Please Explain: Breast Cancer

Friday, February 21, 2014

A recent long-term study questioning the benefits of annual mammograms for older women. This week’s Please Explain is about breast cancer. Dr. Larry Norton, Deputy Physician-in-Chief for Breast Cancer Programs at Memorial Sloan Kettering Cancer Center, describes how the disease is detected and the ways it can be treated.

Cancer cells not only divide more than normal cells, they can move around the body and "set up shop in other places" in the body. However, people die from tumors, which are made up of cancer cells and other cells.

"Any lump should be tested," Dr. Norton says, and he recommends a core biopsy because it enables doctors to see the relationship between cancer cells and other cells.

According to Dr. Norton, the study that recently made headlines by questioning the benefits of annual mammograms is "actually a very old study that’s been reported before." And because the technology has improved dramatically in the last few decades, "the mammograms [administered in the study] were just not mammograms by modern standards." The overwhelming evidence, he says, supports the use of mammography.

Dr. Norton says that women should be getting annual mammograms starting at age 40. “With breast cancer, if you find it early, it makes a big difference in the management.” However, mammograms aren’t necessarily that effective for younger women, and for certain women, particularly those with what are called “thick breasts,” an MRI may be an important diagnostic tool.

Certain things predispose people to breast cancer including hormone replacement therapy; radiation exposure, but it has to be significant; and obesity.

The key to better understanding breast cancer, Dr. Norton says, is more research on breast cancer causation. And that requires more funding. "This is probably one of the most exciting times in all of biomedical history in terms of making advances."


Dr. Larry Norton

Comments [20]

maryann from Brooklyn

Larry Norton's misinformation about the recent findings from the Canadian trial should be countered with an interview with Dartmouth's H.Gilbert Welch, MD, and expert on overdiagnosis. Here's his recent take on this important clinical trial.

Feb. 21 2014 03:10 PM

I missed most of this. Did Dr Norton really dismiss the recent findings?

Feb. 21 2014 01:57 PM
Joe from nearby

Excellent segment- thanks, Dr Norton. Keep up the great work!

Feb. 21 2014 01:53 PM
Arcy from NYC

Do post-menopausally prescribed vaginal estrogen creams count tas HRT? Can they contribute to breast cancer?

Feb. 21 2014 01:51 PM
Amy from Manhattan

My mother died of breast cancer. It was advanced & had already metastasized when she had it diagnosed (in the mid-1990s), & they never found a primary tumor, even though she'd had routine mammograms for years. Are there methods available now that can detect cancer in cases like hers?

Feb. 21 2014 01:50 PM
June from Englewood NJ

Hormones in dairy and meat increasing risk?

Feb. 21 2014 01:48 PM
megfeeley from Brooklyn

My mother had a lumpectomy and radiation. She developed Lymph edema. Later, she developed angiosarcoma of the breast, going through three operations. SHe was 'clean' and released; four months later, she had pleurisy in the lungs, and died within months of metastasis. What is the link between breast cancer and angiosarcoma of the breast, and how prevalent is the latter?

Feb. 21 2014 01:46 PM
bernadette from douglaston

what about the radiation in the water supply on long island rud40 that was put in containers and dumped out in montauck and now have leaked into the aqufer under long island?? also isn't breast tissue under the arms and even a total mastectomy can not protect you??

Feb. 21 2014 01:46 PM
Catherine from Northport, NY

Please eplain Stage 0 breast cancer. My sister was diagnosed three years ago and had a lumpectomy and some radiation. Was that necessary, rather than more frequent mamograms?
Thank you.

Feb. 21 2014 01:45 PM
Steven from Brooklyn

I've been diagnosed with cancer 4 times starting in 1996. Lymphoma and prostate cancer. I've had chemotherapy and radiation. I feel fine and am currently clear. I've been treated at 3 major NY hospitals and been to Sloan Kettering several times for opinions. I've never been treated there.

Sloan typically recommended the most aggressive treatment. A key element of prostate cancer diagnosis is Gleason Score which if I recall ranges from 2 to 10, higher numbers indicating more serious disease. The jump from Gleason 6 to 7 was regarded as especially significant, 7 being significantly worse than 6.

My biopsy slides were evaluated as Gleason 6 by the first hospital I went to. The slides were sent to Sloan who read them as Gleason 7. Both hospitals recommended more aggressive treatment for Gleason 7. I chose not to be treated at Sloan, following treatment protocol recommended for Gleason 6 at another hospital.

I speculated to the doctors who treated me that Sloan read them at higher score for the nefarious motivation that this could be used to demonstrate better results for more severe disease. They did not discount this interpretation.

Feb. 21 2014 01:43 PM

I had fibroadenoma and phylloid tumor removed previously, do I still have a risk of having breast cancer?

Feb. 21 2014 01:41 PM
anthony from brooklyn

The guest is an advocate who runs a hospital where mammography is a pillar of their practice and a primary source of revenue.
He dismisses the recent findings, not on the basis of science, but on the basis of "evidence." What is this evidence, why not cite it, so we can judge the wisdom of your argument. This was the largest, most rigorous examination of mammography ever conducted. Why is it wrong? He has no scientific basis for dismissing it.

Instead he relies on his own clinical experience. He says he doesn't know anyone who hasn't seen a cancer grow.

He is clearly not a scientist. He is an interested party in this debate and I find his certainty and air of confidence disturbing.

Feb. 21 2014 01:38 PM
Carol from UWS

Is there a relationship between breast cancer and smoking marijuana?
I've heard there is.

Feb. 21 2014 01:35 PM
Carol from UWS

Is there a relationship between breast cancer and smoking marijuana?
I've heard there is.

Feb. 21 2014 01:33 PM

Dr Norton is part of the cancer-industrial complex and should acknowledge his bias in finding, treating and researching cancer. You can always complain that the latest research findings have been made irrelevant by new technology, but if you go back 10+ years when the study in question was designed, he and his brethren were probably saying that era's mammography results warranted the frequent surveillance protocols still recommended by those who favor mammography.

His biases are also reinforced by where he practices. He routinely sees the bad aggressive and metastatic cancers, whereas the false positives and over-interpretation of tiny shadows, that make frequent mammograms starting at puberty (I exaggerate) a problem and lead to un-necessary invasive procedures, rarely make it to MSKCC.

Feb. 21 2014 01:31 PM
Carola from Bed-Stuy, Brooklyn

There is a less invasive and more sensitive diagnostic imaging method called thermography. The United Breast Cancer Foundation provides scholarships that cover most of the cost; contact them for info: Knowledge of this alternative to mammograms should be much more widely available, and they too should be covered by insurance.

Feb. 21 2014 01:31 PM

My question is: "Has breast cancer increased in the last say, 25 years? And could the increase be from hormones in our food chain happening from hormones given to chickens and cattle etc.?

Feb. 21 2014 01:28 PM
Maria from Morristown

I've heard that our thyroids should also be covered by a radiation shield. The lab technician should have it there and offer it to us when we get out mammograms. SO far, I have never been offered this shield. I've read a lot about how thyroid cancer and diseases are on the rise and this could be a leading factor. I have friends who have had breast cancer and thyroid problems. Can your guest please shed some light on this.

Feb. 21 2014 01:26 PM
Jackie from New Brunswick NJ

Alcohol as risk factor?
Environmental risk factors?
More emphasis on PREVENTION???

Feb. 21 2014 01:24 PM
Amy from Manhattan

One main characteristic of cancer cells is that they lose their differentiation--the characteristics that made them a breast cell or a lung cell. Does that make it harder to tell by looking at a cancer cell what tissue the cancer originated from?

And what is a core biopsy? What other kinds are there?

Feb. 21 2014 01:22 PM

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