FAQ
Q. Does breast cancer run in families?
A. Having one close relative (mother or sister) with breast cancer doubles your risk of getting breast cancer, when compared to women with no cases in the family. Having two close relatives affected increases your risk further.
There are a very few families in which breast cancer is very common - ie four or more cases. Most of these families carry faulty versions of the 'BRCA' breast cancer genes. Women with a faulty BRCA gene have a 50% to 80% chance of getting breast cancer. Testing for faulty BRCA genes is available on the NHS.
Q. Who is most at risk?
A. Breast cancer is a female disease, but about 1% of cases occur in men. Amongst women it becomes more common as age increases. Taking the contraceptive pill slightly increases the risk. Taking hormone replacement therapy significantly increases your risk somewhat more, but the health benefits derived from hormone replacement are better overall. Obesity and heavy drinking also significantly increase the risk.
If one or more relatives have had breast cancer, this also increases your risk of developing it.
Q. What are the symptoms of Breast cancer?
A. Common symptoms of breast cancer include:
Change in the size or shape of a breast
Dimpling of the breast skin
The nipple becoming inverted
Swelling or lump in the armpit
Mammography can detect very early breast tumours even when they are too small to be felt. Most of the breast cancers detected by screening are at this very early stage, when they are relatively easy to cure and increase its survival rate. Studies have shown that women who take part in screening are more likely to have breast cancer diagnosed early and more likely to have it cured and, as a result, are less likely to die from it, than women who do not take part in mammography screening.
Another method of screening available to all women is to feel the breasts for any lumps. A guide on how to do this properly can be obtained specifically at the well woman clinic or any doctor's surgery.
The most important method used to diagnose breast cancer is by taking a biopsy (a tissue sample). A hollow needle is pushed into the breast lump to capture a tiny sample of the tissue. This is examined under a microscope. The shape and appearance of the cells in the tissue sample reveals whether the lump is benign, which is true of the vast majority, or if it is cancerous.
Q. How important is early detection?
A. In the western world six out of every seven patients can now be cured if diagnosis is at the early stage. However, if they are diagnosed when it has become advanced, the cure rate falls to about one in seven. It is extremely important to catch breast cancer at an early stage.
The main treatment for breast cancer is surgery. In most cases, conservative surgery is used, which preserves the shape and appearance of the breast. For very early breast cancer, only the lump and a small area of tissue around it is removed. For later stage breast cancer, much more tissue is removed but it is replaced with muscle to rebuild the breast. Since breast cancer cells usually spread first to the lymph node in the armpit, the surgeon will usually cut into it to check for any spread.
The surgery may be followed by a short course of radiotherapy or chemotherapy, depending on the type of tumour and how advanced it is. In most cases, the patient will be given a longer course of hormone therapy (eg tamoxifen) which reduces the risk of the cancer recurring.
The treatment for breast cancer has been improving for the last twenty years. In the early 1970's, only half of all women diagnosed with the disease survived for five years. Now, over three quarters survive for that long and most of them will live for very much longer.
Q. What is Inflammatory Breast Cancer (IBC)?
A. IBC is the most aggressive form of breast cancer and has a faster doubling time than other breast cancers. (Doubling time is the time it takes for cancer cells to divide and grow.) IBC usually grows in nests or sheets in the breast rather than a solid tumor.
Q.Do you have to have a lump in your breast to have breast cancer?
A. No. Since IBC grows in the dermal lymphatic system there is often no breast lump. The cancer cells clog the lymph vessels just below the skin giving the classic symptoms of warmth and color changes to the skin.
Q. What are the symptoms of IBC?
A. Rapid, unusual increase in breast size; Redness, rash, blotchiness or other skin color; changes of the breast; Persistent itching of breast or nipple; Lump or thickening of breast tissue; Stabbing pain and/or soreness of breast; Feverish breast; Swelling of lymph nodes under the arm or above the collar bone; Dimpling or ridging of breast; Flattening or retracting of nipple; Nipple discharge or change in pigmented area around nipple. Although the above symptoms may indicate a benign breast disorder, any change to your breast(s) should be reported to your healthcare professional immediately. In addition, these symptoms may appear quickly and suddenly.
IBC is the most aggressive form of breast cancer and has a faster doubling time than other breast cancers. (Doubling time is the time it takes for cancer cells to divide and grow.) IBC usually grows in nests or sheets in the breast rather than a solid tumor.
Q. How is IBC detected?
A. Unfortunately, mammograms and ultrasounds often miss IBC unless there is a defined tumor. If you notice any of the symptoms above, go to your doctor so he or she can begin the diagnostic procedures.
Q. How is IBC diagnosed?
A. A skin punch biopsy, a needle core biopsy, MRI, and/or PET scan may assist in diagnosis. Any biopsy must include the skin and tissue in the layers below the skin surface. The biopsy report may say "dermal lymphatic involvement", rather than inflammatory breast cancer.
Q. Where can I find more information in IBC?
A. The Inflammatory Breast Cancer Research Foundation is the only organization dedicated solely to inflammatory breast cancer. Visit their website at www.ibcresearch.org or call the toll-free telephone line at 877-786-7422 for more information.
Q. What is Obesity?
A. Obesity is an excess proportion of total body fat. A person is considered obese when his or her weight is 20% or more above normal weight. The most common measure of obesity is the body mass index or BMI. A person is considered overweight if his or her BMI is between 25 and 29.9; a person is considered obese if his or her BMI is over 30.
"Morbid obesity" means that a person is either 50%-100% over normal weight, more than 100 pounds over normal weight, has a BMI of 40 or higher, or is sufficiently overweight to severely interfere with health or normal function.
Q. What causes obesity?
A. Obesity occurs when a person consumes more calories than he or she burns. For many people this boils down to eating too much and exercising too little. But there are other factors that also play a role in obesity. These may include:
.Age As you get older, your body's ability to metabolize food slows down and you do not require as many calories to maintain your weight. This is why people note that they eat the same and do the same activities as they did when they were 20 years old, but at age 40, gain weight.
• Gender . Women tend to be more overweight than men. Men have a higher resting metabolic rate (meaning they burn more energy at rest) than women, so men require more calories to maintain their body weight. Additionally, when women become postmenopausal, their metabolic rate decreases. That is partly why many women gain weight after menopause.
• Genetics . Obesity (and thinness) tends to run in families. In a study of adults who were adopted as children, researchers found that participating adult weights were closer to their biological parents' weights than their adoptive parents'. The environment provided by the adoptive family apparently had less influence on the development of obesity than the person's genetic makeup. In fact, if your biological mother is heavy as an adult, there is approximately a 75% chance that you will be heavy. If your biological mother is thin, there is also a 75% chance that you will be thin. Nevertheless, people who feel that their genes have doomed them to a lifetime of obesity should take heart. Many people genetically predisposed to obesity do not become obese or are able to lose weight and keep it off.
• Environmental factors . Although genes are an important factor in many cases of obesity, a person's environment also plays a significant role. Environmental factors include lifestyle behaviors such as what a person eats and how active he or she is.
• Physical activity . Active individuals require more calories than less active ones to maintain their weight. Additionally, physical activity tends to decrease appetite in obese individuals while increasing the body's ability to preferentially metabolize fat as an energy source. Much of the increase in obesity in the last 20 years is thought to have resulted from the decreased level of daily physical activity.
• Psychological factors. Psychological factors also influence eating habits. Many people eat in response to negative emotions such as boredom, sadness, or anger. While most overweight people have no more psychological disturbances than people at their normal weight, about 30% of people who seek treatment for serious weight problems have difficulties with binge eating. During a binge-eating episode, people eat large amounts of food while feeling they can't control how much they are eating.
• Illness. Although not as common as many believe, there are some illnesses that can cause obesity. These include hormone problems such as hypothyroidism (poorly acting thyroid slows metabolism), depression and some rare diseases of the brain that can lead to overeating.
• Medication. Certain drugs, such as steroids and some antidepressants, may cause excessive weight gain.
Q. When should I seek help?
A. You should call your doctor if you are having emotional problems related to your weight, need help losing weight, or if you fall into either of the following categories.
• If your BMI is 30 or greater, you're considered obese. You should talk to your doctor about losing weight since you are at high risk of having health problems.
• If you have an "apple shape" - a so-called, "potbelly" or "spare tire" -- you carry more fat in and around your abdominal organs. Fat in your abdomen increases your risk of many of the serious conditions associated with obesity. Women's waist measurement should fall below 35 inches. Men's should be less than 40 inches. If you have a large waist circumference, talk to your doctor about how you can lose weight.
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