The appropriate treatment for breast cancer has changed dramatically during the past few decades. At one time, the standard practice was radical mastectomy with an extensive regional lymph node dissection. Current surgical approaches generally involve ultrasound guided biopsy of a suspicious breast lesion that, if positive for malignancy, is followed by surgical removal, irradiation treatment and staging via the excision and microscopic examination of a ‘sentinel’ axillary lymph node draining the tumor. Most patients with invasive cancer have a treatment plan individualized to their particular tumor with regard to stage, tumor pathology and genetic studies. There are many new exciting neoadjuvant treatments for breast cancer.
Early diagnosis through regular self-examination of the breasts for changes in texture, contours or actual lumps and screening mammography are the keys to early diagnosis and treatment that produce better outcomes.
The guidelines for when to start screening mammography are controversial. In general, women ages 40-49 should get screening mammograms every one to two years, if they have an average risk for developing breast cancer. For women 50 years and older, mammograms are recommended every one to two years.
Women at higher than average risk should start mammography before age 40 and this includes:
- History of breast cancer
- More than one family member with breast cancer
- Genetic changes and markers that carry a higher risk of getting breast cancer
- Plus many more minor risk factors which are beyond the scope of this editorial.
With newer surgical and neoadjuvant treatments plus earlier diagnosis, the percentages of long term survival from breast cancer has greatly improved.