Breast Cancer

Breast cancer is the most common type of cancer in American women. Each year in the United States , more than 180,000 women learn they have this disease. Early detection increases the changes of survival. Women with small, localized breast cancers (where the cancer has not spread beyond the breast) have an excellent chance of living many years after cancer treatment.

Causes

Factors that can increase the risk of developing breast cancer include:

• Family History. Your risk doubles if your mother or sister has had breast cancer. It is even higher if they developed breast cancer before menopause. Premalignant Cells on Biopsy. Women who have had a previous breast biopsy that was benign but showed certain suspicious cells are at increased risk. • Age. Two-thirds of all breast cancer occurs in women over age 50. As you grow older, your risk increases.

• Alcohol Use. Some studies have shown that alcohol consumption may be linked to breast cancer. If you drink alcohol, having more than one drink per day could put you at risk.

• Childbirth and Menstruation. Never having children or giving birth to your first child after age 30 increases your risk of breast cancer. Getting your first period before the age of 12 or starting menopause after the age of 55 may also add to your risk.

• Estrogen. Some studies suggest that the longer a woman is exposed to estrogen, the more likely she is to develop breast cancer. Beginning menstruation before the age of 12, experiencing menopause after the age of 55, never having children, or taking hormone replacement therapy for long periods are factors that increase the amount of time a woman is exposed to estrogen.

• Other Factors. Other factors linked to breast cancer include obesity and a history of ovarian, colon, or endometrial cancer. Even so, the most important risk factors are growing older and being a woman. About 80 percent of women who get breast cancer do not have a personal or family history of the disease.

Symptoms

Breast cancer usually does not cause pain in its early stages. There may be no symptoms when it is first developing. There are some signs to watch for. See your doctor if you notice any of the following:

•  New lumps or changes in the size or shape of existing lumps

• Change in the shape or contour of a breast or unusual swelling

• Dimpling, puckering, crusting, or rash in the skin, especially around the nipple

• Any discharge from the nipple

Methods for Detecting Breast Cancer

Breast cancer screening includes regular breast self-exams (BSE), clinical breast exams performed by a doctor, and mammograms.

Breast Self-Examination

Many women are afraid to examine their breasts because of what they might find. Most breast lumps are not cancerous. Even if a breast lump is cancerous, your best defense is early detection. Breast self-examination (BSE) is easy and takes only about 5 minutes a month. Among women with breast cancer, 34 percent said they first discovered their breast cancer through BSE. BSE is a way to discover any change from what is “normal” for you. Your doctor can review this technique with you (see box on p. 285). There is some disagreement in the medical community about the effectiveness of BSE. Some believe BSE is not very accurate and can create needless anxiety and expense. This is especially true for younger women who have no special risk factors. However, women who already do self-exams should not stop.

Clinical Breast Examination

Many doctors do routine breast exams for women of all ages during general physicals or pelvic exams. The doctor will check each breast using fingertips to feel for lumps and to look for other suspicious changes, such as dimpled, scaling, or puckered skin or fluid leaking from the nipple. When combined with a mammogram, a breast exam by a doctor is the best way to detect cancer in its early stages.

Mammograms

Mammograms can detect breast cancers while they are very small, sometimes 2 years earlier than they can be felt by a woman or her doctor. A mammogram is an examination in which a low dose of radiation (an x-ray) is passed through the compressed breast. Compression of the breast tissue is necessary to ensure the highest quality image. Compression is not dangerous to your breast tissue, and any mild discomfort you experience should be temporary. “Routine” or “screening” mammograms are for patients without symptoms. If your mammogram is routine, a radiologist may not look at the mammogram before you leave the office. Sometimes the radiologist needs to clarify findings on the mammogram, and you may be asked to return for additional views or procedures soon after your initial screening. A follow-up exam may be scheduled 3 to 6 months after your mammogram. Follow-up is common and doesn’t necessarily mean that cancer is suspected. “Nonroutine” mammograms are scheduled for patients who have known abnormalities or conditions, such as a lump, dimpling, or nipple discharge, for the first year following breast cancer diagnosis or breast surgery. If you are one of these patients, a radiologist reviews films before you leave, reducing the chance of being called back for additional views.