Breast Cancer - Diagnostic Studies And Procedures

Breast cancer is the most common malignancy in women, and second only to lung cancer in female cancer mortality. Presently, about one in nine American women develops this disease at some time in her life, compared to one in 17 in 1950. Experts are uncertain whether this represents a true rise in the incidence of breast cancer or improved detection of it due to mam mography and better public awareness. The risk of breast cancer increases with age, especially after menopause. Risk is also higher among women who had their first child after age 30 or never had children; already have had cancer in one breast, had an early first menstrual period or a late menopause; or have a close relative, such as a sister or mother, who was diagnosed with breast cancer before menopause.Some studies have linked a high-fat diet to an increased risk of breast cancer, but others have shown otherwise. Cancer specialists emphasize that about 70 percent of all cases of breast cancer arise in women with none of the above risk factors. In rare instances, men also develop breast cancer, accounting for less than five percent of occurrences.

Diagnostic Studies And Procedures

Early detection is the single most important factor in surviving breast cancer, because early, localized malignancies are more than 90 percent curable. The American Cancer Society (ACS) recommends that all women age 20 or older perform a monthly self examination of their breasts . Although more than 80 percent of the lumps found by women during self examination are benign, women initially discover more than 85 percent of all breast cancers. Breast examination by a physician is recommended every three years between the ages of 20 and 40 and annually thereafter. The age at which a woman should begin regular screening with mammography remains controversial. Present guidelines from the National Cancer Institute recommend starting annual mammography at age 50, but many cancer experts advocate beginning at age 40. There is no doubt, however, that mammography is the most effective means of early breast cancer detection in women over 50 because it can locate suspicious areas of calcification, a common sign of cancer, long before a tumor is large enough to be felt by a woman or her doctors. Mammography is not as effective in younger women because they have denser, lumpier breasts, making it harder to discern normal from abnormal tissue. Mammography should be scheduled for the week after menstruation, when breasts are unlikely to be swollen and painful. To help assure an accurate mammogram and avoid repeats, no deodorant, powder, cream, or other substance should be applied to breasts or the underarm area that day because they can cause misleading results.

If any suspicious areas are found by mammography or physical examination, a biopsy is necessary to rule out cancer. In most cases, a doctor will attempt to obtain a tissue sample by aspiration, a procedure in which a hollow needle is inserted into the lump. If fluid can be withdrawn, it will be analyzed for malignant cells, but such lumps, especially those that disappear after aspiration, are usually harmless cysts. If a lump returns rapidly, no fluid can be withdrawn, or malignant cells are detected in the fluid, another biopsy is necessary. Again, this may be done by needle. With a new procedure called stereotaxic needle aspiration, a special X-ray scanning technique is used during aspiration to locate suspicious areas too small to be felt. In some cases, a surgical biopsy is necessary. This may be excisional, in which the entire mass is removed, or incisional, in which only part of the lump is taken out. A pathologist will then determine whether the tissue is cancerous, and if so, what kind of cancer it is. Cells from a cancerous lump will also be tested to determine if they are stimulated by estrogen or proges terone, a finding that may influence the choice of anticancer drugs. If breast cancer is diagnosed, additional tests are needed to find out if it has metastasized to other parts of the body. These may include a bone scan, X-rays, and sampling of lymph nodes.