You wake one morning and find a lump in your breast. Or perhaps you go for a screening mammogram and get recalled for additional views. 

Welcome to the roller coaster of breast disease. However, this process doesn't need to be frightening; you are in control and you determine where you are going. What you need now is information.

The most important thing to do is to get the answers to all of your questions. A mass in your breast or an abnormality on your mammogram will require further evaluation. An ultrasound is often required to further characterize a mass as solid, requiring biopsy, or cystic which may or may not require aspiration.

There are also microscopic findings on mammograms called calcifications that may require spot magnification views. Depending upon the findings of your radiologic studies, you may be referred to a surgeon or radiologist for a biopsy.

Most procedures to biopsy the breast can be performed in an office setting, which will allow you to have the procedure performed more quickly. Oftentimes an ultrasound or mammogram is used to guide your surgeon to the abnormal area of your breast. If the lump in your breast is not apparent on any studies, it still needs to be evaluated and likely require a biopsy to determine whether it is or is not cancerous. Remember, 20% of all cancers are not seen on mammograms or ultrasounds; therefore, palpable masses with negative x-ray studies also need to be thoroughly evaluated.

The bottom line with an abnormal mammogram or ultrasound or a palpable mass is that a tissue biopsy is the gold standard to determine whether the mass is benign (not cancer) or malignant (cancer). If your questions are not adequately answered, get a second opinion.

Breast Cancer and the Whole Woman 

As an added resource, Virginia Breast Center has joined an online education resource and support community of women who have breast cancer, and those who treat the disease.Learn more or become a member.


What Causes Breast Cancer? 


In order to prevent breast cancer from occurring we must understand what causes it to begin and what causes it to grow. Ultimately all breast cancer is "genetic." It does not mean that everyone who is diagnosed with breast cancer has had a relative affected by breast cancer. In fact, only 25% of all women or men diagnosed have a positive family history. It means that in breast cancer cells there is a change in the genes that control the cells growth and division. Once altered, the cells begin to divide in a "chaotic" or disorganized manner forming a mass or a cancerous growth.

Not all cancers grow at the same rate. Some are very rapidly dividing tumors and others may take years to become evident on mammography or on clinical exam. There are many factors that play a role in the growth and development of breast cancer. 

Although genetics plays a role in all cancers, one single genetic alteration is not enough for a cancer to form. Even women with BRCA-1 and BRCA-2 gene alterations are not guaranteed to develop cancer. They are clearly at a much greater risk for the development of breast and ovarian cancer but other factors still come into play. Women who test positive for the BRCA-1 and BRCA-2 genes have an 80 to 90% chance of developing cancer. But this gene alteration accounts for only 5 to 9% of all breast cancers diagnosed. Other internal and external factors are involved in the formation of a cancer.

GAIL Risk Assessment

Your physician can determine your individual risk for the development of cancer in the future. The most widely used formula is called the GAIL risk model and takes into consideration many factors. This is only an estimate and can be used to assess your risk profile.

The most prominent factor in the risk assessment is having been born a woman. Only 1% of breast cancers are diagnosed in men, therefore being female is the most obvious risk factor. The next factor that comes into play is age. The preponderance of breast cancers are diagnosed in women over 60 but cancer can occur at any age. (80% of all breast cancers occur in women over 50 with no family history) The next factor we look at is how many first-degree family members (mother, sister or daughter) have been diagnosed with this disease. 

A history of multiple breast biopsies, particularly those with atypical changes is a significant factor. Estrogen exposure is the next factor that has many components. Estrogen does not cause a cancer to form, but it can promote the growth and progression of the disease. Menarche, the age of your first menstrual period, is a factor that you cannot control. The earlier your period begins the higher the risk. Being nulliparus, never having given birth, and having your first child after the age of thirty, also increases your risk profile.

The GAIL risk assessment allows your physician to determine your five-year and lifetime risk and can become an important factor in your decision making process when it comes to breast cancer prevention.

Risk Factors and Strategies

There are risk factors that are under your control. The foods you eat and the toxins that you choose to put in your body is an area within your control. The obvious toxins tobacco and excessive alcohol consumption can be eliminated, as they are associated with so many cancers and disease processes in our bodies.

Obesity, a diet high in saturated fats, lack of exercise, and environmental pollutants are also linked to the development of breast cancer. Radiation exposure (in levels much higher than mammography requires for screening) has deleterious effects on normal cellular function. Free radical formation is thought to be at the root of the aforementioned factors and therefore, vitamins, antioxidants, and a healthy lifestyle are certainly an option for those who choose to be proactive.

All women may want to adopt these strategies since they are all, by virtue of being female, at risk. The incidence of breast cancer has increased over the past 25 years from 1 in 15 to 1 in 8. Certainly our lifestyles have been altered during that time period and we have the power to alter them in a positive manner. 

In addition to lifestyle and dietary modification, there are several options for women at high risk. If you are premenapausal and at a significant risk, your physician may recommend you take a drug called tamoxifen. In a recent study, the National Cancer Institute and National Surgical Breast and Bowel Project were able to show a 44% reduction in the development of breast cancer in women at high risk. It works by blocking estrogen receptors in the breast and therefore prevents the cells with the potential for cancer from dividing. The decision to go on tamoxifen should be discussed at length with your team of physicians, as there are potential side effects along with its benefits.