Myths Surrounding Breast Cancer

DONEE PATTERSON, MD: Hi, I'm here with, I want you to introduce yourself and just say where you work.

JENNIFER SIMMONS, MD: I'm Dr. Jennifer Simmons and I am the Director of the Breast Program at Einstein Medical Center, Montgomery.

PATTERSON: Welcome.  We hear you are new to the Einstein family and we welcome you.

SIMMONS: Thank you so much.

PATTERSON: We are going to talk today about myths surrounding breast cancer because I really believe that people are afraid of cancer and rightly so, but we want to make sure that people understand we are here on your side and we want to do anything we can to help you prevent getting breast cancer.  If you actually do have it we want to make sure that transition is smooth and you get it taken care of.  Today I want to ask you, I just want people to know how often people should get mammograms and what age it should start.  I just want that on the record.

SIMMONS: I believe in following the American Cancer Society guidelines which is a screening mammogram at the age of 35.  If that screen is normal, one between the age of 35 and 40 and then after 40, yearly.  I know this goes against the current recommendations that came out two years ago by the United States Prevention Task Force, but I also think those decisions were financially motivated rather than based on science and so I believe the American Cancer Society screening recommendations are the most appropriate ones that are out there now.  The only exception I would say to that rule is that if you have a first degree relative who had breast cancer at the age of 35 or below, you should start screening at least 5 years, most likely 10 years, before that first degree relative.

PATTERSON: So let me just clarify for the people listening.  By first degree relative, we mean mother, father, brother or sister.

SIMMONS: Yes.

PATTERSON: So if a woman has breast cancer and she's not diagnosed until she is 60 and she has daughters that may be in their 20s or 30s, when do you recommend for them to get their mammograms?

SIMMONS: I recommend that they follow the standard screening guidelines.  A screening mammogram at the age of 35 and the decision as to where to go from there can be based on the finding.  60 isn't a particularly young age.  I find the most difficult decisions for screening are made when your mother got cancer at 50.

PATTERSON: Or younger?

SIMMONS: Younger it is easy to decide how to screen them but it is those right in the middle, is this a young cancer?  With perimenopausal cancers, it is always difficult to advise the family. 

PATTERSON: OK, so talk to your doctor.  Is that the basic message?

SIMMONS: Absolutely.  Those cancers and the screening for those family members, those decisions have to be made around that specific case.

PATTERSON: So let's step back and talk about what is a breast surgeon.  I think people hear that title and they say oh that person is going to do surgery on me, but it is not actually that and I want people to understand.

SIMMONS: Breast surgery has now become the gateway to evaluation of breast disease.  Anyone who has any kind of abnormality with their breast, so they have new pain or feel a little lump or have nipple discharge or their breast doesn't look like it did before, those people go to a breast surgeon for evaluation.  Breast surgeons are specifically trained in the physical examination of the breast; they are specifically trained in taking an appropriate breast history and then we review all of our own images.  We read mammogram; we read ultrasound; we read MRI.  We are also trained to perform the biopsies and perform surgery but we are the decision makers as to who gets those things rather than just doing surgery alone.

PATTERSON: So let's talk about some of the myths.  I know the answers to these but I want to do this for the sake of this pod cast.  True or false and then you can explain.  Is it a myth, true or false, that finding a lump in your breast means that you have breast cancer?  

SIMMONS: That is absolutely false. Most of the lumps that we find in the breasts, especially in young women are benign noncancerous masses, but statistically speaking, young women with lumps in their breasts are going to have benign masses.  Older women with lumps in their breasts are going to have cancers and then the women in the middle it just depends, are you in your 30s, that is most likely benign.  Are you in your 40s that is most likely benign.  Once you hit your 50s, it is a 50/50 chance of whether or not its going to be benign, and then the 60s is kind of when it turns the table and those are mostly cancer.  70s are mostly cancer, 80s are always cancer.

PATTERSON: So for my patients, again, I do know these answers, but I just want it for the sake of this pod cast.  True or false, men do not get breast cancer?

SIMMONS: That's false.  1 in 1,000 breast cancers are in men.  That doesn't mean 1 in 1,000 men, but 1 in 1,000 breast cancers are in men.  It is a rare disease.  It generally runs in families but it does happen.  That said, the most common cause of a lump in a man is a condition called gynecomastia which is male development of the breast tissue and that is incredible common.  I see one or two men a week with this condition.  Sometimes it does require surgery but it is always benign, not cancer.

PATTERSON: There are also medications that can cause gynecomastia in men.  If men are on new medication, often high blood pressure or congestive heart failure medication, make sure you talk to your doctor because it can cause very painful breast tissue and sometimes it can cause cysts, so talk to your doctor about that, don't just ignore it.

SIMMONS: Absolutely.  What I will add to that is it doesn't necessarily have to be a new medication.  I find that most of the time when I see these men, they have been on those medications for two and three years and are now developing gynecomastia.  

PATTERSON: True or false, I have patients that say I have no family history of breast cancer, so I don't have to get a mammogram even if I am 40. What do you say to that?

SIMMONS: That is absolutely false.  Most breast cancers are not familial in that you don't have to have a family history.  At least 60% of breast cancers will have no family history at all.  Another let's say 30% will have some family history but remote and then the other 10% will have familiar breast  cancers where it is pasted from generation to generation.

PATTERSON: So ladies, if you are 40 you have to get annual mammograms and if you are 35, get a baseline and sometime between 35 and 40 get another mammogram just as a screen.  So that is the take home message.  All right, back to our myths, true or false, mammograms can cause the spread of breast cancer?

SIMMONS: That is absolutely false.  There is some perception that squeezing on a breast cancer makes it explode and spread.  It is absolutely ludicrous. The reason that cancer spreads is due to growth of cancer and mammogram has done nothing to alter the cancer at all and in fact, has saved so many olives because it is found cancer before the time that we can feel it.  In the time of what I call subclinical where you could have discovered it or your doctor could have discovered it, there is this window that mammogram alone discovers it.  It is not harmful to your cancer, it can only be helpful.

PATTERSON: Some patients get concerned, they actually say to me, well the breast cancer is on my father's side of the family so I don't have the same risk as it being on my mother's side of the family.  What do you say to that?

SIMMONS: You have to remember that you get half of your genes from your father and half of your genes from your mother.  Just because you didn't inherit your breasts from your father, it does not mean you did not inherit the diseases that run in that family.  The passing on of a cancer trait, especially in the instance of breast cancer, has nothing to do with what sex it comes from.  You are just as likely to inherit a risk for breast cancer from your father's side of the family as you are from your mother's side.

PATTERSON: So we have to take it seriously; our family history.  I encourage people to know their family history.  If your family is still living ask them, say did anyone in our family have breast cancer on mom's side or dad's side, so you can have more information and share that information with your doctor.

SIMMONS: I agree.  Unfortunately, we are still living in a time where there are parents and grandparents that didn't speak of the kind of diseases that they had.  It was taboo to talk about what kind of cancer people had so there are still so many people that know that their mother died of or their grandmother died of some kind of cancer but no one discussed what kind it was.

PATTERSON: I would encourage people to really ask their family.  Not to the point of making people upset, but really try to find the information out.  What people should know is that physicians are trained to screen people sometimes based on their family history.  As we have been talking about, often if you come in and say my mother has breast cancer, then we will screen you differently, not the technique but we will screen you at an age that is different.  Know your family history.

SIMMONS: And we will also have a heightening awareness so we will be looking for different things if your mother had a history of breast cancer than if your mother had a history of colon cancer.

PATTERSON: I understand that all this may be a little frightening, the word cancer, but we are not looking for you to have cancer, we are looking to prevent cancer and the sooner we find something we can take care of it sooner and not wait until it has spread or gotten very aggressive.

SIMMONS: Exactly.  It is always easier to treat an early stage breast cancer than it is to treat a late stage breast cancer.  While we can't necessarily prevent it from happening, catching it at it's earliest stage, at its infancy, is always an advantage to the patient.

PATTERSON: So as a family doctor, I often get people asking me everyday actually from family members to neighbors or people I just meet out, they ask me medical questions.  Have you ever had to counsel someone that you know personally; a friend or a family member, about getting a mammogram or having breast cancer?

SIMMONS: I actually went and spoke at a breast cancer event two weeks ago and the woman who sponsored the event, who is 54 years old has not had a mammogram.  Her mother died of ovarian cancer so she certainly has risk factors.  She has a terrible fear of it and she hasn't had a mammogram.  I gave her a prescription for a mammogram and instructions to take 600 mg of Motrin before she goes and to go.

PATTERSON: That's very important.  I want people to know that often people are afraid to get mammograms, but it is a ten minute test.  It may be a little uncomfortable but it is a ten minute test to make sure you do not have cancer.  It is so important.  I want to encourage people to talk to their family members that are 35 or older and encourage them to go and to go yearly.  Make sure they don't miss a year because things can show up in a year that you may have missed.

SIMMONS: That is absolutely true.

PATTERSON: Another myth, let's go back to the myths.  Some women with small breasts feel like they can't get breast cancer because their breasts are small.  What do you say about that?

SIMMONS: Absolutely false.  Breast cancer can happen in small breasts, large breasts, in medium breasts, and everything in between.

PATTERSON: There is also some myths about using antiperspirants.  What do you say about antiperspirants causing breast cancer?

SIMMONS: This is one of my favorites.  I give a whole talk every year on the myths surrounding breast cancer and this is one of them; the facts and fallacies. There has never been any studies that has proven that any kind of deodorant, antiperspirant, any topic anything causes breast cancer.  So ladies, go ahead and use your hygiene products.

PATTERSON: I think where that initially came from is that some of the antiperspirants, they have weak estrogens in them so people started to study that but none of the studies have ever proven that that actually is true.  That is not something you have to avoid; that is not something you have to worry about.  I think we have a lot of things in our busy lives to worry about and that's not one of those things.

SIMMONS: Agreed.

PATTERSON: So what do you say about portable mammograms?  Those little trucks that go around and they have portable mammograms?  What do you think about those?

SIMMONS: I think they serve a wonderful purpose because they get a lot of people to be imagined who wouldn't otherwise get imaged.  It is not a perfect system because they don't have the prior films and it is so important to have your mammogram done at the same place every year so that technique is the same, the equipment is the same and we can compare year to year and the only thing that is different every year is you.  I believe in those portable units for the purpose of screening people who wouldn't otherwise get screened, but my recommendation for the average person is to make sure you get your mammogram every year at the same place.

PATTERSON: I agree.  What do you think about self breast exams?  What do you tell people about self breast exams?

SIMMONS:  I absolutely believe in self breast examination.  I think that no one should know your breasts better than you do; not your doctor; not your spouse; not your anything.    I believe that breast examinations should be done once a month, the same time every month.  In women who hare still menstruating they should do it one week after their menstrual cycle has started because that is the time of the month where their breasts are the least stimulated.  In a post menopausal women, it just needs to be done every month.  Pick either the first of the month or the day you pay your bills, find something that is going to trigger you to remember to exam your breasts and make sure you do it.  Every woman believes they have lumpy breasts.  Some of them do, some of them don't but it is important to just know your own lumps, to know what your normal is and that way you will recognize something that is a change, something that is abnormal in your usual breast.

PATTERSON:  I tell my patients, I see your breasts once a year, but you see your breasts every day so please make sure you do your self breast exams and learn how to do it correctly and don't be afraid if you find a lump, but bring it to us if you find something different.  Do you feel that self breast exams actually help in the detection of breast cancer?

SIMMONS: Though the studies don't bear it out, I have had plenty of women who have had normal studies but discovered their own cancers.  I can't ignore that.  Even though when I think you look over a large populations, mammogram is more effective at screening for cancers, I can't ignore the individual who found her own cancer and it wasn't detected on a mammogram and that woman would have been lost had she not done her own breast examination.

PATTERSON: What do you say about diet and breast cancer?

SIMMONS: I think that there is no way to absolutely prevent breast cancer.  That said, the anticancer diet is the same diet that you would follow to protect your heart and to protect your general well being.  I tell women to decrease the amount of animal fat in their diet; to make sure that most of what they eat either grew in the ground, fell from a tree or came from nature in some way, so most of your diet should be vegetable product or legumes or some kind of natural, unprocessed diet.  You can eat meat, but not every day and not a lot of it and to mostly stay away from the processed food.  All the things your body doesn’t know how to digest, that it has to work really hard to do it.  If your body is spending all of its energy on digesting all of this manufactured food that is in our western diet, then it doesn't have the energy to take care of you.  I believe that is where all the cancers are coming form, is that we are spinning our wheels, digesting all this food that we weren't suppose to be eating in the first place.

PATTERSON: I tell my patients to eat the rainbow, but not a skittles commercials, I'm talking a lot of different color fruits and vegetables. 

SIMMONS: You have to be careful with that because they take that in their own way.

PATTERSON: I follow the next sentence, I'm not talking about candy, I'm talking about different color fruits and vegetables, the yellows, the reds, the purples, the greens because they all have different antitoxigen properties in them and antiinflammatory properties in them.  I try to be very specific about fruits and vegetables.

SIMMONS: Most importantly, that is what we were meant to eat, in addition to meat, because we are carnivores, but well I should say we are omnivores, but we were meant to eat nature's diet.  What we weren't meant to eat are twinkies and pasta and all the things that we have come to know as the western diet.  That is what we have to get away from, our bodies are just working too hard to digest that food and they are not taking care of us  the way that we need to take care of us.

PATTERSON: With that said, I know that there are studies that relate how much alcohol intake you have to diet and exercise and to breast cancer.  What do you say about that?

SIMMONS: I think that mostly relates to an elevated estrogen state as a result of the alcohol consumption, so I think that is where the link is and it's undeniable.  The more alcohol you drink, the more breast cancers we see in that population.  That needs to be taken into moderation just like any dietary element needs to be taken in moderation.  

PATTERSON: And speaking of elevated estrogen levels, there is also a link to obesity and breast cancer for similar reasons, would you agree?

SIMMONS: Yes, absolutely.  That is the same exact cause.  Women who are obese, and men too, have elevated estrogen states and that eventually results in more breast cancers.

PATTERSON: Now here at Einstein, Philadelphia, women that do not have insurance are eligible to get free mammograms through the Women's Center.  For anyone who is listening, if they know someone in the area that is eligible that does not have insurance to get a free mammogram; they can call 1-215-254-2700 and inquire about a free mammogram.  Do they have similar things in your center in Montgomery.

SIMMONS: We are going to get that started fairly soon but we will apply for the same grant that is running that program here, so fairly soon.

PATTERSON: Can you tell us a little bit about the women's Health Center in Montgomery, I hear it's fabulous.

SIMMONS: Oh my God, it is so beautiful. We really spend a lot of time thinking about how women would want this experience and so it's remote from the hospital, it is this beautiful building  in a beautiful center and everyone who works there is just very aware of the anxiety associated with going to get a mammogram and what is running through everyone's heads so there is a lot of kindness and gentleness and then  when something happens, out nurse navigators are over there and she is just a wonderfully sensitive woman and we get the patients taken care of as quickly as we can to reduce the anxiety time associated with all of this.  We are trying to make what could be a terrible experience really manageable and something that the women look back on and say even though I had to go through this; this was the best possible experience I could have had.

PATTERSON: Got it.  So where are you located exactly?

SIMMONS: 700 West Germantown Pike in East Norriton.

PATTERSON: OK, awesome.  So for those women who are listening and for men that are listening, we encourage the women in your lives, your sisters, your nieces, your daughters, we encourage you all to get your mammograms at the regular screening time and not  to be afraid of getting this test.  It is a screening test and we are hoping to help you through it.  I hope yo can hear t hat we really care about you and we really want you to be as healthy as you possibly can be.  My motto for this year is I wish you the best of health, but if you can't be the best, you can be better.  So we can be better by reaching out to people we know and making sure they get  their mammogram so we can screen you appropriately and help yo through that.  Do you have any final thoughts for us right now?

SIMMONS: I love your message, if you can't be the best, be better.  That is my take home message for the day, I love it.

PATTERSON: Awesome.  I think even if you eat well, we can always eat a little bit better.  We can always drink a little bit more water, we can always exercise a little bit more.  Even for those people who exercise, there are some things they can tweak to be doing better.  I think we can all be self advocates and we can do better.  Thank you so much for coming out.  You guys visit Dr. Simmons in Montgomery.  If you need a breast surgeon or have questions about your breasts and follow us on twitter.  You can also follow the Einstein Facebook page, which is Einstein health.com.  Einstein Health on the Facebook page or you can follow me on Twitter, I am @DrDonee and we look forward to hearing your feedback.