TIME Cancer

Most Women Should Not Get Yearly Mammograms, Group Says

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A U.S. panel of experts reaffirms its recommendations

Six years ago, the United States Preventative Services Task Force (USPSTF) caused a stir when it changed long-held breast cancer screening recommendations and advised women to wait until age 50 rather than 40 to start getting mammograms. The task force also said women should do it every other year, and women under age 50 were told the choice to get mammograms at their age was an individual one.

In the intervening years, that’s become a less controversial opinion, partially because of growing evidence that too much screening can lead to anxiety-ridden false positive results, overdiagnosis and overtreatment. On Monday, the USPSTF released its updated recommendations which look very similar to the recommendations released in 2009.

The new draft guidelines suggest women ages 50 to 74 get a mammogram every two years and women ages 40 to 49 should make their own decision on whether to start screening in consultation with their doctors. The task force also concluded that there was not enough evidence to make a recommendation for or against mammograms for women ages 75 and older, 3D mammography or additional screening besides mammograms for women who have dense breasts. The guidelines will now undergo a public commenting period, and you can send in comments here.

“In 2009, to suggest that mammography has limitations and that it has harms and that we need to look at the balance was not the way most people were thinking about it,” says Dr. Michael L. LeFevre, past chair of the USPSTF. “Much has been written about mammography in the last five years. I think people understand that it is a good test, it’s not a perfect test, and that there may be some significant harms associated with it.”

The task force added a nuance in the new guidelines that highlights which women might want to consider mammography more strongly, saying women in their 40s who have had a mother, sister or daughter with breast cancer are at a higher risk, and may benefit from mammography at a younger age than women who are at an average risk.

MORE: Diagnosed With Breast Cancer? Get a Second Opinion

In the last year, there’s been compelling evidence in support of the 3D mammogram as an accurate—and perhaps better—screening tool. One June study showed 3D mammograms can pick up more breast cancers and lead to fewer callbacks for more testing than 2D mammography. LeFevre says that while it’s a promising technology, he doesn’t think there is enough evidence to prove if it will result in improved health. “We are going to have to see more than just detection. There have to be more studies that look specifically at the outcomes in order for us to be certain,” he says.

Despite the fact that the mammogram recommendations happened over six years ago, many doctors still insist on yearly mammograms for their patients over age 40. The American Cancer Society also continues to recommend that women age 40 and up get yearly mammograms.

“There are plenty of women in the position with people just telling them you need to have a mammogram every year. I am somewhat embarrassed to admit that is still going on,” says LeFevre. “On the other hand, I think women are being more proactive about their discussions of mammography and I think that’s reflective of the environment change we are in.”

The task force guidelines are intended for women age 40 and up who do not show signs of breast cancer, have never had breast cancer and do not have risk factors like a genetic mutation that put them at higher risk. High-risk patients should consult with their doctor for an individualized screening plan.

“Mammography helps. We can reduce women’s likelihood of dying of breast cancer by undergoing some regular screening at some interval during certain ages. That’s a common theme across almost all organizations that look at this,” says LeFevre. “We think we should be doing it in a way where we maximize the balance of benefits and harms. That’s our topline message and that’s what I hope women hear.”

TIME Cancer

New Trials Show Promise For Future Skin Cancer Treatment

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In some cases, the results were even better than the current frontline treatment for the cancer

Drugs that spur the immune system to target cancer cells may prove an effective skin cancer treatment, according to two clinical trials published Monday.

The drugs, called immune checkpoint inhibitors, had impressive results in treating advanced melanoma, according to the trials published in the New England Journal of Medicine. In some cases, the results were even better than the current frontline treatment for the cancer.

One trial showed the drug Keytruda (pembrolizumab) had better outcomes compared to the commonly used treatment for skin cancer, Yervoy (ipilimumab). The other trial showed patients’ tumors responded better to a combination of the drugs Opdivo (nivolumab) and Yervoy than just Yervoy on its own. However, around half of patients getting the combination therapy experienced moderate to serious side effects.

Such treatments could also prove expensive. According to the Wall Street Journal, the drugs used in the combination treatment study, for instance, come at a hefty price with a four-treatment course of Yervoy costing $120,000 and Opdivo costing $12,500 a month.

The study results were presented at the annual meeting of the American Association for Cancer Research. The trial with the combination drugs was funded by Bristol-Myers Squibb and the other trial was funded by Merck.

[Health Day]

TIME Cancer

Breast Cancer May Increase 50% By 2030

By 2030, the number of breast cancer cases in the United States will grow by 50% compared their 2011 rates, according to new research from the National Cancer Institute.

In the new study, presented at the American Association for Cancer Research’s annual meeting, researchers used cancer surveillance data, census data and mathematical models to arrive at projections. Part of the reason the numbers are so high, they note, is because women are living longer. Another factor is the increase in screening that enables doctors to spot and diagnose more cases of in-situ tumors—very early stage growths that may not require treatment—as well as more invasive tumors.

MORE: This Mammogram Saves Lives and Money

The data comes amid concerns about the over-treatment of breast cancer. Last year, an analysis of women with stage 1 or stage 2 breast cancer in the Journal of the National Cancer Institute found little difference in survival rates 20 years after diagnosis between women who had an unaffected breast removed and those who did not.

“There’s certainly concern, especially in the older patients, about over-diagnosis of breast cancer, and that’s one of the reasons that screening mammography can become very controversial in older patients,” says Dr. Sharon Giordano, MPH, department chair of health services research at MD Anderson Cancer Center. (Giordano was not involved in the research.) “We don’t want to end up diagnosing and treating a disease that would never cause a problem during the person’s natural lifetime.”

Not all in-situ breast cancer progresses into a dangerous condition, Giordano explains. “One of the unanswered questions is, how do we identify the in-situ cancers that are the ones that go on and progress to a life-threatening illness, and which are the ones that we should be leaving alone and not subjecting people to invasive surgery and radiation for treatment?”

The researchers also teased out some more hopeful projections: that the number of estrogen-receptor negative (ER-negative) cancers, the kind that don’t need estrogen to grow and don’t typically respond to endocrine therapy, will drop from 17% in 2011 to 9% in 2030. That may be good news, since ER-positive breast cancers tend to grow slower and have better long-term survival rates. The reasons for the expected drop aren’t clear yet, the study authors say, but one contributing factor could be that women are having children later in life, and having a child young is a risk factor for ER-negative tumors.

“In sum, our results suggest that although breast cancer overall is going to increase, different subtypes of breast cancer are moving in different directions and on different trajectories,” said study author Philip S. Rosenberg, PhD, a senior investigator in cancer epidemiology and genetics at the National Cancer Institute, in a statement. “These distinct patterns within the overall breast cancer picture highlight key research opportunities that could inform smarter screening and kinder, gentler, and more effective treatment.”

TIME Cancer

Why Some Cancer Patients Are Losing Their Fingerprints

A strange and rare side effect of some cancer drugs

Fingerprints are the ultimate way to tell one person from another—they’re unique, permanent and seemingly immutable.

But a 65-year-old woman was denied service at a bank recently when she showed up without fingerprints, according to a report in the New England Journal of Medicine. The woman, a breast cancer patient, is one of a small group of people who have lost their fingerprints as a result of chemotherapy drugs.

Courtesy of The New England Journal of Medicine
Courtesy of The New England Journal of Medicine

 

The loss of fingerprints is the extreme version of a common ailment known as Hand-Foot Syndrome, which afflicts more than half of patients taking some cancer drugs. Typical symptoms of Hand-Foot Syndrome include redness and swelling on the hands and feet.

It’s hard to say exactly how many people experience fingerprint loss as a result of Hand-Foot Syndrome, but the number represents a small fraction of patients with the ailment, says Massachusetts General Hospital oncologist Don Dizon, an expert at the American Society of Clinical Oncology who was not involved with the report.

In this case, a situation at the bank revealed the fingerprint loss and the doctors explained the circumstances to the bank. But many cases likely go unreported because most people don’t need to use their fingerprints in day-to-day life, Dizon says. Many of the known cases of fingerprint loss have been discovered at United States Border Patrol stations that require fingerprints, he says.

But since fingerprints are increasingly being integrated into cell phone use and identification technology, we might see fingerprint loss more and more, says Dizon.

Because Hand-Foot Syndrome is a side effect of a lifesaving drug, most doctors largely treat the symptoms. Dizon recommends patients chill their hands and feet to reduce swelling. For most people, hands and feet will return to their normal condition once they’ve stopped their chemotherapy treatment. But there’s no answer from current literature about whether fingerprint loss can ever be reversed.

“I’m not sure,” Dizon says about whether or not a patient can get fingerprints back. “You would need to study these patients a little longer.”

Read next: Smokers Don’t Think a Few Cigarettes Will Harm Their Health

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TIME health

How Doctors of the Past Blamed Women for Breast Cancer

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Fine Art Photographic/Getty Images 'Motherhood' by Hector Caffieri, circa 1910

Breastfeeding, corsets and aging: the mysterious dangers of womanhood

History Today

 

 

 

This post is in partnership with History Today. The article below was originally published at HistoryToday.com.

‘I congratulate … [my fair countrywomen] on their present easy and elegant mode of dress’, wrote the surgeon James Nooth, in 1804, ‘free from the unnatural and dangerous pressure of stays.’ Nooth’s concern was not aesthetic. The danger he saw in restrictive bodices was cancer: ‘I have extirpated [removed] a great number of … tumours which originated from that absurdity.’

Breast cancer in the 19th century was a consistent, if mysterious, killer. It preoccupied many doctors, unable to state with any confidence the disease’s causes, characteristics or cures. While the orthodox medical profession in Britain were broadly agreed on cancer’s ultimate incurability, they were less uniform in their understanding of its origin. The disease was thought to develop from a range of harmful tendencies and events acting together. Both the essential biology of being female, as well as typically ‘feminine’ behaviors, were understood as causes of breast cancer.

Breastfeeding was a contentious topic at the end of the 18th century. An image of idealised motherhood emerged that infiltrated concepts of femininity: women were by nature loving, maternal and self-sacrificing. This ideology was expressed through changing social and political attitudes to breastfeeding and an outcry against wet-nursing across western Europe. In 1789 only 10 per cent of babies born in Paris were nursed by their own mothers; by 1801, this number had increased to half of all Parisian infants and two thirds of English babies.

Late 18th-century medical men were explicit about the associations between breastfeeding and breast cancer. In 1772, man-midwife William Rowley wrote: ‘When the vessels of the breasts are over-filled and the natural discharge through the nipple not encouraged … it lays the foundation of the cancer.’ Frances Burney – an aristocratic novelist who underwent a mastectomy in 1811 – attributed her disease to her inability to breastfeed properly: ‘They have made me wean my Child! … What that has cost me!’

Menstruation was seen as particularly hazardous. The surgeon Thomas Denman wrote: ‘Women who menstruate irregularly or with pain … are suspected to be more liable to Cancer than those who are regular, or who do not suffer at these times.’ However, their risk only increased after menopause. Denman considered ‘women about the time of the cessation of the menses’ most liable to cancer. Elderly women were blighted by a dual threat: their gender and their age. While surgeons insisted their theories were based on clinical observation, designating these various female-specific processes as causes of cancer supported their broader thoughts about female biology.

Eighteenth-century theory dictated that all diseases were explained by an imbalance in ‘humours’: black bile, yellow bile, blood and phlegm. Into the 19th century the insufficient drainage of various substances continued to be invoked as a cause of cancer; women’s ‘coldness and humidity’ made them particularly prone to disease. Menstruation was the primary mechanism by which the female body cleansed the system of black bile and its regularity was seen as central to a woman’s wellbeing. Certain situations in which the menses were disrupted or had been terminated were, therefore, especially dangerous: pregnancy, breastfeeding and menopause. Similarly, when the female body and its breasts were not used for their ‘correct’ purpose – childbearing and rearing – the risk of breast cancer increased.

The historian Marjo Kaartinen has noted that 18th-century theorists considered just ‘being female and having breasts’ a threat to a woman’s health. This way of thinking about female biology suggested that women were more likely to suffer from all cancers, not just cancer of the breast. Denman wrote: ‘It can hardly be doubted … that women are more liable to Cancer than men.’

This association between womanhood and disease and between breastfeeding, pregnancy, menopause and cancer is still part of our 21st-century understanding of breast cancer; that certain female-specific processes make you more or less likely to succumb to it. On its website, the breast cancer charity Breakthrough lists various ways you can reduce and increase your chances of disease. According to contemporary research, having children early and breastfeeding them reduces your risk. The later a woman begins her family the higher her risk is. The contraceptive pill, growing older and the menopause also increases your risk of breast cancer.

Drawing attention to such historical continuities questions the social and cultural environments that make certain medical assumptions possible. The causes of cancer suggested by Denman, Nooth and friends were informed by their understandings of female biology and female inferiority more generally. They were working within a school of thought that suggested any deviation from ‘appropriate’ womanhood could have hazardous consequences for a woman’s health. While the role of the historian might not be to deny the validity of 21st-century medical research, it is part of our remit to question cultural assumptions that continue to have some effect on both the conclusions of scientists and the way those conclusions are accepted by the broader public.

Agnes Arnold-Forster is a PhD candidate at King’s College London.

TIME Innovation

Five Best Ideas of the Day: April 14

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Have the missing Nigerian schoolgirls been trained to fight?

By Amnesty International

2. Why more roads means more traffic, not less.

By Matthew Beck and Michiel Bliemer in the Conversation

3. Let’s face it. There’s no perfect deal to be made with Iran.

By Pierre Atlas in the Indianapolis Star

4. Does more spending guarantee a better military?

By Pascal-Emmanuel Gobry in the Week

5. What if we could detect some types of cancer with a simple breath test?

By Smitha Mundasad at the BBC

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME celebrities

Rita Wilson Undergoes Double Mastectomy After Breast Cancer Diagnosis

EE British Academy Film Awards 2014 - Red Carpet Arrivals
Mike Marsland—WireImage Rita Wilson attends the EE British Academy Film Awards 2014 at The Royal Opera House on February 16, 2014 in London, England. (Mike Marsland--WireImage)

Says husband Tom Hanks was by her side

Rita Wilson announced Tuesday that she has been diagnosed with breast cancer, and has undergone a double mastectomy and reconstructive surgery in order to fight the disease.

The actress revealed her diagnosis and treatment in a statement to People, and said the prognosis is good. “I am recovering and most importantly, expected to make a full recovery,” she said. “Why? Because I caught this early, have excellent doctors and because I got a second opinion.”

Wilson has recently appeared on Girls and The Good Wife and recently took a leave from the play A Fish in the Dark because of her health. Wilson said that her husband Tom Hanks was “by my side” through it all.

Read more at People.com

TIME Cancer

What to Do If You Have a Cancer Scare

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Don’t over-rely on Dr. Google

Late last month, Angelina Jolie announced that she had surgery to remove her ovaries and fallopian tubes with the aim of reducing her cancer risk. In her New York Times op-ed, she noted that she had recently had a cancer scare: Her doctor was concerned about some unusual blood test results, and sent her for further scans.

“I went through what I imagine thousands of other women have felt,” she wrote. “I told myself to stay calm, to be strong, and that I had no reason to think I wouldn’t live to see my children grow up and to meet my grandchildren.” Fortunately, the follow-up tests showed no signs of cancer.

Chances are at least once in your life you’ll have some sort of cancer scare—a strange mole that needs to be biopsied, a repeat mammogram, an abnormal Pap smear. In most cases, it’s nothing to worry about: “This happens every day in doctors’ offices all across America,” says Richard Wender, MD, chief cancer control officer at the American Cancer Society.

But it can be hard to stay calm when it’s actually happening to you. Here are five things to keep in mind:

Take a step back

Abnormal cancer screening results happen all the time: As many as 35% of women over the age of 40 report having had an abnormal Pap smear or mammogram at some point. “The most common resolution of that abnormal test is finding that you don’t have cancer,” Dr. Wender says.

Remember, the reason these tests have such high cancer-detection rates is because they screen women for any small thing—like calcification on a mammogram—that could potentially indicate cancer.

Read more: 19 Medical Tests Everyone Needs

Make sure you’re hearing your doctor

“Sometimes, when I explain a screening test result to a patient, I can sense that she’s so anxious she’s not processing what I’m saying,” says Dr. Wender. Research shows that almost half of the details remembered from a doctor’s visit are incorrect.

Don’t rely on your memory, especially at an emotional time like this. Either jot down exactly what the doctor says (and don’t be afraid to have them repeat it) or make sure a friend or family member is either in the office with you or on the phone when you speak to your physician.

Read more: What Doctors Don’t Tell You (But Should)

Try not to stress about additional waiting

If suspicious mammogram findings mean your doctor recommends a biopsy, don’t worry if it’s several weeks away. “Waiting three weeks will not change the prognosis and outcome at all if it does turn out to be cancer,” says Dr. Wender.

You also shouldn’t necessarily be alarmed if your doctor doesn’t recommend more invasive testing—such as a colposcopy or biopsy—and instead suggests simply returning for follow-up screening in six months.

“Oftentimes a doctor or technician will see something that doesn’t look like cancer, but they just want to double check it in a few months to be safe,” explains Dr. Wender.

Read more: A Complete Guide to Breast Cancer Screening

Don’t go overboard on Dr. Google

Sometimes, Google can be reassuring: “If you type in ‘abnormal pap smear’ or ‘abnormal mammogram’ or even ‘suspicious mole,’ you’ll see how common the false positive rate is,” says Dr. Wender.

But other times, you’ll just scare yourself unnecessarily. “I had a patient recently who had some tests come back suggestive of a very lethal form of uterine cancer,” recalls Dr. Wender. “When I called her, I said, ‘Don’t research it on the Internet. Just don’t do it.’ She didn’t—and six weeks later, when we learned after a surgical biopsy that the results were benign, she was tremendously relieved.”

Read more: 9 Scary Symptoms You Don’t Need to Worry About

Ask lots of questions

If you’ve got fears, articulate them. “If you ask your doctor what the likelihood is that your test result indicates cancer, they may not have exact numbers but they should be able to respond to you in a general way, which is usually reassuring,” says Dr. Wender.

And if they brush off your worries, or refuse to answer you, it may be time to seek out another doctor—or at least get a second opinion.

Read more: How Good Is Your Doctor?

This article originally appeared on Health.com.

Read next: This Is What Getting Cancer Looks Like on Social Media

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TIME Innovation

Five Best Ideas of the Day: April 8

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. Mountaintop removal coal mining has made the air and water in Appalachia carcinogenic.

By Jeff Biggers in Al Jazeera America

2. Police officers are far more likely to commit intimate partner violence.

By Leigh Goodmark in Fusion

3. Why the “Internet of Things” might mean the end of privacy.

By Danny Bradbury in the Guardian

4. Don’t worry. If we wipe out all of the planet’s crops, we have a backup plan.

By Chris Mooney in the Washington Post

5. Here’s how a slum in Ghana’s capital is preparing young women for careers.

By Thomas Page at CNN Voices

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Cancer

How Fish Oil Makes Chemo Less Effective

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“You lose at least half the effect of the chemotherapy” because of the fish oil, the scientist says

It wasn’t something Dr. Emilie Voest and his colleagues expected to see, but in their labs, they found a disturbing connection between fatty acids and their effect on chemotherapy drugs. Fatty acids—the good fats found in fish like mackerel, salmon and sardines—turn out to work against chemotherapy agents in cancer patients, according to research published Thursday.

Voest, medical director of the Netherlands Cancer Institute, stumbled upon this in 2011 when he found that certain stem cells in mice with cancer that he was studying also produced fatty acids — and that these fats neutralized the effects of chemotherapy. Would the same occur in cancer patients, he wondered, who took fish oil supplements or ate fatty fish?

MORE: Omega 3s Reality Check: Are We Over-Exaggerating Their Benefits?

In a series of experiments described in JAMA Oncology, he and his team established that after getting fish oil supplements from commercially available brands, mice showed higher blood levels of the fatty acids for several hours. The same happened when healthy volunteers took one of two doses of fish oil supplements from three popular brands. Even at the lower dose, which was the recommended daily amount of fish oil of 10 ml (about two teaspoons), levels of fatty acids in the blood of the volunteers doubled on average after several hours.

In mice with tumors who were also given chemotherapy, the fish oil supplements suppressed the anti-tumor effects of the chemotherapy; “You lose at least half the effect of the chemotherapy” because of the fish oil, says Voest.

MORE: Fish Oil Fail: Omega-3s May Not Protect Brain Health After All

He stresses that there’s still a lot about the connection between fish oil and chemotherapy drugs that isn’t known. The effect seems to be limited to certain cytotoxic chemotherapy agents that work by damaging the DNA of tumor cells; some more targeted chemo agents won’t be as affected by the fatty acids. Voest also notes that fish oil supplements, because they aren’t regulated by the U.S. Food and Drug Administration, vary widely on how much fatty acids they contain. What’s more, the content of fish oil can change from pill to pill or drop to drop.

“I don’t want patients who had chemotherapy in the past and it didn’t work to think that it was their fault because they took fish oil,” he says. “Obviously there is a balance between how sensitive a tumor is to chemo v the resistance-causing effect of fatty acids.”

MORE: Omega-3 Supplements Don’t Lower Heart Disease Risk After All

In his studies, Voest also analyzed the effects of fish oil from eating fish among healthy volunteers without cancer; mackerel and herring — even at servings slightly smaller than a deck of cards — were two that contributed to the biggest peaks in fatty acid levels in the blood several hours later. Salmon and tuna only led to negligible blips in this particular study.

The one thing Voest and his team could not do was test the effects of fish oil on cancer patients. Because mouse studies showed that fish oil could compromise the effects of chemotherapy, he says it was “unethical in our view to demonstrate that chemo combined with fish oil was less effective than chemo alone,” he says, since some patients may be receiving an intentionally inferior therapy.

“These authors went beyond theory and showed with animal data that there may be an impact,” says Dr. Don Dizon, co-director of gynecologic oncology at Massachusetts General Hospital and a spokesperson for the American Society of Clinical Oncology, who was not involved in the research. “And in the absence of human data, we need to take this quite seriously and discuss these results with our patients.”

With most supplements, Dizon says, it’s difficult to counsel patients since there isn’t even data from animal studies to guide doctors, as there now is with fish oil. Dizon says he advises patients getting chemo to avoid taking antioxidants, for example, but only because in theory, chemotherapy causes oxidative stress and the supplements may counter that effect. “But I have absolutely no data to support that.”

But between the animal studies and the tests on healthy human volunteers, he’s more comfortable advising patients about fish oil. “I think I will be using this clinically, and discussing it with my patients,” says Dizon, especially since he relies on a DNA-damaging chemotherapy agents to treat the cancers he sees. Voest also says he’s advising patients to avoid taking fish oil or eating large amounts of fish on the day before, the day of and the day after receiving chemo. That may be difficult for some, especially since cancer websites advise patients to take fish oil as a way to reduce side effects from chemotherapy. But, as Voest says, “now we know why.” It may be that the fish oil is hampering the anti-cancer effects of the drugs instead of mitigating their adverse effects.

Voest is planning on studying the biological link between fatty acids and chemotherapy drugs more carefully. He’s also launching a clinical trial to see if a compound that inhibits the function of fatty acids might work to improve chemotherapy’s effect in patients taking fish oil and getting chemo.

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