Hello world! Dr. Karen’s Blog: Breast Health Awareness Month

In a seated room, when asked to look to the person on your right and then, to the person on your left, the significance of that action would be revealed in a statistic. “One out of the three females would develop breast cancer in her lifetime”. Indeed, as per the U.S. Breast Cancer Statistics; See More at: Breast Cancer “About 1 in 8 U.S. women (about 12%) will develop invasive breast cancer over the course of her lifetime. In 2016, an estimated 246,660 new cases of invasive breast cancer are expected to be diagnosed in women in the U.S., along with 61,000 new cases of non-invasive (in situ) breast cancer”. In my own practice of Pair O’ Docs in Shreveport, LA, I have worked with women who have concerns for breast cancer. This has led me to evaluate their breast health.

Back to that seated room at my medical school, Tulane University in New Orleans, LA. On that day, I was sitting between my classmates, Helen Simpson and Annelle Ahmed. Dr. Helen Simpson is a family medicine physician in Lake Mary, FL. And, Dr. Annelle Ahmed practiced Obstetrics and Gynecology, with a specialty in high-risk OB.

Take note of the verb tense…”practiced”. Yes, it was “sweet Dr. Annelle Ahmed”, who was diagnosed with breast cancer in her 30’s. At that time in her life, she was married to her best friend and fellow Tulane Medical School alumnus, Dr. Clyde Yancy. Both of them were on staff at University of Texas Southwestern in Dallas, TX. Currently, Dr. Yancy is a cardiologist at Northwestern Memorial Hospital.

Drs. Ahmed and Yancy were blessed with two Daughters, Kristin and Nina. As I remember, it was after the birth of the youngest daughter, Nina, that Dr. Annelle discovered a lump in her breast. She was fully evaluated and was offered a treatment plan that included a lumpectomy. This procedure was successfully accomplished.

The timing postoperatively is unclear, but my sweet friend was found to have metastases involving her liver, lung and hip. She underwent adjuvant therapy, including a 12-week experimental chemotherapeutic regimen, which was conducted at University of Alabama, Birmingham. So for 12 consecutive weeks, she would leave her family and practice in Dallas, TX, and fly to New Orleans, LA to join her sister, Helene. And, on the following day, the sisters would fly to Birmingham, AL for the treatment; and then fly home on the following day. The experimental chemotherapy was effective in causing a reduction in the size of the metastatic lesions.

It was clear that Dr. Annelle truly possessed a deep desire to live for her family, particularly her husband and daughters. One day when Helene was in Dallas, TX, Dr. Annelle felt so ‘good’ that she decided on a shopping spree. As a side note, Dr. Annelle and Helene were close, as well as in age. They were the youngest of a family of 11 siblings. Back to the shopping excursion… This was no ordinary girls’ retail therapy. You see, my sweet classmate had come to the fact that her mortality was close in time.

Dr. Annelle and Sister Helene were on a mission to discover and purchase gifts for Nina and Kristin. These gifts were to celebrate the girls’ milestones:
Their 8th grade graduation
Their 12th grade graduation
Their college graduation
Their wedding

She entrusted Helene with these treasured gifts and instructed her sister to honor Nina and Kristin when those times evolved. Talk about a Mother’s Love!!!
On April 5, 1997, at the age of 39 years, Dr. Annelle Ahmed passed away knowing that her family, friends and patients would continue our battle against breast cancer.

More on the battle to come…
Let me start by informing you as I do with my patients a very important fact. When it comes to any disease / disorder, genetics only contributes a mere 20%. Eighty percent (80%) is related to environmental factors…the choices that we make. The choices of metabolic balance, hormonal balance, positive mindset, lessening our toxic load, incorporating more super nutrition and quality supplements into our diet, detoxification and self-care practices are crucial. Here at Pair O’ Docs in Shreveport, LA, we are able to evaluate all of these factors that affect one’s health and wellness, in particular breast health.
Next, there is a difference in screening for breast cancer and diagnosing it. This important difference was born out in the following article by Dr. Laura Esserman: Rethinking Screening for Breast Cancer and Prostate Cancer  (See more at: GreenMedInfo)
Dr. Laura Esserman of the University of California startled the medical community with an article questioning screening mammography, published in the Journal of the American Medical Association (JAMA).   Dr. Laura Esserman reviewed 20 years of breast cancer data.  Her conclusion is not favorable:
“Mammography screening for breast cancer has significant drawbacks, and expected survival benefits have not materialized.”
“While the incidence of early stage breast cancer has decreased due to mammography, the incidence rates for the killer cancers, (the advanced cancers) have remained stable.  While it is true that overall mortality rates have declined slightly, this is attributed to better treatment rather than increased detection.”

Further…Dr. Esserman’s 2009 observations were made in 2002 by Dr. Barnett Kramer

Seven years ago, Dr. Barnett Kramer, director of the Office of Disease Prevention at the National Institutes of Health, was interviewed in a 2002 article in the New York Times, in which said:
“The number of women with breast cancers with the worst prognosis, those that spread to other organs, had been fairly constant in the years before mammography was introduced, and that trend did not change after the introduction of mammography…If screening worked perfectly, every cancer found early would correspond to one fewer cancer found later. That did not happen. Mammography, instead has resulted in a huge new population of women with early stage cancer but without a corresponding decline in the numbers of women with advanced cancer.”

Right now, annual mammograms are the standard recommendation starting around 40 or 50 years of age, depending on your physician’s recommendation. Obviously, there has been much discussion about this method of screening over the last few years and some schools of thought are suggesting we screen less due to the possibility that mammograms are harming more women than helping. It is true that there are many women (my 1st cousin and my partner’s mother), who have been saved by a mammogram. On the flip side, there are those that have been failed by mammography; however, this is not a problem that is exclusive to mammography — it’s a problem with any test. I believe, as well as, many of my colleagues and other healthcare practitioners (Dr. Hillary Smith and Rebekah Stump) when it comes to detection, using a combination of screenings is best. There are alternatives that I will list but I would like to bring something to your attention. Thermography, which is a valuable preventative screening tool, will be offered monthly at Pair O’ Docs in Shreveport, LA.

Here is a list of some of the current diagnostic tools used in screening for breast cancer:
Clinical breast exam (CBE)
Genetic Testing, i.e., BRCA1 or BRCA2 gene mutation
Mammography
Ultrasonography
Thermography
MRI (magnetic resonance imaging) in women with a high risk of breast cancer

Please review the pros and cons of the more commonly employed tests:
Mammograms – Structural/Anatomical Test
Pros: Can detect cancerous lumps before they can be felt | Shows microcalcifications | Better at detecting slow-growing cancers compared to other screening tests | Covered by insurance.
Cons: Does not provide health information | Exposure to radiation | Potential to damage breast tissue and/or implants | Difficulty evaluating dense breasts | Can only visualize tissue that is placed between the plates (misses certain areas on chest) | Difficulty in the detection of inflammatory breast cancer | Does not provide physiological information (shows a lump, but does not see if there is suspicious activity) | Not 100% reliable.

Thermograms – Functional/Physiological Test
Pros: Can detect inflammatory breast cancer several months before symptoms arise | Can see signs of developing cancer before it is large enough to be seen on a mammogram or ultrasound | Better at detecting aggressive/fast-growing cancers | Radiation-free | No compression or pain | Can be used at any age | Visualizes all areas of the chest | Can be used to monitor chest wall post-mastectomy | Can be used to monitor effectiveness of treatment | Risk assessment tool/predictive test | Provides breast health information — incredibly valuable for prevention efforts.
Cons: Does not detect microcalcifications or cancer cells inside a calcification | Slow-growing cancers can be missed | Does not provide structural information (does not see lumps) | In general, not covered by insurance | Not 100% reliable.

Ultrasounds – Structural/Anatomical Test
Pros: Can detect some cancers not shown by mammogram, especially in dense breast tissue | Helps determine if a lump is just a cyst (benign) or needs further evaluation | Radiation-free | No compression or pain | Can be used at any age | Visualizes all areas of the chest | Covered by insurance.
Cons: Does not provide health information | Can have a higher rate of false positives | Poor detail in images | Does not detect inflammatory breast cancer | Typically does not show microcalcifications | Does not provide physiological information (shows a lump, but does not see if there is suspicious activity) | Not 100% reliable.

FYI: Per breastcancer.org:
Sharing the multitude of tests you may have at different points in the process of screening, diagnosis, and treatment relating to breast health / cancer:
Biopsy
Blood Cell Counts
Blood Chemistries
Blood Marker Tests
Bone Scans
Breast Cancer Index Test
Breast MRI (Magnetic Resonance Imaging)
Breast Physical Exam
Breast Self-Exam (BSE)
CT (CAT) Scans (Computerized Tomography)
Chest X-Rays
Digital Tomosynthesis
Ductal Lavage
EndoPredict Test
FISH Test (Fluorescence In Situ Hybridization)
IHC Tests (ImmunoHistoChemistry)
Inform HER2 Dual ISH Test
MammaPrint Test
Mammograms
Mammostrat Test
MarginProbe
Molecular Breast Imaging
Oncotype DX Test
PET Scans
Prosignia Breast Cancer Prognostic Gene Signature Assay
SPoT-Light HER2 CISH Test
Thermography
Tumor Genomic Tests
Ultrasound
Urokinase Plasminogen Activator Protein Inhibitor Test
Bottom Line:
NO breast test should be used alone in the evaluation of the health of the breast. In our practice, the focus is on prevention more so than detection. As a physician and health coach, I want to always encourage and inspire my patients, both women and men, to become and stay proactive. Let’s not be so dependent upon our government, healthcare systems, insurance companies, and other large organizations. My partners and I are happy to offer many prevention strategies for, not only breast health, but “to keep you from physically, mentally and spiritually dying young”. I truly believe that Dr. Annelle Ahmed’s heart would rejoice in our mantra!!!

An easy way to get started:
1. Undergo a comprehensive Wellness Evaluation at Pair O’ Docs. Contact us for an appointment @ (844-861-5160) or via email:  [email protected].
2. Consider Breast Thermography.
3. Contact us about the Health and Beauty Academy Meetups: (844-861-5160) or via email:  [email protected].