 100
mile races against some very tough competition. I assumed that the most likely explanation of their
long distance running successes was genetic in origin. However, I was desperate to improve my own
stamina and I decided to give the chia seeds a try.

I ordered 5 lbs. of chia seed over the internet (about 8 dollars a pound, but note: one pound of dry chia
seeds makes 10 pounds of hydrated chia seeds, thus the actual cost is 80 cents a pound). I found several
You Tube videos on how to dilute with water and mix with other products to improve taste. The Indians
simply add fresh lemon juice to the mix. I dilute it 50% with Diet Ocean Spray juice, which gives it a
great taste.

I started adding the Chia seeds as a diet supplement in Jan of 2010. Every day I would fill a 4 cup
container with my Chia seed/ Ocean Spray mix and use it as a snack, instead of the usual candy and junk
foods that I relied on in the past for quick energy.

I was hoping for a quick improvement in strength and endurance, but was a bit disappointed when
I observed no immediate benefit from my new diet supplement. Still, I thought that taking the Chia
supplement was healthier then eating sweets and carbs, so I made the commitment to stick with it.

After several months of taking the Chia supplements on a regular basis I began to notice that I was
making definite progress in gaining strength and energy for the first time in 18 months. My workouts
were more intense, and I was no longer fatigued at the end of a busy day. Just as I was gaining
confidence in my new diet something startling happened. My weight which had been steady at 155 lbs.
for more than 30 years started to drop. When it fell to 150 I happily assumed that I was trimming down
in response to a more vigorous exercise program. However, my weight continued to drop. In the next
two weeks it dropped to 140 lbs. which was my weight in high school. At this point I was convinced that
I might have a hidden cancer. I thought about getting a CT-Scan of my abdomen, but I didn’t want my
friends to know about my concerns.

As an alternative to the CT-Scan, I decided to simply increase my caloric intake. I ate larger than
normal meals, and snacked more vigorously between meals. Within two weeks I was able to get my
weight back to normal. I have now learned that I must eat larger meals as long as I continue to work
out vigorously. Being able to eat more and still maintain a healthy body weight is not a bad problem
to have. I am convinced this will work for anyone who is willing to commit to some relatively simple
dietary changes and a reasonable exercise program.

There is more to this story that I want to share with my readers. In subsequent issues of “Ask the
Doctor” I would like to outline the explanation for the chia seed diet. Additionally, I will outline a
more comprehensive diet that will not only give you more strength and energy, but provide you with
protection from breast and colon cancer and reduce your risk for diverticulitis.

Feel free to Ask The Doctor if you have any questions, or you can contact us.

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Aromasin may prove to be the drug of choice for high risk women who are menopausal and have an intact uterus or who are already suffering from menopausal symptoms. It also has advantages in women with a history of clotting or stroke since it does not increase blood clotting.

There are two major clinical problems associated with Aromasin. Many patients who take Aromasin experience joint pains and stiffness. This can be a major side effect that leads to the discontinuation of the drug in some patients. However, these symptoms are easily managed in the majority of patients. Also, Aromasin can cause bone loss, but this problem can be easily managed with drugs such as Fosamax, Actonel, and others which protect against osteoporosis.

One of the important unanswered questions about all of the estrogen blocking drugs is whether they reduce breast cancer mortality. The answer seems rather obvious that they would, but the current data is insufficient to prove this important point. The concern is that they are most effective in preventing or delaying the onset of the most favorable subset of breast cancers, i.e. those that are estrogen dependent. These cancers are associated with a more favorable prognosis than estrogen negative cancers, which are not responsive to estrogen blocking drugs.

Who should consider taking the drug? Some would argue that any women older than 60 years of age should consider taking the drug. These proponents argue that the drug is safe and that now that it is off patent, it is more reasonably priced. The decision to take any of the three preventive drugs requires a clear understanding of relative risk and relative benefit. Women who are at risk should have a discussion with their physician or seek the advice from breast care specialists who will take the time to review options. The good news is that we can now give high risk women one more option for breast cancer risk reduction.

Feel free to Ask The Doctor if you have any questions, or you can contact us.

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The bottom line is that I am convinced that there is a potential risk that cell phones that are in direct contact with the breast will increase the risk for developing a future breast cancer. The chairman of the prestigious Pittsburg Cancer Institute, Dr. Ronald B. Herberman, issued a memo of warning to his entire staff about the potential cancer risks associated with cell phones in contact with the body. He also noted that younger individuals are at increased risk as compared to adults (ref. 2). In other words, the younger the age at exposure, the greater the future risk of getting breast cancer.

What has me so concerned is the fact that so many young girls are hiding their cell phones in their bras. This is typically done during class time in an effort to conceal them from their teachers. This behavior is considered to be the “cool thing to do.”

I am concerned that if we do not act now to discourage this behavior, we will see a major increase in the incidence of breast cancers in the next 10-20 years with particularly high incidences in the 20-30 year age groups. I realize that my preaching to teens about the dangers of cell phones will not make much of an impression, so I am appealing to all mothers to take action now. Please inform your daughters of potential risks, and insist that they immediately stop placing the cell phone in direct contact with any part of the body.

I believe that it is essential to inform all mothers of this risk, but I need your help. Please forward the following link to all of your contacts. Above are links to Twitter and Facebook. It is urgent that we work as a team to get the message out on social media sites and by email. Thanks in advance for your support. Also, let me know if I can be of any assistance to you in terms of spreading the word.
Back ground information:

My first experience with a case in which a cell phone was suspected to have caused a breast cancer was reported in last year’s “Ask the Doctor” (ref. 1) We described a case of a 39 year old woman who routinely kept her cell phone in her bra over a 7 year time period. She developed multiple small cancers which were found in the breast in a distribution that matched the shape her cell phone, and they were located just below the skin in the exact area where there was phone to skin contact.

A few months ago we saw a second case in which a cancer was found in the breast tissue directly below the spot where the phone was in direct contact with her breast. I have asked many of my colleagues if they had observed any similar cases. Several stated that the answer was affirmative, but assumed that it was just a coincidence.

The most remarkable example of this association between cell phones and breast cancer occurred in a 38 year old female with no family history of breast cancer. She worked on an assembly line testing cell phones. The phones were on a conveyor belt and passed directly under both breasts. She developed cancer in the lower aspect of both breasts after several years of work on the assembly line.

Although there is a growing body of concern that cell phones can cause cancer, there is essentially no scientific data that either confirms or refutes this concept. Recent studies do demonstrate that cell phones can cause metabolic changes in the brain, and the authors of the study conclude that more investigation is needed to determine if there are medical risks associated with the use of cell phones. (Ref 3).

Studies on use of cell phones and the risk of developing brain cancer have suggested that prolonged use of the cell phone (>10) years may be associated with an increased risk of brain cancer, but the conclusion remains controversial and more study is needed (Ref. 3-4 ). Also, there appears to be a growing consensus that the younger the age at exposure, the greater the long-term risk. Consensus also agrees that it will take 10 to 20years before the increase incidence in cancer will be detected.

Thus the dilemma, we have reason for concern that cell phones have a link to cancer. It will take years before we get a definitive answer. In the mean time, the use of cell phones is rapidly expanding and cell phone use is starting at a younger age. It seems only reasonable in terms of risk of breast cancer to avoid contact between the cell phone and the breast. If the breast is at risk, there is concern for other potentially vulnerable organs such as the brain, the eyes, and the testicles (ref. 4). Until we have definitive information, we must make every effort to avoid direct contact between the cell phone and the body.

I hope I have convinced my readers of the importance of this issue, and again I ask you to forward the message to all of your contacts! Your comments or suggestion would be appreciated contact us at Ask The Doctor.

References:
1. Be Aware website: Ask the doctor.

2. News release from University of Pittsburg Cancer Institute.

3. Study reported in the Journal of the American Medical Association (JAMA), February 22, 2011.

4. Interview on Larry King Live

5. John West MD, Surgical Director of Breastlink at the Breast Care and Imaging Center of Orange County www.breastcare.com

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What is breast density? Breasts are composed of two basic types of tissue. Breast that are primarily fatty appear to be mostly black on the mammogram. Cancers typically show up as white dots (i.e. calcium crystals) or as white densities (a combination of cancer cells and the reactive tissues from the bodies defense systems). Cancers in fatty breast are typically easily identified since the white cancer show up in stark contrast to the black background. The second component of breast tissue is the glandular (milk producing) and the supportive tissues which in combination show up white areas on the mammogram. Trying to find a white cancer in this mostly white background is like trying to find a snowman is a snow storm. This is one of the reasons that mammography is not as sensitive (i.e. accurate in identifying) early cancers in women with dense breasts.

The issue of difficulty in diagnosing breast cancers in dense breast does not provide an explanation as to how or why increased density is associated with an increased risk for breast cancer. There is one twin study that suggests that breast density pattern is inherited. Even though there is not a lot a woman can do about it if she has dense breast, there are here are a few issues that every woman should be aware of.

Each woman should ask her physician the status of her breast pattern based on the most recent mammogram. It is a requirement for mammographers to report the level of density noted on the mammogram. Women with dense breasts should make certain that they have a digital mammogram as opposed to the older analogue system (just ask your doctor for a copy of your report).

Women with dense breasts should be aware of the need for adding ultra-sound examination in the case of a perceived lump or persistent focal pain. Another test that is extremely valuable in detecting small cancers in women with very dense breasts is the MRI. Although expensive and often not covered by insurance companies, it has a > 95% rate of detection of small cancers whereas the success rate of the mammogram in women with dense breasts is in the range of 70%.

Women with dense breasts should evaluate all of their individual risk factors. Women with multiple risk factors should consider participation in high risk screening clinics. All women should be aware of the modifiable risk factors that can reduce the risk of cancer. Also, all women can improve their chances for early detection by following the Be Aware early detection guidelines.

As always, I hope this brief review has been helpful. Feel free to Ask The Doctor if you have any questions, or you can contact us.

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