REPORTING POINT 02/08
HEALTH NEWS
“Live healthy...Live well”
Dedicated to providing pertinent information on health, fitness, and nutrition to foster a culture of wellness among Southwest Airlines flight crews and their families.
by Larry Kline
SWAPA Voice Mailbox 4337/email: livehealthy-livewell@cox.net
Past issues of “Health News” are available at http://health.theballfamily.org. It includes a search engine; just enter a key word to find past articles. LK
MAMMOGRAM BASICS – mammograms are still the only officially recommended screening test for most women. However, ultrasound and magnetic resonance imaging, or MRI, in combo with a mammogram may do an even better job of detecting cancer in some cases. Here is an analysis of the tests and who should be getting which test:
FILM MAMMOGRAM – this is the most widely available screening test. A machine compresses the breast and then takes an X-ray of each breast. Each breast is imaged twice to get both a top-to-bottom and a side view. Then the image is recorded on film, which the radiologist views on a light box.
PROS: Film and digital mammograms do a good job of picking up calcifications, or tiny calcium deposits, in the breast that can be associated with breast cancer. When done regularly, the tests are also great markers for showing breast changes from year to year.
CONS: Breast tissue, glands, and ducts appear white on a mammogram. Unfortunately, so does breast cancer. This is the big reason mammograms miss 17 percent of all breast cancers; operator error accounts for about 15 percent of that. These false-negatives are more likely to happen among premenopausal women under age 50 whose breasts are more dense (at that age they have more milk glands than they have fat). Genetics and hormone replacement therapy can also cause dense breast tissue. Breast density can only be diagnosed through imaging, and not during a physical exam. Be sure to check with your physician during your next mammogram, even if the result is normal; ask if your breasts are dense. Depending on your level of density, your doctor may advise additional testing with MRI or ultrasound.
Make sure the center you visit has originals of all your previous mammograms. A recent study found that being able to view a current mammogram with prior films decreases the number of false positives by 44 percent. If you have changed centers, ask that your prior films be sent to the new center.
DIGITAL MAMMOGRAM – Digital mammography also uses X-rays to take two pictures of each breast, but in this procedure the images are recorded on a digital detector. The four images, which are stored in a computer and displayed on a high-quality monitor, can be enhanced to get a better view.
PROS: Results from a study of almost 50,000 women found digital mammography to be much better at detecting breast cancers than film mammography among under-50 women who are pre- or perimenopausal or who have dense breasts.
CONS: Digital mammos are not widely available. Only about 20 percent of centers in the United States offer them. This is partly because the technology is new and the machines are very expensive – a single unit costs between $300,000 to $500,000, compared with $60,000 to $90,000 for a film mammography machine. Insurance may cover digital mammos if you are at high risk.
ULTRASOUND – This machine uses high-frequency sound waves to image the body’s tissues and organs. During the procedure, a technician or sonographer smears the breast with gel and uses a wand to scan it. The ultrasound waves reflected from structures in the breast are measured by the wand and are used to create the image.
PROS: a solid tumor produces different waves than a fluid-filled cyst, which is why this technique is ideal for screening breast lumps. Studies also show that ultrasounds are good at detecting cancer in women with dense breasts and identifying invasive cancers that mammograms sometimes miss.
CONS: Ultrasound is not recommended for general screenings because it has a hard time detecting calcifications, which can be a precursor to cancer.
BREAST MAGNETIC RESONANCE IMAGINE (MRI) – In this technique, preliminary images are taken, and then intravenous dye (that travels to areas with increased blood flow, which is a sign of cancer) is injected in the affected breast. The patient lies on a metal table, breast-side down, and is moved through a tube-like scanning device that uses magnetic waves to take hundreds of three-dimensional images of the breast and the images are viewed on a computer.
PROS: MRIs have a breast-cancer detection rate of between 71 and 100 percent. Because of that, the American Cancer Society now officially recommends MRIs be used in conjunction with mammograms for women at high risk, including those with breast cancer gene mutations, a first-degree relative with breast cancer, or a 25 percent or greater lifetime risk of breast caner. MRI is also useful for screening women with dense breasts.
CONS: There is a 10 to 40 percent chance of false-positives. Insurance might not cover a MRI screening.
HOW OFTEN TO GET SCREENED
Most groups – including the National Cancer Institute (NCI), the American College of Obstetricians and Gynecologists (ACOG), and the American Medical Association (AMA) – encourage annual screenings after age 50, while the American Cancer Society recommends annual screening at age 40.
It is best to have a conversation with your physician about what risk factors each woman has. To help determine risk factors, a gynecologist will likely use one of the several personalized breast cancer risk assessment tools designed for physicians. Also, the NCI posts one on its website (www.cancer.gov/bcrisktool). You may use this to evaluate your risk to initiate a conversation with your doctor.
Knowing what risk category you fall into can help you and your doctor determine how often you need to be screened. If you have a first-degree relative (mother, father, brother, sister, or child) who has had breast, ovarian, colon, or prostate cancer, you will want to get screened earlier. The rule is to start going five to ten years before the relative’s age when they were diagnosed. Also, if a family member has a genetic marker for breast cancer (which is determined through genetic testing), you will want to be screened earlier. The American Cancer Society suggests women at high risk have annual MRI scans starting at age 30.
Finally, if there is an abnormal mammogram, you may be asked to come back for further imaging (10 percent of women have this done). This does not mean there is breast cancer. Sometimes, the film is unclear because of operator error. In 90 percent of these cases, it is nothing. When there is an issue, a diagnostic mammogram (or ultrasound or MRI) is often ordered. It will be similar to the normal mammogram, but the technician will take many more imagines of the abnormal area. If the diagnostic screening cannot rule out cancer, the physician will refer the patient to a breast surgeon to obtain samples of breast fluid or tissue by means of:
FINE-NEEDLE ASPIRATION – using a thin needle and local anesthetic, a surgeon takes some fluid from a lump and this sample is screened for cancer.
CORE OR NEEDLE BIOPSY – a radiologist or a surgeon uses a thin needle to take samples of the breast tissue to be examined under a microscope for abnormalities.
SURGICAL BIOPSY – a lump, or parts of it, are removed and checked for cancer. Health 10/07, University of California Berkeley Wellness Letter 8/07.
KNOW CRP? – nope, not the SWA city on the Texas coast, but your C-reactive protein count, the measure of inflammation in the bloodstream. Research shows that having high CRP levels raises LDL (bad) cholesterol, regardless of diet. A study in the Journal of Nutrition of overweight adults that were placed on a low-fat diet for six weeks indicated that those with high CRP levels (3.5 milligrams per liter or greater) experienced a 4.5 percent increase in their LDL-cholesterol levels, while people with low CRP levels lowered their LDL by 3.5 percent. During short periods of inflammation, the body protects itself by producing less HDL (good) cholesterol and more triglycerides. This biochemical combination leads to spikes in LDL. If your lipids (blood fats) are high despite adhering to a good, healthy diet, ask your physician to measure your CRP, and also consider taking statin drugs, as they can significantly lower cholesterol levels and CRP. Men’s Health 10/05.
INCREASED COLON CANCER RISK – people with type-2 diabetes are at increased risk for cancer of the colon or rectum, according to the Journal of the National Cancer Institute. The report looked at 15 studies from the U.S. and Europe and found that diabetes raised the risk of colon cancer by 43 percent and rectal cancer by 33 percent. This supports the theory that insulin resistance can play a role in the development of these cancers. Type 2 diabetes can be a lifestyle disease that may be reduced by regular exercise and maintaining a healthy weight. University of California Berkeley Wellness Letter 5/06.
DECAFFEINATE YOUR WORKOUT – coffee could deliver more than the caffeine boost to your workout. Swiss scientists recently determined that caffeine decreases blood flow to the heart during exercise by as much as 39 percent. Normally as a person’s activity level increases, coronary arteries expand to let in more oxygen-carrying blood. But that process was inhibited when study participants consumed 200 milligrams of caffeine – the amount in two cups of coffee – about an hour before working out. Although the caffeine did not harm the healthy study participants, the lead scientist of the study suggests avoiding caffeine for 4 or 5 hours before exercise if you have a family history of heart disease. Men’s Health 5/06.
MORE BENFITS OF WHOLE GRAINS – another reason to eat whole grains; they may reduce the risk of metabolic syndrome, according to a study of healthy people over age 60. Metabolic syndrome is a cluster of conditions (notably abdominal obesity, high blood pressure, high blood sugar, and low HDL cholesterol) that greatly increases the risk of heart disease, stroke, and diabetes. People who ate the most whole grains, averaging three servings a day – the recommended intake, were less than half as likely to develop the syndrome over a 15-year period, compared to those eating the least. They were also half as likely to die from cardiovascular disease. A study from Germany indicated those who consumed the most fiber from grains (primarily whole grains) as well as magnesium (in whole grains, beans, leafy greens, and nuts) were 23 to 33 percent less likely to develop Type 2 diabetes. University of California Berkeley
Wellness Letter 5/06, University of California Berkeley Wellness Letter 8/07.
AN APPLE (OR TWO) A DAY TO PROTECT YOUR NOGGIN – antioxidants found in apples may protect against oxidative brain damage, a major cause of age-related memory loss. The University of Massachusetts finding was an animal-based study, but the scientists believe that the results would be similar for humans. The animals ate the equivalent of two to four apples a day or two to three cups of apple juice. Men’s Health 5/06.
