BREAST CANCER
Breast cancer is the most common malignancy in women although lung cancer is catching up because of the number of women smokers. Although its exact cause is not clear, it appears to be partially hereditary. Whether hormones such as birth control pills or those taken after menopause play any role in causing breast cancer has not yet been completely proven but seems unlikely Breast cancer is often noticed by chance, either by the woman herself or by her husband or physician. Self-examination, a method that all women should learn, can reveal small lumps, which may be the first sign of breast cancer. If you notice a lump in your breast, consult your physician immediately. Never assume that if you ignore it, it will go away by itself. If you are not certain how to examine your breasts by yourself, you can ask your physician for instruction. Breast clinics also offer examinations and advice of this type. Brochures distributed by national cancer societies explain breast self-examination.
Benign tumors of the breast are more common in younger women. The chances are therefore greater that, with increasing age, if you find a lump, it will require surgical removal. Many physicians recommend special X-rays of the breast (mammograms) to determine whether the lump has the appearance of a malignant tumor. Many physicians now recommend that routine mammograms be performed on all women over the age of 50 although if the person is considered to be at little risk, the frequency of studies might be decreased, especially during the more senior years. Sometimes a needle is placed into the lump under local anesthetic and some cells removed. This may reveal that the lump is in fact a cyst (collection of fluid) and not a tumor. In all cases, if a lump is found, it should be fully investigated and surgery considered if it is likely to be malignant.
Because breast cancer metastasizes (spreads), the tumor should be removed as soon as possible. The physician will also make sure that, if malignant, it has not spread. This is done before surgery by the use of X-rays and scans and during surgery by examining the tissues surrounding the tumor.
There appears to be little evidence that a radical mastectomy, in which underlying muscles and lymph nodes are removed along with the diseased breast, gives any real benefit to women with breast cancer. Especially in older women, the operation that seems most appropriate is the removal of the breast alone and the lymph nodes that drain the breast. In certain cases the removal of the cancerous lump, without the whole breast, may be sufficient, particularly in the very elderly, who may not as readily withstand a longer, more strenuous operation. This operation is sometimes called a “lumpectomy.”
Some patients receive radiation treatment in addition to surgery, whereas others are treated with radiation alone. Sometimes radiation therapy is not given at the time of surgery but is used only if there is evidence that the tumor has recurred. The results of the different treatments are controversial, and it is still not clear what method is best for all women. Recently, the National Cancer Institute recommended that all patients with breast cancer receive chemotherapy or hormonal therapy after surgery even if there is no evidence of spread to other parts of the body. This may eventually prove to be effective in the older population and may become standard practice.
If the tumor has spread to other parts of the body, there may be a good response to various hormones. A hormonelike drug called tamoxifen has been very effective in improving the symptoms of women with metastatic breast cancer. Radiation treatment to bones that may be painful because of invasion by the tumor can be helpful in relieving symptoms. In some instances chemotherapy is of value.
Although breast cancer is a serious disease, in older women its progress and spread can be very slow. Many older women survive surgery and do very well for many years without any evidence of recurrence. Others, although the cancer has spread, respond well to hormonal treatments and live comfortably for many years. With proper treatment, the chance of improvement, even if only temporarily, is good. And each new therapy that is developed offers more hope.
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