Education

Biopsy (removal of a portion of breast for diagnosis and/or treatment):

The microscopic examination of tissue removed from the breast provides fundamental information for determining the diagnosis and prediction of medical management to follow. Indeed, microscopic diagnosis is now and has been for over one hundred years the basis for the diagnosis of breast cancer in all its variations. After the surgeon or other clinician has removed a portion of breast for diagnosis or therapy, it is taken to the pathologist for analysis. These samples can then be sent to the Breast Consultation Service at Vanderbilt for further interpretation of the clinical implications and treatment options.

Many special types of breast cancer are now well described, and an increasing important one is ductal carcinoma in situ. Ductal carcinoma in situ (DCIS) has been recognized for several decades as a lesion similar to invasive breast cancer, but is confined to the ducts and glandular spaces of the breast (not yet invasive). DCIS is a proven precursor of invasive carcinoma, and if it is adequately treated, that specific lesion will not get larger or become invasive carcinoma. Our service has a specific interest in the definition, natural history and treatment of the many kinds of ductal carcinoma in situ.

Fibrocystic changes:

Much has been said about this common condition, particularly in the years preceding the menopause. It cannot be considered a disease because it is not regularly associated with symptoms of pain or discomfort, and is not a reliable indicator of the increased risk of breast cancer. However, it is possible that the very few women with many, large and recurrent cysts (usually needing decompression by removal of fluid) may have an increased risk of breast cancer. The more common indicators of increased risk that are over double that of similar women are discussed here because many of them are determined by analysis of breast tissue under the microscope.

Risk of breast cancer:

Much is said in the popular press and commentary about the risk of breast cancer and its associations with family history, lifestyle, mammographic patterns, and others. Most of these risks are so low that they really are difficult to relate to an individual woman. Risks constantly change with age, and many of the risks discussed in scientific studies are bound or restricted by the types of patients and the studies in which they were done. We believe that risks only become relevant to individuals when they definitely exceed a doubling of similar women over a similar length of time.

Example of understanding breast cancer risk: Within the 12 months between their 40th and 41st birthdays, the majority of women in North America experience a risk of developing invasive carcinoma of the breast (breast cancer capable of producing a measurable risk of causing death) that is approximately one woman in a thousand. This is an absolute risk figure expressed over a specific length of time. A relative risk figure would begin with such a background and work as follows: a doubling risk (synonyms = increased 2 times, or increased by 100%) would produce an actual risk of 2 women developing invasive cancers in a group of 1,000 women with the added risk factor. Viewed in this way, risks of less than double such as 10%, seem too small to deal with.

Risk of breast cancer considered over longer times such as ten years may be more useful. Women born in the U.S.A. and Canada have a ten year risk of invasive breast cancer after the age of forty which is 1 in 67, reaching 1 in 17 if risk is increased four times during this ten year period. Such risks are associated with strong family histories of breast cancer - including multiple close relatives, particularly if diagnosed before the menopause and even more so if there is a history of bilateral breast cancers in the family. On the other hand, history of a single family member with a previous diagnosis of breast cancer of most types does not confer any meaningful risk of breast cancer on the relatives, i.e. the risk of the relatives is not reliably different from women without such a minor history of familial breast cancer.