Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

28 Nisan 5766 - April 26, 2006 | Mordecai Plaut, director Published Weekly










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Home and Family

Your Medical Questions Answered!
by Joseph B. Leibman, MD

I am an emergency physician, not a primary care physician, but there are topics that are crucial to speak about. We have spoken before about the cancer that kills the most women, and we are dedicating this column to an article that appeared in the New England Journal of Medicine on 31 July 2005. The subject is for women only so if you are a male reader of my column, you may skip this column this week.

The subject of our discussion is what to do if you discover a breast lump. The problem here is that the soft tissue of this organ is by nature hard to check, and there are also lumps that are part of normal anatomy. Furthermore there is a predilection to grow lumps in this organ that is so sensitive to hormonal changes. Cysts tend to get more common as women age. Who gets lumps? This can be genetic, or due to taking hormones. Oral contraceptives are a form of hormones, and as many women take these to regulate their periods, they may have more lumps.

Women should regularly check for signs of lumps. Even though all unusual findings should be checked out by a specialist (in Israel that is a surgeon) here is a guide to help.

Pain does not generally imply cancer. This may be completely normal as a prelude to menses, or may be due to other causes that are benign. Two exceptions — lumps that are painful after trauma or accompanied by fever, need to be checked out. It could be an abscess. Multiple lumps or diffuse "lumpiness" is usually fibrocystic disease, and is benign. Nipple discharges are not dangerous, but if they are bloody or if there are skin changes — it needs to be checked out.

So let's look at some of the danger signs. Firm, discrete lumps that appear fixed need to be checked out well. Skin changes — like crusting about the nipple or skin that looks like an orange peel — need to checked out. Ulcers of the skin are particularly cause for concern.

Who is at risk?

Family history is important. Many women carry the BRAC-1 gene that puts daughters at higher risk for breast and ovary cancer and their sons for testicular cancer. Women who are overweight, or started menses late or had their first pregnancy at a later age are at higher risk. (Pregnancy is protective against this disease).

What do you do to know all is alright?

Self-exam is first. Then if something is found, ultrasound and mammography, though the latter is often left out if the patient is less than 35. If there is a suspicious lesion the next step is FNA, or usually a fine needle to take a biopsy. Beware that this is not a disease for denial — if picked up early, the disease can be cured. Mastectomy is rare today. Most often the lump and some tissue is removed, and that is it. By the way, women who are slim also need to check themselves out.

Men can also get this disease. It is obviously easier to be noticed but more dangerous as men usually ignore it. One other note — often boys around puberty develop breast lumps, called gynecomastia. This is just hormones getting reorganized and will pass. Men with alcoholism can have this problem as well.

In summary, I can not stress enough the importance of being vigilant on this disease and spreading the word. There is a lot of hope for survivors of this disease, but you must be on guard. I have a relative who died of it and one who survived, Boruch Hashem. Write me in care of the Yated.

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