The Facts of Life: Examining Reproductive Health

Cancers

Breast Cancer

34 & 35. Film Mammograms Mammograms of right and left breasts of 80-year-old woman. These are magnified views that reveal a large cancerous mass, approximately the size of a quarter, in the right image. White calcifications in the ducts are visible on the image. These are related to breast feeding and benign breast disease (mastitis.) Courtesy of the Department of Radiology, UIHC

There are two main types of breast cancer. Breast cancer that begins in the lobes and spreads to nearby tissue is called invasive lobular carcinoma. Breast cancer that begins in the ducts and spreads to nearby tissue is called invasive ductal carcinoma.

Various procedures are available to detect breast cancer. These include mammography (x-rays of the breast), magnetic resonance imaging (MRI), breast exams by a healthcare provider, and breast self-examinations (BSE). Breasts will vary in size, shape, and feel according to changes due to age, menstrual cycle, pregnancy and menopause. Taking birth control pills or other hormones may also affect breast tissue. Breasts may often feel lumpy and uneven. Usually, this is no cause for alarm. By doing monthly BSE, a woman learns what is normal for her breasts and is more likely to detect a change. Early breast cancer usually does not cause pain. But as the cancer grows, it can cause changes in the breast tissue. If a woman detects any of the changes listed below, she should seek medical attention immediately.

36. Size of Tumors Found by Mammography and Breast Self-exam Courtesy of The Breast Health Prorgam of New York

• A lump or thickening in or near the breast or in the underarm area;
• A change in the size or shape of the breast;
• A discharge from the nipple; or
• A change in the color or feel of the skin of the breast, areola, or nipple (dimpled, puckered, or scaly).

Aspiration or needle biopsy and surgical biopsy are two other methods used to confirm the presence (or absence) of breast cancer. In aspiration biopsy, a needle is inserted into the lump or thickening and a small amount of fluid is drawn off. Surgical biopsy involves the removal of all or part of a lump or suspicious area. The tissue or fluid sample is examined under a microscope for cancer cells, usually by a pathologist.

Treatment
When a woman is diagnosed with breast cancer, there may be several treatment options she can choose from. Methods of treatment are categorized as local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area. For example, surgery and radiation therapy are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the body.

Chemotherapy and hormone therapy are examples of systemic treatments. A patient may have just one form of treatment or a combination of treatments, depending on the type of cancer.

Surgery is the most common treatment for breast cancer. Four types of operations are most commonly employed:

37.lumpectomy removal of the lump and a margin of normal tissue around it;	38. partial mastectomy the tumor, some of the normal surrounding tissue, and the lining over the chest muscles are removed;
39. total mastectomy removal of the entire breast	40. modified radical complete removal of the breast, mastectomy chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. This procedure was once the standard operation for breast cancer surgery, but is seldom performed today.

Radiation therapy (also called radiotherapy) usually involves doses of high-energy rays to kill remaining cancer cells. Sometimes, radioactive materials embedded in thin plastic tubes are placed directly in the breast (implant radiation). Patients may receive both types of radiation therapy simultaneously.

Chemotherapy is the use of medications administered intravenously to kill cancer cells. Chemotherapy is given in cycles; a treatment period followed by a recovery period, then another treatment, and so on.

Hormone therapy prevents cancer cells from receiving the hormones they need to grow. This treatment may include the use of medications that change the way hormones work, or surgery to remove the ovaries, which manufacture hormones.

Breast implant
Breast implants are used for breast reconstruction following removal of a breast due to cancer and for breast enlargement operations performed for cosmetic reasons. Breast implants are produced from silicone, saline, or a combination of the two. Implants are available in a variety of shapes, sizes, and textures.

The U.S. Food and Drug Administration approved silicone gel-filled implants for breast augmentation in women 22 years old and older and for women of all ages undergoing breast reconstruction surgery. According to the FDA's 2006 comments, 22 is the age by which most women's breasts have developed fully. Follow up studies for the safety and effectiveness of the implants is a condition of the aproval.

Mammography
Breast cancer accounts for about 26% of all cancers occurring in women. One in nine women in the United States will develop breast cancer at some time during her life. Detection of breast cancer at an early stage strongly influences the success of any treatment. Survival drops dramatically the later the disease is detected. When the disease is found and treated early, before it has spread beyond the breast, the 5-year survival rate is about 90 percent. An annual mammogram is the most reliable way to detect breast cancer.

A mammogram is a very low dose X ray that can reveal lesions in the breast. During mammography, the breast is compressed briefly and flattened out between two plates to obtain a good image. A specially trained technologist uses an x-ray unit designed expressly to make images of the breast. This apparatus can be raised, lowered, and rotated to take images of the breast from different angles.

The American Cancer Society recommends that women between the ages of thirty-five and forty have their first (base-line) mammogram. Subsequent mammograms are examined alongside the base-line mammogram to detect any changes in the breast tissue. A radiologist scrutinizes each image for abnormalities that appear lighter on the image than the surrounding breast tissue. A good mammogram can image fibrous strands as thin as a spider's web, and calcium deposits so small the film must be examined with a magnifying glass. If a suspicious shadow is present, further examination and/or biopsy will assist in its diagnosis. Fortunately, most breast lumps are not cancerous.

Fabricius Hildanus (1560 to 1634) Hildanus of Bern, Switzerland, was the first surgeon known to remove both breasts for cancer. It was important to work quickly because there were no anesthetics at that time.