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FOR BREAST CANCER, EARLY DETECTION IS KEY

Last month, new medications were approved for the treatment and prevention of breast cancer. And more progress was announced in better understanding why one woman will get the disease but nine others won't.

But we still have a long way to go to defeat one of the worst diseases for women. Breast cancer is second only to skin cancer in how often it occurs. And it's the second leading cause of death from cancer in women.

Many factors increase the risk of getting breast cancer. They include genetic heritage, higher levels of ovarian hormones, increased estrogen, beginning menstruation at an older age and never having had a full-term pregnancy.

The risk factor over which women have the least control is genes. Studies have shown that about 10 percent of women get breast cancer because of chemical change programmed into cells by their genes. I suspect, as we learn more, we'll find that percentage rises.

The risk of getting breast cancer increases if a woman's mother or sister has had the disease, especially if it occurred when they were younger. In a study just published in the Journal of the National Cancer Institute, researchers identified a protein called p53 which, when it accumulates in breast tissue, increases the likelihood of developing breast cancer. However, it's not yet known whether the protein accumulates first, causing the cancer, or another chemical change causes both.

Unfortunately, a woman has little or no control over most risk factors. That's obviously true for the biggest risk of all -- her age.

It also appears that diets high in fat, too much alcohol and too little exercise contribute to an increased risk. Even if the overall contribution of these activities is fairly small, they are controllable and improving them will help your health in many other ways.

Tamoxifen, which counteracts the effects of estrogen, has been used for years in treating breast cancer. Just recently, the Food and Drug Administration has approved the use of tamoxifen for prevention in women at high risk.

A very small number of women have taken an extraordinary step to prevent breast cancer. Because they had factors that put them at high risk and the anxiety was too much, they decided to have their breasts removed.

Each woman needs to decide what she wants to do about prevention. But the best way to lessen the impact of breast cancer is to detect it as early as possible. This is accomplished by a combination of breast self-exams, regular check-ups by a health professional and regular mammograms.

Breast self-exams and check-ups had been the only means of early detection for decades. But all too often, by the time a tumor is detected, the cancer is so advanced that more intensive treatment is needed and the chance of cure is smaller.

Mammograms are proving to be a blessing in early detection. But too many women are not getting them at all or not often enough. But how often is often enough? Researchers have found that:

Women ages 50 to 69 have a lower death rate if they have a mammogram every year.

Women ages 40 to 49 also have a lower death rate in some studies, but the reduction is less.

Women who are 70 and above have not been studied enough to tell.

Unfortunately, research has not been done to determine the additional benefit on quality of life because of early detection. But the anxiety and costs created by a suspicious-looking mammogram that turns out not to be cancer (over half the time) means too many mammograms is not good either.

The detection of a suspicious lesion on a mammogram can cause a great deal of anxiety. Even knowing that most of these are not cancerous usually helps only a little. So I suggest that, before you have a mammogram, consider where and how soon you can get a biopsy, if needed.

Many advances have been made in treatment of breast cancer. For example, for some women, removing only the tumor and sparing the rest of the breast has been shown to be as effective as a mastectomy. Also, since some breast cancers are sensitive to estrogen and some are not, therapy can be better tailored for each person.

For more information about support groups, call the American Cancer Society at (800) ACS-2345. The best online support groups I've found are in the Better Health area on America Online. Use the keyword -- Glenna. It will take you to Glenna's Garden, which is named after one of the first women to use the Internet to support other women with cancer.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@-aol.com.

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