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The questions that keep you up at night are the ones scientists are working hardest on, too. The answers they are finding are sure to reassure you.
1. We get so many scans at the doctor's and, now, the airport. How worried should we be?
Probably less worried than we are. It's true, young women are more susceptible to radiation; damage adds up over time, and monthly breast swelling leaves cells more vulnerable to the rays. This is why doctors don't usually suggest mammograms before age 40. But a recent study tracking 130,000 women 40 and older found that when they were invited to have regular mammograms, they had a 30 percent lower breast cancer death rate compared with those who weren't screened, says coauthor Robert A. Smith, Ph.D., director of Cancer Screening at the American Cancer Society (ACS). The number of lives saved by detection far exceeds those harmed by mammography's radiation, he says.
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It's important to keep our exposures in perspective, says Richard Morin, Ph.D., chair of the American College of Radiology Safety Committee. "Our everyday dose in general is not zero," he notes. Natural radiation emanates from concrete walls and the potassium in bananas. Because granite contains radon, hiking in the Appalachians would expose you to more rays in 30 minutes than one mammogram would.
Scans add to normal exposures, but some pack more of a wallop than others. A chest X-ray equals about the same radiation dose people receive naturally every 10 days. A mammogram is also fairly low-dose, equaling about what you'd get in three months. But a total body CT, promoted by some centers as a way to check for cancer, exposes you to 100 times as much radiation as a chest X-ray. (As for full-body airport scans, you can relax; a 2011 study in Archives of Internal Medicine calculated that 4,000 of them equal the dose of a single mammo.)
Simple steps can manage your risk. To keep mammogram radiation low, skip thyroid shields. "They often get in the way, and you have to repeat the test," says Chris Flowers, M.D., director of breast imaging at the H. Lee Moffitt Cancer Center and Research Institute. If your physician orders a scan you're unsure about, particularly a CT, ask if it's truly needed. Or could she do an ultrasound or MRI, neither of which uses radiation? New lower-dose CTs exist, so see if that's an option. Assuming a scan is warranted, Morin says, "rest assured that the benefit of answering the question, Do you have cancer? is far greater than the risk of the test." -Anna Maltby
2. We have a shot to head off cervical cancer. Are more vaccines on the way?
Cancer caused by a virus: It sounds scary, but the discovery has already paved the way to better prevention-and not only of cervical cancer. Experts have proven that viruses are culprits in about 15 to 20 percent of all cancer cases. In addition to the link between human papillomavirus (HPV) and cervical cancer, they've tied hepatitis B to liver cancer, Epstein Barr to certain lymphomas and human herpesvirus 8 to a form of soft-tissue sarcoma.
Could breast cancer be next? In preliminary findings presented at the 2011 Avon Foundation Breast Cancer Research Forum, researchers looking for viruses in tissue taken at the time of lumpectomy or mastectomy surgery discovered that bovine leukemia virus was present in 58 percent of samples. (BLV is commonly found in cattle; scientists don't yet know how humans get it but don't urge giving up beef or dairy.)
The presence of the virus doesn't mean it triggers cancer. "We have to look at tissue in women who have never been diagnosed with breast cancer to see if the virus is there with the same frequency," says Gertrude Case Buehring, Ph.D., professor of virology at the University of California in Berkeley and coinvestigator with Kimberly Baltzell, Ph.D., of the University of California in San Francisco. "If it is, then BLV is probably harmless, what we call a passenger virus"-a bug that turns up in tumors but doesn't contribute to disease.
Because so many patients' tissue had BLV, she adds, "if this virus played a causative role, it could be responsible for a large portion of breast cancers and important to study further." It took 20 years to prove HPV strains cause cervical cancer, so answers won't come quickly. But the tantalizing notion of intercepting the transmission of cancer before it happens should keep researchers hot on the case. -Dina Roth Port
3. Why is breast cancer in young women so much harder to treat?
Breast cancer is less common in young women than it is in older women, but tragically, when young women do get it, they are more likely to die, ACS stats reveal. For one reason, young women are less likely to have had their cancers detected early by mammography. But researchers suspect there's more than mere screening at work-and they are looking deep inside cancer cells for clues.
Three kinds of tumors are more treatment-friendly: those with estrogen receptors and those with progesterone receptors, both of which can be treated with antihormonal therapies, and those that make too much of a protein called HER2, which doctors treat with Herceptin. Young women often develop aggressive tumors without any of these advantageous features, called triple-negative tumors.
By studying triple-negative tumor tissue, scientists hope to ID any genetic errors within and find drugs to fight them. Antiandrogen drugs, used for prostate cancer, might work: About 10 percent of triple-negative tumors have androgen receptors, says Clifford Hudis, M.D., chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Center.
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Researchers also want to know why young women tend to get aggressive tumors in the first place. One intriguing theory is that tumors suppress the immune system. For some reason, this suppression is stronger in younger women, says Virginia Borges, M.D., who runs a young women's breast cancer program at the University of Colorado Cancer Center Clinic. Dr. Borges and her codirector, Pepper Schedin, Ph.D., are also investigating the idea that during breast feeding, the process of weaning and returning the breast to normal can cause tumors to grow faster and become more aggressive. The hope is that scientists could pinpoint drug therapies to reduce this effect and improve outcomes in new mothers with cancer.
We've never been closer to uncovering the secrets inside women's tumors, says Rita Nanda, M.D., a breast cancer specialist at the University of Chicago Medical Center. But if you're a young woman with the disease, scientists can't do it without you. "I always encourage patients to participate in trials," she says. "The more who take part, the more we learn." -Sue Rochman
4. How close are we to finding a cure?
"Oncologists rarely use the word cure. We joke that it's a four-letter word," says Otis Brawley, M.D., chief medical officer for the ACS. "You can't know if a person is cured unless they live a long life and die of something unrelated." Yet these days, many people with low-stage cervical, breast and lung cancers, as well as lymphoma, go on to do exactly that.
The term cure can also be misleading because "we are really looking for multiple different cures," explains Eric Winer, M.D., director of the breast oncology center at the Dana-Farber Cancer Institute. There are more than 200 kinds of cancer and even more subtypes on a molecular level. "We need specifically tailored treatments to be most effective," says Myra Biblowit, president of The Breast Cancer Research Foundation. A genomic test called Oncotype DX, for example, is helping doctors evaluate how responsive to chemotherapy a cancer is likely to be-sparing patients unnecessary misery. For those with chronic myeloid leukemia, the drug Gleevec fights the disease based on the tumor's genetic profile.
More hope: Although select cancers might be cured in the next 15 to 20 years, experts believe we'll eventually consider most cancers to be chronic illnesses. "Ultimately, we'll be able to treat cancer the way we treat diabetes. We can hold the disease at bay and allow the patient to coexist with it and have a good quality of life," Dr. Brawley says.
Still, researchers warn we shouldn't focus so heavily on a cure that we ignore the best tool in our arsenal: prevention. "Once a tumor has formed, we've lost half the battle," says Sara Sukumar, Ph.D., professor of oncology and pathology and codirector of the breast cancer program at Johns Hopkins Kimmel Cancer Center. "If it's never allowed to exist at all, then we've won." -D.R.P.
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