/BREAST CANCER BASICS
The hard truth is that breast cancer will become a personal reality for one out of every eight American women at some point in her lifetime.
The American Cancer Society reports that during 1997, more than 180,000 women will be diagnosed with breast cancer. Of those afflicted with the disease, at least 44,000 will die. But the harsh reality doesn’t have to be a tragedy. Although there’s no known way to prevent breast cancer, fortunately, there are increasingly effective ways to diagnose the disease when it does occur, and the array of effective treatment options are also increasing. Early diagnosis and prompt treatment are keys to long years of healthy living.

RISK FACTORS
While the incidence is one in eight for any individual woman, this figure is projected over an entire lifetime. A young woman has less than a one in 19,000 chance of developing the disease before her 25th birthday. But odds rise dramatically as women grow older. By her 30th birthday, only one woman in 2,500 is liable to develop breast cancer; by her 50th birthday, the likelihood equals her age-one in 50. If she lives to be 80, her chances rise to one in 10.
Other factors that may increase breast cancer risk include having a first-degree relative {mother, sister, daughter) who has had breast cancer, beginning menstruating at an early age, starting menopause late, giving birth to one’s first child after age 30, and not having any children at all. There’s even evidence that what you eat and drink may put you at risk.
"Medical journals report that a weight gain of 22 pounds after adolescence doubles a woman’s risk, and that three drinks a day increases it by 50 percent. So [avoid] alcohol, caffeine, junk foods, and saturated fats," is the advice of Dr. Rudy Rivera, who practices bariatric (weight management) medicine in Piano. "Take garlic on a regular basis, in some form or fashion. Load up on fresh fruits and vegetables. Increase fiber." Iodine is a nutrient that specifically helps protect against breast cancer, he says.
Together, patient and doctor can establish an individual risk profile for monitoring state of health.

DETECTION
Where breast cancer is concerned, the best protection is early detection. The Susan G. Komen Breast Cancer Foundation recommends three simple steps that can save women’s lives: breast self-examination, clinical breast examination, and mammography.
By age 20, every young woman should be practicing breast self-exam (BSE) at the same time every month. Using her fingers, shell learn what’s normal for her, so that she can recognize any abnormalities and quickly report them to her doctor. Easy instructions on how to do a BSE are available at any hospital, clinic, center, or medical facility.
Also by age 20, every woman should have her first clinical breast examination by a medical professional. This exam should be repeated at least every three years until she is 40, and once a year after that.
Annual screening mammography is becoming a prime weapon in the war against breast cancer. "Every woman should have a baseline mammogram between the ages of 35 and 40 and once a year after that," says Dr. Martha McQuaid, MD/radiologist specializing in women’s imaging and mammography at Columbia Medical Center of Las Col-inas. These initial X-rays provide a starting point for comparing changes that may occur in subsequent years.
The mammogram procedure involves compressing the breasts between X-ray plates in order to get useful pictures and valuable information. This "compression is important to reduce motion on the film,11 explains Janet Starkweather, radiologic technologist. "And it also reduces the amount of radiation needed to [get images of] the breast."
Mammograms can identify many tumors long before they are large enough to be felt in a BSE or clinical exam, and well in advance of any other symptoms indicating the presence of cancer. "But annual physicals and regular self exams remain crucial because 10 to 20 percent of cases may not be detected by mammograms," adds McQuaid. At Presbyterian Hospital of Piano, where Ms. Starkweather is assistant director of radiology, "Women can be referred by physicians or can make appointments on their own," she says. However, every woman must have a physician to whom her mammogram report will go, and any follow-up contact will be with that personal physician.
While a woman will certainly want to tell her doctor about any unusual breast pain, pain is not usually a symptorn of early-stage breast cancer. What she should be looking for during BSEs and be conscious of at all other times are: a lump or thickening in or near the breast or underarm...a change in the size or shape of the breast...a change in the color or feel of the breast skin...a discharge from the nipple. If she finds any of the above, she should see her doctor immediately. Diagnostic tests will be needed to learn whether or not they indicate breast cancer.

DIAGNOSIS
"What I don’t know can’t hurt me" is anything but true where breast cancer is concerned. Yet even today, despite all our knowledge, too many women-paralyzed by fear-continue to deny symptoms.
When a woman finds a lump or other suspicious change in her breast or when something abnormal is detected by mammography, a prompt physician checkup is imperative. By palpating a lump-carefully feeling it and the tissue that surrounds it-a doctor is able to learn much. Ultrasound may be used to determine if a lump is solid or rilled with fluid, and often there will be additional mammogram views to aid in diagnosis.
In most cases, no cancer is found but sometimes more information is needed. A needle biopsy-also called aspiration-will show whether a lump is merely a fluid-filled cyst or a solid mass that may be cancer. In a surgical biopsy, all or part of a suspicious area is removed. Tissues are then sent to labs for microscopic examination by a pathologist.
"It’s exciting right now," says Dr. Phil Evans, medical director of the Susan G. Komen Breast Center housed on the Baylor medical campus. "With some of the new technologies, we’re able to find very small abnormalities through mammography, then remove them completely by needle and determine if they’re cancer." During these biopsies, doctors use computer monitors to observe needle placement and tissue removal.
"Computer-assisted diagnosis is on the horizon now," according to Dr. Evans. Today’s diagnostic process may involve only local anesthesia and a small amount of time. In the past, a woman often gave her doctor advance permission to do whatever seemed necessary while she was under general anesthesia on the operating table. The patient did not know until she awoke after surgery whether or not she actually had cancer.
Along with improved medicine has come the empowerment of women, who can now make informed choices in advance about how their own breast cancer will be handled. The Women’s Center at Trinity Medical Center in Carrollment is a breast-sparing lumpectomy, surgeons will remove only the tumor and enough tissue around it to assure that the area is left cancer-free. Recovery usually includes radiation therapy, five days a week for five or six weeks.
If the entire breast is to be removed-often the best choice for women who have large tumors and/or small breasts-the treatment will be a simple or modified radical mastectomy, with little or no damage done to the chest muscles and other underlying tissue. Breast skin may be retained to facilitate immediate or future reconstruction.
In either surgical case, possible follow-ups include chemotherapy (to destroy any cancer cells that might be left in the body) and/or hormone therapy (to deprive potential cancer cells of the materials they need for growth). Chemotherapy usually involves a combination of drugs, given by injection or by mouth, over a period of several months. Today’s most common hormone therapy is a small, estrogen-blocking tamoxifen tablet, taken twice a day for five years after surgery: it may actually decrease cholesterol and diminish chances of developing osteoporosis while helping prevent breast cancer recurrence.
Treatment decisions are a complex puzzel whose pieces include facts about the woman who has breast cancer and facts about the cancer itself.

RECOVERY AND RECONSTRUCTION
After treatment, when the urgency has subsided, a patient begins mental and physical process of recover;’. Ernie’s Appearance Center at Baylor is a hospital-based boutique that meets self-image needs with breast prostheses, specially designed post-mastectomy clothing, hairpieces, hats and headwraps. At Trinity Medical Center in Carrollton, volunteer beauticians offer their services free in the Women’s Center Look Good, Feel Good Shop. "This is a community service," Center Director Cindy Kastler, RN, emphasizes. "We are out there for the community."
Breast replacement is the post-surgical choice of m any women. Depending on the physical needs and desires of their patients, doctors use implants and/or muscle and tissue from a woman’s own back or abdomen to construct a new breast. (The abdominal method, called a TRAM flap, has a side benefit: The patient gets a "tummy tuck" as well!)
Miriam Mitchell of Dallas had a mastectomy in 1990 at age 34, but didn’t decide to have reconstruction surgery until June of this year-more than seven years after losing her breast. "For a longtime I didn’t want any more surgery," she says. "But walking through department stores, seeing all the frilly, silky lingerie, I began to feel a little sorry for myself. Now I can wear everything!"
In contrast, an increasing number of women today choose to have reconstruction at the same time as their mastectomies. "We’re becoming bigger fans of immediate reconstruction," says Dr. Denton Watumull of Regional Plastic Surgery in Garland. "A mastectomy can be overwhelming, It benefits the patient’s self-esteem when she wakes up with a breast." This option also means one surgery can take the place of two, representing savings of about $10,000 for the patient and/or the insurance companies and health plans now covering costs of breast reconstruction for cancer patients.
According to Dr. Neil Saretsky, who practices plastic surgery in Dallas? "There’s been an escalating shift toward immediate reconstruction in the last four to five years." Not only does the woman need only a single hospitalization, but "she’s giving up something very dear, very personal [with the mastectomy], and she will get something for it."
Dr. Scott Oishi, also of Regional Plastic Surgery, advises all women to learn about all their options in advance of need. "Then, when there’s a blip on a mammogram, at least these terms aren’t foreign to them," he says. Free seminars, videos, brochures, and consultations are offered for women’s education through hospitals, health centers, and physicians’ offices.

LOOKING TOWARD THE FUTURE
Integration of all services is the hallmark of UT Southwestern’s Center for Breast Care, "a model for the 21st century" according to Dr. George Peters, its executive director. He describes it as a patient-oriented, caring place where prevention, diagnosis, treatment, and research meet under one roof.
In the Center’s projected new facility, "Women will go to one place, change into their [examining room] gowns once, and everyone necessary will come to them."
There’s a program called Patient to Patient in which breast cancer survivors are on the scene to support women with abnormal mammograms or who have just been diagnosed. Another program, Between Us, provides a one-on-one match between the newly diagnosed patient and someone who has been in her exact situation.
Saving the lives of women by promoting awareness of breast cancer-the importance of early detection, prompt diagnosis, and appropriate treatment-is a goal that can be achieved together.