Hilary Term Week 6, 2004
Breast cancer
Cases of breast cancer: It is very rare in women under the age of 40, even rarer under 30. However, the fatality rate is much higher in women who get it before their menopause, though there are far more incidents of it in women who have been through the menopause. This is probably linked to oestrogen production, as these tumours possibly feed off oestrogen.
Chances: Doctors can only talk about population statistics, individual cases do vary.
- Has single primary tumour and no secondary tumours: 95% chance of surviving 5 years
- Has single primary tumour and secondaries in lymph nodes: 77% chance of 5 years
- Has secondary tumours elsewhere: 21% chance of surviving 5 years
Doctors do not talk about cures in cancer; they talk about years of survival. Chances improve after more years.
Treatments: The difficulty here is that what works for one person, may not work for everyone else. Scanning is easier in women over 50; under 50 the breast tissue is thicker and plumper from oestrogen, so harder to get good mammograms. In order to get good mammograms more radiation needs to be used. The jury is still out on early mammograms, there isn't enough evidence yet so say one way or another for sure on whether they are a good idea or not. It is a good idea to scan those who are at extra risk.
There is an increased risk in people who:
- started their period before the age of 12.
- have a relative who had breast cancer (primary relatives - grandmother, mother, sister - more so than secondary relatives - aunts, cousins).
- have a late menopause (after the age of 55 - 51 is the average age to go through the menopause in Caucasian women).
- have BRCA genes (1 and 2), which are not necessarily found only in women with a family history of breast (and ovarian) cancer. There is testing for the genes, for women who have a family history.
- are taking HRT- it shouldn't be taken for longer than 5 years.
- have their first child late (after 30 or 35 years), or don't breast-feed or don't have any children - a slight increase in risk.
This last point doesn't fit in with the oestrogen factor, that cases of breast cancer tend to be linked with women who have oestrogen in their body for longer than average.
Examination of breasts: The best time to examine breasts is just after menstruation. The main difficulty and pit-fall of self-examination is there is often no point of reference; what do other breasts feel like? They do change in how they feel during the month.
Are what stage should one pursue mammograms?
- Young women (that is those under 40), can get fibrous lumps, which are different from the lumpiness that women often get when they are pre-menstrual. Pre-menstrual lumpiness is a granular feeling and bilateral.
- Women between 40-50 usually get cysts (fluid filled lumps).
Look for lumps that do not go down after the period and are only on one side. Dangerous lumps tend not to be painful. They also tend to feel craggy and irregular, and are fixed to surrounding tissue and can lead to changes in the contour of the breast. If there are dimples in the breast then this can mean that the breast is being tethered in by something. However, always have lumps checked.
To check for lumps: Put arm behind head, as this pulls the pectoral muscles back and allows you to feel breast better. Palpate all around the breast. Armpits need to be examined as well. For this arms need to be relaxed, then doctor will feel inside arm- often when there are problems the lymph nodes will swell.
Oddities: Discharge from the nipples is not always to do with cancers; could be due to pituitary problems too.
Main points:
- early detection is the main thing, this can make a huge difference to the outcome.
- family history - there is gene testing available.
- get all lumps checked out.
Testicular cancer
Cases of testicular cancer: These are mostly in young men (20-40 year olds).
Examination: Self-examination is very important. There are again the same problems of often not having any points of reference; of not knowing what is normal and what is not.
There are not just testes in the scrotum, but also tubes.
Look for lumps on the testicle. A lump the size of half a pea is a cause for concern.
Lumps that are not fixed to the testicle are usually cysts.
Again, dangerous lumps are usually painless.
Undescended testicles are a high predictor for testicular cancer- checking for undescended testicles is not for future fertility but for this.
Treatment: This always involves the removal of the entire testicle.
Chances: If the lump is found and treated before it has spread, then there is a 99% chance of survival. The figures are still good if it has spread to the lymph nodes, around 88%.