Why Rita Wilson Says a Second Opinion Caught Her Breast Cancer

Yesterday, Rita Wilson shared with PEOPLE that she recently had a double mastectomy and reconstructive surgery following a breast cancer diagnosis. The 58-year-old actress explained her personal health challenge in detail in a statement, and says she hopes her story will help others.

“I have taken a leave from the play Fish in the Dark to deal with a personal health issue,” Wilson wrote. “Last week, with my husband by my side, and with the love and support of family and friends, I underwent a bilateral mastectomy and reconstruction for breast cancer after a diagnosis of invasive lobular carcinoma. I am recovering and most importantly, expected to make a full recovery. Why? Because I caught this early, have excellent doctors and because I got a second opinion.”

RELATED: 25 Breast Cancer Myths Busted

She also explained how her tough-to-diagnose form of the disease almost slipped through the cracks. “I have had an underlying condition of LCIS (lobular carcinoma in situ) which has been vigilantly monitored through yearly mammograms and breast MRIs. Recently, after two surgical breast biopsies, PLCIS (pleomorphic carcinoma in situ) was discovered. I mention this because there is much unknown about PLCIS and it is often found alongside DCIS (ductal carcinoma in situ). I was relieved when the pathology showed no cancer.”

“However, a friend who had had breast cancer suggested I get a second opinion on my pathology and my gut told me that was the thing to do. A different pathologist found invasive lobular carcinoma.”

According to Erin Bowman, MD, a breast surgical oncologist at Atlanta Breast Care who is not treating Wilson, PLCIS is a subtype of LCIS. “It is treated more aggressively than usual type LCIS because studies have shown LCIS variants to be more associated with a malignancy,” she told Health in an e-mail.

RELATED: Do You Need a Mammogram?

Wilson consulted with a third pathologist, who confirmed that she has invasive lobular carcinoma, the second most common form of breast cancer. “I share this to educate others that a second opinion is critical to your health. You have nothing to lose if both opinions match up for the good, and everything to gain if something that was missed is found, which does happen. Early diagnosis is key.”

How common is it for pathologists to disagree on whether abnormal-looking cells are indeed a sign of cancer? Surprisingly, it’s not as rare as you might think. “A recently reported study out of Seattle found pathologists across the U.S. matched a panel of experts only 75% of the time when looking at breast biopsies,” says Dr. Bowman. While the pathologists and the expert panel were most likely to agree on biopsies that were invasive cancer, they were less likely to agree on benign lesions or DCIS (abnormal cells that haven’t spread or invaded other tissues, which may be monitored or treated, depending on the circumstances).

“When hospital centers are able to have specialized teams of pathologists that read only breast pathology, the rate of ‘missing cancer diagnoses’ is usually lower,” says Dr. Bowman.

RELATED: The Diet That May Fight Breast Cancer

The actress is thankful for not only her breast cancer care, but the support of her family, including husband of almost 27 years, Tom Hanks.

“I feel blessed to have a loving, supportive husband, family, friends and doctors and that I am the beneficiary of advances in the field of breast cancer and reconstruction,” Wilson wrote. “I am getting better every day and look forward to renewed health. I hope this will encourage others to get a second opinion and to trust their instincts if something doesn’t ‘feel’ right.”

RELATED: 5 Ways to Cut Your Breast Cancer Risk

How to Buy a Bra That Actually Fits

Lori Kaplan, who owns the intimate-apparel store Bra Tenders in New York City and has fitted celebrities like Brooke Shields and Uma Thurman, shares a few of her tricks for finding the perfect brassiere.

Swoop and scoop

Lean forward and pull your boob tissue into the center of your cups. Now stand up and survey the situation. “If you see gapping, the cups are too big,” Kaplan says, “and if your breasts are bulging out, they’re too small.” The underwire should be in line with your armpits, and the bridge of the bra should sit flat against your chest.

RELATED: What the Perfect Breast Looks Like, According to Men and Women

Do the two-finger test

“The number one mistake I see is women wearing a too-big band size,” Kaplan says. You want the back of your bra band to be parallel to the floor and snug all the way around. “You should be able to easily slip two fingers underneath the band. No more, no less.”

RELATED: The 10 Best Sports Bras for Women With Big Busts

Yank it up

If you’ve tightened the straps as much as possible but your gals are still drooping, chances are it’s time to replace your bra. “The average life span of a bra is about a year, even if it once fit you like a glove and you took good care of it.”

Pro tip: If the band rides up between your shoulder blades, it’s too big.

RELATED: 5 Myths and Facts About Sagging Breasts

Should Women With Lumpy Breasts Get Mammograms Earlier?

If I have lumpy breasts, should I start getting mammograms at an earlier age?

Nope, not necessarily. Women with lumpy breasts don’t
have a higher risk of breast cancer, so there’s no reason 
to suggest earlier screening. The technical term for lumpy breasts is “fibrocystic breasts,” and the lumps are nodules of fibrous tissue or cysts that form in response to fluctuating hormones. These lumps, which more than 50 percent of women have, may feel tender, and they tend to change in size throughout your menstrual cycle.

If you have fibrocystic breasts, be sure to perform monthly self-exams and keep track of how your breasts normally feel so you don’t miss something that may actually be cancer. Anything that doesn’t feel right—like a new lump that sticks around or a thickening 
or new firmness in an existing lump—should be investigated by your doctor right away.

Otherwise, when to start screening is a big decision
 (and a hot-button issue). The latest guidelines from the U.S. Preventive Services Task Force say that the decision to begin routine screening before age 50 (for women not at high risk) is one that women should make for themselves, in discussion with their doctor, by weighing their family history, tolerance for risk and other factors. But many organizations, including The American Congress of Obstetricians and Gynecologists, say
that every woman should get an annual or biannual mammogram beginning at age 40. Personally, I advise patients to look closely at their specific health history with their doctors and begin screening when it makes sense for them.

Health‘s medical editor, Roshini Rajapaksa, MD, is assistant professor of medicine at the NYU School of Medicine and co-founder of Tula Skincare.

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More Women Surviving Breast Cancer, Dutch Study Finds

By Amy NortonHealthDay Reporter

TUESDAY, Oct. 6, 2015 (HealthDay News) — Even with recent strides in breast cancer treatment, a woman’s chances of surviving the disease still partly depend on early detection, a new study says.

The study of nearly 174,000 Dutch breast cancer patients found that survival rates improved between 1999 and 2012 — and that included women with more advanced cancer.

Still, women’s survival odds were best when their tumors were caught early, the researchers reported in the Oct. 6 issue of the medical journal BMJ.

“The general prospects for a woman diagnosed with breast cancer in the Western world are very good,” said lead researcher Dr. Madeleine Tilanus-Linthorst, of Erasmus University Medical Center in the Netherlands.

Her team found that among women diagnosed with breast cancer between 2006 and 2012, the five-year survival rate was 88 percent. That compared with 83 percent among women diagnosed with the cancer between 1999 and 2005, the study said.

The brighter outlook extended to women with more advanced cancer. Among those with larger tumors — more than 2 inches across — the research revealed that the five-year survival rate rose from 63 percent to 73 percent.

However, the smaller a woman’s tumor at diagnosis, the better the outlook. Of women diagnosed in more recent years, nearly all survived at least five years if their tumor was caught when it was less than three-quarters of an inch across, the study found.

In fact, their five-year survival rates were comparable to those of an average woman their age who’d never been diagnosed with breast cancer, the study showed.

“Catching the cancer early is still highly important,” Tilanus-Linthorst said.

Of the women diagnosed between 2006 and 2012, she noted, 65 percent had their tumors caught when they were still less than three-quarters of inch in size.

Dr. Harold Burstein cowrote an editorial published with the study. “The cancers caught these days are smaller and better-behaved when you look at them under a microscope,” said Burstein, an oncologist at the Dana-Farber Cancer Institute in Boston.

“And this study shows that even with the treatment advances of recent years, tumor size still matters,” he said.

That might sound unsurprising, Burstein noted. But the substantial improvements in breast cancer treatment in the past decade or so have raised the question: Is early detection as important as it used to be?

Those treatment advances include “targeted” drugs such as Herceptin that zero in on specific abnormal proteins found in certain breast tumors; wider use of hormonal therapies that lower the risk of a breast cancer recurrence; and better chemotherapy regimens, according to the study.

In this study, women diagnosed with breast cancer in more recent years were more likely to receive those treatments. They were also more likely to receive “breast conserving” surgery — where only the tumor and some surrounding tissue are removed — and less likely to undergo a mastectomy, the study found.

Even with those therapy changes, though, tumor size at diagnosis remained a key factor in a woman’s outlook, the researchers said.

And that, Burstein said, underscores the value of mammography screening.

The study did not actually look at the effects of breast cancer screening, Burstein pointed out. “But,” he said, “I think this indirectly supports mammography screening.”

That’s important, he said, because the benefits of mammography screening have been debated in recent years, especially when it comes to women younger than 50.

In the United States, mammography guidelines vary. The American Cancer Society and some other groups suggest yearly mammograms starting at age 40.

However, the U.S. Preventive Services Task Force (USPSTF) suggests that women begin screening at age 50, and continue every two years. Women in their 40s are advised to weigh the pros and cons of screening.

The “cons” include false-positive mammography results that lead to invasive testing — as well as unnecessary treatment of tiny tumors that would never progress to threaten a woman’s life, according to the USPSTF.

The “pros,” Burstein noted, include catching and treating tiny tumors that would have threatened a woman’s life.

More information

The American Cancer Society has more on treating breast cancer.


NFL Player Will Pay for 53 Mammograms, One for Each Year of His Mom's Life

Every October, the NFL asks players to don a very non-uniform color—pink—for Breast Cancer Awareness month. For Pittsburgh Steelers running back DeAngelo Williams, you don’t have to ask him twice.

His mother, Sandra Kay Hill, passed away from breast cancer in May 2014, and he’s glad to have the opportunity to honor not only his mother but also four of his aunts, who sadly died of breast cancer as well. This year, he even asked his bosses at the NFL if he could continue to wear pink shoes or wristbands throughout the year.

But the NFL’s vice president of football operations Troy Vincent said no, citing uniform rules.

RELATED: 22 Ways to Help a Friend With Breast Cancer

When asked what it felt like to get that response, he told ESPN’s Lisa Salters: “The same way it made you feel after you heard it—like, man. He told me no.”

But shortly after, he announced that he will pay for 53 mammograms at a hospital in Pittsburgh, and in Charlotte, North Carolina; one mammogram for every year of his mom’s life. Insurance covers mammograms, but people without insurance must pay out of pocket, making it quite an expense for many.

RELATED: 25 Breast Cancer Myths Busted

And while the NFL covers equipment and merchandise in a hot, magenta pink every October (and only for October), purportedly to raise money for breast cancer research, they’ve come under fire recently about how much of that money actually goes towards cancer research—and how much goes straight back to the NFL.

Just think what could be accomplished if every NFL player donated a few mammograms this month instead of just wearing pink?

Still Williams’ commitment to that awareness color is heart-warming. To that end, he actually already has a workaround for wearing pink every month, regardless of the NFL rules: he can dye his hair. “It’s part of the uniform from the standpoint of being tackled, but it’s not specific on what color it has to be or if it has to match the uniform,” he told ESPN’s Stalter.

^tfw

 

In the above NFL video, he summed it up with this: “Pink is not a color, it’s a culture for me. I’ll wear the color pink on the field for the rest of my career.”

RELATED: 15 Worst Things You Can Say to Someone Battling Breast Cancer

Update (October 16, 2015): After numerous outlets reported on Williams’ decision to pay for mammograms, he posted a clarification on both his Twitter and Facebook accounts. Turns out, “there’s much more to it,” he says. He will also fund follow-up care for the women, and he is extending the initiative, which began in 2014, to a hospital in Memphis, as well as those in Pittsburgh and Charlotte, North Carolina.

Amy Robach on What Life After Breast Cancer Is Really Like

It’s been nearly two years since Good Morning America anchor Amy Robach announced her breast cancer diagnosis on live TV, following an on-air mammogram that colleague Robin Roberts urged her to get. In Amy’s new memoir, Better ($27, amazon.com), she writes candidly about her mastectomy, chemotherapy, and recovery over the next 12 months. In this excerpt from the book’s last chapter, she reflects on her new “normal” and what it’s like to live with the odds of a recurrence.

For women who’ve been successfully treated for breast cancer, there is a 30 percent chance that the disease will come back. There’s also something called an “Onco Score,” which weighs the details of each case to arrive at an individual’s specific odds of a recurrence. My Onco Score predicts my chances of bad news at 16 percent. But as my brother explained to me, the odds for any given individual are either 100 percent of zero percent. That’s because, where it counts, each of us is a population of one.

The disease gets cut out and blasted and poisoned away, and then you sit and wait. Doctors say, “You’re going to be fine,” but it really breaks down into survival rates at five years and survival rates at ten years. If breast cancer metastasizes, it’s terminal. I’ve always been a very positive person, even during my divorce and earlier medical issues. I’m like Orphan Annie, I guess, always believing that everything’s going to be better tomorrow, even when it’s hitting the fan today.

But when I was diagnosed, I felt that my sunny outlook had been stolen, and for a long time I was pissed that I couldn’t get it back. I kept trying to frame things in a positive way, but somehow I couldn’t find the unbridled joy and optimism I used to have. That’s because, deep down, I spent a lot of my time feeling terrified.

RELATED: 15 Worst Things You Can Say to Someone Battling Breast Cancer

Fear is an adaptation meant to keep us out of trouble, so it can be a good thing, but only if we learn how to manage it and make the most of what it’s trying to tell us. But there have been plenty of moments since my diagnosis when what I felt was plain old vanilla fear, and that’s when I’d break down.

Living with cancer is like your first time on a sailboat: If you’re not used to sailing, it takes a while to adjust to the way the boat heels over on its side. It takes time to relax and accept that this is just how sailboats are and that you’re not going to go down because you’re on a slant and a few waves are coming over the railing.

When you’re living with cancer, your feet can be on dry and solid ground, but you still feel tippy. You are never fully stable and secure. I’ve always been a list-maker, a goal-setter, and a forward thinker, because I’ve always had the luxury of assuming that the future is part of the deal. I felt robbed of that, as well. For the first time in my life, I was afraid to think about next year, or the year after. Trying to picture five or 10 years down the road seemed impossibly audacious. I’ve had to work to see the future as part of the excitement of life, and that excitement comes not only from anticipating it but from investing in it, too.

I think we all begin to see mortality as less distant and abstract as we get older. Our expectations no longer flow endlessly from this decade to the next and on and on. Instead we start counting backward, keeping a tally of how much time we figure we might have left. When I got my diagnosis, that sense of limited time hit me in the face with a whopping one-two punch.

RELATED: 22 Ways to Help a Friend With Breast Cancer

So for a while I stopped making to-do lists and caring about whether the laundry was neatly folded. But being indifferent to the small stuff is unsettling when being super-organized and getting all those details right is essential to who you are.

Technically, a breast cancer patient is back to “normal” after a year out of chemo. But the fear lingers in your gut because you’re only good until you find that next lump, or that next ache, or you do the next blood work. You no longer have the luxury of feeling that tomorrow is a given.

When I am going to die becomes front and center in your consciousness, you lose touch with the little pleasures of moment-to-moment existence. The cup of coffee in the morning isn’t as tasty, and going to bed at night isn’t as cozy, because you’ve looked beyond the veil. Once you’ve lost the positive illusion of endless time, you have to struggle to feel that life is good, because you can never say to yourself, Relax. Settle in. I’m going to be here awhile.

There have been a lot of days since October 2013 in which I’ve felt in my gut that my cancer will come back. But, as my husband Andrew always reminds me, “Don’t die before you die.” Every day I try to bring my focus back to the beauty of life rather than the fear of death.

In books and movies, characters who have a health crisis always quit their high-powered jobs to do something “more meaningful,” like work with wood or grow organic vegetables. But you don’t have to completely reinvent yourself in a one-stoplight town in order to be transformed by a horrible experience. I would say that there’s also something called “transformation in place.” It’s more subtle, because it looks like you’re doing the same things. But the difference is, you’re doing all those things in a more mindful way, because you’ve looked into the valley of death.

The issue isn’t whether your life is hectic or low key but whether it is authentically yours. Whether I have five years or another 50, I want to relish every minute. And for me, that means living in the moment and doing exactly what I do, at the same frenetic pace, because I really love it.

Excerpted from BETTER by Amy Robach Copyright © 2015 by Amy Robach. Excerpted by permission of Ballantine Books, a division of Random House LLC. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

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Brad Pitt Describes the Moment He Heard About Angelina's Cancer Scare

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In case you forgot who holds the crown for most heart-warming power couple in history, Brad Pitt and Angelina Jolie are here to remind you that it’s them.

On the Today show this morning, Tom Brokaw interviewed the pair to promote their upcoming film By the Sea. While it’s exciting that the movie, which was also written and directed by Jolie, will be the first time the duo have worked together on-screen since Mr. and Mrs. Smith, the best parts came when the couple opened up about supporting one another through Jolie’s health struggles the past few years.

Jolie is a carrier of the BRCA 1 gene, which gives her an 87% chance of breast cancer and a 50% chance of developing ovarian cancer; her mother, grandmother, and aunt died of cancer. In 2013, Jolie had a preventive mastectomy to avoid breast cancer. Earlier this year, she announced that a blood test revealed possible signs of early ovarian cancer, so she made the decision to have her ovaries and fallopian tubes removed as well.

“I made the choices I made because I believe they were right for me,” Jolie said of her surgeries.

RELATED: What You Should Know About Angelina Jolie’s Cancer-Preventing Surgery

Pitt recalled the moment he got the news that his wife may have ovarian cancer, saying the hardest part was not being by her side.

“I was out in France, and Angie called me and I got straight on a plane to return,” Pitt said. “Seeing my wife have to be her strongest and knowing that it’s the scariest of news is terribly moving. And not being there is a horrible feeling.”

Pitt also called her decision to go through the surgery “mature.”

It was like, “this is our life and we’re going to make the best of it,” Pitt explained. “There was strength in that. It was just another one of those things in life that makes you tighter. She was doing it for the kids, and she was doing it for her family, so we could be together. It was… It trumped everything,” he told Brokaw.

Jolie added that her husband’s support played a huge role in getting her through this difficult time.

“I knew through the surgeries that he was on my side and that this wasn’t something where I was going to feel less of a woman because my husband wasn’t going to let that happen,” Jolie added. “To face these issues together and speak about them and talk about what it is to be human, I think can be a beautiful thing.”

RELATED: What Breast Cancer Docs Really Think About the “Angelina Effect”

 

With Early Breast Cancer Treatment, Less May be More: Studies

Women with early-stage breast cancer have a few options when it comes to how to treat the disease. That choice can be based on the particularities of the cancer, to personal preference or, as is often the case, the recommendations of health groups, breast surgeons and oncologists. Certain data that would be helpful in informing that choice can be scant, however, including long-term health outcomes to the costs of different treatments. Now, two new studies add more nuance to the picture.

The first study, presented Thursday at the 2015 San Antonio Breast Cancer Symposium, found that mastectomies followed by breast reconstruction was both costlier and came with more complications than lumpectomies (sometimes referred to as breast-conserving therapy) followed by radiation.

In the study, Dr. Benjamin D. Smith, an associate professor and research director of the breast radiation oncology at the University of Texas MD Anderson Cancer Center, and his team used two databases to look up insurance claim information on younger and older women who were diagnosed with early-stage breast cancer in 2000 through 2011. The researchers also looked at results from the different treatment options offered to women with early-stage breast cancer. The studied authors assessed complications from the women’s treatments as well as complication-related costs and total costs.

MORE: Why Doctors Are Rethinking Breast Cancer Treatment

They found the risk for complications from mastectomy with reconstruction but without radiation was double that of lumpectomy with radiation for older and younger women. Costs from complications for the mastectomy with reconstruction was $8,608 higher compared to lumpectomy with radiation for younger women with private insurance and $2,568 higher for older women on Medicare.

One of the reasons some women opt for lumpectomy over mastectomy is that the procedure preserves the breast as much as possible. Many women who choose the mastectomy option, on the other hand, stress that it allows them to avoid radiation. (Others say they prefer surgery because they think it means they can’t have a recurrence of the cancer, which is incorrect.)

The rates of mastectomy and reconstruction rates have been on the rise in the U.S. over the last 10 years, and his study helps parse the harms associated with the procedure compared to others. “I was very surprised. I wasn’t expecting there to be such a difference, especially in terms of cost,” says Smith.

A second study led by Sabine Siesling, a senior researcher at the Netherlands Comprehensive Cancer Organisation, similarly found that breast-conserving therapy resulted in better health outcomes compared to mastectomies for women with early-stage breast cancer. Siesling and her team looked at the overall survival and disease-free survival rates among women after breast-conserving therapy or mastectomy.

They studied two groups of thousands of women with early-stage breast cancer and found that the women who underwent breast-conserving therapy were 21% more likely to still be living 10 years later compared to the women who underwent mastectomy. When looking at the smaller of the two cohorts, they also found that the women who underwent brachytherapy—an advanced procedure that that involves placing radioactive material inside your body—developed fewer regional recurrences or distant metastases (cancer that spreads from the initial organ to elsewhere in the body) compared to women who had mastectomies.

“I think this will be surprising for women because most trials and observational studies said there were similar prognosis. I think some women feel more secure if they’ve had they’ve had their breast amputated,” says Siesling. “I think the main message is that women should be very well informed at the time of decision-making.”

Dr. Mehra Golshan, a surgical oncologist at the Dana-Farber/Brigham and Women’s Cancer Center says the findings underline the basic fact that when you do a bigger surgery, there’s a longer recovery time which could contribute to more complications. “Women and and providers should know that once you do the surgery the woman should be prepared to deal with the wounds and recovery and possibility other surgeries,” he says. Golshan was not involved in the study.

Dr. Shelley Hwang, a surgical oncologist at Duke Medicine, says the findings have limitations since the women in the study get to choose what group they are in (since they choose their treatment method). There are other factors that women may take into account, like family history, that can’t be accounted for in the research design. Women who get more treatment might have a different risk, she says. “Overall, this underscores the findings of prospective randomized trials which show that breast-conserving therapy is not worse [than mastectomy], but the magnitude of benefit of breast-conserving therapy is difficult to quantify since there are imbalances in the groups,” she says. Hwang was also not involved in the trial.

This article originally appeared on Time.com.

Delays Can Be Deadly in Early

By E.J. MundellHealthDay Reporter

THURSDAY, Dec. 10, 2015 (HealthDay News) — The sooner early stage breast cancer patients have surgery following their diagnosis, and chemotherapy after their surgery, the better their chances of survival, two new studies find.

In one study, researchers at Fox Chase Cancer Center in Philadelphia analyzed data from more than 94,500 American women aged 66 and older. All were diagnosed with breast cancer between 1992 and 2009.

The team, led by Dr. Richard Bleicher, found a 9 percent increased risk of death from all causes for each 30-day delay in the time from diagnosis to surgery.

The link between time to surgery and risk of death from all causes was only statistically significant for patients with earlier stages of cancer, the researchers noted. In the study, delays seemed to affect prognosis for patients with stage 1 and stage 2 cancers, but not for those with stage 3 cancers.

The findings were similar when Bleicher’s team conducted a second analysis of data involving more than 115,700 American women age 18 and older, who were diagnosed with breast cancer between 2003 and 2005.

Even after adjusting for a number of other factors, a longer time to surgery was still associated with increased risk of death, the researchers found.

This is “the most comprehensive study of the subject ever performed, and includes two extraordinarily large groups from two of the largest cancer databases in the United States,” Bleicher, associate professor of surgical oncology, said in a Fox Chase news release. “The findings from the analysis answer a question that nearly every patient asks: ‘Will my prognosis be affected by the time it takes me to get to surgery?'”

Long delays were rare: Only 1.2 percent of patients in the first analysis and 1.5 of those in the second analysis had surgery more than 90 days after their breast cancer diagnosis, the researchers noted.

In a second study, researchers at the University of Texas MD Anderson Cancer Center in Houston tracked outcomes for almost 25,000 patients in California who were diagnosed with invasive breast cancer (stages 1 to 3).

The researchers wanted to see if survival was affected by the time elapsed between breast cancer surgery and the initiation of follow-up chemotherapy.

The women averaged 53 years of age and the median time to chemotherapy after their breast cancer surgery was 43 days, reported a team led by Dr. Mariana Chavez-MacGregor.

The researchers found no differences in outcomes for patients whose chemotherapy began anywhere between 31 days and 90 days after their surgery.

However, women whose post-op chemo started 91 days or longer after their surgery did fare worse. Those women had a 34 percent higher odds for death from any cause, and a 27 percent higher risk for death linked to breast cancer, compared to women whose chemo started sooner, the researchers said.

“Given the results of our analysis, we would suggest that all breast cancer patients that are candidates for adjuvant chemotherapy should receive this treatment within 91 days of surgery or 120 days from diagnosis,” Chavez-MacGregor and colleagues wrote.

“Administration of chemotherapy within this frame is feasible in clinical practice under most clinical scenarios, and as medical oncologists, we should make every effort not to delay the initiation of adjuvant chemotherapy,” they added.

Both studies were published Dec. 10 in JAMA Oncology.

Experts in breast cancer care agreed that timing is important to patient outcomes.

“Though these two studies are retrospective, and not the highest level of evidence, they nonetheless support the notion the delays of beyond 30 days in both time to surgery and time to adjuvant chemotherapy after breast surgery—especially in women with triple negative breast cancer—should be kept to a minimum as much as possible,” said Dr. Charles Shapiro, director of Translational Breast Cancer Research at Mount Sinai Health System in New York City.

Another expert said that a patient’s medical team must work together to ensure that treatments occur in a timely manner.

“The best way to treat breast cancer is with a team approach,” said Dr. Frank Monteleone, chief of breast services and director of the Breast Health Center at Winthrop-University Hospital in Mineola, N.Y.

“Radiologists, breast surgeons, radiation oncologists, and medical oncologists need to work together to ensure that the time between diagnosis, surgery, and oncology treatment is done in the quickest time possible,” he said. “Also important is a supportive staff, including nurse navigators and social workers, to identify and reduce or eliminate barriers that will delay patients from receiving the care they need.”

Dr. Lauren Cassell, chief of breast surgery at New York City’s Lenox Hill Hospital, agreed. “There’s nothing wrong with a little helping hand in navigating the process, particularly for a patient who may be overwhelmed by her diagnosis,” she said.

More information

Breastcancer.org has more about breast cancer surgery.


If All Women Breastfed, 800,000 Lives Might Be Saved

THURSDAY, Jan. 28, 2016 (HealthDay News) — If nearly all women worldwide breastfed their infants and young children, there would be about 800,000 fewer children’s deaths and 20,000 fewer breast cancer deaths a year, researchers report.

That decrease in children’s deaths is equivalent to 13 percent of all deaths in children younger than 2 years of age, the study authors reported in a two-part series published online Jan. 28 in The Lancet.

The researchers also said that current breastfeeding practices cost the world’s economy hundreds of billions of dollars a year.

“There is a widespread misconception that the benefits of breastfeeding only relate to poor countries. Nothing could be further from the truth,” series author Cesar Victora, of Federal University of Pelotas in Brazil, said in a journal news release.

“Our work for this series clearly shows that breastfeeding saves lives and money in all countries, rich and poor alike. Therefore, the importance of tackling the issue globally is greater than ever,” Victora added.

Only one in five children in high-income countries is breastfed for 12 months, the researchers said. And, only one in three children in low- and middle-income countries is exclusively breastfed for the first 6 months.

This means that millions of children and women don’t receive the full benefits offered by breastfeeding, which has been shown to be healthy for both mothers and children, the study authors said.

In a detailed worldwide analysis, the researchers identified a number of benefits of breastfeeding. For example, breastfeeding lowers the risk of sudden infant death in high-income countries by more than one-third, they said.

The study also found that breastfeeding could prevent about half of all cases of diarrhea and one-third of respiratory infections in low- and middle-income countries.

Breastfeeding reportedly also boosts children’s intelligence and may protect them against obesity and diabetes later in life, the researchers said. Among mothers, long-term breastfeeding reduces the risk of breast and ovarian cancer, the researchers added.

The investigators also estimated that poorer thinking skills among children who aren’t breastfed cost the global economy about $302 billion in 2012. The loss in high-income countries alone was $231 billion, the study concluded.

Increasing breastfeeding rates for infants younger than 6 months to 90 percent in the United States, China and Brazil, and to 45 percent in the United Kingdom, would lower treatment costs of common childhood illnesses—such as pneumonia, diarrhea, and asthma. This could save health care systems about $2.5 billion in the United States, $29.5 million in the United Kingdom, $224 million in China and $6 million in Brazil, according to the study.

Despite the many benefits of breastfeeding, rates are low, especially in high-income countries, the study showed.

“Breastfeeding is one of the few positive health behaviors that is more common in poor than richer countries, and within poor countries, is more frequent among poor mothers,” Victora explained.

“The stark reality is that in the absence of breastfeeding, the rich-poor gap in child survival would be even wider. Our findings should reassure policymakers that a rapid return on investment is realistic and feasible, and won’t need a generation to be realized,” he said in the news release.

Reasons for low breastfeeding rates include poor promotion and support of breastfeeding, and aggressive marketing and rising sales of infant formula, the study authors said.

“There is a widespread misconception that breast milk can be replaced with artificial products without detrimental consequences,” Victora said.

“The evidence outlined in the series, contributed by some of the leading experts in the field, leaves no doubt that the decision not to breastfeed has major long-term negative effects on the health, nutrition and development of children and on women’s health,” Victora concluded.

More information

The U.S. Office on Women’s Health has more on breastfeeding.