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mammogram

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.

METRO photo

Senator Mario R. Mattera (2nd Senate District), in cooperation with the Middle Country Public Library, is hosting the Stony Brook Cancer Center’s Mobile Mammography Van at the library’s Selden location.  This no-cost breast cancer-screening event will be held from 9 am to 4 pm on Monday, December 6th at the library, which is located at 575 Middle Country Road.

Stony Brook University Cancer Center operates and staffs the mobile van, which is supported by more than $3 million in funding from the New York State Department of Health.  The van provides convenient access to screening services for all women in our area to ensure they get the information and services needed to protect themselves from breast cancer.

This event is for women 40 and older who have not had a mammogram in the past year. To help ensure proper coordination of the event, residents are being asked to schedule an appointment by calling 631-638-4135.

According to information provided by Stony Brook Cancer Center, most screenings are no cost to the patient since the cost of mammograms are covered by most insurance plans.  Any resident without insurance will be referred to the New York State Cancer Services Program.

“Thank you to the Stony Brook Cancer Center and the Middle Country Public Library for taking part in this important event.  Hopefully, this will help residents who may face challenges that prevent them from accessing this very important regular screening get the information they need to protect their health.  Early detection is the most critical protection in the fight against breast cancer and I hope everyone who needs this service will join us on December 6th,” stated Senator Mattera.

For more information on this important event, including eligibility requirements and directions to the library, please visit Senator Mattera’s website at mattera.nysenate.gov.

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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Patients arriving at the Fortunato Breast Health Center use sanitizing gel before being given a mask and having their temperature taken.

Early detection is crucial in diagnosing and treating breast cancer. But screenings in the time of the COVID-19 pandemic have become more complicated, with many screening centers closing for a time and patients fearful to come into a hospital or clinic setting. Mather Hospital’s Fortunato Breast Health Center has responded with strict safety protocols designed to protect patients and staff.

Above, patients are socially distanced from Fortunato Breast Health Center staff when checking in for a screening.

“As always with breast cancer and other cancers, your best bet is to have an early diagnosis,” said Breast Center Co-Medical Director Michelle Price, MD. “The importance of early detection cannot be overstated. Therefore, we have adapted protocols so that we can continue to provide expert care in the setting of the COVID-19 pandemic.”

The Breast Center recommends that women receive their first screening mammography at age 40 and continue annual screening every year thereafter. Many professional societies involved with the diagnosis and treatment of breast cancer also continue to recommend annual screening mammography starting at age 40, including the Society for Breast Imaging, American College of Radiology and National Comprehensive Cancer Network. In some high-risk situations, screening may begin even earlier.

Strict safety protocols have been implemented at the Breast Center in response to the COVID-19 pandemic. Dr. Price said this includes all staff and patients wearing masks at all times, everyone undergoing temperature checks when they arrive at the Breast Center, patients completing a COVID screening questionnaire about possible exposure to the virus, and the use of sanitizing gel.

“We no longer routinely have patients use waiting rooms, to minimize personal interactions,” said Dr. Price. “When patients arrive, they first call from their car, and are brought in one at a time for a streamlined experience.”

Where patients once routinely filled out a medical history form to provide information, the technologist now interviews the patient and records the pertinent data. This change eliminates the need for patients to handle a pen and paper.

Fortunato Breast Health Center Co-Medical Directors Michelle Price, MD, and Joseph Carrucciu, MD, with a 3D mammography unit in a photo taken prior to the COVID-19 pandemic.

“We have a socially distant protocol where the patient has very limited contact with anyone else, providing maximal safety. The technologist brings the patient to the mammography room, where she is provided a gown to change in to privately. When ready, the technologist enters the room and performs the mammogram. When the study is complete, the patient is again given privacy to get dressed, and she is escorted out of the department by the technologist. As has always been the case, the imaging equipment is thoroughly disinfected between patients. People seem very satisfied with what we have done from the point of safety protocols. It’s a similar setup they’ve experienced at other doctors’ offices,” said Dr. Price who stressed the importance of continuing with annual mammograms despite the pandemic.

“Early in the pandemic, non-urgent medical care was postponed, but now the situation has changed,” she said. “The current consensus is that screening should continue if it can be done safely. We have implemented protocols to maximize safety for patients and staff alike. Early detection of breast cancer offers us the best chance for successful treatment.”

The Fortunato Breast Center uses advanced 3D mammography that is designed to make screening more comfortable. The 3D mammography also offers sharper, clearer images for improved diagnostic accuracy all while providing the lowest radiation dose of all FDA approved mammography systems.

Fortunato Breast Center radiologists are specialists who only read breast imaging studies and look back as far as possible at a patient’s history of breast images for any subtle changes or abnormalities in order to provide the most accurate reading.

Should a patient have a breast cancer diagnosis, the Breast Center’s compassionate nurse navigators provide personal guidance with scheduling appointments for tests and follow-up procedures, getting prescriptions, insurance questions, and any other help patients may need. The Breast Center’s nurse navigators provide support throughout every step of the patients’ journey to recovery.

The Breast Center offers no cost or discounted mammography screenings for those individuals with low income and no health insurance. For more information, visit www. matherhospital.org/breasthealth or call 631-476-2771.

All photos courtesy of Mather Hospital