By Philip Caravella M.D.

Breast cancer can also be detected in earlier stages than before, using new technology. And new treatments are leading to greater success in managing and curing the disease.But for all patients with breast cancer, particularly those who are newly diagnosed, the details of preventing and treating the disease can be confusing. What follows is a breast cancer prevention and detection primer:

There are several known factors associated with the development of breast cancer.

1) Genetics affects a small percentage of patients.

2) Weight gain after the age of 18 is related to an increase in breast cancer occurring after menopause. The more weight gained, the greater the risk of developing breast cancer. Gaining five pounds increases your risk by about 10%. Gaining 88 pounds or more at least doubles your risk.

3) Exercise appears to lower the risk of developing breast cancer. Those who exercise 1-4 hours per week lower their risk by one–third when compared to a sedentary woman. Exercising over four hours per week lowers the risk by 50%.

4) Reducing alcohol consumption to a minimum seems to lower the risk of breast cancer as well. Limited alcohol consumption is believed to be beneficial in reducing the risk of heart disease, so a compromise is needed. Up to three drinks of red wine per week could be beneficial, but consult your physician. Women consuming between two to five drinks per day have a 40% greater risk of developing invasive breast cancer. The risk is the same for all forms of alcohol.

5) Increasing the intake of vegetables lowers your risk. The more brilliantly colored the vegetable, the more vitamins, minerals, and nutrients it has. Eat the darkest green, the reddest red, and the brightest yellow vegetables and fruits for best results. Fruits are not as closely linked as vegetables to reducing breast cancer but are certainly beneficial in preventing other diseases.

6) High fiber foods are beneficial in preventing colon and heart disease but may or may not be helpful in preventing breast cancer. Phytoestrogens found in soy products may lower the risk of breast cancer but this has not been confirmed.

Including the latest technique: TOMOSYNTHESIS

Background: About twenty percent of patients have a significant family history of breast cancer occurring in first-degree relatives including siblings, parents, and grandparents.

There are other factors that increase the risk of developing breast cancer such as obesity. The Gail Risk Assessment Model (GRAM) developed at the National Cancer Institute can be used to identify women between the ages of 35-85 at increased risk for breast cancer.

Women outside of this age range, or those being treated with Tamoxifen, must be evaluated using other methods. The GRAM scale takes into account such factors as age, onset of menarche (menstrual periods), age of first pregnancy, number of previous breast biopsies, and other factors. Your physician may be able to determine your risk profile by using this assessment tool.

Other developments in breast cancer detections includes:

1) Daniel B. Kopans, M.D., Professor of Radiology, Mass General Hospital, reported in a study of 450 patients a new method of detecting early breast cancers not seen by conventional mammography. Data reported by Dr. Kopans indicates about twenty percent of breast cancers are missed by mammograms and will go undetected until the breast examination at the time of a patient’s next visit. Clearly, better technology is needed.

One new technique is referred to as "Tomosynthesis". It visualizes breast cancers hidden behind normal breast tissue not found with mammograms. Tomosynthesis provides a three dimensional view, utilizing 111 images over a 7 second time span, from a single breast compression.

This method prevents false positive results from overlapping structures within the breast eliminating the need for additional views. It more precisely locates the suspicious area and reduces the need for unnecessary biopsies.

Benign breast cysts are more easily distinguished from cancer. Dr. Kopans believes digital Tomosynthesis will replace two-dimensional mammography for breast cancer screening. He stated, “For the first time the computer will be able to compare studies between years.” Many patients universally praise the lower discomfort level from this method.

2) MRI is being used for some high-risk individuals to detect breast cancer not found by conventional mammography. High cost is its main deterrent.

3) DUCTAL LAVAGE: This is a fairly new procedure used with imaging studies to collect and analyze cells obtained from the milk ducts of women found to have abnormal nipple discharge or suspicious lumps near their nipples. Women who have been found to have abnormal cells in their milk ducts (atypical ductal hyperplasia) are at 5-6 times greater risk of developing breast cancer. When those same women are placed on Tamoxofen, their risk diminishes by about 85%, when compared to a placebo group.

4) Ten to fifteen percent of breast cancers are found by self-breast examination in women with normal mammograms. Self-breast examination is worth the effort.

5) Imaging studies to evaluate for breast cancer include mammography and breast ultrasound.

6) Annual medical visits to screen for serious medical problems are worth the effort.

A favorable outcome to any medical problem, especially breast cancer is often dependent upon how well you accept your role in the process. Following instructions, taking medications, returning for follow up visits and testing, and seeing consultants are often critical to long term success and recovery.

Philip Caravella, M.D., is a faculty member at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. He is board certified and a Fellow of the American Academy of Family Medicine. He authored a patient advocacy guide, The Art of Being a Patient.