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Breast Cancer Screening
Breast cancer is the second most common cancer women face second
only to lung cancer, however it is the most feared cancer or
disease for most women. It occurs in about 12% of women who will
live to the age of 90. Several well established factors increase
the risk of breast cancer and they include family history,
nulliparity (not having had children), early menarche (starting
menstrual cycles early), advanced age and a personal history of
breast cancer. Other risks include exposure to environmental toxins
such as tobacco smoke that increase the chance for cancer growth.
October is Breast Cancer Awareness Month. The American Cancer
Society has many activities this month to bring this to the public
attention.
Early education on self-breast exam and early screening is
extremely important in achieving good outcomes. Self-exam and
physician examination will detect cancer at a rate between 70 -
80%. Adding screening mammography (mammograms) will increase
detection to 96 - 98%. It has been shown that early detection
through clinical exam and mammography can reduce breast carcinoma
mortality by 20 to 30%. Today's gold standard for screening
(mammograms) will still miss between 10 and 15% of neoplasm.
Therefore, if a clinically noted mass is followed by a negative
mammogram the work up should then include a breast ultrasound
and/or a fine needle aspiration cytology and close interval
examinations. The modality of Magnetic Resonance Imagining (MRI) is
a method of examining the breasts that is far more sensitive in
picking up smaller tumor than Mammogram. MRI is widely used in
Europe but has not taken on in the US yet. It is more expensive as
a screening tool in the USA, but since it is so widely used in
Europe it is actually less expensive there. Even with open biopsies
of suspicious masses the diagnosis of a malignancy is one in about
five biopsies performed. This may seem costly but the morbidity and
mortality of missing a malignancy is even more so.
Screening should start with a baseline mammogram at age 35, or
younger if there is a strong family history. Annual examinations
should be performed once a woman reached 40 years of age, and self
examination should be encouraged monthly starting at the age of
twenty. Disease prevention & early screenings is the mainstay
of a preventive medical practice despite the somewhat conservative
recommendations made by medical specialty societies and the managed
care industry. Oftentimes the risk-benefit ratio for cancer
screening has the dollar as it's bottom line, but if you are the
unfortunate patient to have a cancer that was not detected early,
then all the statistics in the world will not matter to you. My
philosophy is to pay a little more in time and money upfront to
assure a disease free state.
An important thing for women to remember is a positive family
history alone increased lifetime risk of cancer to about 25%, that
is double the incidence of no such history. Recently the interest
has focused on cancers associated with germ line (inherited)
genetic mutations. While approximately 5 - 10% of all breast cancer
sufferers have a mutation in BRCA1 gene (located on chromosome 17)
and BRCA2 gene (located on chromosome 13), this type of screening
should only be done when a first degree relative with know cancer
and a positive mutation is detected or whether a women falls into a
certain ethnic group. Women who have inherited a BRCA1 or BRCA2
mutation have a relatively high lifetime risk of breast cancer
(about 50-85%). Risk for cancer in the opposite breast of a woman
with a BRCA1 mutation is about 25%. In such cases genetic screening
may be advocated. Once a tumor is detected important prognostic
determiners as stage of the disease, histology and nuclear grade,
estrogen and progesterone receptor status and HER2/neu gene
amplification tests are advisable.
For more information on Breast Cancer the following websites are
helpful: http://cancerweb.ncl.ac.uk/cancernet/ and
www3.cancer.org/cancerinfo. Also a call to the American Cancer
Society at (800) ACS-2345 can be of help. To conclude, it is
extremely important for women to maintain annual physical exams and
aggressive cancer screening regiments. There are means to help
prevent cancer in those women who seem predisposed. Screening is
one thing, but taking measures to help prevent cancer growth is yet
another. There are things women do on a daily basis that can
increase their chances for breast cancer (and other cancers) that
they are not aware. The programs advocated at my center are based
on lifestyle modification, prevention, early detection, natural
hormone replacement and nutritional medicine. Women should take a
proactive approach to the breast cancer issue, for it may save
their lives. This topic is one that is close to my heart, as my
ex-wife is a breast cancer survivor.
Breast Cancer Screening and Prevention
By JP Saleeby, MD
JP Saleeby, MD is Assistant Medical Director of the Emergency
Room at LRMC, Hinesville, GA. He hold adjunct professorship in the
School of Nursing at Georgia Southern University. He performs
online telemedicine consultation via http://www.saleeby.net
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