Q. My mother had breast cancer. Does that mean that I'll probably get it too?

A. Only one in fifteen American women develops breast cancer. If your mother, sister, or maternal aunt has had breast cancer, your chance of developing the disease is about twice that of a woman without such a history. You should therefore be more certain to examine your breasts regularly and see your physician periodically for a thorough breast examination. Should you or your physician find any change in your breast, more frequent examination and other diagnostic procedures may be indicated.

Q. I was struck violently on the breast. It became discolored and a lump developed which gradually disappeared. Could such an injury lead to breast cancer?

A. No, there is absolutely no evidence that injury or manipulation as may occur in love-making has any connection with breast cancer. The breast, because of its exposed position, is subject to many bumps and bruises which heal completely, although a lump may persist for a varying time and gradually disappear. All lumps, however, should be checked by your physician promptly.

Q. I have had breast cancer. I have a grown daughter. What precautions should she take, if any?

A. Although her risk of developing a breast cancer may be increased, she should face the situation without fear. After all, the odds remain very much against her developing the disease. After her breasts begin to develop, she should learn to examine her breasts and be checked by her physician regularly. After 35, mammography should be added. She should inform her physician promptly of any change that she may find at any time between examinations.

Q. I have heard that nursing a baby protects one against breast cancer. Is that true?

A. It used to be thought that breastfeeding—especially prolonged breastfeeding—was associated with a lower incidence of breast cancer. The latest data on a worldwide basis refute this concept. Apparently there is no relationship between nursing and breast cancer.

Q. All my life I have had very large breasts. After my menopause, they became larger. Do I run a greater risk of getting a cancer?

A. Size of breast has no relation to breast cancer. The large-breasted woman should be watched more closely with a complete examination, because a small mass may be undetected for a longer time in a very large breast. Mammography is a good diagnostic method for the large breast which usually contains much fat in which small masses are more readily visible.

Q. I have had a watery discharge from my right nipple for the past few months. I have no pain or other discomfort. Is it cause for concern?

A. Slight nipple discharges are not unusual. They are due to duct irritations and have no connection with the development of breast cancer. They may be thin or thick, colorless, white, yellow, or green. Such breasts should, of course, be evaluated by a physician. Discharges are ordinarily no cause for concern unless they are conspicuously bloody or clear yellow. However, physicians will check the breasts for masses, and the fluid for cells.

Q. Three years ago I had a plastic insert put into my breasts because they were very small and caused me anguish. Do such inserts act as irritants? Am I more likely to develop a cancer?

A. No, silicone implants do not lead to cancer. Plastic surgery on the breast also does not have any relation to cancer. Of course, any distortion of the breast in this way may make mammography more difficult, and so more frequent study may be recommended by the physician. Under no circumstance, however, should any woman permit injections of silicone to be given. Such injections are dangerous.

Q. I have been on the birth control pill for five years with no untoward symptoms. Recently I heard that some gynecologists think there may be a relationship between the pill and breast cancer. Is that so?

A. No, there is no definite evidence so far to incriminate the Pill in the development of breast cancer. The truth is that it will take another ten years before we may know definitely whether or not such pills could cause harm. In the meantime, most authorities agree that the possible danger from the Pill is considerably less than the medical risks of pregnancy. Any woman on the Pill should definitely have a complete breast examination at least once a year and be under the care of her gynecologist while taking it.

Q. If I take hormones for the symptoms of menopause will they lead to breast cancer?

A. There is some controversy about the use of female hormones in the menopause. Most authorities agree that these replacement hormones are harmless. Some feel strongly that hormones have a protective effect on the breast—that less breast cancer develops in women taking postmenopausal hormones. Some physicians feel equally strongly that this medication is dangerous and should not be used. Your best approach is to use hormones only when prescribed by your physician.

Q. What part does pregnancy play in breast cancer development? I have heard that women who have never been pregnant have a higher risk of developing breast cancer. Is this so?

A. A woman who has had several children has a smaller chance of developing breast cancer than one who has never borne children. If a woman has a full-term child when she is under 20 years of age, her risk of developing breast cancer drops to one third of the usual risk. Pregnancy as such is not associated with breast cancer.

Since a woman who has had no children or one who has her first child after the age of 30 has a slightly increased risk of breast cancer, such women should definitely have the complete breast examination regularly. Never, however, forget the monthly self-examination!

Q. Is there any relationship between cancer and the shape, size, and consistency of women's breasts?

A. No. Cancer occurs in all types of breasts. It may be more difficult to detect cancer earlier in very large or very firm breasts. Until we find dependable high-risk indicators, all women must be alert to the danger of breast cancer and learn the simple rules of protection.

Q. A year ago, while nursing my third child, I developed a sore breast. It became red, hot, and painful, but gradually subsided with medication. I still have some pain in this breast and it is still firmer than my other breast. Is such a breast more likely to develop a cancer?

A. No. Inflammations, irritations, or infections in the breast do not cause cancer, although residual lumps may be present for a long time and will eventually disappear. However, there is one unusual type of "inflammatory" cancer which is not related to infection. This rare breast cancer grows rapidly and may resemble a generalized infection of the breast. Under any circumstances, definite breast lumps should be checked by a physician promptly.

Q. I've heard it said that it is good for the mother as well as the child to nurse for six months or longer. While I was nursing my last child, my breasts dried up early. Is there any connection between this and the development of breast cancer?

A. No. We used to think that prolonged nursing protected against breast cancer. The latest data, however, indicate that it makes no difference whether a woman nurses at all or for long periods. It also makes no difference whether the breasts dry up naturally or with medication. To nurse or not to nurse is a question to be decided by you and your physician.

Q. Is there any relationship between diet and breast cancer? Are overweight women more likely to develop breast cancer than those who are thin?

A. We cannot prove that a relationship exists between diet and breast cancer. Some epidemiologists are convinced that increased risk of getting breast cancer is associated with a large intake of the kind of fats found in dairy food and beef. Some investigators think that an increase in saturated fats in the diet leads to increased production of female hormones and perhaps an increase in breast-cancer development. The increased numbers of breast cancer in those countries in which a substantial proportion of food intake is in saturated fats—as in northern Europe as compared with the Orient—is often cited as evidence. If a definite connection could be demonstrated, it might lead to another method of cancer control.

Q. I have had cysts drained by my doctor in both breasts. It has been very disturbing to watch these large lumps reappear. Some of my friends have even had operations for this condition. Is there a connection between cysts and breast cancer?

A. Many women have large breast lumps which develop rather quickly. They become extremely worried and then are reassured when the masses are found to have fluid which can be quickly and simply removed with a needle. Many women have cysts which require frequent examination. There is a difference of opinion among the experts as to whether large cysts induce a higher risk for breast-cancer development. An increased risk, if any, must be small or it would be easier to confirm as fact. Fortunately, large breast cysts tend to disappear after the menopause.

Large cysts usually do not constitute what is usually called "fibrocystic disease," a label that more often describes the lumpy texture of most normal breasts. This term refers to a vague, poorly defined entity which is probably not at all related to the development of breast cancer. It is usually used by physicians to describe a normal variation of breast consistency.

Q. Is there any danger in having an annual examination of the breast in screening programs?

A. No. Manipulation of the breast during regular clinical examination has potential benefit and no danger. Thermography uses no X rays and cannot have a deleterious effect. Transillumination or ultrasonic examination of the breast is also completely harmless. Mammography does use X rays, but in expert hands and with modern methods, the dose needed is so minute that specialists agree that repeated examination is innocuous. Not having an examination, and possibly missing an early cancer, is more dangerous.

Q. I am 42 years old and have no breast symptoms. How often should I be examined?

A. Every woman, including teenagers, should learn the details of breast self-examination and practice them regularly every month, preferably right after a period. After the menopause, the first of each month is an excellent time. Ask your physician to teach you how. A complete examination by a physician is advised once a year for all women over 35. Under 35, mammography is not advised unless symptoms are present.

Q. My physician recommends that I report for examination every six months. Does this mean I am more likely to develop breast cancer?

A. Many physicians recommend examinations more frequently than once a year. It certainly does not mean that a cancer is developing. It simply means that for medical reasons there may be a slightly increased risk and that they are taking extra precautions. This kind of special attention by a physician should be appreciated. Women needing more frequent examinations include those who (1) have already had a mastectomy; (2) have had breast operations; (3) have very large breasts; (4) have multiple, apparently benign large masses evident on clinical examination or on mammography; (5) have increased heat in one breast on thermography without any other abnormality; and (6) have a strongly positive family history, such as two or three close relatives with breast cancer.

Q. Is a complete examination painful, tiring, or dangerous?

A. Not at all. These procedures are not painful, are all quickly done, and are completely without risk. Even mammography in expert hands uses so minute a dose of radiation that it can be repeated regularly for many years without risk. No injections or extra manipulation are usually used. The complete examination, including interview, clinical examination, mammography, and thermography can be done in about twenty minutes.

Q. I go to my gynecologist regularly once a year. He examines my breasts at that time. Is that enough of a breast examination?

A. A complete examination includes not only the clinical examination but also mammography and thermography. If your physician does not have the necessary equipment for some of these studies (as is usually the case), he may refer you to an appropiate source. Don't hesitate to ask about further studies. The increased reassurance of a complete examination using modern methods is well worth the extra time. It is most important for you to discuss breast self-examination with your gynecologist and have him go over the details with you.

Q. Does breast cancer ever cure itself without treatment?

A. It is extremely rare for breast cancer to be cured without treatment, if it occurs at all. Some advanced breast cancers are controlled by treatment as though a truce had been proclaimed. Occasionally, a woman may live for many years with breast cancer still present. For this reason no case of breast cancer should be considered hopeless.

Q. My 18-year-old daughter found a small lump in her left breast three months ago. It has not changed since then. Could this become breast cancer? Should it be removed?

A. Such lumps are common and cause concern, although only very rarely is such a mass serious. Each patient must be evaluated individually by the physician. Removal of these lumps is a simple procedure and often is the best answer. Occasionally, these masses, which are solid, not cysts filled with fluid, enlarge during pregnancy.

Q. So many women in my community seem to have or have had breast cancer that my friends and I are beginning to worry that we may be in the middle of a breast cancer epidemic. Is breast cancer increasing?

A. The latest data report a slight increase in incidence of breast cancer in the population, which is offset by our greater success in saving women from the disease. Because our population has increased and women are living longer, we do have more cases of breast cancer, but its proportion to other diseases has changed only slightly. There certainly is no epidemic of breast cancer.

Q. I have read in newspapers and magazines that some physicians tell women who have breast cancer that they have a right to enter into the decision regarding the type or extent of surgery to be performed. Is this correct?

A. Yes; no operation can be done without the patient's consent. Since the most effective treatment for breast cancer is surgical, and since the breast is important in the psychology of women—and men—treatment should be discussed openly. Surgeons and their patients would prefer to have operations less extensive than mastectomy if they were proved to be effective. Unfortunately, there are no data which completely convince the general medical profession of the treatment needed for all individuals. The guiding principle in this situation fraught with emotional upheaval must be to consider the whole woman with cancer, rather than the cancer itself. Certainly, the surgeon about to perform a mastectomy understands the effects of that operation on the patient. It is his responsibility to prevent emotional turmoil as much as possible, as well as to cure the disease. To do this, he should also discuss the problem in detail, with sympathy and understanding, with the husband as well as the patient. The surgeon must determine what is best for the emotional and the physical well-being of the patient. The woman, with her obvious lack of scientific knowledge about the type of treatment best for her particular problem, must rely on the advice of her personal physician and the surgeon. One thing is certain—the earlier the cancer is found, the better the outcome. When earlier breast cancer detection becomes the rule, and not the exception as it is today, perhaps surgery less extensive than mastectomy may become acceptable to more surgeons.

Q. Do men get breast cancer?

A. They do, but only one hundredth as often as women. When it does occur, it is usually after the age of 60. Because it is uncommon, men tend to neglect the findings until the disease is advanced. A man who finds a lump or any enlargement in his breast should observe the rules that apply to women.

Samantha Peia

Samantha Peia is associated with http://www.FiveHeroes.com.

Copyrighted material; do not reprint without permission.

 

View all articles by Samantha Peia