Dr. M.J. Bazos, MD
Patient Handout
BREAST
CANCER
About Your
Diagnosis
Breast cancer is the most
common cancer among women. More than 180,000 new cases of breast cancer were
diagnosed in the United States in 1996. One of every 10 women has breast cancer
in her lifetime. The specific cause of breast cancer is not known, but risk
factors for breast cancer are as
follows:
1. Starting menstrual periods at
an early age (11 or 12 years) and going through menopause at a late age
(50s).
2. Never having or who having a
first child in the mid 30s.
3. Having a
relative (mother, sister, or child) with breast
cancer.
4. Using birth control pills for a
long period of time (8 to 10 years) or before having a first child (possible
risk). Using estrogen replacement therapy after menopause (small
risk).
5. Eating a high-fat diet and
drinking alcohol. The only sure way to detect breast cancer is by means of
biopsy and removal of a suspicious lump that has been detected with mammography
(radiograph [x-ray] of the breast) or by means of feeling it. Breast cancer is
curable if detected before it has a chance to
spread.
Living With Your
Diagnosis
A lump in your breast is
usually the first sign of a tumor. The tumor sometimes can be detected with a
mammogram before you feel a lump. Mammograms have been shown definitely to
reduce the chance of dying of breast cancer when the tumor is detected in women
older than 50 years. Whether this benefit applies to women in their 40s is
controversial. Breast cancer is a very slow growing cancer and spreads through
the lymphatic and circulatory systems to other parts of the body (lymph nodes,
bone, lungs, liver, and brain). Other signs and symptoms are nipple discharge,
redness of the breast skin, dimpling of the breast skin, and inversion of the
nipple. With spread, swollen lymph nodes are felt, and bone pain, shortness of
breath, abdominal pain, and neurologic symptoms can
occur.
Treatment
Once
the diagnosis is confirmed by means of biopsy, a physician stages the cancer and
determines whether the cancer has spread. Blood tests, radiography of the chest
and breasts, computed tomography (CT) of the head, chest, and abdomen, and bone
scans can be ordered to exclude spread of the cancer. If these studies do not
reveal spread, a surgical procedure is extremely important in staging. During
the operation the surgeon determines the size of the tumor, whether the tumor
has spread to the lymph nodes, and whether the cancer has a specific hormone
receptor. This information is vital in deciding on the type of treatment.
Management of breast cancer can be surgical therapy, radiation therapy,
chemotherapy, hormonal therapy, or a combination of the four. Treatment involves
many different specialists working as a team to offer all the treatments. The
care is coordinated by the primary care physician. Side effects of surgical
treatment depend on the type of operation. Because many lymph nodes are removed
from the armpit area, arm swelling may occur after the operation. Breast
deformity depends on the amount of breast tissue and the type of surgical
procedure (lumpectomy, mastectomy; Fig 1). Side effects of radiation therapy
include dry, red, and itchy skin over the radiation site. Because radiation is
over the chest and armpit area, shortness of breath, coughing, and arm swelling
may occur. Side effects of chemotherapy are nausea, vomiting, hair loss, easy
bruising, easy bleeding, infections, and sometimes toxicity of the heart muscle.
Side effects of hormonal treatment are hot flashes, nausea, vomiting, irregular
menstrual cycles, vaginal bleeding, and skin
rash.
The
DOs
• Seek a team of physicians
who have experience in all aspects of breast cancer treatment. The management of
breast cancer is complex, and you must feel comfortable with the treatment
approach you and your team of physicians have decided on. Included in this team
of physicians are your primary care physician, oncologist (cancer specialist),
surgeon (general surgeon and plastic surgeon if reconstruction of the breast is
being considered), and radiation
oncologist.
• Remember the importance
of nutrition and exercise during and after
treatment.
• Educate family members
about screening for breast cancer. The American Cancer Society recommends that
women between 20 and 39 years of age perform self breast examinations
every
month and that a physician perform a breast
examination every 3 years. Women 40 to 49 years of age do the same and undergo
mammography every 1 or 2 years. Women 50 years and older do the same but undergo
mammography once a year.
The
DON’Ts
• Do not ignore any
lumps in the breast.
• Do not be
afraid to ask for emotional
support.
• Do not miss follow-up
appointments, because this is the time to monitor treatment success and look for
tumor recurrence.
When to Call Your
Doctor
• If you feel a
lump.
• If you have any drainage from
the nipple or irregular dimpling of the breast or
nipple.
• If you are having back
pain, lower leg weakness, or bladder or stool incontinence
(leaking).
• If you have fever,
nausea, or vomiting after
chemotherapy.
• If you feel
depressed.