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Wednesday, September 14, 2011

Breast Cancer Awareness

A few years ago, I lost one of my cherished friends to breast cancer.  I watched her go through chemo regimens and even bone marrow transplant only to ultimately have the disease claim her life.  It was heartbreaking for her family and friends, and her light in this world is sorely missed.  As I remember her life and her friendship, I am inspired to remind all women to be proactive in their pursuit of breast health.  So are mammograms still the best way to find cancer?  Don't we have something better by now?  Well, not really.
Mammograms, MRIs, ultrasounds….with such a dizzying array of tests for breast disease from which to choose, how do we know what is best for early detection of breast cancer?  The short answer is that mammography remains the simplest, cheapest most effective breast screening tool in our medical arsenal.  But there are some situations that women should know about that might make additional testing appropriate for their particular situation.
An estimated one in eight women are diagnosed with breast cancer in their lifetime.  Screening for detection of the disease before it spreads to other parts of the body is the most effective way to beat breast cancer, and women must not become complacent in getting tested at the recommended intervals.   In addition to the mammogram, a breast examination by a health care provider (clinical breast exam) has traditionally been part of the well-woman’s annual exam along with breast self-exam.  
Magnetic resonance imaging (MRI) has come into more common use in detecting breast disease, but it is still not recommended for the average woman as a routine screening test.  It has issues of false positive results as well as the potential to miss an early lesion that mammogram would otherwise pick up.  MRI can be used in some cases as an adjunct to regular mammogram particularly in women who have already had breast cancer in one breast, women with breast implants and women with very high risk of breast cancer based on their history.
The American College of Obstetricians and Gynecologists has stated that they will continue to recommend the screening mammography every year for women beginning at age 40.  They also feel that breast self examination has potential benefit along with periodic clinical breast examinations starting at age 20.  When to initiate mammogram screening and how often should be a topic of discussion between a woman and her health care provider based on that woman’s individual risk factors and desires for testing.
Ultrasound technology can be used in conjunction with mammograms for further evaluating areas of concern, and needle biopsy of a solid tumor or sucking out fluid from a cystic mass can then be performed.  A good use of ultrasound is when a breast lump is actually able to be felt on clinical exam.
Even better than early detection would be prevention of breast cancer, and there are clearly steps that women can take to lower their overall risk.  Studies have shown that overweight women, women who consume two or more alcoholic beverages a day and those with diets containing a high amount of animal fat have a substantial increase in the baseline risk of breast cancer.  In overweight women who can decrease their weight by twenty or more pounds (and keep it off), there is a forty percent risk reduction for breast cancer…so go for it!

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