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         Breast Cancer

Surgery

Surgery is generally the first step after the diagnosis of breast cancer. The type of surgery is dependent upon the size and type of tumor and the patient's health and preferences.

Lumpectomy involves removal of the cancerous tissue and a surrounding area of normal tissue. This is not considered curative and should almost always be done in association with other therapy such as radiation therapy with or without chemotherapy or hormonal therapy.

At the time of lumpectomy, the axillary lymph nodes (the glands in the armpit) need to be evaluated for the spread of cancer. This can be done by either removing the lymph nodes or by sentinel node biopsy (biopsy of the closest lymph node to the tumor).

If a sentinel node biopsy is done at the time of lumpectomy, it may allow the surgeon to remove only some of the lymph nodes. In this procedure, a dye is injected into the area of the tumor. The path of the substance is then followed as it travels to the lymph nodes. The first node reached is the sentinel node. This node is considered most important to biopsy when evaluating the spread of the tumor.

If the sentinel node biopsy is positive, the surgeon will usually remove of all of the lymph nodes found in the axilla (armpit).

Simple mastectomy removes the entire breast but no other structures. If the cancer is invasive, this surgery alone will not cure it. It is a common treatment for DCIS, a noninvasive type of breast cancer.

Modified radical mastectomy removes the breast and the axillary (underarm) lymph nodes but does not remove the underlying muscle of the chest wall. Although additional chemotherapy or hormonal therapy is almost always offered, surgery alone is considered adequate to control the disease if it has not metastasized.

Radical mastectomy involves removal of the breast and the underlying chest wall muscles, as well as the underarm contents. This surgery is no longer done because current therapies are less disfiguring and have fewer complications.

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Follow-up

People who have been diagnosed with breast cancer need careful follow-up care for life. Initial follow-up care after completion of treatment is usually every three to six months for the first two to three years.

This most often includes careful breast examination, mammography, blood work, and, possibly, a chest x-ray or other studies.
Other tests, such as bone scans or CT scans, are done as needed.

Prevention

The most important risk factors for the development of breast cancer are sex, age, and genetics. Because women can do nothing about these risks, regular screening is recommended in order to allow early detection and thus prevent death from breast cancer.

Regular screening includes breast self-examination, clinical breast examination, and mammography.
Breast self-examination (BSE) is cheap and easy. Routine monthly examination may be helpful. Previously considered critical, more recent studies suggest that self breast exam may be less valuable than previously thought, especially for women who are having routine clinical breast examination and/or mammography.

For women who are menstruating , the best time for examination is immediately after the monthly period.
For women who are not menstruating or whose periods are extremely irregular, picking a certain date each month seems to work best.
Instruction in the technique of breast self-examination can be obtained from your health-care provider or from any one of several organizations interested in breast cancer.

Clinical breast examination: The American Cancer Society recommends a breast examination by a trained health-care provider once every three years starting at age 20 years, and then yearly after age 40 years.

Mammograms are recommended every one to two years starting at age 40 years. For women at high risk for the development of breast cancer, mammogram screening may start earlier, generally 10 years prior to the age at which the youngest close relative developed breast cancer.

Obesity  after menopause  and excessive alcohol intake may increase the risk of breast cancer slightly. Physically active women may have a lower risk. All women are encouraged to maintain normal body weight, especially after menopause and to limit excess alcohol intake. Hormone replacement should be limited in duration if it is medically required.

In women who are genetically at high risk for the development of breast cancer, tamoxifen has been shown to significantly decrease the incidence of the disease. Side effects should be carefully discussed with your health-care provider prior to embarking on therapy. A second drug, raloxifene (Evista), which is now being used for the treatment of osteoporosis , also blocks the effects of estrogen and appears to prevent breast cancer. Initial studies showed that both tamoxifen and raloxifene were able to reduce the risk of invasive breast cancer, but raloxifene did not have this protective effect against noninvasive cancer. Studies are ongoing to further characterize the effectiveness and indications for use of raloxifene as a breast cancer preventive drug.

Occasionally, a woman at very high risk for development of breast cancer will decide to have a preventive or prophylactic mastectomy to avoid developing breast cancer. Additionally, removal of the ovaries has shown to reduce the risk of developing breast cancer in women who have the BRCA1 mutation and who have their ovaries surgically removed before they reach age 40.

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