Carcinoma of the breast is the mos...

Carcinoma of the breast is the mostly common cancer in women, and it is the other leading cause (after lung cancer) of cancer deaths in women causing 46000 deaths in 1993 (Figure 1)(1) In 1993 there were 17 million just discovered cancer cases in the United States, and of that number, 182000 were carcinomas of the female breast (Figure 2) Although carcinoma of the breast also evolves in men, the incidence is greatly reduced--only 300 male deaths from breast cancer were reported in 1993(2)

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The incidence of breast cancer has increased during the past pair decades, but this rate has slowed since 1993(3) Knowledge of breast cancer and its epidemiology, natural course, and rejoinder to treatment continue to unroll Screening, diagnosis, and treatment are essential to survival, and the importance of early detection cannot be overemphasized. Patients must be well informed and should decide, in partnership with person specially versed physicians and nurses, what their options are for treatment. This article discusses generally received understanding of these issues and provides an overview of screening, diagnosis, and treatment of breast cancer.

SCREENING

Thirty years ago, the five-year survival rate for patients with breast cancer was 60% commonly the survival rate for all stages of breast cancer is as high as 78%(4) principally of this improvement is the deduction of earlier detection from improved screening and awareness, as well as from just discovered chemotherapy, radiation therapy, and surgical treatment modalities.

The goal of screening is to identify breast cancer at the earliest possible stage, which allows the highest possibility of corrective Breast cancer begins as precancerous masses that progres to preclinical tumors (de tumors too small to be ascertained by mammography or physical examination), then to tumors that can be discovered only by mammography, and finally to tumors that are large enough to be discovered by physical examination.

Mammography. Until the 1980 the sole way to identify breast cancer was on detecting palpable breast tumors, and these tumors frequently were far advanced by the time they were raise With mammography, breast tumors sometimes can be identified as many as couple years before they become palpable, allowing a greater likelihood of therapy Mammography can identify tumors les than 1 mm in size that consist of barely a few thousand cells.

Mammography is associated with a false-negative rate of 10% to 15% however, which means that 10% to 15% of proven breast cancers cannot be seen upon mammograms.(5) This may be because of the density or location of the tumors, the density and heterogeneity of the breasts, or the quality of the mammograms. It is, therefore, essential that women bear physical examinations in addition to mammograms.

Although the National Cancer Institute has wavered in its recommendations forward mammograms for women less than 50 years of age, the American Cancer Society continues to approve that women have mammograms each one to two years beginning between 40 and 50 years of age.(6) At the Lahey Clinic Medical Center Burlington, Mass, we commend that patients less than 50 years of age have mammograms at least each two years and more repeatedly when any risk factors are near We also recommend that after women reach 20 years of age, they perform monthly breast self-examinations and have annual examinations from their physicians. Women with higher than average risk factors, however, may require more intensive surveillance.

Risk factors. American women in the 1990 are aware of one of the risk factors for breast cancer, especially that of having family histories of breast cancer. What they are les aware of is that 80% of breast cancers are build in women who have no major risk factors.(7)

Variables that can increase a woman's risk of developing breast cancer include early menarche, late menopause, first full-term pregnancy after 30 years of age or no pregnancies at all, a family history that includes first-degree relatives (de mother, sister, daughter) with breast cancer, a previous history of breast cancer, and a biopsy showing hyperplasia with atypia (de cellular variations from normal that are not at the same time cancerous).(8) Simple hyperplasia and fibrocystic breast disease are not risk factors for breast cancer.

EVALUATION OF A BREAST TUMOR

When a woman's mammogram present to views abnormal results or the woman has a palpable bright in her breast, several factors must be considered in deciding whether to proce with a biopsy. The initial grade in the evaluation is a thorough patient history, which includes

* information about the breast lump's presentation, its duration, and its shooting pattern;

* the nearness or absence of pain;

* fluctuation of the clear with menstrual cycles;

* the patient's menopausal status;

* the patient's use of estrogen replacement therapy or oral contraceptives; and

* the personality of significant risk factors.

forward physical examination of a breast plain the physician assesses such features as fixation of the bright to overlying skin or to muscle, the personality of enlarged axillary or supraclavicular lymph nodes, and hepatomegaly. The physician may select to evaluate a breast mass from using bilateral mammograms to assess the remainder of the involved breast and the opposite breast or at using ultrasonography to establish whether the mass is cystic or solid. Although a patient's mammogram may not put in mind of a cancerous tumor, the physician will still praise obtaining a tissue sample of a clinically suspicious mass. Tissue sampling of a breast mass can be accomplished by dint of one or a combination of several methods: fine-needle aspiration or core-cutting needle biopsy, incisional biopsy, or excisional biopsy.