Risk Factors For Heart Disease In Women

December 9, 2009 by  
Filed under Education

Risk factors are habits or traits that make a person more likely to develop a disease. Many of those for heart disease can be controlled. These include:

  • Cigarette smoking
  • High blood pressure
  • High blood cholesterol
  • Overweight
  • Physical inactivity
  • Diabetes

The more risk factors you have, the greater your risk. So take action–take control!
Coronary Heart Disease

Coronary Heart Disease is a woman’s concern. Every woman’s concern. One in ten American women 45 to 64 years of age has some form of heart disease, and this increases to one in five women over 65. Heart disease is the number one killer of American women. In addition, 1.6 million women have had a stroke, and 90,000 women die of stroke each year. This fact sheet tells you what kinds of habits and health conditions increase the chances of developing these diseases- and how you can help keep your heart healthy.
What Are These Diseases?

Both heart disease and stroke are known as cardiovascular diseases, which are disorders of the heart and blood vessel system. Coronary heart disease- the main subject of this fact sheet- is a disease of the blood vessels of the heart that causes heart attacks. A heart attack happens when an artery becomes blocked, preventing oxygen and nutrients from getting to the heart. A stroke occurs when not enough blood gets to the brain, or in some cases, from bleeding in the brain. Some other cardiovascular diseases are , angina (chest pain), and rheumatic heart disease.
Who Gets Cardiovascular Diseases?

Some women have more “risk factors” for cardiovascular diseases than others. Risk factors are habits or traits that make a person more likely to develop a disease. Some risk factors for heart-related problems cannot be changed, but many others can be.

The three biggest risk factors for cardiovascular disease that you can do something about are cigarette smoking, high blood pressure, and high blood cholesterol. Other risk factors, such as overweight and diabetes, also are conditions you have some control over. Even just one risk factor will raise your chances of having heart-related problems. But the more risk factors you have, the more likely you are to develop cardiovascular diseases- and the more concerned you should be about protecting your heart health.

Major Risk Factors
Smoking

Smoking by women in this country causes almost as many deaths from heart disease as from lung cancer. If you smoke, you are two to six times more likely to suffer a heart attack than a nonsmoking woman, and the risk increases with the number of cigarettes you smoke each day. Smoking also boosts the risk of stroke.

are not the only health risks connected to smoking. Women who smoke are much more likely to develop lung cancer than nonsmoking women. Cigarette smoking is also linked with cancers of the mouth, larynx, esophagus, urinary tract, kidney, pancreas, and cervix. Smokers also are more likely to develop other kinds of lung problems, including bronchitis and emphysema.

Smoking during pregnancy is also linked to a number of problems. They include bleeding, miscarriage, premature delivery, lower birth weight, stillbirth, and sudden infant death syndrome, or “crib death.” Also, young children who breathe in cigarette smoke have more lung and ear infections.

There is simply no safe way to smoke. Although low-tar and low-nicotine cigarettes may reduce the lung cancer risk somewhat, they do not lessen the risks of heart diseases or other smoking related diseases. The only safe and healthful course is not to smoke at all.
High Blood Pressure

High blood pressure, also known as hypertension, is another major risk factor for coronary heart disease and the most important risk factor for stroke. Even slightly high levels can increase your risk. High blood pressure also boosts the chances of developing kidney disease.

Older women have a higher risk of high blood pressure, with more than half of all women over age 55 suffering from this condition. High blood pressure is more common and more severe in black women than it is in white women. Using birth control pills can contribute to high blood pressure in some women.

Blood pressure is the amount of force exerted by the blood against the walls of the arteries. Everyone has to have some blood pressure, so that blood can get to the body s organs and muscles. Usually, blood pressure is expressed as two numbers, such as 120/80 mm Hg. Blood pressure varies through the day and in response to your activities. It is considered high when it stays above normal levels over a period of time.

High blood pressure is called the “silent killer” because most people who have it do not feel sick. That means it is important to have it checked each time you see your doctor or other health professional. But because blood pressure changes often, your health professional should check it on several different days before deciding if your blood pressure is too high. If your blood pressure stays at 140/90 mm Hg or above, you have high blood pressure.

Although high blood pressure can rarely be cured, it can be controlled with proper treatment. If your blood pressure is not too high, you may be able to control it entirely through weight loss if you are overweight, regular physical activity, and cutting down on alcohol, table salt and sodium. (Sodium is an ingredient in salt that is found in many packaged and processed foods, baking soda, and some antacids.)

But if your blood pressure remains high, your doctor will probably prescribe medicine in addition to the lifestyle changes described above. The amount you take may be gradually reduced, especially if you are successful with the changes you make in your lifestyle.

During pregnancy, some women develop high blood pressure for the first time. Other women who already have high blood pressure may find that it gets worse during pregnancy. Without treatment, such high blood pressure can be life-threatening to both mother and baby. Since you can feel perfectly normal and still have high blood pressure, it is important to get regular prenatal checkups so your doctor can find and treat a possible high blood pressure problem.

Blood pressure tends to get higher as you age. That means even if your blood pressure is normal now, it makes sense to take steps to prevent high blood pressure in the years to come. You will be less likely to develop high blood pressure if you are physically active, maintain a healthy weight, limit your alcohol intake, and cut down on table salt and sodium.
High Blood Cholesterol

High blood cholesterol is another very important risk factor for coronary heart disease that you can do something about. Today, about one-quarter of American women have blood cholesterol levels high enough to pose a serious risk for coronary heart disease.

Blood cholesterol levels among women tend to rise sharply beginning at about age 40, and continue to increase until about age 60. The higher your blood cholesterol level, the higher your heart disease risk.

The body needs cholesterol to function normally. It makes enough to fill its needs. But cholesterol also is taken into the body through the diet. Over a period of years, extra cholesterol and fat circulating in the blood settle on the inner walls of the arteries that supply blood to the heart. These deposits make the arteries narrower and narrower. As a result, less blood gets to the heart and the risk of coronary heart disease increases.


Getting Your Cholesterol Checked

Getting your blood cholesterol level checked is a relatively simple process. Your doctor or other health professional will take a small sample of your blood and measure the amount of cholesterol. When you have this test for the first time, it is important to have the following measurements taken:

Total Blood Cholesterol
For all adults, a desirable level of total blood cholesterol is less than 200 mg/dL. A level of 240 or more means you have high blood cholesterol. But even “borderline-high” levels (200-239) boost your risk of coronary heart disease.

High Density Lipoprotein
You also will need a measurement of your level of high density lipoprotein, or HDL, if an accurate result is available. Lipoproteins are the packages that carry cholesterol through the bloodstream. HDL is often called “good cholesterol” because it helps remove cholesterol from the blood, preventing it from piling up in the arteries.

If your HDL level is less than 35, your risk of heart disease goes up. This is true even if your total cholesterol level is within a desirable range. The good news is that if your HDL level is 60 or above, you have a lower risk of developing heart disease.

Low Density Lipoprotein
Your doctor also may want to measure your level of low density lipoprotein, or LDL. LDL is often called “bad cholesterol” because it carries most of the cholesterol in the blood, and if the LDL level is too high, cholesterol and fat can build up in the arteries. An LDL level below 130 is desirable, while levels of 130-159 are “borderline-high.” An LDL level of 160 or above means you have a high risk of developing coronary heart disease.
If your LDL level is not checked during your first test, your doctor still may want to measure it if your initial tests show that you have any of the following:

  • high total blood cholesterol
  • borderline-high cholesterol and at least two other risk factors for heart disease
  • desirable or borderline total blood cholesterol but low HDL levels.

Treatment
After studying your total cholesterol, HDL and LDL levels, and other risk factors for heart disease, your doctor may recommend a treatment plan for you. Lowering LDL cholesterol is the main goal of treatment. Cutting back on foods rich in fat, especially saturated fat, and in cholesterol, can lower both total and LDL cholesterol.
Weight loss for overweight persons and increased physical activity may also lower blood cholesterol levels.

Losing extra weight and becoming more physically active, as well as quitting smoking, also may help boost HDL cholesterol levels.

Your doctor may also suggest that you take cholesterol-lowering medications. This recommendation will depend on how high your LDL cholesterol level remains after you have made the diet and lifestyle changes described above. The need for medicine will also depend on whether you have any other risk factors for coronary heart disease.

Other Important Risk Factors
Physical Inactivity

Various studies show that physical inactivity is a risk factor for heart disease. Heart disease is almost twice as likely to develop in inactive people as in those more active.

So by getting regular physical activity even mild to moderate exercise you ll lower your risk of heart disease. The best exercises to strengthen your heart and lungs are aerobic ones, such as brisk walking, jogging, cycling, and swimming. Do them for 30 minutes, three or four times a week.

But even low-intensity activities, such as gardening and housework, can help lower your risk of heart disease if done daily.


Overweight

Excess body weight in women is linked with coronary heart disease, stroke, congestive heart failure, and death from heart-related causes. The more overweight you are, the higher your risk for heart disease.

Overweight contributes not only to cardiovascular diseases, but also to other risk factors, including high blood pressure, high blood cholesterol, and the most common type of diabetes. Fortunately, these conditions often can be controlled with weight loss and regular physical activity.

What is a healthy weight for you? There is no exact answer. Check the “What Should You Weigh?” table for the weight range suggested for women of your height. Ranges are given because women of the same height and amounts of body fat can differ in their amounts of muscle and bone. Weights above the suggested ranges are believed to be unhealthy for most people.

Body shape as well as weight may affect heart health. “Apple-shaped” individuals with extra fat at the waistline may have a higher risk than pear-shaped people with heavy hips and thighs. If your waist is nearly as large, or larger, than the size of your hips, you may have a higher risk for coronary heart disease.


Diabetes

Diabetes, or high blood sugar, is a serious disorder that raises the risk of coronary heart disease. The risk of death from heart disease is about three times higher in women with diabetes. Diabetic women also are more apt to have high blood pressure and high blood cholesterol.

Diabetes is often called a “woman’s disease” because after age 45, about twice as many women as men develop diabetes. While there is no cure for this disorder, there are steps a person can take to control it. Being overweight and growing older are linked with the development of the most common type of diabetes in certain people. Losing excess weight and boosting physical activity may help postpone or prevent the disease. For lasting weight loss, get regular exercise and eat foods that are low in calories and fat.


Stress

In recent years, you may have heard a lot about the connection between stress and heart disease. In particular, you may have heard that “type A” behavior being aggressive, competitive, and constantly concerned about time is linked to the development of heart disease. But while some studies have shown this connection in men, there is no evidence that type A behavior in women is linked with coronary heart disease.

Employment outside the home is another factor that often has been connected to women s heart disease. But so far, studies show no difference in rates of coronary heart disease between homemakers and employed women. However, more research is needed before we can rule out stress as a risk factor for women.


Birth Control Pills

Women who use high-dose birth control pills (oral contraceptives) are more likely to have a heart attack or a stroke because blood clots are more likely to form in the blood vessels. These risks are lessened once the birth control pill is stopped.

The risks of using low-dose birth control pills are not fully known. Therefore, if you are now taking any kind of birth control pill or are considering using one, keep these guidelines in mind:

  • If you smoke cigarettes, stop smoking or choose a different form of birth control. Smoking boosts the risks of serious cardiovascular problems from birth control pill use, especially the risk of blood clots. For women over 35, the risk is particularly high.
  • Use of birth control pills may increase blood pressure, and the risks appear to increase with age and length of use. If you take oral contraceptives, you should get your blood pressure checked regularly. If hypertension develops, you should stop using the pill.
  • If you are a diabetic or have a close relative who is and you take birth control pills, you should be especially careful to have regular blood sugar tests. Blood sugar sometimes changes dramatically in women who take birth control pills.
  • If you have a heart defect, if you have suffered a stroke, or if you have any other kind of cardiovascular disease, oral contraceptives may not be a safe choice. Be sure your doctor knows about your condition before prescribing birth control pills for you.

Alcohol

Several recent studies have reported that moderate drinkers those who have one or two drinks per day are less likely to develop heart disease than people who don’t drink any alcohol. If you are a nondrinker, this is not a recommendation to start using alcohol. And certainly, if you are pregnant or have another health condition that could make alcohol use harmful, you should not drink. But if you re already a moderate drinker, you may be less likely to have a heart attack.

But remember, moderation is the key. More than two drinks per day can raise blood pressure, and the “Dietary Guidelines for Americans” recommend that for overall health women should have no more than one drink a day. Further, binge drinking can lead to stroke. People who drink heavily on a regular basis have higher rates of heart disease than either moderate drinkers or nondrinkers.

Keep in mind, too, that alcohol provides little in the way of nutrients mostly just extra calories. So, if you are trying to control your weight, you may want to cut down on alcohol and substitute calorie-free iced tea, soda, or seltzer.


Hormones and Menopause

Should menopausal women use hormone pills? There is no simple answer to this question. Menopause is caused by a decrease in estrogen and other hormones produced by a woman s ovaries. At this time, some women begin to take prescription hormone pills every day. Some women take pills that contain only estrogen. Others take estrogen combined with a second hormone called progestin.

Estrogen has several important benefits. Taking estrogen pills may relieve “hot flashes” and generally help you feel more comfortable as your body adjusts to lower estrogen levels. They also help to prevent osteoporosis, a thinning of the bones that makes them more likely to break in later life. Estrogen pills also may help protect women from developing coronary heart disease, but more research is needed before we will know this for sure.

Estrogen pills also have risks. They may increase the chances of developing gallbladder disease, and they may worsen migraine headaches. They also may increase the risk of .

But by far, the biggest risk of taking estrogen pills is cancer of the uterus. Women on estrogen pills after menopause are up to six times more likely to develop uterine cancer than women not on this treatment. It is important to point out that women are much more likely to die of coronary heart disease than from uterine cancer. Still, the cancer risk exists and must be taken seriously and discussed with your doctor.

To reduce the risk of uterine cancer, some doctors now prescribe estrogen in combination with the hormone progestin. But we don t yet know how this newer “combo” treatment affects the risks of heart disease, osteoporosis, and breast cancer.

At present, a woman and her doctor must decide whether the benefits of hormone pills are worth the risks. If you are thinking about starting this treatment, you will need to consider your overall health and your personal and family history of heart disease, osteoporosis, and uterine and breast cancer.

If you are now taking hormone pills, check with your doctor to be sure you are taking the lowest possible effective dose. At least every 6 months, you and your doctor should discuss whether you need to continue treatment. Be alert for signs of trouble abnormal bleeding, breast lumps, shortness of breath, dizziness, severe headaches, pain in your calves or chest and report them immediately. See your doctor at least once a year for a physical examination.


Aspirin

You may have heard that taking aspirin regularly can help prevent heart attacks. Is this a good idea for you? Maybe.

A recent study found that women who took a low dose of aspirin regularly were less likely to suffer a first heart attack than women who took no aspirin. But since this was the first study to show this benefit in women, more research is needed before we can be sure that aspirin is safe and effective in preventing heart attacks in women.

What we do know for sure is that aspirin is a powerful drug with many side effects. It can increase your chances of developing ulcers and having a stroke from a hemorrhage. Because of these serious risks, you should not take aspirin to prevent a heart attack without first discussing it with your doctor.

Preventing Heart Disease

You now know something about the kinds of habits, health conditions, and other factors that affect your chances of developing heart disease. Just as important, you know that by taking an active role in your own heart health, you can make a difference.

Tags: cholesterol, pain in your calves or chest, rheumatic heart disease, Cardiology, Aging-associated diseases

Breastfeeding at Work

December 8, 2009 by  
Filed under Education

Here are some simple tips to help you manage your work efficiently while making sure your baby is taken care of.

Supplies

Buy or rent a good breast pump. There are many on the market, so choose the one that best suits your needs. Some things to consider are:

  • portability
  • ease of cleaning
  • a pump with intermittent pressure (as it is not as likely to injure your breast)

When testing a pump, practice with both hands so you know it???s easy to use. Have plenty of nursing pads and breast shields, as they help make you feel more confident. Bring disposable wipes and paper toweling for easier clean-up and tape or labels to mark the milk containers. If you don???t have a refrigerator, bring a small cooler with a plastic refreezable ice pack.

When to Breast Feed or Pump

Use your time at work as efficiently as you can and try to structure your schedule so you don???t have to rush.

  • Breast feed before you leave home.
  • Express you milk on a morning break if possible.
  • Reserve lunch for yourself, unless the morning expression was incomplete.
  • Express on an afternoon break.
  • Feed your baby right when you get home, and as often as he or she needs to at night (in fact, if you encourage night feedings, the baby will need less milk the next day).
  • If you miss a feeding, just provide formula for your caregiver.
  • See if you can go home to breast-feed during the day, or have your caregiver bring the baby to you.

What to Wear

  • Make your wardrobe work for you.
  • Wear shirts or blouses which button in the front, pull up easily, or have concealed zippers.
  • Wear a nursing bra to work – it???s easier to undo one side rather than take the whole thing off.
  • Avoid solid colors and whites – bright patterned blouses or dark colors mask leaking and hide breast pads.
  • Wear washables. They are easier to clean if your breasts do leak.
  • Keep a spare shirt or blouse at work for backup in case of an accident.

Remember to be open and talk with your co-workers about your breast-feeding. Try to gain their support and interest.

Tags: breastfeeding, breast cancer, Breastfeeding at work, Infant feeding, button

What is a Mammogram?

December 8, 2009 by  
Filed under Education

A mammogram is a safe, low-dose x-ray picture of the breast.

Mammograms are taken during a mammography exam. There are two kinds of mammography exams screening and diagnostic.

A screening mammogram is a quick, easy way to detect early, when treatment is more effective and survival is high. Usually two x-ray pictures are taken of each breast. A physician trained to read x-ray pictures-a radiologist-examines them later.

It is generally agreed that screening mammography decreases deaths from breast cancer in women 50 and over. There is a range of opinion about the value of screening mammography for women under 50.

Have a screening mammogram as often as your doctor or other health care provider suggests. A screening mammogram often can show breast changes like lumps long before they can be felt.

A diagnostic mammogram is used if there may be a problem. It is also used if it is hard to get a good picture because of special circumstances (for instance, in women with breast implants). Diagnostic mammography takes a little longer than screening mammography because more x-ray pictures usually are taken. A radiologist may check the x-ray pictures while you wait.

Tags: Screening, breast cancer, Breast, Radiology, Oncology, Medical imaging, Breast implant, Mammography

BRCA- The Breast Cancer Susceptibility Genes

December 8, 2009 by  
Filed under Education

What are Genes?

Genes, which are in each of our body cells, help guide the growth and development of our bodies. We are all born with two copies of each gene – one we inherit from our mother and the other one from our father. When functioning normally, certain genes actually help to prevent .

What are the “ susceptibility genes”?

In rare cases, a family carries genes that have been altered or changed and do not work as well. This may lead to a much higher chance, or susceptibility, for getting breast or ovarian cancer. These genes are called the breast cancer susceptibility genes (BRCA).Men in some of these families may have a chance of getting breast cancer too. You can inherit these changed genes from either your mother???s or father???s side of the family. So far, only two breast cancer susceptibility genes, BRCA1and BRCA2, have been found. As research continues, new BRCA genes may be found in the future. While these changed genes result in an increased chance of getting breast or ovarian cancer, they do not cause cancer. Not everyone who inherits changed BRCA genes will develop breast or ovarian cancer.

If I have a family history of breast or ovarian cancer, does it mean that I may have changed BRCA genes?

Not necessarily. Most breast or ovarian cancer that occurs within families is not due to having inherited changed BRCA genes, but is instead caused by other factors. In fact, less than 10% of breast cancer is thought to be due by these changed BRCA genes.

How do I know if I might carry changed BRCA genes?

Answer “yes” or “no” to the questions below. You may have a higher chance of carrying changed BRCA genes if you answer “yes” to one or more of the following:

  • You have a close relative with a positive test for changed BRCA genes.
  • You have had both breast and ovarian cancer.
  • You have breast or ovarian cancer, and
  • You have one or more close relatives with breast cancer (especially before age 50) and/or ovarian cancer.
  • You have a strong family history of breast cancer (especially before age 50) and/or ovarian cancer in many relatives across two or more generations.
  • You had breast cancer before you were 30.
  • You are of Ashkenazi (Central or Eastern European) Jewish heritage and
  • You have had either breast cancer before you were 40, or ovarian cancer.
  • You have had breast cancer that appeared in both breasts or in many places in the same breast.

After answering “yes” to one of the preceding questions, I know I have a higher chance of carrying changed BRCA genes. What should I do?

First, talk with your provider about your concerns. After confirming your risk by looking at your family history and your personal health history, your provider may refer you toa genetic counselor. Genetic counseling is the first step in determining if changed BRCA genes are in your family, and the chance that you may have inherited these genes. During counseling, the genetic counselor will review your medical records, your health history, and your family history of cancer.

Is there a test to find out if I have changed BRCA genes?

If it seems like there may be an inherited susceptibility to cancer in your family, a blood test for the BRCA genes may be available. However, the test is not for everyone, but rather it is sometimes useful for individuals thought to be at high risk. The genetic counselor will go over the pros and cons of testing with you. With this information, you can decide, with your genetic counselor, whether this test is right for you.

If I don???t have a higher chance of carrying changed BRCA genes (I did not answer “yes” to any of the questions), should I go to genetic counseling and consider testing?

Not at this time. The only genetic test available is for women who are at very high risk. If your family history of breast cancer doesn???t fall into the high-risk pattern but continues to bother you, talk with your practitioner.

What can I do to take care of myself?

Since all women are at risk for breast cancer, screening to find breast cancer early when it is most treatable and curable is a very important step you can take for yourself.

There are 3 important screening steps you can take to find breast cancer in the early stages:

  1. Monthly breast self-exam
  2. Breast exams (done by your practitioner) in the medical office
  3. Regular mammograms. Mammography is strongly recommended for all women who are between the ages of 50-74. If you are age 40-49, talk with your health care practitioner about the age to begin having regular mammograms.

A healthy, low fat diet, regular exercise, drinking alcohol in moderation, and not smoking are other very important ways of taking care of yourself that may reduce your chances of getting breast cancer.

Testing for Breast Cancer Susceptibility Genes

The decision about taking this blood test is a very personal one and can have complex and sometimes unexpected emotional effects. An important part of genetic counseling is to help you explore what testing might mean for you and your family. Here are some simple answers to common questions and concerns. The genetic counselor will discuss the pros and cons in more detail. Results of the test will remain confidential.

What are some of the benefits of BRCA testing?

Some people who get a negative test result are relieved. Some who test positive use the results to help plan their medical care or to make personal decisions about their lives. Although we are not certain, it is likely that starting to have mammograms and breast exams at a younger age and having them more often is generally recommended and may help find breast cancer early.

Although these are drastic measures, some women who test positive for BRCA decide to have surgery to remove their breasts or ovaries to prevent cancer. At this time, we do not know how effective these surgeries will be to prevent breast or ovarian cancer.

What are some of the drawbacks to BRCA testing?

Having a negative test may give some women a false sense of security, so they may not come in for regular mammograms and breast exams like they should. Testing positive can create stress in a woman???s life, especially if she has no clear plan of action to take.

What does it mean if the BRCA test is positive?

A positive BRCA test means that the person???s chance of getting breast cancer in her lifetime may be as high as 85%, but this means that there is still at least a 15% chance that she won???t get it. It also means that their risk of getting ovarian cancer goes up but is not as high as for breast cancer. We do not know yet why some people with changed genes get cancer, and others do not.

If I decide to have BRCA testing, how will I be told my test result?

Because it is a very complex test, it may take several months to get your test result back. Once the result is available, your genetic counselor will meet with you to talk about the results and to help you decide what to do next.

Tags: genetic counselor, Mammography, Breast cancer screening, Oncology, Genetic testing, Surgery, ovarian cancer, cancer, breast cancer, surgeries

What is Breast Cancer

December 8, 2009 by  
Filed under Education

Breast , a common cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the breast. Each breast has 15 – 20 sections called lobes, which have many smaller sections called lobules. The lobes and lobules are connected by thin tubes called ducts. The most common type of is ductal cancer. It is found in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma. Lobular carcinoma is more often found in both breasts than other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer. In this disease, the breast is warm, red, and swollen.

The genes in your cells carry the hereditary information that you got from your parents. Sometimes, a test can be done to look for a gene that may be associated with a certain hereditary trait. Recently, a gene was found to be defective in 5% of breast cancer patients. Hereditary breast cancer makes up approximately 5%-10% of all breast cancer cases. Relatives of breast cancer patients who carry this defective gene may be more likely to develop breast or ovarian cancer. Tests are being developed to determine who has the genetic defect long before any cancer appears.

You should see your doctor if you notice changes in your breast. Women older than 50 years of age should also have a special x-ray called a mammogram, which may find tumors that are too small to feel. Check with your doctor on how often you should have this x-ray.

If you have a lump in your breast, your doctor may need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy. Sometimes the biopsy is done by inserting a needle into the breast and drawing out some of the tissue. If the biopsy shows that there is cancer, it is important that certain tests (called estrogen and progesterone receptor tests) be done on the cancer cells.

Estrogen and progesterone receptor tests may tell whether hormones affect the way the cancer grows. They may also give information about the chances of the tumor coming back (recurring). The results help your doctor decide whether to use hormone therapy to stop the cancer from growing. Tissue from the tumor needs to be taken to the laboratory for estrogen and progesterone tests at the time of biopsy because it may be hard to get enough cancer cells later, although newer techniques can be used on tissue that is not fresh.

About 15%-20% of breast cancers are sometimes called carcinoma in situ (found only in the duct area). They may be either ductal carcinoma in situ (sometimes called intraductal carcinoma) or lobular carcinoma in situ. Sometimes lobular carcinoma in situ is found when a biopsy is done for another lump or when an abnormality is found on the mammogram. Even though it is referred to as a cancer, it is not actually cancer. However, patients with this condition have a 25% chance of developing breast cancer in either breast in the next 25 years.

Your chance of recovery (prognosis) and choice of treatment depend on the stage of your cancer (whether it is just in the breast or has spread to other places in the body), the type of breast cancer, certain characteristics of the cancer cells, and whether the cancer is found in your other breast. Your age, weight, menopausal status (whether or not you still have menstrual periods), and general health can also affect your prognosis and choice of treatment.

Stages Of Breast Cancer

Once breast cancer has been found, more tests will be done to find out if the cancer has spread from the breast to other parts of the body. This is called staging. To plan treatment, your doctor needs to know the stage of your disease. The following stages are used for breast cancer.

Breast Cancer In SituAbout 15%-20% of breast cancers are very early cancers. They are sometimes called carcinoma in situ (found only in the duct area). There are two types of breast cancer in situ. One type is ductal carcinoma in situ (also known as intraductal carcinoma); the other type is lobular carcinoma in situ. Lobular carcinoma in situ is not cancer, but for the purpose of classifying the disease, it is called breast cancer in situ, carcinoma in situ, or stage 0 breast cancer. Sometimes lobular carcinoma in situ is found when a biopsy is done for another lump or abnormality found on the mammogram. Patients with this condition have a 25% chance of developing breast cancer in either breast in the next 25 years.

Stage IThe cancer is no larger than 2 centimeters (about 1 inch) and has not spread outside the breast.

Stage IIAny of the following may be true:

The cancer is no larger than 2 centimeters but has spread to the lymph nodes under the arm (the axillary lymph nodes).

The cancer is between 2 and 5 centimeters (from 1 to 2 inches). The cancer may or may not have spread to the lymph nodes under the arm.

The cancer is larger than 5 centimeters (larger than 2 inches) but has not spread to the lymph nodes under the arm.

Stage III

Stage III is divided into stages IIIA and IIIB.

Stage IIIA is defined by either of the following:

The cancer is smaller than 5 centimeters and has spread to the lymph nodes under the arm, and the lymph nodes are attached to each other or to other structures.

The cancer is larger than 5 centimeters and has spread to the lymph nodes under the arm.

Stage IIIB is defined by either of the following:

The cancer has spread to tissues near the breast (skin or chest wall, including the ribs and the muscles in the chest).

The cancer has spread to lymph nodes inside the chest wall along the breast bone.

Stage IVThe cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain. Or, tumor has spread locally to the skin and lymph nodes inside the neck, near the collarbone.

Inflammatory breast cancerInflammatory breast cancer is a special class of breast cancer that is rare. The breast looks as if it is inflamed because of its red appearance and warmth. The skin may show signs of ridges and wheals or it may have a pitted appearance. Inflammatory breast cancer tends to spread quickly.

RecurrentRecurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the breast, in the soft tissues of the chest (the chest wall), or in another part of the body.

How Breast Cancer Is Treated

There are treatments for all patients with breast cancer. Four types of treatment are used:

  • surgery (taking out the cancer in an operation)
  • Radiation therapy (using high-dose x-rays to kill cancer cells)
  • Chemotherapy (using drugs to kill cancer cells)
  • Hormone therapy (using hormones to stop the cells from growing).
  • Biological therapy (using your body’s immune system to fight cancer) and
  • Bone Marrow transplantation are being tested in clinical trials.

Most patients with breast cancer have surgery to remove the cancer from the breast. Usually, some of the lymph nodes under the arm are also taken out and looked at under a microscope to see if there are any cancer cells. Different types of surgery are used:

Surgery To Conserve The Breast:Lumpectomy (sometimes called excisional biopsy or wide excision) is the removal of the lump in the breast and some of the tissue around it. It is usually followed by radiation therapy to the part of the breast that remains. Most doctors also take out some of the lymph nodes under the arm.

Partial or segmental mastectomy is the removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor. Usually some of the lymph nodes under the arm are taken out. In most cases, radiation therapy follows.

Other Types Of Surgery:

Total or simple mastectomy is the removal of the whole breast. Sometimes lymph nodes under the arm are also taken out.

Modified radical mastectomy is the removal of the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles. This is the most common operation for breast cancer.

Radical mastectomy (also called the Halsted radical mastectomy) is the removal of the breast, chest muscles, and all of the lymph nodes under the arm. For many years, this was the operation most used, but it is used now only when the tumor has spread to the chest muscles.

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the breast area.

If tests show that the breast cancer cells have estrogen receptors and progesterone receptors, you may be given hormone therapy. Hormone therapy is used to change the way hormones in the body help cancers grow. This may be done by using drugs that change the way hormones work or by surgery to take out organs that make hormones, such as the ovaries. Hormone therapy with tamoxifen is given for 5 years in patients with early stages of breast cancer (no lymph nodes involved). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase your chance of getting cancer of the uterus. You should go to your doctor for a pelvic examination every year, and you should report any vaginal bleeding other than your menstrual period to your doctor as soon as possible.

If your doctor removes all the cancer that can be seen at the time of the operation, you may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Therapy given after an operation when there are no cancer cells that can be seen is called adjuvant therapy.

Biological therapy tries to get your body to fight cancer. It uses materials made by your body or made in a laboratory to boost, direct, or restore your body’s natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. This treatment is currently only being given in clinical trials.

Bone marrow transplantation is a newer type of treatment that is being studied in clinical trials. Sometimes breast cancer becomes resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy your bone marrow, marrow is taken from your bones before treatment. The marrow is then frozen and you are given high-dose chemotherapy with or without radiation therapy to treat the cancer. The marrow you had taken out is then thawed and given to you through a needle inserted into a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow you are given is taken from another person, the transplant is called an allogeneic transplant.

Peripheral blood stem cell transplant is another type of autologous transplant. Your blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop) and then returns your blood to you. This procedure is called leukapheresis and usually takes 3 or 4 hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted to you. This procedure may be done alone or with an autologous bone marrow transplant.

A greater chance for recovery occurs if your doctor chooses a hospital that does more than five bone marrow transplantations per year.

Treatment By Stage

Treatment for breast cancer depends on the type and stage of your disease, your age and menopausal status, and your overall health.

You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are going on in most parts of the country for all stages of breast cancer. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Treatment For Breast Cancer In Situ

Your treatment depends on whether you have ductal carcinoma in situ or lobular carcinoma in situ. Since it is difficult to distinguish between these two types, it may be helpful to have a second opinion by having your biopsy preparations (slides) studied by pathologists at another hospital.

If you have ductal carcinoma in situ, your treatment may be one of the following:

1. Surgery to remove the whole breast (total mastectomy).
2. Surgery to remove only the cancer (lumpectomy) followed by radiation therapy.
3. Clinical trial of surgery to remove only the cancer (lumpectomy) followed by radiation therapy with or without hormone therapy.

Rarely, some of the lymph nodes under the arm may also be removed during the above surgeries.

If you are going to have a mastectomy, you may want to think about having breast reconstruction (making a new breast mound). It may be done at the time of the mastectomy or at some future time. The breast may be made with your own (non-breast) tissue or by using implants. Different types of implants can be used. The Food and Drug Administration (FDA) has announced that breast implants filled with silicone gel may only be used in clinical trials. Saline-filled breast implants, which contain saltwater rather than silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to obtain additional information, then discuss any questions you have with your doctor.

If you have lobular carcinoma in situ (LCIS), you have a marker for a higher risk of an invasive cancer in both breasts: about a 25% chance over 25 years. LCIS is not breast cancer, and many women with LCIS never develop breast cancer. The treatment options for LCIS are varied and quite controversial. Your treatment may be one of the following:

1. Biopsy to diagnose the LCIS followed by regular examinations and yearly mammograms to find any changes as early as possible.
2. A large clinical trial is testing hormone therapy with the drug tamoxifen to see whether it can prevent cancer from occurring. You can call the Cancer Information Service for more information (1-800-4-CANCER).
3. Surgery to remove both breasts, called total mastectomy.

Treatment For Stage I Breast Cancer

Your treatment may be one of the following:

1. Surgery to remove only the cancer and some surrounding breast tissue (lumpectomy) or to remove part of the breast (partial or segmental mastectomy); both are followed by radiation therapy. Some of the lymph nodes under the arm are also removed. This treatment provides identical long-term cure rates as those from mastectomy. Your doctor’s recommendation on which procedure to have is based on tumor size and location and its appearance on mammogram.

2. Surgery to remove the whole breast (total mastectomy) or the whole breast and the lining over the chest muscles (modified radical mastectomy). Some of the lymph nodes under the arm are also taken out.

Adjuvant therapy (given in addition to the treatments listed above):

1. Chemotherapy.
2. Hormone therapy. If you receive a drug called tamoxifen, you will probably take it for 5 years.
3. Clinical trials of adjuvant chemotherapy in certain patients.
4. Clinical trials of no adjuvant therapy for patients with a good chance of recovery (prognosis).
5. Clinical trials of treatment to keep your ovaries from working.

If you are going to have a mastectomy, you may want to think about having breast reconstruction (making a new breast mound). It may be done at the time of the mastectomy or at some future time. The breast may be made with your own (non-breast) tissue or by using implants. Different types of implants can be used. The Food and Drug Administration (FDA) has announced that breast implants filled with silicone gel may only be used in clinical trials. Saline-filled breast implants, which contain saltwater rather than silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to obtain additional information, then discuss any questions you have with your doctor.

Treatment For Stage II Breast Cancer

Your treatment may be one of the following:

1. Surgery to remove only the cancer and some surrounding breast tissue (lumpectomy) or to remove part of the breast (partial or segmental mastectomy). Some of the lymph nodes under the arm are also removed. Radiation therapy is given following surgery. This treatment provides identical long-term cure rates as those from mastectomy. Your doctor’s recommendation on which procedure to have is based on tumor size and location and its appearance on mammogram.

2. Surgery to remove the whole breast (total mastectomy) or the whole breast and the lining over the chest muscles (modified radical mastectomy). Some of the lymph nodes under the arm are also taken out.

Adjuvant therapy (following surgery):

1. Chemotherapy with or without hormonal therapy.
2. Hormone therapy. If you receive a drug called tamoxifen and your lymph nodes are not involved, you will probably take it for 5 years
3. Clinical trial of chemotherapy before surgery (neoadjuvant therapy).
4. Clinical trials of high-dose chemotherapy with bone marrow transplantation for patients with cancer in more than three lymph nodes.

If you are going to have a mastectomy, you may want to think about having breast reconstruction (making a new breast mound). It may be done at the time of the mastectomy or at some future time. The breast may be made with your own (non-breast) tissue or by using implants. Different types of implants can be used. The Food and Drug Administration (FDA) has announced that breast implants filled with silicone gel may only be used in clinical trials. Saline-filled breast implants, which contain saltwater rather than silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to obtain additional information, then discuss any questions you have with your doctor.

Treatment For Stage III Breast Cancer

Stage III breast cancer is further divided into stage IIIA (can be operated on) and IIIB (biopsy is usually the only surgery performed).

Stage IIIA cancer:

1. Your treatment may be one of the following surgeries: Surgery to remove the whole breast and the lining over the chest muscles (modified radical mastectomy) or the whole breast and the chest muscles (radical mastectomy). Some of the lymph nodes under the arm are also taken out.
2. Radiation therapy given after surgery.
3. Chemotherapy with or without hormone therapy given with surgery and radiation therapy.
4. Clinical trials are testing new chemotherapy with or without hormonal drugs; they are also testing chemotherapy before surgery (neoadjuvant therapy).
5. Clinical trials of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.

Stage IIIB Cancer:

Your treatment will probably be biopsy followed by radiation therapy to the breast and the lymph nodes. In some cases, a mastectomy may be done following radiation therapy.

1. Chemotherapy to shrink the tumor, followed by surgery and/or radiation therapy.
2. Hormonal therapy followed by additional therapy.
3. Clinical trials are testing new chemotherapy drugs and biological therapy, new drug combinations, and new ways of giving chemotherapy.
4. Clinical trials of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.

Treatment For Stage IV Breast Cancer

You will probably have a biopsy and then be given one or more of the following:

1. Radiation therapy or, in some cases, a mastectomy to reduce your symptoms.
2. Hormonal therapy with or without surgery to remove your ovaries.
3. Chemotherapy.
4. Clinical trials are testing new chemotherapy and hormonal drugs and new combinations of drugs and biological therapy.
5. Clinical trials of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.

Treatment For Inflammatory Breast Cancer

Your treatment will probably be a combination of chemotherapy, hormonal therapy, and radiation therapy, which may be combined with surgery to remove the breast. The treatment is usually similar to that for stage IIIB or IV breast cancer.

Treatment For Recurrent Breast Cancer

Breast cancer that comes back (recurs) can often be treated, but usually cannot be cured when it recurs in another part of the body. Some patients with recurrence in the breast can be cured, however. Your choice of treatment depends on hormone receptor levels, the kind of treatment you had before, the length of time from first treatment to when the cancer came back, where the cancer recurred, whether you still have menstrual periods, and other factors.

Your treatment may be one of the following:

1. Hormonal therapy with or without surgery to remove your ovaries.
2. For the small group of patients whose cancer has come back only in one place, surgery and/or radiation therapy.
3. Radiation therapy to help relieve pain due to the spread of the cancer to the bones and other places.
4. Chemotherapy.
5. A clinical trial of new chemotherapy drugs, new hormonal drugs, biological therapy, or bone marrow transplantation.

To Learn More

You can also write to the National Cancer Institute at this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Tags: Radiation, cancers, leukapheresis, breast cancer, Lung cancer

Facts About Breast Cancer

December 8, 2009 by  
Filed under Education

Getting the facts about and mammograms is an important step in taking care of your health. This page will help you get the information that you need. It provides information on a woman’s risk for breast cancer, the National Cancer Institute’s recommenda-tions about mammograms, and the benefits and limitations of the procedure.

After skin cancer, breast cancer is the most frequently diagnosed cancer in women in the United States. It is second only to lung cancer in cancer-related deaths. Approximately 180,000 new cases of breast cancer are estimated for 1997, and about 44,000 women are expected to die from the disease.

Who Is at Risk for Breast Cancer? Simply being a woman and getting older puts you at some risk for breast cancer. Your risk for breast cancer continues to increase over your lifetime. Several known factors can further increase your risk for breast cancer. Most women who get breast cancer have no known risk factors such as a family history of the disease. Talk to your doctor about the known risk factors for breast cancer.

What factors can increase your risk for breast cancer? One or more of the following conditions place a woman at higher than average risk for breast cancer:

  • Personal history of a prior breast cancer
  • Evidence of a specific genetic change that increases susceptibility to breast cancer (BRCA1/BRCA2 mutations)
  • Mother, sister, daughter, or two or more close relatives, such as cousins, with a history of breast cancer (especially if diagnosed at a young age)
  • A diagnosis of a breast condition (i.e., atypical hyperplasia) that may predispose a woman to breast cancer, or a history of two or more breast biopsies for benign breast disease

Additional factors can play a role in a woman’s risk for breast cancer.

  • Women age 45 or older who have at least 75 percent dense tissue on a mammogram are at some increased risk.
  • A slight increase in risk for breast cancer is associated with having a first birth at age 30 or older.

In addition, women who receive chest irradiation for conditions such as Hodgkin’s disease at age 30 or younger, remain at higher risk for breast cancer throughout their lives.

Not having any of the above risk factors does NOT mean that you are “safe.” The majority of women who develop breast cancer do not have a family history of the disease, nor do they fall into any other special high-risk category.

What Can You Do?

  • If you are in your 40s or older, get a mammogram on a regular basis, every 1 to 2 years.
  • Talk with your doctor or nurse about planning your personal schedule for screening mammograms and breast exams.
  • Gather as much information as you can about your family history of cancer, breast cancer, and screening mammograms.
  • Call the National Cancer Institute’s Cancer Information Service for more information about breast cancer and mammograms at 1-800-4-CANCER (1-800-422-6237). People with TTY equipment, dial 1-800-332-8615.
  • For the latest information on cancer, visit the National Cancer Institute’s website for patients and the public at rex.nci.nih.gov or CancerNet at cancernet.nci.nih.gov.

What Are the Benefits of Getting Mammograms?

  • A mammogram can find breast cancer before a lump can be felt.
  • A mammogram is the best method available today to detect breast cancer early. Early detection of the disease may allow more treatment options.

What Are the Limitations* of Getting Mammograms?

  • Mammograms may miss cancer that is present.
  • Mammograms may find something that turns out NOT to be cancer.

*These limitations occur more often in women under age 50.

Tags: Risk factors of breast cancer, Breast cancer; calcium and vitamin D, Breast, cancer, breast cancer, Hodgkin's disease, Lung cancer, Mammography

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