Mammograms and breast cancer
Comments
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I don't know where Dr. Axe with the thermography clinic got that stat, but on e the NCI website it says the following:
"Radiation-Induced Breast Cancer: Radiation-induced mutations can cause breast cancer, especially if exposure occurs before age 30 years and is at high doses, such as from mantle radiation therapy for Hodgkin disease. The breast dose associated with a typical two-view mammogram is approximately 4 mSv and extremely unlikely to cause cancer. One Sv is equivalent to 200 mammograms. Latency is at least 8 years, and the increased risk is lifelong.[12,13]12,13]
Study design: Descriptive population-based.For all these potential harms of screening mammography, internal validity, consistency and external validity are good." http://www.cancer.gov/cancertopics/pdq/screening/...
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Really, are people still spreading the idea that mammograms "rupture" cancer?
I am not even going to get started on that but...no.Anyway, this is directly from the National Cancer Institute site on their "Harms of Mammography" site:
Radiation Exposure
The
major predictors of radiation risk are young age at exposure and dose.
For women older than 40 years, the benefits of annual mammograms
probably outweigh the potential risk,[19] but certain subpopulations of women may have an inherited susceptibility to ionizing radiation damage.[20,21]
In the United States, the mean glandular dose for screening mammography
is 1 to 2 mSv per view or 2 mSv to 4 mSv per standard two-view exam.[22,23]
By comparison, a single chest computed tomography (CT) scan delivers 7
mSv and an abdominal CT scan delivers 12 to 20 mSv. The whole-body
environmental radiation dose is approximately 3 mSv per year. Thus, it
may be estimated that up to one breast cancer may be induced per 1,000
women aged 40 to 80 years undergoing annual mammograms.Well, that seems to contradict that: "....mammograms definitely involve MORE radiation than common chest x-rays."
As for the "women
under 35, mammography could cause 75 cases of breast cancer for every 15
it identifies" and am rather suspicious of the source for that and I also could not find anything on NCI about this. In any event, women under 35 are NOT routinely screened and if they are they are generally high risk to begin with. All I COULD find was this:Radiation-Induced Breast Cancer: Radiation-induced mutations can
cause breast cancer, especially if exposure occurs before age 30 years
and is at high doses, such as from mantle radiation therapy for Hodgkin
disease. The breast dose associated with a typical two-view mammogram is
approximately 4 mSv and extremely unlikely to cause cancer. One Sv is
equivalent to 200 mammograms. Latency is at least 8 years, and the
increased risk is lifelong.[12,13]Mantle radiation is indeed a known risk factor for breast cancer, but that is not the same as a mammogram at all.
ETA: Oh, I see Dr. Axe shills a thermography clinic, and is a doctor of chiropractic medicine...yet holds himself out as a physician. So, yes, I continue to be suspicious of his claims and of his alleged expertise in oncology.
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Are we talking about radiation AGAIN????
I love to get my radiation info from the folks at a place called MIT....the comments are also interesting.....Over the years, IMHO, I've come to discover that radiation and specifically nuclear energy are our friends:
http://mitei.mit.edu/publications/reports-studies/update-2003-future-nuclear-report
http://web.mit.edu/newsoffice/2012/prolonged-radiation-exposure-0515.html
Reiterating what I said earlier, the only thing damning about the Canadian study is that it is building on the idea that population based screening for cancers may NOT save as many lives as previously thought.
Selena...I saw Dr. Weiss's comments earlier in the week and they seem to be in lock step with the American College of Radiology's position, headed up by the very vocal Dr. Kopans..... As I said earlier too, there are two sides to the discussion and somewhere in the middle is the truth.
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Common sense tells me that if you severely compress a ball full of liquid and soft tissue, that what is inside of that ball, can easily rupture onto the surrounding environment. Isn't that pretty basic? DCIS is supposedly contained. Can it stay contained if it is being compressed? If you say yes, How do you know when common sense says otherwise?
Common sense tells me that compressing bodily tissue to the point of bruising, especially tissue filled with delicate glands and lymphatic's, can damage and scar that tissue, quite possibly creating permanent blockages or disruptions in the glands and lymphatic's. Then nuking that already damaged tissue with any amount of radiation, can't be a good thing.
I don't know what the NCI really said but a simple threat of a lawsuit would get the man to remove a slanderous quote. Would be extremely easy for the NCI to do. Is it possible that out of all the people representing the NCI, that the NCI might have stated both?
I wonder if putting more $ toward thermography machines, could help them to work on increasing their accuracy? Sure seems safer to me.
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Somebody posted Dr. Weiss' position on mammograms? You do know she is a radiologist and makes her living from mammograms?
Asking a mammography professional about mammograms is like asking Burger King what they think of hamburgers.
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I don't know about you Lucy, but I can't sit under a pile of research papers and wait for a bunch of people invested in mammograms to tell me what they think is the right thing for me to do, especially when the answer is already so obvious.
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"...if you severely compress a ball full of liquid and soft tissue, that what is inside of that ball, can easily rupture onto the surrounding environment"
Okay, so that describes a benign cyst. So maybe a mammogram can make a cyst rupture. I've had lots of cysts and that's never happened, but maybe it's possible.
But that doesn't describe breast cancer cells and breast cancer lesions. You can't squish and break open cells and squishing doesn't cause a cell to split or multiply.
As for DCIS, with DCIS the cancer cells are contained within the milk duct. A mammogram cannot force a hole into a milk duct, or break a milk duct, thereby allowing the DCIS cancer cells to flow out. But even if that could happen, it wouldn't turn DCIS into invasive cancer. If you cut a milk duct (as happens whenever someone has an excisional biopsy) the DCIS cells don't come tumbling out. And if any DCIS cells somehow are moved or placed outside of duct in the open breast tissue, those DCIS cells don't suddenly become invasive cancer. A biological change is needed at the cellular level before DCIS can develop into invasive cancer. Without that biological change, a displaced DCIS cell will remain a DCIS cell (and will not travel or invade) and will eventually die.
So, no fear that a mammogram will squeeze a breast so hard that it will turn DCIS into invasive cancer. It's not a question of common sense or logic; it's biology. It's biologically impossible.
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Beesie, Biologically impossible? how do you gather that? biologically speaking? I think any bodily tissue, tumor and/or a cyst, milk duct,etc can rupture, tear and become damaged if compressed. Besides, cysts sometimes contain cancer too. Its often how cancer starts for many women.
I would like to hear a physiologist (preferably one not invested in the cancer industry) explain to me how carcinogenic breast tissue biologically cannot possibly spread among benign tissue when it is compressed and how breast tissue,(fine and delicate lymphatics and glands) cannot possibly be damaged by compression and radiation from a mammogram.
Sorry Beesie, but my common sense wins out over your explanation.
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Lucy: Dr. Weiss hopefully makes her living trying to diagnose breast cancer and save lives. I might live in Canada, but I just cannot imagine that all doctors in the United States are recruiting persons to their specialty simply for the sake of earning money. If so, I would hope that you and everyone else in your country go elsewhere for medical care immediately!
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This Alternative Forum thread is titled "Mammograms and breast cancer" and Lela's original post expressed a personal impression about radiation in regard to mammograms, and also noted commentary about the recent Canadian study results.
The question about potential compression damage when combined with radiation is not one that has been addressed (and in particular, is not addressed in the Canadian study that is part of the debate here). People choose to do radiation in the belief that it will help to "wipe out" cancer cells, not just in terms of local recurrence but in terms of metastasis. What is the evidence about whether mammographic compression is destructive of delicate tissues and may release "rogue" cancer cells to bring about metastasis or recurrence? Are some breast cancers encapsulated in a way that allows them to remain cancerous, yet allows them not to cause further disease? What happens if some cancer cells "escape" due to the pressure of compression? What does radiation do that might allow damage to normal cells to create cancer?
I appreciate Beesie's discussion of the Canadian study in trying to focus on what the study does and does not question, as a matter of accuracy.
I have posted elsewhere raising a concern I have in regard to all of the investigations about mammograms. How can the issue of radiation by any method, including mammograms, be considered so inconsequential that the medical profession does not bother to produce proof of radiation exposure for each and every patient and each and every procedure involving radiation, such as "annual mammograms" (especially when so often even those turn into "6-month" mammograms, and into the "repeat mammogram because the mammogram we just did today for you wasn't positioned right orcompressed adequately or wasn't clear enough, etc.") If the medical community had kept running exposure records for each and every one of us for each and every exposure over time, there would be clear proof about the risk vs benefit of exposure. Why isn't that standard practice? Without it, we are going in circles with these studies. I appreciate the debate, and the controversial nature of the Canadian study, because it helps to consider the "blind spots" the medical community is so prone to ignoring and putting down to being "inconsequential".
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lightandwind,
Do you actually understand anything about DCIS? I've probably read 500 studies and articles about DCIS over the past 8 years... or maybe it's closer to 1,000. I have about 30 studies bookmarked in which scientists propose and test theories on which genetic factors trigger that biological change that causes DCIS to develop to become invasive cancer. It's a major area of study. Nowhere in any of those studies does anyone suggest that squishing a breast in a mammogram will cause DCIS cells to break through the milk duct and become invasive cancer.
Your common sense wins over my explanation? Well, to you I'm sure it does. To anyone in the scientific and medical community, to anyone who understands DCIS, and to most people with common sense, I don't think it would.
Oh, and cysts are "often how cancer starts for many women". Seriously? Do you just make all this stuff up? Do you know anything cysts and which types of cysts might possibly develop into cancer (only about 0.3%, and only those that are complex cysts, which means that they include solid components). I really don't mean to be rude, I have tried to remain polite through all of this conversation, and in fact I've understood and even agreed with some of your points in your previous posts. But I'm honestly astonished at your latest post. I wouldn't be replying at all except that I worry that a naive newly diagnosed woman might happen upon this thread, and prior to doing her own research might actually think that some of what you said in your last post is true.
Believe what you will. I'm not trying to change your beliefs. But I do think it's important to provide factual scientific data for others who may be reading, even though this is posted in the Alternative Forum (I never thought that "factual" and "scientific" were in conflict with "Alternative"). Then they can decide for themselves what they choose to believe.
AA, you raise some good points. I don't disagree that there are "blind spots" in the medical community. And I agree that there is a lot that we don't know and there are too many unanswered questions.
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Beesie....May I sum up what you said for others who might be newbies..I'm going to quote Paul Offit, MD, author of Do You Believe in Magic. He writes, "There's no such thing as conventional or alternative or complementary or integrative or holistic medicine. There's only medicine that works and medicine that doesn't."....And, "The best way to sort it out is by carefully evaluating scientific studies."
The sad thing about this mammography war is that the two sides involved, the biostatisticians and the radiologists are growing further and further apart and that's not helping any of us! And AA....I agree with you....what you suggest with documenting radiation is doable. It's time for it to be DONE!
For those of you who really want to understand the mammography controversy, please read the late radiologist, Handel Reynolds' book, that he wrote shortly before he passed, "The Big Squeeze." It's fewer than 100 pages. However, in those pages, he packs a punch.
http://www.themammogramdilemma.com/
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Beesie, I really did not mean to offend you. You did explain about DCIS, and I can appreciate that explanation, but still can not buy that smashing DCIS or any tissue in the breast is okay.
My breast cancer was one of many that developed from a fibrous cyst or fibrocystic breast disease, which I realize is different from fluid filled cysts. Fibrous cysts are very common, and when atypical hyperplasia is present, this can be a sign of a pre-malignant state..
http://www.ncbi.nlm.nih.gov/pubmed/2690835
So, what I really would like to know is generally how is it "biologically impossible" for DCIS, IDC, ILC, IBC or pre cancerous hyperplasia to spread upon smashing it? How is it biologically impossible to damage the lymphatic and glandular system upon smashing and radiation?
How is it that everything else in the world is damaged, ruptures, and spreads all around when you smash it, but not the breast?
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Beesie,
As always, your knowledge and firm grounding in reality make your comments so valuable. Although, theoretically, all sorts of things are possible, your knowledge of biology and how cells work, puts science based facts at the forefront of any discussion.
Caryn
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lightandwind, one of my points was that even if a pre-cancerous or pre-invasive lesion were to be smashed and spread about (which my knowledge and common sense tell me wouldn't happen with a mammograms but that's a separate point), it wouldn't turn it into invasive cancer. Damaging a pre-cancerous or pre-invasive cell doesn't make it become invasive.
Smashing a hammer on a DCIS cell and moving that cell into the liver isn't going to allow for the development of breast cancer liver mets. All that will happen is that the damaged DCIS cell will die. Smashing a hammer on a milk duct filled with DCIS and splitting that duct open wide isn't going to turn those escaping DCIS cells into invasive cancer. They are still DCIS cells and they still lack the ability to invade tissues and survive outside of the breast.
"My breast cancer was one of many that developed from a fibroadenoma, often called cysts or fibrocystic breast disease" I don't want to start a "benign breast condition" tutorial here, but fibroadenomas (a solid mass of glandular and connective tissue) and cysts (fluid-filled sacs) are completely different. However both are benign conditions and are very low risk. Fibroadenomas may be associated with having fibrocystic breasts but are not always. 60% of women have fibrocystic breasts; it's so common that it's considered normal and in many cases (depending on the specific conditions involved, i.e. if there are no proliferative changes) there is no increase in breast cancer risk. Fibroadenomas are made up of glandular breast tissue and therefore just as proliferative fibrocystic changes can develop within breast tissue (and slightly increase breast cancer risk; a condition that confers a 1.5-2.0 times risk is considered a low risk condition), these same changes can develop within fibroadenomas, increasing breast cancer by about the same amount. But most fibroadenomas do not present this type of risk. (And by the way, neither do most cysts.) And the actual rate of cancer development within fibroadenomas is extremely low. This happens about 0. 01% of the time (and that's at the high end of what the studies say).
Caryn, thank you!
Edited to add: Just for the record, I have had extremely fibrocystic breasts since I was a teenager, I've had a couple of fibroadenomas, and I've had more cysts than I can count (and still have a couple in my breast now). So being the research geek that I am, I've done my share of research on all these conditions.
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You are endlessly patient, Beesie. As one of those 60% of women with fibrocystic condition (very few even will call it a "disease" anymore due to the connotations) and who has had cysts and fibroadenomas, and who sees so many women come on here very worried about diagnosed benign conditions, your continued efforts to ensure the information on these forums about these benign conditions remains accurate is not unnoticed.
Thank you too for your explanation on how even if it was possible to "rupture" a cancer and/or duct, that does not change the biological makeup of the cancer cell. It would be lovely to know WHAT exactly happens to make a non-invasive cancer turn invasive...and it is something a dedicated few are working on determining, but "squeezing" is far-fetched for the reasons you mentioned.
P.S. I also have never had a cyst rupture during a mammogram.
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As to Dr Weiss - she had breast cancer too, so she knows all about it. Just because she is a radiologist, doesn't mean she's out to rip people off.
Beesie - you are THE research queen on this site!!!!
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Beesie, thanks. You keep mentioning smashing cells, but I was asking about smashing cancerous tissue. Suppose someone that had 2cm IDC tumor (not DCIS) had a mammogram. Are you still saying that it is "biologically impossible" for it to spread by smashing that tissue?
It seems that there are more than a few of us on this site that had cancer develop from a fibrous cyst, Atypical hyperplasia, and calcifications are precancerous and both are associated w/ fibrocystic breast disease. Regardless, all I am saying is that possibly spreading precancerous tissue (from smashing it), can't be much better than spreading cancer itself. Furthermore if the tissue is damaged from smashing then it seems that the health of the tissue could be compromised further.
You do typically have nice way of explaining things, and I'm not sure what I said that upset you. It's just that for me to be able to accept an explanation, I have to be able to keep basic laws of physics intact. My respect for science is why I find some things that happen in the medical community so disturbing.
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Light, cancerous tissue is made up of cancerous cells. The cancer is in the cells.
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yes, I realize that Momine, which is why I ask about potential danger involved with smashing tissue that is full of cancerous cells and further how the functioning of the delicate glands and lymphatics of the breast might also be compromised upon smashing and radiating.
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Compression could affect cancer cells, for better or worse. I found two contradictory studies, one about how mechanical compression could cause malignant breast cancer cells to revert to normalcy, another about how compressive stress can lead to migration of mammary cancer cells. I wouldn't rule out mammograms having a physical impact on existing breast cancer. Mammograms may have benefits that outweigh their costs (at least in some women), but I do not believe they are risk free.
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I had one mammogram and then skipped a couple of years. I did breast exams every month. Something told me to go back for a mammogram even though I never felt any lumps neither to my OBGYN. Guess what? The mammogram found the grade 3 almost three centimeter cancer I had. At that time my friend's Friends SIL who never had a mammogram was xrayed because she fell down the stairs. She had breast cancer everywhere and just died last year. I don't get mammograms anymore because I had reconstruction. I will still be getting them if I had not had my breasts removed. IMO I am five years out and I believe that mammogram saved my life.
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lightandwind, I didn't mean to suggest or imply that no one develops breast cancer from having fibrocystic breasts. Yes, it does happen. And I wasn't offended by your posts, but just concerned about the impression that they might leave with someone who is new and scared and comes to this board with a fibroadenoma or a cyst. I spend most of my time in the "Not Diagnosed" forum, and so many women arrive here with these conditions, often scared out of their wits. The vast majority of these women will never have any serious problem - and will never develop breast cancer - because they had a cyst or a fibroadenoma or fibrocystic breasts. And that's the point that I wanted to clarify.
I understand things through numbers, so let me lay out the numbers, starting with those from the link that you provided.
"The relationship between fibrocystic disease and the risk of developing
breast cancer has been established based on proliferative changes seen
in breast biopsies and the follow-up of patients. 70% of the female
patients present a non-proliferative fibrocystic process without any
risk of further development of cancer as compared with the rest of the
population. 30% of patients with fibrocystic disease present a
proliferative process with or without atypia. Those without atypia have a
risk of 1.5-2.0 X as compared to non-biopsied patients. Age, family
history and presence of microcalcification increases the risk factor in
those patients with proliferative lesions. It is recommended that the
pathologic diagnosis include the risk factor when fibrocystic disease is
reported."So let's start here, with a well-established number:
- 60% of women have fibrocystic breasts. Then let's incorporate the information from this article.
- 42% of women have fibrocystic breast conditions that do not increase breast cancer risk.
According to this article, 70% of women with fibrocystic breasts are not at increased risk. They have non-proliferative changes, fibrocystic conditions that do not increase risk. Most cysts fall into this category. So does fibrosis, mild hyperplasia, fat necrosis, lipomas, and various other conditions.
- 18% of women have fibrocystic breast conditions that increase breast cancer risk. This is the other 30% of women with fibrocystic breasts, those who do have conditions that increase risk.
Some of these women have conditions such as sclerosing adenosis, complex cysts, moderate or florid hyperplasia without atypia - conditions described as 'proliferative lesions without atypia'. These conditions present a small increase in breast cancer risk, raising the risk by 1.5X to 2X. That sounds like a lot, but it's not. In North America, the average woman faces a 12.4% chance that she will develop breast cancer during her lifetime. That's the risk level we all tend to think we have, but in fact it's an 'average' risk, the risk faced by all women combined, whether they have a family history or not, whether they are BRCA positive, whether they have no risk factors at all, etc.. It's everyone's risk all blended together and averaged out.
The "1.5X to 2X the risk" estimates are not assessing risk against 'average' risk. These increases are instead measured against 'base' risk, the risk level that each of us starts out with just because we are women, before any of our individual risk factors are considered. Base risk is about 4% - 6% (recently I read 3% - 5% - but I'll err on the high side). So when it's said that proliferative lesions without atypia increase risk by 1.5X to 2X, it means that women with these conditions have a 6% to 12% risk of breast cancer (average risk: 9%). That's still below the average 12.4% risk that we all tend to think we have - and that's why these are considered to be low risk conditions.
Then there are the women who have fibrocystic breasts that include conditions such as ADH and ALH. These are 'proliferative lesions with atypia'. These conditions increase risk by 3.5X to 5X vs. base risk. So having these conditions put women at a 14% to 30% risk (average risk: 22%) to develop breast cancer. Where someone falls depends on whether they have other risk factors such as family history.
I don't know how the 18% is split - what percentage of these women have conditions without atypia vs. those who have conditions with atypia. But let's say it's half and half. So (finally!) here's how many women develop breast cancer because they have fibrocystic breasts:
- 9% of women with fibrocystic breasts have proliferative changes without atypia, which puts their average risk in the range of 9%, meaning that approx. 1% will develop breast cancer because of having this condition.
- Another 9% of women with fibrocystic breasts have proliferative changes with atypia, which puts their average risk in the range of 22%, meaning that approx. 2% will develop breast cancer because of having this condition.
- 3% of women have fibrocystic breast conditions that will lead to the development of breast cancer. In most cases, the particular condition that leads to the development of breast cancer is ADH or ALH. The rate of cancer from having cysts and fibroadenomas (without associated atypia) is just a fraction of a percent.
Of course, if you are one of the 3%, you don't care that the risk from having fibrocystic breasts is so low. But for the hundreds of women who come to this board every year who have fibrocystic breasts (and who may happen upon this thread), it's really not something that they could be worried about all, particularly if they do not have a condition with atypia. Of course, they should be diligent and they need to understand the specifics of their condition and whether in fact it does increase their risk or not. But in most cases, it doesn't.
My apologies to those bored by this, and my apologies for taking this discussion off track. I started writing this post not actually knowing what the final numbers would be (although I knew the risk would be low) - my curiousity was tweaked by lightandwind's posts and I wanted to see for myself how this would all add up.
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Light, OK, but then the risk, if any exists, would be that the squashing caused cancer cells to go for a walk-about somehow, since we know (as I understood previous posts) that the cancer cells do not somehow "break" and "spill" cancer that way.
I don't know if the compression of a mammogram can cause cancer cells to migrate. Maybe someone more knowledgable has an answer.
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Thanks so much Beesie for that very detailed response. That is very interesting.
But thing I still would like to know above all else is:
How is it that everything else in the world is damaged, ruptures, tears, and spreads all around when you smash it, but not the breast? or cancer contained within the breast?
Thanks for addressing this Falleaves. Appreciate your post, and I agree with you completely.
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I was aware that there was a very small BC risk associated with fibroadenomas, which is why I took my sweet ass time getting it checked out. It felt like a fibroadenoma to me, and my PCP thought it did, too. And we were both right! It just had some IDC, too....
But as far as mammograms causing cancer to spread, it may seem ridiculous to some of you, but there are plenty of things I thought were far-fetched but research has shown. For example, cancer seeding from biopsies, and the idea that removing primary tumors can increase distant metastasis.
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lightandwind, like Momine, I can't answer your question specifically about invasive cancer. I understand (relatively speaking, as a layperson), how DCIS develops and becomes invasive cancer (and hitting it with a hammer won't make that happen), but I don't know as much about invasive cancer. It's an interesting question and I'll see if I can dig anything up if I have a chance.
But your sentence in your last post has me thinking. You said "How is it that everything else in the world is damaged, ruptures, tears,
and spreads all around when you smash it, but not the breast? or cancer
contained within the breast?" Well, does everything else really do that? Does other soft tissue in our bodies rupture, tear and spread all around when smashed? If you hit your arm with a hammer, you might break your bone but you'll only bruise (and possibility tear) the skin and the tissue. And then it will heal. The tissue won't migrate or spread anywhere. If you have a pre-cancerous mole on your leg and you whack your leg against an iron post, you'll bruise up but you won't cause that mole to become cancer and start to spread. At least I don't think you will. When we inflict damage to the soft tissue in our bodies,we develop tears in the skin and bruising and swelling and hematomas but those are temporary conditions that heal over time. Damaged tissue doesn't permanently rupture and it doesn't spread. -
I understand the concern in behalf of those with apparent benign conditions, but I too still am not convinced with the arguments presented in that too often the questions have not been seriously researched. I interpreted Beesie's statement that there are still too many questions without answers to mean exactly that -- including the question of whether the combination of repeatedly applying significant compression in conjunction with repeatedly applying radiation raises our risk to an unacceptable level.Science refuses to keep any tally of our exposure-plus-abnormal compression over time, and wants to only address that in terms of the radiation level of "the single mammogram" being harmless.
I am not holding anyone here, including Beesie, responsible for having to come up with a clear and definite answer to those kinds of questions. For me, and for lightandwind and some others who understand the importance of those unaddressed questions, mammographic radiation exposure is being belittled by blind trust in providers who won't do on their own what they should be doing in our behalf.
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Beesie, here's one hypothesis (just my thought), mammograms cause tissue damage, which leads to the production of proinflammatory cytokines, which causes progression of breast cancer.
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As far as mammos spreading cancer, I suspect (I don't know) the answer is quite simple. For an invasive cancer to spread it needs access to the lymphatic and/or vascular system. If the tumor already has this access it is likely to spread with or without a mammo. Conversely, without such access, I imagine the squashing can't cause it to spread. So, in short, the issue there is lympho-vascular invasion, not mammos.
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- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
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- 591 Pain
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- 109 Welcome to Breastcancer.org
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