Stacy was a young physician in training when I first met her. It was the summer of 2002 when we started our internal medicine residency training.
Fellow residents knew Stacy as the kindest, most levelheaded and supportive member of the team, and it was a privilege working with her.
Stacy passed away in 2006, in her mid-30s, after an unsuccessful battle with metastatic breast cancer, leaving behind a husband and a 4-year-old son.
On a Saturday morning, during her final weeks, we were talking and eating breakfast together in her room in the oncology wing of the hospital. I remember looking at her and noticing her sunken eyes, cachexia, loss of hair, and bright smile! Stacy was strong and positive even at the end. She will always be remembered.
Most medical societies agree that women of average risk who are 40 years or older should get annual screening. There are several methods by which breast cancer screening can be done. The most common is traditional mammography.
This diagnostic test involves compression of the breast while low-dose X-rays penetrate the breast to form several images on film. Traditional mammography is more sensitive in postmenopausal women because as women age, the breast tissue gradually transforms from dense glandular to less dense fatty tissue. It can be difficult to detect abnormalities in a dense glandular breast.
Several factors can affect accuracy of mammography: hormone replacement therapy (HRT), previous breast surgery and the time in the menstrual cycle of a pre-menopausal (typically younger than 50 years old) woman.
Be sure to talk with your doctor about ways you can get the most accurate mammographic screening.
The full-field digital mammography (FFDM) technique is similar to the traditional mammography, except the film is stored electronically. This allows better visualization and comparison by the radiologist, which is important when screening younger women.
Computer–aided detection (CAD) involves a computer program that assists the radiologist in identifying suspicious areas of the breast.
Magnetic resonance imaging (MRI) is recommended in screening only high-risk women.
Clinical breast exams (CBE) are the breast exams performed by the health care provider. Together CBE and mammography should be a part of an annual screening program. Talk with your doctor to see if self-breast exams are right for you and to find out how to properly perform one.
Tips on Breast Cancer Prevention
• Get regular screening. If you fall into a high-risk category, see your doctor earlier than you otherwise would, as some additional testing may be done.
• Maintain a healthy weight.
• Eat more fresh fruits and vegetables and limit animal fats and red meat.
• Exercise regularly.
• Limit alcohol.
• Limit long-term use of HRT if you’re a postmenopausal woman. Talk with your doctor about non-hormonal alternatives.
• Some new data suggests that certain antioxidants such as those derived from Vitamins A, D, E and C may have a role in prevention.
• Medications called selective estrogen receptor modulators (SERMs) have been used as a preventative treatment in certain patients, but they too have their risks.
The information provided here is general and directed at women who are at average risk for breast cancer, not women at high risk or men.
Please check with your doctor or healthcare provider to see which risk category you fall into, which screening is right for you, and which lifestyle changes are safest and most beneficial for you.
For more information, visit the National Cancer Institute at www.cancer.gov, the American Cancer Society at www.cancer.org, the U.S. Preventative Services Task Force at www.ahrq.gov, or the Centers for Disease Control and Prevention at www.cdc.gov.
Remember, prevention is better than cure!