The Sooner the Better

The bad news is that more than 10 percent of women in the U.S. – one out of every eight or nine – will develop breast cancer at some time during their lives. The good news is that in its early stages, breast cancer is very curable. Even more advanced cancers can be treated with much better results than in the past. Effective treatment involves working with your primary care physician, whether that is your family doctor, internal medicine specialist or gynecologist, and early detection is the key.

Most professionals would recommend that women get their first mammogram at the age of 40 and yearly thereafter. There are some exceptions to this general rule, such as earlier exams when there is a strong family history for the disease. Your physician can help you decide whether more stringent screening is necessary. However, a mammogram is not enough: you should have a thorough breast exam by your doctor also. Lumps sometimes appear in the breast but are not identified on your mammogram; these lumps need to be investigated, or at the very least, followed up with another exam in the short term. In addition, I recommend that all women perform monthly breast self-exams. No one can know your breasts like you do. It’s not uncommon for women to go to their physicians because of lumps that they found while examining themselves – this practice has come under some criticism because these alarms can lead to more breast biopsies that, in retrospect, were not needed. However, the key to that statement is “in retrospect.” Everything is easy once you know the outcome. In my view, since we are dealing with cancer, I’d rather my wife have a biopsy that is proven benign than ignore an early malignant tumor that is potentially curable.

This is where the health care team can be of great service. It includes your primary care physician, the radiologist who does your mammograms and a general surgeon. General surgery is the specialty that handles the surgical treatment of breast cancer and, along with your other physicians, can help recommend the best course to follow regarding possible biopsies or definitive treatments. Undoubtedly, there will be some biopsies that will be benign (not cancerous), but there are times when it is necessary in order to know whether an abnormality in the breast is serious. Usually, this can be done with a needle biopsy under local anesthesia, and an open surgical biopsy may not be needed.

As a general surgeon, I am much happier to see my patients diagnosed early so that we have a better opportunity for treatment. This does not always mean disfiguring surgical procedures such as mastectomy – it could simply necessitate a lumpectomy (removal of the tumor itself and not the entire breast) coupled with radiation. If however, a mastectomy is needed, plastic surgeons have provided excellent results with breast reconstruction. With the combination of surgery, radiation and sometimes chemotherapy, the modern treatment for breast cancer is improving at a rapid pace… with success rates greatly improved by rapid detection.

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