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Breast Cancer (cont.)

Breast Cancer 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, may be done as needed based on patient symptoms.

Breast Cancer Prevention

The most important risk factors for the development of breast cancer are gender, 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 involved in breast cancer awareness and treatment.

Clinical breast examination: The American Cancer Society historically recommended a breast examination by a trained health-care provider once every three years starting at 20 years of age and then yearly after age 40 years. More recent recommendations have called this recommendation into question. The issue should be discussed with a patient's healthcare provider as there is some controversy. Unquestionably the discovery of a breast cancer at as early a stage as possible is still associated with the best outlook or prognosis for long term survival.

Controversy has also arisen regarding when to begin mammograms for breast cancer screening. Screening truly refers to studies done in people with average risk and no symptoms in order to look for hidden cancers. The American Cancer Society is only recommending mammograms every two years in women under 50, then yearly between 50 and 64, then every 1 to 2 years until life expectancy is less than 10 years. Most presently prefer to recommend the prior recommendations of an annual mammogram beginning at 40 and continuing until life expectancy can be estimated to be getting quite limited. A breast cancer overlooked late in life can be a morbid, if not lethal problem.

For women at high risk for the development of breast cancer, mammogram testing 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, to limit excess alcohol intake, and to get regular exercise. 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, estrogen-blocking drugs (Tamoxifen) have shown to decrease the incident of breast cancer. 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 or BRCA2 mutations and who have their ovaries surgically removed before they reach age 40.

Medically Reviewed by a Doctor on 12/18/2015

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