Diagnosing breast cancer

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Diagnosis starts with a triple assessment. 

The physician will take a history and examine the patient. The radiologist will do a mammogram and/or an ultrasound. The cells of the lump may be sampled, using a fine needle or by taking a core of tissue.

If all of the above suggest the lump is not malignant, the lump may be watched and followed up. If one of the tests casts any doubt, the lump should be removed.

Clinical assessment: there are two parts: the patient’s history and the examination. The general medical history from the patient includes the history of the illness, family history and past medical history of the patient. In a clinical exam, the examiner gently palpates (feels) your breasts, noting shape, texture, changes in skin and nipples and location of any lumps, and whether these are attached to skin or deeper tissues. Lymph nodes under the arm and above the collarbone are palpated for swelling.

Mammography: low-intensity X-ray of the breast. This may be done for screening (if no abnormalities were found in an examination) or for diagnosis. A mammogram takes about 20 minutes and can detect many changes or abnormalities before they grow large enough to be felt. Diagnostic mammography may indicate whether a breast lump is malignant or not. If the mammogram was done for screening and shows an area of abnormal tissue that is probably benign, you need to return in four to six months for a re-check. If it shows no serious abnormality, regular screening programmes should be adhered to. These include mammographic screening and clinical screening. When the mammogram shows abnormalities, the radiologist may recommend another type of exam, such as a biopsy. If the mammogram was done as a diagnostic test, the results must be seen in the light of the clinical findings and the biopsy. 

Prevention 
For now, breast cancer cannot be prevented, but it can be diagnosed much earlier than before. Early diagnosis is possible with routine mammography and early biopsy of suspicious lesions. The earlier cancer is found, the better the chances of a cure. American specialists advise that women should have a baseline mammogram at the age of 40. Between 40 and 50 years of age, mammograms are recommended every other year. After age 50, annual mammograms are recommended. Between 20 and 39, women should have a clinical breast examination every three years, and annually from 39 on.

Live healthy:

A low-fat diet (less than 20 percent fat), with plenty of fruit and vegetables, and ideal weight maintenance.
• When cancer is found and treated early, there are more treatment choices and a better chance of recovery. Talk to your doctor about symptoms to watch for, and an appropriate check-up schedule.
• Between clinical check-ups, do a monthly breast self-exam (BSE). Every woman's breasts are different, and they change with age, menstrual cycle, pregnancy, menopause, oral contraceptives or other hormones. It may be normal for your breasts to feel lumpy, swollen or tender at times. With a monthly BSE, after age 20, you learn what is normal for your breasts, and are more likely to detect changes.
• Breastfeeding may slightly decrease risk, especially if continued for 18 to 24 months. Moderate physical activity as an adult can lower your risk.
• In certain high-risk groups – women with a strong family history of breast cancer (mother, sister, maternal aunt) – genetic testing looking for mutated genes associatied with an increased risk of breast and ovarian cancers (BRCA 1 & 2) is available. This can be useful as an indication of the potential of developing breast cancer. In certain exceptional cases, bilateral prophylactic mastectomy is used to try and reduce the risk of the patient developing a breast cancer later in life.



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