Breast Density: Radiologist Puts New Notification Law into Perspective

A healthy lifestyle means knowing a few things about your body – even if you’d rather ignore those facts. Weight, cholesterol readings, hormonal cycles, and osteoporosis risk are starting points for many women. Now you can add something else to the list – breast density.

Density refers to the amount of fibroglandular tissue (tissue besides fat or muscle, including milk ducts and lobules, connective tissue, etc.)  in the breast. On a mammogram (which looks like an x-ray to the untrained eye), dense tissue appears white and opaque, while the fatty tissue appears black.

The problem is that breast tumors or benign masses also appear white on the mammogram. So, for radiologists, searching for very small lesions in dense breasts is like looking for a snowman in a blizzard. Most women don’t know what type of tissue they have, and therefore don’t have enough information to start a conversation with their doctors.

A new law in New York changes everything. As of Jan. 19, 2013, providers are required to notify women if more than 50 percent of their breast tissue is dense. To learn more about why this is important, we spoke with Dr. Avice O’Connell, director of Women’s Imaging at the University of Rochester Medical Center and Highland Breast Imaging.

Scripts: It seems that many women might not realize that density is an issue in breast health. Is this true, in your experience?

O’Connell: Yes, absolutely. I see many women who are not familiar with their own breasts. They may not do monthly self-breast exams, and they often don’t ask questions during their routine mammograms. Awareness of breast density is low.  However, later, if women do find out that they have very dense tissue, they’ll say, ‘if I only had known this.’ The new law gives women more information – and in my opinion, more information is usually a good thing.

Scripts: Why do some people have dense breast tissue?

O’Connell: We’re not sure why some people have dense breasts. You can’t tell from the outside. In other words, it’s not related to a person’s size, age, or any other characteristic. We do know that density tends to ebb slightly with age (50s and post-menopause) – but only a mammogram can give us that information.

Scripts: Why is dense breast tissue a health hazard?

O’Connell: It’s a problem for two main reasons. First and foremost, small cancers can hide more easily in dense tissue. And simply having dense breasts slightly increases the risk of cancer.

The latter issue, however, is still being investigated and the risk is slight. In general we still have many questions about the impact of breast density on breast health. But from a practical standpoint as a radiologist who reviews thousands of films a year, I can say with certainty that detecting breast cancer in dense tissue is more difficult. A cancerous mass appears white and can be obscured by the white dense breast tissue and the spidery-looking fibrous glands surrounding it.

Scripts: Can you explain how the new law works — and why it’s important?

O’Connell: When a woman gets a routine, screening mammogram and we find no problems – other than dense breast tissue – she’ll receive a letter in a few days notifying her that her tissue is dense. The law’s intention is to boost awareness, not necessarily to prompt more testing. At that point, most healthy women with few or no risk factors for cancer will choose to do nothing. Radiologists are not required to make any recommendations on testing, either.

However, if you get one of those letters, we’re urging women to talk to their primary care physician or ob/gyn about their personal risk for breast cancer. Discuss family history, start of menstruation and early menopause (an early start and late finish are both risk factors), childbirth (if you’re older with your first pregnancy, that’s also a risk factor), and lifestyle habits such as overeating and excessive drinking. Based on an assessment of your personal risk for breast cancer, coupled with your dense breasts, your physician may recommend supplemental testing with a screening ultrasound or an MRI.

But this isn’t a simple decision, or a perfect solution. Sometimes an ultrasound opens a Pandora’s Box. Plus, additional testing takes time and money. The law doesn’t require insurance to cover screening breast ultrasounds, but most insurers have indicated they’ll pay for it with a physician’s referral.

Scripts: By ‘Pandora’s Box,’ you must mean that more information will cause needless worry for some women, correct?

O’Connell:  Yes. The main drawback is that the more ultrasounds we do, the greater likelihood of finding small, solid masses that need to be biopsied and followed up.  More than 90 percent of the time they will turn out to be benign. But an ultrasound provides a different view of the breast tissue, and studies show that ultrasounds will detect about three more cancers per thousand patients with an otherwise normal mammogram. And when cancer is detected earlier, it’s often more treatable. So, I like to say: “A little worry is better than a little cancer.”

Avice O’Connell, M.D., has practiced radiology for over 30 years in Rochester, New York. To contact Dr. O’Connell or to make an appointment at University Breast Imaging, please call 585-334-5519. Locations include 500 Red Creek Drive, Suite 130, in Henrietta; and Highland Breast Imaging at Highland Hospital, 1000 South Ave., Rochester

To learn more about good breast health and protective breast screening exams, watch Dr. O’Connell in this video clip, produced by URMC-based Peri-FACTS Academy, a multimedia continuing education program for OB/GYN healthcare providers.

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Colon Cancer: Silent Killer is Gaining Voice

What did Audrey Hepburn, Ronald Reagan, and Peanuts’ cartoonist Charles Shultz all have in common?

Colon cancer.

This week, in light of March being Colorectal Cancer Awareness Month, we’re sharing a heartfelt message from URMC colorectal surgeon Dr. John Monson, who writes to underscore the importance of routine screenings and other health habits that can help protect you from the deadly disease. For his insights, read on.

Simple Screenings Save Lives

Colorectal cancer, which affects the colon (the large intestine) and/or the rectum, has historically been a ‘silent’ disease – both in the sense that it rarely manifests obvious symptoms, but also in that, until earlier recent years, it was little talked of. Not only did the subject seem taboo for dinner table conversation, but it affected an older population and failed to elicit the same attention enjoyed by other diseases, such as breast cancer – the awareness and prevention of which was enthusiastically championed by women’s magazines, pink-ribbon fundraisers, and a passionate surge of young survivors.

But the message about the danger of colorectal cancer is raising its voice, as it should. It will kill more than 50,000 Americans this year – more than die in car crashes. Three times as many Americans will be diagnosed, making it the third most common cancer (not counting skin cancer), and the second leading cause of cancer deaths nationwide. But perhaps what’s most staggering is that, despite these daunting numbers, the cancer is nearly 90 percent curable if caught early.

As visible public figures have battled the disease – including Sharon Osbourne, Audrey Hepburn, Ronald Reagan, and Peanuts’ cartoonist, Charles Shultz – its prominence has been lifted in the public eye, freeing the topic for more open discussion. In fact, in 2000, Katie Couric televised her first colonoscopy live on the set of the Today Show, having a powerful influence on viewers. Inspired by the premature death of her 42-year-old husband, who fought the cancer for nearly a year, Couric urged viewers to take these screening tests more seriously. The number of colonoscopies shot up 20 percent in the months that followed – a phenomenon dubbed the “Katie Couric effect.”

The encouraging news about this deadly cancer is that a little education and adopting a few healthful habits can go a long way in conferring protection. Consider the advice below:

• When you turn 50, schedule your first colonoscopy screening and repeat it every five years. If your primary care physician doesn’t suggest it, you should. Cancers caught early are five times as curable as those that have advanced (and possibly spread). In this preventive scan, you’ll be sedated while a small, lighted endoscope inspects your colon and rectum for polyps – mushroom-like growths at risk for turning cancerous. If discovered during the scan, the polyps can be removed immediately, greatly diminishing your future risk.
• Eat grilled meats in moderation, and avoid smoking and chewing tobacco. Whether inhaled or swallowed, carcinogens in charred/smoked meats, tobacco smoke and “chew” all eventually pass through the colon, where they can up your risk for cancer.
• Balance your diet between “red” and “green” foods. Over-indulgence in red meats (eating more than a pound a week) has been linked to increased risk for colon cancer; on the contrary, adding more green, leafy vegetables to your diet and reducing your intake of foods with high-carb, high-fat, high-cholesterol content, has been shown to reduce risk.
• Stay active. Incorporating more physical activity – walking a pet, taking the stairs over the elevators, cleaning your house – helps stimulate your body’s waste to keep moving along (the longer stool sits in your rectum or colon, the more time toxic chemicals have to leech out into the surrounding tissues).
• Maintain a healthy weight, and know your shape. Obese men and women are at greater risk for colon cancer; “apple” shapes, which gain weight around the waist and vital organs, tend to be at greater risk than “pear” shapes, which store fat in their thighs and hips.
• Know the obvious symptoms. Through colorectal cancer is a notoriously “quiet” killer, in the later stages, it can give undeniable clues. If you experience bloody stools, diarrhea, cramping and unexplained weight loss, call your doctor immediately.

Remember, as many as half of people diagnosed with colon cancer will die from the disease, usually because it is caught so late. Simple screenings practices, if implemented unilaterally (once every five years starting at 50), could wipe out more than 80 percent of these diagnoses.

Dr. Monson serves as the chief of the Division of Colorectal Surgery at URMC. His areas of expertise include minimally invasive technologies for colorectal cancer treatment, in addition to basic research exploring a broad range of cancer-related subjects.

For more information about colon cancer screening, talk to your primary care physician, or learn more at http://www.urmc.rochester.edu/cancer-center/colon/.

Why Mammograms Really Matter

Sparky needing an urgent appointment at the vet. A flat tire. A child sick at school. That last-minute presentation that crept up on you at work.

As wives, daughters, sisters and mothers, there are so many urgent demands on today’s women’s schedules. And unfortunately, that too often relegates routine health screenings, like mammograms, to the back burner.

With October in full swing, pink ribbons abound and many women are talking – rather candidly – about the importance of good breast health. The recurring question, it seems, is always the same: Do you really need to bother with a regular mammogram? Even if you’re already vigilant about self-exams?

Yes, experts agree, you do. But don’t take our word for it — in the clip below, URMC’s Dr. Avice O’Connell, director of Women’s Imaging Services at URMC, joins to together with breast cancer patients and survivors to underscore the life-saving value of mammograms.

To learn more about the comprehensive breast health services available at URMC, visit mammo.urmc.com.

Ready to make your appointment? Call 585-487-3300, or send an e-mail  to University Breast Imaging detailing the best times for you, and a representative will call you back.

Men: How Many Candles Will Top Your Final Birthday Cake?

American men may be living longer than ever, but statistics show they still lag about five years behind women.

So, to equip men with powerful knowledge that could not only add years to their lives, but quality life to their years, the University of Rochester Medical Center is inviting local community men to its eighth annual Men’s Health Day. Set for Sept. 23, the day-long festivities present a unique (non-nagging!) opportunity to learn about health topics ranging from cardiovascular wellness and prostate health to cataract surgery and sleep disorders.

To celebrate, we’ll spend the four weeks leading up to this year’s event featuring men’s health-focused video snippets here on our Scripts blog. This week, urologist and surgeon Dr. Jean Joseph kicks off this mini blog-tour by shedding light on why women so often survive male counterparts.

But please, don’t miss the moral of his story: According to Dr. Joseph, it’s never too late for men to adopt a healthy lifestyle and habits. In fact, you can take a step in the right direction right now – just watch the clip below.

Want to register for this year’s Men’s Health Day event?

Act fast! In 2010, Men’s Health Day sold out, attracting more than 400 men.

In addition to terrific speakers, the day will also include health screenings, hands-on demonstrations, giveaways, healthy snacks, breakfast and lunch, and deluxe raffle prizes. New this year, attendees also can receive an individual analysis of their “gait,” since the way you walk can predict the likelihood of a fall. A flu shot clinic also will be available.

Registration begins Aug. 29 by calling (585) 275-2838. Tickets cost $15 and include breakfast, lunch, giveaways, prizes, and free parking at the Hyatt Regency Rochester (125 Main Street).

For more information, visit www.menshealth.urmc.edu.

The Mammography Mess: To Scan, or Not to Scan?

Pink ribbons abound, as this is the month for breast cancer awareness.

But for many women, it might as well be the month for breast cancer confusion. Lately, when it comes to the value of annual mammograms, one scientific report after another only muddies the issue more.

Questions loom large:

“Is it cost-effective to start screenings at age 40?”

“Can’t mammograms turn up ‘false positives’ – that is, ‘harmless’ cancers that don’t actually need treatment?”

“How much do mammograms really cut the rate of breast cancer deaths?”

“Last November, the United States Preventive Services Task Force recommended that most women stop getting routine mammograms in their 40s,” said URMC expert Dr. Avice O’Connell.

“Since then, many women have opted out of mammograms, believing this was OK,” she said. “But the new Health Care Law adopted this past spring specifically says we should ignore the 2009 Task Force recommendations in favor of earlier guidelines.”

Need some more light shed on this issue? Watch this week’s clip to hear Dr. O’Connell makes sense of the reports.

(In this video, Dr. O’Connell is specifically addressing a Norwegian study, published Sept. 23 in the New England Journal of Medicine, which found that the screenings account for just 10 percent of the reduction in breast cancer deaths. Since then, however, Swedish findings released late last week showed that when mammography is made available to women, there could be as much as a one-third reduction in mortality from breast cancer.)

Dr. O’Connell is chief of Women’s Imaging for URMC’s James P. Wilmot Cancer Center’s Comprehensive Breast Care Center. She is also the director of Highland Breast Imaging, one of the few all-digital, full-service breast imaging and diagnostic centers in the area.

Need a mammogram? Click here.

A Crash Course: Flu 2010

On the heels of a downright bamboozling flu season – thanks to the debut of a novel H1N1 virus strain in May 2009 – many people are asking what they can expect later on this fall and winter.

To get to the bottom of the most common questions, we asked URMC flu guru Dr. John Treanor:

• Why we’re back to having just one flu shot (the seasonal vaccine);
• Why it might seem like you can get sick from the flu shot (really, you can’t!);
• To briefly review the vaccine’s safety record (he also divulges one surprising finding from the close scrutiny of the H1N1 vaccine);
• To offer tips for parents who are concerned about Australian reports suggesting an increased fever/seizure risk from one brand of vaccine.

After watching this clip, let us know if you feel like a flu expert yourself! And if you like, help us make this clip “go viral” by sharing with friends and family.(Couldn’t resist a flu pun!)

Looking for a flu shot? The University of Rochester School of Nursing holds several public clinics, linked here.

(URMC staff: Vaccine will be offered to hospital employees in early October, and to all other University staff via Well-U clinics beginning this month!)

No Bad Foods — Just Bad Diets

There’s no such thing as a “bad” food, according to Dr. Tom Pearson. But an imbalanced diet that caters too much towards fats, salts and sugars can spell trouble.

Pearson is one of 11 members  to sit on the advisory committee that’s shaping the new 2010 U.S. Dietary Guidelines — the “Bible” by which America takes her nutrition commandments. The official guidelines, to be issued later this year, are likely to slash the recommended daily consumption of salt by another 800 milligrams (to give some context, the average adult ingests more than 3,400 milligrams of salt daily, though current guidelines recommend no more than 2,300 milligrams. The new 2010 guidelines, if the advisers have their way, will aim even lower, setting the cap at 1,500 milligrams.)

“It’s not that foods are more salty, per say,” Pearson said.

After all, most Americans have exceeded the recommended allowance for salt for almost four decades. It’s the sheer amount of food that’s the culprit, Pearson explains.

“We’re eating a lot of sodium because we’re eating a lot of food, and the food contains sodium,” he says.

Sodium increases blood volume, and when more blood is cycling through the same arteries and veins, blood pressure is higher. Over time, this extra pressure leads to faster to wear and tear, paving the way for stroke, heart disease, heart failure and kidney failure.

“If you add those up, he says, you’ve got the major causes of chronic disease and early death in the U.S.,” Pearson says.

We need to balance, he says, and take responsibility for our choices.

“One of the things I’ve always wanted to see is not ‘how many cookies per serving,’ but, for a serving size of, say, three cookies, how many miles you’ll have to work to burn that off,” he says. “Sort of a calorie debt you have, so you can make a choice at that point.”

Pearson recommends that people looking to eat healthier start by making small, easy swaps — like trading a glass of 2 percent milk for skim, or having a piece of fruit in lieu of a candy bar.  The good news, he says, is that you can retrain your body and its cravings over time.

Pearson is the Albert Kaiser Professor of Community and Preventive Medicine at the University of Rochester Medical Center. Pearson also directs URMC’s new Clinical and Translational Science Institute.

Make No Bones About It: You’re In Charge of Your Skeleton

When it comes to your skeleton, it’s all downhill after 30.

That’s the age when growth hormone dwindles, bone-building slows to a crawl, and your body is likely to reach its maximal bone mass, explains bone expert (and bone “sleuth”) Dr. Susan Bukata.

“After that, bones begin to deteriorate,” she says. “Luckily, there are a few things you can do to slow down the clock.”

Bukata suggests the following tips for keeping the bone you’ve got:

• Spend 2 percent of your day exercising. You can spread this goal — 30 minutes of weight-bearing exercise — throughout your day in small bursts.  For instance, picking a spot further out in the grocery store parking lot can bring you a few minutes closer towards that half-hour goal.
• Find secret sources of calcium and Vitamin D. Hate milk? A half-cup of collard greens has the same calcium punch as an 8-ounce glass. Plenty of other creative sources of calcium (broccoli, salmon, bread) and Vitamin D are linked here and here.
• Kick the habit (no ifs, ands, or “butts”). Quitting smoking — or better yet, not  starting in the first place — can dramatically cut your risk for fractures. While osteoporosis is undoubtedly a bad disease, Bukata says that avoiding a debilitating fracture is really the “name of the game.”

Bukata is the Clinical Director of  URMC’s Center for Bone Health. A regional referral center for the diagnosis and treatment of bone disorders like osteoporosis, calcium bone disorders, and metabolic bone disease, the Center also works to advance patient care through research.