Do I need a Bone Mineral Density Exam?
Q: What is the importance of early detection of Breast Cancer?
A: Breast cancer now strikes one in eight women during their lifetime. In the United States this year alone, breast cancer will affect 225,000 women causing 45,000 deaths, 225 of which are here in New Mexico.
Many factors affect survival including size, histology grade, and lymph node involvement. Of these, the most important is size. If we can diagnose breast cancer early, when the tumor is less than 10 mm, survival rates are greater than 90%.
We have the tool for early detection at the Breast Imaging Center. It is high quality mammography, dedicated, highly trained technologists and caring, knowledgeable specialty physicians.
Getting your first screening mammogram by the age of 40 and yearly thereafter, along with breast self-examinations and clinical exams is the best formula for early detection.
Q: Who is at risk for Breast Cancer?
A: Age is the major risk factor for breast cancer and this risk increases as you get older. Personal and family history are the second most important risk factors. If you have had breast cancer, lobular carcinoma in situ or a biopsy leading to a diagnosis of cancer, you are at higher risk than the general population for developing another breast cancer. If you have a family history of breast cancer- most importantly in an immediate relative such as a mother, sister or daughter- your risk is higher, especially if their breast cancer was pre-menopausal. Less important risk factors such as age at your first menstruation, first pregnancy and no history of pregnancy or nursing may slightly increase your risk of breast cancer, but only when several risk factors are present. The most important thing to remember-being at risk does not mean you will develop breast cancer.
Q: When should I start Breast Exams?
A: At age 20, you should have a breast physical exam by your doctor or practitioner. During this visit you should receive instruction on how to examine your own breasts. Then, begin breast self-examination every month. Between the ages of 20 and 39, see your doctor at least every three years for a complete breast exam. After 40, have a breast physical exam and mammogram every year.
Q: What should I be looking for when I examine my breasts?
A: By performing monthly self-examination, you should begin to learn how your breasts normally feel. If you notice any change in your nipple or skin- including redness, indentation or itchiness- you need to have this checked. Any lump that you feel might be new should be checked as well. Always check your armpits for any lumps and squeeze your nipples to see if you can express any liquid. If you can, and if the discharge is clear or bloody, you should contact your practitioner. If the discharge appears milky, cloudy, yellow or greenish, this is the normal appearance of secretions from the glands within the breast.
Q: What can I do to decrease my risk of having Breast Cancer?
A:
- Perform regular breast self-examinations
- Have regular clinical exams
- Get regular mammograms starting at age 35 (earlier with significant family history)
Q: What exactly is a Mammogram?
A: A mammogram is a low dose x-ray of the breast. Mammograms are safe and highly accurate in detecting breast cancer. During a mammogram, compression is used to spread the breast tissue out and allow breast structures to be clearly seen.
Q: What is the role of Ultrasound in diagnosing Breast Cancer?
A: Breast ultrasound is an important supporting test to mammography - primarily for determining if structures are solid or fluid and in guiding biopsies. It is often used as the first diagnostic test in women under the age of 30.
Q: What is Fibrocystic Disease?
A: Fibrocystic disease is a normal condition in at least half of all women and we no longer refer to this as a disease. Instead, it is called fibrocystic change. Fibrocystic change is more common in the childbearing years. This makes sense because fibrocystic change means there is more glandular activity in the breast, and in the child-bearing years, the breasts are on "standby", so to speak, to nurse or lactate. Fibrocystic change usually presents as tender, lumpy or thick breasts, especially before your menstrual period is about to begin. Hormones such as estrogen can also make the breast more fibrocystic.
"Fibrous" means fibrosis-this is just another word for connective tissue found in body structures. "Cysts" are fluid filled spaces within the glands of the breast. Fibrocystic change does not increase your risk of developing breast cancer.
Q: What can I do to make my breasts less Fibrocystic?
A: Some women report their breasts are less lumpy and tender if they stop drinking caffeinated drinks and eat less chocolate. This relationship between these foods and drinks and fibrocystic breasts has never been proven scientifically. Taking Vitamin E daily may help decrease the symptoms. If cysts become large and very painful, they can be aspirated. This involves local anesthetic (a numbing shot) next to the cyst, then placing a needle into the cyst and removing the fluid. This is best accomplished using ultrasound to help your doctor guide the needle into the cyst. Up to 50% of aspirated cysts may reaccumulate fluid.
Q: What is a biopsy and when is it necessary?
A: A biopsy is a procedure in which a sample of breast or other tissue is removed for examination under a microscope by a pathologist to see if the area in question is benign or malignant. There are several types of breast biopsies:
- FINE NEEDLE ASPIRATION (FNA) - After some local numbing medicine, a small needle is placed into the lump or unusual area. Then suction is applied with a syringe to remove or "aspirate" fluid or tiny pieces of tissue. This may be done by a surgeon if the lump can be felt. If it cannot be felt or is difficult to feel and can be seen on an ultrasound study, then the radiologist performs the aspiration using ultrasound to guide the needle to the area.
- ULTRASOUND CORE NEEDLE BIOPSY - This is very similar to FNA but uses a larger needle to obtain the sample of breast tissue. The core needle is generally about 1/16th inch in diameter and long enough to reach the lesion. The samples obtained resemble a long grain of rice in size. This is best done by a radiologist using ultrasound for guidance.
- STEREOTACTIC CORE BIOPSY - This is a type of core needle biopsy used when an abnormal area is best seen on a mammogram. Using a special mammogram machine called a stereotactic unit; a mammogram is taken to locate the area in question. Then a local anesthetic is given and the core needle placed into the suspicious area. A mammogram picture is taken before the sample is removed to insure that the needle is within the suspicious area.
- EXCISIONAL BIOPSY OR SURGICAL BIOPSY - This type of biopsy is usually done in a day surgery setting as an outpatient and requires some sedation and regional or local anesthesia. The surgeon makes an incision (which will require stitches or sutures to close) and removes a sample of the abnormal area. This sample is, of course, larger than that removed by a needle in a core biopsy. Sometimes an excisional biopsy may indeed remove the entire abnormal area. Biopsy samples are sent to a pathologist for microscopic evaluation.
- NEEDLE/WIRE LOCALIZATION WITH SURGICAL BIOPSY- If the area in question is too small to be felt and can best be seen on a mammogram or ultrasound, the patient will come to the Breast Imaging Center prior to the biopsy to have the suspicious area localized. After local anesthetic is given, a needle with a tiny wire inside will be placed into the unusual area. The mammogram or ultrasound images are repeated to make sure the needle is in the correct location, then the needle is removed leaving the wire in place as a marker or "localizer" to guide the surgeon for the excisional biopsy.
If the pre-surgical abnormality is identified by ultrasound, it will be localized using this modality and the procedure described above.
Q: What is osteoporosis?
A: Osteoporosis is a bone abnormality that is characterized by low bone mass and microarchitectural deterioration that leads to bone fragility and increased fracture risk. Simply put, the bones lose their structural strength. Osteoporosis affects an enormous number of people. Between 13% and 18% of post-menopausal white women in the US have osteoporosis and an additional 30% to 50% have low bone density of the hip - placing them at increased risk of osteoporosis and fractures. These common fractures may be followed by full recovery or by chronic pain, disability and even death.
You can contact the National Osteoporosis Foundation at
1150 Seventeenth Street NW Suite 500
Washington D.C. 20036
Fax Number (202) 223-2237
www.nof.org
Q: Do I need a Bone Mineral Density Exam?
A: You should be tested if the following apply -
- All post-menopausal women under the age of 65 who have one or more risk factors for osteoporosis (besides menopause)
- All women over the age of 65
- Post-menopausal women with history of fractures
- Women considering therapy for osteoporosis
- Women on hormone prescriptions for prolonged periods
