The words breast cancer strike fear into the hearts of most women. Yet, it is one of the few cancers that are easily treated if caught early enough.

Part of the reason we fear cancer is the thought of a mastectomy – where we lose what to most is an essential part of our femininity.

There is good news on that front, however. Surgery is not always disfiguring, breast conservation and reconstruction surgery now play a major role in management.

Many women don’t report lumps in their breasts because they aren’t painful. Nine out of 10 times, however, breast cancer is painless. Any lump you find in your breast should be investigated.

The doctor uses three modalities to assess the breast, this is called the triple assessment. By using all three modalities together there is a negligible chance of missing a cancer.

These three modalities are clinical examination; mammography and ultrasound and needle tissue biopsy.

All patients should be examined, have sonar or a mammogram, and a needle biopsy to ascertain whether or not the lump is cancerous.

Screening mammograms are not routinely performed in women under 40 mainly because these women fall under the age for routinely recommended mammogram. The reason for this is the increased density of the breast tissue, results in a higher false negative finding on mammogram.

Breast ultrasound is safe, accurate and provides a rapid differentiation of cystic and solid masses and should be used routinely in young women with a suspected breast cancer.

It is important to realize that in most cases it is not necessary for a woman to undergo a general anaesthetic to determine whether the lump in her breast is a cancer or not.  This is the important concept behind the triple assessment.

Once a cancer has been diagnosed, there is no harm in taking a few days to discuss the different treatment options. Waiting a day or two, participating in the discussions and understanding what the different treatment options are, will help ensure ultimate psychological, cosmetic and best cancer management.

Again to stress once the diagnosis is made, there is no need to jump into a decision. Breast cancer is not flu – patients need to explore their options and find out what treatment is available to them. The average doubling time of breast cancer cells in 40 days, the cancer did not arrive yesterday and will not be gone tomorrow so go for a second opinion, speak to other patients who have been treated by the doctor you chose.

Instead of looking at treatment of breast cancer stage for stage, it is important to remember that each patient presents, as an individual and the specialist must tailor the treatment to each individual patient. There are certain fundamental treatment principles that should be adhered to, such as who should receive chemotherapy, who should receive radiation therapy and what different surgical options available for each patient.

In other words, the size of the tumour, the type of cancer the size of the breast and position of the tumour and the state of general health and the psychological make-up of the patient help determine which treatment options are utilized and in what order they are employed.

The treatment of breast cancer is a multimodal approach involving three lines of attack.

	Surgery.
	Radiotherapy (DXT).
	Oncology (chemotherapy and hormone manipulation).

These are often used in various combinations with each other, as is decided by the “breast team.

Your doctor check list:

	Explains clearly and effectively.
	Discusses your health in partnership with you.
	Does not suggested emergency “surgery” or treatment.
	Prepared to accept you going for a second opinion.
	Is up to date with international accepted treatment.
	Works as part of a team.

Your check list

	Preferably chose to be treated at unit with a specialist cancer team.
	Take a partner or friend to consultations.
	Take time before making irrevocable choices (eg emergency mastectomy).
	Listen and read around your diagnosis.
	Ask for a detailed explanation about the recommended treatment.
	Read your consent forms carefully and ask for explanations about the success rate, and complications prior to starting treatment.