"EARLIER DETECTION"- REACHING A GENERATION IN CRISIS

WHAT ABOUT IF YOU'RE TOO YOUNG FOR A MAMMOGRAM?   I went to my doctor for a lump I felt in my breast and she gave me a response that set off red flags: "don't worry about it". Being a researcher involved in breast density and breast cancer, I knew that I had to take action; I was fortunate enough to have my breast ultrasound training with Dr. Robert Bard (cancer imaging specialist, NYC) upcoming in the next week. Dr. Bard showed me how to use the ultrasound to help me find two benign tumors in my breasts, and it was there that he reported that I have dense breasts. Had I not taken action in getting screened at the young age of 22, I would have never known that I should be getting screened via ultrasound every 6 months (because having dense breasts puts me at a higher risk for breast cancer), nor would I have known that I had benign breast tumors. 

- ALEXANDRA FIEDERLEIN, 22

Cancer Researcher/ Graduate- Molloy Univ.

CURRENT DATA FROM PUBLIC SURVEY Assembled by Dr. Roberta Kline, OBGYN & Co-Editor of Women's Health Digest Source: CDC (link) Enclosed is research-based public information by the CDC that widely supports the current reality about new cancers (including breast cancer) in women under 40.  The data used by public health comes from a wide variety of places within our local communities: hospitals, laboratories, doctors' offices – anywhere that a person receives healthcare. Age-specific rates breast cancer for 2020 (Total for ages 20-39):  • Rate of new breast cancers = 27/100,000 • Equals 11,368 new cases/42,765,288 women Details: <20: numbers less than 16 cases for lower age categories, data suppressed 20-24: 1.7/100K; equals 174 new cases/10,239,813 women 25-29: 10.4/100K; equals 1,146 new cases/11,016,549 women 30-34: 30.5/100K; equals 3332 new cases/10,939,868 women 35-39: 63.5/100K; equals 6716 cases/10,569,058 women

"EARLIER DETECTION"...
REACHING MY GENERATION IN CRISIS

By: Alexandra Fiederlein (23)  | Edited by: Dr. Roberta Kline and the ICRS Editorial Team

I belong to the graduate-level age group that continues to witness the increasing numbers of breast cancer cases in our country.  The women in this generation also happens to be the next group that falls prey to being UNDERDIAGNOSED. Insurance companies and the medical community have made little or no action to support or identify the need for women in their 20's and 30's to be approved for  standardized early detection / breast cancer screening.  

From the front-row perspective, younger women are as much at risk of getting cancer. Reports show an uptick in genetic predisposition for breast cancer*, alongside a dangerous attitude of denial. Addressing this calls for widespread education and screening programs in our community as essentials to a life of wellness and prevention.  To subscribe to a regular screening routine at the early stage of womanhood raises awareness and prevention for decades to come.  Perhaps someday, installing breast cancer screening centers in  college campuses may be commonplace and a powerful step toward a national prevention initiative.

Click to download the latest ACS report

Targeting the young working PROFESSIONAL is a major part of our population, where the vast majority tends to put off checkups and screenings because they are just "too busy". Professional women need to value their health above anything else, and therefore the narrative needs to be amplified in that area. We find this problem to be quite prevalent in urban areas with the constant on-the-go culture. Offering local resources and improved access for personal scanning are just some progress driven programs. 

GEN Z is a sensible focus group because these are the women who absolutely must receive routine scanning. We need to advocate for the narrative that age 40 is not the starting age where screening needs to begin- especially since we are now seeing cancer cases in younger ages are growing in numbers. Getting OB/GYN professionals on board is especially important because this is where women are getting their prescriptions. 

We need to educate on the benefits of ultrasound. People need to know HOW it works, WHY it works, and why it holds certain benefits over a mammogram. People need to know that it is SAFE and EFFECTIVE, and this technology can save lives. I think it is especially important to emphasize the option of ultrasound for younger women. Many younger women have dense breasts and don't even know it, putting them at a greater risk (I wouldn't have known if it weren't for all of you!). Ultrasound is obviously a safe and effective screening method for young women. It is also not linked with the stigma/fear of getting a mammogram like many women my age hold (X-Ray exposure, etc.). 

If the drive for EARLIER DETECTION means proactive awareness, may this lead to turning social concern into clinical action.  This includes clinicians joining hands with advocacy groups who recognize the many potential areas for at-risk women in my generation whose lives and safety continue to go unrecognized. And once the count of cancer cases and deaths rise exponentially due to inaction, perhaps then will the medical community find urgency in upgrading the required breast cancer screening age to (finally) include generations like mine.  So say we all! 

Ref:

*Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures, PMC9038417. (NIH)- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9038417/

This article is sponsored by the educational program of Bard Diagnostic Imaging

---

A major concern is the presence of breast cancer in underserved communities, including those TOO YOUNG FOR A MAMMOGRAM.  Whereby the medical community touts the recommended (and legal/billable status) of getting a mammo scan should be between 40-50, what happens to the many women who do not fit this age criteria?  How would they even know to get checked without the support of their clinicians or an alarm from family history? Decades into the battle against breast cancer, clinicians and the public are much more educated about EARLY DETECTION, PREVENTION and the current protocols and modalities available to save lives.  Recent headlines on DENSE BREAST and the advancements in ULTRASOUND SCANNING supports a major part of this battle. SEE COMPLETE FEATURE

WATERBURY, Conn. (October 12, 2023) JOE CAPPELLO/ARE YOU DENSE? FOUNDATION RECEIVES KEY TO THE CITY FROM MAYOR O'LEARY
Waterbury celebrated a citywide Pink Out on Thursday, October 26th! Saint Mary’s Hospital Foundation has once again partnered with the City of Waterbury to recognize Breast Cancer Awareness. Waterbury Mayor Neil O’Leary, Saint Mary’s Hospital President, Kim Kalajainen and special guest Joe Cappello will address organizers and volunteers from the Waterbury Police and Fire Departments as well as the Education Department, area students and others at 11:00 a.m.  at Waterbury City Hall.  

Video News Release: Innovations in Early Detection "Are You Dense?" Foundation Co-founder Joe Cappello joins the medical diagnostic community to promote the "Get Checked Now!" campaign. Dr. Robert Bard from the Bard Cancer Center (NYC) supports supplemental imaging including the 3D Doppler Ultrasound scanner to offer dense breast detection.  This video presents some of the latest advancements in ultrasound features to detect tumors through dense breast tissue- reportedly a significant challenge with mammograms.

---

GO "EARLIER" WITH EARLY DETECTION (FOR WOMEN AGES 20-40)

According to the American Cancer Society (ACS),  women ages 45 to 54 and post-menopausal years are required to get mammograms every year.[1a] But for the underserved ages (20-40), the risk for breast cancer exists in growing numbers. In support of Breast Cancer Awareness month, the Integrative Cancer Resource Society, the AngioFoundation Institute (501c3) and the "Are You Dense?" Foundation  addresses the continuing concerns for breast cancer in the New York area by recommending early detection screening programs for women over 20 (and not just anyone 40+ as standardized by the insurance companies.

The medical community has identified over 5% of all breast cancer cases occur in women over 20 and under the age of 40. The increased risk for breast cancer in dense tissue also exists and is identified by the medical community.  Diagnostic Imaging specialist Dr. Robert Bard of NYC identifies the need for paying more attention to breast cancer screening to ages younger than the mandated 40+.  "It's about time the (medical) community recognizes the growing rate of breast cancer in women of younger ages... from genetic predisposition to geography to having dense breast tissue, earlier detection should be our next national initiative."

• Breast cancer in younger women may be more aggressive and less likely to respond to treatment.

• Women who are diagnosed with breast cancer at a younger age are more likely to have genetic mutations predisposing them to breast and other cancers.

• Younger women who have breast cancer may ignore the warning signs—such as a breast lump or unusual discharge—because they believe they are too young to get breast cancer. This can lead to a delay in diagnosis and poorer outcomes.

• Some healthcare providers may also dismiss breast lumps or other symptoms in young women or adopt a "wait and see" approach.

• Breast cancer poses additional challenges for younger women as it can involve issues concerning sexuality, fertility, and pregnancy after breast cancer treatment. [1]

2) INCLUDE SUPPLEMENTAL SCREENING FOR DENSE BREAST TISSUE (WITH HIGH RESOLUTION ULTRASOUND): Women diagnosed with dense breasts should continue to get regular screening mammograms. But there are additional screening tests that can help doctors detect tumors that may not be identified by conventional mammography or DBT. [2]  Any woman who has dense breasts may want to consider supplemental screening, usually with breast ultrasound. Studies show that screening with ultrasound, in addition to mammography, improves detection of breast cancers in women with dense breasts. [3]

3) WHOLE BODY MRI (NO CONTRAST) FOR CANCER SCANNING: In simplistic terms, having a full-body access comports to the fact that everything is connected in one way or another.  Our full-body MRI provides early diagnosis and the largest view of the body, where finding any cancers in the body and/or where they may spread can provide the best chance of treatment success.  In suspected cases of early breast malignancy, the exclusion of metastatic disease is clinically vital and emotionally supportive.

1a) "Infographic: 7 Things to Know About Getting a Mammogram"- ACA/American Cancer Society: https://www.cancer.org/cancer/types/breast-cancer/mammogram-tips-infographic.html#:~:text=Women%20between%2040%20and%2044,choose%20to%20continue%20yearly%20mammograms.

1) "Breast Cancer in Young Women"- Cleveland Clinic: https://my.clevelandclinic.org/health/articles/16805-breast-cancer-in-young-women

2)  "What additional breast cancer screening tests are available for women who have dense breasts?"- Yale medicine- https://www.yalemedicine.org/conditions/dense-breasts#:~:text=Women%20diagnosed%20with%20dense%20breasts,(whole%2Dbreast%20ultrasound).

3) Columbia Doctors/ "What Are Dense Breasts? A radiologist offers guidance":-Health Insights: October 14, 2022 https://www.columbiadoctors.org/news/what-are-dense-breasts#:~:text=Any%20woman%20who%20has%20dense,in%20women%20with%20dense%20breasts.

---

"In order to catch cancer, you need to be able to detect it at an early stage so we can treat patients with the most effective mechanisms.  Ultrasounds are an easy, cost-effective method for screening for early breast cancers, especially in women below the age of 45, who are likely to have dense breasts. When you are young and premenopausal your breasts are dense and we know that breast density is linked to cancer and which also makes it harder for cancers to be seen on a mammogram. Although breast cancer is rare in women under the age of 40, early detection is key.  Public health campaigns are spending so much money on mammograms for this population of women who can easily and cost effectively be screened using an ultrasound."

"I LOVE this new program! Early detection is essential! There is a stigmatization around mammograms that they are painful and frightening. There is anxiety while you wait for the results. And, don't forget the appointment scheduling hassle.  Women, particularly younger women with active lives, small children, careers don't want to have to fit one more thing into their hectic and demanding schedules. However, mammogram technology itself has advanced and it no longer has to be a painful experience. Clinics and imaging centers are offering untraditional scheduling opportunities, such as very early morning appointments to late evening appointments that are timed for very minimal wait times. And, clinicians are often prioritizing mammogram interpretations so the results are back within 24 hours. The Self Care message is trending right now. Mammograms should be a part of self care."

THE RISK OF BREAST CANCER STARTS EARLIER THAN 40

According to the American Cancer Society (ACS),  women ages 45 to 54 and post-menopausal years are required to get mammograms every year.[1a] But for the underserved ages (20-40), the risk for breast cancer exists in growing numbers. In support of Breast Cancer Awareness month, the Integrative Cancer Resource Society, the AngioFoundation Institute (501c3) and the "Are You Dense?" Foundation  addresses the continuing concerns for breast cancer in the New York area by recommending early detection screening programs for women over 20 (and not just anyone 40+ as standardized by the insurance companies.

MOVEMENT: "EARLIER DETECTION"  FOR WOMEN AGES 20-40
The medical community has identified over 5% of all breast cancer cases occur in women over 20 and under the age of 40. The increased risk for breast cancer in dense tissue also exists and is identified by the medical community.  Diagnostic Imaging specialist Dr. Robert Bard of NYC identifies the need for paying more attention to breast cancer screening to ages younger than the mandated 40+.  "It's about time the (medical) community recognizes the growing rate of breast cancer in women of younger ages... from genetic predisposition to geography to having dense breast tissue, earlier detection should be our next national initiative."

• Breast cancer in younger women may be more aggressive and less likely to respond to treatment.

• Women who are diagnosed with breast cancer at a younger age are more likely to have genetic mutations predisposing them to breast and other cancers.

• Younger women who have breast cancer may ignore the warning signs—such as a breast lump or unusual discharge—because they believe they are too young to get breast cancer. This can lead to a delay in diagnosis and poorer outcomes.

• Some healthcare providers may also dismiss breast lumps or other symptoms in young women or adopt a "wait and see" approach.

• Breast cancer poses additional challenges for younger women as it can involve issues concerning sexuality, fertility, and pregnancy after breast cancer treatment. [1]

2) INCLUDE SUPPLEMENTAL SCREENING FOR DENSE BREAST TISSUE (WITH HIGH RESOLUTION ULTRASOUND): Women diagnosed with dense breasts should continue to get regular screening mammograms. But there are additional screening tests that can help doctors detect tumors that may not be identified by conventional mammography or DBT. [2]  Any woman who has dense breasts may want to consider supplemental screening, usually with breast ultrasound. Studies show that screening with ultrasound, in addition to mammography, improves detection of breast cancers in women with dense breasts. [3]

3) WHOLE BODY MRI (NO CONTRAST) FOR CANCER SCANNING: In simplistic terms, having a full-body access comports to the fact that everything is connected in one way or another.  Our full-body MRI provides early diagnosis and the largest view of the body, where finding any cancers in the body and/or where they may spread can provide the best chance of treatment success.  In suspected cases of early breast malignancy, the exclusion of metastatic disease is clinically vital and emotionally supportive.

1a) "Infographic: 7 Things to Know About Getting a Mammogram"- ACA/American Cancer Society: https://www.cancer.org/cancer/types/breast-cancer/mammogram-tips-infographic.html#:~:text=Women%20between%2040%20and%2044,choose%20to%20continue%20yearly%20mammograms.

1) "Breast Cancer in Young Women"- Cleveland Clinic: https://my.clevelandclinic.org/health/articles/16805-breast-cancer-in-young-women

2)  "What additional breast cancer screening tests are available for women who have dense breasts?"- Yale medicine- https://www.yalemedicine.org/conditions/dense-breasts#:~:text=Women%20diagnosed%20with%20dense%20breasts,(whole%2Dbreast%20ultrasound).

3) Columbia Doctors/ "What Are Dense Breasts? A radiologist offers guidance":-Health Insights: October 14, 2022 https://www.columbiadoctors.org/news/what-are-dense-breasts#:~:text=Any%20woman%20who%20has%20dense,in%20women%20with%20dense%20breasts.

---

"In order to catch cancer, you need to be able to detect it at an early stage so we can treat patients with the most effective mechanisms.  Ultrasounds are an easy, cost-effective method for screening for early breast cancers, especially in women below the age of 45, who are likely to have dense breasts. When you are young and premenopausal your breasts are dense and we know that breast density is linked to cancer and which also makes it harder for cancers to be seen on a mammogram. Although breast cancer is rare in women under the age of 40, early detection is key.  Public health campaigns are spending so much money on mammograms for this population of women who can easily and cost effectively be screened using an ultrasound." - By: Noelle Cutter, PhD 

"I LOVE this new program! Early detection is essential! There is a stigmatization around mammograms that they are painful and frightening. There is anxiety while you wait for the results. And, don't forget the appointment scheduling hassle.  Women, particularly younger women with active lives, small children, careers don't want to have to fit one more thing into their hectic and demanding schedules. However, mammogram technology itself has advanced and it no longer has to be a painful experience. Clinics and imaging centers are offering untraditional scheduling opportunities, such as very early morning appointments to late evening appointments that are timed for very minimal wait times. And, clinicians are often prioritizing mammogram interpretations so the results are back within 24 hours. The Self Care message is trending right now. Mammograms should be a part of self care."  - By: Mary Nielsen, Tigard, OR

---

"EARLIER DETECTION"- REACHING A GENERATION IN CRISIS   By: Alexandra Fiederlein (23)

Edited by: Dr. Roberta Kline and Carmen Regallo-Dewitt

I belong to the graduate-level age group that continues to witness the increasing numbers of breast cancer cases in our country.  The women in this generation also happens to be the next group that falls prey to being UNDERDIAGNOSED. Insurance companies and the medical community have made little or no action to support or identify the need for women in their 20's and 30's to be approved for  standardized early detection / breast cancer screening.  

From the front-row perspective, younger women are as much at risk of getting cancer. Reports show an uptick in genetic predisposition for breast cancer*, alongside a dangerous attitude of denial. Addressing this calls for widespread education and screening programs in our community as essentials to a life of wellness and prevention.  To subscribe to a regular screening routine at the early stage of womanhood raises awareness and prevention for decades to come.  Perhaps someday, installing breast cancer screening centers in  college campuses may be commonplace and a powerful step toward a national prevention initiative.

Click to download the latest ACS report

Targeting the young working PROFESSIONAL is a major part of our population, where the vast majority tends to put off checkups and screenings because they are just "too busy". Professional women need to value their health above anything else, and therefore the narrative needs to be amplified in that area. We find this problem to be quite prevalent in urban areas with the constant on-the-go culture. Offering local resources and improved access for personal scanning are just some progress driven programs. 

GEN Z is a sensible focus group because these are the women who absolutely must receive routine scanning. We need to advocate for the narrative that age 40 is not the starting age where screening needs to begin- especially since we are now seeing cancer cases in younger ages are growing in numbers. Getting OB/GYN professionals on board is especially important because this is where women are getting their prescriptions. 

We need to educate on the benefits of ultrasound. People need to know HOW it works, WHY it works, and why it holds certain benefits over a mammogram. People need to know that it is SAFE and EFFECTIVE, and this technology can save lives. I think it is especially important to emphasize the option of ultrasound for younger women. Many younger women have dense breasts and don't even know it, putting them at a greater risk (I wouldn't have known if it weren't for all of you!). Ultrasound is obviously a safe and effective screening method for young women. It is also not linked with the stigma/fear of getting a mammogram like many women my age hold (X-Ray exposure, etc.). 

If the drive for EARLIER DETECTION means proactive awareness, may this lead to turning social concern into clinical action.  This includes clinicians joining hands with advocacy groups who recognize the many potential areas for at-risk women in my generation whose lives and safety continue to go unrecognized. And once the count of cancer cases and deaths rise exponentially due to inaction, perhaps then will the medical community find urgency in upgrading the required breast cancer screening age to (finally) include generations like mine.  So say we all! 

Ref:

*Global Increase in Breast Cancer Incidence: Risk Factors and Preventive Measures, PMC9038417. (NIH)- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9038417/

ALSO SEE:

A major concern is the presence of breast cancer in underserved communities, including those TOO YOUNG FOR A MAMMOGRAM.  Whereby the medical community touts the recommended (and legal/billable status) of getting a mammo scan should be between 40-50, what happens to the many women who do not fit this age criteria?  How would they even know to get checked without the support of their clinicians or an alarm from family history? Decades into the battle against breast cancer, clinicians and the public are much more educated about EARLY DETECTION, PREVENTION and the current protocols and modalities available to save lives.  Recent headlines on DENSE BREAST and the advancements in ULTRASOUND SCANNING supports a major part of this battle. SEE COMPLETE FEATURE

NANCY'S LIST: The Power of Compassion and Loving Help

INTRODUCTION

10/12/2023- For so many in the cancer community, it is rare to spot a bouquet of white roses and not think about the kindness and the giving spirit of Dr. Nancy Novack, founder and CEO of Nancy's List (NancysList.org).  This year, Nancy (as she prefers to be addressed) was inducted unanimously by the collective board of the Integrative Cancer Resource Society (ICRS) as "the Top 2023 Cancer Crusader" during the Fall Women's Roundtable Powermeet Conference.  

This meeting, hosted by the Coalition for Women's Cancers aligned a special grouping of community leaders, clinicians and advocates working together to share information about the current state of cancer care. "It was such an honor to finally be connected with Nancy", starts Dr. Leslie Valle-Montoya- recently elected executive director of ICRS. "You couldn't be in the cancer awareness community and not hear about Nancy's List. To hear firsthand HER story (with that soft and genuinely loving voice) including how it all started truly hits you deep into your soul- and makes you want to be part of her mission!"

Nancy's List is a free website that started in 2008, researching, organizing and publishing resources for cancer patients and survivors. According to the website, it's core beliefs "inspire community-wide support system for children, teens, and adults who are living with, through, and beyond cancer.  Nancy's List is a compassionate grassroots effort committed to significantly improving the quality of life for these individuals, their families, and their caregivers.  

INSPIRING OUR COMMUNITY "TO BE THE VERY BEST IT CAN BE" - From an interview by: Nancy Novack

I am a survivor of 20 years of stage four ovarian cancer. I knew nothing about cancer at that time, and just was complaining of what I thought was an appendicitis attack. (Of course) that didn't turn out that way. I was swept away to Stanford where I was treated pretty traditionally by a wonderful man whom I have a tremendous amount of respect and trust in- and I haven't had a recurrence in 20 years. I love being Stanford's poster poster child, but I think in the process I learned a great deal about the psychology (which I'm a psychologist) of cancer. I don't have the medical knowledge, but I certainly understand the psychology within my work with so many cancer patients.

As it turned out, I spent a great deal of time in the infusion room with a ton of chemo.  Because I'm a psychologist, I tend to ask a lot of questions and started talking to everybody in the room about what their experience was. I call it immediate intimacy that you have with another cancer patient. All of a sudden you cut through everything and you're everybody's best friend, and what I was struck by was the amount of fear that went into (not about dying, but) the fact that they didn't have enough money to have cancer. And that they feared that if they told their doctors they wouldn't be treated if they told their doctors that they couldn't afford their medications- and instead put food on the table for their families, they would be dismissed. So many stories of people telling me deep pain that they were suffering and a lot of stress about the money. 

AFFORDING CANCER

They didn't get why they were so vulnerable but they all came to together and did a community action to adopt the families that were living in Marin. Most of this early group had prostate cancer and breast cancer. It was almost like an epidemic. It was huge numbers, and we just adopted them. And the little kids sent get well cards. The teenagers made food for the families. It was just an all out community action. And then that changed and it became  a club for kids who were living with cancer where we went on adventures every weekend like going sailing. These were kids that had all kinds of brain cancer or leukemia. They're all alive today and I still hear from them, but during that time, they got to be kids. And that was important to me that they have that opportunity to be kids; they were supportive of each other, and they all ended up going to camps together for, for cancer kids and their families.  It was a great project and it just kept changing a little bit when I see something that needs to happen. 

I'm still working on the financial resources every day. However, since the pandemic, I find cancer patients also have a lot of problems with Covid-- and again, people just don't have money to support themselves. Cancer survivors are so vulnerable as covid patients so finding out the foundations that can support people who have cancer AND have Covid. 

When I moved to Texas, I lost my license to practice legally. I still help people by phone, but I don't have a legitimate license here. There's no reciprocity with California, which shouldn't surprise anybody. So I decided I could make a bigger network without a license and just kept identifying needs.  And one was to make people much more aware of integrative oncology and how this could really support and deepen the healing process. 

We have a huge director, probably a thousand people all over the country of practitioners and healing centers that they can access. That's been very well received because they don't know this stuff on their own. It explains all the different modalities that are well connected with common will.  I think my job (here) is to connect people with different resources that can help them focus on the real healing process at the same time.  We have a real push for quality of life stuff that really gives them a free retreat or a free cancer camp, or a wish fulfillment project - something that really deepens their family connections and connects them emotionally to one another and to their bodies. I still talk about that a lot in many podcasts where we dive into financial resources and quality of life.

THE DENSE BREAST PARADIGM

Another panelist of the Cancer Powermeet was Joe Cappello of the "Are You Dense" Foundation, who was astonished at how Nancy fully-related to his awareness mission about Dense Breasts and its links to cancer.  "I actually have dense breasts", starts Nancy. "...and nobody has done a thing about it any different than the old fashioned mammogram. And every time I go in there and I say, "but wait a minute, what about sonogram?"... and they act like this is such an odd request. I'm very interested in this subject and I'd like to help you educate more women about this and what's available to them. I believe they can push for the same kind of techniques that we should all be having. I do worry about it because I've been following Dr. (Robert) Bard's work and that's a concern to me. And probably many of the women that I deal with-- 40% post-menopausal women, sign us up!  My ultimate job is to educate people and give them opportunities and possibilities other than the leftovers that we've been doing for so long." 

A CONTAGIOUS LEGACY OF COMPASSION AND ANSWER-FINDING 

Dr. Leslie-Montoya underscores Nancy's monumental achievements by building what many call "the largest national cancer resource online... just about every support resource and cancer doc and healer from every type of modality is at Nancy's list!".  Moderator Lennard Goetze (founder of the now-national ICRS charter) admits in this forum that each time he produces a group and mentions the word 'resource', he thinks of Nancy every time. "To follow in her footsteps or even being in her shadow is goodness x10! I drive so many cancer patients and their families to her site, and I also find myself to reference it 'too often' either to get inspired and/or to find that kind of helpful information." He adds, "With great thanks to Nancy Novack, I have become a patient advocate (by profession), a publisher of cancer news and even a call-in center for many cancer cases (alongside my publishing partners "Cousin Sal" Banchitta and Dr. Robert Bard in our "Get Checked Now!" program).  Giving of ourselves in the form of education, advocacy and resource sharing has made us all a cancer resource ourselves... I guess being touched by Nancy is CONTAGIOUS!"

The continuance of Nancy's inspiration also sparked the next ICRS development of the 2024 WOMEN'S HEALTH DIGEST- a collaborative free publication managed/edited by Dr. Roberta (Bobbi) Kline- offering field-based articles, videos and reports by clinical professionals and academic educators.  WHD is collectively designed mostly "by women for women" in support of women's health, lifestyle and early detection, and a significant section covers the latest topics about women's cancers.

---

2024 CLINICAL PROFILE OF THE DENSE BREAST PARADIGM - for the Obstetrics & Gynecology Society 

Written by: Roberta Kline, MD

Published by ICRS Medical Press Ltd.

Breast cancer affects the lives of hundreds of thousands of women every year and is a leading cause of death.  While we have made great progress in advancing earlier diagnosis and more individualized treatments, we still need to improve our approach to achieve our ultimate goal - prevention. This requires a deeper understanding of the molecular mechanisms and the multitude of factors that contribute to the development of breast cancer.  

Dr. Roberta Kline, recognized speaker and publishing crusader for women's health brings you a comprehensive review and a deep-dive analysis of the current research  findings about breast density and its major risk factors for breast cancer.  Her reports uncover current imaging practices and clinical protocols updated in great support of breast density detection and the means of addressing this growing condition that affects over 45% of the female population. "Knowing a woman has greater breast density is a critical first step, but it doesn’t end there... we need to go further by understanding the causes of breast density, and how they relate to breast cancer-- we now have another avenue to proactively intervene to reduce risk or even prevent breast cancer in the first place."  This textbook is a champion in targeting the Dense Breast Paradigm as a blueprint and a clear course study for all clinical professionals who are dedicated to women's early detection and prevention programs. (More information)

---

LAUNCHING IN 2024: NATIONAL COALITION OF WOMEN'S HEALTH SUPPORT

Professional health orgs, foundations and advocates of women's health disorders (primarily cancers) is uniting to form a national alliance of collaborators. This collective group is focused on "doing more together" as far as exploring new resources, sharing current ideas and addressing a wide range of topics about women's issues. Meetings like our latest Women's Powermeet series discussed the latest in diagnostic and therapeutic solutions while introducing who's who in national crusadership in the advocacy realm. Clinicians are also welcome to discuss patient-dedicated road maps and a more thoughtful health analysis and research-based evaluation. It is this level of commitment to women's health that provides a deeper sense of care for the patient that lends itself to a more holistic and integrative strategy to therapeutics. It is also this philosophy that draws more intuitive and insightful awareness on a global scale to offer collaboration platforms too better share insights on a patient's disorders to seek out better solutions. (See Women's Health Digest)

---

WOMEN’S HEALTH DIGEST

From the publishers of THE WELLNESS JOURNAL and the WOMEN'S DIAGNOSTIC NETWORK NEWS comes a consortium of IPHA'S top professional contributors in women's health & wellness advocacy. Subscribe to our latest community E-news forum and get the insiders news on pain therapeutics, diagnostics and lifestyle upgrades. We welcome special guest contributors from all modalities of healing - from practitioners, product innovators and researchers. Also, gain valuable insight from success stories of real people and their experience with WHAT WORKED for them! Get front row access to our latest headlines. Visit: WomensHealthDigest.org

Early Detection Alert: The Risk of Being "Too Young for a Mammogram"

A major concern is the presence of breast cancer in underserved communities, including those TOO YOUNG FOR A MAMMOGRAM.  Whereby the medical community touts the recommended (and legal/billable status) of getting a mammo scan should be between 40-50, what happens to the many women who do not fit this age criteria?  How would they even know to get checked without the support of their clinicians or an alarm from family history?

Decades into the battle against breast cancer, clinicians and the public are much more educated about EARLY DETECTION, PREVENTION and the current protocols and modalities available to save lives.  Recent headlines on DENSE BREAST and the advancements in ULTRASOUND SCANNING supports a major part of this battle.

WHAT ABOUT IF YOU'RE TOO YOUNG FOR A MAMMOGRAM?   I went to my doctor for a lump I felt in my breast and she gave me a response that set off red flags: "don't worry about it". Being a researcher involved in breast density and breast cancer, I knew that I had to take action; I was fortunate enough to have my breast ultrasound training with Dr. Robert Bard (cancer imaging specialist, NYC) upcoming in the next week. Dr. Bard showed me how to use the ultrasound to help me find two benign tumors in my breasts, and it was there that he reported that I have dense breasts. Had I not taken action in getting screened at the young age of 22, I would have never known that I should be getting screened via ultrasound every 6 months (because having dense breasts puts me at a higher risk for breast cancer), nor would I have known that I had benign breast tumors. 

- ALEXANDRA FIEDERLEIN, 22

Cancer Researcher/ Graduate- Molloy Univ.

---

UNDERSERVED AGE FOR EARLY DETECTION

By Dr. Robert L. Bard and Joe Cappello of AreYouDense.org

Doppler Sonography offers clinical accuracy and access
to breast imaging evaluation (www.breastcancernyc.com)

According to Breastcancer.org, "Where mammography is available, ultrasound should be seen as a supplemental test for women with dense breasts who do not meet high-risk criteria for screening [with] MRI and for high-risk women with dense breasts who are unable to tolerate MRI... but if mammography isn’t available, then ultrasound seems to be a good alternative for breast cancer screening."

A recent cohort study is underway under a partnership between Molloy College and AreYouDense.org  to publish new findings about low BMI patients and younger women about the presence of dense breast tissue.  This same review also covers the advantages of ultrasound use where mammography is not available.

Mammography is the current standard for breast cancer early detection for women 40 & older. Recent studies have shown nearly half of all women who get mammograms are found to have dense breasts, exposing this population to the risk that mammograms may miss potentially cancerous tumors concealed by dense breast tissue.  Dr. Cutter's initial concepts to target LOW BMI (bet 12-22% body fat) was personally inspired.  As an active TRIATHLETE, her own diagnosis sparked her survey and inquiry throughout the athletic community where she uncovered a significant trend that became the basis for this research. She wishes to target younger women, athletes and members of underserved communities. "Younger women may be more likely to have dense breasts... also I find athletes with LOWER BMI (body mass index) or those with  less body fat are more likely to have more dense breast tissue compared with women who are obese." (See complete feature article)

NEWS FROM THE FIELD  Click to see NEWS The DENSE BREAST TISSUE / CANCER CONNECTION is a topic that has finally achieved proper recognition in our community. Thanks to organizations like The 'ARE YOU DENSE?' Foundation, awareness of this health concern has now shed light to the risk to 40+% of the national women's population whereby more clinicians are now recognizing the need to state a patient's dense breast status.  Research crusaders like  Dr. Noelle Cutter and research associate Alexandra Fiederlein from Molloy University are underway the 2022 National Survey of Dense Breast Studies by bringing ultrasound access to underserved members of the women's community.  In a recent episode of SPOTLIGHT ON AMERICA, Dr. Bard spoke as the clinical expert in the report "Millions of women have this breast cancer risk factors... why aren't they being informed?" -- TND REPORT/Spotlight on America is pressing to ensure women have access to a crucial health fact that could save their lives. According to the Centers for Disease Control and Prevention, 40% of women have dense breast tissue, which is a risk factor for cancer. The TND team first highlighted this issue in October 2021, and more than a year later, we expose how some women are still being left in the dark about their density, and federal health bodies are failing to make sure they’re informed.

REVIEW ON WOMEN'S EARLY DETECTION STANDARDS 

Excerpt from the 2021 NYCRA Dense Breast Diagnostic Conference By: Dr. Roberta Kline

Breast cancer is still one of the most common cancers in women, and the leading cause of cancer mortality. While mammography is considered the standard imaging for early detection, it falls short for many – including those with dense breasts. Approximately 40% of women have dense breasts, which we now know is associated with an increased risk of breast cancer. On top of this increased risk, mammogram is less sensitive for early detection – up to 50% less for women with the highest breast density. [1] As a result many women are not diagnosed until they have a much later stage cancer – and a worse prognosis. [2]

The State of Connecticut passed legislation requiring notification of breast density in 2009, after having passed legislation requiring insurance coverage for ultrasound for dense breasts in 2005. As an ObGyn physician practicing in CT at the time, I remember the discussions with colleagues and patients around this issue although at the time there were no formal efforts to raise awareness or update guidelines from our national specialty organization, the American College of Obstetricians and Gynecologists (ACOG). 

PERSPECTIVE: PERSONAL FINDINGS BY A CLINICAL PROFESSIONAL

I was fortunate to have benefited personally from this effort when I had my first screening mammogram shortly after the law went into effect. The reading radiologist personally informed me of my high breast density immediately after the mammogram, and after recommending a breast ultrasound for further evaluation this was done right then and there. I walked away from my appointment feeling well informed, and any potential anxiety relieved by the prompt additional imaging and results. I also knew that I needed a different approach for my screenings going forward.

Between 2009 and 2019, 37 other states and D.C. passed legislation requiring notification of breast density, one of the last being my new home state of New Mexico. In 2019 a federal law was passed to require both clinician and patient reports contain plain language around the woman’s breast density, and to discuss with her provider. The FDA then created standard language that has now been implemented, requiring reporting on a woman’s individual breast density, and recommendation to discuss with her provider.

There is still much to be learned about what causes dense breasts and why women with dense breasts have an increased risk of breast cancer, and our ongoing study is one of many that are seeking to answer these questions at the molecular and genetic level. But the evidence that supplementing mammograms with other imaging modalities can increase the rate of early detection is substantial, and provides us with tools we can use right now to make a difference. [3,4]  Despite this progress, there are still significant hurdles in changing the standard of care. A recent experience with my routine breast cancer screening highlighted the ongoing challenges. When I had asked to schedule an ultrasound with my screening mammogram, I was informed that it was not done this way – I could only get a mammogram. After my mammogram, I had to wait to receive my letter in the mail approximately one week later to be able to take any additional steps. The interpretation included a description of breast density and recommended to discuss any additional care with my physician. 

When I called to schedule an ultrasound, I was told that since the radiologist did not recommend it in the report, I could not schedule it. I then had to speak with my primary care provider, educating her on dense breasts and why I needed an ultrasound. Luckily, she agreed to order one. While the radiology facility still questioned the order, eventually I was able to have this done. When the radiologist came in to discuss my results, she too was confused as to why I was having the ultrasound, and was not aware that this should be standard for women with dense breasts.

See 2022 Dense Breast Ultrasound Study

Fortunately all was fine, but had I not been a physician that was fully aware of this issue, I would very likely have had only a mammogram and walked away with a dangerously false sense of security. This experience highlighted for me how much still needed to be done more than 20 years after my first experience. Legislation is only part of the solution. Clinician education and public awareness are the keys to changing how the intention behind these laws gets translated into actual change in health care.

As I experienced, many clinicians are ill-informed about the nature of dense breasts, and options for adjunctive screening including ultrasound or MRI. This means that many of these reports end up being filed away with no further action being taken that could make a significant difference in early detection and saving lives.

EPILOGUE: CURRENT STANDARDS VS NEEDS

ACOG still officially does not recommend any further imaging for women with dense breasts on mammogram, despite the significant body of evidence suggesting that mammogram alone is insufficient and adjunctive imaging with ultrasound or MRI increases rate of early detection. [5] The U.S. Preventive Task Force [6]  does not recommend routine adjunctive imaging for screening women with dense breasts. This leaves many healthcare practitioners, from ObGyns to other primary care providers, unprepared to discuss this with their patients or provide sound recommendations. 

The American College of Radiologists, who also publishes the BIRADS standards for breast cancer screening, acknowledges awareness of breast density detection issues with mammography but stops short of recommending routine adjunctive imaging. Instead, they list ultrasound and MRI as “may be appropriate”. [7] We have enough evidence to know how to better serve women with dense breasts, and we can do better. Now we need to push for better education of all primary health care providers, including ObGyns, and continue to raise awareness for women around current knowledge and best practices. 

References

1) Gordon PB. The Impact of Dense Breasts on the Stage of Breast Cancer at Diagnosis: A Review and Options for Supplemental Screening. Curr Oncol. 2022 May 17;29(5):3595-3636.

2) Chiu, S.Y.H.; Duffy, S.; Yen, A.M.F.; Tabár, L.; Smith, R.A.; Chen, H.H. Effect of baseline breast density on breast cancer incidence, stage, mortality, and screening parameters: 25-Year follow-up of a Swedish mammographic screening. Cancer Epidemiol. Biomark. Prev. 2010, 19, 1219–1228

3) Harada-Shoji N, Suzuki A, Ishida T, Zheng YF, Narikawa-Shiono Y, Sato-Tadano A, Ohta R, Ohuchi N. Evaluation of Adjunctive Ultrasonography for Breast Cancer Detection Among Women Aged 40-49 Years With Varying Breast Density Undergoing Screening Mammography: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2021 Aug 2;4(8):e2121505

4) Mann, R.M., Athanasiou, A., Baltzer, P.A.T. et al. Breast cancer screening in women with extremely dense breasts recommendations of the European Society of Breast Imaging (EUSOBI). Eur Radiol 32, 4036–4045 (2022).

5) Management of Women With Dense Breasts Diagnosed by Mammography. ACOG Committee Opinion. CO Number 625 March 2015

6) https://uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

7) American College of Radiology ACR Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density. 2021

Copyright Notice: The materials provided on this website/web-based article are copyrighted and the intellectual property of the publishers/producers (The NY Cancer Resource Alliance/IntermediaWorx inc. and The AngioFoundation). It is provided publicly strictly for informational purposes within non-commercial use and not for purposes of resale, distribution, public display or performance. Unless otherwise indicated on this web based page, sharing, re-posting, re-publishing of this work is strictly prohibited without due permission from the publishers.  Also, certain content may be licensed from third-parties. The licenses for some of this Content may contain additional terms. When such Content licenses contain additional terms, we will make these terms available to you on those pages (which his incorporated herein by reference).The publishers/producers of this site and its contents such as videos, graphics, text, and other materials published are not intended to be a substitute for professional medical advice, diagnosis, or treatment. For any questions you may have regarding a medical condition, please always seek the advice of your physician or a qualified health provider. Do not postpone or disregard any professional medical advice over something you may have seen or read on this website. If you think you may have a medical emergency, call your doctor or 9-1-1 immediately.  This website does not support, endorse or recommend any specific products, tests, physicians, procedures, treatment opinions or other information that may be mentioned on this site. Referencing any content or information seen or published in this website or shared by other visitors of this website is solely at your own risk. The publishers/producers of this Internet web site reserves the right, at its sole discretion, to modify, disable access to, or discontinue, temporarily or permanently, all or any part of this Internet web site or any information contained thereon without liability or notice to you.