Breast cancer is the most frequent cancer among women. The chances of the average woman developing breast cancer are one in eleven. Furthermore, three groups have a higher than average risk of developing breast cancer .
These are women over age 50, women whose mother or sisters have had breast cancer, and women who have already had breast cancer. Other factors which may increase the risk are long term cystic disease of the breast, onset of menstruation before age 11, having no children or having a first pregnancy after age 30, high fat diet, upper socioeconomic class, and being a white person.
The specific cause of breast cancer is unknown. However, the earlier the cancer is detected and treated, the better the chance is for its cure. It is reassuring to know that eight out of ten breast lumps are not cancer. However, any lump, thickening, skin dimpling or puckering, or nipple discharge should be examined and evaluated by your health care practitioner as soon as possible.
Fear of breast cancer prevents some women from doing so. This is unfortunate, causing unnecessary anxiety for the large majority who do not have cancer and delaying effective treatment for those who do. Since 90 percent of breast lumps are discovered by women themselves, early detection begins with breast self examination (BSE). All women should examine their breasts once a month. Women past menopause should pick a date they will remember, such as the first of the month or the monthly anniversary of their birth dates to remind themselves to do a BSE.
The examination is performed monthly so that women become familiar with the appearance and texture of their own breasts, enabling them to recognize a change. In addition to a monthly BSE, all women should have their breasts examined yearly by their health care practitioners. This can be done during the yearly gynecological examination or routine physical examination.
The third method of detection is mammography. This consists of special x-rays of the breasts which can reveal tumors which are too small to be found by breast examination. The American Cancer Society recommends a yearly mammogram for women over 50. Other experts recommend mammography at regular intervals but not necessarily once a year.
Mammography has been controversial because of the possibility that radiation from the x-rays themselves may cause cancer. However, with current x-ray equipment the dose of radiation is quite small, and for women over 50 it is thought that the value of the examination outweighs the risk.
Two other detection methods, which are still under investigation, are thermography, in which special film records heat patterns of the breast, and ultrasound, which bounces sound waves off the breast tissue. Neither of these techniques use x-rays, so there is no chance of radiation exposure.
If a breast lump is found, a biopsy is usually performed to establish a diagnosis. If cancer is present, there are now several options to the once standard radical mastectomy (surgical removal of the breast, surrounding lymph nodes, and muscle). Studies are under way to evaluate less disfiguring surgery such as removal of the tumor only (lumpectomy), or breast only, along with follow up treatment with radiation to kill any remaining cancer cells.
If the breast is removed, breast reconstructive surgery is now available. Since there are so many choices, it is important to discuss all available alternatives with your health care practitioner and surgeon. In the past few years women have demanded and obtained many changes in the treatment of breast cancer. It is up to you to take advantage of them.