Attai: A vital question for all women: Are you dense?

By the time I see my breast cancer patients, many of them already know their diagnosis. All are shaken by the discovery of cancer, especially those whose cancer was found belatedly and who thought they had done everything right — regular mammograms and self-exams — to catch any cancer early.

While tumor biology often dictates the course and aggressiveness of the disease, early detection can improve the chances of survival, which is why doctors recommend regular mammograms.

Yet, as a surgeon specializing in the treatment of breast disease, I know that mammography is far from ideal. This is particularly true for women with a normal and common condition called dense breast tissue — a relatively higher concentration of glandular tissue to fatty tissue.

But while normal and common, the added risk presented by dense breast tissue is not well known among women, which is why the California Legislature declared last Wednesday "Are You Dense? Day," as was called for in a resolution authored by state Sen. Joe Simitian, D-Palo Alto.

The goal of "Are You Dense? Day" was to inform women that dense breast tissue both increases the risk of cancer and makes it harder to detect. Dense breast tissue is present in approximately 40 percent of all women undergoing mammograms. Yet, fewer than 10 percent of women are aware of their breast density.

Women who are aware of their breast density, and who talk to their physicians about it, are more likely to discover any abnormalities early in their development. Every year in this country, approximately 200,000 women will be diagnosed with breast cancer, and approximately 40,000 will die from it. A woman with dense breast tissue is four to five times more likely to develop cancer than a woman without it.

The breast is a very difficult and complex organ to image. Because both dense breast tissue and cancer and calcifications create a mammogram image that is mostly "white," looking for cancer amid dense breast tissue has been described as "trying to find a polar bear in a snowstorm."

A woman with dense breast tissue has a 50 percent to 75 percent chance that her cancer will be missed on a screening mammogram, increasing the likelihood that it will not be detected until a later stage, possibly when it is no longer potentially curable.

In many areas of medicine, patients are given a copy of test results and can ask about results they do not understand. This often does not happen with a mammogram. The federal Mammography Quality Standards Act dictates that centers that perform mammography provide a woman with a "layperson letter," which in very basic terms notes whether an abnormality is present or not. It might commonly say "your mammogram shows no evidence of cancer," along with a recommendation to return in one year.

The patient's physician receives a very different report. It will describe detailed findings, including a notation of the density of the breast tissue such as "due to the breast density, the sensitivity of mammography is limited." Many physicians inform the patient only that the mammogram was "normal." Most women with dense breast tissue do not know that their mammogram might have missed something.

To assure that women receive this information, Senate Bill 1538, introduced by Simitian, would require that the patient's mammogram report include breast density information and suggest further discussion with her doctor of the possible benefits of additional screening.

The root of the word "doctor" is from the Latin docere — "to teach." Physicians should welcome the opportunity to provide patients with information and guidance.

"Are You Dense? Day" seeks to educate women about the importance of asking about their breast density.

If they learn they have dense breast tissue, this should prompt further discussion regarding risk factors and whether additional imaging such as ultrasound or MRI might be helpful, depending on the individual situation. Even though no imaging technique is perfect, supplemental screening increases the chances of discovering cancer, and newer, more sensitive tests are continually being developed.

Only when patients are provided with full test results, placed in proper context, can they partner with their physicians to make decisions that are in their best long-term health interest. Ask your physician, "Am I dense?"

Deanna Attai, M.D., is a breast surgeon at the Center for Breast Care Inc. in Burbank. She has been in practice for 17 years and has focused exclusively on the care of patients with diseases of the breast since 2004.

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Read more: http://www.vcstar.com/news/2012/aug/11/attai-a-vital-question-for-all-women-are-you/#ixzz23S5ft2Mj
- vcstar.com 

Individualized Care Best for Lymphedema Patients, MU Researcher Says

http://www.healthcanal.com/public-health-safety/31500-Individualized-Care-Best-for-Lymphedema-Patients-Researcher-Says.html

MU researcher directs foundation that reviews published research; makes recommendations based on findings
By Kate McIntyre
COLUMBIA, Mo. – Millions of American cancer survivors experience chronic discomfort as a result of lymphedema, a common side effect of surgery and radiation therapy in which affected areas swell due to protein-rich fluid buildup. After reviewing published literature on lymphedema treatments, aUniversity of Missouri researcher says emphasizing patients’ quality of life rather than focusing solely on reducing swelling is critical to effectively managing the condition.
Jane Armer, professor in the MU Sinclair School of Nursing and director of nursing research at Ellis Fischel Cancer Center, said many insurance providers and health care professionals assess whether lymphedema patients need treatment based solely on how swollen their limbs are. However, several studies have shown that the volume of fluid doesn’t necessarily correspond with patients’ discomfort.
“Practitioners need to treat the swelling while considering patients’ distress. We don’t want to burden them with unnecessary or ineffective treatments,” Armer said. “Health care providers should focus on managing symptoms and choose carefully among various treatments to provide individualized care plans that comfort patients, which may require modifying existing protocols.”
In their literature review, Armer and her colleagues found that Complete Decongestive Therapy (CDT), a comprehensive approach for treating lymphedema involving skin care, exercise, manual lymphatic drainage and compression of the swollen limbs, may be the best form of specialized lymphedema management.
“Patients have different medical needs and come from culturally diverse backgrounds. They have different goals, support systems, pain levels and treatment tolerances. All these factors influence patients’ responses to care, which affects their well-being,” said Marcia Beck, a review co-author and an MU graduate who now works at Truman Medical Centers in Kansas City, Mo.
“Caring for lymphedema patients should be flexible and adjusted to maintain patients’ quality of life,” said Ausanee Wanchai, another co-author who received her doctorate at MU and now teaches at Boromarajonani College of Nursing in Buddhachinnaraj, Thailand.
In a separate literature review, the researchers found that Intermittent Pneumatic Compression (IPC) therapy, in which sequential inflatable devices surrounding swollen limbs are used to increase lymphatic circulation, is beneficial as an adjunct therapy for chronic lymphedema patients who have limited or no access to medical care; patients can use the compression devices in their homes.
Armer said further research is needed to demonstrate the usefulness of various lymphedematreatments, such as CDT and IPC. The literature reviews were the third and fourth in a series of 12 to be published in conjunction with the American Lymphedema Framework Project (ALFP). As director of the ALFP, Armer works alongside clinical experts and investigators to increase awareness of lymphedema and related disorders. The ALFP was founded in 2008 and is headquartered at the MU Center for Lymphedema Research, Practice and Health Policy. Its steering committee and staff currently are partnering with the International Lymphedema Framework (ILF) in producing an updated edition of the ILF Best Practice Document from 2006.
The article, “Palliative Care for Cancer-Related Lymphedema: A Systematic Review,” recently was published in the Journal of Palliative Medicine. Armer’s co-authors also included researchers from MU and the University of Texas. The other review, “Intermittent Pneumatic Compression Therapy: A Systematic Review,” was published in the journal Lymphology earlier this year. Researchers from the NorthShore University HealthSystem, Walter Reed Military Medicine Center and University of Texascontributed to the review.

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Story Contact: Jesslyn Chew, (573) 882-8353, ChewJ@missouri.edu

Why You Should See Your LE Therapist Every 6 Months

Here is an important article that we found on the discussion boards of BreastCanceer.org

The Lymphatic Research Foundation’s National Walk for Lymphedema and Lymphatic Diseases

The Lymphatic Research Foundation’s National Walk for Lymphedema and Lymphatic Diseases will take place in Denison, Texas on September 17, 2011, at Eisenhower Park, East Meadow, NY on September 24, 2011, and in Melrose, Massachusetts on October 2, 2011.

The goal of the Walk is to bring together lymphatic disease and lymphedema patients for mutual support, encouragement, and information sharing while giving them a fun way to raise funds for the biomedical research that will impact their lives.

The Walk also provides patients and their families a forum to educate their family members, friends and colleagues who may not understand their battle with lymphatic diseases.

For more information, please visit the Walk website at www.walklrf.org

Thank you.

Colleen

Colleen McGuire

Development Associate

Lymphatic Research Foundation

40 Garvies Point Road, Suite D

Glen Cove, NY 11542

Phone: 516-625-9675

Fax: 516-625-9410

Avon Foundation White Paper on Lymphedema

The Avon Foundation recently published a "white paper" review of Lymphedema: http://www.avonfoundation.org/programs-and-events/lymphedema-information.html

This review of lymphedema was written by leading experts in the field of lymphology and is an excellent reference.

The overall message was that lymphedema starts long before swelling is clinically apparent, and early diagnosis and treatment are key to halting progression.

The authors state that anyone who has been treated for breast cancer is at risk of lymphedema.

My only concerns with the paper are:

1) The reliance on and endorsement of bioimpedance: although researchers have found bioimpedance to be a helpful tool in detecting increased fluid in the tissues in research, we've heard from women who received one reading and were told that they did not have lymphedema--bioimpedance is used to detect lymphedema with serial measurements--one measurement can not rule out the condition, and another researcher, who was using both bioimpedance and perometry, found bioimpedance insensitive. On the L-dex (bioimpedance device) site, there is a disclaimer that the device is not intended to be used to diagnose lymphedema.

Because lymphedema lacks a diagnostic criteria that is reproducible and universally agreed upon, any measuring device that is objective, reliable and detects lymphedema reliably would be welcomed. I would like to see firm standards for the use of bioimpedance, and proof of its sensitivity and specificity.

2) The statements about the benefits of weight lifting: the article states that weight lifting reduces the onset of lymphedema in women with greater than 5 nodes removed by 70%. This was a sub-analysis of the JAMA article and can not be a blanket endorsement of all weight lifting in women with greater than 5 nodes removed. The actual JAMA article stated:

“Slowly progressive weight-lifting had no significant impact on arm swelling among breast cancer survivors with lymphedema, and resulted in a reduced incidence of lymphedema flares and improvement in symptoms. In breast cancer survivors at risk for lymphedema, a program of slowly progressive weight-lifting, compared with no intervention, did not result in increased incidence of lymphedema. In secondary analyses, women with 5+ nodes removed who did weight-lifting were less likely to experience increases in arm swelling.”

So, the actual results of the two published trials on weight-lifting so no harm, and some benefit, but to counsel women that it will cure their lymphedema, or prevent it, is not supported by the evidence, and women must be given specific guidelines on safe resistance training. Exercise is beneficial to all women--those with lymphedema and at risk for it, but women need the facts of how to exercise safely.


Those two caveats aside, the Avon Foundation White Paper is an excellent resource and reference.