Women's Health Specialists of St. Louis
Obstetrics and Gynecology

Articles - Introduction

As an Obstetrician/Gynecologist, my job is to understand the female reproductive system, hormones, and sexuality. I have the privilege of assisting women through moments in life that define us as women such as menstruation, birth, and menopause. As a woman, these subjects are also personal. I hate having a period, I worry about breast cancer, and sometimes I have PMS.

In my practice, I offer my patients compassionate and scientifically based care, but unfortunately the office environment does not always allow for the depth of explanation. For some time, I have considered a column as a means of communicating one on one and woman to woman the issues that I am asked about daily. As October is breast cancer awareness month it is only fitting that I should begin with this subject.

Breast cancer is second only to lung cancer as the leading cause of cancer deaths. This means that it will affect one out of eight women who live to be in their eighties. The majority of these cancers are not genetic. So, if you do not have a family history of breast cancer it does not mean that you cannot or will not get breast cancer. Since breast cancer is so common, however, about one out of every four women will have at least one relative with a history of breast cancer. Women who have a first degree relative (mother or sister) with PRE-menopausal breast cancer or a family history of ovarian cancer are more likely to have inherited a gene mutation that increases the risk for breast cancer. Inherited risk for breast cancer causes only 5-10% of breast cancers. There are medical options to help prevent cancer in women who are at increased risk.

So how do we protect ourselves? Statistical models are available to help identify women who may be at increased risk. These models take into account a woman's age, family history and reproductive history. Anyone who is concerned about their risk should talk with their physicians about available options. All women should do monthly self breast exams. Many women complain to me that their breasts are too lumpy to feel what is normal. The important thing is symmetry. If both breasts are lumpy in the same location, it is likely to normal. It also is normal for your breasts to be more tender and lumpy around the time of your period. Some women are plagued by very lumpy and painful breasts which make exams difficult. This is called fibrocystic breast change and is not a precursor to cancer. Fibrocystic breast changes are more common in women who have changes in their hormones (perimenopausal, new HRT, or new birth control pills). So what do you do if you find a mass? Dont panic but be proactive. First, compare to the opposite breast. If the mass is unilateral contact your doctor. Notify your doctor if you have discharge from your breast. Depending on your age, medical history, and family history, your doctor may begin with an exam, mammogram or breast ultrasound. Sometimes the exam may need to be repeated after a menstrual cycle has passed. All women should have a screening mammogram at age 35 and then routine screening as directed by their physician starting at age 40. Mammograms are not generally recommended before age 35 for screening as the breast tissue is too dense. Thankfully, breast cancer doesn't equal a death sentence. Early detection is the key. Though detection techniques are improving with technology, it is important that we as women make sure that we get screened.