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Breast cancer: tips on detecting and treating the disease



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1. How many women are affected by breast cancer?

The American Cancer Society estimates that 211,240 women will be diagnosed with new cases of invasive breast cancer in the United States in 2005, and about 40,410 will die of the disease. An additional 58,490 will be diagnosed with in situ (noninvasive) breast cancer.

2. Is breast cancer the most common cancer among women?

Among women, breast cancer trails only skin cancers as the most frequently diagnosed. It is the second-leading cause of death from cancer among women, after lung cancer.

3. Can men get breast cancer?

It's rare, but it can happen. An estimated 1,690 men will be diagnosed with breast cancer in 2005, and about 460 will die of it. Men account for less than 1 percent of all breast cancer cases.

4. Who is at risk for developing breast cancer?

There are several risk factors for developing breast cancer; the primary one, after gender, is age. As you age, your risk for developing breast cancer rises. Women ages 50 and older account for 77 percent of breast cancer cases.

5. What are some of the other risk factors?

- If a woman's mother or sister had breast cancer, especially before menopause.

- Menstrual periods beginning before age 12.

- Never having children.

- Having children after age 30.

- Radiation treatment for other cancers.

- Long-term use of hormone replacement drugs.

- Lack of exercise.

- Being 20 percent or more overweight.

- Alcohol use. (Two to five drinks a day increase risk by 40 percent.)

- High-fat diet low in fruits, vegetables; exposure to pesticides.

6. What impact does a family history of breast cancer have on the risk of getting the disease?

If your mother or a sister was diagnosed with breast cancer before age 50, your risk of developing the disease is higher. But most women with breast cancer don't have close relatives with the disease, and most women who have a family history won't develop it themselves.

7. What can be done to reduce the risks?

Your family history and your genes can't be altered, but you can make lifestyle changes to reduce your risk of breast cancers, including:

- Stop smoking.

- Exercise regularly, aiming for three to four hours a week.

- Don't drink more than two alcoholic drinks a week.

- Limit your consumption of red meat and other sources of animal fat (including dairy fat in cheese, milk and ice cream) because they may contain stored hormones or pesticides.

- Lose excess weight and keep the pounds off.

- Use techniques, such as meditation, yoga and prayer, to reduce stress.

8. What is the importance of early detection?

Early detection has been shown to save lives and increase treatment options. The five-year survival rate for breast cancer is 97 percent among those whose cancer has not spread beyond the breast at diagnosis.

9. What are the signs and symptoms of breast cancer?

Physical symptoms include persistent breast changes, such as a lump, thickening, swelling, dimpling, skin irritation, distortion, retraction, scaliness, ulceration, pain and tenderness of the nipple or spontaneous nipple discharge. On a mammogram, breast cancer appears as irregular images. During a clinical breast exam, your doctor may check the lymph nodes under your armpit and above your collarbone to see if they are enlarged or firm, an indication of a possible spread of breast cancer.

10. What is a mammogram?

A mammogram is a low-dose X-ray procedure enabling doctors to see the internal structure of the breast and possibly detect breast cancers that cannot be felt.

11. When should women have mammograms?

Women should begin having annual mammograms at age 40 and continue for as long as they are in good health. Anyone with serious health problems or a short life expectancy should evaluate ongoing early-detection testing with a doctor.

12. Does mammography detect all breast cancers?

Mammograms are considered the "gold standard" in breast cancer detection, but they fail to detect about 10 percent to 20 percent of breast cancers.

13. How should you prepare for a mammogram?

- If you have sensitive breasts and are still menstruating, try to avoid having the test during the week before your period.

- Do not wear deodorant, powder or cream under your arms; they may interfere with the quality of the mammogram.

- Bring a list of the places and dates of other mammograms, biopsies and other breast treatments you have had.

14. Is mammography the only technology available to screen for breast cancer?

Other techniques are being studied, including magnetic resonance imaging, positron emission tomography and ultrasound. Some of these are used to follow up if a patient has suspicious findings from a physical exam or a mammogram.

15. What should women do other than get mammograms?

The American Cancer Society also advises women to get clinical breast exams as part of a regular health exam, about every three years for women in their 20s and 30s, and every year for women 40 and older. You should also familiarize yourself with how your breasts normally feel and report any changes immediately to your doctor. If you are at increased risk, talk with your doctor about the benefits and limitations of starting mammography earlier, having additional tests, such as breast ultrasound and MRI, or having more frequent exams.

16. Are breast cancer screenings covered by insurance?

Medicare provides coverage for annual screening mammography for women beneficiaries ages 40 and over. Unlike other Medicare benefits, the deductible is waived for mammography. For a diagnostic mammogram, the deductible is paid by the patient in addition to the copayment. In addition, most states ensure that private insurance companies, Medicaid and public employee health plans provide coverage and reimbursement for the early detection of breast cancer.

17. What happens if a mammogram is abnormal?

There are many types of prodecures and tests a woman may undergo to find out if an abnormal area of a mammogram is cancer:

- Physical exam. A doctor checks for a lump.

- Diagnostic mammogram. This procedure magnifies the breast image to see the area better.

- Ultrasound. Sound waves are used to locate fluid-filled cysts.

- Needle biopsy. A long needle is used to remove fluid, cells from the abnormal spot to test for cancer; local anesthesia is used.

- Surgical biopsy. During this procedure, some or all of the abnormal area is removed. The tissue is then tested for cancer. Local or general anesthesia is used. This procedure will leave a scar.

18. What should you do if you detect a lump during a breast self-examination?

Research has not shown that breast self-examination reduces breast cancer deaths, but doing it may make you more sensitive to changes in your breasts. If you detect a lump, go see your doctor as soon as possible.

19. What are the treatment options if cancer is diagnosed?

Most women with breast cancer will undergo surgery. Depending on the stage of the cancer and whether it has spread, additional treatment may include radiation, chemotherapy, hormone therapy or immunotherapy.

20. What are the common types of surgery?

- Lumpectomy. This is also called breast conservation therapy because it involves removing only the lump and some normal tissue around it. Typically, about six weeks of radiation follows this surgery. If chemotherapy is also necessary, the radiation may be delayed until after the chemo has been completed.

- Partial (segmental) mastectomy. In this surgery, more breast tissue is removed than in a lumpectomy. Six to seven weeks of radiation usually will follow.

- Simple or total mastectomy. The entire breast is removed, but not the lymph nodes under the arm or muscle tissue beneath the breast.

- Modified radical mastectomy. The entire breast is removed, along with some lymph nodes under the arm.

- Radical mastectomy. This surgery, which is rarely done now, involved removing the entire breast, lymph nodes and the chest wall muscles under the breast.

- Fort Worth Star-Telegram

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SOURCES: American Cancer Society, www.cancer.org; www.breastcancer.org; Susan G. Komen Breast Cancer Foundation, www.komen.org; University of California, San Francisco.

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(c) 2005, Fort Worth Star-Telegram. Distributed by Knight Ridder/Tribune News Service.

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