Fort Myers, FL

October Awareness: Breast Cancer
Dr. Anne Lord-Tomas, Board Certified OB/GYN

It is Breast Cancer Awareness Month and we are truly excited to see so many women educating themselves in the most common female cancer in the United States. Breast Cancer is the second most common cause of cancer-related death in women behind lung cancer. The mortality rates have declined over the years mainly due to the increased use of mammography and greater use of postoperative therapy.

The strongest risk factors for breast cancers include age and gender. Women are one hundred times more prone to breast cancers than men. The precedent in females rises sharply with age until the age of 45 to 50. This drop in rate of breast cancer after this age is most likely due to a hormonal change or menopause. Race/Ethnicity is another strong risk factor with the highest rates occurring in whites. Family history is an important risk factor for breast cancer. However, it is important to point out that a positive family history is found in only 15-20% of newly diagnosed women with breast cancer. This should raise one’s awareness to the high incidence of sporadic breast disease. A personal history of previous breast biopsies with certain types of benign breast disease (fibroadenoma, papilloma) can increase one’s risk for breast cancer. Of course, having a personal history of invasive breast cancer can increase an individual’s risk of developing invasive contralateral breast cancer. This percentage is roughly 1 percent per year for pre or post-menopausal women. Finally, lifestyle and dietary factors can increase your risk for breast cancer. An increase in alcohol and fat has been proven to increase the risk for post-menopausal breast cancer. One controversial point is hormonal therapy and its risk with breast cancer. The long-term use (ie. greater than 7 years) of hormone therapy may increase your risk for breast cancer, especially hormone receptor positive cancers. However, it should be noted that short-term hormone therapy does not significantly increase one’s risk for breast cancer. This should be an individual discussion and decision between yourself and your physician.

A woman who feels a breast lump should immediately see their physician in order to have it evaluated by physical exam and mammography/ultrasound. The lump or mass will then require a biopsy in order to take a sample of tissue to determine if there are malignant cells. This type of biopsy can be stereotactic, ultrasound guided or excisional. These types of biopsies can be done on an outpatient basis and the pathology reports obtained within a week. This can be a long week indeed!

The two major types of breast cancer include in situ and invasive breast cancer. The in situ type (DCIS, intraductal carcinoma) of breast cancer is confined to the duct system and is non-invasive. It is considered to be a precursor of invasive breast cancer. The majority of these types of cancers can be treated conservatively with removal of the mass (lumpectomy) alone without the need for removal of lymph nodes. Treatment will then be followed by radiotherapy of the breast. Your surgeon and radiation oncologist will work together with you in your treatment options. The invasive type of breast cancer moves beyond the ducts and enters into the surrounding breast tissue and lymphatics. The breast drains into the lymph nodes in the axilla (armpit) and that is why it is essential to perform an axillary lymph node biopsy when one is diagnosed with this type of breast cancer. The axillary lymph nodes are the single best prognosticator for breast cancer survival. Treatment for invasive breast cancer can include breast conserving therapy or mastectomy. In breast conservation the breast lump is removed and the lymph nodes need to be sampled in order to determine spread of cancer. If one does not desire breast conservation therapy OR if one is not a candidate, then mastectomy may be the necessary option. Following your surgical treatment, adjuvant therapy will most likely be indicated by your oncologist. This can include radiation and/or intravenous/oral chemotherapy. This therapy will be determined based upon several different factors including your pre- or post-menopausal status. Your surgical and postoperative treatment plan depends upon the recommendations of your surgeon and oncologist, your pathology/tissue results and your personal desires. It is clearly a team effort.

Early intervention is key with this as in any disease. Yes, the incidence of breast cancer was increasing but early detection and therefore improved survival have also increased. Both a decrease in cancer-related deaths and an increase in quality of life post-diagnosis have been statistically significant in recent years. The American Cancer Society recommends routine screening mammograms starting at age 40. Clinical breast exams are also recommended at an annual visit in this age group and clearly offered in younger ages as well during an annual exam. Proper Self breast exam instruction can be an important adjuvant as well. These recommendations may be modified based upon one’s genetic history and other identifiable risk factors as stated previously. Other diagnostic studies may be indicated along with or following a routine screening exam, including breast ultrasound and MRI. You should always receive a call or letter from your radiology institute regarding your initial results. If you do not, be your own advocate and call to get your results and assure that your ordering physician(s) receive them as well.

Family, friends and your physician team-along with personal education- are all important parts of your decision-making and support. You may send any related questions to our web page at www.ufirsthealth.com, whether guided towards a gynecologist’s view or a general surgeon’s view. We have the unique asset of providing Gyn primary care/screening with Gen surgical treatment options. We truly thank you for your attention with this extremely relevant discussion and pray for continued advancements towards a cure. Other local resources include the American Cancer Society, the Local County Medical Society and the Susan G. Komen Association. We also want to thank Partners for Breast Cancer for their instrumental achievements in providing affordable screening/treatment for women in the Fort Myers area.

Dr. Robert Tomas, Board Certified General Surgeon
Dr. Anne Lord-Tomas, Board Certified in Gynecology
U First Health, Fort Myers, FL