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Sanjay Gupta MD

New Tools Helping Decrease Deaths From Breast Cancer; Inflammatory Breast Cancer Rare and Aggressive; Reality of Government- Mandated Wellness Policy in Schools

Aired October 14, 2006 - 08:30   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

BETTY NGUYEN, CNN ANCHOR: "Now in the News," possible evidence that North Korea did conduct a nuclear test. Sources tell CNN the U.S. has preliminary indications of radioactivity at that test site. Officials say radioactive debris was detected in air samples. It will take a few days to finish analyzing those test results.
Concerns over North Korea's nuclear ambitions are front and center at the United Nations today. The U.S. is hoping for a vote on sanctions to punish North Korea. Diplomats plan to meet in about a few hours from now, at 12:00 Eastern. We'll have complete coverage of that meeting, and actually throughout the day on the results of it.

Well, a grim string of sectarian revenge killings may be under way in Iraq. The bodies of 26 Iraqis have been found north of Baghdad. Officials think they were killed to retaliate for the kidnapping and slaying of 14 Shi'ite construction workers.

A health update this morning for you concerning former President Gerald Ford. Ford's son Steven says his father is doing well and that he is strong. Ford was admitted to the hospital this week for unspecified tests. And he underwent heart surgery in August. At 93, Gerald Ford is the oldest living American president.

Let's get you straight to Rob Marciano for a quick check of the weather outside. Good morning, Rob.

ROB MARCIANO, CNN METEOROLOGIST: Hi, Betty. The snow from Buffalo yesterday has now shifted down to the south, Cleveland over towards Erie, P.A. But it really shouldn't accumulate all that much. It's kind of a wet snow.

Here's that storm. Much of the eastern two thirds of the country really should enjoy a pretty nice fall day with high pressure control, in the desert southwest. And SoCal, at least this morning, we'll see some showers and thunderstorms. Daytime highs 40s and 50s to the north, 60s and 70s to the south. Betty, back to you.

NGUYEN: All right, thank you. And your next check of the headlines, that is coming up at the top of the hour. But first, HOUSE CALL WITH DR. SANJAY GUPTA starts right now.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: Coming up on HOUSE CALL, we're answering your questions on the most common cancer in women. You may not even know it exists.

UNIDENTIFIED FEMALE: I actually noticed that my left breast was very inflamed. I mean, really inflamed. Very bright red.

UNIDENTIFIED FEMALE: It's aggressive, targets younger women, and is often misdiagnosed. What you need to know about IBC.

And later, fewer doughnuts or fries, three times a week. Does this sound like a wellness plan to you? We investigated and found some schools have a very different idea of wellness.

(END VIDEO CLIP)

DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Good morning and welcome to HOUSE CALL. I'm Dr. Sanjay Gupta.

This morning, we're talking about the most commonly diagnosed cancer in women and also the second deadliest: breast cancer. Now from screening to treatment, new tools are helping decrease deaths from this disease. But that doesn't mean women should let their guard down.

(BEGIN VIDEOTAPE)

GUPTA (voice-over): Beth Suitt was 30-years old, pregnant with her first child Connor when she discovered she had breast cancer.

BETH SUITT, BREAST CANCER SURVIVOR: It felt very different. It was a very sore. So I wanted to go ahead and have it clicked out and I did. And it turned out to, you know, be cancer at that time. You know what that is?

GUPTA: She was diagnosed with the most common form of breast cancer called Invasive Ductal Carcinoma.

SUITT: And it was just very surreal. It was, you know, your body is harboring and generating and giving this protective environment for it to grow life for a new life. And then on the flipside, I had cells that were inside of me that were cancerous, that could potentially kill me.

GUPTA: Breast cancer in your 30s is still rare. Only five percent of breast cancers occur in women over 40. However, according to the National Cancer Institute, breast cancer during pregnancies does occur. Most often between the ages of 32 and 38. About once in every 3,000 pregnancies. Genetic mutations are often the cause of breast cancer in young women.

DR. CAROLYN RUNOWICZ, PRES., AMERICAN CANCER SOCIETY: For women with mutations are at very high risk, we may begin screening mammography or with MRI. Or the average woman over the age of 30, though, we discussed breast self-exams.

GUPTA: Beth had no known family history of breast cancer. She did do breast self-exams, which is how she found her cancer. After treatment, she's been cancer free for five years. UNIDENTIFIED MALE: You're doing your breast self-exam?

UNIDENTIFIED FEMALE: Yes.

GUPTA: Starting at age 40, the American Cancer Society recommends annual breast exams by your doctor and annual mammograms. X-rays of the breast that can detect abnormalities inside the tissue.

However, some women in their 40s can still have very dense breasts, making it hard for a mammogram to pick up abnormalities. That's why oncologists like Dr. Carolyn Runowicz, president of the American Cancer Society, encourage women to continue to do breast self-exams. It's how she found her own tumor when she was just 41.

RUNOWICZ: I said I'll never get cancer because this is what I do for a living. I am very careful about my diet, my exercise. And it can't possibly happen to me. And of course, I was incredibly naive. And I felt the lump. And I had a mammogram, it was normal. I had a needle put in and it was cancer.

GUPTA: Now in her mid 50s, this cancer survivor knows how important regular screenings are, especially since the majority of new breast cancers occur in women 50 and older.

Until more is known about the cause of breast cancer, catching the disease early is still the best way to reduce cancer deaths.

(END VIDEOTAPE)

GUPTA: And just in the last few months, researchers revealed ways that women can help prevent and survive breast cancer. This year, for example, a new study showed gaining weight after menopause seems to increase your risk of getting breast cancer. But the good news, losing weight also decreased a woman's risk.

In June, researchers found a new drug combination that may help women with a specific type of advanced breast cancer, for whom the cancer drug Herceptin has already failed.

And for those struggling through treatment, a recent study shows women with early stage breast cancer can safely wait up to 12 weeks after an operation before beginning chemotherapy.

Now here to bring us up to date on all the latest in treatments and prevention is Dr. Marisa Weiss. She's a radiation oncologist. She specializes in breast cancer. She's also the founder of breastcancer.org. Welcome back to the show, doctor.

DR. MARISA WEISS, BREAST CANCER SPECIALIST: Well, thank you for having me.

GUPTA: Sure. You know, there's a lot of interest, obviously, in breast cancer research. There's a new test out there I find interesting. It can really spotlight if a woman with estrogen positive breast cancer, that's something you check, whether they need chemotherapy. Tell us about that. WEISS: Well, for women with early stage breast cancer, no lymph nodes involved. The hormone receptors are present in the cancer. She wants to know do I really need chemotherapy? Or can I just go with hormonal therapy alone? And this test tells us what is her risk for developing recurrence after hormonal therapy alone? And will chemotherapy give her a meaningful extra benefit that makes it worth the side effects? It's called the Oncotype DX test.

GUPTA: All right.

WEISS: And it's done on the cancer tissue itself.

GUPTA: That's potentially great news, possibly avoiding chemotherapy or at least picking the people who need chemotherapy a lot better.

Dr. Weiss, a lot of questions coming into our inbox. So I want to get started now with one from Martha, who's in Chicago. She writes this. "My 29-year old sister was diagnosed with breast cancer, as my older sister who had a double mastectomy. I and my four other sisters are obviously quite concerned. Is genetic testing worthwhile, or would regular mammograms be just as effective?"

Sort of a two part question. Doctor, first of all, are mammograms enough for someone with a strong family history?

WEISS: Well, she certainly has a strong family history, because two sisters, presumably at a relatively young age, were affected. So a breast cancer gene may run through that family. And she would benefit from genetic counseling, because she and her other four sisters may or may not have a breast cancer gene.

If the family has the gene, the other sisters have a 50 percent chance of getting that gene. But if you get the gene, it doesn't mean you necessarily get cancer. But it means you are at high risk for developing a breast cancer and possibly other cancers like ovarian cancer, colon cancer.

And for you, screening with mammography is very important once a year. That's digital mammography is best for women who are 50 years of age and younger. And also, annual MRI scanning is very helpful in finding an invasive breast cancer as early as possible in women at high risk. That's women with a strong family history of breast cancer like this particular family.

GUPTA: OK. All right, doctor, like I said a lot of information. Let's try and stick with genetics here though and get to a question from Santa Barbara, California.

Lekha writes this. "Does a family history of breast cancer increase the likelihood of other female cancers?"

I think you sort of touched on that. But do you have to worry about other cancers as well?

WEISS: Yes. If a woman has a history of breast cancer, she is also at increased risk for developing ovarian cancer, colon, thyroid cancer, pancreatic cancer. The chance of getting those things is unlikely, but your risk is still increased. And you do need to follow for the - you know, take care of the whole of you in a very proactive way.

GUPTA: So making sure you follow the guidelines in terms of getting screened for the other cancers as well?

WEISS: Exactly.

GUPTA: All right, well, good information there. We're answering your questions about breast cancer. A lot more coming up after the break.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: It's been called a silent killer.

UNIDENTIFIED FEMALE: I have never heard of it before that, no. Completely out of the blue.

UNIDENTIFIED FEMALE: A deadly breast cancer few doctors or women look for. Do you know about IBC? You should. We'll fill you in after the break.

(COMMERCIAL BREAK)

(END VIDEO CLIP)

GUPTA: If you've never heard of IBC, you're not the only one. IBC or Inflammatory Breast Cancer is a rare and aggressive cancer, accounting for just one to three percent of breast cancer cases.

And here's the problem. Many doctors have never seen this type of cancer. It's hard to diagnose. They're usually aren't any lumps to show up on mammograms. It disguises itself in a way that looks like an infection, not like breast cancer.

Medical correspondent Judy Fortin has more details in this report.

(BEGIN VIDEOTAPE)

JUDY FORTIN, CNN CORRESPONDENT (voice-over): Up until five months ago, Sandra Mahncke had never heard of inflammatory breast cancer or IBC, but now the 48-year-old is undergoing chemotherapy treatment for the disease.

SANDRA MAHNCKE, IBC PATIENT: I actually noticed that my left breast was very inflamed. And I mean really inflamed, very bright red.

FORTIN: Dr. Sheryl Gabram says those are classic signs of IBC.

DR. SHERYL GABRAM, WINSHIP CANCER INSTITUTE: She would see redness, warmth, swelling, sometimes ridging on the breasts, sometimes an inverted nipple.

FORTIN: IBC is often misdiagnosed. Initially, Sandra was treated with antibiotics for a suspected breast infection, but when it didn't clear up, her gynecologist moved quickly.

MAHNCKE: Of course the biopsy is what indicated it was cancer. And that was really the first point that I heard the word.

FORTIN: Dr. Gabram believes early diagnosis and treatment are vital.

GABRAM: Starting the chemotherapy first, to get control of the disease in the breasts as well as throughout the body, followed by surgery, and then radiation therapy can definitely decrease the local recurrence.

FORTIN: The National Cancer Institute puts the five-year survival rate between 25 and 50 percent. Sandra thinks she's lucky, and is hoping to beat the odds. With today's "health minute," I'm Judy Fortin.

(END VIDEOTAPE)

GUPTA: Now one reason experts believe this cancer has such a poor outlook is because it is often treated for weeks or longer as an infection. Let's bring back our doctor, Dr. Marisa Weiss. She's a breast cancer specialist, and also the founder of breastcancer.org.

You know, it was interesting, a lot of questions coming in on this particular topic from our inbox. Michelle from Tennessee, for example, writes this.

"I have a sore right breast and it seems swollen. I think this might be due to too much caffeine." I'm not sure about that, but we'll talk about that. "Should I have a mammogram," is her question.

Doctor, it's a great example. Michelle has noticed change in her breasts. She's not sure what it is. What does she do?

WEISS: Well, caffeine is unlikely to cause breast redness, particularly a change in only breast. Still, infection is the most common reason why one breast would become, you know, big, red and, you know, swollen and maybe a little uncomfortable. So that's why doctors who see that start antibiotics.

But if you don't have a response in a week or so, talk to your doctor about seeing a breast specialist.

Even though relatively few doctors have seen this, if you've seen one case, you'll never forget it. The woman comes in - a big swollen breast. About half the time there's a lump.

The doctor might move right to a biopsy of the skin and the area that feels most involved. A mammogram shows like, you know, dense tissue throughout. It's not always that helpful. And an MRI scan may also be done. But it's mostly a clinical diagnosis.

GUPTA: OK.

WEISS: Red, big breasts and sometimes only there's a lump.

GUPTA: And obviously, I mean, the concern for a lot of women is infection's probably more common than cancer. So I mean, that's a better diagnosis to have. But how - when does a woman know to push her doctor towards treatment for something other than an infection?

WEISS: If you're on antibiotics for a week and there's been no improvement, ask to see a breast specialist because you do want to move quickly on with diagnosis. And they check out your whole body, make sure they know the extent and nature of the problem.

A biopsy that tells you what kinds of cells are in there, are there hormone receptors, are there - is there - are there cancer genes that are acting out that we need to address?

GUPTA: OK.

WEISS: Because you need to get critical information to know the best treatment.

GUPTA: All right, so a week on antibiotics, acceptable. Then see somebody else. Good information there from Dr. Marisa Weiss.

Coming up on HOUSE CALL, moving on after breast cancer.

(BEGIN VIDEO CLIP)

UNIDENTIFIED FEMALE: Rock star Sheryl Crow shares how cancer changed her life.

Plus, can survivors ever stop worrying about a recurrence? And what men need to know about their own risk for breast cancer.

First, this week's medical headlines.

(END VIDEO CLIP)

(BEGIN VIDEOTAPE)

FORTIN (voice-over): Smoke-free environments lead to rapid health improvements, according to a study in The Journal of the American Medical Association. Scottish bar workers reported the significant drop in respiratory symptoms two months after a smoking ban went into effect.

Congress is under pressure to push the Food and Drug Administration to make sweeping drug safety reforms. A panel of former and current FDA advisors is calling for more funding and staffing.

Put down the books and pick up a pale and shovel. The American Academy of Pediatrics is calling on parents and schools to ease up on children and allow them more time to play. The AAP says loss of free time is leading to more stress, anxiety, and depression for some children.

Judy Fortin, CNN.

(END VIDEOTAPE)

(COMMERCIAL BREAK)

(BEGIN VIDEO CLIP)

SHERYL CROW, BREAST CANCER SURVIVOR: You have this knowledge about what life can be after your diagnoses, after your treatment. And it gives you a new path I think. At least for me it has. It's given me a new path about how I feel about myself and what my potential is, and just the knowingness that I don't want to spend anymore time doing one -- even one more thing that I don't want to be doing.

(SINGING)

(END VIDEO CLIP)

GUPTA: Rock star and breast cancer survival Sheryl Crow at MD Anderson Cancer Center in Texas. And she performed an impromptu concert. She also talked with cancer patients. Crow is a success story. She caught her cancer at an early stage while doing a self exam.

But according to a CNN online poll, Crow is unusual. Just 27 percent of female online readers do self-exams every month.

And talking with us about that is Dr. Marisa Weiss. She's a radiation oncologist. She's also author of "Living Beyond Breast Cancer: A Survivor's Guide for When Treatment Ends and the Rest of Your Life Begins."

Doctor, a lot of e-mails lined up on this topic. Peggy from Arkansas has this question. "I had ductal carcinoma in situ and had a complete bilateral mastectomy. Do I ever have to worry about recurrence? I'm five years out."

Doctor, are you ever cured of this disease?

WEISS: Well, your -- we can't promise any one person that she's cured, but this woman has a particularly great prognosis. Five years disease-free, after a very early kind of breast cancer.

She still needs to be followed carefully and lead a healthy lifestyle, including you know, exercising three to four hours a week, consuming five to nine fruits and vegetables a day, being close to her ideal body weight. No smoking. And limit your alcohol use to five or fewer drinks per week.

GUPTA: OK, all good stuff. Another question from Gord in Toronto. "Is it possible for males to develop breast cancer and, if so, what is the probability compared to females?" Not something you hear about very much.

WEISS: No it's not. But men can get breast cancer. Each year in the United States, about 1500 new cases of male breast cancer is diagnosed.

In contrast in women, it's about 225,000 new cases. And if your doctor asks you if you have family history of breast cancer, tell them about the men and the women in your family, both from your mother's side and your father's side, because genetic counseling is important. Men with breast cancer are more likely to have a breast cancer gene abnormality than a mother or a woman with a breast cancer.

GUPTA: We are talking with Dr. Marisa Weiss about breast cancer.

Plus, a "Fit Nation" reality check. Stay with us.

UNIDENTIFIED FEMALE: Coming up, a "Fit Nation" investigation. Denver, Atlanta, northern Pennsylvania, we went across the country to find out what's really being done to keep this nation's children healthy. Some surprising results ahead on HOUSE CALL.

(COMMERCIAL BREAK)

GUPTA: We're back with HOUSE CALL. The government-mandated wellness policy is being implemented in schools nationwide this year. In theory, these policies are meant to help fight the obesity epidemic, making school meals healthier, nutrition education available, and physical activity more accessible.

The reality is what you end up with depends on where you live.

(BEGIN VIDEOTAPE)

UNIDENTIFIED FEMALE: Today's lunch, we'll be having nachos, refried beans, and applesauce.

GUPTA (voice-over): Wellness is being added to the program at schools across the country this year.

UNIDENTIFIED FEMALE: Today we have regular toast, cinnamon toast, and cinnamon ...

GUPTA: Well, at least in theory anyway. Congress didn't give schools any extra money for new wellness programs. It left decisions about how to improve nutrition and exercise up to state and local leaders.

Success depends on how hard schools want to work. In Atlanta, the district held a wellness plan kickoff day. But most of the specifics were left up to individual schools.

District wide menus did change. Kids got one percent milk, instead of 2 percent. Their pizza crust went from white to wheat. Other wellness plans, North Allegheny, Pennsylvania killed their regular doughnuts with dad day. And in Pinellas County, Florida, middle schoolers get fries just three times a week now, down from last year's daily allotment.

Alice Moag-Stahlberg randomly served wellness policies this past August and found that they vary widely. The federal mandate is a good idea in theory, she says, but it may not have enough teeth.

ALICE MOAG-STAHLBERG, ACTION FOR HEALTHY KIDS: What's the carrot? What's the stick? And unfortunately, there's not a lot funds available for helping schools to implement these policies. And on the other side, too, there's really not a lot of restrictions or consequences if you don't.

UNIDENTIFIED FEMALE: Pineapple, cherry, pears.

LEO LESH, FOOD SERVICE DIRECTOR: Oh, OK. So nice good array of fruits today for the kids. Good.

GUPTA: Denver's school system, which is millions of dollars in debt, says it made wellness a priority throughout the entire district. There are no more school stores or vending machines selling junk food and competing with healthy cafeteria options.

LESH: So now the wellness policy, everybody has to follow the same rules that we have to live with.

GUPTA: The school kitchens also go out of their way to market the healthy items and package them in a way that's more kid friendly. Applesauce, dyed bright colors. Colored milk in small plastic bottles instead of hard to open cartons.

And every child, regardless of income, gets a healthy free breakfast delivered to their class if their school wants it. Lesh says wellness plans can help schools beat the obesity epidemic, but only if schools commit to making them work.

(END VIDEOTAPE)

GUPTA: And here at HOUSE CALL, we hope more schools can find a try to make their wellness programs work.

More coming up after the break.

(COMMERCIAL BREAK)

GUPTA: For more about breast cancer, click over to our Web site, CNN.com/HouseCall. You're going to find links there to the latest studies and CNN stories on breast cancer.

Also, don't forget to check out breastcancer/org. It has a wealth of resources for patients, survivors, and loved ones.

Dr. Marisa Weiss has been our guest. She's the founder of breastcancer.org. Do have a final thought today for our viewers?

WEISS: Well, I know how scary and overwhelming a breast cancer diagnosis is, but the good news is that it's not a death sentence. And it's not an emergency. You have time to read information and find out what you're up against, how to solve the problem, and also how to connect with other people. And at breastcancer.org, 24 hours a day, seven days a week, we're open to provide that medical information and - for the community of other survivors who can really give you the encouragement that can really feel much - make you feel much better.

GUPTA: Well, thank you so much, Dr. Weiss.

We're out of time, unfortunately, for today. Dr. Marisa Weiss, thank you for being with us this morning. Make sure to tune in every weekend as well for another edition of HOUSE CALL. E-mail us your questions, HouseCall@CNN.com.

I'm Dr. Sanjay Gupta. Stay tuned now for more news on CNN.

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