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Breast Cancer's Facts of Life

Mammography remains a key to deffending against the disease

Breast cancer is the most common form of cancer among American women. According to the American Cancer Society, 180,000 American women develop breast cancer each year, and 46,000 die of the disease annually. Although more women now die of lung cancer, one in every nine women in the United States will develop breast cancer over her lifetime. Dr. Mark Brenner, director of the Radiation Oncology Center at Sinai Hospital in Baltimore, Md., explains the risks, the precautions that should be followed, and the treatment options that are available.

What are the symptoms of breast cancer?

There are rarely symptoms of early breast cancer. The most common sign is a painless lump or thickening that does not go away or change with the menstrual cycle. The upper outer quadrant of the breast is the most common area to find a cancer. Some 80 percent or more of cancers begin in the milk ducts. Cancer that starts in the glands that produce milk is less common.

All lumps should be checked by a doctor. Other signs are swelling, puckering or dimpling in the skin, skin irritation, pain or tenderness in the nipple and discharge from the nipple, and lymph nodes under the armpits that are hard. Any pain or tenderness that persists throughout the menstrual cycle should be reported to a physician.

Who is at risk of developing breast cancer?

Every woman is at risk for breast cancer. About 75 percent of all breast cancers diagnosed each year are among women without any known risk factors.

But aren't there certain factors that predispose a woman to breast cancer?

Yes. Risk factors to breast cancer include being older than 50; having a personal family history of breast cancer, especially on the maternal side; never giving birth; giving birth to the first child after age 30; being on birth control pills for 15 or 20 years; getting your first period at an early age; and having late menopause. There is also some data that if you've had endometrial cancer or ovarian cancer, you're at a greater risk of getting breast cancer.

In spite of all this, unless you have a very strong family history of the disease - for example, your sisters, mother, aunt, and grandmother all have it - these factors just slighly increase your risk. If you have one of these risk factors, it doesn't mean you're doomed, it just means you have to be more careful.

If a woman has one or more of these risk factors, what can she do to protect herself?

Be very fastidious about self-exams, have mammograms when recommended, and see the doctor regularly. Women with one or more of the risk factors should be especially alert to the warning signs of breast cancer and make sure to perform breast self-examination monthly. These women should also have breast exams by a health professional more often and start having exams at an earlier age.

What should women with no risk factors do?

They should ask their doctor, nurse, or mammography technician to teach them the proper method of performing a monthly breast exam. Women over age 20 should examine their breasts once a month. The best time for a menstruating woman to do a breast self-exam is right after her period when the breast swelling and tenderness is over. Women who are past menopause should perform breast exams at the same time of the month, every month, so that it's not forgotten.

Although the recommendations about when regular mammograms should start are somewhat controversial and may change, at present the American Cancer Society, the American College of Radiology and the American College of Surgeons recommend that a woman get a baseline mammogram beginning at age 35 to 40. This mammogram will be compared to future mammograms.

Between the ages of 40 and 50 a woman should get a mammogram every two years. After age 50 a woman should get a mammogram every year. See your doctor for regular breast exams at least every three years between the ages of 20 and 40 and every year over 40.

What good are mammograms?

A mammogram is an X-ray picture of the breast. Mammography can find masses before they can be felt. In some cases, mammograms can find masses several years before they can be felt. There are two major studies that show that early detection significantly increases the chances of beating cancer.

Are mammograms safe?

Modern mammography equipment will only expose women to a minimal amount of radiation. A trained radiologic technologist positions your breast between two plastic plates that compress it, spreading the breast out so that the X-ray can produce as precise an image as possible. If a mammography facility is accredited by the American College of Radiology, the mammography machines and the facility staff have met special quality standards and tests. To find out where to get a quality mammogram, call your local American Cancer Society office.

How much does a mammogram cost?

A screening mammogram costs about $100 to $150 and is usually covered by insurance.

What if the doctor finds breast cancer?

There will be a number of diagnostic studies done on the tumor to find out how advanced it is, to find out what treatments are appropriate, and to make recommendations. The tumor itself is removed from the breast, and usually lymph nodes are taken from the armpit area. The physician needs to know the size of the tumor and whether it has spread to any of the lymph nodes. DNA analysis is done on the tumor to get a feeling for how aggressive the tumor seems to be, and "receptor status" is analyzed to see if the tumor would respond to hormonal therapy.

What are the treatment options?

There are two main lines of decision. One is to ask whether this patient is at risk for the tumor to spread outside the breast to the rest of the body, and whether systemic therapy is therefore appropriate. This can be done through chemotherapy and/or hormonal therapy. Chemotherapy is used more often with premenopausal women, and hormonal therapy is more often used with postmenopausal women.

The second approach is to treat the breast locally. If the doctor simply removes the cancerous lump from the breast and does nothing else locally, there is at least a 40 percent chance that the tumor will regrow within the breast. The two treatment options are either mastectomy, which is removing the entire breast, or treating the remaining breast with radiation. In seven randomized studies worldwide, both mastectomy and lumpectomy with radiation have equal results. The decision whether to undergo a mastectomy or preserve the breast should be made jointly with a surgeon and a radiation oncologist.

What are the chances of beating the disease through treatment?

According to the American Cancer Society, the 5-year survival rate is 92 percent if the cancer has not spread to the lymph nodes. After 10 years the survival rate for someone who had breast cancer that didn't spread to the lymph nodes is more like 80 percent. If the cancer has spread to the lymph nodes, the chance of survival in 5 years is 70 percent. After 10 years it's 50 to 60 percent. Early detection leaves you with the most options and the best chance of survival.


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