"A Mother's Day Present - Screening for Breast Cancer" by Allen Weiss, MD, CEO & President

Dr. ALlen Weiss, MD, MBA, FACP, FACR

May 1, 2008 - Each May, for Mother's Day, I like to honor the Moms with a health suggestion in caring for themselves This year let's focus on a disease which affects one in eight women: breast cancer.

Each year over 211,000 women learn they have breast cancer. There are some risk factors which can't be changed. However, there are certain behavior modifications which can not only help to decrease risk but can aid in early detection and thereby improve prognosis.

The chance of getting breast cancer increases with age and after menopause. Women who have had breast cancer in one breast, or have a relative less than forty years of age with breast cancer also have a higher risk of getting the disease themselves. Interestingly, certain genes are also associated with a higher risk factor. BRAC1 and BRAC2 are genes that can now be searched for in women at risk.
Today, many women who are having their first child later in life, or have never had children, are at increased risk. The early onset of menstruation increases risk too, as does late menopause. Both expose the breasts to estrogen for a longer period of time. Hormone replacement therapy (HRT) has also been linked to breast cancer, although this entire subject remains very controversial. There is no link between abortion or miscarriage and breast cancer.

All the above risks are either not controllable or have already occurred. Being proactive is always important. Avoidable risk factors include overweight or obesity after menopause, being out of shape and consuming excess alcohol.

In any event, screening to find breast cancer at an early stage has never been more important and less controversial. At age forty, all women should have a mammogram yearly or every other year, according to the National Cancer Institute. If you are younger than forty but have any risk factors annual screening is highly recommended. Any physical abnormality also calls for a mammogram and subsequent biopsy depending on the results.

Physical self-examination can also be helpful but has not been shown to be sufficiently effective against breast cancer when used alone. The combination of a physical examination AND a diagnostic mammogram or other imaging study of the breast, such as an MRI or ultrasound, helps to confirm a diagnosis. The definitive test is a biopsy where tissue is obtained and examined by a pathologist.

There are other conditions which can mimic some of the physical and radiological findings but are benign: cysts, benign tumors or just calcifications. The biopsy usually differentiates among these conditions.

There are a multitude of effective treatments ranging from medications to surgery to radiation therapy. Each stage and person is different, requiring careful consultation with your physician in order to determine the correct therapy.

The good news is that the prognosis is better than ever. There are now more therapies with fewer side effects and better long term outcomes. The most important news is that early detection still works best.

This Mother's Day let's encourage the women in our lives to get screened early for breast cancer so that we can all enjoy this holiday together for years to come. Happy Mother's Day!

Dr. Allen Weiss is CEO & President of the NCH Healthcare System. He is board certified in Internal Medicine, Rheumatology and Geriatrics, and was in private practice in Naples, Florida from 1977 - 2000. Dr. Weiss is active in a variety of professional organizations and boards, and has been published in numerous medical journals, including the American Journal of Medicine and the Journal of Clinical Investigation.