Dear Worried,

Breast cancer, or the fear of breast cancer, can be so overwhelming that it becomes difficult to have rational discussions or take appropriate, sensible action. In addition, with all of the diagnostic procedures and therapies that are available, deciding which type of medicine or treatment is best for a specific illness or problem can be confusing and difficult. And, helping people you love be active and informed consumers of health care can be equally frustrating, especially when they are wary of traditional medical practices. The important part is for your mother to get properly diagnosed.

Once a suspicious mass (e.g., a breast lump) has been identified and benign explanations (such as cysts, infections, or calcium deposits) have been ruled out, a biopsy is needed to determine if the lump is cancerous. A biopsy is the only definitive way to diagnose breast cancer.

The good news is that most lumps that women find in their breasts are not cancerous — they are usually fibro-cystic masses or cysts (fluid filled sacs), both of which are benign. A new lump or mass in the breast or underarm region is the most common sign of breast cancer. Cancerous lumps are most often hard, painless, and have asymmetrical borders, but all lumps found in or around the breast need further evaluation by a health care professional. Breast lumps can be evaluated in a few ways, including:

Diagnostic mammography A low dose X-ray can be used to look for changes in the breast that could signal the growth of abnormal cells. Mammograms performed before any signs or symptoms of breast cancer have been found are known as screening mammograms. Diagnostic mammograms are used to provide more information about and help diagnose any potentially dangerous changes in the breast (including lumps, abnormal nipple discharge, or breast pain). Mammograms allow health care providers to identify calcium deposits, areas of tissue that have become distorted or more dense (possibly from the presence of abnormal growth). They can also show whether or not lumps are solid masses (which are more likely to be problematic), or simply harmless, fluid-filled cysts.

Breast ultrasound
This technology uses the echoes of high frequency sound waves as they bounce off internal body structures to create a picture of what lies beneath the surface. Ultrasound may be used in conjunction with mammography for women who have very dense breasts (more glands and less fatty tissue), since small tumors may be harder to detect in breasts that are made up of densely packed glands.

Biopsy
During a biopsy, a small sample of tissue from the lump is removed and examined. A small needle or wire may be used to remove a few cells or tiny fragments of the lump, or the procedure may be done surgically under anesthesia, depending on the size and location of the lump. Cells that are removed from the lump are examined in a laboratory to assess whether or not they're benign or malignant. If cancer is detected, or if the cells are questionable, further tests will be conducted to determine the type of cancer and which procedures and treatments would work best.

It seems that your mother has already been diagnosed without a biopsy as not having cancer by an "alternative type doc." A second opinion from a provider of Western medicine will offer her with more info to make the best decision for herself. If, however, she learns that she has cancer, she has additional choices. But in order to accurately identify an effective course of treatment, your mom needs to be diagnosed by means of a biopsy. In all of this, it's important to talk with your mom about her choices, share with her the info you receive, and support her in her decisions, while still telling her your concerns. Your mom is probably more used to making health care decisions for you, than having her child offer her medical advice.

Since you asked, health care providers (i.e., doctors, nurses, dentists, psychologists, social workers, physician's assistants, dietitians, etc.) need to be licensed, accredited, and regulated by state or local regulatory agencies, and should provide information on her or his training, licensing, and accreditation to patients and potential patients upon request. Regulatory agencies, such as your state or city Department of Health, keep records about practitioners' licensing, credentials, and any complaints that may have been filed against their practice. Many alternative and complementary treatments are not as strictly regulated, but practitioners still need to be willing to answer questions about their practices and training.

Traditional Western medicine practices, such as radiation and immuno- and chemotherapies, have been demonstrated in clinical research to offer the best chances of long-term survival to people with cancer. Many people with cancer, however, are turning to complementary therapies, alternative treatments used in conjunction with more traditional medicine, to minimize the side effects of treatment, relieve stress, and help maintain a positive attitude.

Contact the American Cancer Society for further information and assistance. For more info on the use of complementary and alternative therapies, check out the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine and The Richard and Hinda Rosenthal Center for Complementary and Alternative Medicine web sites.

Alice

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