askthedoctor Breast Cancer A

Male Breast Cancer Each year, about 2,350 men are diagnosed with invasive breast cancer; about 440 die from it. Hormonal differences (less estrogen and pro- gesterone) are one rea- son incidence rates are much lower in men.

52 MILITARY OFFICER OCTOBER 2015

Second only to lung cancer as a cause of cancer deaths in women, breast cancer kills 40,000 women each year and causes 3 percent of their deaths. By Rear Adm. Joyce Johnson, D.O.

About 232,000 new cases of breast cancer are diagnosed annually; 1 in 8 women will be diagnosed with invasive breast cancer in their lifetime. Regular screening for breast cancer is recommend- ed for women, but specifi c guidelines diff er. The American Cancer Society and the Na- tional Comprehensive Cancer Network rec- ommend an annual mammogram beginning at age 40; the U.S. Preventive Services Task Force has a draft set of guidelines under review that recommend screening every two years for women age 50 to 74. The draft guidelines recommend for women age 40 to 49 an individualized decision about whether to begin biennial screening and provide no recommendation for women age 75 and older (because of inadequate data). Diff erent protocols might be more appropriate for women at high risk. Screen- ing decisions are best made between a woman and her health care provider. Most often, a patient will receive noti-

fi cation that her screening mammogram was normal. In the rare circumstance a lump or suspicious area is identifi ed, prompt follow-up is essential. This usually will involve a diagnostic mammogram to get a better understanding of the situation. Possible additional tests include an ultra- sound, an MRI, or other exams. A biopsy is the only way to confi rm a lump is cancerous. A fi ne needle aspira- tion biopsy, done under local anesthesia, is simplest but obtains a small sample. A core needle biopsy involves a larger needle and

extracts tissue that is about 1/16-inch in di- ameter and a half-inch long. Rarely, an out- patient surgical procedure or open biopsy is needed. Whatever the biopsy type, lymph nodes usually are biopsied as well to deter- mine whether cancer has spread to them. Based on the pathologist’s report, the cancer is graded to determine how aggres- sive it is and how quickly it might grow and spread. Other tests might be done for gene-expression profi ling or to determine whether it has estrogen or progesterone receptors or tests positive for HER2 (a growth-promoting protein). Additional radiographic tests, such as chest X-rays, bone scans, CT scans, MRIs, ultrasounds, or positron emission tomography, can de- termine whether cancer has spread. Blood and other tests also might be done. Based on the classifi cation and staging

(whether the cancer has spread), as well as other patient characteristics and pref- erences, patients and their providers will develop a treatment plan. Surgery usually is part of the plan, with radiation therapy, chemotherapy, hormone therapy, targeted therapy, and bone-directed therapy as other options. Treatment is focused on treating any existing cancerous tumors and assessing whether adjuvant therapy might prevent recurrence.

MO

— Rear Adm. Joyce Johnson, USPHS (Ret), D.O., M.A., is a health care consultant in Chevy Chase, Md. Find more health and wellness resources at www.moaa.org/wellness. For sub- mission information, see page 6.

PHOTO: STEVE BARRETT