MEDICAL SURFARI: BREAST CANCER KILLS THOUSANDS

Early in this 20th Century, the words "cancer" and "breast" weren't even mentioned in polite company. Great strides have been made since that time and today not only can we talk about breast cancer openly, we can find answers to our questions about prevention, detection, treatment and recovery. These answers give women the power to make appropriate decisions that affect the quality of their lives.

Facts and figures

About 80 percent of women diagnosed with breast cancer have NO known risk factors. About 5 to 10 percent have a family history of breast cancer. Only 10 percent have some risk factor.

In 1997, about 180,200 women will be diagnosed with breast cancer. This is the equivalent of 493 women each day.

During the 10 years of the Vietnam War, 58,000 men and women died. During that same time period, 330,000 women died of breast cancer.

Do we know the cause?

The American Cancer Society responds:

-- No. We don't know the cause, but we do know what certain risk factors are.

-- We know every women is at risk.

-- Over all ages combined, white women are more likely to develop breast cancer than African-American women, but the latter are more likely to die of breast cancer.

-- The Society is funding millions of dollars in breast cancer research.

Risk factors

The risk of developing breast cancer is 10.2 percent, but dying from the disease is only about 3.6 percent. Much of the risk is after age 75. A family history of breast cancer in a parent, sibling or child increases two to three fold in a woman's chance of developing the disease. Women at the highest risk are those with a history of malignant breast cancer.

Women who have early menstruation, late menopause and late first pregnancy are at increased risk. Although fibrocystic disease has been show to increase risk, it is a relatively imprecise diagnosis. Consequently, it is difficult to forecast risk based on this diagnosis. Lumpy breasts are normal, therefore these women shouldn't be considered high risk.

Most studies have failed to demonstrate an association between the use of birth control pills and subsequent development of breast cancer, but their use over four years prior to the first pregnancy may increase risk. The use of hormone replacement therapy after menopause appears to link modestly, but only after 10-20 years of estrogen.

Evidence indicates that environmental factors, such as diet, also play a role in causing or promoting the growth of breast cancers, but there is no conclusive evidence that a particular diet is more likely to be associated. Obese post-menopausal women are at increased risk, but there is no evidence that dietary modifications reduces this risk.

Symptoms/What to Look For

Each month, a woman's breasts go through temporary changes associated with menstruation. While 90 percent of these are not cancerous, any new lump should be examined. Lumps are most common in the small sacs that produce milk. More than 80 percent of breast cancers are discovered as a new lump by the woman herself.

Routine mammograms reduce breast cancer deaths by 25 to 35 percent in women over 50 who don't have any symptoms and by a lesser degree in women under 50 who don't have symptoms. The American Cancer Society recommends a baseline mammogram between ages 35 and 39, and repeat studies at 2 year intervals between ages 40 and 49, and yearly in women over 50.

In early stages, breast cancer usually has no symptoms. As a tumor progresses, you may notice:

-- Swelling in the armpit

-- Pain or tenderness in the breast

-- A lump, often the first symptom. Lumps are usually visible on a mammogram (an x-ray of the breast) long before they can be seen or felt

-- Any changes in texture, shape or temperature of the breast: a reddish, pitted surface like the peel of an orange

-- A change in the nipple, a dimpled appearance, itching or burning sensation; or scaling.

-- Unusual discharge from the nipple

If any these symptoms exist, see your physician.

World Wide Web Resources

http://oncolink.upenn.edu/disease/breast/

A resource from the University of Pennsylvania Cancer Center, this site provides information about recommendations for screening and diagnostics including mammography and breast self exam. Also included is information about biopsy, classification and staging of breast tumors.

http://nyservnet.org/bcic/

The Breast Cancer Information Clearinghouse provides information for breast cancer patients and their families. This site, as referred to "Medical Surfari" (Gibbs 1996), contains patient-directed information concerning detection, diagnosis and treatment.

http://www.y-me.org/

Y-Me National Breast Cancer Organization is an excellent site. It's well organized resource with content ranging from contact information to a "kid's corner," where original essays written by patient's children are posted.

Dr. Scott Gibbs is a neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbssemissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, MO, 63701.