Half of Women Can Benefit from Mammography at Age 40.

A new study shows that women at the age of 40 should undergo a mammogram, as nearly half of them would benefit from the breast cancer screening. For the review, the researchers found that half of the women aged 40 to 44 had above average risk for breast cancer, which made them eligible for yearly screenings.

The findings presented at the American Society of Breast Surgeons annual meeting in Dallas is important because the latest guidelines on mammograms advise that most women can wait until the age of 45 or 50 to start having annual screenings.

But the review of female patients between the ages of 40 and 44 found that 50 percent had an above-average risk for breast cancer, and therefore would be eligible to begin screening mammography at age 40, said lead researcher Dr. Jennifer Plichta. The study also found a significant percentage of women would qualify for other breast screening methods, including breast MRI and genetic testing, Plichta said. “We believe formal risk assessment is essential for women ages 40 to 44 in order to identify those who require screening mammography to start at the age of 40, and those who would qualify for screening MRIs and genetic testing,” Plichta said.

The cancer society updated its guidelines in 2015, recommending that women could wait until age 45 to start receiving annual mammograms. Previously, the cancer society had recommended yearly screenings starting at age 40. The American Society of Breast Surgeons (ASBS) subsequently changed its guidelines to mirror the new cancer society recommendation, Plichta said. The American Society of Breast Surgeons (ASBS) also updated their guidelines with a few more details, which included:

  • Women should have mammograms prior to 45 years of age if their risk of developing breast cancer exceeds 15 percent.
  • Women with 20 percent or higher should also undergo MRI.
  • Women with at least a five-percent risk of a breast cancer-related genetic mutation should undergo genetic testing.

 

“Critical to the development and interpretation of both of these new guidelines is formal risk assessment,” Plichta said. “Furthermore, risk assessment is needed not only to determine who qualifies for mammography, but also who may require screening MRIs and/or genetic testing.”

Breast cancer risk assessments are typically not a part of standard care for this age group, the researchers noted. Since the new guidelines lean heavily on knowing breast cancer risk, doctors need to redouble their efforts to make sure risk assessments are done for women in their early 40s, they concluded.

Bottom line: Given that more than half of women between the ages of 40-45 had risk factors for breast cancer, mammogram screenings should begin at age 40, rather than age 45 or 50. Risk assessment is the best way to determine who would benefit from mammography screening at age 40.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Never Too Old for a Mammogram?

You are never too old to get a mammogram. According to a new study presented at RSNA 2016 in Chicago, researchers from the University of California, San Francisco (UCSF) found that women between the ages of 75 and 90 continue to benefit from screening.

Lee’s group used data from the National Mammography Database, evaluating more than 5.6 million screening mammograms performed between January 2008 and December 2014. The exams were done at 150 facilities across 31 U.S. states. Lee and her colleagues looked at patient age, mammogram results, recall rates for more testing, biopsy referrals and biopsy results. The investigators also looked at the percentage of breast cancers found when a biopsy was recommended or performed. Ideally, Lee explained, screening should result in a higher cancer detection rate and a low recall rate.

Based on an analysis of nearly 7 million mammograms over a seven-year period, “the benefit continues with increasing age up until 90,” said study author Dr. Cindy Lee. She is an assistant professor in residence at the University of California, San Francisco.

The question of when to stop having mammograms has been widely debated. In 2009, the U.S. Preventive Services Task Force issued new guidelines, saying there wasn’t enough evidence to assess the balance of benefits and harms of screening mammography in women aged 75 and older.

In the analysis, which included data from 39 states from 2008 through 2014, nearly four breast cancers were found for every 1,000 patients screened. The recall rate was 10 percent.

“We are finding more cancers with increasing age,” Lee said, which makes sense because the risk rises with age. “We are doing better at catching them,” she said. And, “we have decreased the recall rate. We are calling back fewer women for additional testing, but are finding more cancers.”

The study authors concluded that “there is no clear age cut-off point” to determine when to stop screening. The study suggests the decision to screen may depend on a woman’s personal choice and health status. Older women with 10 years of life expectancy, for instance, might choose to continue screening, Lee said.

Robert Smith, vice president of screening for the American Cancer Society, said the study findings show that mammograms are still worthwhile after the age of 70.

“Breast cancer incidence and mortality increase as women age, and roughly 30 percent of breast cancer deaths each year occur in women who were diagnosed after the age of 70,” he said.

“Many of these deaths are avoidable, as Lee and colleagues demonstrate in this new report, since mammography screening performs increasingly well as women get older. While incidence is high, the disease is slower growing and density is lower, providing improved opportunity for early detection,” Smith explained.

Bottom line: Older women can benefit from continued mammography screening and no age should be defined as the cut-off for screening. As always, the choice to continue screening should be a shared decision between the patient and her physician.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Breast Cancer Deaths Increasing for Black Women

While breast cancer deaths are on the decline, black women still have worse outcomes than white women, according to data released by the CDC. The report noted disparate trends in breast cancer incidence among different races and age groups. The new study also finds that the rates vary from city to city and the disparity is getting worse, not better.

The study, which looked at breast cancer deaths between 2010 and 2014 in the 43 most populous U.S. cities, found that African-American women are 43% more likely to die from breast cancer than white women. That is an increase from 2009, when the difference in death rates was 39.7%.

“This disparity results in 3,854 excess deaths of black women every year. That is a shocking and alarming number,” says study researcher Marc S. Hurlbert, PhD, of the Breast Cancer Research Foundation in New York.

In 42 of the 43 cities examined in the study, African-American women die from breast cancer at higher rates than white women. In Boston, women of both races die at about the same rate. The difference in death rates is “startlingly high” in Atlanta, where African-American women are dying of breast cancer at a rate more than double that of white women, according to the Avon Foundation, which funded the study.

Cities topping the list with the largest breast cancer death disparities are:

  1. Atlanta
  2. Austin, TX
  3. Wichita, KS
  4. San Antonio, TX
  5. Kansas City, MO
  6. Dallas
  7. Memphis, TN
  8. Los Angeles
  9. Oklahoma City
  10. Chicago

 

Interestingly, mortality rates fell at the same pace for women younger than 50, regardless of race. This data could provide some hope for the future, according to the CDC.  The study did find some cities, such as Boston, Philadelphia, and Memphis, had significantly improved the disparity. Researchers say these cities are taking steps like setting up task forces aimed at improving mammography quality and expanding screening, diagnosis, and treatment programs to cover uninsured women.

The declining mortality rate among younger women supports prior studies that showed screening efforts like mammography have been successful in catching more cancers at an early stage. The report also recommended initiatives to combat obesity, which is increasing in prevalence among black women and is associated with a higher risk of breast cancer.

Bottom line: Breast cancer deaths in black women are increasing. We need a greater targeted effort on early detection among black women and increasing awareness of the known risks, such as obesity, associated with a higher risk of breast cancer.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.


New Genomic Test REDUCES Need for Chemotherapy in Breast Cancer Patients

For some women, surviving breast cancer may no longer need to involve chemotherapy. Doctors have long known that many early-stage breast cancer patients who undergo chemotherapy don’t actually need it to prevent recurrence of the disease after surgery. But they haven’t known exactly which patients might safely skip the toxic treatment.

A new study published in the New England Journal of Medicine says based on the gene activity of tumor.  The so-called genomic test measures the activity of genes that control the growth and spread of cancer, and can identify women with a low risk of recurrence and therefore little to gain from chemotherapy.

The MINDACT trial analyzed whether a different genomic test – the 70-gene MammaPrint test — could also determine which women needed chemotherapy with early stage breast cancer. The researchers estimated that their findings would apply to 35,000 to 40,000 women a year in the United States, and 60,000 to 70,000 in Europe. They are patients with early disease who because of tumor size, cancerous lymph nodes and other factors would normally be prescribed chemotherapy. The biggest benefit to patients, using this genomic test, is the ability to avoid the toxicities of chemotherapy (potentially including permanent nerve damage, heart failure and leukemia).

The results of the study will be of most use for cases that have fallen into a gray zone, when the disease is in an early stage but has some anatomical features that suggest it may be aggressive. But the genomic test says it is low risk.

Dr. Fatima Cardoso, an author of the study and a breast oncologist at Champalimaud Clinical Center in Lisbon, said that traditionally, women with early cancer, but a high clinical risk were usually given chemotherapy. She said that doctors knew that not all would benefit from it, but gave it to all anyway to err on the side of caution, because they could not identify which women did not really need it.

The main goal of the study was to find out whether women with a high clinical risk but a low genomic risk could safely forgo chemotherapy. The researchers said that it was safe for women with early disease and high clinical risk, but low genomic risk, to skip chemotherapy. The findings mean that 46 percent of women with early-stage disease who are thought to be at high clinical risk may be able to skip chemotherapy.

The genomic test is expensive, but the price pales in comparison to the cost of chemotherapy. By allowing patients to avoid toxic and costly unnecessary chemotherapy treatments, this particular test demonstrates the value of advanced diagnostic testing which leads to better decision-making for women with breast cancer.

Bottom line: Genomic testing and other advanced diagnostic tools are re-shaping the way we treat breast cancer and improving decision making. The end result is better for patient care and improves clinical outcomes.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Women’s Imaging Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Molecular Breast Imaging for Detecting Breast Cancer? The What and How.

Molecular breast imaging (MBI) is a method for detecting breast cancer. The technique is also known as a Miraluma test, sestamibi, scintimammography, or breast specific gamma imaging.

MBI uses a radioactive tracer that “lights up” any areas of cancer inside the breast. This tracer is injected into the body through a vein in the arm. Breast cancer cells tend to take up the radioactive substance much more than normal cells do. A special camera called a nuclear medicine scanner then scans the breast, looking for any areas where the radioactive substance is concentrated. The process takes about half an hour, and unlike mammography, it yields images of cancerous tissue regardless of the tissue’s density.

MBI continues to be tested, but it appears to hold promise for detecting breast cancer in women who are at higher-than-average risk for the disease and have dense breasts. When women have a lot of dense breast tissue, tumors become hard to spot on mammograms. On mammograms, fatty breast tissue looks dark, but dense tissue is light, like tumors, so it can hide any cancerous areas that may be present.

In a recent study published in the August 2016 issue of the American Journal of Roentgenology, Molecular breast imaging was shown to be effective as a supplementary screening tool to mammography for women with dense breasts. Researchers from Ohio, California, and New Hampshire performed a retrospective study to assess the utility of MBI as a supplementary screening tool for 1,696 women with dense breast tissue. The results showed that 13 mammographically occult malignancies were detected among the study group. Eleven were invasive, one was node positive, and one had unknown node positivity. Other findings showed:

  • Lesion size ranged from 0.6 to 2.4 cm, mean 1.1 cm
  • Incremental cancer detection rate was 7.7%
  • Recall rate was 8.4%
  • Biopsy rate was 3.7%

When incorporated into a community-based clinical practice environment, molecular breast imaging yielded a high incremental cancer detection rate of 7.7 cases of breast cancer for every 1,000 women at an acceptable radiation dose. However, one drawback of MBI is that it involves a much greater dose of radiation than mammograms.

MRI (magnetic resonance imaging), is often the preferred tool for evaluating women who are considered high-risk and have dense breasts. However, MRI has no radiation, but is more expensive than MBI and can return false positive results, leading to unnecessary biopsies. If a mammogram shows that you have dense breast tissue, MBI may be an alternative to ask about.

Bottom line: If you are at average risk for breast cancer and do not have dense breasts, mammography remains the screening tool of choice for you. Many doctors believe that, for most women, mammography is better than MBI at detecting breast tumors when they are small and generally easier to treat.

 

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area


Heart Disease in Women: Breast Cancer Takes a Back Seat

When it comes to women’s health, breast cancer tends to get more attention than heart disease. Many women believe that cancer is more of a threat, but they’re wrong. Nearly twice as many women in the United States die of heart disease, stroke and other cardiovascular diseases as from all forms of cancer, including breast cancer.  New research shows at least five times as many women die from heart disease as breast cancer and misconceptions about cardiovascular risks among women — and doctors who treat them — is partly to blame.

In a new study published in Global Heart, the journal of the World Heart Federation, researchers from Ohio State University found that awareness of women’s risks of developing coronary artery disease (CAD) has increased over the past decade, but men are still more aggressively treated at the first signs of the heart-related condition.

The research indicates CAD kills at least as many women as men each year, but doctors are less likely to recommend preventive measures for women, compared to men at risk for the condition — such as lowering cholesterol, taking aspirin, or making lifestyle changes in their dietary and exercise habits.

Heart disease is still largely considered a “man’s disease” by many women and doctors who should know better, according to lead researchers Martha Gulati, M.D., and Kavita Sharma, M.D. “One in three women get heart disease; one in two get heart disease or stroke, and one in eight get breast cancer,” states Dr. Gulati. “One in four women die from heart disease and one in 30 women die from breast cancer. Heart disease is the No. 1 killer of women. Lack of awareness is a [factor].”

According to the study, cardiovascular diseases are the leading cause of death for men and women worldwide, killing 8.6 million women alone each year. That’s one-third of all deaths in women.

According to the American Heart Association, cardiovascular disease — including heart disease, high blood pressure, and stroke — kills nearly a half-million women in the U.S. each year. That figure exceeds the next seven causes of death combined. More women die from CAD than of all cancers (including breast cancer, which kills about 40,000 women annually), respiratory conditions, Alzheimer’s disease, and accidents combined. Women are also 15 percent more likely than men to die of a heart attack and twice as likely to have a second heart attack in the six years following the first.

The researchers added that while most American women can identify breast cancer as a risk to their health, few can do the same for heart disease.

The new research highlights other differences between men’s and women’s heart risks:

  • Obesity (tied to lack of exercise and unhealthy diets) increases the risk of CAD by 64 percent in women but only 46 percent in men.
  • CT scans and other imaging techniques show that women have narrower coronary arteries than do men, which may account for the greater risks women face.
  • Women with an immediate family member who has had CAD face greater risks than men.
  • Diabetes raises a woman’s CAD risk by three to seven times, while for men it is two to three times.

The researchers said awareness of the impact of CAD on women is growing. In 1997, only 30 percent of American women surveyed were aware that the leading cause of death in women is heart disease. By 2009, that level of awareness had grown to 54 percent. But that figure still indicates many women mistakenly believe breast cancer is a bigger threat to their lives than heart disease. In addition, fewer than one in five physicians recognize that more women than men die each year from CAD.

Health experts recommend the following heart-healthy tips:

  • Diet: Consume at least five daily servings of fruit and vegetables; limit consumption of fried and fatty foods; buy lean, low-fat protein; and choose lower-fat and whole grain foods.

 

  • Exercise: Get at least 20-30 minutes of moderate-intensity exercise five days a week (150 minutes weekly). That activity should be strenuous enough to increase your heart rate and make you break a sweat, but light enough that you can carry on a conversation.

 

  • Stress: Look for ways to lower your stress level through exercise, relaxation techniques, Yoga, swimming, or other activities.

Bottom line: Cardiovascular disease is the number one killer of men and women and far more dangerous to women than breast cancer. Greater awareness is needed among patients and physicians about the prevalence of CVD in women. Following a “heart healthy” lifestyle can significantly reduce your risk of cardiovascular death.

 

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA area.


Linking Obesity to Breast Cancer

Breast cancer is the second most common cancer in women worldwide, representing 16% of all cancers in women. Although early diagnosis and available treatments have improved survival rates, new prevention strategies are sought to reduce the incidence of this disease.

A new study published in the Journal of Cell Physiology describes how inflammation that characterizes fatty tissue is one of the main microenvironment actors responsible for promoting cancer. The authors also describe the involvement of steroid hormones and others factors produced by adipose tissue in breast cancer development. The study, “Multifaceted breast cancer: the molecular connection with obesity,” appeared in the July 1, 2016 edition of the international, per-reviewed journal focused on cancer-related issues.

Increasingly, obesity has been identified as a significant risk factor for many cancers and, after tobacco use, may be the single greatest modifiable cancer risk factor. Excess body weight may affect cancer risk through a number of mechanisms, some of which might be specific to certain cancer types. Excess body fat might affect:

  • Immune system function and inflammation
  • Levels of certain hormones, such as insulin and estrogen
  • Factors that regulate cell growth, such as insulin-like growth factor-1 (IGF-1)
  • Proteins that influence how the body uses certain hormones, such as sex hormone-binding globulin

Many studies have shown that being overweight and obese are associated with a modest increase in risk of postmenopausal breast cancer. This higher risk is seen mainly in women who have never used menopausal hormone therapy (MHT) and for tumors that express both estrogen and progesterone receptors. In contrast, being overweight and obese been found to be associated with a reduced risk of premenopausal breast cancer in some studies.

The relationship between obesity and breast cancer may be affected by the stage of life in which a woman gains weight and becomes obese. Epidemiologists are actively working to address this question. Weight gain during adult life, most often from about age 18 to between the ages of 50 and 60, has been consistently associated with risk of breast cancer after menopause.

The increased risk of postmenopausal breast cancer is thought to be due to increased levels of estrogen in obese women. After menopause, when the ovaries stop producing hormones, fat tissue becomes the most important source of estrogen. Because obese women have more fat tissue, their estrogen levels are higher, potentially leading to more rapid growth of estrogen-responsive breast tumors.

The relationship between obesity and breast cancer risk may also vary by race and ethnicity. There is limited evidence that the risk associated with overweight and obesity may be less among African American and Hispanic women than among white women.

While we still have much to learn about the link between weight loss and cancer risk, people who are overweight or obese should be encouraged and supported if they try to lose weight. Aside from possibly reducing cancer risk, losing weight can have many other health benefits, such as lowering the risk of heart disease and diabetes.

Bottom line: Obesity is associated with an increased risk of breast cancer and other cancers as well. Being overweight or obese also leads to a greater risk for many diseases, including diabetes, high blood pressure, cardiovascular diseases, and stroke. The best response is prevention with a proactive lifestyle focused on a healthy diet and regular exercise.

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.


Breast Cancer and Hormone Replacement Therapy (HRT)

Perhaps the most significant worry that most women have when considering whether or not to take Hormone Replacement Therapy (HRT) is the possible increased risk of breast cancer. Breast cancer is an estrogen dependent cancer and constitutes approximately 25% of all female cancers, therefore any woman who has an early menopause and does not take any estrogen supplementation will actually reduce her risk of developing breast cancer in later life.

There are two main types of HRT:

  • combination HRT contains the hormones estrogen and progesterone
  • estrogen-only HRT contains only estrogen

Combination HRT increases breast cancer risk by about 75%, even when used for only a short time. Combination HRT also increases the likelihood that the cancer may be found at a more advanced stage, as well as increasing the risk that a woman diagnosed with breast cancer will die from the disease. Breast cancer risk increases the most during the first 2 to 3 years of taking combination HRT. Higher-dose combination HRT increases breast cancer risk more than lower-dose combination HRT. Breast cancer risk goes back down to average about 2 years after you stop taking combination HRT.

Estrogen-only HRT increases the risk of breast cancer, but only when used for more than 10 years. Estrogen-only HRT also can increase the risk of ovarian cancer.

If you’ve been diagnosed with breast cancer or have tested positive for an abnormal breast cancer gene (BRCA1 or BRCA2) and so are at high risk, you shouldn’t use HRT. The hormones in HRT can cause hormone-receptor-positive breast cancers to develop and grow. While only a few small studies have looked at HRT use in women with a personal history of breast cancer, the fact that HRT use increases breast cancer risk among women in general makes almost all doctors advise women with a personal history of breast cancer to avoid HRT. The prescribing sheet included with HRT clearly states that it is “contraindicated in women with a diagnosis of breast cancer.”

Menopausal side effects can dramatically reduce quality of life for some women. These women have to weigh the benefits of HRT against the risks.  If you’re having severe hot flashes or other menopausal side effects and have a personal history of breast cancer, talk to your doctor about non-hormonal options, such as dietary changes, exercise, weight management, acupuncture, or meditation.

The small increase in the incidence of breast cancer in long-term users of HRT should be considered in the context of the benefits of HRT. Long-term use is indicated for the prevention of serious disorders as osteoporosis and cardiovascular disease (and perhaps also useful in the prevention of dementia). Only in women without any risk factor for these diseases and especially for cardiovascular disease, the excess of breast cancer is of real importance in terms of cost-benefit calculations. But for some women a small increase in the incidence of breast cancer is so terrifying, that they accept the probability of an earlier (premature) cardiovascular death.

Whether or not you take HRT, there are also lifestyle choices you can make to keep your breast cancer risk as low as it can be:

  • maintaining a healthy weight
  • exercising regularly
  • limiting alcohol
  • eating nutritious food
  • never smoking (or quitting if you do smoke)

These are just a few of the steps you can take to reduce your risk of breast cancer.

Bottom line: If you’ve been diagnosed with breast cancer or have tested positive for an abnormal breast cancer gene (BRCA1 or BRCA2) and so are at high risk, you shouldn’t use HRT.  Patients with menopausal symptoms should speak to their doctor about treatment options.

(*information for this article was obtained from breastcancer.org)

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.


Osteoporosis Affects Women AND Men

Osteoporosis is disease of the bones that occurs when a person loses too much bone, produces too little bone or both and can affect both men and women. Osteoporosis is often called the ‘silent thief’ because bone loss occurs without symptoms unless one has fractured. The disease can result in disfigurement, lowered self-esteem, reduction or loss of mobility, and decreased independence.

But while millions of men suffer from osteoporosis, the vast majority of people with this potentially painful condition are women. The International Osteoporosis Foundation estimates that osteoporosis affects about 200 million women worldwide.

Fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined. At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime. Why the gender gap? Women start with lower bone density than their male peers and they lose bone mass more quickly as they age, which leads to osteoporosis in some women. Between the ages of 20 and 80, the average white woman loses one-third of her hip bone density, compared to a bone density loss of only one-fourth in men.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, osteoporosis statistics show a greater burden for women in the following ways:

  • 68 percent of the 44 million people at risk for osteoporosis are women.
  • One of every two women over age 50 will likely have an osteoporosis-related fracture in their lifetime. That’s twice the rate of fractures in men — one in four.
  • 75 percent of all cases of hip osteoporosis affect women.

Osteoporosis and Estrogen

Estrogen is a hormone that helps regulate a woman’s reproductive cycle. At the same time, it plays a role in keeping bones strong and healthy, in both men and women. While premenopausal women have more estrogen than men, they will experience dramatic drops in estrogen production due to menopause, and are more likely to experience bone loss and osteoporosis at that time.

Women are at increased osteoporosis risk related to estrogen levels if they:

  • Experience irregular or infrequent periods, or began having their periods at a later than normal age.
  • Have had their ovaries removed (at any age).
  • Are going through menopause, with those undergoing menopause at an early age having an even higher risk.

 

Women lose bone mass much more quickly in the years immediately after menopause than they do at any other time in their lives.

In contrast, data suggests that women who have more estrogen than their peers, such as women who began their menstrual cycles earlier than normal or who have used estrogen containing contraceptives, are likely to have higher bone density.

Osteoporosis: Underdiagnosed in Men

Because osteoporosis occurs more frequently in women than men, less attention is paid to bone health in men, and those who have osteoporosis may go undiagnosed and untreated. A study of 895 nursing home residents over age 50 revealed that doctors were less likely to consider osteoporosis diagnosis and treatment for men than women, even when the men had recently experienced a fracture, a widely recognized red flag for osteoporosis. The reality is that 80,000 men experience osteoporosis-related fractures every year, and close to 23,000 die as a result of fracture-related complications.

Bone loss is a normal part of aging in both men and women; by about age 75, men and women lose bone at the same rate and both genders are less able to absorb calcium. However, when men get osteoporosis, it is usually related to another health condition, a lifestyle choice (smoking or alcohol abuse), or medication that has bone loss as a side effect.

Bottom line: Osteoporosis risk is different for men and women, but the disease is dangerous for anyone who gets it. Talk to your doctor about getting an osteoporosis screening if you know you have risk factors.

 

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.


Men Can Get Breast Cancer

Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2016, about 2,600 men are expected to be diagnosed with the disease. For men, the lifetime risk of being diagnosed with breast cancer is about 1 in 1,000.

Wait, men don’t have breasts like women, so how do they get breast cancer? The “breasts” of an adult man are similar to the breasts of a girl before puberty. In girls, this tissue grows and develops, but in men, it doesn’t. But because it is still breast tissue, men can get breast cancer. Men get the same types of breast cancers that women do, but cancers involving the parts that make and store milk are rare.

Who Is at Risk?

Most breast cancers happen to men between ages 60 and 70. Other risk factors of male breast cancer include:

  • Breast cancer in a close female relative.
  • Previous radiation treatment to the chest increases your risk.
  • History of radiation exposure of the chest.
  • Enlargement of breasts (called gynecomastia) from drug or hormone treatments, or even some infections and poisons.
  • Taking estrogen.
  • A rare genetic condition called Klinefelter’s syndrome.
  • Severe liver disease (called cirrhosis).
  • Diseases of the testicles such as mumpsorchitis, a testicular injury, or an undescended testicle.

What Are The Symptoms of Breast Cancer in Men?

The symptoms of breast cancer in men are similar to those in women. These include:

  • A breast lump that you can see or feel
  • An enlargement of one breast
  • Nipple pain
  • Discharge from the nipple
  • Sores on the nipple or areola
  • An inverted nipple
  • Enlarged underarm lymph nodes

 

The good news is that treatment and survival rates are largely the same for men as for women. The five-year relative survival rate for male breast cancer is 84 percent. The 10-year relative survival rate is 72 percent. These are only averages, though. Breast cancer also tends to be diagnosed later in men than in women.

Where the difference lies is in diagnosis and screening. As Marleen Meyers, an assistant professor of medical oncology with NYU Langone Medical Center told U.S. News and World Report last year, men don’t undergo routine breast cancer screenings.  “They only seek medical attention when they feel a lump, whereas women have routine screenings and get it identified earlier,” Meyers said. “By the time men come in, the tumor is usually at least 1 centimeter in size, and the cancer has often spread.”

Because male breast cancer is so rare, experts don’t see much benefit in general-population screenings, such as mammograms, according to the American Cancer Society.

As always, if you experience any of the symptoms associated with breast cancer, see your doctor right away and get evaluated. Regardless whether you are a man or woman, the best way to fight breast cancer is through awareness and early detection.

Bottom line: Less than 1% of breast cancer occurs in men, but men can and do get breast cancer. Although men do not require yearly screening mammograms, awareness of the signs and symptoms can lead to early detection and improved survival.

 

About the author: Raja P. Reddy, MD is a board certified diagnostic radiologist specializing in breast imaging. He is also a contributing editor for Digital Mammography Specialists, a leading provider of outpatient women’s imaging services in the greater Atlanta, GA.