In this year of developing a cancer-screening program by Rural Health, Inc., the third cancer to be addressed is breast cancer.  Columns have previously been written discussing colon cancer and cervical cancer.  Whereas those two cancers can be prevented by appropriate early surveillance, unfortunately there is no step that we know of that will prevent breast cancer.

     Risk factors for development of breast cancer include heredity for certain specific genetic traits although these identified traits account for less than 7% of all breast cancers.  More than 93% occur randomly through the population.  The two identified genetic markers for breast  cancer are called  BRCA1 and  BRCA2. To make matters worse, individuals with these genetic  markers have an increased risk of ovarian cancer also. These genetic markers are inherited in an  autosomal dominate manner;  thus a mother or a father will pass this genetic trait to one half of  their offspring. Little appreciated is the impact this genetic trait has on men. A man with  BRCA1 or BRCA2 has a fourfold  increase in his  risk for  prostate  cancer and a  one-hundred  fold  increase  in  the  risk  for  breast  cancer. Only 6 men in 10,000 develop breast cancer in the  general public but 600 men in 10,000 men with the BRCA genes develop breast cancer.

     The question of whether to have genetic testing done is awesomely complex  and  decisions  in  this  arena  must  be  made  on  an  individual  basis.  One must decide in advance  what will be done if a person is found to have a BRCA trait- carrier. Unfortunately, the likelihood o developing the problem increases with age.  Breast cancer in women younger than 30 years of age is very rare accounting for less than 1½ % of all cases.  At age 50, a woman’s risk of developing breast cancer is one chance in 50.  If she lives to age 85, her chances become one chance in eight.  Thus, the incidence goes up with age.

 For this reason, surveillance to detect breast cancer at an early time is a prolonged vigil.  Unlike the incidence of carcinoma of the cervix which decreases with age, the incidence of cancer of the breast increases with age.  Mammography has been the great advance that has allowed the detection of breast cancer prior to it being detectable by feeling a lump on physical examination.  Long before a tumor can be felt  or detected by any other means, mammography can identify areas that appear to be malignant so these can be biopsied and removed before they spread.

     Current recommendations include all women having a mammogram done at age 40 or younger if there is a strong family history of breast cancer.  If there is no family history of breast cancer, then having mammograms every three years until age 50 is recommended.  At age 50 and after, annual mammography is recommended with no age to recommend stopping this.  The lifesaving impact of this practice is a doubling of survival for women who have a breast tumor. If a tumor is found by physical examination without the use of mammography, there is only a 40% five-year survival. If the tumor is found by mammography prior to it being found on physical examination, there is an 80% five year survival.

     The appropriate treatment once a problem is discovered is till evolving. All suspected tumors need to be biopsied. Once the biopsy is done, modern technique indicates that a “sentinal node” is then dissected out and checked to see if  the tumor has advanced away from the primary site. Depending upon that result, then further surgical and/or chemotherapy is recommended.

     Technology on how to diagnose and treat breast cancer is evolving very rapidly. Something called a positron emission tomograph is now being used to characterize suspicious lumps in a lady’s breast.  This is not advanced to the point of being available for routine use but it may prevent the need for biopsies or other steps in the future.

    All of the steps that a lady needs to protect herself against cancer are available through the local clinics. Mammography can be scheduled and carried out either through local mobile units or through the radiology department at St. Mary’s Hospital in Pierre.  If a problem is detected, the surgical intervention necessary can be carried out through St. Mary’s Hospital in Pierre.  If the biopsy proves to be a malignancy, then the appropriate intervention can be supervised through oncologists who come to Pierre on a regular basis.  In certain situations, referral on to more specialized centers for radiation therapy and/or specialized chemotherapy might be recommended or can be arranged at any patient’s request, if they would like to be referred on.  The only choice that is clearly wrong is to do nothing.  Women are urged to obtain annual mammography, to perform a monthly breast self-examination and to have an annual  physical  exam by a health care provider done on an annual basis.