Breast Cancer

Diet and Lifestyle
Diet and weight have been shown to affect the risk of getting several types of cancer including breast cancer, according to the American Cancer Society (ACS). Being overweight is linked to a higher risk of breast cancer, especially for women after change of life and if the weight gain took place during adulthood. The risk seems even higher if the extra fat is in the waist area. Studies also have shown that exercise reduces breast cancer risk.

Based on these findings, the ACS recommends women stay at a healthy weight, exercise, and limit consumption of red meats. Other lifestyle choices that may affect the risk of breast cancer include:

• Not Having Children -- Women who have not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant more than once and at an early age reduces breast cancer risk.
• Birth Control Pills -- Studies have found that women now using birth control pills have a slightly greater risk of breast cancer. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk.
• Hormone Replacement Therapy (HRT) -- Long-term use (several years or more) of combined HRT (estrogen together with progesterone) after menopause increases the risk of breast cancer.
• Alcohol -- Use of alcohol is clearly linked to a slightly increased risk of breast cancer.

Hormone Therapy
The use of drugs to reduce the risk of cancer in healthy people is called chemoprevention. And for some women who are known to be at increased risk for breast cancer, certain drugs might reduce their risk.

Hormonal therapy falls into this category. Hormones are chemicals produced by glands, such as the ovaries. While some hormones help some types of cancer cells to grow, others can kill cancer cells, make cancer cells grow more slowly, or stop them from growing. Hormone therapy as a cancer treatment may involve taking medications that interfere with hormonal activity or stop hormone production. Hormone therapy also may involve surgically removing a gland that is producing the hormones.

For example, the drug tamoxifen has been used for many years as a treatment for some types of breast cancer. Recent studies show that women at high risk for breast cancer are less likely to get the disease if they take tamoxifen. Another drug, raloxifene, also is being studied for use in reducing breast cancer risk. And there are even newer drugs now under study.

The type of hormone therapy a person receives depends on many factors, such as tumor type and size, patient age, the presence of hormone receptors on the tumor, as well as other factors.

Breast Self Examination
Breast self examination (BSE) is a procedure performed by a woman to physically and visually examine her breasts and underarm areas for any changes or irregularities. Though breast self examination alone cannot accurately determine the presence of breast cancer, it should be used in addition to a breast examination by a physician and mammography.

When Should Breast Self Examination be Done?
By performing breast self examination regularly, you will get to know how your breasts normally feel so that you are more likely to detect changes.

Women should begin practicing breast self examination by age 20 and continue the practice throughout their lives—even during pregnancy and after menopause. Breast self examination should be performed every month. Note: Men also can get breast cancer and should check for breast cancer periodically.

If you still menstruate, the best time to perform breast self examination is several days, or about a week, after your period ends. These are the days when your breasts are least likely to be tender or swollen. If you no longer menstruate, pick a certain day, such as the first day of each month, to remind yourself to do breast self examination. If you are taking hormones, talk with your physician about when to do breast self examination.

Be Alerted to Changes
Check with your physician if you find any change in your breast(s) that concerns you. Changes in your breasts may include:

• Development of a lump
• Discharge other than breast milk
• Swelling of the breast
• Skin irritation or dimpling
• Nipple abnormalities (such as pain, redness, scaliness, or nipples turning inward)

How to Do a Breast Self Examination
The American Cancer Society now recommends this approach to breast self examination. It differs from previous procedure recommendations, emphasizing standing, the areas felt, patterns of coverage and using different pressures because these elements of the exam have been shown in the literature to increase exam sensitivity.

• Start the exam by lying down so that the breast tissue spreads evenly over the chest wall and is thin as possible, making it easier to feel. Place your right arm behind your head.
• Use your three middle finger pads on your left hand to feel for lumps in the right breast. Feel the breast tissue with your finger pads by making overlapping dime-sized circular motions.
• Use different levels of pressure to increase the sensitivity of your exam. Start with light pressure to feel the tissue closest to the skin; then, go to medium pressure to feel a little deeper; and firm pressure to feel the tissue close to the chest and ribs. A firm ridge in the lower curve of each breast is normal. Use each pressure before moving to the next spot. If you are not sure how much pressure to use, ask your doctor or a nurse.
• Move around the breast using an up-and-down pattern, starting at an imaginary line straight down your side from the underarm and moving across the breast to the middle of the chest bone. Check the entire breast area, up to the neck or collar bone and down until you feel only ribs. There is evidence that this up-and-down pattern, or vertical pattern, is the most effective pattern for covering all the breast tissue.
• Repeat the exam on your left breast, using the finger pads of your right hand.
• Stand up in front of a mirror, with your hands pressing firmly down on your hips. This contracts your chest wall muscles and makes breast changes more evident.  Check your breasts for changes in size, shape or contour. Look also for dimpling, redness or scaliness of the nipple or breast skin.
• While sitting or standing, check each underarm by only slightly raising your arm, so that you can easily feel the area. Raising your arm too high tightens the muscles and makes it more difficult to do the exam.   
  (source: American Cancer Society)

What to Do if You Find A Lump
One of the most frightening moments for a woman is when she feels something different or unusual while performing a breast self examination. One of the most important reasons to perform regular breast self examinations is so that you know what is normal for your breasts. If you find a lump, it is important not to panic.

If you discover a lump in one breast or feel something "different" in the tissue, examine the same spot in the opposite breast. Usually, if the same area in the opposite breast feels the same there is little need for worry. However, if they feel different, or you feel a definite lump, there may be valid reason for concern and it is important to contact your doctor immediately. Sometimes, the lumpiness may be due to menstrual changes; however, if you have nipple discharge or skin changes such as dimpling or puckering, your doctor may want to see you right away.

It is natural to be frightened when discovering a lump, but do not let the prospect of cancer delay you from taking action. Remember that 80 percent of all breast lumps are benign or noncancerous.

Mammography
A mammogram is a vital step toward breast cancer detection. A mammogram is an X-ray of the breast that helps detect and diagnose breast disease.

There are two types of mammograms. A screening mammogram is used to detect breast changes in women who have no signs of breast cancer. It usually involves two X-rays of each breast but can involve four views of each breast, especially in women who have breast implants.

Mammogram of the breast indicating a concerous lump Photograph used by permission of the National Cancer Institute

The ACS recommends that asymptomatic (having no symptoms of breast cancer) women 40 years of age and older should have a yearly mammogram and continue to do so throughout their lives, while they are in good health. It is important that they stay on a regular screening schedule, because screening mammography significantly improves the chances that breast cancers will be found early, in the most treatable stage.

According to the American Cancer Society, breast cancer takes years to develop. Often, those who have breast cancer have no symptoms and cannot detect the cancer by touching their breasts. Mammography, while it misses some cancers, can detect cancer before it can be felt or causes symptoms.

When breast cancer is detected before it has spread to the lymph nodes, the 5-year survival rate is 98 percent. If the cancer has spread to nearby lymph nodes (regional disease), the rate drops to 81 percent. If the cancer has spread (metastasized) to distant organs such as the lungs, bone marrow, liver, or brain, the 5-year survival rate is 26 percent.

In addition to a mammogram, the ACS recommends asymptomatic women 40 years of age and older should have a physical examination of the breast every year, performed by a health care professional. This clinical breast exam (CBE) should occur around the time of and preferably before, the annual mammogram. For women age 20 to 39 years, the Society recommends a physical examination of the breast every three years, performed by a health care professional.

Another type of mammogram, a diagnostic mammogram, is an X-ray of the breast used to diagnose unusual breast changes. These changes may include a lump, pain, nipple thickening, or discharge, or a change in breast size or shape.

Certain drugs, such as tamoxifen and raloxifene, have been shown to prevent breast cancer in women who are at higher risk for the disease. Women who are concerned that they may be at an increased risk of developing breast cancer should talk with their doctor about whether to take one of these drugs, or take part in a clinical study involving these drugs.

Genetic Counseling and Testing
The Braman Family Breast Cancer Institute offers genetic counseling and testing in the area of breast cancer. A genetics counselor is on staff and genetic counseling is offered based on specific needs such as significant family history or young age at presentation of cancer.

This service is provideed throught the Center for Cancer Prevention and Genetics.

For more information or to schedule an appointment call Talia Donenberg, M.S., CGC, genetic counselor at 305-243-3627.

Sources: Greystone.net, American Cancer Society, National Cancer Institute, and National Breast Cancer Coalition