This month, we continue our series of articles designed with your health in mind. From January through May, Dental Assisting Digest™ will take a look at the five biggest health challenges facing women, and how you can take steps to avoid or lower your health risks.Click here to read "Women's deadliest killers: heart disease" from the January 2010 issue of DAD.I recently had a chance to talk to Dr. Melinda Molin of the Breast Care Specialists of Maine, a department of Mercy Hospital in Portland, Maine, about breast cancer and some of the current debates surrounding mammograms.
Melinda Molin, MDKevin Henry: There have been some discussions recently questioning the use of and results from mammography tests. What are your thoughts on some of the controversy?Dr. Molin: There are a lot of nuances behind the recent mammogram recommendations. Yes, mammograms as a test do have their problems and by the time the cancer is seen, it may have been growing for up to five years. Positive results on a mammogram don’t occur until the disease is already established. There can also be problems with mammograms because of the density of the breast. A dense breast may not show a cancer until it has already evolved and early detection may not be possible because of an individual woman’s density.There are also issues with false positives. There are a lot of things that can show up on a mammogram test, such as benign calcium deposits, or technical artifact that may be nothing to worry about. These false positives can result in additional testing, unnecessary biopsies, and anxiety for women.Kevin Henry: While many people refer to “breast cancer,” there are actually numerous kinds of cancers that can be found in the breast, correct?Dr. Molin: Yes. Breast cancer isn’t just one disease. Some cancers in the breast may be lazy and not spread, while some are very aggressive and may be incurable with any treatment. It’s possible to overtreat a woman who would never have a problem, even if a cancer is detected. This accounts for some of the controversy around screening women over the age of 75. A third kind of cancer is moderately aggressive, and in this case timely and appropriate treatment can improve survival. That’s the kind you want to find early and at a small level. So currently mammography is the best tool we have for early detection and women should discuss options for screening with their primary caregiver. Advocating for research to discover cause and prevention as well as better tools for earlier detection is where we need to go.Kevin Henry: How can a woman make the best decisions when it comes to preventing breast cancer?Dr. Molin: Talk with her doctor about risk factors including family history of breast cancer under the age of 50 or ovarian cancer at any age. Ask primary caregivers questions including, “How dense are my mammograms?” and “What should I do if I feel a lump after a normal mammogram?”. Sadly, an all-clear report from a mammogram will sometimes not get you off the hook because of the breast density issue. Also if a women under the age of 40 feels a lump it is often best to start with a breast ultrasound; women in this age group often have such dense breasts that mammography may not be useful, and most lumps in this age group are going to be benign: cysts, benign tumors, or normal cyclic glandular change.Kevin Henry: What are the main risk factors?Dr. Molin: There are three ... being female, getting older, and having a personal history of breast or ovarian cancer. Don’t forget that 75% of breast cancer cases happen in women over 50. Yes, the ages of 50 to 70 are prime ages, but it can strike at any age. Also 75% of women with breast cancer have no family history of the disease so having no family history does not mean that a woman cannot develop breast cancer.Also, combined hormone therapy can slightly increase the risk in some cases. Obesity is certainly a factor in a lot of health problems, including breast cancer. Alcohol consumption has been associated with increased risk of breast cancer, but I don’t think that women should forgo the pleasures of a glass of wine or beer with the idea that this will absolutely prevent breast cancer. So much of what causes this epidemic is just not known. There are no specific dietary preventative measures other than low fat to avoid obesity.I want to remind women that they are three to five times more likely to die from heart disease than breast cancer. There is a huge focus on breast cancer, but the matter of overall wellness is important. Smoking is not just a habit. Although it is not associated with increased breast cancer risk, it is associated with heart disease, lung disease, and lung cancer. You are truly doing a disservice to yourself if you aren’t looking at an overall strategy for wellness including exercise and a heart-healthy diet. Women are more than just the sums of their breasts. Young women need to focus on their overall health. When you’re young, you think you’ll have kids and then take off that baby weight. But when menopause happens, you won’t be able to take off the weight because the metabolism slows down so much. The time to get healthy is today. Don’t wait.Kevin Henry:What are some tips you have for women on self-examination?Dr. Molin: If you feel a lump, don’t panic. There’s nothing wrong with waiting through a cycle to see if a lump is still there. I’m not telling women to dismiss a lump, but I am saying to not overreact. The best time to self-examine is four to seven days after cycle bleeding starts. A lump can often be a cyst in women in their 30s, so have an ultrasound done if a lump is found and doesn’t go away.A dedicated breast surgeon since 1996, Dr. Melinda Molin completed advanced fellowship training in critical care at Hartford Hospital and in trauma surgery at the University of California, San Diego Medical Center. Her general surgery training was completed at SUNY Downstate Medical Center in Brooklyn. She is a graduate of the University of Pennsylvania School of Medicine and Brown University. Dr. Molin is the author of several publications relating to trauma and to breast cancer treatment and is a sought after speaker for numerous presentations relating to the treatment of breast cancer.
