How important is a monthly self-exam in detecting breast cancer?

October is national Breast Health Awareness Month, which makes this question very timely. To answer it, we turned to Yale Cancer Center breast surgeon Anees Chagpar, M.D., director of the Breast Center at Smilow Cancer Hospital at Yale-New Haven. She writes:

“There has been a lot of debate about the value of self-breast exams in detecting breast cancer. While the evidence has been varied regarding the importance of self-breast exams in finding cancer early, many still recommend self-breast exams for women to become familiar with their own bodies, so they can detect lumps that may be different from their usual breast texture.

“In addition, particularly for women who are younger than age 40 (when routine annual mammography generally starts), self-breast exams can help women to find new breast lumps, skin changes, or nipple discharge that may be the first signs of breast cancer.

“Some women, however, feel uncomfortable doing monthly self-breast exams or may be anxious when finding ‘lumpy bumpy breast tissue’ that may be completely normal.  Your doctor can help by doing yearly clinical breast exams and recommending that women get regular mammograms beginning at age 40.”

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I have an enlarged prostate gland. Does this put me at greater risk for prostate cancer?

Our answer comes from Peter Schulam, M.D., chairman of the department of urology at Yale School of Medicine, and head of the prostate and urologic cancers program at Yale Cancer Center. He writes:

“An enlarged prostate does not put you at an increased risk for prostate cancer.  Benign prostatic hypertrophy (BPH), however, can result in an elevated PSA and anyone with an elevated PSA should be evaluated by a physician to rule out prostate cancer.”

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I’m a smoker who worries about lung cancer. How long will it take for my lungs to heal after I quit?

For an answer, we turned to Tom Lynch, M.D., director of Yale Cancer Center and physician-in-chief of Smilow Cancer Hospital at Yale-New Haven. Dr. Lynch is a world-renowned expert in lung cancer and the development of novel therapies. He writes:

“The good news is that your risk of cardiovascular (heart and vessels) disease decreases to that of a non-smoker about a year after quitting.  Your risk of lung cancer takes longer to reach that of a non-smoker (25-30 years), and depends upon the age of the patient and the amount of cigarettes smoked. Finally, the good news is that further damage to the lungs that can lead to emphysema and bronchitis stops as soon as you stop smoking.”




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I have seasonal allergies and take over-the-counter medication. Is it necessary to take it every day to build up its effectiveness, or can I just take it on days when my allergies are really bad?

Our answer comes from Mark Bianchi, M.D., ear, nose and throat specialist at Yale Medical Group. 

“There are three categories of allergy pills; antihistamines, decongestants, and leukotriene inhibitors. They all work fairly rapidly. I don’t continue the first two for more than a week if they’re not working. Leukotriene inhibitors (i.e. Singulair) may have a more cumulative effect, especially in children who have large tonsils and adenoids.”

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What causes lower back pain, and why does it sometimes seem to radiate to other parts of the back and hip area?

We turned to Peter Whang, M.D., spine expert at the Yale School of Medicine Department of Orthopaedics. He writes:

“Low back pain is, unfortunately, a ubiquitous problem in our society. Approximately 80% of individuals will have an episode of low back pain at some point in their lives and it is one of the most common reasons for doctor visits.

“Low back pain can be caused by numerous conditions such as arthritis affecting the discs or joints of the spine, or muscle strains.  On rare occasions, more serious disorders can also result in back pain, including fractures, tumors, infections, or even pathology in the abdomen or pelvis. Depending upon which anatomic structures are involved, this pain can radiate to other parts of the body like the buttocks or hips. Specifically, if there is any irritation of the nerves of the spine, a patient can even experience symptoms radiating into one or both legs.

“Because there are so many potential causes, low back pain can be very challenging to treat. Nevertheless, the majority of individuals may be managed effectively with conservative measures consisting of activity modification, physical therapy, and anti-inflammatories or other medications.

“In some instances, it may be beneficial to consider spinal injections, which are intended to decrease inflammation and hopefully provide symptomatic relief. Surgery may be a reasonable option for patients with chronic low back pain that has proven to be resistant to these other types of treatments, or for cases in which there is significant nerve compression (i.e. pain, numbness, or weakness in the legs).

“In the past we often performed fusions for this problem, but in recent years, newer operative strategies have been developed, including minimally invasive and motion-preserving techniques. Unfortunately, recurrent low back pain is not uncommon so if these symptoms do not resolve over time, it may be worthwhile to see your physician for further evaluation.”

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