FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

ANNUAL MAMMOGRAPHY ESSENTIAL CANCER SCREEN AFTER 50

Question: No one in my family has had breast cancer, but I'm still worried about it. I've read conflicting statements about which things increase a woman's risk of breast cancer and about the benefits of mammography. Would you explain these for me?

Answer: Breast cancer is very common. It will strike one out of every nine American women. In 1992 alone there were 100,000 new cases. Women over 55 are twice as likely to get breast cancer as are those between 35 and 55. It is quite uncommon in women under 35. So, it is a disease that is more common after menopause but by no means limited to this age group.

There are several factors that modify a woman's risk of developing breast cancer. I choose the word "modify" carefully because the relationship between the following risks and cancer is not a direct "if-you-have-the-risk-you'll-get-the-cancer" relationship. First, here are factors that increase your chances of having breast cancer: family history of breast cancer in a blood relative. (A sister with breast cancer increases your risk slightly more than if your mother has breast cancer; but, the risk is even higher if both your mother and sister have had this cancer.)

breast biopsy that was benign, but the tissue showed proliferative changes. estrogen replacement therapy after menopause when not accompanied by the use of progesterone.

On the other hand, these things seem to decrease risk:

beginning menstrual periods at a later age and stopping periods at a relatively early age, whether naturally or because of surgical removal of the ovaries.

having children, particularly before the age of 25.

And, finally, here are three things that appear to actually have little effect one way or the other:

oral contraceptives.

estrogen replacement with progesterone.

benign biopsy without proliferative changes.

A diet high in fats had been proposed as increasing one's risk, but more recent research based on a larger and more diverse group of women has disproved this theory. Fats in the diet are not a risk factor for breast cancer.

There are two methods for identifying a breast cancer when it is small (and potentially curable): breast self-examination and mammography. Neither method is so effective that it eliminates the need for the other. I'll briefly review the breast self-exam first.

The "lumps and bumps" of normal breast tissue make it difficult to find a new cancer lump. The signs that help distinguish the feel of normal breast tissue from cancer are as follows:

CANCERNORMAL BREAST TISSUE

lump is hardlump is soft and compressible

lump is rough and irregularlump is smooth and regular

lump can't be moved very muchlump is easily pushed about

no other lump feels like thismany lumps feel about the same

it's new; never felt it beforethese lumps are always here

It's important for every woman to practice breast self-examination once each month. In the reproductive years, it is usually best done after the menstrual period because the normal breast glands are less swollen and a new lump would seem more obvious. For older women, I recommend doing it each month when the phone bill arrives. (They never forget the phone bill.) Mammography is a special type of X-ray of the breast that is good at finding cancer when it is still small. Unfortunately, it isn't very good at finding cancer in reproductive-age women because their breasts are filled with dense-appearing milk glands. The number of glands decrease with increasing age so that by age 50 a yearly mammogram is advisable for all women. The benefit in younger women is a topic of much debate in the medical, insurance, legal and political arenas.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.