Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
How helpful are BRCA1 and BRCA2 genetic tests in identifying women at risk?
In special circumstances, genetic tests can be very
helpful both in identifying exceptionally high-risk patients and reducing the
level of concern for others. We also now know that the presence of one of these
genetic defects does not cause cancer in every patient. The cancers that do occur may also
behave somewhat differently than non-BRCA-associated tumors. There is some
evidence that they have a better outcome.
Before genetic tests are conducted, individuals being tested must have
thorough counseling. A clear understanding of the limitations of the tests and
the problems they may pose must precede the testing. The patient must know the
meaning of the possible results, whichever way they may turn out, before
testing. They should also have settled on a plan for each possible outcome of
the test results. Often, the best way to evaluate a potential genetic risk is to
test a relative who has already been diagnosed with breast cancer. If the
relative's genetic testing (which must cover a large number of possible
mutations) proves negative, then there is no need to perform genetic testing on
the concerned individual. But the concerned individual should still undergo
close monitoring with breast examinations and mammograms. If the test is
positive on the relative, then that specific mutation is the only one that needs
to be checked in the concerned individual and the other family members.
What is the link between estrogen and breast cancer?
Estrogen is a female hormone that is produced by the ovaries. During the
reproductive years, a woman's body is exposed to high levels of estrogen. After
menopause, the production of estrogen by the ovaries decreases. Estrogen is
sometimes prescribed to treat some of the problems often associated with
menopause, such as hot flashes, night sweats, sleeplessness, and
vaginal dryness. Estrogen has the additional benefit of prevention of bone
thinning (osteoporosis). However, results from a large clinical trial of postmenopausal women
receiving hormone therapy (HT) released in 2002 showed that
the overall risks of estrogen plus progestin therapy
outweighed the benefits of
hormone therapy. Combined hormone therapy with estrogen and progestin was shown to increase the risk of
heart disease, stroke,
and blood clots.
High levels of estrogen over long periods also increase the risk of
developing breast and uterine cancers. Estrogen stimulates the cells of the
breast and the uterine lining to grow and divide. Breast cells that are actively
dividing are believed to have a greater chance of DNA damage as well as a higher
number of cells that already have DNA damage. A higher number of cells with DNA
damage elevate the risk of cancer development.
Women who have an early onset of their menstrual period (or menses) and late
menopause are more likely to develop breast cancer than women with late menses
onset and early menopause. This difference is believed to be attributable to the
longer period of estrogen exposure in the first group.
Breast cancer is the most common cancer in women and the second most common cause of cancer death in women in the U.S. Symptoms include a lump in the breast or underarm area, nipple pain, change in breast size or shape, an inverted nipple, nipple discharge, and breast skin changes. Treatment may involve chemotherapy, radiation therapy, biological therapy, hormone therapy, or surgery.
Alcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law.
Fibrocystic breast condition (sometimes called fibrocystic breast disease) is characterized by lumpiness and usually discomfort in one or both breasts. The condition is very common and benign (not malignant). Fibrocystic breast condition is the most common cause of "lumpy breasts" in women. A common symptom of fibrocystic breast condition is breast pain or discomfort. There are two types of fibrocystic breast condition, cysts and fibrosis, and Hyperplasia and atypical hyperplasia of breast cells.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Obesity is the state of being well above one's normal weight. A person has traditionally been
considered to be obese if they are more than 20 percent over their ideal weight.
That ideal weight must take into account the person's height, age, sex, and
build.
Breast lumps in women can have a variety of causes such as breast inflammation, infection, injuries, cancer, and non-cancerous growths. Breast lumps in women are diagnosed with physical exam, mammogram, ultrasound, MRI, and biopsy. Treatment of breast lumps in women depend on the cause.
The breast generally refers to the chest, however, more specifically, to the mammary gland. The mammary gland is a milk producing gland comprised largely of fat. Within the mammary gland is a complex network of branching ducts. The ducts exit from sac-like structures called lobules, which can produce milk in females. The darkened area around the nipple is called the areola. Common medical concerns in regard to the breast include breast lumps, breast cysts, breast cancer, and breast infections.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Though it's difficult to say why some people develop cancer while others don't, research shows that certain risk factors increase a person's odds of developing cancer. These risk factors include growing older, family history of cancer, diet, alcohol and tobacco use, and exposure to sunlight, ionizing radiation, certain chemicals, and some viruses and bacteria.
There are a number of different methods of birth control to include: barrier methods, IUDs, hormonal methods, natural methods, and surgical sterilization. Birth control methods can be reversible or permanent. In simple terms, all methods of birth control are based on either preventing a man's sperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
As breast cancer is the most diagnosed non-skin cancer in American women, it is important to know your breast cancer risk. Risk factors include age, age at menarche, age at first live birth, history of breast abnormalities, breast biopsies, race, and history or breast cancer among first-degree relatives.
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