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HighlightsBreast Cancer Screening GuidelinesExperts continue to review new information on the timing and type of breast imaging studies to best reduce the toll of breast cancer. Lifestyle FactorsAlcohol consumption is a risk factor for breast cancer, especially for women have two or more drinks a day.Disproven Risk FactorsAntiperspirants or use of deodorants after shaving have not been linked with any higher risk for breast cancer. Dietary FactorsDespite much research on the association between diet and breast cancer, there is still little consensus. At this point, recommendations vary, and each woman should discuss options with her doctors to arrive at the plan that best matches her individual needs and preferences. Each year in the United States, about 230,000 women are diagnosed with invasive breast cancer. These are solid benign lumps that occur in women ages 15 - 30.Breast abscesses during breastfeeding. Discharge from the nipple is worrisome to patients, but it is unlikely to be a sign of cancer. This is breast pain that occurs in association with, or independently from, the menstrual cycle.
The best advice is to eat a well-balanced diet and avoid focusing on one "cancer-fighting" food.
The American Cancer Society recommends that women with breast cancer eat only moderate amounts of soy foods and avoid taking dietary supplements that contain high amounts of isoflavones. Premenopausal women at higher risk, usually because of family history, should take as many preventive measures as possible, starting at an early age. Magnetic resonance imaging (MRI) and ultrasound techniques can detect very small tumors (less than half an inch).
DCIS is a non-invasive, early cancer, but if left untreated it may sometimes progress to an invasive, infiltrating ductal breast cancer.
Although breast cancer in men is rare, about 2,000 American men are diagnosed each year with invasive breast cancer.There are many different risk factors for breast cancer. About 8 - 10% of women experience moderate-to-severe breast pain associated with their menstrual cycle. Abortion does not increase risk.Prevention and Lifestyle FactorsExerciseRegular exercise, particularly vigorous exercise, appears to offer protection against breast cancer. However, they are expensive and time-consuming procedures, and ultrasound may yield more false-positive results. DCIS is the most common type of noninvasive breast cancer.Lobular carcinoma in situ (LCIS). Exercise can help reduce body fat, which in turn lowers levels of cancer-promoting hormones such as estrogen. Research is still mixed on the role that fats, and which specific types of fats, play in breast cancer risk and prevention. There have been concerns that high intakes of soy may increase the risk of estrogen-responsive cancers such as breast cancer.
Drugs known as selective estrogen-receptor modulators (SERMs) act like estrogen in some tissues but behave like estrogen blockers (anti-estrogens) in others.
However, they can also raise alarm about cancer when it is not present (so-called false-positive results). Nevertheless, some doctors believe they are important in identifying small tumors missed on mammography in women who are receiving lumpectomy or breast-conserving surgeries. According to the American Cancer Society, about 1 in 8 cases of invasive breast cancer are found in women younger than age 45, while 2 in 3 cases of invasive breast cancer occur in women age 55 and older.Race and EthnicityBreast cancer is slightly more common among white woman than African-American, Asian, Latina, or Native American women.
The American Cancer Society recommends engaging in 45 - 60 minutes of physical activity at least 5 days a week.Exercise can also help women who have been diagnosed with breast cancer and may help reduce the risk of breast cancer recurrence. According to results from the Women’s Health Initiative study of dietary fat and breast cancer, there is no definite evidence that a low-fat diet will help prevent breast cancer.
Two SERMs -- tamoxifen (Nolvadex, generic) and raloxifene (Evista) -- are approved for breast cancer prevention for high-risk women. In addition, mammograms can lead to treatments that do not improve a woman's outcome (so-called overdiagnosis). Data indicate that bevacizumab does not significantly improve patients’ survival time and that its risks outweigh its benefits. This tissue is rich in blood vessels and lymphatic channels that are capable of carrying cancer cells beyond the breast. However, African-American women tend to have more aggressive types of breast cancer tumors and are more likely to die from breast cancer than women of other races. Studies indicate that both aerobic and weight training exercises benefit the body and the mind, and improve quality of life for breast cancer survivors.
However, the study suggested that women who normally eat a very high-fat diet may benefit by reducing their fat intake.Fruits and Vegetables. Tamoxifen and raloxifene are not recommended as prevention for women at low risk for breast cancer or its recurrence. High amounts of fatty tissue increase levels of estrogen in the body, leading to faster growth of estrogen-sensitive cancers.Estrogen is involved in building bone mass. Physical activity contributes to health by reducing the heart rate, decreasing the risk for cardiovascular disease, and reducing the amount of bone loss that is associated with age and osteoporosis. Fruits and vegetables are important sources of antioxidants, which may help protect against the tissue damage linked to increased cancer risk. An important study reported that MRI scans of women who were diagnosed with cancer in one breast detected over 90% of cancers in the other breast that had been previously missed by mammography or clinical breast exam. IntroductionBreast cancers are potentially life-threatening malignancies that develop in one or both breasts.

Social and economic factors make it less likely that African-American women will be screened, so they are more likely to be diagnosed at a later stage. Physical activity also helps the body use calories more efficiently, thereby helping in weight loss and maintenance. Antioxidants include vitamin C, vitamin E, and carotenoids such as beta-carotene and lycopene.
For these women, prophylactic mastectomy of both breasts can reduce the risk of cancer by as much as 97%.
Preventive Services Task Force recommends:For women ages 40 - 49 years, the USPSTF does not recommend routine screening mammography. Currently, few women who are diagnosed with cancer in one breast are offered an MRI of the other breast. It accounts for 70 - 80% of all breast cancer cases.Invasive (also called infiltrating) lobular carcinoma.
Chemicals with estrogen-like effects, called xenoestrogens, have been under suspicion for years. It can increase basal metabolic rate, reduces appetite, and helps in the reduction of body fat.
Richly colored fruits and vegetables -- not supplements -- are the best sources for these nutrients. Prophylactic bilateral salpingo-oophorectomy (removal of both ovaries and fallopian tubes) can halve the risk for breast cancer and also significantly reduce the risk for ovarian cancer. Some doctors advocate MRIs for all women newly diagnosed with breast cancer; others oppose this view. The ducts carry the milk through the breast and converge in a collecting chamber located just below the nipple.Breast cancer is either noninvasive (referred to as in situ, confined to the site of origin) or invasive (spreading).
Having a first-degree relative (mother, sister, or daughter) who has been diagnosed with breast cancer doubles the risk for developing breast cancer.Women who have had ovarian cancer are at increased risk for developing breast cancer. There has been particular concern with pesticides containing organochlorines (DDT and its metabolites, such as dieldrin) and pyrethroids (permethrin), but at this time evidence of any causal association is very weak.Exposure to Diethylstilbestrol. Preventive surgery requires careful and serious consideration, and you should be sure to seek a second opinion from an oncologist before making a final decision.SymptomsBreast cancers in their early stages are usually painless. However, mammograms can help catch tumors while they are in their earliest and most treatable stages.
MRI scans may be most useful for younger women with breast cancer who have dense breast tissue that may obscure tumors from mammography readings.
Women who took diethylstilbestrol (DES) to prevent miscarriage have a slightly increased risk for breast cancer. However, it is not clear whether fruits and vegetables can specifically prevent breast cancer development or recurrence.Calcium and Vitamin D.
The most deadly types of breast cancer tend to occur in women in their 40s.To further complicate matters, not all early-stage breast cancers become life-threatening. MRIs are less likely to be helpful for older women with early tumors in one breast and clear mammography readings in the other.It is very important that women have MRIs at qualified centers that perform many of these procedures each year. There may also be a slightly increased risk for their daughters (commonly called "DES daughters"), who were exposed to the drug when their mothers took it during pregnancy.Radiation Exposure.
Eating lots of foods rich in calcium and vitamin D (such as yogurt and milk) may modestly reduce the risk of breast cancer for premenopausal women. With current science, doctors cannot predict if an untreated early-stage tumor will progress to a lethal stage. MRI is a complicated procedure and requires special equipment and experienced radiologists.
However, certain ethnic groups -- such as Jewish women of Eastern European (Ashkenazi) descent -- have a higher prevalence (2.5%) of BRCA gene mutations.
The issue of whether mammograms may contribute to overdiagnosis and overtreatment is very controversial and is currently a hot topic of debate among breast cancer researchers. MRI facilities should also be able to offer biopsies when suspicious findings are detected.Scintimammography. BRCA gene mutations are also seen in some African-American and Hispanic women.Screening Guidelines for BRCA Genes. Girls who receive high-dose radiation therapy for cancer face an increased risk for breast cancer in adulthood.
In scintimammography, a radioactive chemical is injected into the circulatory system, which is then selectively taken up by the tumor and revealed on mammograms. Low-dose radiation exposure before age 20 may increase the risk for women with BRCA genetic mutations. This method is used for women who have had abnormal mammograms or for women who have dense breast tissue.
Preventive Services Task Force (USPSTF) recommends that women at high risk should be tested for BRCA genes, but does not recommend routine genetic counseling or testing in low-risk women (no family history of BRCA 1 or 2 genetic mutations). Women should avoid unnecessary and excessive exposure to medical radiation, including x-rays and CT scans. In some cases there is a bloody or clear discharge from the nipple.Many breast cancers, however, produce no symptoms and cannot be felt on examination.
Risk assessment is based on a woman’s family history of breast and ovarian cancer (on both the maternal and paternal sides).In general, a woman is considered at high risk for BRCA genes if she has a first-degree relative (mother, daughter, or sister) or several second-degree relatives (grandmother, aunt) diagnosed with breast or ovarian cancer.
With an increase in the use of mammogram screening programs during the last several decades, more breast cancers are being discovered before there are any symptoms.DiagnosisBreast Examination by a Health Professional.
This biopsy is a surgical procedure for removing the suspicious tissue and typically requires general anesthesia.

Women who do not have a family history of breast cancer have a low probability of inheriting BRCA genes and do not need to be tested.The relevance of the inherited BRCA1 or BRCA2 mutations to survival is controversial. Women ages 20 - 49 should have a physical examination by a health professional every 1 - 2 years. Women are encouraged to perform self-examinations each month, but some studies have reported no difference in mortality rates between women who do self-examination and those who do not. This does not mean women should stop attempting self-examinations, but they should not replace the annual examination done by a health professional. Patients with BRCA1 mutations tend to develop tumors that are hormone receptor negative, which can behave more aggressively.Other Genetic Mutations.
Breast awareness may be as helpful as formal self exams as long as women who notice a breast abnormality obtain a professional evaluation promptly.Monthly Self-Examination1. Other genes associated with increased hereditary breast cancer risk include p53, CHEK2, ATM, and PTEN. Pick a time of the month that is easy to remember and perform self-examination at that time each month.
Researchers are continuing to make progress in discovering genetic variants of breast cancer. The breast has normal patterns of thickness and lumpiness that change within a monthly period, and a consistently scheduled examination will help differentiate between what is normal from abnormal. A recent study identified a subtype that appears to share similarities with ovarian cancer and may benefit from similar treatments. Many doctors now recommend breast awareness rather than formal monthly self-examinations.2. Early age at menarche (first menstrual period) or later age at menopause may slightly increase a woman’s risk for breast cancer.Pregnancy.
Women who have never had children or who had their first child after age 30 may have a slightly increased breast cancer risk. Having children at an early age, and having multiple pregnancies, reduces breast cancer risk.
Scientific evidence shows there is no association between abortion and increased breast cancer risk.Studies have been mixed on whether breastfeeding decreases breast cancer risk. With hands on the hips, push the pelvis forward and pull the shoulders back and observe the breasts for irregularities.
Breastfeeding reduces a woman's total number of menstrual cycles, and thereby estrogen exposure, which may account for its possible protective effects. Some studies suggest that the longer a woman breast-feeds, the lower her risk, and that breastfeeding may be most protective for women with a family history of breast cancer.Birth Control Pills.
Although studies have been conflicting about whether estrogen in oral contraceptives increase the chances for breast cancer, the most recent research indicates that current or former oral contraceptive use does not significantly increase breast cancer risk. Women who have used oral contraceptives may have slightly more risk for breast cancer than women who have never used them, but this risk declines once a woman stops using birth control pills.Hormone Replacement Therapy. Hormone replacement therapy (HRT) uses either estrogen alone (known as estrogen therapy [ET]) or estrogen in combination with progestogen (known as EPT or combination hormone therapy): Estrogen-progestogen therapy (EPT) is used by women who have a uterus, because estrogen alone can increase the risk of uterine cancer. EPT significantly increases the risk for developing and dying from breast cancer, especially when used for more than 5 years.Estrogen-only therapy (ET) is prescribed for women who have had a hysterectomy and do not have a uterus.
Press lightly first to feel the breast area, then press harder using a circular motion.Using this motion, start from the collarbone and move downward to underneath the breast. Shift the fingers slightly over, slightly overlapping the previously checked region, and work upward back to the collarbone.
However, prolonged used of ET can increase the risk for other health problems including blood clots, heart attack, stroke, and possibly ovarian cancer.Hormone therapy (EPT or ET) should not be used by women at high risk for breast cancer. Be sure to cover the entire area from the collarbone to the bottom of the breast area and from the middle of the chest to the armpits. In general, most doctors recommend that women use HRT only for short-term (1 -2 years) relief of menopausal symptoms.  Current guidelines advise initiating hormone therapy around the time of menopause only when women are in their 40s or 50s.
Starting HRT past age 59 may increase the risk for breast cancer and other health problems. Women who take HRT should be aware that they need regular mammogram screenings, because HRT increases breast cancer density, making mammograms more difficult to read.
Of special concern are specific or unusual lumps that appear to be different from the normal varying thicknesses in the breast. Despite some concerns that infertility treatments using the drug clomiphene may increase the risk for breast cancer, most studies do not show an association.
Monthly breast self-exams should always include: visual inspection (with and without a mirror) to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses. Some studies indicate that ovulation induction with clomiphene may actually decrease breast cancer risk.
Studies suggest that women with highly dense tissue have 2 - 6 times the risk of women with the least dense tissue. These mostly occur in women in their middle-to-late reproductive years and can be eliminated simply by aspirating fluid from them.

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