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Breast Cancer

Breast cancer is newly diagnosed in about 211,240 women each year in the United States. This is 32 % of all causes of cancer in females. Seventeen percent of all women will be given a diagnosis of breast cancer in their lifetime. Breast cancer is the leading cause of death among American women who are 40 to 55 years of age. When deaths are aggregated by age, cancer has surpassed heart disease as the leading cause of death for persons younger than 85 since 1999. Heart disease caused 356,014 deaths in women in 2002. It is estimated that breast cancer will cause 40,410 deaths in women in 2005.
Needle aspiration is a routine part of evaluating a palpable mass. It is a safe, simple and an inexpensive means of immediately distinguishing cysts from solid masses. If the mass is cystic and the fluid is non-bloody on aspiration, nothing else needs to be done other than a follow-up exam. If the mass is solid, it usually needs to be biopsied. The majority of biopsies are not cancer and nothing else needs to be done. If the mass does show cancer then the patient will be given several options. Presently, some cancers can be removed with a "lumpectomy" which preserves the majority of the breast tissue. Sometimes, it will be necessary to do a mastectomy. Many times the patient may choose to have a breast reconstruction. The surgeon will usually remove some lymph nodes under the arm that is helpful in deciding which additional treatment will be needed. Many times radiation therapy and chemotherapy will be recommended. The five year survival of breast cancer is 98 % if it is localized and the overall five year survival for all breast cancers are 75 %. The most significant risk factor for breast cancer is having other family members that have been diagnosed with breast cancer. The closer the relationship and the younger they were at initial diagnosis, the greater the risk. It is important to remember that 75% of patients with breast cancer do not have a family history of breast cancer, so all females should be screened for breast cancer regardless of their family history. Screening should start at an earlier age if there is a family history of breast cancer. Risk factors for breast cancer are:

1) Onset of menses before 14 years of age.
2) Having your first child when you are over 30 years of age or not having children.
3) Going through menopause after age 55.
4) Having a previous breast biopsy even if for benign breast disease.
5) Obesity.
6) Taking hormones (estrogen and progestin) for 10 to 20 years.
7) Regular alcohol consumption.
8) Higher socioeconomic status.
9) Caucasian race.
10) Increased breast density on mammogram.
11) Family history.
12) Taking antibiotics regularly.

Breast cancer is not increased in women who have taken birth control pills, had an abortion or have taken unopposed estrogen ( women who have had a hysterectomy).

Exercise has been shown to reduce the chance of developing breast cancer.

It is important for all women to perform monthly breast self-exams. If you are not familiar with how this is done, you may obtain a pamphlet from me or the American Cancer Society that explains how to perform a breast self-exam. The American Cancer Society recommends women start getting yearly mammograms at age 40. Mammography is not 100% accurate so a breast biopsy is frequently required to make a definitive diagnosis of a suspicious finding on the mammogram. Most of time the biopsy will be benign. Unfortunately, these biopsies are the only way to definitely rule out a cancerous lesion. This seems to be an acceptable trade-off, particularly if the woman happens to be one of the individuals with a breast cancer that is removed before it is even palpable. In this case the five year survival is 98 %. Overall, screening appears to reduce mortality from breast cancer by about 33% in women over 50 and 18 % in women 40-50 years old. Mammographies are normal in the presence of a palpable known breast cancer up to 20 % of the time. A normal mammogram in the presence of a palpable breast lump does not mean you don't have breast cancer. On the other hand, mammography will show breast cancer before it is palpable in many instances. A biopsy should almost always be performed to rule out cancer if the lesion is solid. Never ignore a palpable breast lump simply because the mammogram is normal.

References
Velicer, CM, Heckbert, SR, Lampe, JW, et al. Antibiotic use in relation to the risk of breast cancer. JAMA 2004; 291:827.

Jemal, A, et al. Cancer statistics, 2005. CA Cancer J Clin 2005; 55:10-30.

Risks and benefits of estrogen and progestin in healthy postmenopausal women: principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002; 288:321.

Boyd, NF, Dite, GS, Stone, J, et al. Heritability of mammographic density, a risk factor for breast cancer. N Engl J Med 2002; 347:886.

Marchbanks, PA, McDonald, JA, Wilson, HG, et al. Oral contraceptives and the risk of breast cancer. N Engl J Med 2002; 346:2025.

Anderson, GL, Limacher, M, Assaf, AR, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women's Health Initiative randomized controlled trial. JAMA 2004; 291:1701.

McTiernan, A, Kooperberg, C, White, E, et al. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women's Health Initiative Cohort Study. JAMA 2003; 290:1331.

Harris J, Lippman M, Veronesi U, Willett W. Medical Progress: Breast Cancer (First of Three Parts). N Engl J Med 1992; 327:319-328.

Harris J, Lippman M, Veronesi U, Willett W. Medical Progress: Breast Cancer( Second of Three Parts). N Engl J Med 1992;327:390-98.


Harris J, Lippman M, Veronesi U, Willett W. Medical Progress: Breast Cancer (Third of Three Parts). N Engl J Med 1992;327:473-80.

Donegan W. Current Concepts: Evaluation of a Palpable Breast Mass. N Engl J Med 1992;327:937-42.

Boring C, Squires T, et al. Cancer Statistics, 1994. Ca 1994; Vol 44 ,No. 1:7-26.


The information provided above is offered as a community service about health-care issues and is not a substitute for individual consultation. Advice on individual problems should be obtained from your personal physician. This information is based on research by the author and represents his interpretation of the literature.

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