Who is at risk to develop breast cancer?
Every woman is at risk for breast cancer. Breast cancer is the most common cancer of women and as you get older, your risk for breast cancer increases. Three-quarters of all breast cancers occur in women over age 50. Though rare, men can also develop breast cancer.
Aren’t there women with special risk factors?
Risk is somewhat higher in women whose close female relatives-their mothers or sisters-have the disease. Also, women who never have had children or had their first child after age 30 appear to be at somewhat higher risk for breast cancer.
What can be done to protect against breast cancer?
It is still not clear what causes breast cancer or how to prevent it. The best protection against breast cancer is to detect it at its earliest stage and to treat it promptly. Researchers are investigating the possible roles of heredity, the environment, lifestyle and diet.
What are the recommended guidelines for early detection of breast cancer?
The recommendation of the American Cancer Society and the nation’s leading health organizations is this three-step early detection program:
- Have regular mammograms: Screening mammograms should begin by age 40. Have one every year or two to age 49, and every year after age 50.
- See your doctor for regular breast exams: At least every three years between the ages of 20 and 40 and every year over 40.
- Practice monthly breast self-exam: Ask your doctor, nurse or mammography technician to teach you the proper method.
What are the signs and symptoms of breast cancer?
The most common sign is a lump or thickening that does not go away or seem to change. Most lumps in the breast are not cancerous-four out of five are from other causes. All lumps should be checked by a doctor. Other signs to be aware of if they persist are swelling, puckering or dimpling, skin irritation, pain, or tenderness of the nipple. If any of these symptoms or signs occurs in a man, they should be checked immediately.
What is a mammogram?
A mammogram is an x-ray picture of the breast. Modern mammography equipment and techniques expose women to only minimal amounts of radiation. A trained radiolologic technologist positions your breast between two plastic plates that compress it, spreading it out so that the x-ray can produce as precise an image as possible. Two x-rays are taken of each breast during mammography-one from above and one from side to side. A specially trained physician-a radiologist-reads the mammogram to see if any suspicious areas exist.
What if breast cancer is found?
Not all breast cancers or breast cancer patients are alike. Treatments for early breast cancer can include lumpectomy (limited surgery which removes the cancer but not the entire breast), followed by radiation therapy; or mastectomy (surgical removal of the breast). Additional treatment may include chemotherapy or hormone therapy. A woman with breast cancer should fully review her treatment options with her doctor before decisions are made on a treatment program.
What is DCIS?
DCIS is a form of breast cancer that is now diagnosed more frequently as a result of the widespread use of screening mammography. The vast majority of women with this condition have no symptoms but are diagnosed via a mammography. In our experience, approximately 1 out of 4 women that require a biopsy have a positive diagnosis of breast cancer.
DCIS originates near the end of the ductal system next to the lobules. Lobules make milk which flows along the duct to the nipple. Normal ducts are composed of small, even rectangular cells with a small central round nuclei. It is thought that an early stage in the development of breast cancer is hyperplasia, in which the cells become irregular and pile up upon themselves. In DCIS, the ducts are lined by cells that are even more irregular and the nuclei become more distorted. In both conditions, the cells are confined to the ducts. In invasive ductal cancer, the cells invade into the surrounding breast tissue. These invasive cells have the potential to spread to other parts of the body.
How is DCIS diagnosed?
In the past, most cases of DCIS were associated with a lump and many of these lumps also contained invasive cancer. Currently, most women diagnosed with DCIS have no symptoms and are diagnosed because a screening mammogram showed a cluster of calcifications.
Calcium is a normal component of bone and often deposits in normal tissue – it has nothing to do with dietary intake of calcium. Most normal mammograms have some areas of calcification; it is only when the calcification shows certain characteristics such as clustering or irregularities in size or shape that it becomes of concern.
In cases where the calcification pattern is considered suspicious, a biopsy is recommended. In most instances, a “localization” will be preformed prior to your biopsy. This technique is used to mark the area of concern that appears on the mammogram, but cannot be felt. Using your mammogram as a guide, a radiologist places a needle at the spot in question. Another mammogram confirms that the needle is in position. Then blue dye is injected and a flexible “hook” wire is inserted and used by your surgeon as a guide to the area of concern. The biopsy specimen is x-rayed to insure that the calcifications are present in the specimen.
What are margins? (and what do they mean?)
The margin refers to the distance between the tumor and the edge of the lumpectomy or mastectomy specimen. To save the breast and avoid mastectomy the margins must be cleared. This is not as easy as it sounds. Breast cancers often have microscopic extensions beyond the obvious tumor that are not visible to the mammographer preoperatively or to the surgeon at the time of the surgery. Immediately after the surgeon removes the tumor from the breast, the pathologist color codes the surface with ink. A few days latter the specimen is examined under the microscope. If there is wide clearance between the tumor and the color coded edges, the margins are considered clear. If the tumor is near or at the margin, the margin is considered positive. If the margins are positive and the woman still desires breast conservation, another surgery is required. Since the margins were color coded, the surgeon knows which area is in need of further removal.
The reason that the margin issue is so important is that breast cancer recurrence rates are higher if the margins are not adequately cleared. How much clearance is necessary is controversial. In our practice we like 2mm of clearance for invasive cancers and 5 mm of clearance for DCIS. With this aggressive approach we have a 5 year local recurrence rate of less than 2% which is very low as compared to national standards.
A common problem facing women who has recently been diagnosed with DCIS is that her margins are positive after the area of calcification has been completely removed. The common explanation is that much of the cancer does not contain calcifications. For this reason it is not seen on the mammogram and cannot be felt by the surgeon. It is usually not found for 2-3 days after the surgery when the pathologist examines the slides under the microscope.
What are your choices if you have DCIS?
If margins are clear, mastectomy can usually be avoided. Small, non-aggressive forms of DCIS may be safely treated with careful observation and follow-up. However, in larger or more aggressive forms, radiation therapy is always required to lower the rate of local recurrence. Even cases with involved margins can often be treated with breast preservation, as long as the margins can be cleared with a subsequent biopsy.
In cases where the DCIS is more extensive or when re-excision margins are again involved, mastectomy with or without reconstruction is usually the treatment of choice.
The most important point to remember is that DCIS is 100% curable! If diagnosed early, the breast can be preserved and most women can live happy and productive lives.
The Breast Care Center encourages patients and their families to become better informed about breast health, disease and treatment. Please click here to learn about our Patient Support Services.
What do the numbers on a mammogram reading refer to?
The numbers are a classification of mammogram which tells the physician what to do with the results. This classification is called BIRADS. The following is what is meant by each number.
- Benign…nothing to worry about.
- Probably benign;<2% chance this is a cancer
- (obtain another mammogram in 6 months)
- Worrisome; consult for biopsy
- Suspicious for cancer; biopsy
What are calcifications and what do they mean on a mammogram?
Calcifications are small white spots seen on the mammogram which represent calcium deposits. Calcium is a byproduct of changing breast tissue. Most of these changes are not cancer. The radiologist can describe which ones are not worrisome and which ones need to be biopsied to see if they are associated with a cancer.
I feel a breast lump but my mammogram was negative. Do I need to see a specialist?
Mammograms are falsely negative 10% of the time in postmenopausal women and 25% of the time in premenopausal women. Lump + negative mammogram = lump. Yes, still have an exam to have your lump checked out.