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A recent study points to the urgent need for women to better understand the difference between mammographically detected ductal carcinoma in situ (DCIS) and invasive and potentially life-threatening breast cancer. Few cases of DCIS are clinically significant, but almost all will be treated surgically.
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Even with increased diagnostic capabilities and awareness, mortality rates have not changed in the last fifty years. Breast cancer still accounts for 17 percent of cancer deaths in females.9 |
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The latest U.S. statistics estimated about 180,300 cases of breast cancer in 1998; that 14 percent of women will be diagnosed with this disease in their lifetime; and that the potential reduction of risk through diet and lifestyle ranges from 33 to 50 percent. In addition, global statistics show that two to five out of every 100,000 women in Thailand and Sri Lanka die of breast cancers compared to the United States' rate of thirty to forty out of 100,000.10 |
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Breast cancer is most often discovered by the patient and presents itself as a painless lump with no cyclical variations. There is usually no bilateral lumpiness, as with cystic breasts, and the lump is normally rock hard and not always apparent. Nipple discharge, unless bloody, is not likely to be an indicator of cancer. |
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Routine mammography may pick up and be of benefit in postmenopausal women, but it does not seem to help premenopausal women. False negatives are twice as likely to occur in premenopousal mammograms because of their denser breast tissue. The risk of death from breast cancer appears to be higher in premenopausal women who undergo annual mammography compared with those who undergo a simple annual physical examination and complete a health questionnaire.11,12 |
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Once breast cancer has been diagnosed, the stage of the cancer and the course of treatment will be determined by a number of factors, including the size of the tumor, its location, specific characteristics of the cancer cells, and the patient's age, menopausal status, and general state of health. (See table 2.2.) |
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The following system of clinical staging has been adopted by most U.S. cancer centers. |
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