By Cherra F. Pumphrey, M.D., HarborSide Internal Medicine –
Breast cancer is the most common cancer in women and the second most common cause of cancer death in women. Cancer is the second leading cause of death in the United States, while cardiovascular disease is the first. According to the American Cancer Society’s Cancer Facts & Figures 2010, there were estimated to be 1,529,560 new diagnoses of cancer and 569,490 deaths due to cancer in the United States that year. In addition, there were estimated to be 209,060 new breast cancer diagnoses and 40,230 deaths due to breast cancer that year.
Screening is implementing testing to identify disease in patients without symptoms, and early detection involves implementing an approach to allow earlier diagnosis than might otherwise have occurred. The concept of breast cancer screening applies to women without signs or symptoms of a breast concern or issue. Available screening modalities for breast cancer include self breast examination, clinical breast examination, mammography, and magnetic resonance imaging (MRI). Different organizations have varying guidelines regarding screening recommendations. The following screening strategy is suggested by the American Cancer Society. Self breast examination is recommended monthly for women starting at age 20. Clinical breast examination is recommended every three years for women in their 20’s and 30’s and yearly for women starting at age 40. Mammography is recommended yearly for women starting at age 40. MRI may be performed annually along with mammography in high-risk women. While breast cancer is one-hundred times more common in women, breast cancer does occur in men with an incidence of one percent and an average age of 68 at diagnosis.
Screening mammography is considered the “single most effective method of early detection since it can identify cancer several years before physical symptoms develop.” Mammography detects 80-90% of breast cancers in asymptomatic women.
A mammogram is a low-dose x-ray procedure that allows for visualization of internal breast structure. Mammography tends to be more accurate after menopause and is somewhat limited for evaluation of dense breast tissue, which is usually present in younger women, pregnant women, and breast-feeding women. If a questionable or abnormal-appearing area is identified on a screening mammogram, further evaluation is indicated and may include additional mammograms (special views and/or subsequent views at a later time), other imaging studies (such as breast ultrasound or MRI), and/or breast biopsy.
When a change or area of concern in the breast is noted by the patient or by a healthcare provider, a diagnostic approach is implemented. A diagnostic mammogram is usually ordered initially and may be accompanied by an ultrasound. A diagnostic mammogram generally includes more views than a screening mammogram and will focus on the area(s) of concern. Potential signs/symptoms of breast cancer include the following:  breast skin changes (dimpling, redness, scaling, thickening);  breast/nipple pain;  breast swelling;  breast lump;  nipple retraction;  nipple discharge (particularly concerning if bloody); and  lymph node swelling.
Factors that increase both women’s and men’s risk of developing breast cancer include the following:  advancing age;  personal history of breast cancer;  positive family history of breast cancer (primarily first-degree relatives);  inherited genetic mutations (BRCA1 and BRCA2 for women, but primarily BRCA2 for men);  history of chest radiation exposure;  obesity; and  excessive alcohol consumption (more than one alcoholic beverage per day for women; more than two alcoholic beverages per day for men). Some additional breast cancer risk factors that are more specific to women include the following:  increased breast tissue density;  certain benign breast conditions, such as atypical ductal hyperplasia and atypical lobular hyperplasia;  history of lobular carcinoma in situ; and  increased estrogen exposure (such as hormone replacement therapy, early menarche, and late menopause). Other factors that specifically increase men’s risk of developing breast cancer include Klinefelter’s syndrome, liver disease, estrogen treatment, and certain testicular conditions.
Some factors appear to decrease the risk of breast cancer:  breast-feeding;  physical activity;  maintaining a healthy body weight; and  minimizing alcohol consumption. Treatment with selective estrogen receptor modulators (tamoxifen and raloxifene) has been shown to decrease risk of breast cancer. However, as with any medications that may be prescribed, these medications have potential side effects, so they are not universally prescribed to women for the purpose of breast cancer prevention.
When breast cancers are identified through screening modalities, they are more likely to be smaller and localized. Treatment is more effective when cancer is identified early. Patients are advised to seek immediate medical attention should they notice any changes in their breasts and are encouraged to discuss any questions or concerns with their physicians. Women are challenged to schedule their screening mammograms upon celebrating their 40th birthdays and to continue having their mammograms every year thereafter!
. Cancer Facts & Figures 2010
. Breast Cancer Facts & Figures 2009-2010
Dr. Cherra Pumphrey obtained her Doctor of Medicine degree from the University of South Florida College of Medicine in Tampa, Florida. She completed her Internal Medicine residency at the University of Tennessee Graduate School of Medicine in Knoxville, Tennessee. She is certified by the American Board of Internal Medicine. She has special interests in Preventive Medicine and Women’s Healthcare. Dr. Pumphrey is accepting new patients.
HarborSide Internal Medicine
522 E. Marion Ave. Punta Gorda, FL 33950