Breast cancer is extremely common, affecting 1 in 8 women.  Most cases are in the elderly.  One of every 100 cases of breast cancer is in men.  A significant percentage of those with breast cancer aren’t aware of the cancer until its too late.  Most patients survive breast cancer but it definitely can kill.

The current guidelines for breast followup are a baseline mammogram age 40, annually ages 45-55, then every 2 years.  Those with dense breasts should have an additional study, either an ultrasound or MRI.  Dense breasts have an increased risk of cancer, this is new information as it was previously believed there wasn’t an increased risk.  15% of breast cancers aren’t visible on a mammogram.  Mammograms can be painful.

Self breast examination is no longer recommended due to the large number of false positives.  If you wish to check yourself you should start at the nipple and move in a circular motion until the entire breast is examined.  If you feel a lump you should see your primary care physician.  Most lumps are benign and may get bigger and smaller based on the menstrual cycle.  If the size goes down its not breast cancer..  If its hard or seems attached to the underlying tissue it needs a biopsy.

Taking post menopausal estrogens lowers the risk of heart attacks and strokes, but increases the risk of breast cancer. However a lack of estrogens causes a lot of health problems.  In general if mother, sister or aunts had breast cancer, you shouldn’t take estrogens. The FDA advises only taking estrogens for a short time.  Each woman will have to decide for herself whether to take estrogens or not.  Estrogen is available in pills, a patch, and a compounded cream.  Sometimes progesterone is added.  Estrogen has minimal effect on sex drive, although a lack of estrogen causes the vagina to tear during painful sexual intercourse  Testosterone controls sex drive in both men and women.

Older women with frequent urinary tract infections can apply estrogen cream to prevent these infections.  The dose is so minimal that topical estrogens can still be used in patients who have breast cancer.

Treatment usually involves an antiestrogen, chemotherapy, radiation, surgery or the newer hormonal treatments.  The antiestrogen will need to be continued for 13 years to be considered a cure, and causes mood swings and irritability.  With chemo its common to lose one’s hair.  The American Cancer Society has a program “Look good, feel better” where they will supply the patient with wigs or other head coverings to cover up the hair loss.  When chemo is done the hair will grow back.  Support groups have been shown to lengthen life for those with breast cancer.