Women's Services
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Breast Care
BREAST CANCER
Breast cancer is a malignant tumor that starts from cells of the breast. A malignant tumor is a group of cancer cells that may grow into surrounding tissues or spread to distant areas of the body. The disease occurs primarily in women, but some men are affected too.
The key to beating breast cancer is early detection. Women should perform monthly self-breast exams, have regular clinical breast examinations and schedule a yearly mammogram. Numerous studies have demonstrated that early detection is the most vital component in successful treatment of breast cancer. Annual screening mammograms starting at age 40 play a central part in early detection because they can detect subtle changes in the breast before they can be felt.
Signs and symptoms of breast cancer may include:
- A breast lump or thickening that feels different from the surrounding tissue
- Spontaneous; bloody or clear discharge from the nipple
- Changes to the skin over the breast, such as dimpling
- Inverted nipple
- Peeling or flaking of the nipple skin
- Redness or pitting of the skin over your breast, like the skin of an orange
If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor as soon as possible.
Risk Factors & Prevention
A risk factor is anything that makes it more likely you’ll get a particular disease. But having one or even several risk factors doesn’t necessarily mean you’ll develop cancer. In fact, most people with risk factors will not develop breast cancer. And three fourths of all women with breast cancer have no known risk factors other than simply being women.
Things that may increase your risk of breast cancer include:
- Being female. Women are much more likely than men are to develop breast cancer.
- Increasing age. Your risk of breast cancer increases as you age.
- A family history of breast cancer. If you have a mother, sister or daughter with breast cancer, you have a greater chance of being diagnosed with breast cancer. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
Inherited genes that increase cancer risk. Certain gene mutations such as BRCA1 and BRCA2 greatly increase the risk of breast cancer. Doctors estimate this accounts for 5-7% of all breast cancer. - Radiation exposure. If you received radiation treatments to your chest as a child or young adult, you’re more likely to develop breast cancer later in life.
- A personal history of breast cancer. If you’ve had breast cancer in one breast, you have an increased risk of developing a second cancer.
- There are a number of additional minor risk factors.
Unfortunately, breast cancer cannot be prevented. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage. First, follow the American Cancer Society guidelines for early detection by getting an annual mammogram, beginning at age 40. Additionally, if you exercise regularly, drink alcohol in moderation if you drink alcohol, and maintain a healthy body weight you may also decrease your risk for breast cancer.
If you have a strong family history or personal history of breast cancer, speak to your physician about when to start mammograms. If you have a first degree relative (mother, sister, or daughter), you should consider starting annual mammograms 10 years younger than their age of diagnosis, or at age 40, whichever is younger. The National Cancer Institute offers a tool to assess risk online click here.
THE POWER OF MAMMOGRAPHY
A mammogram is special low-dose x-ray of the breast. A radiologist physician uses the images to detect breast cancer. With screening mammograms, it is possible to find a cancer, sometimes years before a lump can be felt.
Current guidelines from the American Cancer Society (ACS), the American College of Obstetrics and Gynecology (ACOG) and the American College of Radiology (ACR) recommend screening mammography every year for women of average risk, beginning at age 40.
Mammography is the only screening method that is consistently proven to reduce breast cancer deaths. In fact, it is the major reason breast cancer deaths have declined by 30% since 1990. In addition, early detection through mammography often gives women more treatment options such as reduced surgery, better cosmetic outcomes, and may decrease the need for harsh therapies. And since breast cancer found in women under age 50 may be more aggressive, it’s important to schedule your mammogram every year.
Mammography Benefits & Risks Accuracy
Mammography is the best screening tool for breast cancer available today. However, mammograms do not detect all breast cancers. A breast finding of concern like a new lump should never be ignored even if you have had a recent normal mammogram. If you notice any new changes in your breast(s) you should bring them to your health care provider’s attention promptly.
Additional Testing
Approximately 15% of women are called back from screening mammograms for additional testing (a diagnostic mammogram and/or breast ultrasound). Most diagnostic mammograms conclude with good results, but it is necessary in order to complete the mammographic evaluation and make an accurate diagnosis. In some cases a follow-up test in 6 months may be advised. A biopsy is sometimes needed to evaluate the tissue under the microscope.
Radiation Dose
Strict guidelines ensure that mammogram equipment is safe and uses the lowest dose of radiation possible. Many people are concerned about the exposure to x-rays, but the level of radiation used in modern mammograms is very low and does not significantly increase the risk for breast cancer. The amount of radiation can be compared to an airplane flight of a few hours due to the thinner atmosphere.
SEE MORE WITH BREAST MRI
Breast MRI has been proven to be more sensitive than any other modality in detecting invasive breast cancer. MRI is superior at demonstrating the size and extent of a breast tumor prior to surgery. In addition, it is beneficial for screening patients at particularly high risk for breast cancer due to genetic predisposition or strong family history, diagnosing breast implant rupture, staging breast cancer and planning treatment. MRI may also play an important role in post-surgical and post-radiation follow-up.
Breast MRI for Women with an Increased Risk of Breast Cancer
In March 2007, the American Cancer Society (ACS) revised the breast cancer early detection guidelines, recommending annual breast MRI screening for women in the following groups:
- Have a known BRCA1 or BRCA2 gene mutation
- Have a first-degree relative (mother, father, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
- Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on a family history that includes both her mother’s and father’s side
- Had radiation therapy to the chest when they were between the ages of 10 and 30 years
- Have a genetic disease such as Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have one of these syndromes in first-degree relatives
Women at moderately increased risk should talk with their physicians about the benefits and limitations of adding MRI screening to their yearly mammogram. These patient groups include:
- Have a lifetime risk of breast cancer of 15% to 20%, according to risk assessment tools that are based mainly on family history (see below)
- Have a personal history of breast cancer, ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), atypical ductal hyperplasia (ADH), or atypical lobular hyperplasia (ALH)
- Have extremely dense breasts or unevenly dense breasts when viewed by mammograms
Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.
KNOW MORE WITH BREAST BIOPSY
If imaging studies show an abnormality with suspicious features, a biopsy is the only definitive way to confirm if breast tissue is benign or cancerous. Needle biopsy is a safe, minimally invasive procedure used to get a sample from an abnormal breast lesion. Small amounts of breast tissue are removed through a needle, and the tissue is studied under a microscope by a pathologist, who will then provide a diagnosis.
There are various methods by which a needle biopsy can be performed. In each, the basic concept is to use an imaging technique to accurately guide needle placement to obtain samples of the abnormal appearing tissue seen on the mammogram, ultrasound or MR images.
