Breast Cancer

Posted on Wed, Jul. 06, 2005

By Dr. Jane McCormick, Family Practitioner

JOYCE FOUND a lump in her breast while taking a shower. Afraid of what it might be, she told no one for a few weeks.

Finally, she confided in her daughter, who urged Joyce to call her doctor who referred her to our clinic. I examined her breasts and confirmed the lump. Since I could feel it, I inserted a small needle into the lump right then to take a sample.

After a few days, the lab reported that Joyce had cancer, though at that point we weren't sure how dangerous it was.

Some cancers grow and spread rapidly, and can kill a person within months. Others are slow-growing and slow to spread, so are less dangerous and more easily cured.

Learning you have breast cancer is frightening. Just the thought brings dread to many women.

But women can do something to minimize their own danger regarding breast cancer. They can make lifestyle changes, get a yearly mammogram, and have their breasts examined by their doctor or nurse practitioner.

Mammograms can detect breast cancers when they are smaller and more treatable. And the therapy for small cancers is less painful and disfiguring.

Experts argue about the benefits of mammograms and similar tests. Those who want to learn the pros and cons of mammograms can go to Web sites such as www.breastcancer.org for a detailed discussion.

The American Cancer Society has reviewed all the evidence and recommends the following for most women:

Mammograms yearly starting at age 40.
Clinical breast exam (by a health professional) every three years for women 20-39, and annually thereafter.
Discuss breast health and the pros and cons of examining their own breasts with their health care provider periodically, beginning at age 20.
Older women should continue to get yearly mammograms unless they have another illness likely to shorten their life expectancy.

Some women have a higher risk of getting breast cancer, and may benefit from earlier or more intensive regular tests. These may include women whose mother or sister had breast or ovarian cancer, and women who have received chest irradiation. They should begin regular tests at an earlier age and may need additional tests.

The benefits of a woman examining her own breasts is controversial. If a woman feels more comfortable and safer examining her breasts regularly, it's probably a good idea.

Women who feel uncomfortable examining their breasts, or who won't feel safer, should probably leave the examination to their doctor.

There is tentative, though not certain, evidence that some medications and lifestyle changes can reduce a woman's risk of getting breast cancer.

Stopping smoking, avoiding estrogens (female hormones), taking aspirin daily, taking a statin drug (e.g., Lipitor, lovastatin), moderate or no alcohol consumption, a vegetarian diet, regular exercise, and normal body weight (not overweight) may all reduce a woman's risk for getting breast cancer.

Fortunately, Joyce's cancer has a 90 percent cure rate. If she had had yearly mammograms, her cancer could have been found at the pre-cancerous state, which would have made her cure rate even higher.

Don't be afraid of breast cancer. Discuss your risks with your doctor. Make lifestyle changes to reduce your risk. And follow the ACS guidelines for regular tests.

Jane McCormick is a family practitioner who works in the Oncology Clinic at the Contra Costa Regional Medical Center. Healthy Outlook is a bimonthly column written by the professional staff of Contra Costa Health Services and the county health department. Send comments and questions to series coordinator Dr. Stephen J. Daniels at sdanielsmd@aol.com.