Ladies’ Lumps, Hockey Bumps and More! By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

In women over 65 years of age, breast cancer remains the number one case of death due to cancer. The majority of breast cancers are found in this age group, but it is the younger women who seem to worry more. It may be due to greater awareness, but there seems to be a trend for some women in their thirties to ask for mammograms. Younger women are more likely to be interested in screening despite almost 60% of breast cancers being found in women over 65. This is a very interesting observation, because it suggests that environmental factors such as toxins are inter-related with the genetic factors.

“Screening” is a term that I think causes at least some confusion. For the greater part, most people feel that it is synonymous with mammogram. It is erroneous to think so. In my view screening starts by assessing the patient as a human being. Attention must be drawn to genetic factors by asking specific questions. I look at people’s lifestyles, what they eat, and levels of exposures to different agents, exercise and finally body-type. The amount of breast tissue present is not a risk factor, but certainly influences the quality of a physical assessment that can be performed on a suspicious lump. This is why arguments exist about the value of doing self-examinations. I tend to favor the pro camp and attempt to teach patients how to perform self-examinations as well as trying to educate what the different findings suggest. Younger women seem to be better adept at finding "things" in their breasts. Ideally, we would like the over 65 crowd to become more astute at this as well. But what actually happens at times is that they tend to be busy dealing with numerous other health problems and simply put it on the back burner. Screening of the whole person has lead to earlier detection and better outcomes. The earlier the better!

After the clinical screen, decisions must be made about other tests that should be performed. Mammography is an X-ray of the breasts, which can "see" the whole breast. It is usually employed as a tool to double-check women over 50 in whom everything seems fine. The good news here is that it can be uncomfortable, and may soon be replaced by a new digital "squeeze free" test. To assess a known lump, an ultrasound is used or the area may be sampled directly using a fine needle. Occasionally an "open biopsy" is used. This is a surgical procedure that looks at and removes the lump and some surrounding tissues.

If cancer is found it must be staged, which is a way of characterizing it for treatment options. Breast Cancer is staged according to the TNM (tumour-node-metastases) system. This system looks at how big the lump is, if there are any associated lumps, and the microscopic data to evaluate treatment options. The two most common breast cancers are ductal and lobar. Rarer forms such as Pagets Disease which mostly affects the nipples are also found. The good news is that the majority of lumps and bumps that we assess in family practice turn out not to be cancer.

Breast Cancer can be beaten! A group of local doctors have decided to put their sticks where their stethoscopes are. Hockey simply got more votes than the Full-Monty Doctor Calendar. So, on Wednesday February 13th, 2008, Hershey Centre, 5 pm. The Mississauga News and the St.Mikes Majors presents “Docs on Ice”. My own Bandage Clad Blades coached by NHL great, Johnny Bower have challenged Dr.Dennis Izukawa’s Tyranical Titans coached by Ron Lenyk to a duel on ice. Even the ice will be pink by the time we are through, and proceeds go to Breast Cancer Research. For a mere $8 you can cheer on your favourite doc, raise funds for breast cancer, meet a famous Maple Leaf Stanley Cup Champion, and even stay to watch the St.Mikes Junior Game at no extra cost. And it’s all thanks to Mr. Ron Lenyk and the News, one of the most valuable, community spirited individuals in our city. We hope to see you there!