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In women over 65 years of age, breast cancer remains the number one cause of death due to cancer. The majority of breast cancer cases are found in this age group, but it is the younger women who seem to worry more. It may be due to greater awareness, but there seems to be a trend for some women in their thirties to ask for mammograms. Younger women are more likely to be interested in screening despite the fact that almost 60% of breast cancer cases are found in women over 65. This observation suggests that environmental factors such as toxins are inter-related with genetic factors.
"Screening" is a term that causes at least some confusion. For the greater part, most people feel that it is synonymous with mammogram. It is erroneous to think so. In my view, screening starts by assessing the patient as a human being. Attention must be drawn to genetic factors by asking specific questions. I look at people's lifestyles, what they eat, levels of exposure to different agents, exercise, and finally their body-type. The amount of breast tissue present is not a risk factor, but it certainly influences the quality of a physical assessment that can be performed on a suspicious lump. This is why arguments exist about the value of doing self-examinations. I tend to favor the pro camp and attempt to teach patients how to perform self-examinations as well as trying to educate what the different findings suggest. Younger women seem to be better adept at finding "things" in their breasts. Ideally, we would like the over 65 crowd to become more astute at this as well. But what actually happens at times is that they tend to be busy dealing with numerous other health problems and simply put it on the back burner. Screening of the whole person has led to earlier detection and better outcomes. The earlier the better!
After the clinical screen, decisions must be made about other tests that should be performed. Mammography is an X-ray of the breast, which can "see" the whole breast. It is usually employed as a tool to double-check women over 50 in whom everything seems fine. This procedure can be uncomfortable. The good news is that it may soon be replaced by a new digital "squeeze free" test. To assess a known lump, an ultrasound is used, or the area may be sampled directly using a fine needle. Occasionally, an "open biopsy" is used. This is a surgical procedure that looks at and removes the lump and some surrounding tissues.
If cancer is found, it must be staged, which is a way of characterizing it for treatment options. Breast cancer is staged according to the TNM (Tumor, Node, Metastases) system. This system looks at how big the lump is, if there are any associated lumps and the microscopic data, in order to evaluate treatment options. The two most common breast cancers are ductal and lobular. Most lumps and bumps that we assess in family practice turn out not to be cancer. But the one message that sometimes gets missed is that men need to examine their breast tissue too!
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