Experts Breakdown Breast Cancer Myths
MICHEL MARTIN, host:
I'm Michel Martin. This is TELL ME MORE from NPR News.
We'll turn to Africa in just a few minutes. NPR's Charlayne Hunter-Gault accompanies Graca Machel on a mission to Darfur. Machel is the wife of Nelson Mandela. She's one of the Elders, and she's calling attention to the needs of traumatized women of the region.
But first, to health care here in the U.S. Women here know they face a threat from breast cancer, but much of what they think they know is wrong, according to a new survey commissioned by the National Breast Cancer Coalition.
Fran Visco is the president of that organization. She joins us from Philadelphia. And Dr. Robert Dewitty, a surgeon at Howard University Hospital, who specializes in breast cancer. He's here with me in Washington.
Welcome, and thank you both for joining me to talk about the facts and the myths around breast cancer.
Doctor ROBERT DEWITTY (Surgeon, Howard University Hospital): My pleasure.
Ms. FRAN VISCO (President, National Breast Cancer Coalition Fund): Thank you.
MARTIN: Fran, why did your organization commissioned this survey, which was released for National Breast Cancer Awareness Month, which is this month?
Ms. VISCO: Well, we had the sense that there was a lot of misinformation out there about breast cancer, and we wanted to be certain that because we educate the public about the disease, that the message was getting through. Seventy-six percent of the women in this survey believe they knew a lot about the disease. So there is a high level of awareness, just not about the right things.
MARTIN: Okay. Well, let's get into that. The first thing I wanted to ask you about is that there is a belief, apparently, that breast cancer can be prevented by eating a lot of fruits and vegetables. Fran? True? Not true?
Ms. VISCO: Yes. It is true that there is a belief out there that we can prevent breast cancer through diet. However, the scientific research shows that that is not the case. We really don't have any strong evidence or any evidence that a low-fat diet will prevent breast cancer. It's good for you, but it's not going to stop you from getting breast cancer.
MARTIN: Dr. Dewitty, is that an issue for you? Do you find that you're dealing with a lot of misinformation when you're dealing with patients that they think they've done something wrong, or is there something you have to wade through before you can kind of get to the facts?
Dr. DEWITTY: To some extent. The biggest problem I had is was when I have a patient - and this doesn't happen very often, but it happened enough - when I have patient that I diagnosed with breast cancer, and they'll look at me and say, well, doctor, what I'm going to do is change my diet and I'm going to eat right so that I don't need that chemotherapy and radiation.
And my response is that, good. We want you to eat healthy. we want you to take exercise, but we also would like for you to do what we think you need to do in this day and age in order to help us take care of you and perhaps, quote/unquote, "cure you of this disease." Sometimes, people do assume that if I'm healthy and I worked out, I exercise, I walk, that this will not affect me. And that is not really the case.
MARTIN: Doctor, I think you've probably heard that, apparently, a lot of people believe that most women at risk for breast cancer have a family history of the disease. True or not true?
Dr. DEWITTY: Oh, I hear that all the time, and that's not true. Most women who have breast cancer have no relatives who have breast cancer, or no family history of breast cancer. And they'll say I don't know how this could happen to me. Nobody in my family has it. Well, certainly, breast cancer is a genetic problem, and it may even be a genetic problem in generations, but we're not able to identify that yet. So most women who have no relatives with breast cancer, and they don't develop that disease.
MARTIN: Fran, what about mammograms? You're discovering through the survey that many people believe that mammograms are very accurate, nearly 100 percent accurate in early breast cancer detection. True or not true?
Ms. VISCO: There is a lot of misconception out there about self-exam, mammograms, about early detection of breast cancer. And the fact is that mammography is not 100 percent accurate or even close to 100 percent accurate. The best evidence we have right now shows that in older women, mammography may result in a 15 percent reduction in mortality in breast cancer. So it isn't the answer to this disease.
MARTIN: So - I don't know, so how should we feel about this, then? Are you saying that you still think people should get them, but they shouldn't over rely on them?
Ms. VISCO: I think women should definitely not over-rely on mammograms. What they need to do is look at the evidence behind them. They need to understand the risks, the benefits of mammography. If they choose to have a mammogram, they need to understand if a mammogram is clear, that doesn't mean they don't have breast cancer. If a mammogram shows a problem, that doesn't mean they have breast cancer. Eighty percent of suspicious mammograms, 80 percent of biopsies are not cancerous. They are benign issues. So I think we do - we overstate the importance of mammography in breast cancer, and we certainly have a complete misunderstanding of breast self-exam.
MARTIN: Well, Dr. Dewitty, we pick up the ball there. What should you be doing if mammography is not enough? What else should you be doing?
Dr. DEWITTY: Certainly, we don't have a machine available yet that's going to be 100 percent, but it's the best we have. And if you look at where we've come from to where we are, then that's the positive message. For the first time in our history a few years ago, the death rate from breast cancer started going down. And why? Because we diagnosed it at a stage where it can be cured. Now, one of the big reasons we do that is because we use mammograms. The mammogram is going to pick up most things that are not malignant, but that's okay, because it picks it up. But we can become more specific in our machine development. Then we'll start having a better batting average, you might say.
MARTIN: You say that there are false positives, or that mammograms can lead you to believe that there is something wrong and perhaps there isn't something wrong, and that's - so that's comforting to know, not to freak out if you should get - there should something on a mammogram. But what if it's the other way that a mammogram doesn't pick up something you should be concerned about? What are some other things you could be looking for?
Dr. DEWITTY: Well, first of all, the mammogram really just identifies something that we need to investigate further. Now, if a lady has a disease or a cancer that is so obvious, then the mammogram was going to be read as what we call a BI-RADS 5. That means highly suspicious. But otherwise, it picks up an area, and that area needs to be addressed.
For those women where it doesn't pick it up - and it certainly doesn't pick it up in everybody - if you feel a certain area in the breast, and that's why self-breast examination can be helpful, then you might want to go to ultrasound or sonogram. If that still doesn't satisfy the need and you're concerned, then we can do MRI.
Now, MRIs is also not the panacea, but, here again, it's another aid for us to identify, perhaps, a suspicious area that we need to address. So there are things we can still do, and we are getting better.
MARTIN: If you're just joining us, this is TELL ME MORE from NPR News.
And we're speaking with Dr. Robert Dewitty and Fran Visco, the president of the National Breast Cancer Coalition, about a new survey revealing that women may know less than they think they do about breast cancer.
Fran, are there other things that we should know about breast cancer that we don't know?
Ms. VISCO: Yeah. I think it's very important to recognize that however well mammograms work or don't work, or however much we've built up a myth of, you know, monthly breast self-exams, which the scientific evidence shows do not really reduce mortality from breast cancer. The reality is we don't know how to detect the disease truly early, and we don't know how to cure it and we have no idea how to prevent it.
And so, women should be involved in making certain that the research is going in the right direction, that we're asking the right questions, that we're not spending money unnecessarily or over treating women who are diagnosed with the disease. So there are some incredibly important, very complicated questions out there in breast cancer, and we can't just hide behind mammography and self-exam and believe that we've answered the questions, because that is not the case.
MARTIN: I also wanted to ask about racial disparities. Recent studies have focused their attention on this question. And while white women are more likely to be diagnosed with breast cancer, black women are more likely to die from the disease.
Dr. Dewitty, why would that be?
Dr. DEWITTY: We think there are probably several reasons, or at least two reasons. Number one, how do you diagnose a disease? Well, you, first of all, you have to look for it. So to some extent, we may not be reaching the numbers of people, African-American, that we need to reach. That's certainly may be one.
The other thing is that, though, if you take stage-for-stage, white women and black women or African-American women, we find that the disease usually in African-American women 0 particular to the young African-American women below 40 - has a more aggressive process - a more aggressive disease. We feel strongly that that's based on genetics.
MARTIN: And what about men? I wanted to ask both of you about this. Should men be more aware of breast cancer?
Ms. VISCO: Yes, breast cancer in men is a very rare disease. There are about 2,000 men a year who are diagnosed with breast cancer, and so men run a lifetime risk of one in 1,000 for breast cancers, as opposed to women of a lifetime risk of one in eight. So men need to understand that they do get breast cancer, but it's not something that they really have to worry about on a day-to-day basis.
MARTIN: Well, let me ask you about that one-in-eight figure, because this is another figure you hear tossed around. You hear people say that one in eight women will be diagnosed with breast cancer this year in the U.S. Is that true?
Ms. VISCO: No. The one-in-eight number is a lifetime risk of breast cancer. And that varies. Your actual risk of getting breast cancer, say, within the next 10 years varies from - depending upon your age. Breast cancer is really a disease of older women. So at age 50, the risk of breast cancer increases significantly, so that if you are, for example, age 50, you have a one-in-28 risk of getting breast cancer over the next 10 years. If you're age 30, you have a one in 234 risk of getting breast cancer. And if you look at the risk overall of the age groups, it adds up, in a way, to a lifetime risk of one in eight.
MARTIN: So people shouldn't go around saying - let's say there were eight women sitting on the bus, and one of them is going to have breast cancer. They should just…
Ms. VISCO: No.
MARTIN: …not think of it in those terms.
Ms. VISCO: They should not. I mean, probably none of them will, and perhaps all of them will, but it is not one in eight women.
MARTIN: Fran, I'm looking to you for some encouragement. You keep throwing that cold water on me. I don't know, I'm kind of…
Ms. VISCO: Well, I think we have made…
MARTIN: I was feeling kind of good about that, but…
Ms. VISCO: We've made significant progress in breast cancer, and I think we've made a lot of progress in large part because women and men across the country have really become advocates for more research, for access to care, for more education and training for individuals across the country so that we are treating breast cancer in different ways. We're understanding more and more about the molecular basis of the disease and women who over express, for example, certain genes or certain proteins, and there are therapies now developed to target those that are less toxic than the treatment we've had in the past.
So I am very encouraged by what's happening. And I think we truly are learning so much more about breast cancer on an almost weekly basis, and we are having many new treatments for the disease. But we have a long way to go, and we have to understand what's myth and what's reality if we really want to make rapid progress.
MARTIN: Okay. A final question to both of you - Dr. Dewitty, first. What do you most want people to know? What would you most like people to walk away from this conversation understanding?
Dr. DEWITTY: I want them to know that there is good news, and, of course, there's bad news. The bad news is that women are still developing breast cancer and are still dying from that disease. The good news is that where we are now. Sure, there are one in eight, but if you go back historically, again, we used to say there were one in 15 - then one in 12, then one in 10. So somebody said to me, oh, it's on the water. It's in everything we eat. No, no, no, no. We are looking for it. And also, continue to be vigilant.
And one comment, quickly, about men. Men certainly don't get breast cancer very often, but if a man should find a lump, don't be macho about it. Don't think it's because he's working out more and his pecks are getting bigger. Men get it, although uncommonly. And if they are suspicious, biopsy it.
Dr. DEWITTY: Biopsy it.
Ms. VISCO: Well, I think a message that everyone needs to hear is that we should not be passive about this, that we women and men across the country are perfectly capable and able of being involved in making certain that research is the right research in pushing to make certain we all have access to care, so that issues of access do not result in higher mortality for any group of women or men for a disease. So women, men across the country, raise your voice, become involved, get informed.
MARTIN: Fran Visco is president of the National Breast Cancer Coalition. She's also a 20-year survivor of breast cancer. And Dr. Robert Dewitty is an oncological surgeon affiliated with Howard University. He was kind enough to join us here on our Washington studios. Thank you both so much for speaking with us.
Dr. DEWITTY: Thank you.
Ms. VISCO: You're welcome.