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General Concerns

Breast cancer. Breast cancer strikes one in nine women in the United States, and 1,300 men a year. Cancer is actually a number of diseases, including leukemia and Hodgkin's disease, caused by the abnormal growth of cells. Often, the cells grow out of control and form masses known as tumors. Malignant or cancerous tumors not only invade normal tissue, but also travel to other parts of the body to form more malignant tumors. This spreading is called metastasis.

Breast cancer most often begins as a painless lump or thickening in the upper outer portion of the breast, but it can occur anywhere, including the nipple (see Figure 12.1). Breast cancers may spread to the lymph nodes in the arm pit and then throughout the body. Because the cause of breast cancer is unknown, there is no way to prevent it.

Risk factors for developing breast cancer include:

Figure 12.1

Anatomy of the Female Breast

Pectoral -muscles

Lymph -nodes

Pectoral muscles

Pectoral muscles

/ Nipple w

Mammary (milk) lobes

Lymph ducts

Pectoral -muscles

Lymph -nodes

Lymph ducts

/ Nipple w

Mammary (milk) lobes

Table 12.1 Preventive Care Recommendations for Adults with MS

Note dates of

Medical Tests:


last & next test

Blood Pressure & Pulse

Yearly if normal.

Height & Weight

Test at initiation of interferon

(Technically not a test,

therapy, repeat in 1 month,

but important to track)

then every 3 months thereafter.


Consider for anyone with

symptoms of fatigue.


Yearly and following the

completion of treatment for a

urinary tract infection, as per

physician recommendation.

Chest X-Ray

Discuss with healthcare provider.

Electrocardiogram (EKG/ECG)

Discuss with healthcare provider.

Total Skin Exam

Discuss with healthcare provider.

Sun avoidance and sunscreen

use are recommended.

Dental Cleaning

Every 6 months. (Note: If daily

and Examination

tooth care becomes difficult,

discuss with healthcare provider

and consider electric appliances.)

Over age 20

Fasting Cholesterol

Every 5 years starting at

(with HDL, LDL, and

age 20.


Fasting Blood Sugar

Every 5 years starting at

age 20.

Over age 40


Consider for women age 40 and

older and for anyone with

symptoms of fatigue.


Every 2-4 years for ages 40-65,

then yearly.

Over age 50

Stool for Occult Blood

Yearly (three stool guaiac cards)

starting at age 50.

(continued on next page)

Medical Tests:


Note dates of last & next test



For those with risk factors

Bone Density Test

(purified protein derivative)

Fasting Blood Sugar

Women Only

Pap Smear

Clinical Breast Exam (by healthcare provider)

Every 5 years starting at age 50 for sigmoidscopy or every 10 years for colonoscopy. Begin screening high-risk individuals earlier. Consult with physician about frequency. (Reference: American Cancer Society.)

Every 5 years over age 50.

Once, for everyone with risk factors including prolonged use of steroids or anticonvulsants, a family history of osteoporosis, and a sedentary lifestyle. Retest periodically, especially women near onset of menopause.

Every 1-2 years if at high risk for tuberculosis (including healthcare workers, persons with HIV, persons living in areas where TB is prevalent).

More frequently than every 5 years for those with risk factors such as obesity or family history of type II diabetes.

At least every 1-3 years for women who are or have been sexually active and have a cervix. The American Cancer Society recommends initiation no later than age 21. Other organizations recommend age 18 because of the high prevalence of sexual activity.


(continued on next page)

Table 12.1 Preventive Care Recommendations for Adults with MS (continued)

Note dates of

Medical Tests: Recommendations: last & next test

Self Breast Exam



Every 1-2 years starting at age 40.

(The American College of

Obstetricians and Gynecologists

recommends every 1-2 years from

age 40-49 and annually over 50

years. The American Cancer Society

recommends annually starting at

age 40.) If there is a family history

of breast cancer, consult with a

physician about appropriate

beginning age.

Men Only

Prostate Exam

Yearly starting at age 50, except

(digital rectal exam)

for African-Americans or those

who have a family history of

prostate cancer, then start at age 40.

PSA (prostate-specific

Yearly starting at age 50, except for

antigen) Test

African-Americans or those who

have a family history of prostate

cancer, then start at age 40.

Clinical Testicular Exam


(by healthcare provider)

Testicular Self Exam

Monthly. The American Academy

of Pediatrics recommends starting

at age 18.


Recommendations: Note dates


Tetanus-Diphtheria Rubella (German measles) Varicella (chicken pox)

Boosters every 10 years.

Women of child-bearing age.

Women of child-bearing age who have not had chicken pox.

(continued on next page)

Vaccines: Recommendations: Note dates

Flu Vaccine

Yearly for those who are

susceptible to the flu, likely to be

exposed, or have respiratory

problems or certain chronic

disorders. Pregnant women who

will be in second or third trimester

during flu season should also

receive a flu shot.

Hepatitis B Vaccine

Healthcare or public safety workers

who have exposure to blood at

workplace. Household contacts

and sex partners of those infected

with hepatitis. Sexually active men

and women with more than one

partner in last 6 months or with

recently acquired sexually

transmitted diseases. Intravenous

drug abusers.


Once at age 65 or older. If received

Pneumonia Vaccine

before age 65, need booster after

5 years.

Other Immunizations

Supplemental immunizations

(Hepatitis A, for example) may be

needed in special circumstances

such as overseas travel.

Acknowledgments: Thank you to the National Multiple Sclerosis Society's National Council of Clinical Advisory Committee Chairs for professional reviews, and to the Southern California Chapter for initiating this project.

To reach the nearest Society office: 1-800-FIGHT-MS

Web site:

General Health and Safety Recommendations

Stop smoking (or don't start) to reduce your risk of cancer and heart disease. It's not too late to join a smoking cessation group and/or consider medication to help decrease the desire to smoke.

• Exercise regularly. Check with your doctor before starting on a new exercise program.

• Eat a well-balanced diet. Limit fat and cholesterol. Emphasize fruits, grains, and vegetables to reduce risk of heart disease, control constipation, and maintain a healthy weight.

• Drink fluids. Drink plenty of fluids every day to maintain general health and health of the urinary system, and to lessen constipation.

• Maintain a healthy weight. If you are overweight, lose weight to reduce your risk of developing heart disease, hypertension, diabetes, and other diseases.

• Consume adequate calcium. Adults between ages 19-50 should consume 1,200 mg daily. Women aged 51 and older and men aged 65 and older should consume 1,200-1,500 mg daily.

• Women of childbearing age should be consuming 0.4-0.8 mg of folic acid every day to prevent common birth defects (neural tube defects or spina bifida). Folic acid (or folate) is a vitamin that is contained in many multivitamin supplements.

• Alcohol can affect balance, coordination, and thinking. It depresses the nervous system and may interact with your medications. Check with your doctor about whether alcohol is safe for you, and if so, how much and how often.

• Protect yourself against sexually transmitted diseases by using condoms whenever appropriate, and by using your best judgment with sexual partners.

• Wear lap and shoulder belts while driving or riding in vehicles.

• Install and maintain smoke detectors.

• Having close relatives, such as a mother, sister, aunt, or grandmother, with breast cancer.

Giving birth to a first child after age 30, or not giving birth at all.

• Having an abortion during first pregnancy.

• Having early onset of menstruation, before age 12.

• Experiencing late menopause.

Smoking cigarettes.

• Consuming alcohol.

Women with neurologic disease are at no greater risk for breast cancer than the general population, although inactivity may lead to weight gain and altered mobility, which can in themselves increase the risk of developing breast cancer. Access to regular medical care may thus be affected. Men too, have a risk (less than women) of breast cancer. Reduced hand function and sensation may interfere with monthly breast self-examinations, which are recommended for all women. If you use a wheelchair, you may find it challenging to get into the proper position for a mammogram.

To reduce your risk for breast cancer, follow these guidelines:

• Maintain a healthy weight and reduce your fat intake.

• Eat foods that are high in fiber.

• Include plenty of deep green vegetables in your diet.

• Limit salt-cured, smoked, or nitrite-cured foods, such as ham, hot dogs, bacon, and sausage.

• If you have fluid-filled sacs or small cysts in your breasts (called fibrocystic breasts), decrease or eliminate caffeine.

• Maintain moderate use of alcohol.

In addition, the American Cancer Society recommends the following:

• Examine your own breasts monthly, so you can detect changes early.

• See your health professional at least every 3 years until age 40, and annually thereafter, for a clinical breast examination.

• Obtain a baseline mammogram by age 40 and annual mammograms after age 50.

• Request a biopsy of all suspicious lumps.

Figure 12.2

Breast Self-Exam (BSE)

Figure 12.2

Breast Self-Exam (BSE)

Bse Step Image

Step 1

Here's what you should do to check for changes in your breasts. Stand or sit before a mirror (above). Check each breast for anything unusual, such as any discharge from the nipples, puckering, dimpling, or scaling of the skin. Each time you examine your breasts you will become more familiar with how they appear and feel, making it easier to notice any changes that may occur. Notice the normal size and shape of each breast (it is not unusual for one breast to be larger than the other) and the normal position of the nipple.

Step 2

Clasp your hands behind your head and press them forward. You should feel your chest muscles tighten. Look in the mirror at the shape and contour of your breasts. Take your time; again, look for any changes in the size and shape of each breast and look for any swelling, dimpling, rash, discoloration, or other unusual changes in the skin.

Step 3

Next, press your hands firmly on your hips and bend slightly toward your mirror as you pull your shoulders and elbows forward. Once again, you should feel your chest muscles tighten. Look for any change in the shape or contour of your breasts.

Step 4

Gently squeeze each nipple and look for a discharge. If present, see your doctor. In fact, if you have a discharge at any time you should check it out with your doctor.

Monthly self-examinations involve inspecting the breasts in a mirror to look for lumps, changes in breast shape, or discharge from the nipple. Use your fingers to evaluate your breasts for lumps or pain. Feel your breasts in overlapping areas about the size of a dime. Remember to also check the underarm and upper chest areas (see Figure 12.2).

If MS interferes with your ability to perform a self-examination, you can teach your husband, care partner, or care provider to assist you. Ideally, this examination should be done four to seven days after your menstrual period (if you are still menstruating)

or on a regularly scheduled basis (if you have gone through menopause).

Self-care to identify changes in breast tissue is very important. If breast cancer is treated at its earliest, noninvasive stage, the survival rate is almost 100 percent.

Ovarian and cervical cancer. Ovarian and cervical cancer are also life-threatening problems if they go unrecognized and, therefore, untreated. Every woman should have an annual pelvic examination with a Pap smear performed by a gynecologist or by a trained nurse practitioner. If you practice birth control, evaluate its effectiveness

Figure 12.2

Breast Self-Exam (BSE)

Figure 12.2

Breast Self-Exam (BSE)

Bse Step Image

Step 5

The next step is done standing or sitting straight up. Raise your left arm. Use the pads of your fingers of your right hand to check your left breast and the surrounding area— firmly, carefully, and thoroughly. Some women like to use lotion or powder to help their fingers glide easily over the skin. Feel for any unusual lump or mass under the skin. A lump is unusual if it has not been felt during earlier breast exams and it now stands out against the normal feel of your breast.

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