Education For Healthy Life

Menopausal hormone therapy (MHT) can help with some symptoms of menopause, including hot flashes, vagi-nal dryness, mood swings, and bone loss, but there are risks, too. For some women, taking hormones can increase their chances of having a heart attack or stroke. If you decide to use hormones, use them at the lowest dose that helps for the shortest time needed. Talk with your doctor if you have questions about MHT.

The patch is generally safe for young, healthy women. The patch can pose heart disease risks for some women, especially women older than 35; women with high blood pressure, dia-betes, or high cholesterol; and women who smoke.Recent studies show that women who use the patch may be exposed to more estrogen than women who use the birth control pill. Estrogen is the female hormone in birth control pills and the patch that keeps you from getting preg-nant. Research is underway to see if the risk for blood clots is higher in patch users. Blood clots can lead to heart attack or stroke. Talk with your doctor if you have questions about the patch.If you’re using the patch, watch for signs of trouble, including:

• Eye problems such as blurred or double vision 
• Pain in the upper body or arm 
• Bad headaches
• Problems breathing 
• Spitting up blood 
• Swelling or pain in the leg 
• Yellowing of the skin or eyes 
• Breast lumps 
• Unusual (not normal) heavy bleed-ing from your vagina

Taking birth control pills is generally safe for young, healthy women if they do not smoke. But birth control pills can pose heart disease risks for some women, especially women older than 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke. Talk with your doctor if you have questions about the pill.
If you're taking birth control pills, watch for signs of trouble, including:

• Eye problems such as blurred or double vision
• Pain in the upper body or arm
• Bad headaches
• Problems breathing
• Spitting up blood
• Swelling or pain in the leg
• Yellowing of the skin or eyes
• Breast lumps
• Unusual (not normal) heavy bleeding from your vagina

Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist (a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease). A biopsy is specified by the technique and/or size of needle used to collect the tissue sample.

• A fine needle aspiration biopsy (FNAB) uses a small needle to remove a small sample of cells.
• A core needle biopsy uses a larger needle to remove a larger sample of tissue. This is usually the preferred biopsy technique for determining whether a physical exam or imaging finding is cancer. A vacuum-assisted biopsy removes multiple large cores of tissue.

An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium (a special dye) may be injected into a patient’s vein to create a clearer picture.

An MRI may be used once a woman has been diagnosed with cancer to check the other breast for cancer, but the benefit of this is questionable. It may also be used for screening. According to the American Cancer Society, women at high risk for breast cancer (for example, women with BRCA gene mutations or a strong family history of breast cancer) should receive MRI screening along with a mammogram.

MRI is often better than mammography and ultrasound at finding a small mass in a woman’s breast, especially for women with very dense breast tissue. However, an MRI has the risk of having a higher rate of false-positive test results (a test result that indicates cancer when there is no cancer present) and may result in more biopsies and other tests. In addition, an MRI does not show calcifications, which could indicate in situ breast cancer (DCIS). Talk with your doctor for more information.

Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also find out which treatments may be the most effective. For most types of cancer, a biopsy (the removal of a small amount of tissue for examination under a microscope) is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:

• Age and medical condition
• The type of cancer suspected
• Severity of symptoms
• Previous test results

The diagnosis of breast cancer usually begins when a woman or her doctor discovers a mass or abnormal calcification (tiny spot of calcium usually found on an x-ray) on a screening mammogram, or an abnormality in the woman’s breast by clinical examination or self-examination. Several tests may be done to confirm a diagnosis of breast cancer. Not every person will have all of these tests.

Women with breast cancer may experience breast abnormalities or symptoms, but many women do not show any of these findings at the time of diagnosis. Many times breast symptoms can be caused by a medical condition that is not cancer.

 
If you are concerned about a breast finding or symptom, please talk with your doctor.
The signs and symptoms to look for include:

• New lumps (many women normally have lumpy breasts) or a thickening in the breast or under the arm
• Nipple tenderness, discharge, or physical changes (such as a nipple turned inward, a persistent sore, or a change in the size or shape of the breast)
• Skin irritation or changes, such as puckers, dimples, scaliness, or new creases
• Warm, red, swollen breasts with a rash resembling the skin of an orange (called peau d’orange)
• Pain in the breast (usually not a symptom of breast cancer, but should be reported to a doctor)

Several breast cancer risk assessment tools have been developed to help a woman estimate her chance of developing breast cancer. The best studied is the Gail model at www.cancer.gov/bcrisktool. After entering some personal and family information the tool provides a five-year and lifetime estimate of the risk of developing invasive breast cancer. Because it only asks for information about breast cancer in first-degree family members and doesn’t include their age at diagnosis, the tool works best at estimating risk in women without a strong inherited breast cancer risk.

For most women, regular mammography and clinical breast examinations can help find early signs of breast cancer. In addition, women should become familiar with their own breasts. Checking your own breasts for lumps and changes with breast self-examination may help if performed correctly. Talk with your doctor for more information.

Women have several options to reduce the risk of developing breast cancer.

• For women with especially strong family histories of breast cancer (such as those with BRCA1 or BRCA2 mutations), a prophylactic mastectomy (preventive removal of the breasts) may be considered. This appears to reduce the risk of developing breast cancer by at least 95%. These women may also consider a prophylactic oophorectomy (removal of the ovaries), which can reduce the risk of developing breast and ovarian cancers.
• Women who are at higher than normal risk for developing breast cancer may consider chemoprevention (the use of drugs to reduce breast cancer risk). Two drugs, tamoxifen (Nolvadex) and raloxifene (Evista), are approved to lower breast cancer risk. These drugs are called selective estrogen receptor modulators (SERMs). A SERM is a medication that blocks estrogen receptors in some tissues and not others.

The following factors may raise a woman’s risk of developing breast cancer:
Age.
The risk of developing breast cancer increases as a woman ages, with most cases developing in women over 50.
Race and ethnicity.
Although white women are more likely to develop breast cancer, black women are more likely to die from the disease. Reasons for survival differences are unclear and probably involve both socioeconomic and biologic factors.
Personal history of breast cancer.
A woman who has had breast cancer in one breast has a 1% to 2% chance per year of developing a second breast cancer in her opposite breast.
Family history of breast cancer.
Women who have a first-degree relative (mother, sister, daughter) diagnosed with breast cancer are at increased risk for the disease. More than one first-degree relative with breast cancer elevates that risk, especially if the cancer occurred before menopause.

Several Factor Causing Cancer can be controlled, such as physical activity and diet, and some uncontrollable factors, such as age and family history. Risk factors that affect the development of most cancers is not directly cause cancer.
Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health care choices.
Many cases of breast cancer occur in women with no obvious risk factors. This means that all women need to be aware of possible changes in their breasts and schedule a clinical breast examination (breast exam performed by a doctor or other health care professional) and mammogram (x-ray of the breast that can detect a tumor that is too small to be felt). It is likely that multiple risk factors influence the development of breast cancer.

One or more of a group of health care professionals may be involved. Most often, the woman’s medical oncologist (a doctor who specializes in treating cancer) and breast surgeon (surgical oncologist) plan the first approach to treatment. They are often helped by a radiation oncologist who is an expert in using radiation as a treatment for cancer.

Other health care professionals who may be involved include the following:
― Orthopedic surgeons play a role if there is a risk of fracture of if a fracture has occurred.
― Neurologists and neurosurgeons may be a part of the team if a tumor in the spine is causing pressure on nerves.
― Physical medicine doctors may prescribe physical therapy.
― Endocrinologists may be called upon if the patient has high levels of calcium in the blood or other metabolic issues.

There are several things that can be done to help prevent or slow the rapid bone loss that can be caused by breast cancer treatment. When such bone loss does occur, early diagnosis and treatment is essential.

Preventing/slowing bone loss. A healthy diet, regular exercise, and daily supplements of calcium and vitamin D can help prevent or slow cancer treatment-related bone loss. Diagnosing bone loss. To make sure bone loss is identified quickly, breast cancer patients should receive bone mineral density tests every 1 to 2 years.

Treating bone loss. Therapies for rapid bone loss include:
― Oral bisphosphonates such as Actonel®, Fosamax®, and Boniva®.
― Intravenous bisphosphonates (Aredia®, Reclast®, and Zometa®*).

Bisphosphonate drugs may cause both short- and long-term side effects.
Short-term side effects that may occur immediately after receiving either pamidronate (Aredia®) or zoledronic acid (Zometa®) are:

― Flu-like symptoms such as fever, chills, and muscle aches. These side effects are often mild, do not last long, and tend not to recur following future treatments. The following long-term side effects have been reported in some cancer patients treated with bisphosphonates:

― Osteonecrosis (dead bone) of the jaw is a rare dental condition. It is an area of exposed jaw bone that shows no sign of healing after eight weeks. The condition can cause a feeling of pain or numbness in the affected area. As most cases of osteonecrosis of the jaw have occurred in patients treated with IV
bisphosphonate drugs – mainly pamidronate (Aredia®) and zoledronic acid (Zometa®) – there is concern, but no proof, that the disorder is a side effect of these medications. Osteonecrosis of the jaw is much more likely to occur after an invasive dental procedure (such a having a tooth removed or dental implant surgery). This is why breast cancer patients should see their dentist for a careful dental examination before
starting therapy with pamidronate or zoledronic acid. If extensive dental work or oral surgery is needed, it is best to delay the bisphosphonate treatment until after the dental work has been completed. Patients should also be sure to follow good oral health procedures (by, for example, regularly brushing and flossing their teeth). Additional information can be found in the Bone and Cancer Foundation publication “Osteonecrosis of the Jaw – Information for Cancer Patients” available online at www.boneandcancerfoundation.org or by calling 1-888-862-0999.

Breast cancer treatment can lead to accelerated bone loss. Bone loss is a fairly common side effect of long-term estrogen-reducing therapies. Unfortunately, this important problem is not recognized as often as it should be.

To understand the relationship between estrogen, breast cancer, and bone health, it is helpful for patients to know that:
― Estrogen makes bones stronger but can also make breast cancer grow. Estrogen, a hormone made by the body, plays an important role in maintaining good bone health. However, estrogen also makes some kinds of breast cancer grow. These are known as estrogen-receptor positive (ER+) breast cancers. Treatments that interfere with the way estrogen works can help prevent breast cancer tumors from growing and spreading. The problem is that this interference can also lead to accelerated bone loss.

There are several effective ways to treat breast cancer that has spread (metastasized) to bone. The treatment used is tailored to the needs of each patient. Bone cancer in one location. If the cancer has spread to bone in only one spot, radiation may be given to treat the bone. In general, this will relieve the pain and prevent
fractures at this site.

Bone cancer in several locations. If breast cancer has spread to several places in the bones, radiation treatment to all of the sites may not be possible because of limitations in the total amount of radiation that can be given safely. In this case, the patient may be given anticancer therapy with hormonal treatment or chemotherapy. Pain relief treatment. Patients experiencing bone pain should be given pain medication.
This may include nonsteroidal anti-inflammatory drugs (NSAIDs) and/or drugscontaining opiates (narcotic pain killers). Radioactive therapy with strontium or samarium may also be used to treat painful bone tumors.

Breast cancer in the bone can cause pain, fractures, pressure on the nerves of the spinal cord, and high levels of calcium in the blood. Patients who experience any of the symptoms described below should tell their doctor at once because there are good treatments for each and it is important to start them quickly. Pain that feels like it is in the bone is the most common symptom that breast cancer has spread to bone. Such pain may occur with or without a fracture.

Fractures can occur when the hard surface of the bone is weakened by the growth of
breast cancer cells. For example:

The chance of breast cancer returning depends on the type of breast cancer and how it was treated.
Women with early stage breast cancer who are treated with surgery alone are at risk of having their cancer return, even 15 to 20 years later. The chance of this happening depends on:
― The size of the original tumor.
― Whether the original tumor had spread to local lymph nodes.
― The characteristics of the tissue that made up the tumor.



The risk of breast cancer returning may be lowered by hormonal therapy, chemotherapy,
and/or radiation therapy.

Breast cancer may return to the breast area or spread (metastasize) to other parts
of the body. This happens when tumor cells from the original cancer break off and
travel through the blood stream to a new location, where they grow and multiply.
If breast cancer returns, it often spreads to the bones. For example, approximately
18 to 20 percent of women diagnosed with early breast cancer will have their cancer
return within 10 years of diagnosis. Among these women, 70 percent have cancer that
has spread to their bones. Breast cancer can also spread to other organs such as the
lungs, liver, or brain.

You can reduce your chances of getting heart disease by taking these steps:

• Know your blood pressure.

People with high blood pressure often have no symptoms, so have your blood pressure checked every 1 to 2 years and get treatment if you need it.

• Don’t smoke.

If you smoke, try to quit. If you’re having trouble quitting, there are products and programs that can help:

1. Nicotine patches and gums
2. Support groups
3. Programs to help you stop smoking

Ask your doctor or nurse for help. For more information on quitting, visit Quitting Smoking.

• Get tested for diabetes.

People with high blood glucose often have no symptoms, so have your blood glucose checked regularly. Having diabetes raises your chances of getting heart disease. If you have diabetes, your doctor will decide if you need diabetes pills or insulin shots. Your doctor can also help you make a healthy eating and exercise plan.

Heart arrhythmias (uh-RITH-mee-uhz) are changes in the beat of the heart. Most people have felt dizzy, faint, out of breath or had chest pains at one time. These changes in heartbeat are harmless for most people. As you get older, you are more likely to have arrhythmias. Don't panic if you have a few flut-ters or if your heart races once in a while.

causes an arrhythmia :

• Coronary artery disease  
• Electrolyte imbalances in your blood (such as sodium or potassium). 
• Changes in your heart muscle.
• Injury from a heart attack.
• Healing process after heart surgery.

Heart failure occurs when the heart is not able to pump blood through the body as well as it should. This means that other organs, which nor-mally get blood from the heart, do not get enough blood. It does not mean that the heart stops. Signs of heart failure include:

• Shortness of breath (feeling like you can't get enough air)
• Swelling in feet, ankles, and legs
• Extreme tiredness

Heart failure is a serious condition. About 5 million people in the U.S. have heart failure. It contributes to 300,000 deaths each year. 

Coronary artery disease (CAD) is the most common type and is the leading cause of heart attacks. When you have CAD, your arteries become hard and narrow. Blood has a hard time getting to the heart, so the heart does not get all the blood it needs. CAD can lead to:

Angina (an-JEYE-nuh).
Angina is chest pain or discom-fort that happens when the heart does not get enough blood. It may feel like a pressing or squeez-ing pain, often in the chest, but sometimes the pain is in the shoulders, arms, neck, jaw, or back. It can also feel like indiges-tion (upset stomach). Angina is not a heart attack, but having angina means you are more likely to have a heart attack.

Heart attack.
A heart attack occurs when an artery is severely or completely blocked, and the heart does not get the blood it needs for more than 20 minutes.

The results of research conducted by the Annals of Internal Medicine of 130,000 people, claimed that coffee drinking good for heart health. However, this effect is more influential for women compared with men. For men, drinking lots of coffee will lebi good, however, researchers are still not ready to declare that coffee may increase heart health. Because they need to know the other factors that may affect these observations, so further research bullet.

Coffee drinkers who don't want to wait another two decades for proof positive that their favorite brew is good for their ticker can at least rest assured that it's doing it no harm.