Breast Cancer 101

Greetings from the Philippines!

Just before Lucie and I left El Centro for an emergency trip to Cebu City, I was invited to lecture on breast cancer to a cancer support grassroots organization.

Breast cancer incidence in the United States is an alarming 90 per 100,000 women. The take home message of my Saturday morning talk was: get a baseline mammogram. At age 40 and above, an annual mammogram can save your life. Regular mammography is the single most effective method of breast cancer surveillance.

While the incidence is highest in the United States and Western Europe where lifetime risk is 12% but lower in Asia and third world countries, carcinoma of the breast is the most common cancer among women worldwide.

Lowest incidence is in 20-24 year old women. However, breast cancer increases with age. 95% of new cases are diagnosed in 40 year old women and older. Median age is 61 years.

The statistics which I presented to the group of cancer survivors and supporters hit close to home this time. A day before our return flight to Southern California, my aunt called to say she had noticed a breast lump. I was very concerned, knowing that breast cancer most commonly manifests as a painless mass.

We brought her to the local hospital where a quick mammogram showed a suspicious 3 centimeter spiculated lesion. A core needle biopsy, done under local anesthesia with ultrasound guidance, confirmed invasive cancer on the frozen section microscopic slides.

We postponed our return flight. With another local surgeon, Dr. Spanky Tablante, who had relocated to the Philippines after practicing twenty years in Virginia, we performed a standard mastectomy with axillary node dissection. My 81-yr-old aunt is recuperating well as I write this and should be back home by the time you read this article.

The operating suite at Perpetual Succour Hospital in Cebu City may not have the latest gadgets we have at our disposal in the United States. For instance, we operated without a harmonic (bloodless) scalpel. But, during the entire two and a half hours of surgery, the Chief of Cardiology, Dr. Victor Gonzalez, was seated next to the Chief Anesthesiologist, Dr. Enricoso, constantly monitoring my aunt's vital signs. We certainly don't have that kind of personalized luxury in California!

Again, it is important to emphasize the need for yearly clinical examination and mammography. Early breast cancer cannot be felt. It is usually not painful. But a good mammogram should detect a suspicious lesion 85-90% of the time. In cases of dense or fibrocystic breasts, physicians may order an MRI (Magnetic Resonance Imaging) which increases detection rate by an additional 5-10%. Soon, digital mammography will be readily available, which will make detection of very tiny and early stage cancers even more accurate.

Several factors are known to put women at risk of developing breast cancer. Increasing age, as mentioned, is one. As one gets older, the risk increases. At age 20 - 24, only 1.4 per 100,000 women are diagnosed with breast cancer. At age 75-79, the incidence rises to 465 per 100,000.

A first degree relative with breast cancer, delayed childbearing, fewer children, late age at first full term pregnancy (>30 years), early menarche (<12>55 years), high dose radiation to the chest, obesity, use of contraceptive pills and hormone replacement therapy are all known risk factors.

Patients with a history of endometrial, ovarian, and colon cancer are also at risk. Mothers that do not breast feed are at higher risk than the average population. Women who are found to have atypical ductal or lobular hyperplasia (by mammography and biopsy) are at risk for developing breast cancer.

Bottom line is that all women should be vigilant. Monthly self breast examination is a worthwhile practice. A woman should be familiar with changes in her breast and should learn to detect thickening, swelling, redness, nipple inversion, discharge and skin erosion. Once noticed, she should not delay in bringing this to the attention of her physician.

In addition to self examination and regular mammography, avoiding rapid weight gain and obesity is important. Regular physical activity and exercise is known to cut down the rate of breast cancer, in addition to improving general health.

Minimize alcohol intake. Two alcoholic drinks a day increases cancer risk by 21%. Hormonal therapy should be taken with caution. Discuss thoroughly with your physician the risks involved before taking hormones as contraceptive pills or menopausal supplements.

In the next article, I will discuss the current standard treatment of breast cancer.