Archive for the ‘breast cancer’ Category

Breast Cancer – to Screen Or Not To Screen

February 15, 2014

When the medical world agreed that mammography and breast self exams were a good thing, the whole discussion turned upside down with a recent publication in the British Medical Journal, that suggest that mammography is no longer necessary. This article will discuss that report and provide advice for women so that they may make the best decision regarding their screening for breast cancer.

What is mammography?
A mammogram is an x-ray picture of the breast. It can be used to check for breast cancer in women who have no signs or symptoms of the disease. It can also be used if you have a lump or other sign of breast cancer.

In the past screening mammography is the type of mammogram that checks a woman when she has no symptoms. It was thought that screening mammography would reduce the number of deaths from breast cancer among women ages 40 to 70. But it can also have drawbacks. Mammograms can sometimes find something that looks abnormal but isn’t cancer. This leads to further testing and can cause a woman significant anxiety. Sometimes mammograms can miss cancer when it is there. It also exposes the woman to radiation. The National Cancer Institute recommends that women age 40 or older have screening mammograms every 1 to 2 years.

How is a mammogram performed?
In a screening mammogram, each breast is X-rayed in two different positions: from top to bottom and from side to side. When a mammogram image is viewed, breast tissue appears white and opaque and fatty tissue appears darker and translucent.

How does it differ from breast self-examination?
A breast self exam is a check-up a woman does at home to look for changes or problems in the breast tissue. Many women feel that doing this is important to their health.
However, experts do not agree about the benefits of breast self exams in finding breast cancer or saving lives. Most organizations and doctors believe that breast self-exams have little value, based on findings from several large studies. However, this is far better than no examination or no mammography at all.

Talk to your health care provider about whether breast self exams are right for you.
The best time to do a self-breast exam is about 3 – 5 days after your period starts. Your breasts are not as tender or lumpy at this time in your monthly cycle.

If you have gone through menopause, do your exam on the same day every month.

What did the recent report say about mammography?
One of the largest and most meticulous studies of mammography ever done, involving 90,000 Canadian women age 40-59 and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age.

It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. And the screening had harms: One in five cancers found with mammography and treated was not a threat to the woman’s health and did not need treatment such as chemotherapy, surgery or radiation.

The study, published in February 2014 in The British Medical Journal, is one of the few rigorous evaluations of mammograms conducted in the modern era of more effective breast cancer treatments. It randomly assigned half of the women to have regular mammograms and breast exams by trained nurses or to have breast exams alone.

The death rate from breast cancer was the same in both groups, but 1 in 424 women who had mammograms received unnecessary cancer treatment, including surgery, chemotherapy and radiation.

The findings of this study will not lead to any immediate change in guidelines for mammography, and many experts will dispute the idea that mammograms are on balance useless, or even harmful.

So what is a woman to do?
The American Cancer Society recommends yearly screening mammograms starting at age 40. However, the U.S. Preventive Services Task Force (USPSTF) does not recommend screening for women in their 40s. For women between the ages of 50 and 74, USPSTF experts say women should have mammograms every two years and do not recommend screening at all after age 74. The American Cancer Society and the American College of Obstetricians and Gynecologists suggest that woman consider screening mammograms beginning at age 40.

It is noted that women whose tumors are discovered through mammography are smaller and present at earlier stages and are more likely to undergo breast conservation therapy, i.e., lumpectomy and women who have their cancer identified through breast self examinations tend to have more advanced cancer and have mastectomies or the entire breast removed.

When you need a mammogram is a personal decision between you and your doctor. If you’re over 40, talk to you doctor about when you should begin mammogram screening.
Bottom Line: Breast cancer remains the most common cancer in women and early detection is important for improving outcomes and saving breast tissue, i.e., having a lumpectomy instead of a mastectomy. I encourage each woman to have a discussion with their doctor about when to begin screening for breast cancer and whether or not to screen with mammography.

X-Rays, CT SCans, Dental X-Rays May Be Killing You

February 3, 2014

Americans are receiving more testing and imaging that makes use of ionizing radiation than ever before. The healthcare profession knows that excessive radiation can be a contributing factor to many forms of cancer such as leukemia (blood cancer) breast cancer, and thyroid cancer just name a few.

Ionizing radiation is high-frequency radiation that has enough energy to remove an electron from (ionize) an atom or molecule. Ionizing radiation has enough energy to damage the DNA or the genetic makeup inside cells, which in turn may lead to cancer.

Ionizing radiation is a proven human carcinogen (cancer causing agent). The evidence for this comes from many different sources, including studies of atomic bomb survivors in Japan, people exposed during the Chernobyl nuclear accident, people treated with high doses of radiation for cancer and other conditions, and people exposed to high levels of radiation at work, such as uranium miners.

Even though great strides have been made in cancer prevention and treatment, cancer rates remain high and may soon surpass heart disease as the leading cause of death in the United States. One of the important culprits may come from your doctor who is prescribing excessive imaging studies that make use of ionizing radiation. The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the last 20 years. Our resulting exposure to medical radiation has increased more than six fold between the 1980s and 2006. The radiation dose of CT scans (a series of X-ray images from multiple angles) is 100 to 1,000 times higher than conventional X-rays such as a chest X-ray.

The risks have been demonstrated directly in two large clinical studies in Britain and Australia. In the British study, children exposed to multiple CT scans were found to be three times more likely to develop leukemia and brain cancer. In a 2011 report sponsored by Susan G. Komen, concluded that radiation from medical imaging, and hormone therapy, the use of which has substantially declined in the last decade, were the leading environmental causes of breast cancer, and advised that women reduce their exposure to unnecessary CT scans.

One in 10 Americans undergo a CT scan every year, and many of them get more than one CT scan every year. While it is difficult to know how many cancers will result from medical imaging, a 2009 study from the National Cancer Institute estimates that CT scans conducted in 2007 will cause a projected 29,000 excess cancer cases and 14,500 excess deaths over the lifetime of those exposed. Given the many scans performed over the last several years, a reasonable estimate of excess lifetime cancers would be in the hundreds of thousands. Unless we change our current practices or overusing CT scans, 3 percent to 5 percent of all future cancers may result from exposure to medical imaging.

We know that these tests are overused. But even when they are appropriately used, they are not always done in the safest ways possible. The rule is that doses for medical imaging should be as low as reasonably achievable. But there are no specific guidelines for the imaging centers to use to identify what optimum low doses are, and thus there is considerable variation within and between institutions. The dose at one hospital can be as much as 50 times stronger than at another.

A recent study at one New York hospital found that nearly a third of its patients undergoing multiple cardiac imaging tests were getting a cumulative effective dose equivalent to 5,000 chest X-rays. And last year, a survey of nuclear cardiologists found that only 7 percent of stress tests were done using a “stress first” protocol (examining an image of the heart after exercise before deciding whether it was necessary to take one of it at rest), which can decrease radiation exposure by up to 75 percent.

But we still have a long way to go. Fortunately, we can reduce the rate of medical imaging by simply avoiding unnecessary scans and minimizing the radiation from appropriate ones. For example, emergency room physicians routinely order multiple CT scans even before examining a patient. For example a patient with possible diagnosis of a kidney stone can often be diagnosed with a history, a physical exam, a urine test, and very simple x-ray called a KUB which has minimal radiation exposure compared to a spiral CT scan that is so frequently ordered.

Better monitoring and guidelines would also help. The Food and Drug Administration oversees the approval of scanners, but does not have regulatory oversight for how they are used. We need clear standards, published by professional radiology societies or organizations like the Joint Commission or the F.D.A. In order to be accredited for CT scans, hospitals and imaging clinics should be required to track the doses they use and ensure that they are truly as low as possible by comparing them to published guidelines.

Patients have a part to play as well. Consumers can go to the website, http://www.choosingwisely.org, to learn about the most commonly overused tests. Before agreeing to a CT scan, they should ask: Will it lead to a better treatment and outcome? Would they get that therapy without the test? Are there alternatives that don’t involve radiation, like ultrasound or MRI? Even when we go to the dentist to have our teeth cleaned, we need to question the dentist about the routine use of dental x-rays and if you do get dental x-rays, it is important to wear a neck shield that protects your thyroid gland.

Bottom Line: We are probably receiving more radiation through medical tests and is important to question your doctor about the necessity of using so many imaging tests that increase our exposure to ionizing radiation.

A version of this op-ed appears in print in the New York Times on January 31, 2014.

Breast Cancer Screening- Does Screen Save Lives?

December 1, 2013

In 2013 there will be nearly 250,000 new cases of breast cancer and 40,000 deaths from breast cancer. Now there is a move to decrease screening for this most common cancer in women. This blog will discuss the guidelines from the Task Force on Preventive Healthcare.

Summary of the task force guidelines. Women 50-69 years of age should have mammograms every 2-3 years instead of every year. Women under 50 should not have mammograms. Clinical examinations by a doctor and breast self-exams have no benefit. Routine screening with MRI scans is not recommended.

These guidelines do not apply to women at high risk. These are women with a family history of breast cancer. Also includes women who test positive for the BRCA gene 1 or 2.

Self-examination has been the suggestion for women for decades. Experts say it is not a good idea.

Screening for women is not the lifesaver it was once thought to be. The task force looked at 2100 women between 40 and 59 years of age would have to be screened every 2-3 years for an eleven year period to prevent one breast cancer death. This suggests a very small benefit over a very large number of screenings. The task force even pointed out that screenings more do more harm than good. Nearly 700 of the 2100 women would have had a false mammogram requiring further imaging. 75 of these 700 women would have a biopsy just to confirm that they do not have breast cancer and at least 10 women would have part or all of their breast removed. This does not include all the anxiety that surrounds a positive mammogram and the waiting and discomfort associated with the biopsy.

What’s my advice? Certainly if a woman is in the high-risk group, mammography and screening is imperative. Women should have a discussion with their doctor and make an informed decision and weight the risks vs. the benefits of screening. This is not a doctor only decision it is a doctor-patient decision. Patients who become informed and have a discussion with their doctor will be the ones that make the best decision. Finally, I am not agreement with the recommendation on the breast self-exam. I still believe this a low cost valuable test that can detect small lesion in the breast before they become clinically relevant.

My next blog will discuss the guidelines on prostate cancer screening.

Man Has Prostate Gland Removed Because He Tested Positive For The BRCA-Gene

May 25, 2013

BRCA-2 Gene

BRCA-2 Gene


Angelina Jolie has come forward and shared with the world her story about having prophylactic bilateral mastectomies and breast reconstruction after learning that she tested positive for the BRCA2 gene mutation that is highly predictive of developing breast cancer.

BRCA gene mutations increase the risk for a number of cancers, including prostate cancer. Now the first man has come forward who tested positive for the BRCA gene mutation who had his prostate gland removed. The surgery took place in London by an eminent surgeon who also had his prostate gland removed for prostate cancer after prostate cancer was found.

Previous results from this trial have shown that a man with a BRCA2 mutation has an 8.6-fold increased risk of developing prostate cancer, and with a BRCA1 mutation has a 3.4-fold increased risk. The same researchers reported that prostate cancer in men with the BRCA2 mutation is more aggressive and more likely to be fatal (J Clin Oncol. 2013;31:1748-1757).

The man who underwent the surgery is described as a 53-years-old businessman from London who is married with children and has several family members who have had breast or prostate cancer. When he found out he was carrying the BRCA2 mutation, he asked to have his prostate removed.

What’s my opinion on this first test case of prophylactic prostate gland removal for men with BRCA gene mutation? First, I don’t think American insurance companies, including Medicare, will pay for prophylactic prostatectomies without a diagnosis of prostate cancer confirmed by a prostate biopsy. Second, I wouldn’t recommend a prostatectomy just on the basis of a positive gene test. I think it is far too early to be removing men’s prostate glands with the associated risk of erectile dysfunction and urinary incontinence just on the basis of a blood test. However, if a man with an elevated PSA blood test has one or two relatives such as a father or brother with prostate cancer and a mother with breast cancer and it is highly likely that he may have or will develop prostate cancer, then I would certainly recommend that the man have a prostate biopsy and close monitoring for prostate cancer.

I do suggest that all men with a family history of prostate cancer have an annual digital rectal exam and a PSA blood test.

BRCA Gene Mutation and What It Means For Men

May 18, 2013

Everyone knows that Angelina Jolie had a double mastectomy as a prophylaxis against developing breast cancer. I think every woman can appreciate how brave she was to undergo the surgery but also how she put this issue on the map and increased the awareness of the BRCA gene. Since Angelina had the mastectomy she has reduced her risk of breast cancer from a dismal 87% to a manageable 5%. But what does the BRCA gene mean if a man carries the gene?

Men and women can inherit and pass on a BRCA mutation. Men with a BRCA mutation have a lower chance overall of developing cancer than do women with a mutation, but their chances of breast cancer, prostate cancer, and a few other specific cancers are increased.
Men with a BRCA gene mutation have a higher risk of developing breast cancer, prostate cancer and skin cancer (melanoma). In some men (and women), BRCA2 gene mutations have been associated with an increased risk of lymphoma, melanoma, and cancers of the pancreas, gallbladder, bile duct, and stomach. Furthermore, these cancers are more likely to develop at a younger age in men with a BRCA mutation. Men with a BRCA mutation have a lower chance overall of developing cancer than do women with a mutation

Both men and women carry the BRCA gene mutation and it is possible for men to inherit the mutated gene from a man’s father.

Men from families with a history of breast and ovarian cancer in the women in the family should consider testing for a BRCA gene mutation particularly if any of the breast cancers occurred before age 50 (in either female or male relatives). Men with breast cancer themselves are highly likely to have a BRCA mutation and should consider testing. Men who have prostate cancer and a family history of breast cancer should also think about testing for the mutated gene.

Men who know they carry a BRCA gene mutation can take proactive steps such as getting screened regularly for some of the cancers associated with the mutation, such as annual prostate cancer screening with a PSA test and annual skin examinations for melanoma. Men with a BRCA mutation should also seek medical advice about any changes in their breasts such as breast tenderness, discharge from the nipple or a breast mass or lump. Even more so, it is important to share this result with your family when you deem appropriate, as it may be life saving information to your sisters, mother and daughters.

Bottom Line: BRCA gene is certainly an important issue for women but it is also important for men as well. If you have a family member with breast or ovarian cancer especially if they have the cancer detected before age 50, then they should have a test for the BRCA gene.

Dr. Neil Baum is physician and the author of What’s Going On Down There, The Complete Guide To Women’s Pelvic Heath and is available from Amazon.com

What's Going On Down There-Improve Your Pelvic Health (amazon.com)

What’s Going On Down There-Improve Your Pelvic Health (amazon.com)

Breast Cancer In Men-Not Just a Woman’s Problem

March 16, 2013

Breast cancer is not as common in men as in women and there are 2400 cases diagnosed each year compared to 232,000 new cases of breast cancer diagnosed in women each year. Unfortunately, most men with a breast lump, bump, or discharge from the nipple will ignore the problem. As a result many men do not seek medical care and are diagnosed when the cancer is at a more advanced stage and is more difficult to treat.
The cause of breast cancer in men is not known. However, there appears to be a relationship between male breast cancer and an increase in estrogen in men. Estorgen is the hormone that is responsible for a woman’s breast development. Since men produce very little estrogen, men rarely get breast cancer. It is thought that the extra estrogen in men may be responsible for breast cancer. Also, breast cancer occurs in older men usually at the time that testosterone, the male hormone produced in the testicle, production is in decline.
It is rare for a man under age 35 to get breast cancer. The likelihood of a man developing breast cancer increases with age. But breast cancer is less common in men because their breast duct cells are less developed than those of women and because they normally have lower levels of female hormones that affect the growth of breast cells.
Most male breast cancers are detected between the ages of 60 to 70 years. Other risk factors of male breast cancer include: a family history of breast cancer in a close female relative, a history of radiation exposure of the chest, enlargement of the breasts following hormone treatment, a rare genetic condition called Klinefelter’s syndrome. severe liver disease. diseases of the testicles such as mumps orchitis, a testicular injury, or an undescended testicle. Another newly identified risk factor is an inherited mutated gene or the BRCA2 gene.
Most breast cancer starts in the lining of the milk ducts in the breast and then if undetected or not treated will spread to the lymph nodes under the arm.
The diagnosis is made by the physical examination of the lump or mass noted in the breast tissue. The diagnosis is made by a mammogram which is the same test used for women with a breast mass and is confirmed with a breast biopsy where a small piece of tissue is removed and examined under a microscope.
The treatment of breast cancer in men is based on the tumor stage which is determined by the size and a determination of how far the cancer has spread. A grade 1 tumor is not very fast growing whereas a grade 3 tumor is more like to grow and spread to the lymph nodes and other organs.

The breast cancer found in men is very receptive to an oral drug tamoxifen, which inhibits the action estrogen on the breast tissue. Tamoxifen works like key blocking a keyhole and stops breast cancer cells from multiplying or growing. The side effects of tamoxifen include hot flashes, decreased sex drive, weight gain, and changes in moods. These are the same symptoms that women experience during menopause.

Bottom Line: Breast cancer in men is not very common. However, if detected early it is curable. If you are a man or a woman and experience a new lump or bump in your breast, make an appointment and see your physician.

Dr. Neil Baum is a physician in New Orleans and the author of What’s Going On Down There-the Complete Guide To Women’s Pelvic Health. The book is available on Amazon.com.

New book on women's health

New book on women’s health

Preventive Healthcare For Women – What You Need To Know

January 21, 2013

Women have had an interaction with the healthcare profession from birth to old age. They have achieved good health as a result of frequent visits to their doctors and practiced good health habits. This blog is written for the purpose of providing women with suggestions for continuing the process of maintaining good health.

Why Screening Tests Are Important
Remember that old saying, “An ounce of prevention is worth a pound of cure”? Getting checked early can help you stop diseases like cancer, diabetes, and osteoporosis in the very beginning, when they’re easier to treat. Screening tests can spot illnesses even before you have symptoms. Which screening tests you need depends on your age, family history, your own health history, and other risk factors.

Breast Cancer
The earlier you find breast cancer, the better your chance of a cure. Small breast-cancers are less likely to spread to lymph nodes and vital organs like the lungs and brain. If you’re in your 20s or 30s, your health care provider should perform a breast exam as part of your regular check-up every one to three years. You may need more frequent screenings if you have any extra risk factors.

Screening With Mammography
Mammograms are low-dose X-rays that can often find a lump before you ever feel it, though normal results don’t completely rule out cancer. While you’re in your 40s, you should have a mammogram every year. Then between ages 50 and 74, switch to every other year. Of course, your doctor may recommend more frequent screenings if you’re at higher risk.
Cervical Cancer
With regular Pap smears, cervical cancer (pictured) is easy to prevent. The cervix is a narrow passageway between the uterus (where a baby grows) and the vagina (the birth canal). Pap smears find abnormal cells on the cervix, which can be removed before they ever turn into cancer. The main cause of cervical cancer is the human papillomavirus (HPV), a type of STD.
Screening for Cervical Cancer
During a Pap smear, your doctor scrapes some cells off your cervix and sends them to a lab for analysis. A common recommendation is that you should get your first Pap smear by age 21, and every two years after that. If you’re 30 or older, you can get HPV tests, too, and wait a little longer between Pap smears. Both screenings are very effective in finding cervical cancer early enough to cure it.
Vaccines for Cervical Cancer
Two vaccines, Gardasil and Cervarix, can protect women under 26 from several strains of HPV. The vaccines don’t protect against all the cancer-causing strains of HPV, however. So routine Pap smears are still important. What’s more, not all cervical cancers start with HPV.
Osteoporosis and Fractured Bones
Osteoporosis is a state when a person’s bones are weak and fragile. After menopause, women start to lose more bone mass, but men get osteoporosis, too. The first symptom is often a painful break after even a minor fall, blow, or sudden twist. In Americans age 50 and over, the disease contributes to about half the breaks in women and 1 in 4 among men. Fortunately, you can prevent and treat osteoporosis.
Osteoporosis Screening Tests
A special type of X-ray called dual energy X-ray absorptiometry (DXA) can measure bone strength and find osteoporosis before breaks happen. It can also help predict the risk of future breaks. This screening is recommended for all women age 65 and above. If you have risk factors for osteoporosis, you may need to start sooner.
Skin Cancer
There are several kinds of skin cancer, and early treatment can be effective for them all. The most dangerous is melanoma (shown here), which affects the cells that produce a person’s skin coloring. Sometimes people have an inherited risk for this type of cancer, which may increase with overexposure to the sun. Basal cell and squamous cell are common non-melanoma skin cancers.
Screening for Skin Cancer
Watch for any changes in your skin markings, including moles and freckles. Pay attention to changes in their shape, color, and size. You should also get your skin checked by a dermatologist or other health professional during your regular physicals.
High Blood Pressure
As you get older, your risk of high blood pressure increases, especially if you are overweight or have certain bad health habits. High blood pressure can cause life-threatening heart attacks or strokes without any warning. So working with your doctor to control it can save your life. Lowering your blood pressure can also prevent long-term dangers like heart disease and kidney failure.
Screening for High Blood Pressure
Blood pressure readings include two numbers. The first (systolic) is the pressure of your blood when your heart beats. The second (diastolic) is the pressure between beats. Normal adult blood pressure is below 120/80. High blood pressure, also called hypertension, is 140/90 or above. In between is prehypertension, a sort of early warning stage. Ask your doctor how often to have your blood pressure checked.
Cholesterol Levels
High cholesterol can cause plaque to clog your arteries (seen here in orange). Plaque can build up for many years without symptoms, eventually causing a heart attack or stroke. High blood pressure, diabetes, and smoking can all cause plaque to build up, too. It’s a condition called hardening of the arteries or atherosclerosis. Lifestyle changes and medications can lower your risk.
Checking Your Cholesterol
To get your cholesterol checked, you’ll need to fast for 12 hours. Then you’ll take a blood test that measures total cholesterol, LDL “bad” cholesterol, HDL “good” cholesterol, and triglycerides (blood fat). If you’re 20 or older, you should get this test at least every five years.
Type 2 Diabetes
One-third of Americans with diabetes don’t know they have it. Diabetes can cause heart or kidney disease, stroke, blindness from damage to the blood vessels of the retina (shown here), and other serious problems. You can control diabetes with diet, exercise, weight loss, and medication, especially when you find it early. Type 2 diabetes is the most common form of the disease. Type 1 diabetes is usually diagnosed in children and young adults.
Screening for Diabetes
You’ll probably have to fast for eight hours or so before having your blood tested for diabetes. A blood sugar level of 100-125 may show prediabetes; 126 or higher may mean diabetes. Other tests include the A1C test and the oral glucose tolerance test. If you’re healthy and have a normal diabetes risk, you should be screened every three years starting at age 45. Talk to your doctor about getting tested earlier if you have a higher risk, like a family history of diabetes.
Human Immunodeficiency Virus (HIV)
HIV is the virus that causes AIDS. It’s spread through sharing blood or body fluids with an infected person, such as through unprotected sex or dirty needles. Pregnant women with HIV can pass the infection to their babies. There is still no cure or vaccine, but early treatment with anti-HIV medications can help the immune system fight the virus.
HIV Screening Tests
HIV can be symptom-free for many years. The only way to find out if you have the virus is with blood tests. The ELISA or EIA test looks for antibodies to HIV. If you get a positive result, you’ll need a second test to confirm the results. Still, you can test negative even if you’re infected, so you may need to repeat the test. Everyone should get tested at least once between ages 13-64.
Preventing the Spread of HIV
Most newly infected people test positive around two months after being exposed to the virus. But in rare cases it may take up to six months to develop HIV antibodies. Use a condom during sex to avoid getting or passing on HIV or other STDs. If you have HIV and are pregnant, talk with your doctor about reducing the risk to your unborn child.
Colorectal Cancer
Colorectal cancer is the second most common cause of cancer death after lung cancer. Most colon cancers come from polyps (abnormal masses) that grow on the inner lining of the large intestine. The polyps may or may not be cancerous. If they are, the cancer can spread to other parts of the body. Removing polyps early, before they become cancerous, can prevent it completely.
Screening for Colorectal Cancer
A colonoscopy is a common screening test for colorectal cancer. While you’re mildly sedated, a doctor inserts a small flexible tube equipped with a camera into your colon. If she finds a polyp, she can often remove it right then. Another type of test is a flexible sigmoidoscopy, which looks into the lower part of the colon. If you’re at average risk, screening usually starts at age 50.
Glaucoma
Glaucoma happens when pressure builds up inside your eye. Without treatment, it can damage the optic nerve and cause blindness. Often, it produces no symptoms until your vision has already been damaged.
Glaucoma Screening
How often you should get your eyes checked depends on your age and risk factors. They include being African-American or Hispanic, being over 60, eye injury, steroid use, and a family history of glaucoma. People without risk factors or symptoms of eye disease should get a baseline eye exam, including a test for glaucoma, at age 40.
Bottom Line: It’s good health sense to talk with your doctor about screening tests. Some tests, such as a Pap test or breast exam, should be a routine part of every woman’s health care. Other tests might be necessary based on your risk factors. Proper screening won’t always prevent a disease, but it can often find a disease early enough to give you the best chance of overcoming it.

Breast Cancer-Not Just A Problem for Women

May 8, 2012

Breast cancer is one of the most common cancers in women. However, men are not immune to this problem although it is far more common in women. Many people do not realize that men have breast tissue and that they can develop breast cancer. Breast cancer is about 100 times less common among men than among women.
The prognosis (outlook) for men with breast cancer was once thought to be worse than that for women, but recent studies have not found this to be true. In fact, men and women with the same stage of breast cancer have a fairly similar outlook for survival.

The most obvious difference between the male and female breast is size. Because men have very little breast tissue, it is easier for men and their health care professionals to feel small masses (tumors). On the other hand, because men have so little breast tissue, cancers do not need to grow very far to reach the nipple, the skin covering the breast, or the muscles underneath the breast. So even though breast cancers in men tend to be slightly smaller than in women when they are first found, they have more often already spread to nearby tissues or lymph nodes. The extent of spread is one of the most important factors in the prognosis (outlook) of a breast cancer.

Another difference is that breast cancer is common among women and rare among men. Women tend to be aware of this disease and its possible warning signs. Women perform self exams on a regular basis and also obtain mammograms every year. However, most men do not realize they have even a small risk of being affected. Some men ignore breast lumps or think they are caused by an infection or some other reason, and they do not get medical treatment until the mass has had a chance to grow. Because breast cancer is so uncommon in men, there is unlikely to be any benefit in screening men in the general population for breast cancer.

Men need to know that breast cancer is not limited to only women. Possible signs of breast cancer to watch for include: A lump or swelling, which is usually (but not always) painless, skin dimpling or puckering, nipple retraction (turning inward), redness or scaling of the nipple or breast skin, or discharge from the nipple
These changes aren’t always caused by cancer. For example, most breast lumps in men are due to gynecomastia (a harmless enlargement of breast tissue). Still, if you notice any breast changes, you should see your health care professional as soon as possible.
Treatment

Most of the information about treating male breast cancer comes from doctors’ experience with treating female breast cancer. Because so few men have breast cancer, it is hard for doctors to study the treatment of male breast cancer patients separately in clinical trials.
Local therapy is intended to treat a tumor at the site without affecting the rest of the body. Surgery and radiation therapy are examples of local therapies. Systemic therapy refers to drugs, which can be given by mouth or directly into the bloodstream to reach cancer cells anywhere in the body. Chemotherapy, hormone therapy, and targeted therapy are systemic therapies.

The prognosis (outlook) for men with breast cancer was once thought to be worse than that for women, but recent studies have not found this to be true. In fact, men and women with the same stage of breast cancer have a fairly similar outlook for survival.

Bottom Line: Breast cancer can occur in men as well as women. While not as common in men as in women, men need to know that any lumps, swelling or discharge from the nipple should be examined by a physician.