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Breast cancer myth busters

By Melissa Arnold

Each October, it seems like the whole world turns pink in the name of breast cancer awareness. From fundraisers to billboards, clothing and social media campaigns, that ubiquitous pink ribbon is everywhere. Of course, there’s a clear need for awareness, as 1 in 8 women on Long Island will develop invasive  breast cancer in their lifetime. But even with the October blitz, myths and misconceptions remain widely circulated among women of all ages.

Susan Samaroo is the executive director of The Maurer Foundation (www.maurerfoundation.org), a nonprofit organization in Melville established in 1995 with one goal in mind — to save lives through breast education. Their interactive workshops held in schools, colleges and community locations debunk long-held breast cancer myths, teach people how to lower their risk through lifestyle modification, and provide instruction to find breast cancer in its earliest stages when it is easiest to treat.

“We believe that it’s important to educate young people specifically and give them the information they need early on,” said Samaroo. “It’s never too early to learn what to look for and how to make positive changes that reduce breast cancer risk.”

The foundation educates roughly 20,000 people each year, the majority in co-ed settings. And Samaroo noted that they tend to hear the same rumors about breast cancer year after year. Let’s set the record straight on some of the most common myths.

MYTH: If you don’t have a family history, you won’t get breast cancer.

FACT: While family history is an important factor when considering potential risk, the National Institutes of Health reports that around 85 percent of people diagnosed with breast cancer do not have a family history.

For people that do have a family history, it’s critical to have a conversation with your doctor as soon as possible. Mammograms and other screening may be recommended as early as age 25, and in some cases, genetic testing is warranted. Having certain genetic mutations causes an individual’s risk to skyrocket, and preventative medication or surgery could be necessary.

MYTH: Only older women get breast cancer.

FACT: There are actually two false statements here. First, the age factor. According to Eileen Pillitteri, program manager of The Maurer Foundation, approximately 12,000 women in their 20s and 30s receive a breast cancer diagnosis each year.

Furthermore, men can and do get breast cancer. The Centers for Disease Control and Prevention (CDC) states that 1 in 100 breast cancers patients are men, making it critical for both men and women to familiarize themselves with the look and feel of their breasts and check regularly for lumps, discharge and changes in appearance.

MYTH: Size matters.

FACT: Some people believe that having larger breasts reflects a greater risk of cancer, but that doesn’t matter. It’s worth noting, however, that some women’s breasts are more difficult to screen for abnormal growths.

“An annual mammogram is the best overall screening test for breast cancer. There are some limitations, especially in women with dense breast tissue,” said Dr. Erna Busch-Devereaux, chief breast surgeon at Huntington Hospital, Northwell Health. “Having dense breasts means that there is not a lot of fatty tissue present in the breasts. These breasts are mostly glandular and the X-rays don’t penetrate that tissue as well, so the picture is not as clear. Finding cancer can be more difficult with dense breasts — it’s like finding a snowball (cancer) in a snowstorm (background breast tissue).”

Your doctor will let you know if you have dense breasts. Different types of screening, such as 3-D mammograms, ultrasound or MRI might be suggested for a clearer picture.

MYTH: Your deodorant or your bra could give you cancer.

FACT: As of right now, there is no scientifically-backed evidence showing an increase in breast cancer risk for women who use antiperspirants or deodorants, though there are “general concerns surrounding the impact of environmental and consumed chemicals on our health,” Busch-Devereaux said, adding that more study is needed.

And as for the rumor that wearing tight bras with underwire or any other type of bra can cause breast cancer by obstructing lymph flow? “That’s completely unfounded,” Pillitteri said.

MYTH: Lifestyle doesn’t change your cancer risk.

FACT:  Across the board, limiting or avoiding alcohol consumption and eating a well-rounded, nutritious diet can help lower your risk of many cancers.

When it comes to breast cancer specifically, other choices you make can make an impact as well, but the specifics can be complicated. 

“Having children at a young age and having multiple children results in a reduced breast cancer risk, but this protection is seen decades later. In the short term, there is an increased risk for breast cancer after having a child which is associated with pregnancy-related hormone surges,” Pillitteri explained.

Contraception is another tricky topic. Hormonal IUDs and oral birth control pills can increase breast cancer risk, but they can also greatly reduce the risk of ovarian and endometrial cancers, Pillitteri said.  Other health professionals, including Dr. Busch-Devereaux, said that birth control pills don’t appear to increase overall breast cancer risk.

Healthcare organizations agree that most types of hormone replacement therapy (HRT) to cope with symptoms of menopause does increase breast cancer risk.

The takeaway: “It’s important to talk to your doctor about the products that are right for you based on your individual risk factors,” Pillitteri said.

Be proactive

In the end, risk of breast cancer can vary from person to person based on genetics, body type and lifestyle. But it’s never too late to make positive changes.

“Eat a healthy, well-balanced diet, exercise, maintain an average weight, avoid smoking or vaping, and limit alcohol — things that are good for overall health are good for the breasts,” Busch-Devereaux said. 

Make sure you have an annual mammogram screening beginning at age 40. If you have a family history or genetic mutations, talk to your doctor about when to start screenings.

And don’t be embarrassed if it’s been a while since your last mammogram. The important thing is to go.

“Sometimes women are too worried to go for a mammogram, or they delay seeking care because they’re afraid,” Busch-Devereaux said. “We stand an excellent chance of curing cancer when it is found early, so mammograms are very important and should always be encouraged. Additionally, women shouldn’t feel afraid or embarrassed to come in for an evaluation if they feel a lump or notice a change in their breast and haven’t gone for a mammogram. We’re here to help.”

This article first appeared in TBR News Media’s Focus on Health supplement on Oct. 20, 2022.

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A Paint Port Pink display at Pasta Pasta
A Paint Port Pink display at Comsewogue Public Library.
A Paint Port Pink displays at Arame Salon and Spa
A Paint Port Pink display at Amy Tyler School of Dance
A Paint Port Pink display at Yoga Delish

Paint Port Pink, Mather Hospital’s annual month-long breast cancer community awareness outreach, kicked off Oct. 1 with the lighting of pink lights by community partners in Port Jefferson, Port Jefferson Station, and surrounding communities. Lamp posts along Main Street in Port Jefferson are aglow with pink lights, along with the Theatre Three marquee and many store windows.

Paint Port Pink’s goal is to raise awareness about breast cancer, encourage annual mammograms, and bring the community together to fight this disease.

A pink pumpkin by Kathleen Fusaro.

Breast cancer is the most common cancer in women in the U.S., except for skin cancers, representing about 30 percent (or one in three) of all new female cancers each year. It is the second leading cause of cancer deaths for women in the U.S. after lung cancer, according to the American Cancer Society. Every two minutes someone is newly diagnosed with invasive breast cancer (Breast Cancer Research Foundation).Only one in three women over 40 have an annual mammogram. 

Paint Port Pink will feature a special HealthyU webinar on Women’s Health on Tuesday, Oct. 11 at noon. Three physicians will talk about breast cancer, menopause, and mental health during the pandemic. Register at matherhospital.org/healthyu 

Oct. 14 is “Wear Pink Day” and everyone — and their pets — are encouraged to get their pink on to raise awareness. Post photos on social media with #paintportpink and send them to [email protected] to be posted on our Facebook page.

Decorate your business window for a chance to win tickets to a 2023 concert at Jones Beach. Send photos of your window by Oct. 20 to [email protected]

The event’s popular “Pink Your Pumpkin” contest returns and encourages everyone to get creative with their pumpkins for a cause. Photos should be emailed to [email protected] by Oct. 24 and posted on social media with #paintportpink. The winner will be chosen Oct. 25 and will receive a $100 gift card. 

Paint Port Pink community sponsors include New York Cancer & Blood Specialists, Lippencott Financial Group, Riverhead Toyota, and Accelerated Services Inc., Po’ Boy Brewery , Tuscany Gourmet Market, Bohemia Garden Center, Brookhaven Expeditors, C. Tech Collections,  Michael R. Sceiford  Financial Advisor/ Edward Jones, PAP Landscape and Design, Inc., Precision Lawn Irrigation, and Swim King Pools and Patios.

A full calendar of events and a list of Paint Port Pink community partners offering promotions to benefit The Fortunato Breast Health Center is available at www.paintportpink.org. Call 631-476-2723

From despair to hope: A breast cancer survivor’s story

By Jennifer Van Trettner

Jennifer Van Trettner

It was late Friday morning on a cool December day when my phone rang. It was the (Fortunato) Breast Center calling about my routine mammogram that I had two days prior. I took a deep breath and hesitantly answered the phone. Marianne, the nurse on the other end, introduced herself and told me in a kind, warm voice that the doctor saw something of concern on my imaging and asked if I could come in for a biopsy within the hour. I said yes before I even had time to exhale.

I drove to the Breast Center alone. All sorts of thoughts were running through my head. Shortly after arrival, I was escorted to the sonogram area by a friendly woman and was given a warm gown. I undressed, wrapped myself in the warm, pink gown, and sat in the waiting room. 

A few minutes later, I was called into the sonogram room. The technician, whom I had met on several occasions, was lovely. The doctor was the same one who did my last biopsy. She explained to me that six tissue samples would be taken from my left breast. 

On Tuesday, December 21, 2021, the Breast Center called. I felt my heart plummet into my stomach and knew my life was about to change forever. As if in slow motion, I answered the call. If I close my eyes, I can still hear Marianne’s voice saying they received my biopsy results and asking if I could come to the breast center that day. This time I didn’t want to go alone. My mother-in-law, a breast cancer survivor, went with me (my mother, also a breast cancer survivor, lives in Georgia). 

With masks on, we walked into the Breast Center and were immediately brought into the office. It was warm and inviting. The doctor came in, introduced herself to my mother-in-law and sat in a chair at the end of the desk, almost directly in front of me. I could feel my eyes welling with tears.

I was told my biopsy was positive for IDC (Invasive Ductal Carcinoma) breast cancer. It was stage 1, estrogen positive, and Her2+. Relatively speaking, it was a good scenario. Marianne held up a pretty, clear box of pearls ranging from 2mm up to 20mm. She took out a 10mm pearl, placed it in my hand and told me this was the approximate size of my cancer. As I held the pearl in my hand, I thought what a nice, kind, warm, and non-scary way to confirm a woman’s fear.

Marianne, having years of my personal information in front of her, explained how she already called and made appointments with the doctors I would need to see. 

I called my mom from the office. I really needed to hear her voice. I asked her to get dad and put the phone on speaker. Telling my parents, from hundreds of miles away, their eldest daughter had breast cancer was not easy. I found myself standing at the entrance to a new path, and I wasn’t quite sure how to take the first step. One thing I knew for sure was that I wouldn’t have to take the first step alone. After hanging up with my parents, I was escorted to have an MRI. A few hours later and completely emotionally exhausted, we headed home.

On the morning of December 30, 2021, I saw my surgeon who would remove the cancer and sentinel lymph nodes. In the afternoon I saw the oncologist who had done genetic testing on me two years earlier (all of which were negative). He explained my cancer and the treatment it would require. I would need 12 weeks of chemotherapy and Herceptin infusions once a week for three to seven hours followed by an additional 13 Herceptin infusions every three weeks. Once those were finished (anticipated finish date: 2/8/23), I would need 10 years of Tamoxifen. The same evening, I had a PET scan. Thankfully, there were no surprises.

I started to tell family, friends, and colleagues of my diagnosis. I was immediately touched by the outpouring of love and concern. Helpful gifts began to arrive. The best gifts of all were the arrival of my parents a few days prior to surgery. 

My surgery at Mather Hospital was scheduled for January 25, 2022, which at the time of diagnosis felt like years away. In the back of my head was a little voice wondering if my aggressive cancer would get larger and spread during those weeks of waiting. I started an online journal and invited those closest to me to follow. 

The warrior in me began to take charge of my treatment, familiarize myself with my cancer, mastectomy options, implant options, and read from cover to cover the amazing book the breast center gave me at time of diagnosis. I reviewed all possible side effects. After that I never looked back. 

On the day of surgery, I arrived at the hospital anxious, nervous, and prayed that waking up after surgery was God’s will. I worried about what would happen to my husband and adult children if I didn’t. 

I  was brought into a large operating room. I fell asleep within seconds of speaking to the anesthesiologist and woke up seven hours later in recovery. The nurses were wonderful. Two of my former students, now nurses working the night shift, visited me bringing with them my favorite sweets, Swedish fish. Seeing familiar, friendly faces that night made my heart happy

Since my surgery, life has had many challenges. The first two weeks post-surgery I spent on the couch with my parents taking care of all household things while my husband went to work. April 14th, I tested positive for COVID, which set me back a week in treatment. Thankfully my oncologist prescribed an antiviral. It helped with my recovery and got me back on track with the infusions.

Treatments began with inserting the IV needle, blood work, Herceptin, a bag of Zofran, a bag of Benadryl and lastly chemo. By treatment six, my hair was very thin, so I decided to take control and shave what was left. The last day of chemo was May 21st, and on May 28th, I began my tri-weekly Herceptin infusions.

Throughout this journey, I have posted consistently on social media. I was born a teacher, and as such I felt it important to share my journey with anyone who wanted to follow. I believe it’s important for me to show my strengths and weaknesses, to be real, raw, and honest. This is a club no one wants to join. In the United States breast cancer affects 1 in 8 women, and on Long Island it’s 1 in 6. I had a support system like no other to help me get through this.

Schedule a mammogram today!

The Fortunato Breast Health Center at Mather Hospital, 75 North Country Road, Port Jefferson uses state-of-the-art breast imaging technology in a warm and assuring environment with a commitment to giving you personalized breast healthcare. 

Their staff of professionals provides 3D mammograms and offers individualized follow-up care, education for patients, families, and the community, as well as breast cancer support groups. 

Their Breast Center radiologists are specialists who only read breast imaging studies and look back as far as possible at your history of breast images for any subtle changes or abnormalities to provide the most accurate reading.

The Breast Health Center has also partnered with the Suffolk Cancer Services Program (CSP) to provide free breast cancer screenings to individuals who qualify. The CSP provides breast cancer screenings to women age 40 and older without health insurance in Suffolk. If any follow-up testing is needed, the CSP will provide those tests too. If cancer is found, CSP will help enroll people who are eligible in the NYS Medicaid Cancer Treatment Program for full Medicaid coverage during treatment. 

To find out if you are eligible for free screenings or to schedule your annual mammogram, call 631-476-2771. 

All photos courtesy of Mather Hospital.

 

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The American Cancer Society recommends women 45-54 get annual screenings. METRO photo
New research on bisphosphonates helps clarify their role in prevention

By David Dunaief, M.D.

Dr. David Dunaief

Breast cancer is the most common cancer diagnosed in U.S. women. Experts estimate that 30 percent of 2022 cancer diagnoses in women will be breast cancer (1). Only 15 percent of cases occur in those who have a family history of the disease, and 85 percent of new diagnoses will be invasive breast cancer.

A primary objective of raising awareness during October is to promote screening for early detection. Screening is crucial, but it is not prevention, which is just as important. Prevention strategies should include primary prevention, preventing the disease from occurring by lowering your risk, and secondary prevention, preventing breast cancer recurrence.

Here, we will discuss current screening recommendations, along with tools to lower your risk.

What are current screening recommendations?

There is some variation in screening guidelines; experts don’t agree on age and frequency. The U.S. Preventive Services Task Force currently recommends mammograms every other year, from age 50 through age 74, with the option of beginning as early as age 40 for those with significant risk (2). These 2016 guidelines are currently undergoing a review and are pending publication.

The American College of Obstetricians and Gynecologists encourages a process of shared decision-making between patient and physician to determine age and frequency of exams, including whether to begin exams before age 50 or to continue after age 75 (3). Generally, it recommends beginning annual or biennial mammograms starting no later than 50 and continuing until age 75. 

The American Cancer Society’s physician guidelines are to offer a mammogram beginning at age 40 and recommend annual exams from 45 to 54, with biennial exams after 55 until life expectancy is less than 10 years (4).

It is important to consult with your physician to identify your risk profile and plan or revise your regular screening schedule accordingly.

When do bisphosphonates help?

Bisphosphonates, which include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate), are used to treat osteoporosis. Do they have a role in breast cancer risk prevention? The short answer: it may help prevent recurrence but doesn’t appear to provide primary protective benefits.

In a meta-analysis involving two randomized controlled trials (RCTs), FIT and HORIZON-PFT, results showed no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The study population involved 14,000 postmenopausal women from ages 55 to 89 women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, bisphosphonates were being used for primary prevention.

However, it does appear that bisphosphonates have a role in preventing breast cancer recurrence. The recent SUCCESS A phase 3 trial considered the optimal time for treatment. Findings published in 2021 indicate that two years of treatment for patients with high-risk early breast cancer reduced recurrence risk as much as five years of treatment (6). This could alter the current paradigm of 3-to-five years of treatment to prevent recurrence of certain types of breast cancer, reducing incidences of troublesome side effects.

A Lancet metanalysis focused on breast cancer recurrence in distant locations, including bone, and survival outcomes did find benefits for postmenopausal women (7). A good synopsis of the research can be found at cancer.org.

What’s the role of exercise?

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (8). These women exercised moderately; they walked four hours a week over a four-year period. If they exercised previously, five to nine years ago, but not recently, no benefit was seen. The researchers stressed that it is never too late to begin exercise. Only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. We need to expend as much energy and resources emphasizing exercise for prevention as we do screenings.

What about soy?

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis, those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (9). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg. Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk when compared to those who consumed the least. In addition, higher soy intake has been associated with reduced recurrence and increased survival for those previously diagnosed with breast cancer (10). The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Hooray for Breast Cancer Awareness Month stressing the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References: 

(1) breastcancer.org. (2) uspreventiveservicestaskforce.org. (3) acog.org. (4) cancer.org. (5) JAMA Intern Med. 2014;174(10):1550-1557. (6) JAMA Oncol. 2021;7(8):1149–1157. (7) Lancet. 2015 Jul 23. (8) Cancer Epidemiol Biomarkers Prev. 2014 Sep;23(9):1893-902. (9) Br J Cancer. 2008; 98:9-14. (10) JAMA. 2009 Dec 9; 302(22): 2437–2443.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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Photo from Stony Brook Medicine

The Stony Brook Medicine Mobile Mammography Van will provide screenings for breast cancer for women 40 and older from 10 a.m. to 2 p.m. Friday, July 8, at St. Anthony of Padua Church in East Northport. The van will be parked at 1025 Fifth Ave. in East Northport, outside the church’s Parish Outreach office.

Screenings are provided by state-registered radiologic technologists trained in mammography. The van has a comfortable waiting area, private dressing room and a complete exam room. Individuals without insurance are processed through the Cancer Services Program of New York, if eligible. 

Call 631-638-4135 for eligibility details and to register.

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Camila dos Santos. Photo courtesy of CSHL

By Daniel Dunaief

Pregnancy and lactation can alter genes in specific mammary cells, which may have implications in a defense against cancer.

In mouse models, mice that became pregnant at a young age have so-called epigenetic changes that survive for the animal life span and some of those are linked to a decrease in breast cancer.

In a recent study published in Cell Reports, Cold Spring Harbor Associate Professor Camila dos Santos and her graduate student Amritha Varshini Hanasoge Somasundara found that a protein involved in mammary cells in mice, called CD1d, boosts the immune system after a full pregnancy cycle, protecting it against breast cancer.

“Our research demonstrated that increased levels of CD1d in breast cells serve as a signal to recruit higher numbers of specialized immune cells” called natural killer T-cells, or NKT, “to come and reside within the breast tissue after pregnancy,” dos Santos explained in an email. These NKTs are part of mechanisms that reduce breast cancer risk after pregnancy.

Dos Santos would like to understand the molecular changes that occur from pregnancy and hopes one day to adapt them in the form of a vaccination or pill to decrease the risk of breast cancer.

To be sure, numerous questions about the process of using the immune system to prevent cancer remain, which means that the development of such a preventive pill requires considerable additional research.

Dos Santos has spent the last eight years developing model systems that allow her to discover pregnancy-induced changes that could lead to preventive strategies.

Enhancing the communication between epithelial and immune cells could represent a way to decrease breast cancer development and even treat cases of developed cancer.

To get to that point, dos Santos, the members of her lab, and her collaborators plan to make discoveries like this one to understand the dynamic interaction between the cascade of molecular interactions from pregnancy and the genetic and immunological reactions.

Humans have four CD1 genes, which all play a similar role in immunity. Additionally, there are several types of NKT cells, and each of them has a different immunological function, which means that any prevention or treatment that tapped into this system would need to bring the right CD1 molecule and the right NKT cells.

It is not yet clear whether enhancing CD1 signals protect women who might have a predisposition to breast cancer. Dos Santos is currently exploring this question in animals.

While dos Santos is focusing specifically on pregnancy-driven changes in the mammary gland, she acknowledged that altering CD1d levels in other organs might also decrease other types of cancer.

Dos Santos described pregnancy as being akin to turning on a light. First, during the course of gestation, pregnancy brightens that light to the top. After birth, the dimmer goes to the middle, leaving the system in a different state, which is not only more prepared for the next pregnancy but also to defend itself against alterations like cancer.

In most pregnancy mammary cells in mice, the scientists found a 10-fold increase in the abundance of NKT cells when compared to cells from an individual who had never been pregnant.

When the researchers removed the CD1d protein in mice, they found an association between the absence or low expression and the development of tumors in the breast.

Dos Santos and Hanasoge hypothesize that this protein is recruiting immune cells to monitor breast cells after pregnancy. If the epithelial cells develop cancer, the NKT cells may kill them, preventing the development and advancement of cancer.

In addition to working with mouse models of pregnancy, dos Santos is collaborating with Northwell Health to study cells from healthy women who are undergoing cosmetic surgery. They are analyzing that data, which wasn’t in this paper. 

Dos Santos is investigating several questions, including how the age at pregnancy influences breast tissue. She is creating organoids, which are three-dimensional models of breast cells that react to change in their environment

Joining a family

From left, Amritha Varshini Hanasoge Somasundara and Camila dos Santos

Amritha Varshini Hanasoge Somasundara, who has been a part of dos Santos’s lab for over two years, explained that she felt comfortable and supported instantly when she arrived. She described the atmosphere as extremely collegial and felt as if she were included in a scientific family.

Joining dos Santos’s group was “possibly the best decision I’ve ever made,” said Hanasoge. Dos Santos’s lab is a “really special place” where lab members often have lunch together and support each other’s research.

Hanasoge was drawn to Dos Santos’s mentorship and the overall lab dynamic. Scientifically, she was also interested in the immunology project, exploring NKT cells. Her main project has involved trying to characterize NKT cells further. 

Hanasoge sees plenty of opportunities to address additional questions in this field. “We don’t know if the process of lactation is causing more CD1d and increasing expression,” she said. “We are still trying to characterize what T-cell receptors are being expressed after pregnancy.”

A resident of Syosset, Hanasoge enjoys reading and said she was fascinated by science when she was growing up in Mysore, Kamataka in India. She asked her parents for a microscope when she was around seven and used it to looked at flower petals and leaves. That toy microscope, which her parents purchased from a science museum in Mumbai, is still in her parent’s house.

Hanasoge is eager to combine basic and translational work and hopes her research has a clinical benefit. She is looking forward to the next steps in her research in dos Santos’s lab.

“I learn from her every day by watching how she interacts with people she mentors, both inside the lab and out,” Hanasoge explained in an email. “Her passion and commitment to being a good mentor and her drive to ask the right questions in our research are inspiring.”

 

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October is Breast Cancer Awareness Month. METRO photo

Understand your risk profile and design a screening plan with your physician

By David Dunaief, M.D.

Dr. David Dunaief

Get out your pink attire, because October is Breast Cancer Awareness Month.

The most common cancer diagnosed in U.S. women, an estimated 30 percent of 2021 cancer diagnoses in women will be breast cancer (1). Of these, 85 percent of cases occur in those with no family history of the disease, and 85 percent of new cases will be invasive breast cancer.

A primary objective of raising awareness is to promote screening for early detection. While screening is crucial, prevention should be just as important, including primary prevention, preventing the disease from occurring, and secondary prevention, preventing recurrence.

Here, we will discuss current screening recommendations, along with tools to lower your risk.

At what age and how often should we be screened?

Here is where divergence occurs; experts don’t agree on age and frequency. The U.S. Preventive Services Task Force currently recommends mammograms every other year, from age 50 through age 74, with the option of beginning as early as age 40 for those with significant risk (2). It’s important to note that these guidelines, published in 2016, are currently being refined and are pending publication.

The American College of Obstetricians and Gynecologists recommends consideration of beginning annual or biennial mammograms at 40, but starting no later than 50, and continuing until age 75. They encourage a process of shared decision-making between patient and physician to determine age and frequency of exams, including whether to continue after age 75 (3).

The American Cancer Society’s physician guidelines are to offer a mammogram beginning at age 40 and recommend annual or biennial exams from 45 to 54, with biennial exams after 55 until life expectancy is less than 10 years (4).

While the recommendations may seem nuanced, it’s important to consult with your physician to determine your risk profile and plan or revise your regular screening schedule accordingly.

Do bisphosphonates help?

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) and are used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials (RCTs), FIT and HORIZON-PFT, results showed no benefit from the use of bisphosphonates in reducing breast cancer risk (5). The study population involved 14,000 postmenopausal women from ages 55 to 89 women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

In a more recent meta-analysis of 10 studies with over 950,000 total participants, results showed that bisphosphonates did indeed reduce the risk of primary breast cancer in patients by as much as 12 percent (6). However, when the researchers dug more deeply into the studies, they found inconsistencies in the results between observational and case-control trials versus RCTs, along with an indication that longer-term use of bisphosphonates is more likely to be protective than use of less than one year.

Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

A Lancet metanalysis focused on breast cancer recurrence in distant locations, including bone, and survival outcomes did find benefits for postmenopausal women (7). A good synopsis of the research can be found at cancer.org.

How much exercise?

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (8). These women exercised moderately; they walked four hours a week over a four-year period. If they exercised previously, five to nine years ago, but not recently, no benefit was seen. The researchers stressed that it is never too late to begin exercise.

Only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. We need to expend as much energy and resources emphasizing exercise for prevention as we do screenings.

What about soy?

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis, those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (9). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk when compared to those who consumed the least. In addition, higher soy intake has been associated with reduced recurrence and increased survival for those previously diagnosed with breast cancer (10). The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Hooray for Breast Cancer Awareness Month stressing the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References:

(1) breastcancer.org. (2) uspreventiveservicestaskforce.org. (3) acog.org. (4) cancer.org. (5) JAMA Intern Med. 2014;174(10):1550-1557. (6) Clin Epidemiol. 2019; 11: 593–603. (7) Lancet. 2015 Jul 23. (8) Cancer Epidemiol Biomarkers Prev. 2014 Sep;23(9):1893-902. (9) Br J Cancer. 2008; 98:9-14. (10) JAMA. 2009 Dec 9; 302(22): 2437–2443.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com. 

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The staff at Mather Hospital's Wound Treatment Center in 2020.
Owner Nancy Hendrick in front of TAAG during Paint Port Pink in 2020.
Message of Hope at Shine Dance Studio during last year's Paint Port Pink.
Salsa Salsa presented a $400 check in 2020.
Port Jeff Brewing Company participated in last year's Paint Port Pink.
The Port Jefferson Chamber decorated for Paint Port Pink in 2020.
One of the entries of the Pink Your Pumpkin Contest in 2020.
Comsewogue Public Library's Paint Port Pink display from last year.
One of the entries of the Pink Your Pumpkin Contest in 2020.
The staff at Accelerated Heating and Cooling wore pink during Paint Port Pink's Wear Pink Day last year.

Paint Port Pink, Mather Hospital’s annual month-long breast cancer awareness community outreach, kicks off on Oct. 1 with a lighting of pink lights by community partners in Port Jefferson, Port Jefferson Station and the surrounding communities. Lamp posts along main street in Port Jefferson will be lit up with pink lights, as will the Theatre Three marquee and many store windows.

Paint Port Pink’s goal is to raise awareness about breast cancer and the importance of early detection, encourage annual mammograms and bring the community together to help fight this disease.

One in eight women will develop breast cancer during their lifetime. In 2021, an estimated 281,550 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 49,290 new cases of non-invasive (in situ) breast cancer. About 2,650 new cases of invasive breast cancer are expected to be diagnosed in men in 2021. As of January 2021, there are more than 3.8 million women with a history of breast cancer in the U.S. This includes women currently being treated and women who have finished treatment. 

Mather Hospital’s HealthyU webinar series will present two free educational programs — The Role of Genetics in Breast Cancer on Tuesday, Oct. 5, and Common Breast Cancer Myths and Screening Options on Tuesday Oct. 12. Both webinars begin at noon. Register for these webinars at matherhospital.org/healthyu.

Oct. 15 is Wear Pink Day, and everyone is encouraged to dress themselves — and their pets — in pink and post their photos on social media with #paintportpink. Then send those photos to [email protected] and they will be included in a collage on the hospital’s Facebook page.

The popular Pink Your Pumpkin Contest returns this October. Get creative and post photos of “pinked” pumpkins on social media with #paintportpink. Send those photos to [email protected] by Oct. 25 for the contest. The winner will be chosen Oct. 26 and will receive a $100 gift card. 

Paint Port Pink community sponsors will again be offering special promotions to raise money for the Fortunato Breast Health Center’s Fund for Uninsured. Redefine Fitness, 5507 Nesconset Hwy #2, Mt Sinai, will host a fitness class on Oct. 24, from 10 to 11 a.m., for $20 per person. Month long promotions include Fedora Lounge (404 Main St, Port Jefferson) offering pink hair extensions — $15 for one, $25 for two. The Soap Box (18 Chandler Square, Port Jefferson) will donate 10 percent of sales of all pink products on display at the main counter. And Chick-fil-A, 5184 Nesconset Hwy, Port Jefferson Station will donate 10 percent of sales on strawberry milkshakes. More information on these and other promotions can be found at www.paintportpink.org 

A complete calendar of events, more promotions and a list of Paint Port Pink community partners is available at www.paintportpink.org. For more informaton, call 631-476-2723.

Schedule a mammogram

The Fortunato Breast Health Center at Mather Hospital, 75 North Country Road, Port Jefferson uses state-of-the-art breast imaging technology in a warm and assuring environment with a commitment to giving you personalized breast healthcare. 

Their staff of professionals provides 3D mammograms and offers individualized follow-up care, education for patients, families, and the community, as well as breast cancer support groups. 

Their Breast Center radiologists are specialists who only read breast imaging studies and look back as far as possible at your history of breast images for any subtle changes or abnormalities to provide the most accurate reading.

The Breast Health Center has also partnered with the Suffolk Cancer Services Program (CSP) to provide free breast cancer screenings to individuals who qualify. The CSP provides breast cancer screenings to women age 40 and older without health insurance in Suffolk. If any follow-up testing is needed, the CSP will provide those tests too. If cancer is found, CSP will help enroll people who are eligible in the NYS Medicaid Cancer Treatment Program for full Medicaid coverage during treatment. 

Patients can find out if they are eligible for free screenings or schedule your annual mammogram by calling 631-476-2771. 

 

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Daily exercise is protective against breast cancer. METRO photo
Exercise and diet can significantly reduce risk

By David Dunaief, M.D.

Dr. David Dunaief

October is Breast Cancer Awareness Month, and everyone agrees that awareness is crucial. The incidence of invasive breast cancer in 2020 in the U.S. is estimated to be over 270,000 new cases, with approximately 40,000 patients dying from this disease each year (1).

A primary objective of raising awareness is to promote screening for early detection. But at what age should screening start and how often should we be screened?

Here is where divergence occurs; experts can’t agree on age and frequency. The U.S. Preventive Services Task Force recommends mammograms every other year, from age 50 through age 74 (2). The American College of Obstetricians and Gynecologists recommends consideration of beginning mammograms at 40, but starting no later than 50, and continuing until age 75. They encourage a process of shared decision-making between patient and physician (3).

Just as important as screening is prevention, whether it is primary, preventing the disease from occurring, or secondary, preventing recurrence. Potential ways of doing this may include lifestyle modifications, such as diet, exercise, obesity treatment and normalizing cholesterol levels. Additionally, although results are mixed, it seems that bisphosphonates do not reduce the risk of breast cancer.

Bisphosphonates

Bisphosphonates include Fosamax (alendronate), Zometa (zoledronic acid) and Boniva (ibandronate) used to treat osteoporosis. Do they have a role in breast cancer prevention? It depends on the population, and it depends on study quality.

In a meta-analysis involving two randomized controlled trials (RCTs), FIT and HORIZON-PFT, results showed no benefit from the use of bisphosphonates in reducing breast cancer risk (4). The study population involved 14,000 postmenopausal women from ages 55 to 89 women who had osteoporosis, but who did not have a personal history of breast cancer. In other words, the bisphosphonates were being used for primary prevention.

In a more recent meta-analysis of 10 studies with over 950,000 total participants, results showed that bisphosphonates did indeed reduce the risk of primary breast cancer in patients by as much as 12 percent (5). However, when the researchers dug more deeply into the studies, they found inconsistencies in the results between observational and case-control trials versus RCTs, along with an indication that longer-term use of bisphosphonates is more likely to be protective than use of less than one year. 

Randomized controlled trials are better designed than observational trials. Therefore, it is more likely that bisphosphonates do not work in reducing breast cancer risk in patients without a history of breast cancer or, in other words, in primary prevention.

Exercise

We know exercise is important in diseases and breast cancer is no exception. In an observational trial, exercise reduced breast cancer risk in postmenopausal women significantly (6). These women exercised moderately; they walked four hours a week over a four-year period. If they exercised previously, but not recently, five to nine years ago, no benefit was seen. The researchers stressed that it is never too late to begin exercise.

Only about one-third of women get the recommended level of exercise every week: 30 minutes for five days a week. Once diagnosed with breast cancer, women tend to exercise less, not more. We need to expend as much energy and resources emphasizing exercise as a prevention method as we do screenings.

Soy intake

Contrary to popular belief, soy may be beneficial in reducing breast cancer risk. In a meta-analysis (a group of eight observational studies), those who consumed more soy saw a significant reduction in breast cancer compared to those who consumed less (7). There was a dose-response curve among three groups: high intake of >20 mg per day, moderate intake of 10 mg and low intake of <5 mg.

Those in the highest group had a 29 percent reduced risk, and those in the moderate group had a 12 percent reduced risk when compared to those who consumed the least. In addition, higher soy intake has been associated with reduced recurrence and increased survival for those previously diagnosed with breast cancer (8). Why have we not seen this in U.S. trials? The level of soy used in U.S. trials is a fraction of what is used in Asian trials. The benefit from soy is thought to come from isoflavones, plant-rich nutrients.

Western vs. Mediterranean diets

A Mediterranean diet may decrease the risk of breast cancer significantly.

In an observational study, results showed that, while the Western diet increases breast cancer risk by 46 percent, the Spanish Mediterranean diet has the inverse effect, decreasing risk by 44 percent (9). The effect of the Mediterranean diet was even more powerful in triple-negative tumors, which tend to be difficult to treat. The authors concluded that diets rich in fruits, vegetables, beans, nuts and oily fish were potentially beneficial.

Hooray for Breast Cancer Awareness Month stressing the importance of mammography and breast self-exams. However, we need to give significantly more attention to prevention of breast cancer and its recurrence. Through potentially more soy intake, as well as a Mediterranean diet and modest exercise, we may be able to accelerate the trend toward a lower breast cancer incidence.

References:

(1)breastcancer.org.(2)uspreventiveservicestaskforce.org. (3) acog.org. (4) JAMA Inter Med online. 2014 Aug. 11. (5) Clin Epidemiol. 2019; 11: 593–603. (6) Cancer Epidemiol Biomarkers Prev online. 2014 Aug. 11. (7) Br J Cancer. 2008;98:9-14. (8) JAMA. 2009 Dec 9; 302(22): 2437–2443. (9) Br J Cancer. 2014;111:1454-1462.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com.

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Photo courtesy of St. Catherine of Sienna

“Life is like a disco, no matter how the music changes, you just keep on dancing.” The charmed quote is taken from the 2011 movie, Jumping the Broom, and captured the essence of St. Catherine of Siena Hospital’s 8th Annual Pink Ribbon Salute, held on Oct. 2. Each year, the breast cancer survivor event adopts a creative theme to add a layer of fun to the celebration.

This year, the event took on a disco theme — and more than 100 breast cancer survivors showed up in their best Saturday Night Fever attire ready to dance the night away as they triumph, despite the changes cancer may have brought upon their lives. 

“It was wonderful to see familiar and new faces in our growing family of courageous women celebrating their fearless determination to overcome,” said St. Catherine’s Administrative Director of Reconstructive Microsurgery Dr. Diana Yoon-Schwartz.

The event was moderated by St. Catherine’s breast health navigator Meiling Alsen, and a special welcome was given by chief nursing officer Mary Jane Finnegan. 

“When I look at all of you, I know I am surrounded by strong, courageous women, along with your family members and friends, who have survived or are in the process of surviving a fight that no one should ever have to fight — you truly are my inspiration,” said Finnegan. 

The welcome was followed by the latest updates in breast care by St. Catherine’s Medical Director of Breast Health Services Dr. Jana Deitch, who also took the opportunity to address survivors directly. “Tonight is a wonderful night about celebrating women who fight the tough fight every day — you are not only surviving, but thriving and giving back to other women who may need some encouragement on the journey to healing,” said Deitch.

The disco mood was further set with live renditions of the era’s top hits, played by Just Cause Band. The band, originated by attorneys, has grown into a diversified group, born from the love of music and a desire to help the community by supporting charity events at no cost. Thanks to the philanthropic and harmonizing skills of Just Cause Band, survivors and supporters danced and sang all night, and when the rendition of Gloria Gaynor’s “I Will Survive” was played, the room erupted in unified triumph. 

“It is a moment I will always remember — it was electrifying and inspiring,” said Deitch.

The Pink Ribbon has become a tradition that survivors and staff look forward to annually. “Our survivors and staff dance the night away in celebration — it is an evening we all cherish, filled with laughter and hope, share with family and friends,” said St. Catherine’s Medical Director of Breast Imaging Dr. Anne Green. 

“I’m proud to be a part of an exceptional group of compassionate breast health specialists who service patients from one location in their own community — we are a community that provides the true continuum of care for our patients — so, we will keep on dancing right beside them!”

The Pink Ribbon Salute is supported by St. Catherine of Siena’s senior leadership, and the event was co-sponsored with the support of Suffolk Anesthesia Associates, Genomic Health Inc. Myriad Genetics, New York Cancer Specialists, New Street Plastic Surgery and Square Care.

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Many businesses in the Village of Port Jefferson and Port Jefferson Station will be ‘dressed in pink’ throughout the month of October.

Pink pumpkins, chocolate nights and yoga classes will be part of this year’s Paint Port Pink, Mather Hospital’s month-long October breast cancer awareness community outreach in Port Jefferson and Port Jefferson Station. The event was created in 2015 to raise awareness about the disease, share information and education and foster solidarity in the community.

Employees at Mather Hospital will celebrate Wear Pink Day on Oct. 9.

New this year are Pink Your Pumpkin and Pink Your Windows contests and chocolate-making classes. It Takes a Village Wellness will offer yoga classes with a portion of the registration fees going to the Fortunato Breast Health Center’s Fund for Uninsured and Underinsured. 

Paint Port Pink begins on Oct. 1 with Turn Your Pink Lights On!, when local merchants and residents will be asked to light up Port Jefferson and Port Jefferson Station. On Wear Pink Day, Oct. 9, Mather employees and community residents will be encouraged to dress in pink and to post their photos on Facebook and Instagram using #paintportpink. 

Local residents and merchants can Pink Their Pumpkins and Pink Their Windows in contests designed to raise awareness about breast cancer. Month-long promotions by local businesses will raise funds for the Fund for Uninsured and Underinsured. Mather has teamed up with about 120 local community partners — businesses and professional offices — to help spread the word about the importance of breast health.

Mammograms can help save lives

The American Cancer Society reports that the chance of a woman having invasive breast cancer in her life is about one in eight. That is why increased awareness, education and early detection are important parts of breast health care.

Fortunato Breast Health Center co-medical directors Dr. Michele Price and Dr. Joseph Carrucciu.

A mammogram can reveal a tumor as much as two years before you or your health care professional can feel it. Following the American College of Radiology guidelines, the Fortunato Breast Health Center recommends that you get annual mammography screening starting at age 40. In some higher risk situations, earlier mammography screening or additional breast imaging studies, such as ultrasound, may be recommended. To make an appointment, call 631-476-2771, ext. 1.

If you are uninsured or underinsured, you may be eligible for no cost or discounted screenings through the center’s Fund for Uninsured and Underinsured. If you have been diagnosed with breast cancer and need financial assistance, contact Pink Aid at www.pinkaid.org.

Women receiving their annual mammograms will now have even more accurate screenings thanks to two new state-of-the-art 3-D mammography units at the Fortunato Breast Health Center. Advances in imaging technology deliver highly detailed images that enhance a radiologist’s ability to provide accurate diagnoses. Improvements in ergonomic design allow for improved patient comfort and relaxation. The units also protect patients by delivering the lowest radiation dose of all FDA approved 3-D mammography systems.

“The mammographic images are very clear and detailed, which helps us to identify abnormalities at the smallest possible size,” says Dr. Michelle Price, co-medical director of the breast center. 

Above, one of the new 3-D mamography units at Mather Hospital

The new devices allow for improved detection rates and diagnostic accuracy over older mammography technology through the addition of tomosynthesis, also known as three-dimensional (3-D) mammography. This allows radiologists to see more than what is shown on a standard digital mammogram. “A traditional mammogram offers a top-down picture from compression of the breast tissue. With tomosynthesis, the ‘3-D’ portion of the exam, we get thin cross-sectional images so we can see what it looks like at different angles — in that respect, it is almost like a CAT scan,” said Price.

Having your mammogram done by the same center year after year allows your doctor to compare prior images and look for subtle changes or abnormalities. This can allow for early detection of breast cancer, which in turn can lead to life-saving treatment. “Being able to look back at a history of breast images and compare with prior films is critical for being able to interpret studies correctly. That’s a major advantage of coming to a place where you have established your medical records,” said Price. “It improves the accuracy of the reading.” 

Special community events

Paint Port Pink will offer several events throughout the month of October hosted by Mather’s community partners. Register for events at www.paintportpink.org.

Monday, Oct. 1: Turn Your Pink Lights On!

Thursday, Oct. 4, 6 to 8 p.m.: Chocolate Making Class, Chocolate Works, Stony Brook. Join them for some sweet fun molding and decorating your own chocolate creations! Registration is required.

Tuesday, Oct. 9, Noon: Wear Pink Day, Mather Hospital, Port Jefferson. Get dressed up in your best pink outfit, take a photo and post using #paintportpink

Wednesday, Oct. 10: Pink Sale, Mather Hospital, Port Jefferson. Come and find some pink treasures at the Mather Hospital Thrift and Gift Shop lobby sale. 

Saturday, Oct. 14, Noon & 1 p.m.: Community Reiki Circle, It Takes a Village Wellness, Port Jefferson with two chances to participate in and learn about the power of reiki. Registration is required.

Friday, Oct. 19, 6 to 7 p.m.: Meditation Session, It Takes a Village Wellness, Port Jefferson. Attend a meditation session to enhance your health and tune in to mindfulness. Registration is required. 

Friday, Oct. 19, 7 to 9 p.m.: Chocolate Making Class, Chocolate Works, Stony Brook. Join them for some sweet fun molding and decorating your own chocolate creations! Registration is required. 

Monday, Oct. 22, 6:30 to 7:30 p.m.: Yoga for Health class, Mather Hospital, Port Jefferson offered through It Takes a Village Wellness in Mather Hospital’s conference room B. Registration is required.

Friday, Oct. 26, 12 to 2 p.m.: Wellness Luncheon, Nantucket’s, Port Jefferson. Hosted by It Takes a Village Wellness, attend their “whole health” wellness luncheon and learn about staying healthy naturally. Registration is required. 

Saturday, Oct. 27, 9 a.m to 1:30 p.m.: HealthyU, Mather Hospital, Port Jefferson, a seminar series and health fair focused on physical, emotional and financial well-being. Registration is required. Call 631-686-7879.

Wednesday, Oct. 31: Winners of the Pink Your Pumpkin and Pink Your Window contests will be announced. 

* Proceeds from all events benefit the Fortunato Breast Health Center Fund for Uninsured and Underinsured.

Month-Long Promotions

Chick-fil-A, Port Jefferson Station: $1 from all milk shake sales during the month of October will benefit the Fund for Uninsured.

LI Pour House, Port Jefferson Station: Hosting Wine Down Wednesdays. Every Wednesday during the month of October a glass of wine will be $4 with 10 percent of your purchase benefiting the Fund for Uninsured.

East Main & Main, Port Jefferson: $1 from all pink donut sales during the month of October to benefit the Fund for Uninsured.

Amazing Olive, Port Jefferson: $1 from all extra virgin olive oil sales during the month of October to benefit the Fund for Uninsured.

Luck Soap, Port Jefferson: 40 percent of all Luck Soap Pink Ribbon soap sales (available for sale at Amazing Olive, Port Jefferson and Patchogue locations) during the month of October to benefit the Fund for Uninsured.

The Soap Box, Port Jefferson: 20 percent off Pink Sugar Kiss items during the month of October.

Yogo Delish, Port Jefferson: Donate $1 with your purchase during the month of October and get a $1 off coupon for your next visit.

Tapestry Salon, Mount Sinai: A portion of all pink hair extension sales during the month of October will benefit the Fund for Uninsured.

Cutting Hut, Port Jefferson Station: 10 percent of all pink hair extension sales during the month of October will benefit the Fund for Uninsured.

The Pie, Port Jefferson: Give a donation during the month of October and receive a free Pink Lemonade.

MAC Hair Salon, Mt. Sinai: Pink hair strands for $15 or $10 per pink foil during October with 50 percent of the proceeds to benefit the Fund for Uninsured.

Theatre Three, Port Jefferson: Receive a 20 percent discount on the purchase of your tickets in October when you mention Paint Port Pink.

For more information, please visit www.paintportpink.org.

All photos courtesy of John T. Mather Memorial Hospital

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