Article Category: Prevention

For Your Health: Breast density and why it matters

Just in time for Breast Cancer Awareness Month, many women will begin to see important new information about their breast health on their mammogram reports.

A new federal rule now requires that women be informed about the density of their breasts following their mammograms. Breast density is a measure of how much breast tissue and connective tissue is in the breast compared to how much fat tissue. Higher-density breasts have higher amounts of breast and connective tissue. Lower-density breasts have more fat tissue.

“Having dense breast tissue is very common, affecting almost half of women getting screening mammograms,” said Dr. Debbie Bennett, chief of breast imaging at Washington University School of Medicine in St. Louis. “And dense breast tissue is not a cause for worry or concern. It can, however, mean your mammogram is harder for the radiologist to read, and it also slightly increases your overall risk for developing breast cancer at some point.”

With the new rule, women will get a message on their mammogram results that says either, “Your breast tissue is dense” or “Your breast tissue is not dense.”

Because denser breasts may make it harder to see abnormal areas on a mammogram, some women may get extra screening tests that can provide other images of the breasts.

“Depending on how dense your breast tissue is and whether you have any other risk factors for developing breast cancer – such as family history of breast cancer – your doctor may recommend that you have additional imaging tests done to screen for breast cancer,” Bennett said. “This could include MRI, ultrasound or contrast-enhanced mammograms.”

Such testing can be covered by insurance, but it can vary from plan to plan. So, it’s important to talk to your insurance company or health-care provider about specific costs.

Mammograms, and any additional screening tests, can help find breast cancer early when it can be more effectively treated. While breast cancer is the second most deadly cancer in women, when found and treated in its earliest stage, it can have a very high rate of survival, with over 99% of women living at least five years after being diagnosed.

No matter their level of breast density, all women should get a mammogram every year, with most starting at age 40. Women at higher risk of breast cancer may need to begin screening earlier, so it’s important to talk to a doctor about your risk factors for breast cancer. There are benefits of doing this at any age, but ideally it should be done by age 30.

Taking healthy steps to help prevent breast cancer is also important, regardless of breast density, Bennett said.

Around half of breast cancer cases could be avoided with healthy behaviors. Most of these may sound familiar, but they can have an important impact on risk – and even small changes can lead to large benefits over time. These healthy behaviors include:

  • Keeping weight gain in check
  • Eating a diet rich in fruits, vegetables, whole grains and beans
  • Not drinking alcohol
  • Being physically active
  • Staying smoke-free or getting smoke-free

Breast cancer touches many of us to some degree, whether it’s personally or through family or loved ones. A positive note, though, is that there are steps to help manage or lower the risk. And Breast Cancer Awareness Month is a great reminder of that and the benefits of working toward better breast health.

It’s your health. Take control.

For Your Health: How’re your knees? Tips for treating – even preventing – osteoarthritis

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When it comes to daily aches and pains, it’s not uncommon for our knees to be a main source. And while there can be many different long-term causes of such issues, osteoarthritis often is a reason why, especially as we age.

In knee osteoarthritis, the cartilage between knee bones wears down. In a healthy knee, this cartilage helps the joint move smoothly and also helps protect it. When that cartilage thins and wears down, problems can begin – and often get worse over time.

“Osteoarthritis can cause knee pain and stiffness, which can negatively impact a person’s activity level, risk of falling, mood and general quality of life,” said Dr. Abby Cheng, an orthopedic surgeon at Washington University School of Medicine in St. Louis who also specializes in physiatry, which is the non-surgical treatment and rehabilitation of conditions like arthritis.

And these issues can impact us in ways we may not immediately think about. Pain and mobility problems from osteoarthritis can lead to days off work and lost income, and lower levels of physical activity can lead to increased risk of other chronic diseases, including heart disease, cancer and diabetes.

For a disease that can have such a wide-ranging impact on people’s lives, it’s also quite common. More than 30 million adults in the U.S. have some form of osteoarthritis, with the knee most often impacted. And while the disease usually affects older adults, about half of cases are in people of working age.

“Having weak leg muscles and being overweight or obese increases a person’s risk for knee osteoarthritis,” Cheng said. “Women, older adults, people with a prior knee injury and those with a family history of osteoarthritis are also more likely to have the condition.”

For people with osteoarthritis, healthy behaviors and other treatments can help deal with symptoms like pain and poor mobility – and may even slow worsening of the condition.

“Eating more plants and less processed or sugary food reduces inflammation in the body, which can reduce pain from osteoarthritis in all joints,” Cheng said. “Other common treatments for knee osteoarthritis include strengthening the thigh muscles, using knee braces, taking anti-inflammatory medications, getting cortisone and other injections, and sometimes having knee replacement surgery.”

Health-care providers can help patients put together plans for managing their condition as well as put them in touch with programs and other resources to get started and keep up with healthy behaviors over time.

And even small changes to behaviors can have important benefits when it comes to osteoarthritis, Cheng said. For example, in someone who is overweight, losing 10 pounds reduces stress on the knees by 40 pounds with each step, and that can significantly help with joint pain.

Many of these same approaches can also help lower the risk of developing osteoarthritis in the first place. This includes being physically active – including running, contrary to popular belief – keeping weight in check and eating a healthy diet rich in whole grains, fruits and vegetables and low in processed and refined foods.

While osteoarthritis is a different type of disease than cancer or heart disease, it still has a major impact on the health, well-being and quality of life of millions of people. And like those other diseases, there are steps we can take to help lower our risk – and that of our families.

“Some people think that because a parent or grandparent had osteoarthritis, they will develop it too,” Cheng said. “And while it’s true that osteoarthritis can run in families, it doesn’t mean there’s nothing a person can do to successfully lower their risk of developing it.”

It’s your health. Take control.

For more on ways to lower the risk of colon and other cancers, visit 8ways.wustl.edu.

What is the most common type of skin cancer? What you need to know and what to look out for

Basal cell carcinoma (BCC), the most common type of skin cancer and the most common type of cancer in humans, accounts for about 8 out of 10 skin cancers. Basal cell carcinomas usually develop in skin that has been exposed to sunlight. These cancers grow slowly, meaning that most are curable and cause minimal damage when caught and treated early.

What is basal cell carcinoma?

Basal cells are one of the three main types of cells in the top layer of the skin. When DNA is damaged due to exposure to ultraviolet (UV) radiation from the sun or tanning beds, changes occur in the basal cells in the outermost layer of the skin, resulting in uncontrolled growth. This is when BCC most often occurs. However, it may also result from exposure to ionizing radiation and/or arsenic.

If you have fears concerning BCC and its potential consequences, you’re not alone

Finding out that you have BCC, or worrying that you might have it based on family history or changes in your skin, is a very scary experience and gives way to many types of fear: fear of the unknown, fear of needles, fear of mortality, fear of the future. Know that no matter the fear you may be feeling, Siteman will be there to support you throughout your skin cancer journey. It’s also important to remember that while receiving a diagnosis of BCC can certainly be frightening, it is rarely fatal. Still, if left untreated, it can become locally destructive.

BCC symptoms and skin changes to look out for

Keeping an eye on your skin is crucial to ensuring that you are able to identify abnormalities should they arise. Check for BCC where your skin is most exposed to the sun, such as the face, ears, neck, scalp, chest, shoulders and back (though this cancer can occur anywhere on the body). Five warning signs of BCC are:

  • Lumps or skin nodules that appear shiny or that have visible blood vessels. The lumps may grow over time
  • Areas on the skin that look like scars
  • Itchy patches of skin
  • Red or patchy areas of skin that resemble eczema
  • Sores that have a depression in the middle, look crusty or bleed often

Hereditary predisposition, skin color and increased risk for BCC

There are several genes and hereditary syndromes that are linked to the development of skin cancer. Basal cell nevus syndrome (also known as BCNS, Gorlin syndrome, Gorlin-Goltz syndrome or nevoid BCC syndrome), Bazex-Dupré-Christol syndrome (BDCS), Rombo syndrome and xeroderma pigmentosum are rare inherited skin disorders that can lead to basal cell carcinoma.

People with fair skin, blond or red hair, blue, green or grey eyes, or skin that burns easily are at highest risk of developing BCC. However, all people with a history of sun exposure or indoor tanning are at some level of risk, so ensuring that you are protected any time you’re exposed to UV radiation is critical.

BCC screening, diagnosis and beyond

Regular screening for basal cell carcinoma is not usually recommended, but if you find something on your skin that concerns you, you should make an appointment with your provider right away. During a skin exam, your provider will look for any growths, spots, moles or bumps that might be cancerous or precancerous. If something abnormal is found, your provider may do a biopsy, which will reveal whether you have skin cancer and, if so, what type. Being proactive about examining your skin and getting anything abnormal checked promptly means greatly reducing your risk of developing BCC.

BCC can almost always be cured when caught and treated early. While this type of cancer rarely spreads beyond the original tumor site, the lesions can become dangerous and grow deep into the skin, invading soft tissues, bones or nerves when left untreated. It is very rare that a BCC spreads to lymph nodes or metastasizes, and it almost never endangers life.

The Siteman approach

As a leader in cancer treatment, research, prevention, education and community outreach, Siteman has the expertise, experience and compassion to carry you through your cancer journey. With a multidisciplinary approach, a full team of specialists meets each week to discuss all cases, reviewing each one and determining the best treatment plan for each patient.

Many people diagnosed with skin cancer are concerned about what will happen to their appearance as a result of their cancer, particularly if tumors are on the face. Siteman is a leader in Mohs micrographic surgery, a procedure that minimizes damage to healthy tissue and leaves the smallest possible scar.

BCC treatment options

At Siteman, skin cancer patients receive treatment from multidisciplinary teams made up of dermatologists, dermatologic surgeons, medical and surgical oncologists, radiologists, radiation oncologists, ophthalmologists, otolaryngologists and plastic surgeons. Our physicians meet regularly to coordinate and discuss treatment options, putting together personalized treatment plans for each and every patient. No two cancers are the same; no two treatment plans should be, either.

Siteman currently offers the following treatment options for BCC:

Excision/Mohs micrographic surgery: excision involves the removal of a skin cancer along with some healthy tissue around it. Mohs micrographic surgery involves removing individual layers of cancer tissue in stages, allowing for the removal of the greatest number of cancer cells. Mohs has the highest cure rate of any BCC treatment.

Radiation therapy: low-energy X-ray beams are used to destroy the tumor, with no need for excision or anesthesia. It may take several treatments over the course of a few weeks, or daily treatments for a specified amount of time, to fully destroy the tumor.

Vaccines/immunotherapy: HPV is strongly linked with BCC and other non-melanoma skin cancers. The 9-valent HPV vaccine has been proven not only to prevent BCC from forming in the first place, but also to effectively treat BCC when injected directly into tumors. Immunotherapy involves the use of medicines to stimulate a person’s immune system to identify and destroy cancer cells.

Topical chemotherapy: this type of chemotherapy is put directly on the skin (usually in the form of a cream or ointment), rather than being given by mouth or injected into a vein. Since the drug is only applied to the skin and doesn’t spread to other areas of the body, it doesn’t cause the same side effects as systemic chemotherapy. Because topical chemotherapy can’t reach deep cancer cells or those that have spread to other organs, it is only ideal for those with superficial BCCs.

Surgery: in addition to excision and Mohs surgery, there are other surgical treatment options for BCC. Curettage and electrodesiccation is a treatment in which a spoon-shaped tool (curette) is used to scrape cancerous skin tissue, followed by the application of an electric current with a thin metal instrument or needle to destroy any remaining cancer cells. Additionally, laser ablation involves directing a carbon dioxide laser at the tumor(s) and can be used to treat superficial BCCs.

Our care team

The skin cancer treatment team at Siteman is comprised of a wide range of specialists, including medical oncologists, radiation oncologists, surgeons, dermatologists and psychologists. The diverse expertise of our collaborative team is what allows our specialists to create personalized and compassionate treatment plans for each and every patient.

The importance of getting screened

The American Cancer Society (ACS) recommends a cancer-related checkup, including skin examination, every three years for people aged 20-40. It also recommends that patients perform a skin self-examination monthly. By remaining proactive about wearing sunscreen when exposed to UV radiation, regularly monitoring your skin and seeing your provider when something looks concerning, you can greatly reduce or even eliminate your risk of developing BCC and other skin cancers.

You’ve been diagnosed with BCC. Now what?

If you’ve been diagnosed with BCC, you may be experiencing a wave of emotions including fear, anger and sadness. Siteman providers are here to support you every step of the way throughout your cancer journey. With our exceptional physicians, psychological services and survivorship care, we are committed to caring for your body, mind and wellness, even after treatment ends.

To schedule a skin cancer screening, please contact the Washington University Division of Dermatology. The division is made up of a team of dedicated doctors who are skilled at detecting and treating basal cell carcinoma as well as many other skin cancers. If you have found something concerning on your skin, or if you simply want to come in for a routine checkup, please call them at314-362-8180. If cancer cells have already been detected during your screening exam and you wish to schedule a follow-up appointment with a skin cancer specialist at Siteman, please call 800-600-3606.

Ask the Doctors: How to Check Yourself for Testicular Cancer

Testicular cancer is most common among men ages 15-35. In fact, it is the most common type of cancer for men in this age range. Men can play an important role in detecting testicular cancer through self-examination. Despite the ease and benefit of performing a self-exam, not many men know how to check for testicular cancer, or how to talk to a doctor about sensitive men’s health issues. To help start the conversation, Washington University urologist Zachary Smith, MD, answers some of the most frequently asked questions about performing a testicular self-exam.

Testicular Cancer: Frequently Asked Questions

What is testicular cancer?

Testicular cancer (TC) is—just as it sounds—cancer that forms in the testicle itself. This does not include any tumors or cancer of the other scrotal contents or penis. It is a relatively rare cancer, with only about 9,000-10,000 cases per year in the United States. Fortunately, it is very curable in most situations, even if advanced, and there are only approximately 400 deaths per year in the U.S.

Why should I check myself for testicular cancer?

The goal of testicular self-examination is to find TC early. Compared to other tumors, it has a more rapid growth rate. Early detection decreases a man’s likelihood of the disease spreading and requiring more extensive treatment. While the data is mixed on the absolute benefit of self-examination, since TC is a very treatable disease for most men, it is generally felt that this is an easy and low-risk test to detect tumors early and potentially help men avoid more aggressive treatment.

How do I perform a testicular self-exam?

The examination is best performed in a warm environment, so the scrotum and muscles can relax and hang free. It is often recommended to be done in the shower.

  • Check each testicle one at a time.
  • Gently roll each testicle between the thumb and the other fingers
  • Palpate the entire surface of the testicle, checking for any hard lumps, bumps, or irregularities

Note that the testicle itself (the oval shaped body) is the portion we are generally concerned about. The epididymis (the tube-like structure on the back of the testicle), is a normal part of the anatomy and may often have some asymmetry. Similarly, the spermatic cord (the blood vessels and tubes that the testicle hangs from) may feel different from person to person and is of low risk for cancer. Any change in shape, contour or firmness of the testicle itself should be noted and raise concern.

What should I do if I feel something?

If you feel anything concerning, you should reach out and make an appointment to see your doctor as soon as possible. It is important to make sure that the office knows the reason for your visit. Do not leave the reason for your visit nondescript. That way, the appointment may be scheduled in a time-sensitive fashion. Abnormalities in the testicles are often something for which men delay medical evaluation for a number of reasons. However, there is no reason to be embarrassed, as this is very routine for doctors. This is what we are here for. Early evaluation could make a profound impact on the extent of treatment required if the abnormality turned out to be TC.

How often should I check myself?

It is generally recommended to perform self-examination monthly. Monthly exams help to reduce the chance of missing a tumor. Routine examination also allows a man to be more familiar with what “normal” feels like. This makes it more likely you will be able to detect something “abnormal.” It is easiest to remember to do this monthly if you choose the same day each month (like doing the exam in the shower on the first day or the last day of the month).

What does testicular cancer feel like?

It is important to know that most cancerous tumors are not painful. So just because you “feel fine” or it “doesn’t hurt” doesn’t mean that a lump is fine. If there is any question, seek evaluation. Also, while it is generally easiest to be seen by your primary care physician, since you have an established relationship with them, you can also always reach out to a urology office, where you would generally be seen very soon for any testicular lump. Here at Washington University and Siteman Cancer Center, we specialize in treatment of TC and have the experience and knowledge to walk you through the diagnosis from start to finish.

To make an appointment with a Washington University urologist, please call 314-862-8200 or fill out the online appointment form.

To learn more about testicular cancer treatment at Siteman Cancer Center, please call 1-800-600-3606.

Under 50? What you need to know about colon cancer risk and prevention

In recent years, doctors have noticed an unsettling trend: an increase in the number of people under the age of 50 who are being diagnosed with colon or rectal cancer. While this trend is alarming, there is good news: colon cancer can be prevented entirely or at least caught early, when it’s easier to treat.

Much of the world became painfully aware of this trend when Hollywood’s Chadwick Boseman died tragically at the age of 43 from colon cancer. For many, the question became: what can I do to keep this from happening to me and my loved ones?

How can I prevent colon cancer?

In order to ensure that you can go on to live a longer and healthier life, you must be aware of your family history and be on the lookout for key symptoms. Washington University colorectal surgeon Radhika Smith, MD, who treats colon cancer patients at Siteman Cancer Center, emphasizes the importance of knowing family history of colorectal cancer.

“If anybody in their family has a history of malignancies, especially at a young age, that really should prompt them to seek medical attention. This will allow them to ensure that there’s nothing with their family genes that could increase their risk,” she said.

It is important to be aware of your family history when it comes to taking charge of your health. At the same time, it is just as important to keep an eye out for signs of potential problems.

“Colorectal cancer doesn’t frequently strike young people. However, when you experience symptoms, you never want to ignore them,” says Smith. “You always want to have them evaluated. Make sure that you’re protecting yourself and doing all you can to give attention to any underlying issues you might have.”

Identifying symptoms is essential for effective treatment for colorectal cancer.

It is also important to note that certain genetic syndromes create hereditary risks for colorectal cancer, including Lynch syndrome and FAP. Additionally, Crohn’s disease and ulcerative colitis may potentially increase risk.

What symptoms should I look out for?

When it comes to identifying symptoms prior to diagnosis, it can be a bit tricky. This is because there are routine issues (such as constipation and diarrhea), and then there are alarm symptoms.

“If you have run-of-the-mill constipation, you should address it with changes in the food you eat, fiber supplements, and be sure to take in 64 ounces of an uncaffeinated beverage. If that doesn’t fix it, then you should go see a provider,” says Smith. “Most young people don’t know how to really fix constipation, so engaging a doctor is important.”

Because many young people eat low-fiber diets, they experience constipation, which then becomes their norm. This is why it’s important to stay on top of your health from a young age. It will allow you to be able to identify potential issues in the future.

Constipation can, of course, be just that – constipation. However, it also can be a sign of a larger issue. Here are some symptoms that may be more concerning:

  • Rectal bleeding
  • Change in stool caliber
  • Weight loss
  • Constipation or diarrhea
  • Abdominal pain
  • Fatigue or tiredness

How do I speak with my provider about my concerns?

It can feel uncomfortable to bring up colorectal health concerns with your provider. While this might be the case, doing so is the only way to be proactive when it comes to your health.

“At the end of the day, you just need to remind yourself that every provider at Siteman and at Washington University really just wants to help people,” says Smith. “You won’t feel any sort of judgment. You just need to be honest about the symptoms you’re experiencing. Most of the time, you will simply need to make minor changes in your diet. This can have a huge impact on your overall bowel function and improve your quality of life. But in some rare cases, this may also save your life.”

Early intervention can prevent many problems down the road. All you need to do is take charge of your health and be honest with your provider.

If a larger issue does happen to arise in the future that needs to be addressed, there are many effective treatment options. These colon cancer treatments and colon cancer surgeries can prolong and improve your quality of life.

At what age should I have my initial colon cancer screening?

Siteman recommends that you have your initial screening at age 45, but there are some factors that can lower that recommendation. If you have a first-degree family member who has had colorectal cancer, you should get tested 10 years before the age of their diagnosis. In this case, you should be tested at 5-year surveillance intervals following your initial screening. However, if you experience any symptoms, you should get screened, regardless of your age.

Smith underlines the importance of symptom surveillance.

“If you have any symptoms that concern your doctor, even if they’re minor, you should get a colonoscopy. Then you can go forward with a clean bill of health, knowing this is your baseline. If you have a departure from that baseline down the road, you’ll know it’s time for more medical attention.”

What healthy practices can I bring into my life to avoid future colon risks and issues?

Looking out for symptoms and establishing a relationship with your provider are key elements to taking charge of your health. Additionally, there are many healthy habits that you can adopt before and after symptoms arise. These include:

  • A high-fiber diet with low amounts of processed foods and smoked meats
  • Exercise
  • Normal weight
  • Avoiding excessive amounts of alcohol
  • Avoiding tobacco
  • Knowing your family history so that you can be on a proper colorectal surveillance program

Learn more

  • Your Disease Risk — Find out your risk of colorectal cancer and other diseases and get personalized tips to help prevent them.
  • 8IGHTWAYS® to Prevent Colon Cancer — Seventy-five percent of all cases could be avoided by things you can do or start doing now. Use these eight tips as a guide to lowering your risk.
  • The Young-Onset Colorectal Cancer Program at Siteman is one of the first in the country to focus exclusively on providing care for colorectal cancer patients under 50 while addressing concerns that are especially important to younger people.

Initiative to help cancer patients quit smoking

Smoking rates in the United States have decreased dramatically in recent decades, but many smokers diagnosed with cancer continue to light up. To make smoking cessation a major focus at cancer centers, including Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, the National Cancer Institute (NCI) of the National Institutes of Health (NIH) is funding the Cancer Center Cessation Initiative.

Compared with a national smoking rate of about 15 percent, the rate is 16 percent in Illinois and 22 percent in Missouri.

“But among the patients at Siteman, the smoking rate is 23 percent,” said Li-Shiun Chen, MD, an associate professor of psychiatry at the School of Medicine. “The idea of this project is to treat not only cancer — which often is a consequence of smoking — but also to help smokers quit to improve survival and help prevent future cancers.”

The project at the Siteman — supported with a $480,000 grant — is one of 22 funded by the NCI’s Cancer Moonshot initiative.

Some cancer patients may think the damage already is done, or they may feel overwhelmed with their diagnoses and the treatments they receive.

Chen, a nicotine-addiction specialist, said continuing to smoke following a cancer diagnosis can interfere with treatment and make a patient’s prognosis worse. Quitting, meanwhile, can improve patients’ symptoms and their ability to recover more quickly from treatment, improving their long-term outcomes.

“Under this new program, when patients see oncologists or surgeons, they will get advice about quitting, referrals to telephone quit lines or to Smokefree.gov, an NCI program that involves text messages and a smoking-cessation app,” Chen said. “They also will have the opportunity to receive prescriptions for medications to help them quit.”

Smoking contributes to about 30 percent of all cancer deaths. And under the new program, Chen said people who receive care at Siteman, including those who come for cancer screenings, will be asked if they smoke and have the opportunity to receive counseling or medication.

“Our goal is to eliminate tobacco, and we want to help even our sickest cancer patients take that step,” Chen said.