| Breast cancer is the second most common cancer | | | | so. |
| women face second only to lung cancer, however it | | | | Screening should start with a baseline mammogram |
| is the most feared cancer or disease for most | | | | at age 35, or younger if there is a strong family |
| women. It occurs in about 12% of women who will | | | | history. Annual examinations should be performed |
| live to the age of 90. Several well established factors | | | | once a woman reached 40 years of age, and self |
| increase the risk of breast cancer and they include | | | | examination should be encouraged monthly starting at |
| family history, nulliparity (not having had children), | | | | the age of twenty. Disease prevention & early |
| early menarche (starting menstrual cycles early), | | | | screenings is the mainstay of a preventive medical |
| advanced age and a personal history of breast | | | | practice despite the somewhat conservative |
| cancer. Other risks include exposure to environmental | | | | recommendations made by medical specialty societies |
| toxins such as tobacco smoke that increase the | | | | and the managed care industry. Oftentimes the |
| chance for cancer growth. October is Breast Cancer | | | | risk-benefit ratio for cancer screening has the dollar |
| Awareness Month. The American Cancer Society has | | | | as it’s bottom line, but if you are the |
| many activities this month to bring this to the public | | | | unfortunate patient to have a cancer that was not |
| attention. | | | | detected early, then all the statistics in the world will |
| Early education on self-breast exam and early | | | | not matter to you. My philosophy is to pay a little |
| screening is extremely important in achieving good | | | | more in time and money upfront to assure a disease |
| outcomes. Self-exam and physician examination will | | | | free state. |
| detect cancer at a rate between 70 – 80%. | | | | An important thing for women to remember is a |
| Adding screening mammography (mammograms) will | | | | positive family history alone increased lifetime risk of |
| increase detection to 96 – 98%. It has been | | | | cancer to about 25%, that is double the incidence of |
| shown that early detection through clinical exam and | | | | no such history. Recently the interest has focused on |
| mammography can reduce breast carcinoma mortality | | | | cancers associated with germ line (inherited) genetic |
| by 20 to 30%. Today’s gold standard for | | | | mutations. While approximately 5 – 10% of all |
| screening (mammograms) will still miss between 10 | | | | breast cancer sufferers have a mutation in BRCA1 |
| and 15% of neoplasm. | | | | gene (located on chromosome 17) and BRCA2 gene |
| Therefore, if a clinically noted mass is followed by a | | | | (located on chromosome 13), this type of screening |
| negative mammogram the work up should then | | | | should only be done when a first degree relative with |
| include a breast ultrasound and/or a fine needle | | | | know cancer and a positive mutation is detected or |
| aspiration cytology and close interval examinations. | | | | whether a women falls into a certain ethnic group. |
| The modality of Magnetic Resonance Imagining (MRI) | | | | Women who have inherited a BRCA1 or BRCA2 |
| is a method of examining the breasts that is far | | | | mutation have a relatively high lifetime risk of breast |
| more sensitive in picking up smaller tumor than | | | | cancer (about 50-85%). Risk for cancer in the |
| Mammogram. MRI is widely used in Europe but has | | | | opposite breast of a woman with a BRCA1 mutation |
| not taken on in the US yet. It is more expensive as a | | | | is about 25%. In such cases genetic screening may |
| screening tool in the USA, but since it is so widely | | | | be advocated. Once a tumor is detected important |
| used in Europe it is actually less expensive there. | | | | prognostic determiners as stage of the disease, |
| Even with open biopsies of suspicious masses the | | | | histology and nuclear grade, estrogen and |
| diagnosis of a malignancy is one in about five biopsies | | | | progesterone receptor status and HER2/neu gene |
| performed. This may seem costly but the morbidity | | | | amplification tests are advisable. |
| and mortality of missing a malignancy is even more | | | | |