Cervical & Breast Cancer

                                                              Cervical Cancer
 

Cervical cancer develops from abnormal cells of the cervix. Nearly all cervical cancers are caused by persistent infection with high-risk types of human papillomavirus (HPV). HPV is extremely common and is usually cleared naturally by the immune system. Cancer generally develops only when a high-risk infection persists and causes precancerous cellular changes over many years.

Risk Factors

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• Persistent high-risk HPV infection

• Smoking

• Weakened immune system

• HIV infection

• Previous cervical precancer

• Inadequate or infrequent cervical cancer screening

Symptoms
 

Precancerous cervical changes usually cause no symptoms, which is why screening is important. Cervical cancer may cause:
 

• Bleeding between periods

• Bleeding after sex

• Bleeding after menopause

• Unusually heavy or prolonged bleeding

• Watery, bloody, or unusual vaginal discharge

• Pelvic pain

• Pain during intercourse
   

Cervical Cancer Screening
 

Cervical screening looks for HPV infection and/or abnormal cervical cells before cancer develops. Depending on age and the guideline being followed, screening may involve:
 

• Primary HPV testing — tests for high-risk HPV

• Pap test (cytology) — examines cervical cells for abnormalities

• HPV/Pap cotesting — performs both tests

Screening generally begins in early adulthood and continues at regular intervals through approximately age 65. The exact starting age and interval depend on the screening method and guideline used.
 

People with previous high-grade cervical precancer, cervical cancer, HIV, significant immunosuppression, or certain other risk factors may require a different screening schedule.
 

Screening is still recommended based on age and risk even if someone has never had sexual intercourse, although their HPV exposure and cervical cancer risk may be substantially lower.
 

What Happens if a Screening Test Is Abnormal?
 

An abnormal HPV or Pap result does not mean you have cancer.

Depending on the specific results and previous screening history, management may include:

• Repeat HPV or Pap testing

• HPV genotyping

• Colposcopy — close examination of the cervix under magnification

• Cervical biopsy

• Treatment of high-grade precancerous lesions

HPV Vaccination
 

HPV vaccination can prevent most HPV-related cervical cancers as well as several other HPV-associated cancers. It also reduces the chances of getting genital warts, which are usually caused by low-risk strains. 

Gardasil 9 protects against nine HPV types and is routinely recommended beginning at ages 11–12, although vaccination can begin at age 9. Catch-up vaccination is recommended through age 26 for people who were not adequately vaccinated previously. Adults ages 27–45 may choose vaccination after discussion with their healthcare provider.
 

Vaccination does not eliminate the need for routine cervical cancer screening.
 

                                                                      Breast Cancer
 

Breast cancer occurs when abnormal breast cells grow uncontrollably. Most breast abnormalities and breast symptoms are not cancer, but breast cancer is common enough that appropriate screening and evaluation of concerning symptoms are important.

Breast cancer can occur in women and men, although it is much more common in women.

Risk Factors

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• Increasing age

• Female sex

• Family history of breast or ovarian cancer

• Certain inherited mutations, including BRCA1 and BRCA2

• Previous breast cancer

• Certain high-risk breast lesions

• Dense breasts

• Previous chest radiation, particularly at a young age

• Earlier onset of menstruation or later menopause

• Certain reproductive and hormonal factors

• Postmenopausal obesity

• Alcohol consumption

Most people who develop breast cancer do not have a known inherited breast-cancer mutation.
 

Possible Symptoms
 

• A new breast or underarm lump

• Thickening or firmness within the breast

• Change in breast size, shape, or contour

• Skin dimpling or puckering

• Persistent focal breast changes

• New nipple inversion

• Spontaneous unilateral nipple discharge, particularly bloody or clear discharge

• Nipple ulceration, scaling, or crusting

• Redness or thickening of breast skin

• Enlarged underarm lymph nodes

Many of these findings have benign causes, but new or persistent abnormalities should be evaluated. It is also important to note there there are different kinds of breast cancers, so any of these symptoms should warrant medical evaluation. 
 

Breast Cancer Screening

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-Mammography is the primary screening test for breast cancer.

For women at average risk, major organizations recommend regular mammography beginning around age 40. The recommended interval varies somewhat among organizations, with screening generally performed every 1–2 years. Screening recommendations should be individualized based on age, health, personal risk, and patient preferences.

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-Breast MRI is not routinely covered nor receommended for average-risk screening.

Annual MRI in addition to mammography may be recommended for certain people at substantially increased risk, including some individuals with a high risk. A person's lifetime breast cancer risk can be estimated using risk calculators such as the Tyrer-Cuzick model, which considers factors such as age, breast density, family history, reproductive history, genetics, and previous breast biopsies. Women with an estimated lifetime breast cancer risk ≥20% are generally considered high risk and may require annual breast MRI in addition to mammography.
 

• BRCA1 or BRCA2 mutations

• Certain other inherited cancer syndromes

• A very strong family history

• A calculated lifetime breast-cancer risk of approximately 20–25% or greater

• Previous therapeutic chest radiation at a young age
   

-A clinical breast exam is an examination of the breasts and underarm areas by a healthcare provider to look for abnormalities. Routine clinical breast exams are not universally recommended for average-risk women who are already receiving appropriate mammography screening. The USPSTF does not currently recommend for or against CBE because evidence is insufficient, while the American Cancer Society does not recommend routine CBE for average-risk women. Patients are encouraged to become familiar with their breasts. 
 

Common Benign Breast Lumps & Changes
 

Breast Cysts — Fluid-filled sacs within the breast. They may feel smooth, round or oval, and can be tender, particularly around menstruation. 
 

Fibroadenoma — A common benign solid breast tumor, particularly in adolescents and younger women. It is typically firm, smooth, well-defined, and mobile. 
 

Fibrocystic Breast Changes — Hormone-related changes that can cause lumpy or nodular breasts, tenderness, swelling, and cysts, often worsening before menstruation. These changes are very common and generally benign.
 

Fat Necrosis — Damaged fatty tissue can form a firm breast lump, sometimes after trauma, surgery, radiation, or other injury, although a patient may not remember an injury. 
 

Lipoma — A benign growth of fatty tissue that typically forms a soft, movable, painless lump. Imaging can usually identify its fatty composition.
 

Intraductal Papilloma — A small, usually benign growth inside a milk duct. It may cause a small lump near the nipple or spontaneous clear or bloody nipple discharge. Imaging and often biopsy are used to establish the diagnosis and determine whether atypical cells are present.
 

Breast Abscess — A collection of infected fluid that can produce a painful lump with redness, warmth, swelling, and sometimes fever. 

Galactocele — A benign milk-filled cyst that occurs during or after pregnancy and breastfeeding. It may present as a painless breast lump and can usually be identified with imaging.

Hamartoma — A benign mass composed of normal breast tissues arranged abnormally. It is often painless and may be discovered incidentally on breast imaging.