Q: I am a 60-year-old woman. Following a routine mammogram I was
recently diagnosed with a precancerous condition of the breast known as
DCIS. Can you explain what this is? I am a little confused as I thought
precancerous isn’t the same as breast cancer, but my surgeon has
advised that I get a larger portion of the breast removed, followed by
radiation therapy. This makes it sound much more serious. They have
already operated and taken a small piece out.
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A: This diagnosis is difficult for many women to understand. DCIS
stands for ductal carcinoma in situ. It is also sometimes labelled a
precancerous condition because it has not yet progressed beyond the
lining of the ducts, and the cancer is not an invasive type. These
ducts are the tubes that carry the milk to the nipple and are located
throughout the breast. Because the cancer cells are confined completely
within these ducts, they are unable to spread outside the breast to
anywhere else in the body.
Until recently, the treatment for DCIS was mastectomy, because if the
whole breast was removed there was absolutely no chance of any further
spread.
In the last few years, cancer specialists have been suggesting surgical
removal of the affected area. This is not quite the same as a
lumpectomy because often there isn’t a lump.
As in your case, most of these cases are picked up on a routine
mammogram. This is a good argument for having one, because it is
unlikely that either you or your doctor would feel much of a lump on a
regular breast examination. The surgery is then followed by a course of
radiation therapy and sometimes a drug known as tamoxifen, which
reduces the levels of estrogen in the body. In your case, as you are
probably post-menopausal, this medication may not be required.
Some women still opt for the mastectomy to gain more peace of mind.
There is also a cosmetic factor. A total reconstruction of the breast
may make you look better than after the lesser surgery, which may
distort and disfigure the breast to a greater or lesser degree,
depending on how much breast tissue is removed.
Exercise and cholesterol
Cardiologist William Kraus from East Carolina University in North
Carolina did a study of 84 people who had a sedentary lifestyle and
were overweight. All had high cholesterol levels.
They were divided into three groups. One jogged 32 kilometres a week,
another 19 km and the remaining exercisers walked briskly for 19 km a
week. Some participants in the study did not exercise at all.
The group that jogged 32 km a week showed the greatest reduction of
cholesterol levels. While they lost only an average two kilograms,
their cholesterol particle sizes changed dramatically.
Cholesterol carried by large, fluffy particles is less damaging to the
arteries than that carried by smaller, denser particles, which are able
to pass through the bloodstream more easily.
Those people who did not exercise actually gained about two kg over six
months and also had
rising blood cholesterol levels, showing that even a small amount of
exercise is healthier than doing nothing.
Clare Rowson is a medical doctor with a practice near Belleville, Ont.
Her columns are intended for general information only. Individuals are
encouraged to also seek the advice of their own doctor regarding
medical questions and treatments.
