Breast cancer concerns all women. The risk is related to gender and increases with age. The good news is that in recent years survival of patients with medical treatment has increased.

• What is the best method for screening for breast cancer?

  Until recently, the mammogram has been the only approved method of population screening (asymptomatic women). The mammogram can detect malignancies before they are palpable, though this depends on breast density and the quality of the mammogram. A clinical examination is usually done before the mammogram and it is also advisable to be done yearly after the age of 25. The ultrasound (U/S) and MRI are additional tests.

• When should a mammogram be done?

  Screening for breast malignancies in asymptomatic women with a mammogram should begin after the age of 40 years and it is advisable to be done yearly. Many doctors recommend a first mammogram at the age of 35, so that breast quality is better assessed. However, if a lump is felt, a screening should be done immediately, regardless of the time since the last mammogram.

• Should I do a digital or analogical mammogram?

  The digital mammogram has an advantage over the analogical for pre/peri-menopausal women and for women with “dense” breasts. The images can be saved and can be reviewed in the future. In addition, the digital image can be worked to obtain a clearer image, or magnify a region that is suspicious.

• Are all palpable breast lumps malignant?

  No, most regard benign tumors, especially in younger women. Only a biopsy of the lump can identify the type of lesion.

• What type of surgical therapy will be followed?

  The surgical treatment for breast cancer is the total mastectomy, meaning the complete removal of the breast, and the conservative treatment, where lesions are removed with healthy margins (lumpectomy) or a quarter of the breast tissue (quadratectomy, partial mastectomy). This is always followed by sentinel node sampling, and depending on the pathology results, axilla lymph node dissection. The type of operation (mastectomy versus lumpectomy) does not influence survival, yet local recurrences are low when the right type of operation has been chosen.

• When is conservative surgical therapy contraindicated?

  Conservative surgical therapy is contraindicated when tumors are located in more than one quadrant, when tumors are large compared to breast size, when there are suspicious calcifications covering a large area, when there are no health margins after broader tissue removal, in cases with collagen diseases and previous breast radiation.

• When do I have radiation therapy after breast surgery?

  Radiation therapy must always be done after conservative surgery, after mastectomy for tumors greater than 4cm, when tumors have solid adhesion with thoracic wall, and when there are many positive axilla lymph nodes.

• Must chemotherapy always be done?

  No, the decision for chemotherapy is made after all the tumor characteristics are discussed extensively amongst the oncologist, surgeon and the patient.

• Which women are at higher risk for breast cancer?

  1. Women with heredity, particular with first-degree relatives with breast or ovarian cancer.
  2. Women with histological evidence of LCIS or atypia
  3. Women that already have a history of breast cancer.
  4. Women that at a young age underwent mantle thoracic radiation for Hodgkin lymphoma.
  5. Women with the first full-term pregnancy after the age of 30 years.
  6. Women with a mammogram showing very high density breast tissue.

• Do only high-risk women get breast cancer?

  No, all women are at risk, and the risk become higher after the age of 40 years. Most breast cancers occur in ages over 50 years, with mean age of 62 years. Recently there is an increased frequency in premenopausal women.