Breast Cancer

According to the National Cancer Institute, in the United States, breast cancer is the most common non-skin cancer and the second leading cause of cancer-related death in women. Each year, a small number of men also are diagnosed with and die from breast cancer.

What are the Causes?

The underlying cause of breast cancer is unclear. However some of the risk factors that have been identified include:

• Began menstruating at an early age
• Older age at first birth or never having given birth
• Treatment with radiation to the breast/chest area
• Obesity and lack of exercise
• Long-term use of menopausal hormone therapy
• History of taking DES
• Increased breast density
• Personal or family history of breast cancer

What are the Symptoms?

It is very unusual for breast cancer to produce symptoms in the early stages. Although the following symptoms most often result from non-cancerous conditions, if you experience any of them you should consult an internist.

A lump or thickening in or near the breast or in the underarm area.
• A change in the size or shape of the breast.
• Dimpling (like an orange peel) or puckering in the skin of the breast.
• A nipple turned inward into the breast.
• Scaly, red, or swollen skin on the breast, nipple, or areola (the dark skin that is around the nipple).
• Fluid, other than breast milk, from the nipple, especially if it's bloody.

How is Breast Cancer Diagnosed?

You should conduct self-breast exams regularly to look for lumps and other abnormalities. See your internist if you notice any changes in your breast. Tests used to diagnose breast cancer may include the following:

• Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
• Screening Mammogram: An X-ray of the breast used to detect breast changes in women who have no signs or symptoms of a breast abnormality or problem.
• Diagnostic Mammogram: An X-ray of the breast that is performed to evaluate a specific problem or symptom in the breast.
• Breast Ultrasound: Uses sound waves to image the breast and is used to see whether a breast lump is filled with fluid (cyst) or if it is a solid lump. An ultrasound does not replace the need for a mammogram; it is often used along with a mammogram to check a problem in the breast.
• Breast MRI: Uses a powerful magnetic field, radio waves and a computer to produce images of the breast. This a supplemental tool for detecting and staging breast cancer and other breast abnormalities. Breast MRIs may be helpful in certain women who are at high risk of developing breast cancer in their lifetime and may have value for women with breast cancer.
• Breast PET CT: PET/CT is used to provide fused whole body metabolic and cross-sectional imaging to help stage and follow response to chemotherapy.
• Breast Biopsy: Small samples of tissue are removed from the breast using a hollow core needle with or without a vacuum-assisted device that is precisely guided to the correct location using continuous ultrasound imaging.

Breast Cancer Treatments

The treatment for breast cancer depends on whether the cancer is affecting one area or if it has spread throughout the body. Once a full assessment has been made, your internist and oncologist will discuss treatment options with you. Treatment may include one or a combination of the following:

• Surgery (removal of the cancerous tumor)
• Radiation therapy
• Chemotherapy
• Hormonal therapy

Reference: American College of Physicians. Internal Medicine. http://www.acponline.org/patients_families/special_topics/womens_issues/breast_cancer/