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EARLY DETECTION AND TREATMENT ARE CRITICALStatistics indicate that ten out of every hundred women will develop breast cancer during their lifetimes. Safely anonymous, isn’t it? Cancer…the BIG C…the ENEMY… is something that only happens to other people, never to you or to someone you love. Unfortunately, that is what a lot of women want to believe. The cold, hard facts are that every woman is at risk for breast cancer, some just more so than others. Breast cancer worries more women than any other disease, perhaps because the breast is not only linked so inextricably to the unique life giving, nurturing functions of womanhood, but to a woman’s self-image as well. The statistics, alarming as they are, do not provide the whole picture. First of all, they can be misleading. The 10 percent figure, for example, is based on risk during lifetime - birth to 110 years. Breast cancer occurs most often after age 75, so the risk to younger women is probably more like seven and one-half percent. The annual one percent increases in the number of breast cancers may be credited to better diagnosis and the act that more women live long enough to get the disease. The important thing is that knowing the risks for breast cancer, detecting it early, and seeking immediate treatment can save your life. KNOWING THE RISKS No one knows exactly what causes breast cancer; so there is little one can realistically do to prevent it from occurring. Research has shown, however, that there are several categories of women that are at higher risk than others: two-thirds of all breast cancers are found in women over 50 years of age; the risk for women whose mothers or sisters have already had breast cancer is roughly double the average; and women who have already had cancer in one breast have a three times greater chance of developing it in the other breast. Just because none of these risks apply to all women, doesn’t mean that she cannot develop breast cancer. They should be used as guidelines to remind those at greater risk to be especially alert to the early warning signals. Every woman’s breasts are unique and they change throughout her lifetime. Their size, shape and texture may be influenced by age, menstrual cycle, pregnancy, birth control or other hormone pills, menopause or even a blow or bruise to the chest. The breast is a remarkable combination of ducts, lobes, fat and underlying bone. They feel lumpy and uneven. And they are all different; in fact, no two are alike - even on the same woman. One of the most important things a woman can do for herself is to learn the proper technique for a breast self-exam (BSE) so she becomes intimately familiar with her own breast “geography”. After she learns what is normal for her, she will be able to detect any changes or lumps that were not felt in the previous exam. Ask your doctor or contact the local unit of the American Cancer Society for instructions for performing the simple three-step BSE. Scientists report that breast cancer is really a group of diseases, containing many types of cells that not only look different under the microscope, but they grow at different rates and respond to medications differently. Thanks to new research and technological advances, doctors now have significantly more information about breast cancer that allows them to plan just the right treatment with much more precision than ever before. They can predict, with some degree of certainty, the survival rates for the different types of breast cancer, and this knowledge provides the clues to how aggressive the treatment needs to be. Breast cancer can take many forms that may or may not produce the changes or abnormalities women have been taught to look for. Any change, therefore, warrants investigation. A lump or thickening of the breast is the most common symptom. It is most often painless but may be tender to the touch, and there are no restrictions where it can be located on the breast. The good news is that eight out of ten breast tumors are not cancerous at all, so don’t be afraid t make an appointment with your doctor t find out for sure. A lump is unusual if it has not been felt during an earlier exam, if a similar structure is not in the same place on the other breast, or if it persists both before and after your period. Be on the lookout for the minute changes; train your fingers to find even the smaller-than-pea-sized lumps and consult your doctor right away if you find one. Another common symptom is a discharge from the nipple that may be clear, milky or even bloody. As with most lumps, most discharges also indicate benign conditions. Dimpling of the skin could mean that a growth is pulling the overlying skin inward. Changes in skin color or texture, swelling, redness or heat in the breast should also be checked out by your doctor. One other sign to look for is swelling in the underarm area This could be an enlarged lymph node and calls for a doctor’s examination. Mammograms, a low-dose X-ray procedure which can spot a breast tumor before it can be felt by the woman or her doctor, detects 80-90 percent of all breast cancers. While there is considerable discussion as to when a woman should have her first mammogram, the American Cancer Society suggests that a “baseline” mammogram be performed when a woman is between 35 and 40 years old. For women who are not at high risk and without symptoms, between 40 and 49 mammograms should be done every one to two years and then annually after age 50. Mammography is currently the best technique available for screening and detecting early breast cancer. Make sure that you have this test done at a facility that has been certified by the American College of Radiology to assure that the equipment is state-of-the-art and uses the lowest possible dose of radiation. It is also a good idea to make sure that a board certified radiologist - specially trained in mammography - interprets the results. A typical mammographic study consists of two views of each breast, one from the top and one from the side. The complete procedure takes only a few minutes to complete. You will be asked to remove your clothing above the waist and to put on a lose smock that opens down the front. The technologist will position one breast at a time in a special device that flattens the breast tissue, spreading it out so that the X-rays can produce as precise an image as possible. There may be a little discomfort as the breast is compressed, but it will last for only a moment. It is important to understand that even though the results of your mammogram may come back normal, this does not eliminate the need for routine, professional examinations and your own breast self-exams. Mammograms should be considered part of your overall health regimen, not a substitute. If the mammogram confirms a suspicious lump or questionable area, a biopsy may be recommended. Sometimes a biopsy can be done with a needle that withdraws fluid or tissue from the lump. The sample is then analyzed in a laboratory to determine whether cancer cells are present. More typically, however, a biopsy is a surgical procedure performed under local or general anesthesia in a hospital or outpatient surgery center. With this method, the lump - or a piece of it - is removed and analyzed. YOU HAVE CHOICES If the doctor recommends a biopsy, the woman has some options to consider. She can have a biopsy and authorize immediate breast removal (mastectomy) if cancer is found (the one step procedure). Or, she can elect a two-step method that involves biopsy one day and, if cancer is found, the treatment takes place several days to a week later. Generally speaking, the two-step method is better for most women because it allows additional tests to determine the extent of the disease as well as time for a second medical opinion. It gives the physician time to discuss treatment alternatives with her family that helps her feel more involved and “in charge” of her health care decisions. It also gives her a little more time to become mentally adjusted to the need for further surgery. A short delay between the biopsy and treatment will not affect the spread of the disease or the chances for successful treatment. One of the factors that play an important role in helping a person overcome cancer is a positive emotional attitude; so a few extra days to make the appropriate mental adjustments can actually help her in the long run. A relatively new test available today is the estrogen receptor assay. This test is done on the cancerous tissue to determine if the female hormone estrogen stimulates the cancer growth. The results of this test can be very helpful in planning additional treatment. The information may not be as readily available later, so it should be scheduled at the same time as the biopsy.
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Randy A. Birken, M.D., F.A.C.S., F.A.C.O.G. Copyright 2000-2006 Randy A. Birken, M.D., F.A.C.S.,
F.A.C.O.G. All Right
Reserved
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