Michael Sterchi, PhD, Ret.
The early diagnosis of breast cancer begins with the patient. Self-breast exam is very important. Examining your own breast is not a difficult or scary thing. Feeling your breast in a lying down and upright position should be carried out several times a year, carefully covering all areas of the breast, including the area near the armpit. A doctor should evaluate any lumps found. Other findings, which may be important, include: bright red bleeding from the nipple, irritation of the nipple, dimpling of the nipple, thickening or dimpling of the skin anywhere on the breast surface and a lump (lymph node) in the armpit.
Stage 1 breast cancer is when the cancer is confined to a limited area of the breast. Stage 2 is when the cancer has spread to the lymph nodes in the armpit. Stage 3 is when the cancer is advanced to a larger area of the breast and armpit. Stage 4 is when the cancer has spread to other areas of the body (bones, lung, brain and liver).
Studies have shown that women who practice self-breast exams have an earlier diagnosis of breast cancer, usually Stage 1 and thus a better survival.
Early diagnosis can also be increased by the use of mammography. Numerous centers now exist where x-rays of the breast can be carried out. It is recommended that all women begin yearly mammograms at age 50 and at age 40 whenever a family history of breast cancer exists. However, the recommendations for mammography are in a state of change, therefore the changes should be followed closely.
Whenever a breast lump is found or if other suspicious findings exist (usually seen on mammograms), a biopsy must be carried out to determine the diagnosis. If the lump can be felt a direct needle biopsy can be performed. Needles exist which can draw out small amounts of tissue or a larger core of tissue. In some cases a needle biopsy can be carried out with x-ray or ultra-sound guidance. Needle biopsy is much less traumatic, can be done in the office, only requiring local anesthesia.
If a needle biopsy cannot be done, open biopsy may be necessary. This is most often necessary whenever the lump is small, cannot be felt and seen on x-ray. In this case a needle is placed in the breast under x-ray guidance to localize the lump, allowing the surgeon to precisely remove the suspicious tissue. Open biopsy should only be carried out as a last resort, since surgical incision into the breast may complicate further surgery to treat the diagnosed breast cancer.
If there is a possibility of Stage 4 breast cancer, then a bone scan, chest x-ray and CAT scan may be performed. A discussion on the treatment of breast cancer will follow.
Published Dec. 7, 2011