BREAST CANCER
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Approximately one in nine American women will develop breast cancer
sometime in her life. It is the most common cancer in women, excluding
skin cancer, accounting for about 1/3 of all malignancies. It is the
second leading cause of cancer deaths in women. Breast cancer is
responsible for 18% of cancer deaths in women. These are sobering
statistics which can be downright scary. It is a significant health
hazard which medicine hasn't been able to alter much. Breast cancer is
different from other cancers in our society because it has been
inextricably entwined with a woman's sexuality. Until recently this last
aspect has been largely ignored by the medical community. However,
currently, breast conserving surgery as well as breast reconstruction
are an integral part of the management of female breast cancer.
Prevention of breast cancer is a hot research topic. Breast cancer does
occur in males (26kb photo) but is much more uncommon.
How is breast cancer found? The diagnosis of breast cancer is made in
basically made two ways - physical exam or mammography. The patient or
physician feels an abnormality in one of the breasts. It may be a firm
lump, something different compared to the other breast, or just
something new. This is why self examination is so important. A woman who
once a month examines her own breasts is going to recognize an
abnormality sooner. I have heard various objections from women
concerning self-examination. "I never know what I am feeling." You will
easily learn how your breasts normally feel. Something different will
show up immediately. You will know better than your Doctor if something
is different in your breasts. If it persists for more than a month or
into the next menstrual cycle, the breast should be examined by a
physician. Also a woman should have a yearly breast exam by a physician
when she has her PAP smear taken. Don't let your gynecologist skip the
breast exam or perform one too hurriedly. More uncommonly, some other
symptom may be the first sign of breast cancer.
Mammography (view inline picture above) is the second method for
diagnosing breast cancer. Mammography is a efficacious proven tool for
diagnosing breast cancer for women over 50 years of age. For women 40 to
50 years old, it is more controversial. If I had other risk factors, I
would undergo regular mammographic screening before age 50. A baseline
mammogram around age 40 is appropriate. Though I have never had a
mammogram, I am told they are relatively painless if performed by an
experienced mammography technician. The most useful tool we have for
fighting breast cancer is early detection. Breast cancer is curable when
found early.
What happens next? An abnormality is found by physical examination or
mammography. Another non-invasive test is ultrasound. Ultrasound helps
determine if a mass is solid or cystic. Cysts can also be diagnosed by
needle aspiration. Cystic lesions are generally benign but may be
confirmed by needle aspiration. Needle aspiration of cysts is different
from needle biopsy of solid masses. Any physician can aspirate a cyst,
but only physicians who are experienced with the procedure should
perform needle biopsy of solid masses. Palpable, able to be felt,
suspicious masses should have some sort of tissue biopsy. Fine needle
aspiration biopsy (FNAB) is simple, quick, accurate, and painless when
performed properly. When combined with mammography and physical exam, it
is 98 to 99% sensitive in detecting breast cancer. An alternative to
FNAB is open surgical biopsy. These may be performed with local
anesthesia (you don't have to be put to sleep). If the lesion is large
enough, a frozen section can be done by the pathologist with a
preliminary answer at the time of surgery. However, many lesions are
quite small and a frozen section should not be performed. Frozen section
damages the tissue and is not as accurate as routine pathological exam.
The answer is usually available within 24 to 48 hrs.
If the lesion is detected by mammography and is not palpable, a
relatively new biopsy procedure is available. It is called stereotactic
needle biopsy. This biopsy procedure is performed with the help of a
special mammographic biopsy table. The alternative is open surgical
biopsy with prior needle localization (see above diagram). The patient
has a mammogram immediately before surgery with placement of a fine
localization wire. The wire tells the surgeon what breast tissue to
remove. The wire and biopsy specimen (15kb photo) are x-rayed after
removal from the patient to be sure the abnormal area has been removed.
Frozen section should not be done on most mammographically detected
lesions.
The pathologist exams the biopsy and determines if it is malignant
(cancer), premalignant (high risk of becoming cancer), or is benign
(harmless). If it is benign, then the whole scary story is over. If it
is malignant or premalignant, the patient then discusses what else needs
to be done with her surgeon. Usually, if the cancer has not been
completely removed surgically, additional surgery is indicated. The
additional surgery also adds more information that is needed to choose
optimal treatment. Depending on the histology (type of cancer), grade
(how aggressive it looks under the microscope), stage (how big the
cancer is as well as how far it has spread), and additional prognostic (
predictive of how patients do) factors, additional radiation therapy or
chemotherapy is indicated. All of this information should be found in
the Pathology Report. This is a complex issue which demands the
cooperation of various doctors including the surgeon, pathologist,
radiotherapist, and oncologist. The patient should listen to
recommendations from all of these professionals before deciding on her
course of action.
Breast cancer, as well as other cancers, is a complex disease which
requires the interactions of various physicians. All patients should
understand their disease in as much detail as they would like. They
should be comfortable with their physicians as well as their diagnosis.
Acquiring a second opinion is sometimes useful if for nothing more than
peace of mind. Ultimately, patients should be in control of the whole
process.
A few extra photos related to pathology and breast cancer can be found
here.
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Hotlinks
Breast Cancer Information Clearinghouse - NY
This is a comprehensive site for breast cancer information. The hotlinks
are extensive.
Breast Cancer Home Page
Eleanor Smeal & The Feminist Majority Foundation have a good general
reference on breast cancer.
How to Perform a Breast Self-exam
A nice "how to" reference
National Breast Cancer Centre in Australia
This is a good resource with extensive data on breast cancer in
Australia.
Breast Cancer Lighthouse
A somewhat personalized breast cancer resource with a CD-ROM available.
NABCO
National Alliance of Breast Cancer Organizations - Varied Info
OncoLink, The University of Pennsylvania Cancer Center Resource
This is an excellent general resource on Cancer related information.
There is a nice breast pathology section which can be located quickly by
searching "breast".
The Beth Israel Patient's Guide to Breast Cancer/Contents
This is an excellent general resource on Breast Cancer related
information.
The Pink Ribbon Breast Cancer Awareness Campaign
Carol Sutton, a breast cancer survivor, is doing her part to disseminate
information about Breast Cancer. She also is quite an accomplished
artist.
WWWomen Search Directory
This site provides many links to women's health sites and is worth a
look.
Stan and Carols Breast Cancer Resources
Carol is a breast cancer survivor. This site provides many useful links
for breast cancer information.
Dr. Susan Love's Breast Book - Addison-Wesley Publishing
You should get a copy of this comprehensive book with more than any
breast cancer patient needs to know.
Myriad Genetics Homepage
This company specializes in Breast Cancer Gene testing. It has useful
information.
Breast Cancer Bookstore
A good source of books concerning Breast Cancer.
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Pap test.
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Number of Visitors to this Page (excluding resets): 30426
Address comments and suggestions to Pat Connelly (fnadoc@erinet.com)
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