|
Screening for breast cancer
There is no doubt that the best chance for curing breast cancer is through early
detection. Early detection relies on a program of screening, which involves
breast self-examination (BSE), physician examination, and mammography.
Women who have not had any breast problems should probably have their first
baseline, mammography examination by their mid- to late 30s. After that, they
should follow this general screening schedule:
- Women ages 40 to 49, mammogram every other year
- Women age 50 and over, mammogram every year
Mammograms are the only way to detect breast cancer before it can be felt
during a breast examination. Research has shown that mammograms can increase
breast cancer survival. However, not all breast cancers can be detected on
mammography. This is especially true for younger women who have denser breast
tissue. Thus, it is important to include a breast examination (by BSE and an
examination by a doctor or nurse) as part of the screening process.
Recognizing normal, hormonal changes
Breast physical examinations can be very challenging. Breast tissue changes
during a woman's entire life. It is particularly sensitive to estrogen and
progesterone hormone influences.
In some women, changes in hormone balances during normal, monthly cycling can
create symptomatic breast changes that are referred to as "fibrocystic
disease" or "fibrocystic change." These are general terms that
consist of a number of different findings, including breast swelling and
tenderness, pain, nodularity (tissue resembling or containing small nodes),
thickening, lumps, and masses.
Fibrocystic changes can occur in one or both breasts. The changes are often
prominent during a woman's 40s. It is relatively uncommon for postmenopausal
women to have symptomatic breast changes due to a lack of hormone stimulation of
the breast tissue.
Detecting breast changes through breast self-examination
Many women are anxious about practicing breast self-examination. They wonder
what is normal and what is not normal. The best way for a woman to become
familiar with her breast tissue is to practice BSE regularly.
Breast self-examination should be performed at the same time each month. For
premenopausal women, the best time is usually several days after a menstrual
period. Over time, women who practice BSE become familiar with how their breast
tissue changes from month to month. This can help them to be more alert to any
changes that are not normal.
Conditions that should be checked by a physician include:
- An area that is distinctly different from any other area on
either breast
- A new fullness or thickening that persists through one's
menstrual cycle
- A mass or a lump, which may feel as small as a pea
- A marble-like area under the skin
- Any changes in the skin, nipple, or contour of the breast
- Bloody or clear discharge (fluid) from the nipple
Fortunately, the majority of breast lumps are non-cancerous.
Diagnosing breast cancer
Breast cancer is diagnosed by taking a sample of cells or tissue from an
abnormality found during breast examination or by mammography. These procedures
are called breast biopsies. Cells from breast tissue are obtained by a form of
breast biopsy called fine needle aspiration (FNA). Breast tissue is obtained
using a surgical procedure that takes a core of tissue or by removing a larger
portion of tissue. For abnormalities identified by mammography (termed
non-palpable abnormalities), the stereotactic breast biopsy is used. This
technique samples but does not remove the tissue.
Cells or tissue that are removed are given to a pathologist, a physician who
specializes in diagnosing abnormal changes in tissue. Pathologists have years of
advanced training in determining which cells and tissue are derived from breast
cancer.
Treating breast cancer
If breast cancer is diagnosed, treatment plans are made to reduce the chance of
the cancer returning in the breast or traveling to a location outside of the
breast. Treatment of the breast itself can be done by one of two methods. The
first method is called breast conservation. If breast conservation therapy is
not used, then mastectomy (removal of the breast) is another option.
- Breast conservation strives to preserve the normal
appearance of the breast. It consists of removing the cancer portion of
the breast and an area of normal tissue surrounding the cancer. This
procedure has often been called a lumpectomy, a partial mastectomy, or a
quadrantectomy. Some of the lymph nodes under the arm are also removed.
Usually, six to eight weeks of radiation therapy is then used to treat the
remaining breast tissue. Most women who have a small, early stage breast
cancer are excellent candidates for this approach.
- The mastectomy procedures performed today are not the
same as the older, radical mastectomies. Radical mastectomies were
extensive procedures that involved removing the breast tissue, skin, and
chest-wall muscles. Today, mastectomy procedures do not ordinarily remove
muscles and, for many women, mastectomies are accompanied by either
immediate or delayed breast reconstruction.
Breast reconstruction can be done either by using an artificial breast
implant or by using the patient's own tissue, which is usually taken from
the lower abdomen. The second method is called transverse rectus
abdominous myocutaneous flap reconstruction or TRAM reconstruction.
Following local breast cancer treatment, the treatment team will determine
the likelihood that the cancer will recur outside the breast. This team usually
includes a medical oncologist, a specialist trained in using medicines to treat
breast cancer. The medical oncologist, who works with the surgeon, may advise
the use of tamoxifen (tamoxifen citrate, Nolvadex) or possibly chemotherapy.
These treatments are used in addition to, but not in place of, local breast
cancer treatment with surgery and/or radiation therapy.
Breast cancer diagnosis and treatment are best accomplished by a team of
experts working together with the patient. Each patient needs to evaluate the
advantages and limitations of each type of treatment, and work with her team of
physicians the develop the best approach.
|
