I have been treating patients with breast problems for over a decade, and
have treated more than one thousand patients with breast cancer, as well
as thousands more with benign breast health concerns. Women, and sometimes
men, present with numerous questions concerning their risk for breast
cancer, as well as the benign conditions that plague them. I would like
to answer some of the most common questions that I hear.
Q: Why am I having pain in my breast, and what can I do about it?
A: One of the most frequent reasons patients see me about is breast pain.
Commonly, the cause is fibrocystic change. This used to be called “fibrocystic
disease,” but it really isn’t a disease at all, but irritated
breast tissue. Sadly, caffeine and chocolate are among the things that
will irritate fibrocystic breasts. Cancer is an unlikely reason for breast
pain, but needs to be ruled out with mammograms, sonograms, and a good
physical exam. Once these things are done and are negative, the pain can
be addressed. Limiting caffeine in the diet can often help reduce the
pain, although for some people, like me, that would be extremely difficult
if not impossible. I tell patients to use their judgment on how bad their
pain is and how much they need that coffee. Vitamin E is also useful in
limiting fibrocystic pain, and 400 units a day is a safe dose. Anecdotally,
fibrocystic breast pain seems to be worse during the peri-menopausal time,
so in addition to hot flashes and insomnia, breast pain often gets worse.
Thank you Mother Nature!
Q: I have a breast lump. Should I be worried?
A: Well, first off, don’t panic. There are more causes of breast lumps
that are benign than are not. This includes cysts, fibroadenomas (benign
tumors), and even fibrocystic change (see above). Having said that, cancer
needs to be ruled out by mammograms, sonograms, a good physical exam,
or biopsy. These days, most biopsies are done by needles rather than by
surgery. A needle biopsy of a breast lump will give us the diagnosis most
of the time. And remember, about 75% of all needle biopsies are not cancer,
so the odds of that lump being cancer is small. Still, it shouldn’t
be ignored, just checked out.
Q: What are the current recommendations for screening for breast cancer?
A: Good question. Over a year ago, some federal task force decided that women
under the age of 50 didn’t need mammograms. They quickly back-pedaled
on that when there was a fire-storm raised by numerous groups. I remember
it well since we had 3 new breast cancers diagnosed in women aged 40-49
in 2 weeks following that, based on mammogram findings alone. So now,
the current recommendations are that women should start annual screening
mammograms at age 40, unless there is a family history, in which case
the first baseline mammogram should be at age 35. Of course, if there
are any new breast changes, such as a lump, pain, nipple discharge or
nipple retraction, mammograms are recommended to check these out. Annual
physical exams are also important for screening. The recommendations on
self-exams vary. I tell my patients to do self-exams if they feel comfortable,
or have their partners check things out. I have had several cancers found
by significant others.
Q: My mother and all of her sisters have had breast cancer. What are my risks?
A: Unfortunately, one of the highest risks of breast cancer is a family
history of first-degree relatives with breast cancer (mother, sister,
daughter). There are some genetic predispositions that we can actually
test for, such as the BRCA mutation. If a family member is positive for
BRCA-1 or -2, then you can also be tested. If negative, your risk is normal
(read on below). If positive, there are ways to reduce that risk (again,
see below). However, there are other mutations that have not yet been
identified, and are therefore not able to be tested for. So, with a strong
family history that is negative for BRCA, we have to treat the patient
as high risk and go from there.
Q: What is my risk of breast cancer?
A: This is a complex question with a complex answer. The highest risks of
breast cancer include:
- Having already had a breast cancer (no, you’re not out of the woods
after 5 years, as we previously thought)
- BRCA mutation
- Previous breast biopsy with atypia (funny-looking cells) or lobular carcinoma-in-situ (LCIS)
- Chest wall radiation, such as for Hodgkin’s lymphoma
- Strong family history of breast cancer (mother, sister, daughter).
Of course there are numerous other factors involved, such as increasing
age, being female (men have less breast tissue than women, but still can
get breast cancer), age at puberty, number of children, whether or not
you breast-feed, etc. There are actually computer models that can give
you a percentage of developing breast cancer, although none are perfect.
Q: How can I reduce my risk of breast cancer?
A: First, your risk will need to be identified (see above). If at normal
risk, then lifestyle factors such as maintaining a normal body weight,
exercise program, and normal vitamin D levels have been shown to decrease
your risk. If at high risk, then a patient may also chose to take tamoxifen
or Evista to reduce her risk. Of course all medications have risks and
benefits, and the addition of any new medication will need to be evaluated
by your health care professional. For patients who have already had a
breast cancer, a BRCA mutation, or LCIS on a needle biopsy, bilateral
mastectomies with reconstruction is also an option, but a really drastic
one that I don’t recommend without thoroughly examining all possibilities.
As always, screening mammograms and physical exams are important.
Q: I have just been diagnosed with breast cancer. What do I do now?
A: First, take a deep breath. Odds are, you will be OK. Survival from breast
cancer has increased over the past decade due to early detection, prevention,
and better treatments. Of course, the road has just begun and there is
a lot of help along the way. Everyone’s cancer is different, as
is every patient, and treatment options will depend on numerous factors
that I can’t get into here. Rest assured that there is help out
there from a variety of sources from Cancer Navigators, the American Cancer
Society, breast cancer Survivors, and us. I am always humbled and amazed
by the courage of our patients, and the support and treatment options
that are available for them.
These are just some of the most commonly asked concerns. I hope that this
has answered some of your questions. As always, if you have any breast
health concerns, we are happy to evaluate you in our clinic.
D. Kay Blanchard, MD, PhD
Tiffany Simons, ANP
Surgical Associates of Fredericksburg
Medical Chair, Breast Cancer Program
Mary Washington Healthcare Regional Cancer Center