Julia A. Smith, MD, PhD, is the director of the NYU Cancer Institute’s breast cancer screening and prevention program and director of the Lynne Cohen breast cancer preventive care program at New York University in New York City.

Q:
Do you recommend that all women perform breast self-exams and have clinical exams and mammograms?

A:
Yes, I do. I recommend getting a baseline mammogram between the ages of 35 and 40 (to compare against tests later in life). Anyone over the age of 40 should have a mammogram every one to two years, and over the age of 50 yearly. Women should also see a doctor for a physical (or “clinical”) breast exam at least once a year. You should check your own breasts monthly. If you’re premenopausal, check them as soon as your period ends.

Q:
How important are breast self-exams?

A:
Breast self-exams have never actually been shown in studies to decrease the number of women who die of breast cancer. However, I do advise women to check themselves because as they get familiar with their own breasts, they are more able to detect things that seem unusual.

Q:
Do mammograms catch every cancerous tumor?

A:
The main concern with mammograms is that they tend to produce false negatives, meaning that they will sometimes miss a lump. That happens in around 20% of mammograms. A mammogram will catch most cancers, though—and those are typically the cancers that would not have been caught by clinical breast exams or self-exams.

Q:
Should more women get mammograms?

A:
Yes, more women should. But unfortunately, the rate of women getting mammograms in recent years has been declining. It’s not known why this is. It doesn’t appear that doctors are recommending mammograms less, and it doesn’t appear that women are not being properly referred. It seems that women are simply not showing up. Depending on the situation, these women are either skeptical, complacent, or scared.

Q:
Should I be afraid of the radiation that mammograms produce by using X-rays? Could it give me cancer, maybe even breast cancer itself?

A:
Studies have shown no increased risk of problems from mammograms, and the dose of radiation is lower than it used to be. The benefits far outweigh any risk.

Q:
How do I know if I need a breast MRI?

A:
Magnetic resonance imaging (MRI), which uses a magnetic field and radio waves to take pictures of the breast, is especially useful to get a closer look at patients who have a diagnosis of breast cancer. But MRIs are also often recommended for women who are at high risk for breast cancer, such as women with a family history of the disease, BRCA gene mutations, or previous personal experience with breast cancer.

Q:
Are there any downsides to having a breast MRI?

A:
While a mammogram can give a false negative, a breast MRI can result in a false positive. It’s so sensitive that it can pick up things that turn out not to be cancer. If that leads to an unnecessary biopsy, it can be upsetting for the patient, not to mention the financial burden—or the fact that repeat biopsies may make future mammograms harder to read.

That being said, the breast MRI is a very valuable tool in both screening and diagnosis, and when applied correctly, the benefits of the procedure far outweigh the potential risks.

Q:
How do I know if I need an ultrasound?

A:
After a suspicious clinical exam or a mammogram, you may have an ultrasound, which uses sound waves to make a picture of the tissues inside the breast. The procedure can also be useful as part of standard annual screening for women with very dense breasts or at high risk for breast cancer.

Q:
What should I do if there are no breast cancer screening facilities where I live?

A:
Talk to a trusted family doctor or health professional and let them recommend someone. Keep in mind, however, that your mammogram needs to take place in a radiology setting and not in an oncologist’s or general practitioner’s office, because the reading of the mammogram and the upkeep of the mammogram machine have to conform to American College of Radiology standards. In very remote areas, the alternative may be a traveling mammogram van.

Q:
How is mammography changing?

A:
The technology has improved so that each mammogram X-ray delivers less radiation than before, further lowering the already low cancer risk. And there’s been a standardization of the way mammograms are read and the way radiologists and technicians are certified. Another improvement is the advent of digital mammograms, which are not available everywhere yet, but they may be more accurate and easier to read for women who have very dense breasts or are very young.

Q:
When are digital mammograms helpful?

A:
If a doctor sees something suspicious on your regular mammogram, following up with a digital image may provide a clearer and more accurate look at the breast, in the same way a patient may benefit from an ultrasound or an MRI.

Q:
What does the future of breast cancer screening look like?

A:
We hope to be able to better identify each patient’s level of risk and then tailor screening procedures more to that level. This involves looking more closely at family history, using genetic testing, understanding ancestry and hormonal history, and factoring in personal breast history, such as whether there have been biopsies in the past and what they have shown.

A breast cancer diagnosis and stress—you can pretty much count on the two going hand in hand. Now, a new study is raising hopes about the effects of group therapy and relaxation techniques on the well-being and survival rates of women with breast cancer. Learning how to handle the stress of a diagnosis and treatment in the first year may help such women live better and longer, researchers said today.

The Ohio State University randomized clinical trial looked at 227 women with stage II or stage III breast cancer over 11 years. About half took part in what researchers call intervention—26 small therapy groups led by psychologists in the first year—and half did not.

The result: That one year of therapy and stress reduction (weekly sessions for four months and monthly sessions for eight months) was linked to improved survival 11 years later in the intervention group, the researchers write in the December 15 issue of Cancer, an American Cancer Society journal. In fact, breast cancer patients who had the group therapy were 45% less likely to have a recurrence of breast cancer and 56% less likely to die of breast cancer than those who did not.

Interestingly, breast cancer patients in the intervention group who were open to the idea that stress reduction could make a difference and who practiced progressive muscle relaxation techniques daily had the greatest reductions in distress and physical symptoms.

Progressive muscle relaxation involves slowly tensing and relaxing each muscle group (you can watch a video here). The technique, along with guided imagery, has been studied as a way to reduce anxiety in patients being treated for breast cancer. But this was the first study to link the technique to increased immunity and breast cancer survival.

The pro-intervention results of this study are a boost for those who believe that psychological therapy, such as talking with a psychologist, improving diet and exercise habits, and learning new coping skills and relaxation techniques, can provide big benefits—from increased immunity to better survival rates—in cancer patients. Past studies on the role of group therapy have been controversial and sometimes have yielded conflicting results.

That’s why Michael Stefanek, PhD, vice president of behavioral research and director of the Behavioral Research Center at the American Cancer Society, is only cautiously optimistic. “Psychological interventions have been found in the majority of well-controlled studies to enhance quality of life and reduce distress,” he said in a statement. Patients may learn healthy lifestyle habits and strategies that enhance their quality of life and communication skills, he said, but “it would not be reasonable for patients to participate in psychological interventions with the goal of extending survival.”

It’s understandable that experts don’t want to falsely raise hopes of survival. But the authors of the new study do link stress-reduction techniques with improved immunity: “Added immune control of disease processes, particularly early—when patients were recovering from surgery and receiving adjuvant cancer therapies—may have occurred with the declining stress.”

And they hypothesize that psychological interventions that reduce stress may also interrupt the inflammatory process, which has been linked to tumor growth and disease progression.

The fact is, the patients who received therapy had a reduced risk of death from all causes, not just breast cancer. Wrap this research up with 30 years of hundreds of psychological intervention trials, the study authors say, and you have a good case for promoting group therapy and stress reduction as a survival technique.

Indeed, policy makers and oncology professionals in the United States and around the world recommend treating those diagnosed with breast cancer for their psychological distress. The researchers hope their study results are a step toward making that goal a reality.

Read Anne’s previous posts:
Good News: My Migraines May Be Good for My Breasts

It’s Breast Cancer Awareness Month. Should You Think Before You Pink?

Christina Applegate Chose Breast Reconstruction, So How Come Other Women Don’t?

The Survivor Files: Amazing Women Share Their Breast Cancer Journeys

Could Where I Live Raise My Risk of Breast Cancer?