Breast cancer and new panic headlines
Such a great post. I am in my mid-40s and was diagnosed with early stage BC this year. I have met a number of women with no cancer history diagnosed with BC under 50. One thing I've thought about a lot is the role that having children later (I had mine at almost 39) is associated with BC because of the hormones needed to delay childbirth. In other words, are women taking more birth control for longer (IUD or the Pill) and this increases their chance of BC? This paper mentions some of that research in the lit review, for example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10040158/#:~:text=A%202017%20prospective%20cohort%20study,%2C%20CI%201.11%2C%201.33).
Also, just a PSA: I *only* found my cancer through an MRI, never a mammogram (it wasn't visible on a mammo at 1cm a week before surgery). I was able to get MRIs because I was getting high risk screening due to family history--if you are at a higher risk, try to get high risk screening 2x a year (mammo once and MRI once) so you can get the MRI and catch tumors earlier and those that are not visible on mammos.
Getting early screening is huge. Once the tumor is big enough to be felt under the skin it is often at Stage 2 (or higher) and may have already spread to lymph nodes or sent tumor cells to other places in the body which may then require chemo. I didn't have to do chemo because I caught it so early. Just wanted to share.
Personally, I get great peace of mind from cancer screenings. I
Started mammograms at 40, colonoscopy at 45 and get a pap and the recommended intervals. For me, the screenings are covered by insurance which makes it easier and I like
Knowing that if I did have a positive result it could be a false positive or at least be an early treatable stage. Many of my friends tho disagree and do not get screenings because they find the possibility of a positive very stressful. I see
Both sides but for me like to get the screenings.
Just listened to Vinay Prasad on EconTalk about cancer screenings - completely changing my mind on the value of screenings. Especially mammograms which he said have no clear evidence. I found his argument convincing but would like to hear more on the evidence behind them.
Is it true that self breast exams work? The United States Preventative Service Task Force does not recommend self breast exam as a screen for breast cancer.
I suspect some of the recent increase in breast cancer detection is due to overdiagnosis. (Overdiangosis is the detection and treatment of cancer that never would have posed a threat.) We have gotten much better at finding small cancers, many of which are unlikely to be harmful. I just read Gilbert Welch’s book “Overdiagnosed”, which discusses this topic.
The big question is - are we better off by finding more cancer via screening? Certainly, it is good to get a mammogram if someone experiences a new bump/pain/nipple retraction. But I worry that decreasing the mammogram screening age to 40 could lead to more overdiagnosis and unnecessary treatment. Just wrote about this challenging topic here:
At the end of the day, I aspire to “do no harm”, which is challenging when we don’t have data to definitively show that mammography screening decreases all-cause mortality. Similar issue for several other screening programs as well.
Is anyone tracking with the fenbendazole conversation?
"A recent 2022 study in the scientific journal Breast Cancer Research found that mebendazole (fenbendazole)1, a safe, readily available, inexpensive, side-effect free medicine that has had decades of favorable safety and efficacy data, prevents and eradicates triple-negative breast cancer and also prevents the development of metastases by reducing the likelihood of Cancer Stem Cells developing in distant regions."
I keep seeing recommendations for "self-exams" in a variety of places, and was kind of shocked to read that they "work" here. My understanding is that there is absolutely no evidence that they work. In fact, when I was undergoing gene testing, I was educated that they aren't recommended even (and especially) in high risk populations. Rather, a clinical exam every 6 months to 1 year is what is recommended, along with alternating MRI and mammo. The USPTF doesn't even recommend them. Second, I have a personal bugaboo with the concept of early detection the way it's explained, especially for breast cancer, as I think it's massively oversold (as well as mammography) at being effective. Survival rates are definitely skewed by how early we can diagnose some of these tumors. But most interestingly, the metastatic rate in breast cancer HAS NOT CHANGED despite early detection. Meaning...if you get stage one breast cancer, you have a 30% risk of it becoming metastatic one day, which has been a very stubborn statistic. To me, the ENTIRE point of screening is that you reduce that risk of metastasizing. To me, the small number of lives saved (and certainly all cause mortality does not go down with screening programs) does not square up with the astronomical increase in stage 0 cancers. (Which, by the way, can involved quite a bit of treatment even though it's "early.") Breast cancer is actually MANY different diseases, and sometimes mammography works, and sometimes early intervention works. A lot of times...it doesn't. We need more personalized screening approaches and something with less false positives and false negatives.
I was diagnosed at 41 in 2021 with Stage IV breast cancer about 6 months after I stopped breastfeeding my youngest child. Mammograms may work if they are offered to women liberally; I was reassured by my ob/gyn that I didn’t need one both when I turned 40 (-12 weeks pregnant from IVF) and at my postpartum 6 week check-up. As the pandemic - along with exhaustive work and childrearing - wore on in 2020, I started having back pain. The back pain was dismissed by my GP, a doctor of physical therapy, a chiropractor, and an orthopedic doctor as “routine post-pregnancy side effects”, nothing losing weight and exercise couldn’t cure. Eventually I asked for a mammogram, suspicious of my breasts without other evidence. My estrogen positive breast cancer diagnosis is now triple negative with a poor prognosis. Despite my being a young mom, all treatment for metastatic breast cancer is geared as if we were in our 70s, focused on quality of life and not remission or cure. Asking young women to take the screening burden into our own hands and “know our breasts” is insufficient. The medical community needs to lower cancer screening ages, actually read patients’ medical history to look for risks and proactively refer for follow-up, and not gaslight women who show up in their offices with serious medical concerns. It’s too late for me, but I hope we can do better for our daughters.
While anecdotal, my mom, an oncology nurse for more than 30 years, has told me she sees more younger women coming in lately.
I work at a Cancer Center and in the past year we have seen a lot more young people being diagnosed with cancer than I can ever remember in the past 12 years that I've worked there, especially among breast and colon, though we've also been seeing esophageal, lung, and even pancreatic at much younger ages than previously and presenting due to symptoms, so often advanced and before they'd be eligible for screening. It's scary. Is it the chemicals in our air, our food, our water that maybe wasn't there 25, even 10 years ago?
This was just released yesterday...https://www.nih.gov/news-events/news-releases/high-levels-particulate-air-pollution-associated-increased-breast-cancer-incidence#:~:text=NIH%20researchers%20combined%20historical%20air%20quality%20data%20with,associated%20with%20an%20increased%20incidence%20of%20breast%20cancer.
One question: what role has genetic counseling played in the increase of BC diagnoses for younger women?
Is it possible that in the last decade many high risk women received genetic counseling and earlier screenings, thus leading to more young women diagnosed?
Personally, I received genetic counseling in my early 30s due to my OB-GYN noting my high risk. Once my genetic predisposition was identified, I was on an MRI/mammogram regimen, which eventually caught my early stage breast cancer at 35.
If I had the same body, but was living just a decade ago, it’s likely I would have never been screened, and started my mammograms at the recommended age of 40, and face a much more advanced cancer.
I just wonder how many more women in 20s and 30s are being diagnosed due to their genetic risk, and if that is contributing to higher numbers.
Do the papers explain the decrease in prostate cancer? It might be interesting in comparison. What did we do that lead to that? Can we do that with breast cancer too?
Depth information about Cancer
Preventive measures prior to detection is not explained even if is this possible
Could this increase be in any way tied to increase usage of fertility treatments since those are more common for women that have kids later?
This has been on my mind as I currently have 2 friends and a family member undergoing cancer treatment and they are all under 45. The males have colon cancer and the female breast cancer. They are all very healthy, active people with kids. My cousin was diagnosed with stage 4 colon metasticized to his liver and his treatment bought him about a year, but he’s not going to make it until Christmas. It certainly feels like cancer is on the rise among younger people.
I don’t know how to read the charts in the European study linked above looking at age at childbirth and HR-positive tumors - what does the chart about OC (oral contraceptive) use indicate?