Tuesday, March 20, 2007

High blood pressure (hypertension)

You can have high blood pressure (hypertension) for years without a single symptom. But silence isn't golden. Uncontrolled high blood pressure increases your risk of serious health problems, including heart attack and stroke.

Blood pressure is determined by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.

High blood pressure typically develops without signs or symptoms. And it affects nearly everyone eventually. If you don't have high blood pressure by age 55, you have a 90 percent chance of developing it at some point in your life, according to the National Heart, Lung, and Blood Institute. Fortunately, high blood pressure can be easily detected. And once you know you have high blood pressure, you can work with your doctor to control it.

Signs and symptoms
Most people with high blood pressure have no signs or symptoms, even if blood pressure readings reach dangerously high levels.

Although a few people with early-stage high blood pressure may have dull headaches, dizzy spells or a few more nosebleeds than normal, these signs and symptoms typically don't occur until high blood pressure has reached an advanced — possibly life-threatening — stage.

In 90 percent to 95 percent of high blood pressure cases, the American Heart Association says there's no identifiable cause. This type of high blood pressure, called essential hypertension or primary hypertension, tends to develop gradually over many years.

The other 5 percent to 10 percent of high blood pressure cases are caused by an underlying condition. This type of high blood pressure, called secondary hypertension, tends to appear suddenly and cause higher blood pressure than does primary hypertension. Various conditions can lead to secondary hypertension, including kidney abnormalities, tumors of the adrenal gland or certain congenital heart defects.

Certain medications — including birth control pills, cold remedies, decongestants, over-the-counter pain relievers and some prescription drugs — also may cause secondary hypertension. In a 2005 study, women who took an average of 500 milligrams or more of acetaminophen (Tylenol, others) daily over several years were more likely to develop high blood pressure than were women who didn't take any acetaminophen. It's not known if the same holds true for men.

Various illicit drugs, including cocaine and amphetamines, also can increase blood pressure.

Risk factors
High blood pressure has many risk factors. Some you can't control.

Age. The risk of high blood pressure increases as you get older. Through early middle age, high blood pressure is more common in men. Women are more likely to develop high blood pressure after menopause.
Race. High blood pressure is particularly common among blacks, often developing at an earlier age than it does in whites. Serious complications, such as stroke and heart attack, also are more common in blacks.
Family history. High blood pressure tends to run in families.
Other risk factors for high blood pressure are within your control.

Excess weight. The greater your body mass, the more blood you need to supply oxygen and nutrients to your tissues. As the volume of blood circulated through your blood vessels increases, so does the pressure on your artery walls.
Inactivity. People who are inactive tend to have higher heart rates. The higher your heart rate, the harder your heart must work with each contraction — and the stronger the force on your arteries. Lack of physical activity also increases the risk of being overweight.
Tobacco use. The chemicals in tobacco can damage the lining of your artery walls, which promotes narrowing of the arteries.
Sodium intake. Too much sodium in your diet — especially if you have sodium sensitivity — can lead to fluid retention and increased blood pressure.
Low potassium intake. Potassium helps balance the amount of sodium in your cells. If you don't consume or retain enough potassium, you may accumulate too much sodium in your blood.
Excessive alcohol. Over time, heavy drinking can damage your heart.
Stress. High levels of stress can lead to a temporary but dramatic increase in blood pressure. If you try to relax by eating more, using tobacco or drinking alcohol, you may only fuel problems with high blood pressure.
Certain chronic conditions also may increase your risk of high blood pressure, including high cholesterol, diabetes, kidney disease and sleep apnea. Sometimes pregnancy contributes to high blood pressure.

In a 2006 study, adults who worked more than 40 or 50 hours a week — particularly clerical and unskilled workers — were more likely to have high blood pressure than were those who worked 40 hours or less a week. Researchers tied the higher risk for workers with longer hours to unhealthy eating, less exercise, more stress and less sleep.

Although high blood pressure is most common in adults, children may be at risk, too. For some children, high blood pressure is caused by problems with the kidneys or heart. But for a growing number of kids, poor lifestyle habits — such as an unhealthy diet and lack of exercise — contribute to high blood pressure.

When to seek medical advice
Ask your doctor for a blood pressure reading at least every two years. He or she may recommend more frequent readings if you have prehypertension, high blood pressure or other risk factors for cardiovascular disease.

Screening and diagnosis
Blood pressure is measured with an inflatable arm cuff and a pressure-measuring gauge. A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The first, or upper, number measures the pressure in your arteries when your heart beats (systolic pressure). The second, or lower, number measures the pressure in your arteries between beats (diastolic pressure).

The latest blood pressure guidelines, issued in 2003 by the National Heart, Lung, and Blood Institute, divide blood pressure measurements into four general categories:

Normal blood pressure. Your blood pressure is normal if it's below 120/80 mm Hg — but some data indicate that 115/75 mm Hg should be the gold standard. Once blood pressure rises above 115/75 mm Hg, the risk of cardiovascular disease begins to increase.
Prehypertension. Prehypertension is a systolic pressure ranging from 120 to 139 or a diastolic pressure ranging from 80 to 89. Prehypertension tends to get worse over time. Within four years of being diagnosed with prehypertension, nearly one in three adults ages 35 to 64 and nearly one in two adults age 65 or older progress to definite high blood pressure.
Stage 1 hypertension. Stage 1 hypertension is a systolic pressure ranging from 140 to 159 or a diastolic pressure ranging from 90 to 99.
Stage 2 hypertension. The most severe hypertension, stage 2 hypertension is a systolic pressure of 160 or higher or a diastolic pressure of 100 or higher.
Both numbers in a blood pressure reading are important. But after age 50, the systolic reading is even more significant. Isolated systolic hypertension (ISH) — when diastolic pressure is normal but systolic pressure is high — is the most common type of high blood pressure among people older than 50.

A single high blood pressure reading usually isn't enough for a diagnosis. Because blood pressure normally varies throughout the day — and sometimes specifically during visits to the doctor — diagnosis is based on more than one reading taken on more than one occasion. Your doctor may ask you to record your blood pressure at home and at work to provide additional information.

If you have any type of high blood pressure, your doctor may recommend routine tests, such as a urine test (urinalysis), blood tests and an electrocardiogram (ECG) — a test that measures your heart's electrical activity. More extensive testing isn't usually needed.

Excessive pressure on the artery walls can damage your vital organs. The higher your blood pressure and the longer it goes uncontrolled, the greater the damage.

Uncontrolled high blood pressure can lead to:

Damage to your arteries. This can result in hardening and thickening of the arteries (atherosclerosis), which can lead to a heart attack or other complications. An enlarged, bulging blood vessel (aneurysm) also is possible.
Heart failure. To pump blood against the higher pressure in your vessels, your heart muscle thickens. Eventually, the thickened muscle may have a hard time pumping enough blood to meet your body's needs, which can lead to heart failure.
A blocked or ruptured blood vessel in your brain. This can lead to stroke.
Weakened and narrowed blood vessels in your kidneys. This can prevent these organs from functioning normally.
Thickened, narrowed or torn blood vessels in the eyes. This can result in vision loss.
Metabolic syndrome. This syndrome is a cluster of disorders of your body's metabolism — including elevated waist circumference, high triglycerides, low high-density lipoprotein (HDL), or "good," cholesterol, high blood pressure and high insulin levels. If you have high blood pressure, you're more likely to have other components of metabolic syndrome. The more components you have, the greater your risk of developing diabetes, heart disease or stroke.
Uncontrolled high blood pressure also may affect your ability to think, remember and learn. Cognitive impairment and dementia are more common in people who have high blood pressure.

Treating high blood pressure can help prevent serious — even life-threatening — complications. Your doctor also may suggest steps to control conditions that can contribute to high blood pressure, such as diabetes and high cholesterol.

Blood pressure goals aren't the same for everyone. Although everyone should strive for blood pressure readings below 140/90, doctors recommend lower readings for people with certain conditions. The goal is 130/80 if you have or have had chronic kidney disease or diabetes.

Changing your lifestyle can go a long way toward controlling high blood pressure. But sometimes lifestyle changes aren't enough. In addition to diet and exercise, your doctor may recommend medication to lower your blood pressure. Which category of medication your doctor prescribes depends on your stage of high blood pressure and whether you also have other medical conditions. To reduce the number of doses you need a day, which can reduce side effects, your doctor may prescribe a combination of low-dose medications rather than larger doses of one single drug. In fact, two or more blood pressure drugs often work better than one. Sometimes finding the most effective medication — or combination of drugs — is a matter of trial and error.

The major types of medication used to control high blood pressure include:

Thiazide diuretics. These medications act on your kidneys to help your body eliminate sodium and water, reducing blood volume. Thiazide diuretics are often the first — but not the only — choice in high blood pressure medications. In a 2006 study, diuretics were a key factor in preventing heart failure associated with high blood pressure.
Beta blockers. These medications reduce the workload on your heart, causing your heart to beat slower and with less force. When prescribed alone, beta blockers don't work as well in blacks — but they're effective when combined with a thiazide diuretic.
Angiotensin-converting enzyme (ACE) inhibitors. These medications help relax blood vessels by blocking the formation of a natural chemical that narrows blood vessels. ACE inhibitors may be especially important in treating high blood pressure in people with coronary artery disease, heart failure or kidney failure. Like beta blockers, ACE inhibitors don't work as well in blacks when prescribed alone, but they're effective when combined with a thiazide diuretic.
Angiotensin II receptor blockers. These medications help relax blood vessels by blocking the action — not the formation — of a natural chemical that narrows blood vessels. Like ACE inhibitors, angiotensin II receptor blockers often are useful for people with coronary artery disease, heart failure and kidney failure.
Calcium channel blockers. These medications help relax the muscles of your blood vessels. Some slow your heart rate. Calcium channel blockers may work better for blacks than do ACE inhibitors or beta blockers alone. A word of caution for grapefruit lovers, though. Grapefruit juice interacts with some calcium channel blockers, increasing blood levels of the medication and putting you at higher risk of side effects. Researchers have identified the substance in grapefruit juice that causes the potentially dangerous interaction, which may one day lead to commercial grapefruit juices that don't pose a risk of interaction. For now, however, talk to your doctor or pharmacist if you're concerned about interactions.
If you're having trouble reaching your blood pressure goal with combinations of the above medications, your doctor may prescribe:

Alpha blockers. These medications reduce nerve impulses to blood vessels, reducing the effects of natural chemicals that narrow blood vessels.
Alpha-beta blockers. In addition to reducing nerve impulses to blood vessels, alpha-beta blockers slow the heartbeat to reduce the amount of blood that must be pumped through the vessels.
Central-acting agents. These medications prevent your brain from signaling your nervous system to increase your heart rate and narrow your blood vessels.
Vasodilators. These medications work directly on the muscles in the walls of your arteries, preventing the muscles from tightening and your arteries from narrowing.
Once your blood pressure is under control, your doctor may add aspirin to your regimen to reduce your risk of cardiovascular disorders.

Lifestyle changes can help you control and prevent high blood pressure — even if you're taking blood pressure medication. Here's what you can do:

Eat healthy foods. Try the Dietary Approaches to Stop Hypertension (DASH) diet, which emphasizes fruits, vegetables, whole grains and low-fat dairy foods. Get plenty of potassium, which can help prevent and control high blood pressure. Eat less saturated fat and total fat. Limit the amount of sodium in your diet. Although 2,400 milligrams (mg) of sodium a day is the current limit for otherwise healthy adults, limiting sodium intake to 1,500 mg a day will have a more dramatic effect on your blood pressure.
Maintain a healthy weight. If you're overweight, losing even 5 pounds can lower your blood pressure.
Increase physical activity. Regular physical activity can help lower your blood pressure and keep your weight under control. Strive for at least 30 minutes of physical activity a day.
Limit alcohol. Even if you're healthy, alcohol can raise your blood pressure. If you choose to drink alcohol, do so in moderation — up to one drink a day for women, two drinks a day for men.
Don't smoke. Tobacco injures blood vessel walls and speeds up the process of hardening of the arteries. If you smoke, ask your doctor to help you quit.
Manage stress. Reduce stress as much as possible. Practice healthy coping techniques, such as muscle relaxation and deep breathing. Getting plenty of sleep can help, too.
Practice slow, deep breathing. Do it on your own or try device-guided paced breathing. In various clinical trials, regular use of Resperate — an over-the-counter device approved by the Food and Drug Administration to analyze breathing patterns and help guide inhalation and exhalation — significantly lowered blood pressure.

Coping skills
High blood pressure isn't a problem that you can treat and then ignore. It's a condition you need to manage for the rest of your life. To keep your blood pressure under control:

Measure your blood pressure at home. Home blood pressure monitoring can help you keep closer tabs on your blood pressure, show if medication is working, and even alert you and your doctor to potential complications.
Take your medications properly. If side effects or costs pose problems, don't stop taking your medications. Ask your doctor about other options.
Schedule regular doctor visits. It takes a team effort to treat high blood pressure successfully. Your doctor can't do it alone, and neither can you. Work with your doctor to bring your blood pressure to a safe level — and keep it there.
Adopt healthy habits. Eat healthy foods, lose excess weight and get regular physical activity. Limit alcohol. If you smoke, quit.
Manage stress. Say no to extra tasks, release negative thoughts, maintain good relationships, and remain patient and optimistic.
Sticking with all this can be difficult — especially if you don't see or feel any symptoms of high blood pressure. If you need motivation, remember the risks associated with uncontrolled high blood pressure. It may help to enlist the support of your family and friends as well.

Thursday, March 8, 2007



You wake up in the middle of the night, and your big toe feels as if it's on fire. It's hot, swollen and so tender that even the weight of a blanket on it seems intolerable. These problems could indicate an acute attack of gout — or gouty arthritis — a form of arthritis that's characterized by sudden, severe attacks of pain, redness and tenderness in joints.

Gout is a complex disorder that can affect anyone. Men are more likely to get gout than women are, but women become increasingly susceptible to gout after menopause.

Fortunately, gout is treatable, and there are ways to keep gout from recurring.

Signs and symptoms


The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:

Intense joint pain. Gout usually affects the large joint of your big toe but can occur in your feet, ankles, knees, hands and wrists. The pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free.
Inflammation and redness. The affected joint or joints become swollen, tender and red.


The cause of gout is an inflammation in your joint resulting from an accumulation of urate crystals. Uric acid is a waste product formed from the breakdown of purines. These are substances found naturally in your body as well as in certain foods, especially organ meats — such as liver, brains, kidney and sweetbreads — and anchovies, herring, asparagus and mushrooms.

Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much or excretes too little of this acid. In that case, uric acid can build up, forming sharp, needle-like crystals (urate) in a joint or surrounding tissue that cause pain, inflammation and swelling.

Crystal deposits also cause another condition, known as false gout (pseudogout). But rather than being composed of uric acid, pseudogout crystals are made of calcium pyrophosphate dihydrate. And while pseudogout can affect the big toe, it's more likely to attack large joints such as your knees, wrists and ankles.

Risk factors

The following conditions or circumstances can increase the chances you'll develop high levels of uric acid that may lead to gout:

Lifestyle factors. Excess consumption of alcohol is a common lifestyle factor that increases the risk of gout. Excess alcohol generally means more than two drinks a day for men and more than one for women. Gaining 30 pounds or more than your ideal weight during adulthood also increases your risk.

Medical conditions. Certain diseases make it more likely that you'll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions, such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).

Certain medications. The use of thiazide diuretics — used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone a transplant.

Genetics. About one out of five people with gout has a family history of the condition.

Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop symptoms after menopause.

When to seek medical advice

If you experience sudden, intense pain in a joint, call your doctor. Gout that goes untreated can lead to worsening pain and joint damage.

Seek medical care immediately if you have a fever and a joint is hot and inflamed, which also can be a sign of infection.

Screening and diagnosis

To help diagnose gout, your doctor may withdraw fluid from the affected joint to check for crystals of uric acid in your white blood cells. Other tests may include:

Urine test. You may have a urine test to measure the amount of uric acid you're excreting.
Blood test. Your doctor may have you undergo a blood test to measure the uric acid level in your blood.


Some people with gout develop a chronic form of arthritis, often with discolored deposits under the skin called tophi. A small number of people with gout also develop kidney stones.


For gout attacks, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others), may provide relief. Keep in mind that these medications can cause side effects, including stomach pain, bleeding and ulcers. What's more, NSAIDs have a ceiling effect — a limit as to how much pain they can control. This means that beyond a certain dosage, they don't provide additional benefits.

For severe cases, your doctor may prescribe a corticosteroid drug such as prednisone. Although steroids can provide dramatic relief, they can also cause serious side effects, including thinning bones, poor wound healing and decreased ability to fight infection. Sometimes doctors inject cortisone into the affected joint, but this approach can still cause side effects, and shots are generally limited to no more than three a year.

Once the acute attack is under control, your doctor may recommend preventive treatment to slow the rate at which your body produces uric acid or to increase the rate at which it's excreted.


There's no sure way to prevent initial or subsequent attacks of gout, but if you already have gout, your doctor may prescribe certain drugs to reduce the risk or lessen the severity of future episodes. These drugs include allopurinol (Zyloprim, Aloprim) and probenecid. Taken daily, they slow the rate at which uric acid is produced and speed its elimination from your body. In general, keeping uric acid levels within a normal range is the long-term key to preventing gout.


Lifestyle changes can't cure gout, but the following measures may help relieve symptoms:

Maintain a healthy weight. Gradual weight loss will lessen the load on affected weight-bearing joints. Losing weight may also decrease uric acid levels. Avoid fasting or rapid weight loss because doing so may temporarily raise uric acid levels.

Avoid excessive amounts of animal protein. Although medications have decreased the need for severe dietary restrictions in people with gout, some dietary changes can help lessen the severity of gout attacks. They may also serve as an alternative treatment for those who have problems with gout medications. Government guidelines advise eating no more than 5 to 6 ounces of lean meat, poultry or fish a day for nearly everyone — especially people who have gout, because high-protein foods increase the blood level of uric acid. Organ meats (liver, brains, kidney and sweetbreads), anchovies, herring and mackerel are particularly high in purines.

Limit or avoid alcohol. Consuming too much alcohol can inhibit the excretion of uric acid, which in turn can lead to gout. Limit alcohol to no more than two drinks a day if you're a man and one drink a day if you're a woman. If you're having a gout attack, it's best to avoid alcohol completely.

Drink plenty of liquids. Fluids help dilute uric acid in your blood and urine, so be sure you get enough water and other fluids every day.

Tuesday, March 6, 2007

High blood cholesterol


Cholesterol is found in every cell in your body. This fat-like substance is an important component of cell membranes and a building block in the formation of some hormones. But your body makes all the cholesterol it needs. Any cholesterol in your diet is extra — and it's up to no good.

When there's too much cholesterol in your blood, you may develop fatty deposits in your blood vessels. Eventually, these deposits make it difficult for enough blood to flow through your arteries. Your heart may not get as much oxygen-rich blood as it needs, which increases the risk of a heart attack. Decreased blood flow to your brain can cause a stroke.

But there's good news. High blood cholesterol (hypercholesterolemia) is largely preventable. A healthy diet, regular exercise and other lifestyle changes can go a long way toward reducing high cholesterol. Sometimes medication is needed, too.

Signs and symptoms

High cholesterol has no symptoms. A blood test is the only way to detect high cholesterol.


Cholesterol is carried through your blood attached to proteins. The cholesterol-protein package is called a lipoprotein. The main types of lipoproteins are:

Low-density lipoprotein (LDL). LDL, or "bad," cholesterol transports cholesterol throughout your body. LDL cholesterol builds up in the walls of your arteries, making them hard and narrow.
High-density lipoprotein (HDL). HDL, or "good," cholesterol picks up excess cholesterol and takes it back to your liver.
Various factors within your control — such as inactivity, obesity and an unhealthy diet — contribute to high LDL cholesterol and low HDL cholesterol. Factors beyond your control may play a role, too. For example, your genetic makeup may keep cells from removing LDL cholesterol from your blood efficiently or cause your liver to produce too much cholesterol.

Risk factors

You're more likely to have high cholesterol if you're inactive, obese or eat unhealthy foods. Although high cholesterol can lead to heart disease on its own, other factors compound the risk:

Smoking. Cigarette smoking damages the walls of your blood vessels, making them likely to accumulate fatty deposits. Smoking may also lower your level of HDL cholesterol.
High blood pressure. Increased pressure on your artery walls damages your arteries, which can speed the accumulation of fatty deposits.
Diabetes. High blood sugar contributes to high LDL cholesterol and low HDL cholesterol. High blood sugar also damages the lining of your arteries.
Family history of heart disease. If a parent or sibling developed heart disease before age 55, high cholesterol levels place you at a greater than average risk of developing heart disease.

When to seek medical advice

Ask your doctor for a baseline cholesterol test when you're in your 20s and then have your cholesterol tested at least every five years. If your test results aren't within desirable ranges, your doctor may recommend more frequent measurements.

Screening and diagnosis

A blood test to check cholesterol levels — called a lipid panel or lipid profile — typically reports:

Total cholesterol
LDL cholesterol
HDL cholesterol
Triglycerides — a type of fat in the blood
For the most accurate measurements, don't eat or drink anything (other than water) for nine to 12 hours before the blood sample is taken.

Interpreting the numbers
Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. To interpret your test results, use these general guidelines.

Total cholesterol
Below 200 mg/dL Desirable
200-239 mg/dL Borderline high
240 mg/dL and above High

LDL cholesterol
Below 70 mg/dL Optimal for people at very high risk of heart disease
Below 100 mg/dL Optimal for people at risk of heart disease
100-129 mg/dL Near optimal
130-159 mg/dL Borderline high
160-189 mg/dL High
190 mg/dL and above Very high

HDL cholesterol
Below 40 mg/dL Poor
40-59 mg/dL Better
60 mg/dL and above Best

Below 150 mg/dL Desirable
150-199 mg/dL Borderline high
200-499 mg/dL High
500 or above Very high

LDL targets differ
Because LDL cholesterol is closely associated with heart disease, it's the main focus of cholesterol-lowering treatment. But it's not as simple as the chart may appear. Your target LDL number can vary, depending on your underlying risk of heart disease.

Most people should aim for an LDL level below 130 mg/dL. If you have other risk factors for heart disease, your target LDL may be below 100 mg/dL. If you're at very high risk of heart disease, you may need to aim for an LDL level below 70 mg/dL.

So who's considered very high risk? You might be if you've had a heart attack or if you have diabetes. In addition, two or more of the following risk factors might also place you in the very high risk group:

High blood pressure
Low HDL cholesterol
Family history of early heart disease
Age older than 45 if you're a man, or older than 55 if you're a woman


Development of atherosclerosis

High cholesterol can cause atherosclerosis, a dangerous accumulation of fatty deposits on the walls of your arteries. These deposits — called plaques — can reduce blood flow through your arteries. If the arteries that supply your heart with blood (coronary arteries) are affected, you may have chest pain and other symptoms of coronary artery disease.

If plaques tear or rupture, a blood clot may form — blocking the flow of blood or breaking free and plugging an artery downstream. If blood flow to part of your heart stops, you'll have a heart attack. If blood flow to part of your brain stops, a stroke occurs.


Lifestyle changes can help improve your cholesterol level. Eat a healthy diet, get regular physical activity and avoid smoking. If you've made these important lifestyle changes and your total cholesterol — particularly your LDL cholesterol — remains high, your doctor may recommend medication.

The specific choice of medication or combination of medications depends on various factors, including your individual risk factors, your age, your current health and possible side effects. Common choices include:

Statins. Statins — among the most commonly prescribed medications for lowering cholesterol — block a substance your liver needs to make cholesterol. This depletes cholesterol in your liver cells, which causes your liver to remove cholesterol from your blood. Statins may also help your body reabsorb cholesterol from accumulated deposits on your artery walls, potentially reversing coronary artery disease. Choicesinclude atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev, Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).
Bile-acid-binding resins. Your liver uses cholesterol to make bile acids, a substance needed for digestion. The medications cholestyramine (Prevalite, Questran), colesevelam (WelChol) and colestipol (Colestid) lower cholesterol indirectly by binding to bile acids. This prompts your liver to use excess cholesterol to make more bile acids, which reduces the level of cholesterol in your blood.
Cholesterol absorption inhibitors. Your small intestine absorbs the cholesterol from your diet and releases it into your bloodstream. The drug ezetimibe (Zetia) helps reduce blood cholesterol by limiting the absorption of dietary cholesterol. Zetia can be used in combination with any of the statin drugs.
Combination cholesterol absorption inhibitor and statin. The combination drug ezetimibe-simvastatin (Vytorin) decreases both absorption of dietary cholesterol in your small intestine and production of cholesterol in your liver.
If you also have high triglycerides, your doctor may prescribe:

Fibrates. The medications fenofibrate (Lofibra, Tricor) and gemfibrozil (Lopid) decrease triglycerides by reducing your liver's production of very-low-density lipoprotein (VLDL) cholesterol and by speeding up the removal of triglycerides from your blood. VLDL cholesterol contains mostly triglycerides.
Niacin. Niacin (Niaspan) decreases triglycerides by limiting your liver's ability to produce LDL and VLDL cholesterol. Various prescription and over-the-counter preparations are available, but prescription niacin is preferred. Dietary supplements containing niacin are not effective for lowering triglycerides.
Most of these medications are well tolerated, but effectiveness varies from person to person. The most common side effects are stomach pain, constipation, nausea and diarrhea. If you decide to take cholesterol medication, your doctor may recommend periodic liver function tests to monitor the medication's effect on your liver.


Lifestyle changes are the first line of defense against high cholesterol. To promote healthy cholesterol levels, lose excess weight, eat healthy foods and increase your physical activity. If you smoke, quit.

Lose excess pounds
Excess weight contributes to high cholesterol. Losing even 5 to 10 pounds of excess weight can help lower total cholesterol levels. Start by taking an honest look at your eating habits and daily routine. Consider your challenges to weight loss — and ways to overcome them.

Eat heart-healthy foods
What you eat has a direct impact on your cholesterol level. In fact, researchers say a diet rich in fiber and other cholesterol-lowering foods may help lower cholesterol as much as statin medication for some people.

Choose healthier fats. Saturated fat and trans fat raise your total cholesterol and LDL cholesterol. Get no more than 10 percent of your daily calories from saturated fat, and try to avoid trans fat completely. Monounsaturated fat — found in olive, peanut and canola oils — is a healthier option. Almonds and walnuts are other sources of healthy fat.
Limit your cholesterol intake. Aim for no more than 300 milligrams (mg) of cholesterol a day — or less than 200 mg if you have heart disease. The most concentrated sources of cholesterol include organ meats, egg yolks and whole milk products. Use lean cuts of meat, egg substitutes and skim milk instead.
Select whole grains. Various nutrients found in whole grains promote heart health. Choose whole-grain breads, whole-wheat pasta, whole-wheat flour and brown rice. Oatmeal and oat bran are other good choices.
Stock up on fruits and vegetables. Fruits and vegetables are rich in dietary fiber, which can help lower cholesterol. Snack on seasonal fruits. Experiment with veggie-based casseroles, soups and stir-fries.
Eat heart-healthy fish. Some types of fish — such as cod, tuna and halibut — have less total fat, saturated fat and cholesterol than do meat and poultry. Salmon, mackerel and herring are rich in omega-3 fatty acids, which help promote heart health.
Drink alcohol only in moderation. In some studies, moderate use of alcohol has been linked with higher levels of HDL cholesterol — but the benefits aren't strong enough to recommend alcohol for anyone who doesn't drink already. If you choose to drink, do so in moderation. This means no more than one drink a day for women, and one to two drinks a day for men.
Exercise regularly
Regular exercise can help improve your cholesterol levels. With your doctor's OK, work up to 30 to 60 minutes of exercise a day. Take a brisk daily walk. Ride your bike. Swim laps. To maintain your motivation, keep it fun. Find an exercise buddy or join an exercise group.

Don't smoke
If you smoke, stop. Quitting can improve your HDL cholesterol level. And the benefits don't end there. Just 20 minutes after quitting, your blood pressure decreases. Within 24 hours, your risk of a heart attack decreases. Within one year, your risk of heart disease is half that of a smoker's. Within 15 years, your risk of heart disease is similar to that of someone who's never smoked.

Complementary and alternative medicine

Few natural products have been proved to reduce cholesterol, but some might be helpful. With your doctor's OK, consider these cholesterol-lowering supplements and products:

Artichoke extract
Beta-sitosterol (found in oral supplements and some margarines, such as Take Control)
Blond psyllium (found in seed husk and products such as Metamucil)
Garlic extract
Oat bran (found in oatmeal and whole oats)
Sitostanol (found in oral supplements and some margarines, such as Benecol)
If you choose to take cholesterol-lowering supplements, remember the importance of a healthy lifestyle. If your doctor prescribes medication to reduce your cholesterol, take it as directed. Make sure your doctor knows which supplements you're taking as well.

Breast Cancer


Breast cancer is the illness that many women fear most, though they're more likely to die of cardiovascular disease than they are of all forms of cancer combined. Still, breast cancer is second only to lung cancer as a cause of cancer deaths in American women. Although rare, breast cancer can also occur in men — in the United States, more than 200,000 women and around 1,500 men will develop the disease in 2005.

Yet there's more reason for optimism than ever before. In the last 30 years, doctors have made great strides in diagnosing and treating the disease and in reducing breast cancer deaths. In 1975 a diagnosis of breast cancer usually meant radical mastectomy — removal of the entire breast along with underarm lymph nodes and skin and muscles underneath the breast. Today, radical mastectomy is rarely performed. Instead, there are more and better treatment options, and many women are candidates for breast-sparing operations.

Signs and symptoms

Knowing the signs and symptoms of breast cancer may help save your life. When the disease is discovered early, you have more treatment options and a better chance for long-term recovery.

Most breast lumps aren't cancerous. Yet the most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often, the lump is painless. Other signs of breast cancer include:

A spontaneous clear or bloody discharge from your nipple
Retraction or indentation of your nipple
A change in the size or contours of your breast
Any flattening or indentation of the skin over your breast
Redness or pitting of the skin over your breast, like the skin of an orange
A number of factors other than breast cancer can cause your breasts to change in size or feel. In addition to the natural changes that occur during pregnancy and your menstrual cycle, other common noncancerous (benign) breast conditions include:

Fibrocystic changes. This condition can cause your breasts to feel ropy or granular. Fibrocystic changes are extremely common, occurring in at least half of all women. In most cases the changes are harmless. And they don't mean you're more likely to develop breast cancer. If your breasts are very lumpy, performing a breast self-exam is more challenging. Becoming familiar with what's normal for you through self-exams will help make detecting any new lumps or changes easier.
Cysts. These are fluid-filled sacs that frequently occur in the breasts of women ages 35 to 50. Cysts can range from very tiny to about the size of an egg. They can increase in size or become more tender just before your menstrual period, and may disappear completely after it. Cysts are less common in postmenopausal women.
Fibroadenomas. These are solid, noncancerous tumors that often occur in women during their reproductive years. A fibroadenoma is a firm, smooth, rubbery lump with a well-defined shape. It will move under your skin when touched and is usually painless. Over time, fibroadenomas may grow larger or smaller or even disappear completely. Although your doctor can usually identify a fibroadenoma during a clinical exam, a small tissue sample is necessary to confirm the diagnosis.
Infections. Breast infections (mastitis) are common in women who are breast-feeding or who recently have stopped breast-feeding, although you can also develop mastitis when you're not nursing. Your breast will likely be red, warm, tender and lumpy, and the lymph nodes under your arm may swell. You also feel slightly ill and have a low-grade fever.
Trauma. Sometimes a blow to your breast or a bruise also can cause a lump. But this doesn't mean you're more likely to get breast cancer.
Calcium deposits (microcalcifications). These tiny deposits of calcium can appear anywhere in your breast and often show up on a mammogram. Most women have one or more areas of microcalcifications of various sizes. They may be caused by secretions from cells, cellular debris, inflammation, trauma or prior radiation. They're not the result of calcium supplements you take. The majority of calcium deposits are harmless, but a small percentage may be precancerous or cancer. If any appear suspicious, your doctor will likely recommend additional tests and sometimes a biopsy.
If you find a lump or other change in your breast and haven't yet gone through menopause, you may want to wait through one menstrual cycle before seeing your doctor. If the change hasn't gone away after a month, have it evaluated promptly.


Breast anatomy

Each of your breasts contains 15 to 20 lobes of glandular tissue, arranged like the petals of a daisy. The lobes are further divided into smaller lobules that produce milk during pregnancy and breast-feeding. Small ducts conduct the milk to a reservoir that lies just beneath your nipple. Supporting this network is a deeper layer of connective tissue called stroma.

The spaces between the lobes and ducts are filled with fat, which makes up about 80 percent to 85 percent of your breast during your reproductive years. Your breasts also contain vessels that transport lymph — a colorless fluid that carries waste products and cells of the immune system — to lymph nodes located primarily under your arm (axillary nodes) but also above your collarbone and in your chest. These nodes are collections of immune system cells that filter harmful bacteria and play a key role in fighting infection.

In breast cancer, some of the cells in your breast begin growing abnormally. These cells divide more rapidly than healthy cells do and may spread through your breast, to the lymph or to other parts of your body (metastasize). The most common type of breast cancer begins in the milk-producing ducts, but cancer may also occur in the lobules or in other breast tissue.

In most cases, it isn't clear what triggers abnormal cell growth in breast tissue, but doctors do know that between 5 percent and 10 percent of breast cancers are inherited. Defects in one of two genes, breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2), put you at greater risk of developing both breast and ovarian cancer. Inherited mutations in the ataxia-telangiectasia mutation gene, the cell-cycle checkpoint kinase 2 (CHEK-2) gene and the p53 tumor suppressor gene also make it more likely that you'll develop breast cancer.

Yet most genetic mutations related to breast cancer aren't inherited but instead develop during your lifetime. These acquired mutations may result from radiation exposure — women treated with chest radiation therapy in childhood, for instance, have a significantly higher incidence of breast cancer than do women not exposed to radiation. Mutations may also develop as a result of exposure to cancer-causing chemicals, such as the polycyclic aromatic hydrocarbons found in tobacco and charred red meats.

In the long run, establishing a link between genetic mutations and cancer is just the first step. Now researchers are trying to learn if a relationship exists between genetic makeup and environmental factors that may increase the risk of breast cancer. Although these studies are still preliminary, breast cancer eventually may prove to have a number of causes.

Risk factors

A risk factor is anything that makes it more likely you'll get a particular disease. Yet all risk factors aren't created equal. Some, such as your age, sex, and family history can't be changed, whereas others, including smoking and a poor diet are personal choices over which you have some control.

But having one or even several risk factors doesn't necessarily mean you'll become sick — most women with breast cancer have no known risk factors other than simply being women. In fact, being female is the single greatest risk factor for breast cancer. Although men can develop the disease, it's 100 times more common in women.

Other factors that may make you more susceptible to breast cancer include:

Age. Your chances of developing breast cancer increase as you get older. The disease rarely affects women younger than 25 years of age, whereas close to 80 percent of breast cancers occur in women older than age 50. At age 40, you have a one in 252 chance of developing breast cancer. By age 85, your chance is one in eight.
A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
Family history. If you have a mother, sister or daughter with breast or ovarian cancer or both, or even a male relative with breast cancer, you have a greater chance of also developing breast cancer. In general, the more relatives you have with breast cancer who were premenopausal at the time of diagnosis, the higher your own risk. If you have one close relative with the disease, your risk is doubled. If you have two or more relatives, your risk increases even more. Just because you have a family history of breast cancer doesn't mean it's hereditary, though. Most people with a family history of breast cancer (familial breast cancer risk) haven't inherited a defective gene, such as BRCA1 or BRCA2. Rather, cancer becomes so common in women who live into their 80s and beyond that random, noninherited breast tumors may appear in more than one member of a single family.
Genetic predisposition. Between 5 percent and 10 percent of breast cancers are inherited. Defects in one of several genes, especially BRCA1 or BRCA2, put you at greater risk of developing breast, ovarian and colon cancers. Usually these genes help prevent cancer by making proteins that keep cells from growing abnormally. But if they have a mutation, the genes aren't as effective at protecting you from cancer.
Radiation exposure. If you received radiation treatments to your chest as a child or young adult, you're more likely to develop breast cancer later in life. The younger you were when you received the treatments, the greater your risk.
Excess weight. The relationship between excess weight and breast cancer is complex. In general, weighing more than is healthy for your age and height increases your risk if you've gained the weight as an adult and especially after menopause. The risk is even greater if you have more body fat in the upper part of your body. Although women usually have more fat in their thighs and buttocks, they tend to gain weight in their abdomens starting in their 30s, which can increase their risks.
Exposure to estrogen. The longer you're exposed to estrogen, the greater your breast cancer risk. In general, if you have a late menopause (after age 55) or you began menstruating before age 12, you have a slightly higher risk of developing breast cancer. The same is true for women who never had children, or whose first pregnancy occurred when they were age 35 or older.
Race. Caucasian women are more likely to develop breast cancer than black or Hispanic women are, but black women are more likely to die of the disease because their cancers are found at a more advanced stage. Although some studies show that black women may have more aggressive tumors, it's also likely that the disparity is at least partially due to socioeconomic factors. Women of all races with incomes below the poverty level are more often diagnosed with late-stage breast cancer and more likely to die of the disease than are women with higher incomes. Low-income women often don't receive the routine medical care that would allow breast cancer to be discovered earlier.
Hormone therapy. In July 2002, a study sponsored by the National Institutes of Health (NIH) was halted as researchers reported that hormone therapy, once considered standard treatment for menopausal symptoms, actually posed more health risks than benefits. Among these was a slightly higher risk of breast cancer for women taking the particular combination of hormone therapy — estrogen plus progestin — used in the study. In addition, combination hormone therapy can make malignant tumors harder to detect on mammograms, leading to cancers that are diagnosed at more advanced stages when they're harder to treat. Because combination hormone therapy can result in serious side effects and health risks, work with your doctor to evaluate the options and decide what's best for you.
Birth control pills. The hormone therapy studies have raised questions about the relationship between birth control pills and breast cancer. Unfortunately, there are no clear answers. A large study of women between the ages of 35 and 64 published in June 2002 in the "New England Journal of Medicine" concluded that current or former use of oral contraceptives didn't increase the risk of breast cancer. For the latest information on the pill and breast cancer, talk to your doctor.
Smoking. A Mayo Clinic study published in April 2001 found that smoking significantly increases the risk of breast cancer in women with a family history of breast and ovarian cancers. And a 2005 study published in the "International Journal of Cancer" found that exposure to secondhand smoke also increases the risk of breast cancer in premenopausal women. Researchers think that higher estrogen levels combined with cancer-causing agents in tobacco spark the development of breast tumors.
Exposure to certain carcinogens. Polycyclic aromatic hydrocarbons are chemicals found mainly in cigarette smoke and charred red meat. Studies have shown that exposure to these chemicals can significantly increase your chances of developing breast cancer. Exposure to certain pesticides also may increase your risk, but more research needs to be done to establish a clear link.
Excessive use of alcohol. Women who consume more than one alcoholic drink a day have about a 20 percent greater risk of breast cancer than do women who don't drink. The National Cancer Institute recommends limiting alcohol intake to no more than one drink daily.
Precancerous breast changes (atypical hyperplasia, carcinoma in situ). These changes are often discovered only after you have a breast biopsy for another reason, but they can double your risk of developing breast cancer. If you have carcinoma in situ, discuss treatment and monitoring options with your doctor.
Mammographic breast density. Breasts described as "dense" have a high ratio of connective and glandular tissue to fat. On X-rays, dense breast tissue looks solid and white, so it can mask tumors and make mammograms difficult to interpret. Increasingly, though, breast density is also being recognized as a breast cancer risk factor in itself. The mechanism behind this increased risk is unknown, but it could be partly a simple matter of numbers. The abundant glandular tissue in dense breasts means there are many more cells with the potential to become cancerous.

Your age and menopausal status affect your breast density. Younger women tend to have denser breasts. Hormones also have an effect. The estrogen and other hormones your body produces, as well as hormones you ingest, increase the density of your breasts. Still, the actual increase in risk due to mammographic density is very small. If you're at high risk of breast cancer due to such risk factors as family history or prior breast biopsies, and you've been told that you have dense breast tissue, see your doctor to discuss appropriate risk-reduction strategies.

When to seek medical advice

Although most breast changes aren't cancerous, it's important to have them evaluated promptly. If a problem exists, you can have it identified and treated as soon as possible. See your doctor if you discover a lump or any of the other warning signs of breast cancer, especially if the changes persist after one menstrual cycle or they change the appearance of your breast. And if you've been treated for breast cancer, report any new signs or symptoms immediately. These include a new lump in your breast or an ache or pain in a bone that doesn't go away after three weeks. In addition, talk to your doctor about developing a breast-screening program, which may vary, depending on your family history and other significant risk factors.

Screening and diagnosis

Breast self-examination

Screening — looking for evidence of disease before symptoms appear — is the key to finding breast cancer in its early, treatable stages. Depending on your age and risk factors, screening may include breast self-examination, examination by your nurse or doctor (clinical breast exam), mammograms (mammography) or other tests.

Breast self-examination (BSE)
For years, women have been advised to examine their breasts on a monthly basis starting around age 20. The hope was that by becoming proficient at breast self-examination and familiar with the usual appearance and feel of their breasts, women would be able to detect early signs of cancer.

But some studies have shown that teaching women to perform breast self-exams may not accomplish this goal. A large, randomized clinical study in Shanghai, China, for example, concluded that breast self-exams don't actually reduce the number of deaths from breast cancer. In addition, the study found that women who perform regular breast self-exams may be more likely to undergo unnecessary biopsies after finding breast lumps.

In addition, a Canadian task force reviewed all the studies addressing the role of BSE in reducing breast cancer deaths, and found the evidence supporting the effectiveness of BSE to be inadequate. For these and other reasons, the American Cancer Society changed its recommendations on breast self-examination, stating that the procedure should be considered an option, rather than a requirement, for most women.

The new guidelines emphasize breast health awareness instead of a strict series of monthly self-exams. Although the guidelines don't say you shouldn't perform the exams, the importance of self-exams has been replaced by a general need to become more familiar with your breasts. If you'd like to continue performing breast self-exams, ask your doctor to review your technique.

Clinical breast exam
Unless you have a family history of cancer or other factors that place you at high risk, the American Cancer Society recommends having clinical breast exams once every three years until age 40. After that, the American Cancer Society recommends having a yearly clinical exam.

During this exam, your doctor examines your breasts for lumps or other changes. He or she may be able to feel lumps you miss when you examine your own breasts and will also look for enlarged lymph nodes in your armpit (axilla).

A mammogram, which uses a series of X-rays to show images of your breast tissue, is currently the best imaging technique for detecting tumors before you or your doctor can feel them. For that reason, the American Cancer Society has long recommended screening mammography for all women over 40.

Yet mammograms aren't perfect. A certain percentage of breast cancers — sometimes even lumps you can feel — don't show up on X-rays (false-negative result). The rate is higher for women in their 40s. That's because women of this age and younger tend to have denser breasts, making it more difficult to distinguish abnormal from normal tissue.

At other times, mammograms may indicate a problem when none exists (false-positive result). This can lead to unnecessary biopsies, to fear and anxiety, and to increased health care costs. The skill and experience of the radiologist reading the mammogram also have a significant effect on the accuracy of the test results. In spite of these drawbacks, however, most experts agree that all eligible women should be screened.

In May 2003, the American Cancer Society issued updated guidelines on breast cancer screening, strongly reaffirming its recommendation that women 40 and older have annual mammograms. In 2004, the National Cancer Institute issued a report saying that women older than 50 may need mammograms only every other year, but that younger women, beginning at age 40, are likely to benefit from annual exams.

Additional American Cancer Society screening guidelines include the following:

If you're in your 20s or 30s, have a clinical breast exam every three years, and have one annually if you're 40 or older.
Know how your breasts normally feel and report any changes to your doctor. Starting in your 20s, breast self-examination is an option.
If you're at greater risk of breast cancer because of your family history, genetic makeup, past breast cancer or other significant risk factors, talk with your doctor. You may benefit from more frequent exams, earlier mammography or additional tests.
During a mammogram, your breasts are compressed between plastic plates while a radiology technician takes the X-rays. The whole procedure should take less than 30 minutes. You may find mammography somewhat uncomfortable. If you have too much discomfort, inform the technician. If you have tender breasts, schedule your mammogram for a time after your menstrual period. Avoiding caffeine for two days before the test may help reduce breast tenderness.

Also available at some mammography centers is a soft, single-use, foam pad that can be placed on the surface of the compression plates of the mammography machine, making the test kinder and gentler. The pad doesn't interfere with the image quality of the mammogram.

If possible, try to schedule your mammogram around the same time as your annual clinical exam. That way the radiologist can specifically look at any changes your doctor may discover.

Most important, don't let a lack of health insurance keep you from having regular mammograms. Many state health departments and Planned Parenthood clinics offer low-cost or free screenings. So does the ENCOREplus program, available through many YWCAs.

Other screening tests

Computer-aided detection (CAD). In traditional mammography, your X-rays are reviewed by a radiologist, whose skill and experience play a large part in determining the accuracy of the test results. In CAD, a computer scans your mammogram after a radiologist has reviewed it. CAD identifies more suspicious areas on the mammogram, but many of these areas may later prove to be normal. Still, using mammography andCAD together may increase the cancer detection rate.
Digital mammography. In this procedure, an electronic process is used to collect and display X-ray images on a computer screen. This allows your radiologist to alter contrast and darkness, making it easier to identify subtle differences in tissue. In addition, the images can be transmitted electronically, so women who live in remote areas can have their mammograms read by an expert who is based elsewhere. Because it's not yet known whether digital mammography is more accurate or effective than conventional mammography, the procedure is undergoing further investigation.
Magnetic resonance imaging (MRI). This technique uses a magnet linked to a computer to take pictures of the interior of your breast. Although not used for routine screening, MRI can reveal tumors that are too small to detect through physical exams or are difficult to see on conventional mammograms. Some centers may use MRI as an additional screening tool for high-risk women who have dense breast tissue on a mammogram. MRI isn't recommended for routine screening because it has a high rate of false-positive results, leading to unnecessary anxiety and biopsies. It's also expensive, not readily available and requires radiology experts who can interpret the images and findings appropriately.
Ductal lavage. In this procedure, your doctor inserts a tiny, flexible tube (catheter) into the lining of a duct in your breast — the site where most cancers originate — and withdraws a sample of cells. The cells are then examined for precancerous changes that might eventually lead to disease. These changes show up long before tumors can be detected on a mammogram. But because ductal lavage is a new procedure, many unknowns remain, including the rate of false-negative results, the exact location in the breast of abnormal cells and whether those cells will necessarily lead to cancer. Clinical trials are being conducted to help find the answers to these questions. In the meantime, it isn't recommended as a screening tool for high-risk women. And because it's considered experimental, many insurers don't cover the procedure. If you have an interest in or questions about the procedure, talk to your doctor.
Breast ultrasound (ultrasonography). Your doctor may use this technique to evaluate an abnormality seen on a mammogram or found during a clinical exam. Ultrasound uses sound waves to form images of structures deep within the body. Because it doesn't use X-rays, ultrasound is a safe diagnostic tool that can help determine whether an area of concern is a cyst or solid tissue. But breast ultrasound isn't used for routine screening because it has a high rate of false-positive results — finding problems where none exist.
Molecular breast imaging (MBI). This experimental technique tracks the movement of a radioactive isotope that's taken up by breast tissue and especially by tumors. A special camera shows images of your breast and picks up the isotope signals. In preliminary studies, MBI found small tumors that both mammography and ultrasound missed, and because the procedure uses lighter compression, it may be more comfortable than mammography is. On the downside, the MBI takes time — about 40 to 50 minutes as opposed to 15 minutes for a mammogram — and requires that you be injected with a radioactive isotope. It's also not yet clear how any abnormal findings could be biopsied. Studies of MBI are ongoing.
Diagnostic procedures
If you, your doctor or a mammogram detects a lump in your breast, you'll likely have one or more diagnostic procedures to determine if the lump is cancerous, including:

Often, your doctor will suggest a less invasive procedure, such as ultrasound, before deciding on a biopsy. Ultrasound is a procedure that uses sound waves to create an image of your breast on a computer screen. By analyzing this image, your doctor may be able to tell whether a lump is a cyst or a solid mass. Cysts, which are sacs of fluid, usually aren't cancerous, although you may want to have a painful cyst drained with a needle.

In some cases, your doctor may want to remove a small sample of tissue (biopsy) for analysis in the laboratory. Biopsies can provide important information about an unusual breast change and help determine whether surgery is needed and if so, the type of surgery required. To obtain a tissue sample, your doctor may use one of the following procedures:

Fine-needle aspiration biopsy. The simplest type of biopsy, this is used for lumps you or your doctor can feel. During the procedure your doctor uses a thin, hollow needle to withdraw cells from the lump. He or she then sends the cells to a lab for analysis. The procedure isn't uncomfortable, takes about 30 minutes and is similar to drawing blood. Another procedure, fine-needle aspiration, is used primarily to remove the fluid from a painful cyst, but it can also help distinguish a cyst from a solid mass.
Core needle biopsy. During this procedure, a radiologist or surgeon uses a hollow needle to remove tissue samples from a breast lump. As many as 15 samples, each about the size of a grain of rice, may be taken, and a pathologist then analyzes them for malignant cells. The advantage of a core needle biopsy is that it removes tissue, rather than just cells, for analysis. Sometimes your radiologist or surgeon may use ultrasound to help guide the placement of the needle.
Stereotactic biopsy. This technique is used to sample and evaluate an area of concern that can be seen on a mammogram but that cannot be felt or seen on an ultrasound. During the procedure, a radiologist takes a core needle biopsy, using your mammogram as a guide. Stereotactic biopsy usually takes about an hour and is performed using local anesthesia.
Wire localization. Your doctor may recommend this technique when a worrisome lump is seen on a mammogram but can't be felt or evaluated with a stereotactic biopsy. Using your mammogram as a guide, a thin wire is placed in your breast and the tip guided to the lump. Wire localization is usually performed right before a surgical biopsy and is a way to guide the surgeon to the area to be removed and tested.
Surgical biopsy. This remains one of the most accurate methods for determining whether a breast change is cancerous. During this procedure, your surgeon removes all or part of a breast lump. In general, a small lump will be completely removed (excisional biopsy). If the lump is larger, only a sample will be taken (incisional biopsy). The biopsy is generally performed on an outpatient basis in a clinic or hospital.
Estrogen and progesterone receptor tests
If a biopsy reveals malignant cells, your doctor will recommend additional tests — such as estrogen and progesterone receptor tests — on the malignant cells. These tests help determine whether female hormones affect the way the cancer grows. If the cancer cells have receptors for estrogen or progesterone or both, your doctor may recommend treatment with a drug such as tamoxifen, which prevents estrogen from binding to these sites.

Staging tests
Staging tests help determine the size and location of your cancer and whether it has spread. They also help your doctor determine the best treatment for you. Cancer is staged using the numbers 0 through IV.

Stage 0 cancers are also called noninvasive, or in situ (in one place) cancers. Although they don't have the ability to spread to other parts of your body or invade normal breast tissue, it's important to have them removed because they eventually can become invasive cancers. Finding and treating a cancerous lump at this stage offers the best chance for a full recovery.

Stage I to IV cancers are invasive tumors that have the ability to spread to other areas. A stage I cancer is small and well localized and has a very successful treatment rate. But the higher the stage number, the lower the chances of cure. By stage IV, the cancer has spread beyond your breast to other organs, such as your bones, lungs or liver. Although it may not be possible to eliminate the cancer at this stage, its spread may be controlled with radiation, chemotherapy or both.

Genetic testing
The discovery of BRCA1, BRCA2 and other genes that may increase breast cancer risk has raised a number of emotional and legal questions about genetic testing. A simple blood test can help identify defective BRCA genes, but it's not 100 percent accurate and most experts believe that only women at high risk of hereditary breast or ovarian cancers should be referred for testing. If you're one of these women, it's important to know that having a defective BRCA gene doesn't mean you'll get breast cancer. In addition, test results cannot determine how high your risk is, at what age you might develop cancer, how aggressively the cancer might progress or what your risk of death may be.

In general, testing is most beneficial if the results of the test will help you make a decision about how you might best reduce your chance of developing breast cancer. Options range from lifestyle changes and closer screening and therapy with medications such as tamoxifen to extreme measures such as preventive (prophylactic) bilateral mastectomy and removal of your ovaries (oophorectomy). These can be wrenching decisions for any woman to make. Be sure to thoroughly discuss all your options with a genetic counselor, who can explain the risks, benefits and limitations of genetic testing. It can also help to talk to other women who have had to make similar decisions.


A diagnosis of breast cancer is one of the most difficult experiences you can face. In addition to coping with a life-threatening illness, you must make complex decisions about treatment. In most cases no one right treatment exists for breast cancer. Instead, you'll want to find the approach that's best for you.

To do that, you'll need to consider many different factors, including the type and stage of your cancer, your age, risk factors, where you are in your life, the size and shape of your breasts, and your feelings about your body.

Before making any decisions, learn as much as you can about the many treatment options that exist. Talk extensively with your health care team. Consider a second opinion from a breast specialist in a breast center or clinic. Don't be afraid to ask questions. In addition, look for breast cancer books, Web sites, and information from organizations such as the American Cancer Society and the Susan G. Komen Breast Cancer Foundation. Talking to other women who have faced the same decision also may help. This may be the most important decision you ever make.

Treatments exist for every type and stage of breast cancer. Most women will have surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy. And several experimental treatments are now offered on a limited basis or are being studied in clinical trials.

At one time, the only type of breast cancer surgery was radical mastectomy, which removed the entire breast, along with chest muscles beneath the breast and all the lymph nodes under the arm. Today, this operation is rarely performed. Instead, the majority of women are candidates for breast-saving operations, such as lumpectomy. Less radical mastectomies and mastectomy with reconstruction are also options.

Breast cancer operations include the following:

Lumpectomy. This operation saves as much of your breast as possible by removing only the lump plus a surrounding area of normal tissue. Many women can have lumpectomy — often followed by radiation therapy — instead of mastectomy, and in most cases survival rates for both operations are the same. In addition, many more women are satisfied with their appearance after lumpectomy. But lumpectomy may not be an option if a tumor is deep within your breast, or if you have already had radiation therapy, have two or more areas of cancer in the same breast that are far apart, have a connective tissue disease that makes you sensitive to radiation, or are pregnant.

In general, lumpectomy is almost always followed by radiation therapy to destroy any remaining cancer cells. But when very small, noninvasive cancers are involved, some studies question the role and benefits of radiation therapy — especially for older women. These studies haven't shown that lumpectomy plus radiation prolongs a woman's life any better than does lumpectomy alone. A study in the "New England Journal of Medicine" found that it might be reasonable for some women 70 and older who were taking tamoxifen after a lumpectomy to forgo radiation. In the study of 600 older women, the five-year survival rate for the half treated with tamoxifen and radiation after lumpectomy and the half treated with tamoxifen alone was essentially the same, although breast cancer recurred more often in the women who took only tamoxifen. Ultimately, a number of factors will influence your decision regarding radiation after lumpectomy, including the type of cancer you have and how far it has spread, other health conditions you may have, the side effects of radiation, whether you're a candidate for treatment with tamoxifen or aromatase inhibitors, and your own concerns and personal preferences. For some women, the risks of radiation therapy may seem too daunting. For others, fear of cancer recurrence may outweigh all other factors. That's why it's important to review with a radiation oncologist your options and the risks and benefits of treatment.

Partial or segmental mastectomy. Also considered a breast-sparing operation, partial mastectomy involves removing the tumor as well as some of the breast tissue around the tumor and the lining of the chest muscles that lie beneath it. Some lymph nodes under your arm also may be removed. In almost all cases, you'll have a course of radiation therapy following your operation.
Simple mastectomy. During a simple mastectomy, your surgeon removes all your breast tissue — the lobules, ducts, fatty tissue and a strip of skin with the nipple and areola. Depending on the results of the operation and follow-up tests, you may also need further treatment with radiation to the chest wall, chemotherapy or hormone therapy.
Modified radical mastectomy. In this procedure, a surgeon removes your entire breast and some underarm (axillary) lymph nodes, but leaves your chest muscles intact. This makes breast reconstruction less complicated. But serious arm swelling (lymphedema) — a common complication of mastectomy — is more likely to occur in modified radical mastectomy than in simple mastectomy with sentinel node biopsy. Your lymph nodes will be tested to see if the cancer has spread. Depending on those results, you may need further treatment.
Sentinel lymph node biopsy. Breast cancer first spreads to the lymph nodes under the arm. That's why all women with invasive cancer need to have these nodes examined. If your surgeon doesn't plan to do this, be sure you understand the reason why. Until recently, surgeons would remove as many lymph nodes as possible. But this greatly increased the risk of numbness, recurrent infections and serious swelling of the arm. That's why a procedure has been developed that focuses on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to develop cancer. If a sentinel node is removed, examined and found to be healthy, the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed. This spares many women the need for a more extensive operation and greatly decreases the risk of complications.
Reconstructive surgery
Most women who undergo mastectomy are able to choose whether to have breast reconstruction. This is a very personal decision, and there's no right or wrong choice. You may find, however, that you have feelings you didn't expect about your breasts. It's important to understand these feelings before making any decision.

If you would like reconstruction, but aren't a candidate for the procedure, you'll need to find a way to come to terms with your disappointment. It may be extremely helpful to talk to other women who have experienced the same situation.

If reconstruction is an option, your surgeon will refer you to a plastic surgeon. He or she can describe the procedures to you and show you photos of women who have had different types of reconstruction. Your options include reconstruction with a synthetic breast implant or reconstruction using your own tissue to rebuild your breast. These operations can be performed at the time of your mastectomy or at a later date.

Reconstruction with implants. Using artificial materials to reconstruct your breast involves implanting a silicone shell filled with either silicone gel or salt water (saline). If you don't have enough muscle and skin to cover an implant, your doctor may use a tissue expander. This is an empty implant shell that inflates as fluid is injected. It's placed under your skin and muscle, and your doctor gradually fills it with fluid — usually over a period of several months. When your muscle and skin have stretched enough, the expander is removed and replaced with a permanent implant. Recovery may take several weeks. In general, an implant makes your breast firmer than a normal breast. Implants may cause pain, swelling, bruising, tenderness or infection. And they do age over time, requiring replacement. There is also a long-term possibility of rupture, deflation, contracture, hardening and shifting.
Reconstruction with a tissue flap. Known as a transverse rectus abdominis myocutaneous (TRAM) flap, this surgery reconstructs your breast using tissue, including fat and muscle, from your abdomen. Sometimes your surgeon may also use tissue from your back or buttocks. Because the procedure is fairly complicated, recovery may take six to eight weeks. You may also need future adjustments to the breast. Complications include the risk of infection and tissue death. If you have little body fat, this type of reconstruction may not be an option for you. On the other hand, a breast reconstructed from your own tissue doesn't seem to interfere with the detection of tumors. It is also permanent and has the look and feel of a normal breast.
Deep inferior epigastric perforator (DIEP) reconstruction. In this procedure, fat tissue from your abdomen is used to create a natural-looking breast. But because your abdominal muscles are left intact, you're less likely to experience complications than you are with traditional breast reconstruction. You may also have less pain, and your healing time may be reduced. Active women, in particular, tend to opt for this procedure because it maintains the abdominal wall muscles.
Reconstruction of your nipple and areola. After initial surgery with either tissue transfer or an implant, you may have further surgery to make a nipple and areola. Using tissue from elsewhere in your body, your surgeon first creates a small mound to resemble a nipple. He or she may then tattoo the skin around the nipple to create an areola. Your surgeon may also take a skin graft from elsewhere on your body, place it around the reconstructed nipple to slightly raise the skin and then tattoo the skin graft.
Radiation therapy
Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. It's administered by a radiation oncologist at a radiation center. In general, radiation is the standard of care following a lumpectomy for both invasive and noninvasive breast cancer. Oncologists are also likely to recommend radiation following a mastectomy for a large tumor that has spread to more than four lymph nodes in your armpit.

Radiation is usually started three to four weeks after surgery. You'll typically receive treatment five days a week for five to six consecutive weeks. The treatments are painless and are similar to getting an X-ray. Each takes about 30 minutes. The effects are cumulative, however, and you may become quite tired toward the end of the series. Your breast may be pink, puffy and somewhat tender, as if it had been sunburned.

In a small percentage of women, more serious problems may occur, including arm swelling, damage to the lungs, heart or nerves, or a change in the appearance and consistency of breast tissue. Radiation therapy also makes it somewhat more likely that you'll develop another tumor. For these reasons, it's important to learn about the risks and benefits of radiation therapy when deciding between lumpectomy and mastectomy. You may also want to talk to a radiation oncologist about clinical trials investigating shorter courses of radiation.

Chemotherapy uses drugs to destroy cancer cells. Your doctor may recommend chemotherapy following surgery to kill any cancer cells that may have spread outside your breast. Treatment often involves receiving two or more drugs in different combinations. These may be administered intravenously, in pill form or both. You may have between four and eight treatments spread over three to six months.

For many women, chemotherapy can feel like another illness. The side effects may include hair loss, nausea, vomiting and fatigue. These occur because chemotherapy affects healthy cells — especially fast-growing cells in your digestive tract, hair and bone marrow — as well as cancerous ones. Not everyone has side effects, however, and there are now better ways to control some of them.

New drugs can help prevent or reduce nausea, for example. Relaxation techniques, including guided imagery, meditation and deep breathing, also may help. In addition, exercise has been shown to be effective in reducing fatigue caused by chemotherapy.

One side effect for which no treatment exists is "chemobrain," the common term for cognitive changes that occur during and after cancer treatment. Women undergoing adjuvant chemotherapy for breast cancer were the first to call attention to this problem. Since then, researchers have found that chemotherapy can affect your cognitive abilities in a number of ways, including:

Word finding. You might find yourself reaching for the right word in conversation.
Memory. You might experience short-term memory lapses, such as not remembering where you put your keys or what you were supposed to buy at the store.
Multitasking. Many jobs require you to manage multiple tasks during the day. Multitasking is important at work as well as at home — for example, talking with your kids and making dinner at the same time. Chemotherapy may affect how well you're able to perform multiple tasks at once.
Learning. It might take longer to learn new things. For example, you might find you need to read paragraphs over a few times before you really grasp the content.
Processing speed. It might take you longer to do tasks that were once quick and easy for you.
Up to one-third of people undergoing cancer treatment will experience cognitive impairment, though some studies report that at least half the participants have memory problems. Memory changes often continue for at least a year or two after your treatment and may last longer.

Premature menopause and infertility also are potential side effects of chemotherapy. The older you are when you begin treatment, the more likely you are to develop these problems. In rare cases, certain chemotherapy medications may lead to cancer of the white blood cells (acute myeloid leukemia) — often years after treatment ends.

Hormone therapy
Hormone therapy is most often used to treat women with advanced (metastatic) breast cancer or as an adjuvant treatment — a therapy that seeks to prevent a recurrence of cancer — for women diagnosed with early-stage estrogen receptor positive cancer. Estrogen receptor positive cancer means that estrogen or progesterone might encourage the growth of breast cancer cells in your body. Normally, estrogen and progesterone bind to certain sites in your breast and in other parts of your body. But during this treatment, a hormonal medication binds to these sites instead and prevents estrogen from reaching them. This may help destroy cancer cells that have spread or reduce the chances that your cancer will recur.

Medications that reduce the effect of estrogen in your body include:

Tamoxifen (Nolvadex). This is a synthetic hormone belonging to a class of drugs known as selective estrogen receptor modulators (SERMs). It's used as a treatment for women with hormone-sensitive metastatic breast cancer, as an adjuvant therapy for women with early-stage estrogen receptor positive breast , and as a preventive agent in high-risk women. You take tamoxifen daily, in pill form, for up to five years. It may reduce the risk of recurrence of breast cancer and is less toxic than most anticancer drugs. But tamoxifen isn't trouble-free. Women taking tamoxifen may experience menopausal symptoms such as night sweats, hot flashes, and vaginal itch, discharge or dryness. Less common but potentially life-threatening side effects also can occur. These include blood clots in your lungs (pulmonary embolism) and legs (deep vein thrombosis) and endometrial cancer. Older women, especially those with other medical conditions, may be at greater risk of these side effects than are younger women. In addition, some studies have shown that side effects of systemic adjuvant therapies — chemotherapy and tamoxifen — may be more long-term than originally thought.
Aromatase inhibitors. This class of drugs, which includes anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin), blocks the conversion of a hormonal substance (androstenedione) into estrogen. The substance occurs in fat, adrenal gland and ovarian tissues. In a series of clinical trials conducted over several years, the three aromatase inhibitors were tested in various settings. In all cases, women receiving aromatase inhibitors fared better than did those receiving tamoxifen, and the benefits continued even after treatment ended. Women treated with aromatase inhibitors also had a lower incidence of blood clots and endometrial cancer than women taking tamoxifen did. To date, the primary drawback of aromatase inhibitors is an increased risk of osteoporosis. But although some experts recommend that aromatase inhibitors replace tamoxifen as the primary adjuvant treatment for post-menopausal women with breast cancer promoted by estrogen, others urge caution. The main question seems to be whether women should take tamoxifen first and then switch to an aromatase inhibitor or simply take an aromatase inhibitor from the start. More research will likely be needed to answer these and other questions about adjuvant therapies.
Biological therapy
Sometimes called biological response modifier or immunotherapy, this treatment tries to stimulate your body's immune system to fight cancer. Using substances produced by the body or similar substances made in a laboratory, biological therapy seeks to enhance your body's natural defenses against specific diseases. Many of these therapies are experimental and available only in clinical trials. One medication, trastuzumab (Herceptin), is a monoclonal antibody — a substance produced in a laboratory by mixing cells — that's available for treating certain advanced cases of breast cancer. Herceptin is effective against tumors that produce excess amounts of a protein called HER-2.

Clinical trials
A number of new approaches to treating cancer are being studied. The emphasis is on methods that can successfully treat women or extend their survival with minimal side effects. Among these are drugs that block the biochemical switches that cause normal cells to turn cancerous. In addition, a procedure known as anti-angiogenesis — which targets the blood vessels that supply nutrients to cancer cells — is also being studied.

Of particular interest to both women and their doctors are methods of removing breast cancer without actually cutting into or removing the breast. Nonsurgical methods being studied include techniques that use heat or cold to kill cancer cells deep within the breast, leaving only minimal scars.

One of the most researched techniques, radiofrequency ablation, uses ultrasound to locate the tumor. Then a metal probe about the size of a toothpick is inserted into the tumor where it creates heat that destroys cancer cells. In early tests, the procedure has proved successful. Still, not all women would be candidates for the procedure if it eventually were approved for widespread use.

Some of these new treatments are available through clinical trials — the standard way new therapies are tested in people. If you have advanced breast cancer and are interested in participating in a clinical trial, talk to your doctor or contact the National Cancer Institute's Cancer Information Service at (800) 422-6237 for more information.


Clinical exams and mammography won't prevent breast cancer. But these important procedures can help detect cancer in its earliest stages. The sooner you receive a diagnosis, the more options you have, the more effective your treatment and the better your overall prognosis.

In most cases, doctors don't know what causes breast cancer. The number of tumors associated with a mutation in the breast cancer gene is small — about 10 percent to 15 percent. That's why research is focusing on newer measures you can take that may help reduce your risk. Following are some suggestions to reduce your risk:

Ask your doctor about aspirin. Taking an aspirin just once a week may help protect against breast cancer. A study published in the "Journal of the American Medical Association" in May 2004 found that women who had had breast cancer and took aspirin once a week for six months or longer were 20 percent less likely to develop breast cancer than were women who didn't take the drug. Women who took a daily aspirin had an even greater reduction in risk. Regular use of ibuprofen (Advil, Motrin, others) also seems to help protect against breast cancer, but not as effectively as aspirin. These are retrospective studies, however, and other types of studies are needed to determine whether aspirin and other anti-inflammatory drugs are truly beneficial. What's more, aspirin and ibuprofen are effective only against breast cancers that have receptors for the female hormones estrogen and progesterone, which are known to stimulate tumor growth. The drugs may work by reducing estrogen levels in your body and breast tissue. They do this by blocking a hormone-like substance (prostaglandin) that's needed to activate an enzyme (aromatase activity) important in the synthesis of estrogen.

Be sure to talk to your doctor before you start taking aspirin as a preventive measure. When used for long periods of time, aspirin can cause serious side effects including stomach irritation, bleeding and ulcers, bleeding in the intestinal and urinary tracts, and hemorrhagic stroke. In general, you're not a candidate for aspirin therapy if you have a history of ulcers, liver or kidney disease, bleeding disorders, or gastrointestinal bleeding.

Limit alcohol. A strong link exists between alcohol consumption and breast cancer. As little as 10 grams of alcohol a day — an average drink contains about 15 grams of alcohol — may increase your lifetime risk of breast cancer by 10 percent. The type of alcohol consumed — wine, beer or mixed drinks — seems to make no difference. To help protect against breast cancer, limit the amount of alcohol you drink to less than one drink a day or avoid alcohol completely.
Maintain a healthy weight. There's a clear link between obesity — weighing more than is appropriate for your age and height — and breast cancer. This is even more true if you gain the weight later in life, particularly after menopause.
Discuss long-term hormone therapy with your doctor. The Women's Health Initiative study of 2002 raised concerns about the use of hormone therapy for symptoms of menopause. Among other problems, long-term treatment with estrogen-progestin combinations such as those found in the drug Prempro increased the risk of breast cancer. If you're taking hormone therapy, consider your options with your doctor. You may be able to manage your menopausal symptoms with exercise, dietary changes and nonhormonal therapies that have been shown to provide some relief. If none of these work for you, you may decide that the benefits of short-term therapy outweigh the risks. In that case, your doctor will encourage you to use the lowest dose of hormone therapy for the shortest period of time.
Stay physically active. The Nurses' Health Study, a long-term study of more than 120,000 female nurses, found that women who exercised for at least one hour a day reduced their breast cancer risk by 18 percent. Those who exercised for 30 minutes every day reduced their risk by 10 percent. Walking was found to be as effective as more vigorous types of exercise. Other studies have shown that women who exercise consistently for at least 10 years of life — whether in adolescence or adulthood — can cut their risk of cancer by a large margin. In addition, experts now think that young women who routinely exercise even a few hours a week during their teenage years can significantly reduce their risk of breast cancer later in life. Exercise can also help postmenopausal women cut their risk by reducing fat cells, which continue to produce estrogen after menopause. No matter what your age, a good place to start is to aim for at least 30 minutes of exercise on most days. If you haven't been active before, start out slowly and work up gradually. Try to include weight-bearing exercises such as walking, jogging or dancing. These have the added benefit of keeping your bones strong.
Eat foods high in fiber. Try to increase the amount of fiber you eat to between 20 and 30 grams daily — about twice that in an average American diet. Among its many health benefits, fiber may help reduce the amount of circulating estrogen in your body. Foods high in fiber include fresh fruits and vegetables and whole grains.
Consider limiting fat in your diet. Results from the Women's Health Initiative low-fat diet study suggest a slight decrease in risk of invasive breast cancer for women who eat a low-fat diet. But the effect is modest at best. However, by reducing the amount of fat in your diet, you may decrease your risk of other diseases, such as diabetes, cardiovascular disease and stroke. And a low-fat diet may protect against breast cancer in another way if it helps you maintain a healthy weight — another factor in breast cancer risk. For a protective benefit, limit fat intake to less than 35 percent of your daily calories and restrict foods high in saturated fat.
Emphasize olive oil. When it comes to protecting you from cancer, all oils are not created equal. Oleic acid, the main component of olive oil, appears both to suppress the action of the most important oncogene in breast cancer and to increase the effectiveness of the drug Herceptin.
Eat plenty of fruits and vegetables. Fruits and vegetables contain vitamins, minerals and antioxidants that can help protect you from cancer. The American Cancer Society recommends five or more servings of fruits and vegetables every day. Look for deep green and dark yellow or orange fruits and vegetables, such as Swiss chard, bok choy, spinach, cantaloupe, mango, acorn or butternut squash, and sweet potatoes. Especially emphasize broccoli and brussels sprouts, which contain a chemical called sulforaphane that may hinder the growth of breast cancer cells. Lycopene, a nutrient found in tomatoes and other red fruits and vegetables such as strawberries and red bell peppers, also may be a powerful anticancer chemical.
Avoid exposure to pesticides. The molecular structure of some pesticides closely resembles that of estrogen. This means they may attach to receptor sites in your body. Although studies have not found a definite link between most pesticides and breast cancer, it is known that women with elevated levels of pesticides in their breast tissue have a greater breast cancer risk.
Avoid unnecessary antibiotic use. The results of a large-scale study published in the Feb. 18, 2004, issue of the "Journal of the American Medical Association" found a correlation between antibiotic use and breast cancer. The longer antibiotics were used, the greater the risk. Researchers caution, however, that other factors, such as underlying illness or a weakened immune system, rather than antibiotics themselves may account for the elevated cancer risk. At the same time, taking antibiotics when they're not needed can lead to drug-resistant strains of bacteria, a serious and growing problem.
New directions in research
Scientists are investigating a number of potential preventive therapies for breast cancer, including:

Retinoids. Natural or synthetic forms of vitamin A (retinoids) may have the ability to destroy or inhibit the growth of cancer cells. Unlike other experimental therapies, retinoids may be effective in premenopausal women and in those whose tumors aren't estrogen-positive. Research is ongoing.
Flaxseed. Phytoestrogens are naturally occurring compounds that lower circulating estrogens in your body. Flaxseed is particularly high in one phytoestrogen, lignan, which appears to decrease estrogen production and which may inhibit the growth of breast cancer tumors.

Coping skills

A diagnosis of breast cancer can be overwhelming. Suddenly you're confronted with the fear and uncertainty of a life-threatening illness — one you may associate with a loss of femininity or sexuality. What's more, you're likely to be as concerned about others as you are about yourself. How will you tell your children? Will your partner be able to cope? Who will do your job if you can't? You may also know others who have had the disease — those who survived and perhaps those who didn't. This may influence how you feel about your own breast cancer.

Taking control
It may take some time to sort through all your emotions. But you can still feel more in charge of your life. One of the best ways to regain control is to educate yourself about breast cancer and its treatment. You'll have many decisions to make in the weeks and months ahead. The more you know, the better prepared you'll be to make the best choices.

In addition to talking to your medical team — your breast specialist, your surgeon, medical oncologist (a specialist in chemotherapy and hormone therapy) and radiation oncologist (a specialist who administers radiation therapy) — you may also want to talk to a counselor or medical social worker. Or you may find it helpful and encouraging to talk to other women with breast cancer.

There are also excellent books on breast cancer and many reputable resources on the Internet. Be sure to look for the most current information, however. Breast cancer treatments are changing rapidly, and information quickly becomes dated. It's important not to rely on just one source. There are many different approaches to breast cancer treatment.

Telling others
Unfortunately, treatment decisions aren't the only decisions you'll face. Every day may present new challenges. One of the first will likely be how and when to tell those closest to you. If you have children, telling them — no matter what their ages — can be difficult. Yet it's best to be as honest as you can. You don't have to give all the details. How much and what you say will depend on each child's age and ability to understand. But trying to hide your illness isn't a good idea. Instead, tell your children you're doing everything possible to get well.

The decision to tell friends and co-workers isn't an easy one. Especially in the beginning, you may not want anyone outside your family to know. But over time, you may find it helpful to confide in a few close friends or co-workers. Still, how much and who to tell is up to you.

Keep in mind that people may not always react as you expect. Some may have many of the same feelings you do — anger, fear, grief. Others may be incredibly supportive. And some may not say much at all or may even avoid you. That's not because they don't care, but because they may not know what to say. Let them know that there are no right words and that their concern is enough.

Maintaining a strong support system
More and more studies show that strong relationships are crucial in dealing with life-threatening illnesses. In fact, friends and family are often an integral part of your treatment. Sometimes, though, you may want or need different kinds of support. If so, you may find the concern and understanding of other women with breast cancer especially comforting. Breast cancer survivors have developed a tremendous support network. Your doctor or a medical social worker may be able to put you in touch with a group near you. Or contact one of the many cancer organizations.

Dealing with intimacy
Western culture places a great emphasis on women's breasts. They're associated with attractiveness, femininity and sexuality. You may worry that breast cancer will change the way you feel about yourself. If you have a partner, you may worry that your partner will see you differently. Although it can be difficult, you need to talk to your partner about your concerns — preferably before your surgery.

Taking care of yourself
During your treatment, you'll need to plan your schedule carefully. Allow yourself time to rest. And don't be afraid to ask for help. Your friends and family want to help, but they may not always know what to do. Be specific about your needs. For example, you might ask a friend to pick up your children from school, shop for groceries or prepare meals. If you need to, be prepared to relinquish your role as caretaker for a while. This doesn't mean you're helpless or weak. Far from it. It means you're using all your energy to get well.

At the same time, you'll likely want to stay as independent as possible. Sometimes in their desire to help, other people may try to take over your life. Or they may act as if you're terribly fragile. Both can be detrimental to your recovery. Don't hesitate to tell friends and loved ones how you want to be treated.

If you haven't done so before, now is a good time to start eating a healthy diet, getting regular exercise and reducing stress. In fact, stress reduction techniques and exercise can actually help relieve some of the side effects associated with radiation and chemotherapy.

Looking ahead
Having breast cancer affects your life, and the lives of those closest to you. It can create fear and uncertainty and may sometimes strain relationships. It also may change you physically and emotionally. And too often, the emphasis on treating your disease takes precedence over healing you as a person. But both are crucial to your recovery.

It can help to know that some of the changes breast cancer creates in your life can be positive. Many breast cancer survivors find that their lives and relationships become deeper and more meaningful. Many also have a renewed sense of celebration and enjoyment.

Take time to examine what's most important to you. Think about the things you want to accomplish and how you can achieve your goals. And make it a priority to live your life to the fullest.