Patient Information: Breast Care
Statistics on breast cancer: approximately 180,000 women and 1500 men in the United States develop breast cancer each year. Almost a third of them die from the cancer. An average woman has a 1 in 8 chance of developing breast cancer in her lifetime. A woman’s risk of breast cancer increases with age, obesity, prior personal history of breast cancer, personal history of atypia or carcinoma in situ on breast biopsy, family history (first degree relatives primarily) of breast or ovarian cancer, prior radiation exposure, age over 30 for first pregnancy, failing to breast feed, early menarche and late menopause.
Current Breast Cancer Screening Recommendations:
All women-monthly Self Breast Exams (SBEs)—see your doctor if you notice a hard lump, nipple discharge, or other significant change
Average risk women Age 40+: Yearly Mammograms (MMGs) and Physician Breast Exams (PBEs)
High risk women: Consider more frequent and/or earlier start for MMGs and/or PBEs
Bottom line: SBEs, MMGs, and PBEs are all important and are good but not perfect. In fact MMGs miss 10-15% of breast cancers that can be felt as hard lumps by the patient or doctor.
Breast Pain and Tenderness
Breast pain (mastalgia) is usually from fibrocystic changes (normal breast aging) or infection (mastitis).
Most (but not all) breast cancers are painless.
-Mastitis is usually treated with antibiotics and/or surgical drainage of associated abscess (es).
-Fibrocystic changes usually improve with one or more of the following: eliminating caffeine intake, a diet consisting of less than 15% fat calories, limiting salt intake, wearing a good support bra, aspirin or ibuprofen, Vitamin E or B6 (try from 100-400% of the RDA daily), evening primrose oil (3 grams daily). Stronger medications are rarely necessary.
The likelihood that any discrete mass (felt to be clearly different from the surrounding breast tissue) is a cancer increases with patient age and is impacted by other risk factors mentioned above.
Patients identifying a discrete mass on their SBE should bring it to the attention of their physician or surgeon.
The subsequent evaluation of the mass will consist of a directed history and physical examination with review of pertinent records including mammograms.
A mammogram will usually be obtained depending upon the age of the patient if one has not been done in the recent past.
An ultrasound can provide useful information in assessing some masses. It can suggest whether the lesion is solid or fluid filled (cyst).
Fine needle aspiration is an office procedure that involves using a syringe and needle to sample the cells of the mass. If the mass is a simple cyst, the fluid will be withdrawn and the mass will disappear. If the mass is solid, cells will be withdrawn for analysis. Though this is an invasive procedure, the level of discomfort is similar to having a blood sample drawn. It can provide much useful information and in some cases avoid the need for a surgical biopsy.
Tissue sampling by biopsy is the most accurate means to exclude cancer in a breast mass. Most biopsies can be performed under local anesthesia in an operating room or minor surgery setting without the need for hospital admission. These procedures are well tolerated and in most cases cause minimal discomfort that is well controlled with mild pain medications.
All breast masses should be viewed with suspicion until appropriate evaluation has ruled out a potential cancer.
Mammograms are screening x-rays that are used to detect early breast cancers.
Based upon the characteristics of abnormalities, radiologists make recommendations based upon their degree of suspicion that it may represent a cancer. This recommendation is frequently influenced by comparison of previous mammograms the patient has had.
If an area is thought to be suspicious for cancer, a biopsy is recommended.
Options for biopsy of nonpalpable mammographic abnormalities (cannot be felt on examination) include:
Needle localized biopsy. A fine wire is place by the radiologist into the breast marking the area of concern. The surgeon then uses this wire as a marker to guide sampling of the area in question. This is a breast biopsy as described above.
Stereotactic biopsy. This involves sophisticated mammography and computerized tracking equipment. A special biopsy needle is used to sample the area in question under local anesthesia. This procedure can generally be done through a very small incision.
Ultrasound guided biopsy. This involves using an ultrasound probe to guide the needle in obtaining the sample.
Findings of biopsy and further treatment options and recommendations if any will be discussed in follow-up with your surgeon.
Palmetto Surgery Associates, PA
108 Nimmons Circle
Seneca, South Carolina 29678