Breast Cancer Archive

Ask the doctors

Q: I'm expecting and want to have a vaginal delivery, but many of my friends have had cesarean sections lately. Is this a preference, or are there medical reasons to have a cesarean?

A: The health of the mother and baby, the family's personal preferences, and the hospital in which a woman delivers her baby play a role in determining whether she has a cesarean. Common medical reasons for cesareans include fetal malpresentation (when the baby is turned so that its feet or buttocks will come out first), pelvic disproportion (a birth canal that is unusually shaped or too small in relation to the size of the baby), and a past cesarean. A study published in the Journal of the American Medical Association in December 2015 suggests that such commonly cited medical issues may account only partly for high cesarean rates.

Music therapy can calm anxiety, ease pain, and provide a pleasant diversion during chemotherapy or a hospital stay.

It's almost impossible to find someone who doesn't feel a strong connection to music. Even if you can't carry a tune or play an instrument, you can probably reel off a list of songs that evoke happy memories and raise your spirits. Surgeons have long played their favorite music to relieve stress in the operating room, and extending music to patients has been linked to improved surgical outcomes. In the past few decades, music therapy has played an increasing role in all facets of healing.

What is music therapy?

Music therapy is a burgeoning field. People who become certified music therapists are usually accomplished musicians who have deep knowledge of how music can evoke emotional responses to relax or stimulate people or help them heal. They combine this knowledge with their familiarity with a wide variety of musical styles to find the specific kind that can get you through a challenging physical rehab session or guide you into meditation. And they can find that music in your favorite genre, be it electropop or grand opera.

These uterine tumors, though usually benign, can cause heavy bleeding, cramps, and pregnancy complications. But there are several good options for treatment.

Fibroids—smooth muscle tumors of the uterus—are common, affecting as many as 75% of women. They are rarely cancerous, and they cause symptoms in only about 20% of the women who have them. However, if you're one of those with symptoms like heavy menstrual bleeding, bad cramps, pelvic pressure, constipation, or frequent urination, you know how fibroids can disrupt your life. Even if they don't cause symptoms, they may grow into the uterine cavity, potentially complicating a pregnancy and raising the risk of miscarriage.

"Managing uterine fibroids depends on several factors, such as a woman's symptoms, whether or not she wants to have children, her age, and her personal preferences," says Dr. Hye-Chun Hur, director of the Division of Minimally Invasive Gynecologic Surgery at Harvard-affiliated Beth Israel Deaconess Medical Center and associate medical editor of Harvard Women's Health Watch.

There is no evidence that so-called "bioidentical" alternatives to prescription hormones are either safe or effective.

Over the past couple of years, science has validated what many women already know: hot flashes and other symptoms of menopause can persist long after menstrual periods stop. It's also well established that estrogen—alone or combined with a progestin—is the most reliable treatment for menopausal symptoms and that, for most postmenopausal women, it is safe to take these hormones for up to five years at doses that relieve hot flashes.

But in 2002 the Women's Health Initiative reported that Prempro—an FDA-approved preparation combining synthetic estrogens with a progestin—increased the risk of cardiovascular disease and breast cancer. Since then, women have shied away from pharmaceutical companies' hormones. A third of women who use hormones for relief of menopausal symptoms are now choosing custom-mixed preparations from compounding pharmacies, according to research sponsored by the North American Menopause Society (NAMS). Women surveyed by NAMS commonly said they believed "natural" or "bioidentical" hormones from compounding pharmacies to be safer than the available FDA-approved hormones.

The U.S. Preventive Services Task Force recently updated their guidelines on screening for depression. This time around, they recommended widespread screening through primary care practices, plus gave special attention to women who are pregnant or recently gave birth. These matter-of-fact, achievable guidelines and goals have the potential to reap enormous health benefits.

There’s almost always something we can do to improve our health and well-being — even at the end of our lives. Palliative care is designed to improve the quality of life for people with life-threatening illnesses and their families by keeping a person comfortable and making sure his or her values and preferences guide the medical team’s actions. For this reason, good communication with your care team — and your loved ones — is essential, even before you or a loved one has developed a serious illness.

Last year, only months after announcing that he had an aggressive form of melanoma, former President Carter declared that he was cancer free — thanks at least in part to a recently approved immunotherapy drug. Immunotherapy is a type of targeted therapy that helps boost the body’s own immune response to cancer. It does so while sparing healthy cells, thus minimizing side effects.

Ask the doctor

Q. In your discussions of breast cancer screening, you never mention ultrasound. Is it an alternative to mammography?

A. No. Although the FDA has approved an automated breast ultrasound system to be used in addition to mammography for asymptomatic women with dense breasts, there are not enough published data about its effectiveness in screening to support its use. Moreover, ultrasound alone is not an alternative to mammography for routine breast cancer screening because ultrasound cannot pick up the small deposits of calcium (microcalcifications) that can be a sign of breast cancer.

Ask the doctor

Q. My daughter had a miscarriage a few months ago and since then she has been depressed and withdrawn. Do you know anything I can do to help?

A. Miscarriage can involve a difficult emotional recovery, and many women and their partners are surprised at the intensity of their feelings. Many women who have experienced a miscarriage feel that they have done something wrong. They may worry that the miscarriage resulted from stress or lifestyle choices they made during pregnancy. In fact, most miscarriages are the result of chromosomal abnormalities, structural abnormalities of the uterus, or maternal endocrine or autoimmune disorders.