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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