Breast Cancer: How to Cut Your Risk and Control Your Care

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If You Find a Lump

If something abnormal shows up your mammogram -- or you or your doctor find a lump -- don't be immobilized by fear. Most of the time lumps turn out to be cysts or benign fibroid tumors. But contact your primary care physician immediately. If you are premenopausal, she may ask you to come back a week after you finish your next menstrual cycle to make sure the lump is not just a cyst. Getting the right diagnosis normally a three-step process:

Step 1: The Right Tests

If you're young or have very dense breasts, you'll get a diagnostic ultrasound. This identifies benign fibrous tumors or fluid-filled cysts and doesn't involve extra radiation.

If you're over 35 or do not have dense breasts, doctors may do a diagnostic mammogram of both breasts to see if the lump or suspicious abnormality warrants further testing. If these tests turn out to be negative, your physician may recommend another breast check in three to six months and repeat the diagnostic mammogram and other tests. If you get an all clear then, you can resume regular screenings. About 80 percent of suspicious abnormalities turn out to be benign. But mammograms can miss some breast cancers or even palpable lumps, especially in younger premenopausal women with dense breasts. Your doctor may suggest further confirmatory tests, such as an MRI or ultrasound.

Step 2: What a Biopsy Really Does

"If something suspicious is found, the type of biopsy performed will depend on the size and location of the suspicious finding and whether the doctor can feel it," says Elisa R. Port, MD, a breast cancer surgeon at Memorial Sloan-Kettering Cancer Center. "You'll be referred to a radiologist or a breast cancer surgeon."

Needle biopsy. If the lump can be easily felt, the radiologist or surgeon may do a needle biopsy in the office, doing either a fine-needle aspiration or a core-needle biopsy. The first type removes breast tissue through a tiny needle; the second uses a larger needle and may require local anesthetic. If the breast lesions can't be felt, the radiologist or surgeon may use imaging tools, such as mammography, ultrasound, or an MRI, to guide the needle. These can also be done using local anesthetic in a specially equipped radiology suite.

Surgical biopsy. This requires an operating room and usually involves local or general anesthesia. If the tumor is small enough, the surgeon will remove it all, along with a surrounding margin of normal breast tissue. In both cases the tissue is then analyzed by a pathologist. Within two to five days, you should know whether it's cancerous.

Step 3: Understanding Your Test Results

When you get the test results, don't go alone. If your surgeon says, "You have cancer," you probably won't hear anything else afterward. Make sure your doctor explains everything in your pathology report. You may also be recommended for MRIs of the noncancerous breast, a precaution many radiologists recommend. Unless your cancer is extremely aggressive, there is time -- several weeks to a month -- to educate yourself and find your best treatment plan.

Two key questions to ask:

What kind of cancer is it? Most breast cancers start either in the lobules that produce milk (lobular) or the ducts that carry the milk to the nipple (ductal). Either can be just within the location where it started (in situ) or have spread into surrounding breast tissue (invasive). Ductal cancers tend to be in one breast only; lobular may affect both breasts. There are also several very rare types: One looks like an infection (inflammatory); another looks like a skin disorder (Paget's disease of the breast). Or you could have more than one type of cancer.

How aggressive is it? The higher its grade, the more likely it is to spread to the lymph nodes and other parts of the body. One factor to look for: the tumor cell proliferation index, which gauges how fast the cancer cells are growing -- faster means the cancer is more aggressive. Slower-growing tumors give you a better chance for a full recovery.

What's Your Breast Cancer Risk?

For detailed calculation of your individual breast cancer risk, take the questionnaire at More than 75 percent of breast cancers occur in women over age 50. But other risk factors include:

  • Previously had breast cancer.
  • First-degree relative -- daughter, mother, sister -- who had breast or ovarian cancer.
  • Prolonged exposure to estrogen: hitting puberty before age 12, starting menopause after age 55, or having children after age 30 or not at all.
  • An abnormal biopsy even if it later turns out to be benign.
  • A mutation in the BRCA1 or BRCA2 gene (learning this requires genetic testing; discuss this option with your doctor).
  • Currently taking hormone therapy for menopause.
  • Postmenopausal obesity.

Originally published in Ladies' Home Journal, October 2006.


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