Wednesday, Oct 17, 2018

October Is Breast Cancer Awareness Month

October is
Breast Cancer Awareness Month

“The goal of breast cancer awareness campaigns is to raise the public’s knowledge of breast cancer: it’s detection, it’s treatment, and the need for a reliable, permanent cure.”

From the very first exam, I start discussing breast care awareness with my patients. The way I see it, breast cancer should be considered a curable disease. Much depends on the stage of the cancer (how far has it spread) at the time of diagnosis. Some important facts to know:

• 1 in 8 women will develop breast cancer in their lifetime. The longer we live, the more likely it is to occur. Young women tend to develop more aggressive breast cancers

• Breast Cancer is the most common cancer in women

• Most women (8 out of 10) who get breast cancer DO NOT have a family history of the disease. 5-10% of breast cancers can be traced to a gene mutation, such as BRCA 1&2

• 1% of breast cancers occur in men

• The biggest risk factor for developing breast cancer is being a woman. Women with dense breasts on mammogram have a 1.5-2.0 times higher risk of developing breast cancer than those with average breast density

• Women with more menstrual cycles (early menarche & late menopause) have a slightly higher incidence of breast cancer. Breast-feeding over 12 months slightly reduces the risk of developing breast cancer

• Exercise has been shown to reduce the risk of breast cancer. Obesity increases the risk. Smoking cessation reduces the risk of multiple cancers, including breast. Keep alcohol intake to a moderate level (1 glass/day) and maintain a healthy, plant-based diet low in animal products

I discuss the importance of “self-exam” from an early age. Know your breasts! We have moved away from trying to teach “how to do it, “ but rather emphasize the importance of being familiar with one’s own body, and encourage seeking evaluation if changes are noted. This can include a firm mass, signs of infection (e.g., redness and swelling), dimpling, a newly inverted nipple, etc. Rarely is pain a sign of breast cancer, especially if it is cyclic and occurs in both breasts. However a localized, persistent pain deserves investigation.

Ideally, breast cancer screening should be individualized. A comprehensive breast center (such as Hoag Hospital or Pacific Breast Center) will take a detailed history and update it yearly. From that information, a lifetime risk assessment of developing breast cancer can be obtained. Generally, if that risk is greater than 20%, additional imaging techniques will be recommended. I practice The American Cancer Society and The American College of OB/GYN recommendations and begin screening my patients at age 40 and continuing annually. This may begin earlier based on family history or other individual factors

Mammogram is the most important diagnostic tool for detecting breast cancer at an early stage. Tomosynthesis creates a three-dimensional image that allows for better detection, especially in a woman with dense breasts. Digital mammography allows the images to be manipulated/enhanced on a screen for better detail resolution. Mammograms are x-rays that do provide a small amount of radiation. The amount of radiation is roughly equivalent to flying from Los Angeles to New York, and getting mammograms has not been shown to increase the risk of breast cancer.

Ultrasound uses sound waves to image tissue. It is most helpful to determine whether a breast lump is solid or a fluid filled cyst.

MRI (magnetic resonance imaging) uses magnetic and radio waves to create a picture of the breast, which requires an injection of dye.

A breast Biopsy is the way to sample the tissue, look at it under a microscope, and determine whether cancer cells are present. It is the only way to make a definitive diagnosis.

Thermography is not a proven method to screen for breast cancer

Realistically, we are unlikely to decrease the incidence (occurrence) of breast cancer. Breast cancer is far and away the most common cancer I see in my patients, my neighborhood, and among my friends. The good news is that survival and cure rates are better than ever! Women have many choices with their treatment plans, and the majority will go on to live robust, healthy, wonderful lives.

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