Diagnosis and treatment of breast cancer involve choices

[This is the second installment of a three-part series on breast cancer.]

The most common breast cancer symptom is a lump. Other symptoms include swelling, skin irritation, nipple pain or retraction, and an unusual discharge.

Early diagnosis saves lives.The combination of a mammogram, a clinical breast exam and self-exams is recommended by healthcare experts to reduce breast cancer deaths.

A mammogram is a breast x-ray. If mammography finds an abnormality, confirmation by biopsy is required. In a biopsy, a tissue sample is taken for analysis.

About 2/10 percent of mammograms lead to a cancer diagnosis. About 10 percent of women examined will need another mammogram. Only about 10 percent of those women will need a biopsy. Out of those biopsies, 80 percent will come back negative for cancer.

Women 40 and older should have an annual mammogram and breast exam by a healthcare professional. As long as a woman is in good health and would be a candidate for treatment, she should continue to get mammograms and exams.

Research has shown that self exams help find breast cancer. Self examination teaches women how their breasts feel normally and to notice changes.

Ultrasound and MRI are other diagnostic tools.

Ultrasound uses high-frequency sound waves to outline a part of the body. Breast ultrasound can focus upon something picked up by a mammogram.

Magnetic resonance imaging uses radio waves and strong magnets instead of x-rays. MRIs can be used to examine cancers found by mammogram.

Most women with breast cancer have some type of surgery. Surgeries include lumpectomy to remove only the breast lump and surrounding tissue, mastectomy that removes part or all of the breast, or can be more extensive to include lymph nodes and muscle tissue.

Radiation therapy is another form of treatment. It uses high-energy rays or particles that destroy cancer cells. This treatment may be used to destroy cancer cells that remain in the breast, chest wall, or underarm area after surgery.

Medicines are also used to treat breast cancer. Chemotherapy employs intravenous and oral drugs that can kill cancer cells in most parts of the body. The anti-estrogen drug tamoxifen has been used for many years to treat breast cancer.

Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances made by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow.

If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. The hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making estrogen is called ovarian ablation.

Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer.

Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.