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Bonus Feature


Breast Cancer Awareness


By Gabriel Vidal When, why and how should I get mammograms?


All public health groups in the US agree in recommending mammograms from the ages of 50 through 75. However, whether mammograms should also be performed on women in their forties and whether they should be done every year or every other year are still topics of controversy. Decisions at this stage are tailored to the individual’s personal and family medical history. After the age of 75, breast cancers may be less aggressive because of reduced estrogen exposure; therefore, there may be less benefi t to identifying them at the earliest stages. Mammography is not 100% successful in detecting cancers. Cancers in younger women with dense breast tissue can be harder to see, and some less common types of breast cancer such as the lobular subtype don’t show up well at any age.


How is breast cancer diagnosed?


A biopsy is required to confi rm a diagnosis of breast cancer. Typically this t can be done by needle biopsy in the doctor’s offi ce or in the mammography suite.. The doctor can determine where to place the needle based on the loca- tion of a fi rm area on exam. Alternatively, ultrasound can be used if the tumor is small or deep in the breast tissue. A needle is introduced into the mass and used to pull out a few cells, which the pathologist looks at under a microscope. Special stains may be added to look for markers that may guide treatment.


Should I have a genetic test done?


A minority of patients should consider genetic testing. A woman who develops breast cancer at a very young age or who belongs to a certain ethnic group with a high rate of BRCA mutations should consider this option. In addition, somebody who has a very strong family history (for example three relatives all on the mother’s or father’s side with a diagnosis of breast cancer) may have a genetic predisposition. Prior diagnosis of ovarian cancer or male breast cancer in a family member, especially at a young age, may also suggest a BRCA abnormality.


When should double masectomies be considered? This is always a judgment call and something that we can offer to the patient.


There is not an absolute answer on who should do it. Having a diagnosis of


breast cancer puts a woman at higher risk for future diagnoses in the opposite breast or on the same side if the patient has opted for lumpectomy. Over the remaining lifespan, that risk can become quite high. Let’s say a woman is di- agnosed at the age of 35 and has potentially 50 more years to live; she has over a 50% chance of having another breast cancer diagnosis. To avoid anxiety, worry and the need for additional biopsies every time an abnormality is found, some women choose to have both breasts removed. Also, if the pathologist sees extensive pre-cancerous lesions that will likely turn into invasive cancer, that may be a reason for double mastectomy.


Finally, a woman who has no


personal history of breast cancer but who has a strong family history or positive genetic testing (e.g., Angelina Jolie) may choose this approach.


What are some treatment options?


In most cases, surgery will be recommended as the fi rst step. Depending on the size of the tumor and the woman’s breast anatomy, the choices will be to remove the lump itself with a margin of healthy tissue, called lumpectomy, or to remove the entire breast, which is called a mastectomy. Regional lymph nodes will also be sampled at the time of surgery. Based on the extent and type of the cancer in the surgical specimen, we can further consider whether medical therapy such as a hormone blocker, chemotherapy, or radiation would be helpful.


When can I be considered cancer-free? That’s a very diffi cult problem with breast cancer. There is almost no time


from initial diagnosis when you can say for sure that there’s no risk of the cancer coming back. Even 20 years later women can have recurrences. However, once a woman reaches 10 years beyond her initial diagnosis, the chance of cancer recurrence is quite low (You can start to breath a sigh of relief near the 10-year mark.)


How can I decrease the chances of a recurrence? Here’s where radiation, hormone therapy, and chemotherapy may come into


play. Hopefully, the surgeon has removed the entire tumor that can be de- tected. But a few cells may have already broken off and traveled somewhere else in the body. Given enough time, a recurrence will become evident. Certain markers on the initial tumor cells can determine if this has occurred. We have good tools to calculate the risk of recurrence, and if it’s high enough we will recommend adjuvant therapy such as hormone-blocking medications and/or chemotherapy. These have been shown in numerous large-scale studies to reduce the chance of the breast cancer coming back.


During the fi rst Thursday of each month, the SCC hosts a breast cancer support group with lunch provided at no cost. For more information, contact Kristen Squires at 405-271-4514 extension 48527. In addition, if you would like to learn more about breast cancer, visit the National Breast Cancer Foundation, Inc. at http://www.nationalbreastcancer.org/nbcf-programs/ beyond-the-shock.


The fi ght against breast cancer is far from over, and advances towards treat- ment and a cure are being made every day. This October, go out and participate in a community event supporting those who have survived or are currently battling breast cancer. Oklahomans know how to gather together in support of one another. It’s what we do best!


___________________


Written by Gabriel Vidal, Fourth-Year Medical Student, OU College of Medicine and endorsed by Steve Blevins, MD, Associate Professor, OU Internal Medicine.


Every October we observe National Breast Cancer Awareness Month as a way to raise awareness and increase early detection of breast cancer. According to the Oklahoma Central Cancer Registry, there are nearly 3,000 new cases of breast cancer among women in our state every year. Below are researched answers to commonly asked questions regarding the cancer.


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