October is Breast Cancer Awareness month and an opportune time to review some facts about this disease.
The average woman has a one in nine lifetime risk of developing breast cancer. Although the risk rises with age, breast cancer can be diagnosed at any age.
Screening tests are designed to detect disease early in those without symptoms or signs of disease. The single best screening test for breast cancer is the screening mammogram.
Women between the ages of 40 and 79 may book the test themselves through the Screening Mammography Program of B.C. (www.smpbc.ca), 1-800-663-9203 or 604-8776187.
Screening mammograms for women between age 40 and 50 has been shown to reduce cancer deaths; however, because the disease is less prevalent than in women over 50, there is a higher rate of false positives (i.e. the mammogram detects an abnormality, but the patient does not have cancer). This could lead to unnecessary and potentially harmful procedures including biopsies and surgery.
The Canadian Task Force on Preventive Health Care therefore recommends that women under 50 should not do screening mammograms.
Screening mammograms have also been shown to reduce cancer deaths in women up to age 75.
Therefore, a woman should discuss with her family physician when she should start and stop screening mammograms.
Risk factors for breast cancer include: (1) age (as stated above, the risk increases with age); (2) family history (especially in a first-degree relative such as a mother, daughter or sister under age 50 or before menopause); however, nine out of 10 woman who have been diagnosed with breast cancer do not have any family history.
Some woman mistakenly believe that they are unlikely to have a breast cancer if they have no family history.
(3) being overweight (especially after menopause); (4) drinking more than two standard alcoholic drinks per day; (5) taking hormone replacement therapy for more than five years after menopause; and (6) having a first child late in life or not having any children at all.
There is some controversy regarding routine breast self-examination. Current medical evidence has not demonstrated that monthly self-examinations reduce breast cancer deaths. This seems counterintuitive, as many women have discovered breast cancers because of a new area of breast tenderness or a palpable lump.
If they had not done any examination at all, their cancers may have been discovered when much further advanced.
The Canadian Task Force recommends that physicians not advise women to do routine breast self-exams. Note that this recommendation refers to routine self-exams.
It is does not mean that women should not palpate or examine their breasts at all. An important part of self-care is to be aware of your own body and to act on any significant changes.
Some of the symptoms of breast cancer include: abnormal lymph nodes (felt as firm lumps) in the arm pits or above the collar bones, changes in the skin of the breasts (including dimpling or puckering, changes in visible veins or sores), nipple changes (including inversion, bleeding or discharge), a palpable lump (that may or may not be tender), or a new area of breast tenderness.
Although any of these breast symptoms will be understandably alarming, they can be due to benign causes. However, it is important to see a physician you trust to assess them appropriately.
Women with a family history of breast cancer should speak to their doctor about their personal risks. Depending on the details of that family history, some women may be eligible for specific genetic testing.
All women should talk to their family physician about breast health and the timing of the most appropriate screening tests for breast cancer.
Dr. Davidicus Wong is a family physician and writer. His Healthwise column appears regularly in this paper.
