Breast Screening – is it worth it?

It is my opinion that women with breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. should avoid using HRTAbbreviation for hormone replacement therapy, the administration of female hormones in cases where they are not sufficiently produced by the body. (except vaginal oestrogenA hormone involved in female sexual development, produced by the ovaries. creams) for at least two years after diagnosisThe process of determining which condition a patient may have.. The development of new drugs to reduce the risk of bone loss or osteoporosisA condition resulting in brittle bones due to loss of bony tissue. (such as bisphosphonatesA family of drugs that prevent the break down of bone by cells called osteoclasts. and raloxifene) and treat hot flushes (such as venlafaxine and gabapentin) should minimise the need for these women to use HRT.

Mastalgia literally means 'pain in the region of the breast' and is the most common symptom reported by women attending breast clinics. To make a full assessment of the cause, all patients require a full history, examination and, sometimes, investigations.True breast pain can either be cyclical (getting worse before menstruationThe shedding of the lining of the uterus (period), as part of the female reproductive cycle.) or non-cyclical (unrelated to menstruation). It is important to point out that breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. does not usually cause mastalgiaBreast pain.

Approximately one in five patients with breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. will require a mastectomy rather than a lumpectomy. As mastectomy results in the distortion of the body image, it is natural for some patients to seek reconstructive surgery. However, some women are just relieved to have had the cancer removed and are not keen on having breast reconstruction. Although an external implant is available that can be put inside the brassiere, it may be inadequate for some women.

The choice of reconstruction depends upon the woman's build, shape and size of her breasts, previous scars, and her own preferences.

A cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. can be considered as the uncontrolled growth of the cells of the body. There is unlikely to be a single cause of breast cancer but there are two categories of risk factors. We can look at things that seem to be associated with an increased risk and see if we can change any of these to reduce the risk.

To be told you have breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body. is always a huge shock. Before we consider some of the treatments available I want to make the important point of how much the treatment of breast cancer has improved over the years. In the 1970s only 50% of people with breast cancer survived for 5 years. In the best units that figure is now around 90%. Similarly the 10 year survival rate was only 40% in the 70s and it is now 80%, with a twenty year survival rate of nearly 70%. The fundamental fact is that most people will no longer die from their breast cancer; and the treatments continue to improve.

Skin-sparing mastectomy (SSM) has become a valid option for women who are undergoing mastectomy and immediate breast reconstruction for early breast cancerAbnormal, uncontrolled cell division resulting in a malignant tumour that may invade surrounding tissues or spread to distant parts of the body.. With SSM most of the natural skin envelope is preserved during the immediate breast reconstruction leading to a much better aesthetic outcome. It also reduces the need for surgery on the other breast, which may otherwise be required to give a symmetrical appearance.