Breast Cancer and Self Exams.

Good Evening Everyone,

Well we have had a busy week. We had two of our docs rotated home and Travis went on leave so that left only for of us providers to cover the clinic. We have been working around the clock. So we were very happy to have Dr. Perez arrive tonight. He is coming for a three month tour. Additionally, Travis came off leave yesterday and so he will be added back to the schedule as of tomorrow.

We have been working on our mass casualty exercise that will be coming up on the 27th. We will be hosting a group of Iraqi physicians on that day. We will be teaching them some medical classes in the morning and then in the afternoon we will have them participate in our mass casualty exercise. In this environment, real mass casualties are nothing new but we are now trying to prepare the local physicians to manage their own mass casualty event. I will be giving the physicians a class on how we run our exercises and how we utilize our personnel. The Iraqi health care structure has historically excluded or margianalized their ancillary and non-provider staff. Nurses for example, are nothing more than hand maidens for the physician. When I presented our system of health care to the Iraqi's at our December conference, the physicians were amazed that our nurses were not only officers but college educated. They were equally suprised to learn that often times females are in charge of many aspects of our medical health care system. So, I look forward to this collaborative training exercise. Please pray that our efforts are a blessing to our Iraqi friends.

Tonight, I am presenting a medical topic in my main blog area because I feel that the topic is of the highest import. I have always been an advocate of early detection and preventative medicine. Tonight's topic is breast cancer and if there was ever a disease where early detection and preventative measures are essential then this disease is it's poster child.

Let's take a moment and look at the devestating disease that is breast cancer.

Women often are reminded to obtain yearly breast exams from their provider and encouraged to perform monthly self breast exams. The reason for this is because breast cancer is the second leading cause of death from cancer in women just behind lung cancer. This year alone, over 200,000 women in the United States will be diagnosed with breast cancer. The current statistic shows that 1:8 women will be diagnosed with breast cancer at some point in their lifetime.
Whereas breast cancer can develop in completely healthy women, there are risk factors that may increase the likelihood of cancerous growth. The first and most common risk factor is one that cannot be controlled and that is increased age. Increased age doesn’t necessarily mean being elderly when it comes to increasing risk. The age at which a young lady starts menstruating can increase risk. The younger the onset of menses, the more likely breast cancer will develop. Additionally, the older a woman is at the time of her first pregnancy the more likely she is to develop breast cancer. Other factors include the use of exogenous estrogen, increased body weight (Obesity), alcohol consumption and of course, family history.
Detection of breast cancer is sometimes difficult.

Monthly breast exams are encouraged as breast cancer is often times, painless and masses or nodules are not easily palpated. Often times a woman’s sexual partner is the one who detects a cancerous lesion first. When performing self breast exams, a woman should be methodical in her approach. Using the fingers of the right hand a woman should palpate her left breast in a circular pattern being sure to assess for any masses or small nodules then switch hands and do the same to the other breast. Cancer will frequently present as a small BB sized nodule that will be solid and painless. Be sure to palpate the entire breast as well as the axilla or armpit. Enlarged lymph nodes in the axilla can be an indicator of breast cancer so careful inspection of that area is important.

Once palpation is complete, be sure to squeeze the nipple and assess for drainage. If blood is expressed or fluid is returned in a non-lactating woman then notify your provider immediately.

Visual examination of the breast is of noted importance. Be sure to stand in front of a mirror and examine the breast for symmetry. If you notice a change in the size or shape of one breast then notify your doctor. Additionally, be sure to lean forward when visually inspecting the breast. If you notice that indentations or spiculations form when the breast are dangling then you will need to follow up for further testing. In some moderate to advanced cases of breast cancer a tumor will form and then spread in a web like fashion and attach itself to the chest wall. When this happens, the tumor becomes bound down and when a woman leans forward the breast will fall with the exception of the attached tumor which will stay suspended and an indentation or spiculation will form.

Additional methods of breast cancer detection commonly include mammogram screenings and ultrasound evaluations. Mammograms are recommended for all women over the age of 40. If there is a family history of breast cancer, then an initial mammogram should be performed at the age of 35 or as directed by the physician.

Treatment for breast cancer depends on the type and staging of the tumor. Diagnosis of the specific type of tumor can be obtained through a biopsy. A biopsy can be performed through a fine needle or through a lumpectomy. Once a cancer has been identified then the tumor is staged and metastasis is determined. Methods of treatment will be determined through the collaborative efforts of an oncologist, surgeon, and pathologist. A CT scan or MRI maybe necessary to determine the metastatic progression of the cancerous cells.

Possible treatment options are chemotherapy, radiation treatment, and/or surgical removal of the mass or of the entire breast, mastectomy. There has been some recent debate as to weather or not a preventative mastectomy is beneficial in the treatment of breast cancer. Studies have shown that women with a mother or sister who had breast cancer or women who have a genetic predisposition to breast cancer would benefit from having the breast removed prior to even having a diagnosis of cancer. This type of treatment is aggressive but I believe maybe an appropriate course of action. This type of decision should only be made once the patient has been fully educated on the risk and benefits of the procedure.The identification, diagnosis, and treatment of breast cancer can be a difficult process. Often times the emotional stress involved with this disease can be as devastating to the patient as the disease itself. It is important that anyone with the diagnosis of breast cancer be offered and receive appropriate counseling to assist with developing a positive self image post mastectomy and utilizing coping mechanisms to deal with the trauma of the disease.

Breast cancer is a serious and all too common pathology among women. Diligent efforts need to be implemented in order to ensure early detection. Simple self breast exams are essential and painless. Constant vigilance, awareness, and education is the key to combating breast cancer and can save your life.