You’ll find lots of “Myths” and “Fact”
By Deborah Jeanne Post
Whether you heard them from your auntie or “Dr. Google,” breast cancer myths abound.
“There are so many myths surrounding the diagnosis and disease of breast cancer,” said physician Kara Kort, breast cancer surgeon at St. Joseph’s Health. “Some have been around forever and yet continue to pop up despite being previously debunked. Others continue to concern patients and, to the average layperson, may seem logical.”
Women in their 40s shouldn’t have mammograms because of high number of false alarms and callbacks.
“A false alarm or false positive occurs when an area appears suspicious on a screening mammogram but is ultimately found to be normal after additional imaging or testing,” said physician Stamatia Destounis, at Elizabeth Wende Breast Care. “Being called back for additional images can understandably cause anxiety, but it’s important to understand what those callbacks mean. Most women who return for additional testing do not have breast cancer.
“Additional evaluation may include extra mammogram views, a breast ultrasound and occasionally, a minimally invasive biopsy. Most screening mammograms are normal. However, when something requires a closer look, additional imaging allows radiologists to gather more information before determining whether a finding is truly concerning.
“While false positives are a recognized part of breast cancer screening, they must be weighed against the benefit of detecting cancer at its earliest and most treatable stage. Breast cancer does occur in women in their 40s, and screening during this decade can help identify cancers before symptoms develop.”
Each case of breast cancer is the same.
“Thinking that all breast cancer is the same or comparing your breast cancer to your friend’s breast cancer that needed chemotherapy, is a very common misconception and something I spend a lot of time explaining to patients,” Kort said. “Breast cancer is one diagnosis that varies significantly depending on each woman’s specific tumor biology. While some breast cancers can be aggressive and more likely to spread, making chemotherapy recommended, others are very slow growing and often pose little threat to your life. Your breast surgeon or oncologist will explain these differences to you. Remember that while women do die from breast cancer, the overall five-year survival rate remains over 90%.”
Women do better with a double mastectomy when diagnosed with breast cancer.
“This mistaken belief is something I have heard from patients for nearly 30 years,” Kort said. “Almost all breast surgeons have. It is a huge misconception that removing both breasts when either a lumpectomy or single mastectomy is indicated will improve survival. It has been proven repeatedly not to be true. That being said, many women still choose this option, but as physicians, it is always our responsibility to make sure patients understand that it is not medically necessary in the overwhelming majority of cases.”
Staying fit, exercising, eating healthy and limiting or avoiding alcohol will prevent you from getting breast cancer.
“Sadly, while these are all very important and recommended lifestyle habits, they do not prevent everyone from developing cancer,” Kort said. “Unfortunately, 1 in 8 women in the United States will develop breast cancer, and while we are aware of certain risk factors that women can try to limit, many contributing factors are likely beyond our control or are not yet fully understood. I would emphasize that screening and treatments continue to improve, increasing the likelihood that most women will do well despite a diagnosis of breast cancer.”’
Most breast cancer presents as a lump in your breast.
“Approximately one-third of breast cancers do present as a palpable mass in the breast, but today the vast majority, nearly 70%, are detected on a screening mammogram or ultrasound,” Kort said. “In other words, they are often picked up during annual screening breast imaging. While most palpable breast masses cause significant anxiety, most, though certainly not all, are benign. At least 80% of palpable breast masses are benign [noncancerous].”
Sugar feeds breast cancer.
“There are no studies showing that cutting out sugar shrinks cancer,” Kort said. “That being said, an unhealthy diet, including one high in sugar, can lead to obesity. Obesity is known to cause increased chronic inflammation, insulin resistance and increased estrogen levels and these changes are all risk factors for developing breast cancer and for having worse outcomes after diagnosis. I routinely hear many of my patients state that they have cut out all sugar from their diet following their diagnosis. This is not necessary. I urge patients to continue to enjoy meals, but in a healthy way.”
Having a breast biopsy will spread the cancer.
“There is no scientific basis for this common concern,” Kort said. “Modern-day vacuum needles take good samples with minimal disruption to surrounding tissues. Whether a breast tumor spreads has more to do with the biology and aggressiveness of the cancer and, sometimes, how long it has been in the breast.”
Only women get breast cancer
“While the overwhelming majority of breast cancer cases occur in women, men do, albeit rarely, get breast cancer,” Kort said. “Less than 1% of all breast cancer diagnoses occur in men, but any new concerning mass in a male patient (usually under the nipple) should be evaluated.”
Breast cancer usually occurs in older women
“While the majority of breast cancers are indeed diagnosed in women over 50, younger women can unfortunately be diagnosed with breast cancer,” Kort said. “There has been a documented increase in women being diagnosed under the age of 50 in the last 10 to 15 years. Since 2012, there has been an approximate increase of 1% per year in this younger age group being diagnosed. We are definitely noticing it in our practice. Researchers are trying to figure out why. There are some theories, but they are beyond the scope of this article.”
Hormone replacement therapy significantly increases the risk of breast cancer.
“This is a touchy topic,” Kort said. “It is a topic on which the pendulum has swung back and forth for more than 30 years. Current recommendations have evolved significantly over time. Going back to the 1940s, the FDA approved the use of hormone replacement therapy to alleviate menopausal symptoms. By the 1960s, hormone replacement therapy was widely prescribed to women. It was thought to help not only menopausal symptoms but also the heart and cardiovascular system. However, in 2002, recommendations drastically changed when the results of a famous long-term national health study designed to evaluate cardiovascular disease, cancer and osteoporotic fractures noted increased risks of cardiovascular disease, stroke, pulmonary embolism (blood clots in the lungs) and breast cancer in women over 60. Following these findings, physicians stopped routinely recommending and prescribing postmenopausal hormone replacement therapy. While it is beyond the scope of this article to provide details, more recent literature has shown that the use of hormone replacement therapy in average-risk women may not increase breast cancer occurrence as much as previously thought. This is especially true when it is started before age 60, when most women are struggling with new menopausal symptoms and used for shorter periods of time (five years or less). Women should talk to their providers and consider their symptoms and personal risk factors when making decisions about hormone use.
Mammograms are too painful
“Mammograms involve brief compression that may feel uncomfortable, but the exam itself is usually completed quickly,” Destounis said. “Let the technologist know if you are especially sensitive or have concerns so they can help make the experience as comfortable as possible. Mammograms save lives. Whether you have a family history of breast cancer, are concerned about dense breast tissue, worry about discomfort or fear being called back for additional imaging, the benefits of regular screening continue to outweigh the risks for most women.
“Early detection provides more treatment options and can make a significant difference in outcomes,” Destounis said.
Wearing an underwire bra or using antiperspirant deodorant increases your risk of breast cancer.
“This has never been true, ever,” Kort said. “Studies have confirmed that there is no correlation between these things and an increased risk of breast cancer. So, wear your bras and deodorant as necessary.”
The majority of women diagnosed with breast cancer have a family history of it or carry one of the breast cancer genes.
“This may be one of the greatest misconceptions I hear,” Kort said. “It is also the most upsetting and shocking thing for so many newly diagnosed patients. They say, ‘I can’t believe this happened because no one in my family has had breast cancer.’ While it is certainly true that carrying a gene mutation [such as BRCA1 or BRCA2] or having a family history involving first- or second-degree relatives can greatly increase one’s risk of developing breast cancer, the vast majority of patients — at least 75% or more — have no family history. For this reason, having no family history should not change your recommended annual screening.”
Mammograms don’t work well for women with dense breasts.
“Breast density refers to the amount of fibroglandular tissue compared to fatty tissue in the breast,” Destounis said. “Dense breast tissue is common and breast radiologists identify in close to 50% of women screened and is not abnormal. Because dense tissue and breast cancer both appear white on a mammogram, cancers can sometimes be more difficult to identify in dense breasts. Fortunately, advances in breast imaging have improved our ability to detect cancer in these patients.
“Today, digital breast tomosynthesis allows radiologists to evaluate breast tissue in thin layers, reducing the problem of overlapping tissue and improving cancer detection. The X-ray beam moves in an arc over the patient’s breast creating a semi 3D image.
“For some women with dense breasts, supplemental screening such as breast ultrasound, breast MRI or contrast enhanced mammography (CEM) may also be recommended based on their individual risk factors.
“It’s important to remember that mammography remains the best tool for detecting certain early-stage breast cancers, including ductal carcinoma in situ (DCIS), which often cannot be detected by physical examination or ultrasound alone. Having dense breast tissue does not mean mammograms are ineffective. Instead, it means you should discuss with your healthcare provider whether additional screening options may be appropriate for you.”