Kim Strong, director of Breast Health at Lake Charles Memorial Hospital, answers your questions about breast cancer and early detection of this deadly disease.
Q. What is breast cancer?
A. Breast cancer is abnormal cell growth that forms in breast tissue, usually the ducts, which are the tubes that carry milk to the nipple, and the lobules, which are the glands that produce milk.
The second leading cause of cancer death among women, exceeded only by lung cancer, breast cancer will affect one in eight women sometime in her life.
Q. Can men get breast cancer?
A. Breast cancer does occur in men, but it is rare. In 2008, it's estimated that 182,460 women will be diagnosed with breast cancer, as opposed to 1,990 men being diagnosed. It is also estimated that 40,480 women-and 450 men-will die from breast cancer. The good news is that if detected early, the five-year survival rate with breast cancer is 97%.
Q. How is breast cancer detected?
A. Your physician will be able to tell you when to start and how often to check for breast cancer, but three screening tests are: mammogram, clinical breast exam and breast self-exam.
A screening mammogram is an x-ray of the breast that is used to detect changes in women who have no signs or symptoms of breast cancer. It usually involves two x-rays of each breast. Mammograms make it possible to detect tumors that cannot be felt and to find microcalcifications (tiny deposits of calcium in the breast) that sometimes indicate the presence of breast cancer.
Like a clinical breast exam, which is performed by your healthcare provider usually in conjunction with your annual exam, a breast self-exam is performed to check for lumps and other changes in your breast.
Q. How are screening and diagnostic mammograms different?
A. A diagnostic mammogram is a breast x-ray that is used to check for breast cancer after a lump or other sign or symptom has been found. It can also be used to evaluate changes found during a screening mammogram, or to view breast tissue when it is difficult to obtain a screening mammogram because of special circumstances, such as the presence of breast implants.
Diagnostic mammograms take longer than screening mammograms because they involve more x-rays in order to obtain views of the breast from several angles, and the technician may magnify a suspicious area to produce a detailed picture that can help the radiologist make an accurate diagnosis.
Q. What is digital mammography?
A. Both digital and conventional mammography use x-ray to produce an image of the breast; however, conventional mammography stores the image directly on film, while digital mammography stores an electronic image of the breast. An electronic image can be enhanced, magnified, or manipulated for further evaluation.
Digital mammography feels identical to conventional screening from a patient's perspective, though patients may notice shorter exam times and a reduction in call-backs to obtain additional images.
Q. When should a woman have a screening mammogram?
A. The National Cancer Institute recommends that women age 40 and older should have mammograms every 1 to 2 years.
Women who are at higher than average risk of breast cancer should talk with their physician about whether to have mammograms before age 40 and how often to have them.
Q. What factors place a woman at increased risk of breast cancer?
A. Age is the most important risk factor for breast cancer. The older a woman is, the greater her chance of developing breast cancer. In fact, most breast cancers occur in women over the age of 50, and the number of cases is especially high for women over age 60. Breast cancer is relatively uncommon in women under age 40.
However, the risk of developing breast cancer is not the same for all women. Research has shown that other factors increase a woman's chance of developing this disease, including:
- Personal history of breast cancer-Women who have had breast cancer are more likely to develop a second breast cancer.
- Family history-A woman's chance of developing breast cancer increases if her mother, sister, and/or daughter have a history of breast cancer (especially if they were diagnosed before age 50).
- Certain breast changes on biopsy-A diagnosis of atypical hyperplasia, a noncancerous condition in which cells have abnormal features and are increased in number, or lobular carcinoma in situ (LCIS), abnormal cells found in the lobules of the increase the risk of breast cancer. Also women who have had two or more breast biopsies for other benign conditions have an increased chance of developing the disease. This increased risk is due to the condition that led to the biopsy, and not to the biopsy itself.
- Genetic changes-Specific alterations in certain genes, such as BRCA1, BRCA2, and others, increase the risk of breast cancer. However, these alterations are rare, accounting for no more than 10 percent of all breast cancers.
- Reproductive and menstrual history-Women who began having their periods before they were 12 or went through menopause after age 55 are at an increased risk of developing breast cancer. Women who have their first child after age 30 or who never have a child are also at an increased risk of developing breast cancer.
- Long-term use of hormone replacement therapy-Women who use a combination estrogen-progestin menopausal hormone therapy for more than 5 years are at an increased risk for developing breast cancer.
- Breast density-Breasts appear dense on a mammogram if they contain many glands and ligaments, which are called dense tissue, and do not have much fatty tissue. Because breast cancers tend to develop in the dense tissue of the breast (not in the fatty tissue), those older women whose mammograms show more dense tissue are at an increased risk. Abnormalities in dense breasts can be more difficult to detect on a mammogram.
- Radiation (x-ray) therapy-Women who had radiation therapy to the chest (including the breasts) before age 30 are at an increased risk of developing breast cancer throughout their lives. This includes women treated for Hodgkin lymphoma. Studies show that the younger a woman was when she received her treatment, the higher her risk of developing breast cancer later in life.
- DES (diethylstilbestrol)-The drug DES was given to some pregnant women in the United States between 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
- Body weight-Studies have found that the chance of getting breast cancer after menopause is higher in women who are overweight or obese.
- Physical activity level -Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
- Alcohol -Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.
Q. Other than finding a lump, are there signs and symptoms of breast cancer that a woman might notice?
A. Yes, breast cancer may cause pain, skin thickening, nipple discharge, or a change in breast size or shape.
Q. How can a woman schedule a mammogram?
A. I always recommend that patients visit their doctor first if they have any signs or symptoms of breast problems, or if they haven't had a routine exam in the last year or so. Their physicians will then determine the best course of action.
Occasionally, patients who are due their regular mammogram prefer to have their results in advance of their next doctor's appointment.
Either way, Breast Health at Memorial Hospital is equipped with both conventional and digital mammography. With digital mammography, we also employ Computer-Aided Detection (CAD), which highlights characteristics commonly associated with breast cancer. When activated, it flags abnormalities to help the radiologist detect early breast cancer. CAD is, in essence, a second set of eyes to support and enhance the radiologist's judgment.