FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

Editor's Note: Nov. 14-20 is National Osteopathic Medicine Week (celebrated Nov. 6-13 in Athens because of OU-COM academic calendar). 

This year's theme is "Women's health care for a healthy and active lifestyle."

A WOMAN'S "HEALTHY, ACTIVE LIFESTYLE" INCLUDES MAMMOGRAMS

Question: I'm a female college student and have never given much thought to my health. Not too long ago my older sister was operated on for breast cancer, and my mother had this operation when I was about ten. Though they are both doing fine now, I'm starting to worry about my own health. What should I be concerned about? How often should I see the doctor?

Since the theme for the upcoming 1999 celebration of National Osteopathic Medicine is "women's health care for an active, healthy lifestyle," I thought it would be most appropriate to answer this question about breast cancer. I can think of no better way for you to insure an active, healthy life than to take steps to make sure that, like your mother and sister, you are a survivor -- and not a victim -- of this disease. It's commendable that you have already learned an important lesson from your sister's experience -- early detection is a key to successful cancer treatment. While cancer of all kinds is the second most common cause of death for women, this scourge originates in the breast far more often than in any other organ. There are about 180,000 women with this dreaded disease every year! You might be surprised to learn that men, too, can get breast cancer, but it is very uncommon.

Medicine hasn't identified a way to prevent breast cancer, but early detection can dramatically improve chances of survival. Even though you are young, I urge you to start regular monthly breast self-examinations (BSE) and report any questionable findings to your doctor immediately. Your family physician or gynecologist can teach you how to do a BSE. I'm sure most of my female readers know that a yearly breast examination by a physician and yearly mammograms are advised after age 50. But how many of you do these simple tests? A national survey a few years ago showed only 41 percent do. This is disconcerting because an annual physical exam with mammograms reduces the risk of dying from breast cancer by 25-30 percent. Some women avoid mammograms because of a mistaken belief that they have little risk of developing the disease if no one in their family has had it. Unfortunately, 75 percent of women with breast cancer have no family history or other risk factors for the disease.

On the other hand, a woman -- like you -- with a family history of breast cancer should begin yearly physicals and mammograms at an earlier age. Since, with a few exceptions that I'll mention later, we do not yet have blood tests to identify genetic defects that might lead to breast cancer, we must rely on one's family and medical history to indicate who is at high risk.

If you are of Icelandic or Ashkenazi Jewish descent, I urge you to see a medical geneticist. (Experts in this discipline are usually found at university-based medical centers.) Specific gene defects that increase the risk of developing breast cancer have been identified in these populations. Tests are available to identify those who carry these defective genes. The excellent research at the University of Iceland, for instance, has identified a defect known as 999del5 on the BRCA2 gene as being responsible for about 75 percent of all familial breast cancer in that country. This defect, by the way, also seems to increase the risk of prostate cancer among male carriers and pancreatic cancer among both male and female carriers.

However, again, these are the exceptions. If you have a family member who has had breast cancer, you are automatically in a high-risk group. Talk to your family physician about early detection steps you can take. These will increase your chances of having a healthy, active life for years to come.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.