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DIAGNOSIS
Early Detection of Breast Cancer

Statistics show that 1 in 8 women will be diagnosed with breast cancer at some point in their lives. Survival rates improve significantly if cancer is detected early. The American Cancer Society recommends three easy steps that every woman should take to help detect cancer early.

1 ) Get an Annual Mammogram

A mammogram is a very effective tool in our arsenal to detect breast cancer at its earliest stages. The American Cancer Society recommends that all women get a baseline mammogram at age 40, followed by an annual one thereafter. Ask your healthcare professional about the screening recommendations suited for you.

2 ) Get a Clinical Breast Exam

For healthy women and those with no increased risks of breast cancer, an annual clinical breast exam is recommended. This means that you need to have a manual breast exam performed by your physician or other healthcare professional each year. A great time to do this is in conjunction with your annual Pap smear and exam. If you are at a higher risk for developing breast cancer, speak with your physician about establishing more frequent exams if necessary. And remember:  if you detect any changes in your breasts, contact your physician immediately.

3 ) Perform a Monthly Breast Self-Exam (BSE)

Thousands of breast cancer survivors tell the story of how they found a lump in their breast themselves. Get to know your breasts. Perform a monthly self-exam to screen for any bumps, lumps or changes. Learn how to examine your breasts at:
http://ww5.komen.org/BreastCancer/InteractiveTools.html

Notify your physician immediately if you notice any changes in your breasts. Such changes may include:

  • A lump, hard knot or thickening
  • Swelling, warmth, redness or darkening
  • Change in the size or shape of the breast
  • Dimpling or puckering of the skin
  • Itchy, scaly sores or a rash on the nipple or elsewhere.
  • Pulling in of your nipple or other parts of the breast
  • Sudden (nonspontaneous) nipple discharge
  • New, persistent pain in one spot

Abnormal Breast Findings

Finding a lump in your breast or being recalled for additional views on a screening mammogram can be very frightening. A mass in your breast or an abnormality on your mammogram will require further evaluation. Rest assured that the staff understands your fears and will do their best to make the next steps as stress-free as possible.

An ultrasound is often used at this point to learn more about the nature of the mass or abnormality. The ultrasound can determine if a mass is solid or cystic, providing your physician with more information on which to base the next decision. Is a biopsy necessary?

Depending upon the findings or your imaging studies, you may be referred to a radiologist or surgeon for a breast biopsy. Most breast biopsies are performed in an outpatient setting, often in the same center where you did your mammogram.

Breast Biopsy

A breast biopsy is performed based on abnormal findings on breast imaging, such as through a mammogram, ultrasound, MRI, or clinical examination. The goal of a breast biopsy is to get a sample of tissue from the suspicious lesion to determine whether it is benign (no evidence of cancer) or malignant (evidence of cancer cells). The great news is that 80% of breast biopsies are benign.

There are multiple types of biopsies that can be performed and it is helpful to discuss these options with a breast specialist. Comprehensive Breast Care of San Diego has breast specialists who can help you choose which breast biopsy procedure is best for you.

A minimally invasive breast biopsy is the preferred choice when possible. Types of minimally invasive breast biopsies include fine needle aspiration (FNA), core needle biopsy and vacuum assisted needle devices.
  • In some cases where a needle biopsy cannot be performed, a surgical biopsy in the operating room may be necessary.

  • Breast ultrasound imaging has become a very important tool in the diagnosis and treatment of breast cancer. It can be used to further define a mass found through breast self-exam or mammogram and can also help to pinpoint lumps or lesions for needle biopsy.  Breast ultrasound allows the breast specialist to perform minimally invasive biopsies in the office and aids in the operating room as well.

Dr. Julie Barone, Director of Comprehensive Breast Care of San Diego, received extensive ultrasound training during her breast fellowship. She and the other breast surgeons continually consult with radiologists, who image the breasts, and pathologists, who review biopsy tissues, to provide efficient and top quality care.

Benign Breast Disease

As noted earlier, more than 80% of all breast biopsies are not cancerous. While you should immediately report any changes in your breasts to your physician, remember that most times the change will not result in a diagnosis of breast cancer. Some examples of typically benign breast changes include benign breast lesions such as:

Nipple Discharge Spontaneous nipple discharge is abnormal and should be evaluated by your physician. The most common cause of nipple discharge is a benign growth in the ducts called a papilloma. Because most breast disease originates from the cells in the ducts, minimally invasive procedures that can directly assess early changes in these areas are critically important to the early detection and treatment of breast cancer. Ductoscopy is a procedure used to evaluate nipple discharge. A small camera (0.7-0.9 mm) is inserted into the duct to evaluate the duct anatomy and identify abnormalities. During this procedure ductal fluid can be obtained for analysis. If an abnormality is identified, it can be removed through a surgical biopsy.This procedure may identify small abnormalities that are not detected on other imaging modalities and therefore is a useful tool to assist in the early detection of breast cancer. Click here to watch a video clip and learn more. You may read the article on KGTV 10 News San Diego here.


Fibrocystic Tissue Fibrocystic changes in breast tissue are the most common cause of benign breast lumps. They develop from hormonal fluctuations related to a woman’s menstrual cycle. These benign breast lumps are often fluid-filled cysts. They can change in size and often have associated breast swelling and tenderness based on the woman’s hormonal cycle.

Fibroadenoma This is a benign breast lump commonly found in younger women. It feels rubbery when performing a breast self-exam, and will move easily within the breast tissue. One-third of fibroadenomas grow larger, one-third stay the same and one-third become smaller. Very large fibroadenomas are surgically removed, as are those that continue to grow larger. While fibroadenomas can cause concern, they do not develop into cancer and do not increase your risk of developing breast cancer.

Malignant Breast Disease

Unfortunately, 20% of all breast biopsies are cancerous, or malignant. But early detection leads to early diagnosis, which leads to early treatment and return to normal life much more quickly. Treatment options available to you will depend upon a number of factors including the type of tumor, the extent of the disease at the time of diagnosis, your age, medical history, and other factors. Your personal preferences, self-image and lifestyle will also be important considerations when you and your physician decide the course of your treatment. It is important that you also meet with other members of your multidisciplinary breast care team to make sure that your emotional as well as physical needs are being met.

Once you are diagnosed with breast cancer, you may go through a staging process to determine if the tumor has spread to other parts of your body. Your physician may order additional studies such as a chest x-ray, breast MRI, PET scan, bone scan, and a CT scan. An abnormal result in any of these studies does not always mean that the tumor has spread but it may prompt further testing.

Genetic Testing/High Risk Assessment

Familial breast cancer, or breast cancer occurring in multiple members of the same family, accounts for only 5 to 10% of newly diagnosed cases. However if cancer is prevalent in your family, you may be at increased risk for breast cancer.  Genetic testing can be very useful in certain high-risk patients. Genetic testing analyzes genes for mutations responsible for inherited cancers.  Specifically, the BRCA-1 and BRCA-2 gene mutations are linked to hereditary breast and ovarian cancers.  Women who test positive for the BRCA-1 and BRCA-2 genes have an 80 to 90% chance of developing breast cancer. For more information go to www.myriadtests.com . You may also schedule an appointment with our breast surgeons to learn more about genetic counseling, testing and risk factors for breast cancer.

TREATMENT

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