You Found A Lump In Your Breast…Now What?
The focus on breast cancer awareness should not just take place one month out of the year. For women in the U.S., breast cancer death rates are higher than those for any other cancer, besides lung cancer.1 Prevention of breast cancer, and any other cancer, is a life-long commitment to a healthy lifestyle.
But, within our industrial society and with the very real problem of nutrition misinformation, it is well understood you will unwittingly get exposed to many harmful elements that effect one’s health and well-being. Later in this newsletter we will speak more about prevention. The main emphasis here will be placed on detection and what to do after it. Because many women half halfheartedly go for their annual mammogram without thinking about what they would do if something was found, many women do not understand their options and the statistics that follow them. Let’s first discuss different methods of detection.
Adult women of all ages are encouraged to perform breast self-exams at least once a month. Johns Hopkins Medical Center states, “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important.2” Self-exams help you be familiar with how your breasts look and feel. If you feel a lump when doing your self-exam keep in mind the following information:
- Benign (non-cancerous) adenomas are round, firm, mobile, and have true borders.
- Malignant tumors may feel stony hard, have an irregular shape, and non-mobile or fixed.
- Women with fibrocystic breasts usually get lumps in both breasts that increase in size and tenderness just before they get their period.
Studies show up to 80% of all breast lumps are harmless3, however you may still feel scared and want to know you’ll be OK. So what do you do next if you find a lump?
Exploring your options: Always remember that not one test is 100% accurate. You are better off using your options in conjunction with one another for the best outcome. Sensitivity and specificity are often used as scientific terms to describe the accuracy of testing devices and methods. Sensitivity describes a true positive result, or, if a person has a disease, how often the test will be positive. Specificity describes a true negative result, or, if a person does not have the disease, how often the test will be negative. For both measurements, the higher the percentage, the more accurate.
Mammography: Sensitivity is dependent on the quality of the equipment, competence of the radiology staff, and the density of the breast tissue. Estimates of mammography sensitivity range from 75% to 90% with specificity from 90% to 95%.4 There are many limitations to mammography that one must acknowledge and be comfortable speaking about with their primary care physician. The false positives of mammography are becoming more of a concern for women because they cause anxiety and unnecessary follow-up procedures. About half the women getting annual mammograms over a 10-year period will have a false-positive finding.5 Effectiveness of mammograms for women with dense breast tissue is also a concern. Dense breast tissue and cancer both appear white on an X-ray, making it nearly impossible for a radiologist to detect cancer in these women. It’s like trying to find a snowflake in a blizzard. In fact, many states have passed laws that make it mandatory for radiologists to inform their patients who have dense breast tissue that mammograms are basically useless for them.6 Breast density can decrease as one ages.
Ultrasound: Since there is no radiation or compression with ultrasound it usually sounds more appealing to many patients. Ultrasounds are usually recommended as a follow-up procedure if your mammogram comes back with suspicious abnormality. Sensitivity and specificity of ultrasound is known to be statistically greater than mammography in patients with breast symptoms for the detection of breast cancer and benign lesions particularly in dense breast and in young women.7 Ultrasound cannot image the entire breast at once, so it’s used for a diagnostic spot check of areas that a screening mammogram has already revealed. Other limitations are that the procedure may not be covered by your insurance plan, the facility’s and technician’s expertise, and the equipment.
MRI: Studies show that MRI offers a significantly higher sensitivity of 91% and specificity of 97.2% compared to mammography.8 Research presented by the Journal of Clinical Oncology concluded that mammography alone, and also mammography combined with breast ultrasound, seems insufficient for early diagnosis of breast cancer in women who are at increased familial risk with or without documented BRCA mutation. If MRI is used for surveillance, diagnosis of intraductal and invasive familial or hereditary cancer is achieved with a significantly higher sensitivity and at an earlier stage.8
There are many limitations of MRI though. Historically, MRI has been known to be unable to effectively image calcifications that are often associated with DCIS.9 Time is another factor. The test takes up to 60 minutes in a confined space. Patients often complain of the claustrophobic feeling. Another drawback is that it is a very expensive exam costing approximately $1000. If getting an MRI is an absolute must, shop around first. Freestanding diagnostic centers are alternative places to obtain services at a fraction of the cost charged by hospitals. Let’s also not forget the contrast agent called “gadolinium” that is used to enhance abnormal tissue. This chemical is injected intravenously and is known to be toxic. The majority of the gadolinium is removed from the body within the first 24 hours, mostly by the kidneys. It’s important to drink as much water as you can during that first 24 hours, maybe even 48 hours, to eliminate the contrast dye from the kidneys quickly. You can refuse the contrast but accuracy of the MRI may be affected.
Thermography: Breast thermography has an average sensitivity and specificity of 90%.10 It has been documented by a well published study that Thermography is able to detect up to 88% of tumors two cm or smaller while mammography detected 80% .11 However, when used as part of a multimodal approach (clinical examination + mammography + thermography) 95% of early stage cancers will be detected.10 Approved by the FDA since 1982 for the use in detection of breast cancer, this tool provides a physiological view of the underlying tissue. This means that it has the possibility of detecting angiogenesis, the growth of new blood vessels that feed a tumor, which occurs long before the tumor can actually be detected by a mammogram. There is no radiation and no compression when this test is performed. Breast thermography offers younger women a valuable imaging tool that they can add to their regular breast health check-ups beginning with baseline imaging at age twenty.
One of the biggest limitations of thermography is that it may not be covered under your health care policy. This all depends on your individual insurance coverage. Thermography is performed under a very controlled environment. If the facility does not follow exact procedures such as controlling the temperature of the room, calibration of equipment, and acclimation procedures, the results of the patient’s images can be affected. Another drawback of the thermography procedure is that the patient is given very specific instructions to follow 24 hours before the test. If the patient fails to follow these guidelines then the accuracy of the images are effected which can cause a false impression of inflammation.
Blood tests are another way to detect inflammation in the body which can be caused by cancer or other serious diseases. A comprehensive blood test can indicate deficiencies and toxicities that may be affecting the body’s ability to health and repair. The C-Reactive Protein (CRP), CBC, Ferritin, and Alkaline Phosphatase are a few markers that are monitored, depending on the type of cancer or infection one has. For breast cancer, the specific tumor marker, CA 27.29, can be tested as an indicator associated with measuring the antigen in the blood. The FDA approved the CA 27.29 in 1996 as the first and only blood test specific for breast cancer. However, this test should be looked at in conjunction with other inflammatory markers for better accuracy. The CA 27.29 breast cancer tumor marker is not specific or sensitive enough to determine if metastasis has occurred. The normal range for the CA 27.29 is under 38. However, it will never be zero for anyone. Other conditions that may cause the CA 27.29 to rise are Endometriosis, ovarian cysts, first-trimester pregnancy, benign breast disease, and kidney and liver disease.12 After establishing that the lump is not just a cyst, most doctors will recommend following up with a biopsy. Most of the time, the in-office procedure is done by using ultrasound to guide the needle to the suspicious tissue. What patients don’t realize is that they also have the option to get a lumpectomy, or remove the tumor rather than needle biopsy. With the potential risk of malignant cells breaking away from the tumor during a biopsy, why wouldn’t one just remove the whole tumor, or get the lumpectomy, from the very beginning? The tissue removed, whether via biopsy or lumpectomy, will still be tested by a pathologist to determine if it is cancerous. According to studies, needle biopsies may increase the spread of cancer by 50 percent compared to patients who receive lumpectomies.13 After a clear diagnosis is made, the treatment plan can be discussed. After the surgery, treatments depend on individual situations. Some may choose radiation only while others may choose chemotherapy, radiation, and hormonal therapy. One concerning note is that many doctors do not follow up with prevention strategies such as nutrition, exercise, and supplementing the diet to improve deficiencies and toxicities and thus potentially preventive cancer reoccurrence.
By testing a comprehensive blood panel and doing a tissue mineral analysis, individualized dietary and lifestyle strategies can be formulated and monitored to determine effectiveness of these preventive strategies. This baseline testing can also can help determine the best course of cancer treatment and monitor the patient’s response to cancer treatment and prevention of reoccurrence. Many times, patients compliment breast cancer medical treatment plans with nutritional protocols and achieve better outcomes. It’s not easy knowing where to start. That is where your experienced nutritional care provider can help you by analyzing your comprehensive test results and maybe even giving you a second opinion. Ask us today on how you can start on your way towards better health!
Research by Tracey Merkle
- Breastcancer.org. http://www.breastcancer.org/symptoms/understand_bc/statistics Accessed on 09/27/2015.
- Bouchez, Colette. You found a breast lump…now what? http://www.webmd.com/breast-cancer/features/advances-in-diagnosing-breast-cancer. October 2007.
- Hendrick RE. Mammography quality assurance. Current issues. Cancer. 1993 Aug 15;72(4 Suppl):1466-74.
- Miller AB1, Wall C, Baines CJ, Sun P, To T, Narod SA. Twenty five year follow-up for breast cancer incidence and mortality of the Canadian National Breast Screening Study: randomised screening trial. BMJ. 2014 Feb 11
- Devolli-Disha E1, Manxhuka-Kërliu S, Ymeri H, Kutllovci A. Comparative accuracy of mammography and ultrasound in women with breast symptoms according to age and breast density. Bosn J Basic Med Sci. 2009 May;9(2):131-6.
- Christiane K. Kuhl, Simone Schrading et.al. Mammography, Breast Ultrasound, and Magnetic Resonance Imaging for Surveillance of Women at High Familial Risk for Breast Cancer. Journal of Clinical Oncology. 2005.
- Bronzino, Joseph. Medical Devices and Systems. CRC Press. 2006
- Dr. Susan Love Research Foundation. http://dslrf.org/breastcancer Accessed on September 23, 2015.
- Arch Surg. 2004;139(6):634-640.