October is breast cancer awareness month.  Thanks to the efforts of the millions of individuals affected by breast cancer the treatment options for this terrible disease continue to grow.  Historical perspective shows us how far we have come in the surgical treatment of breast cancer.  At the turn of the twentieth century, breast cancer was only discovered when it had grown to a very large size and was incurable.  Surgery at that time consisted of an operation termed Radical Mastectomy. This surgical treatment involved removal of the breast tissue, most of the overlying skin, lymph nodes under the arm, and the pectoral muscle of the chest wall.  Thanks to advances in technology and surgical technique, women today have much less invasive options for the surgical treatment of breast cancer.

But how do we effectively fight breast cancer on the front end of the disease?  The answer is early detection.  Early detection of breast cancer requires a three prong approach.  This approach works best when the patient and physician have a partnership for breast health.  Breast Self Exam or BSE involves the patient doing monthly self exams to notice any changes or masses in the breast or the breast skin.  Clinical Breast Exam or CBE involves physical examination by the physician. Mammogram and ultrasound are the third part of this approach.  These imaging studies allow the physician to see abnormalities not appreciated on a physical exam. 

Women should also be aware of how certain risk factors affect the chance for them to have breast cancer.  Family history is the most important of these risk factors.
BSE and CBE should both be part of well woman exams and health maintenance programs.  But when should women have a mammogram?  The best answer to this question can be provided by a trained health care professional after a thorough history and physical as well as breast cancer risk assessment has been done. All women should have a baseline mammogram between the age of 35 and 40 depending on their family history.  When a mammogram is not normal, where do you go?

Biopsy techniques using guidance by ultrasound and mammogram make surgical biopsy less likely.  The techniques are less invasive and have shorter recovery than surgical biopsy. If a diagnosis of breast cancer is made on a biopsy, this will start an involved process of discussion with your physician concerning options.  This is where new technology and technique really allows us to help our patients.  Research data has shown that lumpectomy or partial mastectomy with post-operative radiation is equivalent to mastectomy for the surgical treatment of the primary breast cancer.  Instead of removal of all lymph nodes under the arm, nuclear medicine technology allows us to remove the sentinel lymph node which drains the tumor bed.  These procedures are both less disfiguring and easier to recover from. Post operative breast radiation takes six weeks of daily treatments.  With new technology, Mammosite partial breast irradiation can treat selected post-op patients in five days.
These advances only scratch the surface of information on advances in the treatment of breast cancer.  Working with oncologists, radiologists, radiation oncologists, gynecologists, and primary care physicians, surgeons will continue to be at the forefront of breast cancer diagnosis and treatment. To win the fight, we need to work together, patients and physicians, to educate as many women as we can about breast cancer.  As new technology advances, we will continue to improve our patients’ treatment options and win the battle against breast cancer.
Scott R. McDearmont, M.D., F.A.C.S., practices General Surgery at Medical Center of Lewisville and Baylor Surgicare in Lewisville