Breast Cancer Screening and Detection

When it comes to breast cancer screening and detection, not all medical institutions and advocacy groups agree on when women should start getting regular breast cancer screening mammograms.

1. The lifetime risk (to age 85) of a woman developing breast cancer in 1940 was 5% or one in 20; the risk is now 13.4% or almost one in 8.
2. It is estimated that in 2009, there will be 192,370 new cases of breast cancer and 40,170 deaths from the disease.
3. Women who undergo breast cancer screening mammograms have demonstrated significantly reduced deaths from the disease.
4. The effectiveness of any breast cancer screening program will depend on how often women are screened, compliance with screening recommendations, and the quality of the screening test.

Recommendations for Breast Cancer Screening

The following are recommendations for breast cancer screening:

• Breast examination by a health care provider every three years starting at age 20; annual clinical breast exam starting at age 40.
• Annual screening mammography starting at age 40 or 50. Breast cancer experts don't all agree. When you need a mammogram is a personal decision between you and your doctor.
• Women in high-risk categories should have screening mammograms every year and typically start at an earlier age. MRI or ultrasound screening can also be given in addition to mammograms. Discuss the best approach with your doctor.   

Fish Oil Linked to Lower Breast Cancer Risk

breast cancer risk, shows a preliminary study in Cancer Epidemiology, Biomarkers & Prevention.

In the study of 35,016 older women with no history of breast cancer, those who reported currently taking fish oil supplements on a regular basis had a 32% reduced risk for developing invasive ductal breast cancer, compared with women who did not take fish oil supplements.

"There is some limited evidence from my study and others that fish oil may be good for preventing breast cancer, but there is not sufficient evidence to make a public health recommendation right now," cautions study researcher Emily White, PhD, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle. "If you are taking fish oil now for other reasons, this is reassuring that it may have beneficial effects beside what you are taking it for," she says. Many people currently take fish oil supplements to decrease their risk for heart disease.

In the study, 880 women developed breast cancer during six years of follow-up. The use of fish oil was linked to lower risk of invasive ductal breast cancer. Ductal breast cancer is the most common type of breast cancer and forms in the milk ducts. Lobular breast cancer forms in the milk glands. Researchers did not have information on the doses of fish oil that were taken by women in the study.

Exactly how fish oil may affect breast cancer risk is not fully understood, but it may be related to its strong anti-inflammatory properties. Some research suggests that inflammation plays a role in the development of breast and other cancers. Other studies have not found a link between eating more fatty fish and breast cancer risk, but it may be that the amount of omega-3 fatty acids in fish oil supplements is much higher than what is typically found in the diet.

Other supplements were not linked to breast cancer risk in the new study, including black cohosh, dong quai, soy, and St. John's wort, which are often taken to relieve some of the symptoms of menopause.

The new research is part of the Vitamins and Lifestyle (VITAL) study, which included data from women 50 to 76 years old from Washington state.

Second Opinion

"This study is one of the largest studies that have come out showing that there may be role for fish oil in the prevention of cancer, specifically breast cancer," says Lorenzo Cohen, MD, director of the Integrative Medicine Program and chief of the section of integrative medicine in the department of general oncology at the University of Texas M.D. Anderson Cancer Center in Houston.

"It is most likely useful for cardiovascular risks, and the jury is still out on whether it helps in the prevention of breast cancer, but it's not going to hurt," he says.

It's buyer beware when it comes to choosing fish oil supplements, he says.

"Some products may be contaminated with heavy metals," he says. "If you are not going to get fish oil from the fish itself, do appropriate homework to make sure you choose a reputable product," he says.

Peiying Yang, PhD, an assistant professor of integrative medicine at M.D. Anderson, recently received a grant to study how fish oil supplements affect lung cancer risk. "Fish oil, in general, is a very good anti-inflammatory agent, and inflammation plays a role in cancer development," she says.
The new findings are "interesting and provocative," says Bette Caan, DrPh, a senior research scientist at the Kaiser Permanente Northern California Division of Research in Oakland. "I would not recommend that people start taking fish oil specifically to prevent breast cancer because the data is just not there yet, but if they are taking it for other reasons, they should continue."

what is Breast Cancer??

    

Breast Cancer??

Breast cancer is a cancer that starts in the cells of the breast in men and women. Worldwide, breast cancer is the second most common type of cancer after lung cancer   and the fifth most common cause of cancer death.   However breast cancer mortality worldwide is just 25% greater than that of lung cancer in women.  In 2005, breast cancer caused 502,000 deaths worldwide . The number of cases worldwide has significantly increased since the 1970s, a phenomenon partly blamed on modern lifestyles in the Western world.

Because the breast is composed of identical tissues in males and females, breast cancer also occurs in males.  Incidences of breast cancer in men are approximately 100 times less common than in women, but men with breast cancer are considered to have the same statistical survival rates as women.

Signs and Symptoms

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different than the surrounding breast tissue. According to the Merck Manual, greater than 80% of breast cancer cases are discovered as a lump by the woman herself.   According to the American Cancer Society (ACS), the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram.

Indications of breast cancer other than a lump may include changes in breast size or shape, skin dimpling, nipple inversion, or spontaneous single-nipple discharge. Pain is an unreliable tool in determining the presence of breast cancer, but may be indicative of other breast-related health issues such as mastodynia.

When breast cancer cells invade the dermal lymphatics, small lymph vessels in the skin of the breast, its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange peel texture to the skin referred to as peau d’orange.

Another reported symptom complex of breast cancer is Paget’s disease of the breast. This syndrome presents as eczematoid skin changes such as redness and mild flaking of the nipple skin. As Paget’s advances, symptoms may include tingling, itching, increased sensitivity, burning, and pain. There may also be discharge from the nipple. Approximately half of women diagnosed with Paget’s also have a lump in the breast.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. More common sites of metastasis include bone, liver, lung and brain. Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are “non-specific,” meaning they can also be manifestations of many other illnesses.

Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

  

 

Steps to Prevent Breast Cancer

1. Maintain a healthy body weight (BMI less than 25) throughout your life. Weight gain in midlife, independent of BMI, has been shown to significantly increase breast cancer risk. Additionally, and elevated BMI has been conclusively shown to increase the risk of post-menopausal breast cancer.

2. Minimize or avoid alcohol. Alcohol use is the most well established dietary risk factor for breast cancer. The Harvard Nurses’ Health study, along with several others, has shown consuming more than one alcoholic beverage a day can increase breast cancer risk by as much as 20-25 percent.

3. Consume as many fruits and vegetables as possible. Eat seven or more servings daily. The superstars for breast cancer protection include all cruciferous vegetables (broccoli, cabbage, brussels sprouts, cauliflower) ; dark leafy greens (collards, kale, spinach) ; carrots and tomatoes. The superstar fruits include citrus, berries and cherries. Note: it is best to eat cruciferous vegetables raw or lightly cooked, as some of the phytochemicals believed to offer protection against breast cancer are destroyed by heat.

4. Exercise regularly the rest of your life. Many studies have shown that regular exercise provides powerful protection against breast cancer. Aim for 30 minutes or more of moderate aerobic activity (brisk walking) five or more days a week. Consistency and duration, not intensity, are key!

5. Do your fats right! The type of fat in your diet can affect your breast cancer risk. Minimize consumption of omega-6 fats (sunflower, safflower, corn and cottonseed oils), saturated fats and trans fats. Maximize your intake of omega-3 fats, especially from oily fish (salmon, tuna, mackerel, sardines, lake trout and herring). Consume monounsaturated oils (canola, olive oil, nuts/seeds, avocados) as your primary fat source, as these foods have potential anticancer properties. Specifically, canola oil is a good source of omega-3 fats; extra virgin olive oil is a potent source of antioxidant polyphenols, including squalene; and nuts and seeds provide you with the cancer protective mineral, selenium.

6. Do your carbs right! Minimize consumption of the high glycemic index, “Great White Hazards” – white flour, white rice, white potatoes, sugar and products containing them. These foods trigger hormonal changes that promote cellular growth in breast tissue. Replace these “wrong” carbs with whole grains and beans/legumes. Beans/legumes because of their high fiber and lignan content are especially special.

7. Consume whole food soy products regularly, such as tofu, tempeh, edamame, roasted soy nuts, soy milk and miso. Only consume organic, non-GMO (genetically modified) soy. Epidemiologic studies have shown a positive association between soy consumption and reduced breast cancer risk.

8. Minimize exposure to pharmacologic estrogens and xeno-estrogens. Do not take prescription estrogens unless medically indicated. Lifetime exposure to estrogen plays a fundamental role in the development of breast cancer. Also avoid estrogen-like compounds found in environmental pollutants, such as pesticides and industrial chemicals. Buy organic produce if you can afford it; otherwise, thoroughly wash all non-organic produce. Minimize exposure to residual hormones found in non-organic dairy products, meat and poultry.

9. Take your supplements daily. A multivitamin, 500-1,000 mg of vitamin C in divided doses, 200-400 IUs of vitamin E as mixed tocopherols, and pharmaceutical grade fish oil. Also take 200 mcg of the mineral selenium or eat one to two Brazil nuts as an alternative. If you have a chronic medical condition or take prescription drugs, consult your physician first.

10. Maintain a positive mental outlook. Engage in self-nurturing behaviors regularly. Develop rich, warm and mutually beneficial relationships with family and friends. Get adequate sleep (7-8 hours per night). The mind-body associations with breast cancer are significant.

After a breast cancer diagnosis, you and your doctors will put together a treatment plan specific to your situation, based on your pathology report. Your treatment plan will be made up of one or more specific treatments that are intended to target the cancer cells in different ways and reduce the risk of future breast cancer recurrence. You and your doctor will base your treatment decisions on YOUR unique situation, including consideration of your overall medical condition and your personal style of making decisions. You may have to re-evaluate your decisions periodically. Your medical team will be your guide.

Treatment of Breast Cancer

There are two methods of treatment – local and systemic.

Local treatments are used to remove or destroy the cancer cells in a specific area. Surgery and Radiation therapy are examples of local treatments.

Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormonal therapy examples of systemic treatments.

The right treatment method, however, depends on the size and location of the breast tumor; the results of the pathologist’ s review of the tumor specimen, the woman’s age, menopausal status, and general health; and the stage of the disease.

Understanding Breast Cancer - the Basics

(continued)

What Causes Breast Cancer? continued...

Some studies suggest that the use of hormone replacement therapy with estrogen and progesterone containing compounds increases the risk of developing breast cancers. The use of estrogens alone does not increase or decrease the risk unless they are used for prolonged periods of time and then the risk increases.The jury is still somewhat out on this matter though. Heavy doses of radiation therapy may also be a factor, but low-dose mammograms pose almost no risk.

The link between diet and breast cancer is debated. Obesity is a noteworthy risk factor, predominately in postmenopausal women, because obesity alters a woman's estrogen levels. Drinking alcohol regularly - more than 2 to 3 drinks a day - may also promote the disease. Many studies have shown that women whose diets are high in fat, either from red meat or high-fat dairy products, are more likely to get the disease. Researchers suspect that if a woman lowers her daily calories from fat - to less than 20%-30% - her diet may help protect her from developing breast cancer.

Understanding Breast Cancer - the Basics 2

(continued)

What Causes Breast Cancer?

Although the precise causes of breast cancer are unclear, we know what the main risk factors are. Still, most women considered at high risk for breast cancer do not get it, while many who do have no known risk factors. Among the most significant factors are advancing age and a family history of breast cancer. Risk increases slightly for a woman who has had a benign breast lump and increases significantly for a woman who has previously had breast cancer or a history of endometrial, ovarian, or colon cancer.  

A woman whose mother, sister, or daughter has had breast cancer is two to three times more likely to develop the disease, particularly if more than one first-degree relative has been affected. This is especially true if the cancer developed in the woman while she was premenopausal, or if the cancer developed in both breasts. Researchers have now identified two genes responsible for some instances of familial breast cancer - called BRCA1 and BRCA2.  About one woman in 200 carries it. Having the gene predisposes a woman to breast cancer and while it does not ensure that she will get breast cancer her lifetime risk is 56-85%. Because of this, risk prevention strategies and screening guidelines for those with the BRCA genes are more aggressive. There are other genes that have been identified as increasing the risk of breast cancer, including the PTEN gene, the ATM gene, and the CHEK2 gene. However, these genes carry a lower risk for breast cancer development than the BRCA genes.

Generally, women over 50 are more likely to get breast cancer than younger women, and African-American women are more likely than Caucasians to get breast cancer before menopause.

A link between breast cancer and hormones is gradually becoming clearer. Researchers think that the greater a woman's exposure to the hormone estrogen, the more susceptible she is to breast cancer. Estrogen tells cells to divide; the more the cells divide, the more likely they are to be abnormal in some way, possibly becoming cancerous.

A woman's exposure to estrogen and progesterone rises and falls during her lifetime, influenced by the age she starts and stops menstruating, the average length of her menstrual cycle, and her age at first childbirth. A woman's risk for breast cancer is increased if she starts menstruating before age 12, has her first child after 30, stops menstruating after 55, or has a menstrual cycle shorter or longer than the average 26-29 days. Current information about the effect of birth control pills and breast cancer risk is mixed. Some studies have found that the hormones in birth control pills probably do not increase breast cancer risk. However other studies suggest that the risk of breast cancer is increased in women who have taken birth control pills recently, regardless of how long she has taken them.

What Is Breast Cancer?

Understanding Breast Cancer - the Basics

Before discussing breast cancer, it's important to be familiar with the anatomy of the breast. The normal breast consists of milk-producing glands that are connected to the surface of the skin at the nipple by narrow ducts. The glands and ducts are supported by connective tissue made up of fat and fibrous material. Blood vessels, nerves, and channels to the lymph nodes make up most of the rest of the breast tissue. All the breast anatomy mentioned above sits under the skin, but on top of the chest muscles.

As in all forms of cancer, the abnormal tissue that makes up breast cancer is the patient's own cells that have multiplied uncontrollably. Those cells may also travel to locations in the body where they are not normally needed, which means the cancer is malignant.

Breast cancer develops in the breast tissue, primarily in the milk ducts (ductal carcinoma) or glands (lobular carcinoma). The cancer is still called and treated as breast cancer even if it is first discovered after traveling to other areas of the body such as the lungs, liver, or bones. In those cases, the cancer is referred to as metastatic or advanced breast cancer.   

Breast cancer usually begins with the formation of a small, confined tumor (lump), or as calcium deposits (microcalcifications) and then spreads through channels to the lymph nodes or through the blood stream to other organs. The tumor may also grow and invade tissue around the breast, such as the skin or chest wall. Different types of breast cancer grow and spread at different rates - some take years to spread beyond the breast while other move quickly.  

Some lumps are benign (not cancerous), however these can be premalignant. The only safe way to distinguish between a benign lump and cancer is to have the tissue examined by a doctor.

Men can get breast cancer, too, but they account for less than one-half of one percent of all cases. Among women, breast cancer is the most common cancer and the second leading cause of cancer deaths behind lung cancer.

If eight women were to live to be at least 85, one of them would be expected to develop the disease at some point during her life. Two-thirds of women with breast cancer are over 50, and most of the rest are between 39 and 49. 

Fortunately, breast cancer is very treatable if detected early. Localized tumors can usually be treated successfully before the cancer spreads; and in nine in 10 cases, the woman will live at least another five years. Experts usually consider a five-year survival to be a cure although recurrences after five years are common.

Once the cancer begins to spread, getting rid of it completely is more difficult, although treatment can often control the disease for years. Improved screening procedures and treatment options mean that at least seven out of 10 women with breast cancer will survive more than five years after initial diagnosis, and half will survive more than 10 years. 

Teen Drinking Linked to Benign Breast Disease

Study Shows Alcohol Use by Teenage Girls May Raise Risk of Noncancerous Breast Lumps

Pediatrics. Benign breast disease or noncancerous lumps, bumps or cysts in the breast are known risk factors for breast cancer.

"These findings raise concern because alcohol intakes by college students has increased greatly in recent years, whereas drinking by adult women is one of few known dietary risk factors for breast cancer," conclude the researchers, who were led by Catherine S. Berkey, ScD, a lecturer in medicine at Harvard Medical School, and a research associate at Brigham and Women's Hospital, in Boston. "If future work confirms our findings, then clinical efforts to delay the onset of alcohol consumption may prevent some cases of benign breast disease and breast cancer."

Girls were aged 9 to 15 when the Growing Up Today Study began. They answered questionnaires from 1996 to 2001, and then again in 2003, 2005, and 2007. The questions about alcohol consumption in the previous year were a part of the 2003 survey.

During the 2005 and 2007 surveys, the participants were asked about benign breast disease; 147 women said they had been diagnosed with it and 67 of these women said this diagnosis was confirmed with a biopsy.

Those participants who drank alcohol six to seven days per week were more than five times as likely to develop benign breast disease as their counterparts who abstained. The teens and adolescent women who drank three to five days per week had three times the risk of developing benign breast disease as their counterparts who did not drink alcohol, the study showed.

Exactly how alcohol use during the teen years raises risk for benign breast disease is not fully understood, but the researchers speculate that alcohol use may increase levels of the female sex hormone estrogen, which may foster the development of benign lumps, bumps, and cysts in the breasts.

"The breasts of young girls are very active and if you give them extra hormones or alcohol, then they can respond by creating lumps and bumps and things in the category of benign breast disease, and if you keep this going, it can increase the risk of breast cancer," says Marisa Weiss, MD, the president and founder of advocacy group Breastcancer.org and the author of several books, including Taking Care of Your Girls: A Breast Health Guide for Girls, Teens, and In-Betweens. "You are laying the foundation for your future breast health during adolescence," says Weiss, who is also the director of Breast Radiation Oncology and the director of Breast Health Outreach at Lankenau Hospital in Wynnewood, Penn.

"The habits that you develop as an adolescent are likely to turn into lifelong habits, and we know that drinking in adult women is a risk factor for breast cancer," she says.

Breast Cancer

Taking part in cancer research

Cancer research has led to real progress in the prevention, detection, and treatment of breast cancer. Continuing research offers hope that in the future even more women with breast cancer will be treated successfully.

Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). Clinical trials are designed to find out whether new approaches are safe and effective.

Even if the people in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about breast cancer and how to control it. Although clinical trials may pose some risks, doctors do all they can to protect their patients.

Doctors are trying to find better ways to care for women with breast cancer. They are studying many types of treatment and their combinations:

• Radiation therapy: In women with early breast cancer who have had a lumpectomy, doctors are comparing the effectiveness of standard radiation therapy aimed at the whole breast to that of radiation therapy aimed at a smaller part of the breast.
• Chemotherapy and targeted therapy: Researchers are testing new anticancer drugs and doses. They are looking at new drug combinations before surgery. They are also looking at new ways of combining chemotherapy with targeted therapy, hormone therapy, or radiation therapy. In addition, they are studying lab tests that may predict whether a woman might be helped by chemotherapy.
• Hormone therapy: Doctors are testing several types of hormone therapy, including aromatase inhibitors. They are looking at whether hormone therapy before surgery may help shrink the tumor.
• Supportive care: Doctors are looking at ways to lessen the side effects of treatment, such as lymphedema after surgery. They are looking at ways to reduce pain and improve quality of life.

If you're interested in being part of a clinical trial, talk with your doctor.

The NCI Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of breast cancer. Information specialists at 1-800-4-CANCER (1-800-422-6237) or at LiveHelp at http://www.cancer.gov/help can answer questions and provide information about clinical trials.

Breast Cancer At A Glance

• One in every eight women in the United States develops breast cancer.
• The causes of breast cancer are not yet fully known although a number of risk factors have been identified.
• Breast cancer is diagnosed with self- and physician- examination of the breasts, mammography, ultrasound testing, and biopsy.
• There are many types of breast cancer that differ in their capability of spreading (metastasize) to other body tissues.
• Treatment of breast cancer depends on the type and location of the breast cancer, as well as the age and health of the patient.
• The American Cancer Society recommends that a woman should have a baseline mammogram between the ages of 35 and 40 years. Between 40 and 50 years of age mammograms are recommended every other year. After age 50 years, yearly mammograms are recommended.

Progress in Predicting Invasive Breast Cancer

Researchers studied nearly 1,200 women with ductal carcinoma in situ (DCIS), a noninvasive and very early form of breast cancer confined to the milk ducts. They found that a combination of three tissue biomarkers was associated with a high risk of developing an invasive breast cancer with the potential to spread eight years later.

Also, DCIS that was diagnosed from a breast lump was linked to a greater risk of subsequent invasive cancer than DCIS that was diagnosed by mammography.
There's still a long way to go before the personalized approach to treatment is ready for prime time.

"But the study gets us closer to our goal of separating women with DCIS into risk groups, so as to avoid overtreatment of women with low-risk breast lesions and undertreatment of women with high-risk lesions," study researcher Karla Kerlikowske, MD, of University of California, San Francisco, tells WebMD.

The study was published online by the Journal of the National Cancer Institute.

Overtreatment of DCIS

Currently, overtreatment of DCIS, which will be diagnosed in over 47,000 women this year, is the big problem, according to Kerlikowske.

"Since there's currently no way to predict which women with DCIS will go on to develop invasive cancer, almost all are offered radiation after the lump is removed [lumpectomy] or mastectomy and sometimes hormone therapy. But our results suggest as many as 44% of women with DCIS may not require any treatment other than removal of the lump and can instead rely on active surveillance, or close monitoring," Kerlikowske says.

The close monitoring offers these women a safety net, she says. "If a tumor comes back, we can always give radiation then."

Radiation therapy not only carries a risk of side effects such as nausea, vomiting, and fatigue but also precludes irradiating the same area of the breast a second time, Kerlikowske says. "So you want to save it for when it is really needed," she says.

Predicting Invasive Breast Tumors

The study involved 1,162 women aged 40 and older who were diagnosed with DCIS and treated with lumpectomy alone between 1983 and 1994.

Overall, their eight-year risks of developing a subsequent DCIS or a subsequent invasive cancer were 11.6% and 11.1%, respectively.

When the researchers looked at women whose DCIS was diagnosed by feeling a lump, the eight-year risk of subsequent invasive cancer was substantially higher than average, 17.8%.

Then they looked at different combinations of biomarkers using tissue that had been stored for 329 of the women when they were first diagnosed with DCIS. These biomarkers include estrogen receptor, progesterone receptor, Ki67 antigen, p53, p16, epidermal growth factor receptor-2, and cyclooxygenase-2.

The study showed that women who express high levels of three biomarkers -- p16, cyclooxygenase-2, and Ki67 -- also had a substantially higher-than-average eight-year risk of developing invasive cancer (27.3%).

The researchers stratified all 1,162 women into four risk groups. A total of 17.3% were in the lowest-risk group, with only a 4.1% chance of developing invasive cancer at eight years; 26.8% were in the next lowest risk group, with a 6.9 chance of developing invasive cancer at eight years. If the findings are validated, it is these two groups that could forgo treatment other than lumpectomy and active surveillance, Kerlikowske says.

A total of 27.6% of the women were in the high-risk group, with a nearly 20% chance of developing invasive cancer at eight years. These are the women who need more aggressive therapy with radiation and perhaps hormone therapy, she says.

Factors associated with a higher risk of having a subsequent ductal carcinoma in situ included having no cancer cells remain within 1 millimeter of the area from which the lump was removed and different combinations of biomarkers.

Unanswered Questions

Still, many questions remain.

For starters, about half of women who developed invasive cancer in the study didn't have the three biomarkers or DCIS diagnosed from a lump, so the researchers have to figure out what other factors are at play, Kerlikowske says.

Also, the approach has not been shown to actually extend lives.

Additionally, the study involved women who had undergone lumpectomy alone, which is no longer the standard of care, says Ramona Swaby, MD, a breast cancer specialist at Fox Chase Cancer Center in Philadelphia.

Recurrence rates are lower in women who also get radiation and if needed, hormone therapy, so it's important to see if the findings hold up in such women, she tells WebMD.

Craig Allred, MD, of Washington University School of Medicine in St. Louis, also calls for further study in an editorial accompanying the study. Still, "if validated, the results could optimize current therapy in certain settings: [withholding] radiation from women with low-risk DCIS, for example," he writes.

Several companies have expressed interest in helping to further develop and eventually market any tissue biomarker test, which will also need FDA approval, according to Kerlikowske.

Since it utilizes the same method and can be done at the same time doctors determine a tumor's hormone-receptor status, she doubts it will cost more than a few hundred dollars.

Funding for the research was provided by the National Cancer Institute and the California Breast Cancer Research Program.

Anti-depressant linked to breast cancer deaths

Women taking a popular anti-depressant at the same time as a drug used to stop breast cancer recurring are more likely to die from the disease, doctors warn.

Researchers have found that the anti-depressant Seroxat can interfere with tamoxifen, which is prescribed to thousands of breast cancer survivors for five years at a time.

The findings have major implications because many of these women also suffer from depression, with up to one in four affected.

Women taking anti-depressant Seroxat at the same time as breast cancer drug tamoxifen are more likely to die from breast cancer, doctors warn

However, other anti-depressants did not have the same effect.

A study led by a team from the Sunnybrook Health Sciences Centre and the University of Toronto in

Canada looked at 2,430 women aged 66 and over who were being treated between 1993 and 2005.

All were taking tamoxifen and one of five anti-depressants, including Seroxat, which was the most commonly prescribed. Seroxat is also known as paroxetine.

Over the next 2.4 years, 374 died from breast cancer. Analysis showed that those taking Seroxat were far more likely to die from breast cancer and slightly more likely to die from any other cause, compared with women not on the drug.

The researchers found that if patients took Seroxat for 25 per cent of the time they were on tamoxifen, they were 24 per cent more likely to die from breast cancer.

When Seroxat was taken for 50 per cent of the time, there was a 54 per cent increase in the chance of death, and when taken for 75 per cent of the treatment patients were 91 per cent more likely to die.

'In conclusion, our findings indicate that the choice of anti-depressant can significantly affect survival in women receiving tamoxifen for breast cancer', their report published in the British Medical Journal said.

But the authors stressed that women should not stop taking tamoxifen and that their study does not imply that Seroxat causes or influences the course of breast cancer.

'This is simply a situation in which [Seroxat] impairs the effectiveness of tamoxifen,' they said.

Dr David Juurlink, one of the study's authors, said: 'When co-prescription of tamoxifen with an anti-depressant is necessary, preference should be given to anti- depressants that exhibit little or no impact on tamoxifen's metabolism.'

Meg McArthur, senior policy and information officer at Breakthrough Breast Cancer, said anyone with concerns should discuss them with their doctor.

A spokesman for GlaxoSmithKline, which makes Seroxat, said the firm was aware of the link and had updated warnings on the label of the drug in 2008.

She added: 'Following publication of this new study, GSK will review these additional data and will work with regulatory authorities to determine next steps

Breast cancer

From breast cancer prevention, diagnosis, treatment, support and advice to the latest developments, we have everything you need to know about breast cancer. Find out about breast cancer symptoms, what a breast cancer diagnosis really means, learn more about 'wonder drug' Herceptin and discover what breast cancer treatment is available to you. Plus, how to check your breasts with our animated breast checker and real life stories from male and female breast cancer sufferers. Ask advice and gain emotional support from other breast cancer survivors and patients in our online support group. Plus, keep up to date with the latest news, developments and research on breast cancer, screening, health advice and more with our health news, factfiles and guides. Help on breast cancer:

Helping your child when diagnosed with cancer

Dealing with breast cancer 

I was first diagnosed with Stage 2-b invasive breast cancer as a 43-year-old mother with a young son. I frantically searched for a book to help him understand my illness and what I would be going through in order to get well. There was nothing suitable that would hold his attention. I wanted to be honest with him discussing my surgery and treatment in broad strokes and answering his questions as they arose.

Below are some tips that got us through this painful journey.

This is our story, each family and situation is different; this is simply what worked for us.
• Digest the news of your diagnosis before telling your child. This way, your anxiety and fears will not scare him or her.  Have a few age appropriate books on hand to explain what will be happening.

• Let your child know the news of your illness as early as possible.  This gives the family time before surgery and treatment so the child won't blame him or herself for the sadness that may become apparent in the house. You also don’t want him/ her to hear it from a well meaning neighbor.
• Be honest and don’t hide the diagnosis.  Our son knew something was amiss and tense in our normally happy household. Telling him that mommy was sick and needed some strong medicine, made him realize that my initial depression and tears were not his fault.  He thought it was cool that I would be bald.  Girls at his school clearly did not share this idea!  We gave the cancer the correct name; mommy had breast cancer.
• Let the child take the lead. They will ask in their own time what they wish to know.  One day in the post office my son asked: "Can boys get breast cancer?" The long line of customers leaned in for the answer (which I promptly and honestly answered in the car). “Very few boys or men get breast cancer.  You shouldn’t worry about that, you will be fine.”  This was also a good time for me to mention that he couldn't "catch" cancer.  The question that brought me to my knees was,” Will I be getting a new mom this spring?"  I answered, while holding back the tears, "I will always be your mama no matter what life brings."
• Include the children in the process from treatment to recovery. Quiet games were a must, and kisses and hugs were the very best medicine. We played endless games of chess and bingo. Our son liked to be in charge of bringing me water and getting the “puke bucket”.
• Schedules are important for children but it is perfectly ok and even beneficial to bend the rules as needed. Our son got to watch a bit more TV than usual; he is none the worse for the wear.
• We also had a gift stash.  When I was too weak to even play bingo; we pulled out a new toy. I received many gifts during that time; why not spoil the child a bit as well?
• Children are resilient; just let them know daily that they are loved immensely.
• Give the child room to vent his/her frustrations and anger. I allowed my son to use bad words – only if he shouted them into his closet with the door shut. He was also able to draw all over the walls of the closet (walk-in) as a safe place to express his emotions. He ended up drawing on the door with markers a family portrait including God. We all had pig noses! I wish I saved that door after our remodel.
• Pray!  If you already pray, step it up a few notches. Now is the best time ever to take up prayer with your family.  Faith will help to answer the tough and seemingly unanswerable questions. 

In summary, be yourself, be honest and know that your family will grow from this devastating experience in the most amazing and positive way.