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Breast cancer is a frequent cause of
cancer in women. It is usually reccomended that women over 40 have a yearly mamogram.
Risk factors
Various risk factors have been identified. However, no single risk factor is common to a
large proportion of women. Hormonal influences (i.e., menopause after age 55) and not
having any children increase the risk of breast cancer. Family history in a
first-degree relative (sister or mother), especially if the cancer occurred
premenopausally, increases the risk of developing breast cancer. Prior breast pathology is
also a risk factor. Dietary factors, including high fat intake and moderate alcohol
consumption, might increase the risk of breast cancer. Finally, age is a major risk
factor, with older women more at risk for developing breast cancer.
Diagnosis
1. Breast self-examination: Monthly breast self-examinations are important, because up to
75% of breast cancers are discovered by patients as a lump.
2. History and breast examination by a physician: The history should include date the lump
was found, prior breast problems, and possible risk factors.
3. Mammograms: Mammography is an integral part of evaluating a breast lump. This
procedure, coupled with the physician examination, is superior to either modality alone.
4. Biopsy: Needle aspiration of cells from a potential tumor site is useful if a larger
mass is palpable. This permits planning of treatment, if necessary.
Treatment
Breast carcinoma is generally divided into two types according to origin. Distinction
should be made between in situ intraductal (noninvasive) carcinoma and infiltrating ductal
or lobular (invasive) carcinoma.
1. Staging: Staging a tumor represents the clinical evaluation of the cancer. This process
involves size of the primary tumor, axillary node involvement, and whether distant
metastasis has occurred. The most important factor in prognosis of patients with breast
cancer is the axillary node status.
2. Treatment strategies: For advanced or recurrent breast cancer, treatment strategies
depend on extent and location of disease, menstrual status, whether a disease-free
interval occurred, receptor status, general health status, and patient wishes. Palliation
may occur with tamoxifen or oophorectomy in the premenopausal woman. Tamoxifen helps with
regression in two-thirds of patients with positive estrogen receptors.
3. Follow-up examinations: Clinical evaluation should continue on a regular follow-up
basis.
Pregnancy and breast cancer
Two percent of all breast cancers are diagnosed in pregnancy, which does not influence
prognosis. If cancer is found during the first or second trimester, a mastectomy and
axillary dissection should be carried out. Therapeutic abortion does not improve outcome.
Third-trimester women can be observed until delivery and then receive prompt therapy.
Chemotherapy administered during the second and third trimesters has no adverse effect on
the developing fetus.
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