Tampa Obstetrics, Fertility & Gynecology

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Adam S. Levine, M.D. recently finished his fellowship in reproductive endocrinology and infertility within the department of gynecology and obstetrics at the Johns Hopkins University School of Medicine. His areas of expertise include reproductive endocrinology, infertility, assisted reproductive technology, reproductive surgery, pediatric and adolescent gynecology, and menopause.

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breast problems

Q:    My 20-year-old daughter has one breast that is approximately one size larger than the other. I took her to the pediatrician when she was in her teens, and the doctor told us that this situation is common and that there was no reason to be concerned. But my daughter is very self-conscious about this, and I am concerned that it may indicate other health problems. Is there any reason for concern and can the size be corrected with hormone or other treatments other than surgery? A:   It is common and normal to have breasts of different size. This type of finding usually does not suggest an underlying health problem. There are no hormonal methods commercially available that will only affect one breast.
   Even though it is not uncommon to have different size breasts some women are uncomfortable with this. There are a multiple ways to deal with this. In addition to cosmetic surgery, there are a number of prosthetic devices that may be worn. In this case, a consultation with a cosmetic breast surgeon may be helpful.

Q:    What are the best ways and most important factors for a woman to assess her individual risk of breast cancer? A:    There is no one best way for an individual woman to assess her risk of breast cancer, because the disease itself is multifactorial. However, a woman may wish to examine which risks apply specifically to her (listed below, with greatest risk listed first) and then discuss them with her physician. Importantly, all the risks listed below probably only contribute to between 20 and 25 percent of all cases of breast cancer. Other causes of breast cancer may be related to defects in the immune system or genetic mutations. Alterations in chromosome 17 (also known as BRCA1) account for between 5 and 10 percent of all cases of breast cancer (25 percent of all cases of breast cancer in women under 30 years of age). Women with this genetic anomaly also have a 40 to 60 percent lifetime risk of developing ovarian cancer.
    Factors associated with an increased risk of breast cancer include: prior history of breast cancer; advancing patient age; family history of breast cancer in a first degree relative (mother, sister, daughter); birthplace (Northern Europe and North America); a history of other female cancers (uterine, ovarian); higher socioeconomic status; never married; never pregnant; first pregnancy after age 30; obesity; and a history of radiation exposure.
    There are many other factors whose association to breast cancer remains unclear, for example, treatment with oral contraceptives or hormone replacement therapy. There are an equal number of studies that report an increase in breast cancer risk with oral contraceptives or hormone replacement therapy as there are that report a decrease in risk.

Q:    My mother-in-law was just diagnosed with calcium deposits in her breast tissue. Is this a serious condition? Could it become cancer? A:    Calcium deposits in breast tissue are fairly common and are usually diagnosed during mammography (breast x-ray). They may result from benign conditions such as past trauma or from malignant conditions such as breast cancer. Generally, the appearance, location and presence of these calcium deposits in one or both breasts will provide some information regarding whether they are benign or malignant. It is important to correlate mammographic findings with physical examination findings. Frequently all that is necessary is to repeat the examination and mammogram in several months. In some cases, depending on the mammographic appearance of the calcium deposits, a breast biopsy may be recommended. This biopsy may either be by a small incision or by a fine-needle aspiration.
   There are several factors associated with an increased risk of breast cancer. They include: prior history of breast cancer, advancing age, family history of breast cancer in a first degree relative (mother, sister, daughter), birthplace (Northern Europe and North America), a history of other female cancers (uterine, ovarian), higher socioeconomic status, never married, never pregnant, first pregnancy after age 30, obesity and a history of radiation exposure.
   Women with unusual breast examinations or mammograms may benefit from an evaluation at a specialized breast center where experienced breast surgeons and radiologists specializing in mammography work closely together.

Q:    I am a 36-year-old woman and I have just been diagnosed with a fibroadenoma in my right breast. My doctor has suggested that it be surgically removed. A fine-needle biopsy identified no cancer. Both the mammogram and the ultrasound were negative. What would be the usual next step? Are there any alternatives? A:   The basic goal in evaluating any type of breast mass is to determine whether the mass is benign or malignant (cancer). In most cases, complete surgical excision with careful pathological (under the microscope) evaluation is the only way to absolutely determine whether the mass is benign. However, not all women with a breast mass need to undergo surgery. Generally a breast mass may be discovered during an annual examination or a self-breast exam. The mass is then characterized by several different methods (physical examination, mammography, ultrasonography, fine-needle aspiration and stereo-tactic biopsy) to predict which ones ought to be surgically removed. In many cases, removing too many benign masses is a better alternative than not diagnosing a malignancy. Further consultation with a surgeon specializing in breast diseases may be helpful.

Q:   What are the risks of radiation from mammography? I am 37 years old, and have had numerous screening and diagnostic mammograms. I have been told that I should be screened every year. My sister has breast cancer and has a history of radiation exposure. (She had scoliosis surgery as a teenager.) A:   The two major screening methods for breast cancer are mammography and monthly breast self-examination. Modern methods of mammography have minimized the amount of radiation a woman is exposed to during an examination. In fact, the radiation exposure is so small that many believe it has a negligible effect on the future development of cancer. The recommendations for mammography are controversial. Routine, yearly mammography has clearly been demonstrated to be of benefit in women 50 years old and older. The controversy involves women younger than 50. Some experts recommend a baseline mammogram between ages 35 and 40, with subsequent screening every two years until age 50. Others recommend yearly examinations after age 40. Most women will benefit from choosing and following one mammography schedule with her primary care physician. It may also be beneficial to have mammograms at the same center each year, so that the old examinations may be compared with the new examination.

©1999 Tampa Obstetrics, P.A. All rights reserved. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.

Q: My 20-year-old daughter has one breast that is approximately one size larger than the other. I took her to the pediatrician when she was in her teens, and the doctor told us that this situation is common and that there was no reason to be concerned. But my daughter is very self-conscious about this, and I am concerned that it may indicate other health problems. Is there any reason for concern and can the size be corrected with hormone or other treatments other than surgery?	A: It is common and normal to have breasts of different size. This type of finding usually does not suggest an underlying health problem. There are no hormonal methods commercially available that will only affect one breast. Even though it is not uncommon to have different size breasts some women are uncomfortable with this. There are a multiple ways to deal with this. In addition to cosmetic surgery, there are a number of prosthetic devices that may be worn. In this case, a consultation with a cosmetic breast surgeon may be helpful.
Q: What are the best ways and most important factors for a woman to assess her individual risk of breast cancer?	A: There is no one best way for an individual woman to assess her risk of breast cancer, because the disease itself is multifactorial. However, a woman may wish to examine which risks apply specifically to her (listed below, with greatest risk listed first) and then discuss them with her physician. Importantly, all the risks listed below probably only contribute to between 20 and 25 percent of all cases of breast cancer. Other causes of breast cancer may be related to defects in the immune system or genetic mutations. Alterations in chromosome 17 (also known as BRCA1) account for between 5 and 10 percent of all cases of breast cancer (25 percent of all cases of breast cancer in women under 30 years of age). Women with this genetic anomaly also have a 40 to 60 percent lifetime risk of developing ovarian cancer. Factors associated with an increased risk of breast cancer include: prior history of breast cancer; advancing patient age; family history of breast cancer in a first degree relative (mother, sister, daughter); birthplace (Northern Europe and North America); a history of other female cancers (uterine, ovarian); higher socioeconomic status; never married; never pregnant; first pregnancy after age 30; obesity; and a history of radiation exposure. There are many other factors whose association to breast cancer remains unclear, for example, treatment with oral contraceptives or hormone replacement therapy. There are an equal number of studies that report an increase in breast cancer risk with oral contraceptives or hormone replacement therapy as there are that report a decrease in risk.
Q: My mother-in-law was just diagnosed with calcium deposits in her breast tissue. Is this a serious condition? Could it become cancer?	A: Calcium deposits in breast tissue are fairly common and are usually diagnosed during mammography (breast x-ray). They may result from benign conditions such as past trauma or from malignant conditions such as breast cancer. Generally, the appearance, location and presence of these calcium deposits in one or both breasts will provide some information regarding whether they are benign or malignant. It is important to correlate mammographic findings with physical examination findings. Frequently all that is necessary is to repeat the examination and mammogram in several months. In some cases, depending on the mammographic appearance of the calcium deposits, a breast biopsy may be recommended. This biopsy may either be by a small incision or by a fine-needle aspiration. There are several factors associated with an increased risk of breast cancer. They include: prior history of breast cancer, advancing age, family history of breast cancer in a first degree relative (mother, sister, daughter), birthplace (Northern Europe and North America), a history of other female cancers (uterine, ovarian), higher socioeconomic status, never married, never pregnant, first pregnancy after age 30, obesity and a history of radiation exposure. Women with unusual breast examinations or mammograms may benefit from an evaluation at a specialized breast center where experienced breast surgeons and radiologists specializing in mammography work closely together.
Q: I am a 36-year-old woman and I have just been diagnosed with a fibroadenoma in my right breast. My doctor has suggested that it be surgically removed. A fine-needle biopsy identified no cancer. Both the mammogram and the ultrasound were negative. What would be the usual next step? Are there any alternatives?	A: The basic goal in evaluating any type of breast mass is to determine whether the mass is benign or malignant (cancer). In most cases, complete surgical excision with careful pathological (under the microscope) evaluation is the only way to absolutely determine whether the mass is benign. However, not all women with a breast mass need to undergo surgery. Generally a breast mass may be discovered during an annual examination or a self-breast exam. The mass is then characterized by several different methods (physical examination, mammography, ultrasonography, fine-needle aspiration and stereo-tactic biopsy) to predict which ones ought to be surgically removed. In many cases, removing too many benign masses is a better alternative than not diagnosing a malignancy. Further consultation with a surgeon specializing in breast diseases may be helpful.
Q: What are the risks of radiation from mammography? I am 37 years old, and have had numerous screening and diagnostic mammograms. I have been told that I should be screened every year. My sister has breast cancer and has a history of radiation exposure. (She had scoliosis surgery as a teenager.)	A: The two major screening methods for breast cancer are mammography and monthly breast self-examination. Modern methods of mammography have minimized the amount of radiation a woman is exposed to during an examination. In fact, the radiation exposure is so small that many believe it has a negligible effect on the future development of cancer. The recommendations for mammography are controversial. Routine, yearly mammography has clearly been demonstrated to be of benefit in women 50 years old and older. The controversy involves women younger than 50. Some experts recommend a baseline mammogram between ages 35 and 40, with subsequent screening every two years until age 50. Others recommend yearly examinations after age 40. Most women will benefit from choosing and following one mammography schedule with her primary care physician. It may also be beneficial to have mammograms at the same center each year, so that the old examinations may be compared with the new examination.