Breast Cancer
Overview:
Breast cancer will affect 1 in 8 women in their lifetime. A new lump or a change found on a screening mammogram can be a anxiety provoking experience. Unfortunately, given the prevelance of breast cancer, most people will already know someone who is dealing with the disease. The good news is that with advances in screening, diagnosis, and treatment, breast cancer survival is increasing.
Risk factors for breast cancer are sex, age, lack of childbearing or breastfeeding, increased exposure to estrogen (hormone replacement), personal history of breast cancer, and family history of breast cancer.
Signs and Symptoms:
Most breast cancers are discovered when a woman notices a lump within the breast. Others are discovered when an abnormality is found on mammogram. Other indications of breast cancer are changes in the size of the breast or the skin, nipple inversion, or unilateral nipple discharge. Pain in the breast is rarely associated with breast cancer.
Diagnosis:
When the clinical exam and/or a mammogram shows a suspicious mass within the breast, a biopsy is performed to evaluate that mass. If the lump is palpable on exam or can be seen with ultrasound, a FNA (fine needle aspiration) biopsy can be performed in the office. This technique is especially good if the mass is suspected to be a cyst because it can be drained in this fashion. If more tissue is desired, a core needle biopsy is performed which takes a large piece of tissue for the pathologist to review. When the lump or mass cannot be felt or seen by ultrasound, a stereotactic breast biopsy is performed. This uses mammogram guidance to place a needle into the mass to get a sample. This can be done as a simple outpatient procedure requiring only local anesthesia. Sometimes this approach is not technically feasible in which case a needle localized breast biopsy is performed. In this case, the radiologist will mark the mass with a wire and the surgeon will use this as a guide in the operating room to find and remove the suspicious area.
For more information about breast biopsies, including fine needle, core needle, stereotactic breast biopsy, as well as open surgical biopsy, please watch the following video:
Treatment:
Breast cancer is treated with surgery and then possibly with radiation therapy, chemotherapy, or both. In addition to surgery, hormone positive cancers (ER/PR or Her-2-neu cancers) are treated with long term hormone blocking therapy. Treatments are given with increasing aggressiveness according to the prognosis and risk of recurrence. Most early breast cancers can be treated with breast conservation surgery (lumpectomy + radiation). To accurately stage and therefore treat breast cancer, a sentinel lymph node biopsy is usually performed to check to see if the cancer has spread to the lymph nodes in the armpit. If this is the case, then all the lymph nodes are removed. This is called an axillary lymph node dissection. A total mastectomy (removal of the entire breast) is usually performed when the tumor is too large to remove by lumpectomy alone or in circumstances where the patient wishes to further decrease their risk of breast cancer recurrence. Your surgeon will discuss these options with you and help guide you through this decision making process.
For more information about breast cancer, please visit one of these trusted sites:
Capital Surgical Clinic Breast Cancer Newsletter
http://www.cancer.org/Cancer/BreastCancer/index
To learn more about stereotactic breast biopsy, please watch the following video.
Not every lump will be breast cancer. Our job is to work with you to make a diagnosis quickly to give you piece of mind as soon as possible.
"My name is Michelle Nichols and this is my story. During a monthly breast exam, i noticed a small lump..."
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