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 is the risk of breast cancer in fibrocystic breast
condition patients calculated?
Assessing the statistical risk for any individual woman requires a careful
assessment of all her relevant health issues. The best estimates of cancer risk
relate specifically to the microscopic tissue types of fibrocystic condition.
Other factors such as family history and the presence of an inherited gene that
increases the risk of breast cancer (BRCA 1 and 2 genes) are also taken into
account. However, unless a woman with fibrocystic breast condition has a breast
biopsy; it is not possible to calculate her specific risk of developing breast
cancer.
Only 5% of women with fibrocystic breast condition have the type of cellular
changes, namely cellular hyperplasia, which represents a risk factor for breast
cancer. When compared to a "normal population" of women, these patients have a
two
to six fold increased risk of breast cancer. The exact risk depends on the degree
of the hyperplasia and whether atypical-appearing cells are also present.
It is critical for the patient with fibrocystic breast condition to understand
that this figure represents her total risk accumulated over a lifetime. This
means that her actual increased risk of breast cancer in any given year is
rather low.
Breast cancer risk assessment can also be performed using a system known as
the Gail Breast Risk Assessment tool. This system takes into account the
following factors when calculating an individual women's risk: age (the model is
valid only for women aged >35 yrs), age at menarche (the begnining of
menstruation), age at first live birth,
number of first-degree relatives with breast cancer, number of previous breast
biopsies, the presence of atypical hyperplasia on any previous breast biopsy,
and race.
What are the treatments for fibrocystic breast
condition?
The treatments for fibrocystic breast condition are directed at the individual
components of the condition, including the relief of symptoms (such as breast
pain and tenderness) and the correction of hormonal irregularities:
Relief of symptoms: Some simple measures, such as adequate support of the
breasts and perhaps wearing a bra at night, may provide relief from many of the
symptoms of fibrocystic breast condition. Antiinflammatory medications, including
acetaminophen and
nonsteroidal antiinflammatory medications (NSAIDs), often
reduce the breast pain significantly.
There are reports suggesting that a variety of
vitamins may be of benefit in
relieving the symptoms of fibrocystic breast condition. These have included
vitamin C, vitamin E, vitamin B6 and vitamin A, among others. In general, the
rationale for using these vitamins is unclear and is not based on duplicated,
controlled clinical studies. The exception may be vitamin E where, at least in
some studies, there appears to be a measurable benefit for some patients.
Another food supplement that has been claimed to be of some benefit in
clinical studies is Oil of Primrose. This substance contains certain essential
fatty acids that allegedly benefit some fibrocystic breast condition patients by
reducing their breast pain. There is no evidence showing any
correction (resolution) of the microscopic cellular abnormalities with use of
this substance, but some women experience symptom relief with this supplement.
Hormonal irregularities: Some women with very irregular menstrual cycles
seem to progressively suffer more severe fibrocystic breast condition. This
tendency is most likely due to the prolonged and irregular hormonal stimulation
of the breasts. In these patients, it is sometimes helpful to establish
menstrual cycle regularity with oral contraceptives. Regular cycles seem to
allow the breast tissue to recover more completely at the end of each menstrual
cycle.
In patients who have had a
hysterectomy and who are on
hormone therapy, it may be helpful to be "off estrogen" for five days during each
monthly cycle rather than remain on continuous estrogen. Again, this schedule is
designed to avoid the continuous stimulation of the breast tissues by estrogen.
It is important that any such hormone regulation be under the direct supervision
of a physician.
Certain common hormonal (endocrine) abnormalities, such as
diabetes or
thyroid dysfunction, may contribute to fibrocystic breast condition. Since these
conditions may aggravate the symptoms of fibrocystic breast condition, they should
be diagnosed and treated.
Studies have shown some benefit from the short term use of the
antiestrogenic drug Tamoxifen in relieving breast pain.
However, tamoxifen
(Nolvadex) use
may be associated with a number of adverse effects, especially in postmenopausal
women, and its use should be limited to the short term. Likewise, the androgenic
steroid drug danazol
(Danocrine) has also been shown to reduce breast pain and nodule size
in women with fibrocystic breast condition. Danazol is also associated with a
number of serious side effects. Both of these medications may be considered for use in
women with severe cyclical breast pain due to fibrocystic condition.
Cysts are saclike structures that can occur throughout the body and usually contain a semisolid, liquid, or gaseous substance. Infections, tumors, genetic conditions, chronic inflammatory conditions, and wear and tear can cause cysts. Though some cysts may be palpable, others may not produce any symptoms. Treatment depends upon the location and cause of the cyst.
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.
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.
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.
Lifestyle changes, a healthy antioxidant-rich diet, exercise, and weight reduction can help reduce a woman's risk of developing breast cancer. It's important to be aware of how risk factors such as family history, lifestyle factors, breast conditions, radiation therapy, and hormonal factors may influence your chances of developing breast cancer. Mammography and breast self-examinations are crucial steps in breast cancer prevention.
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