AOPA Pilot Magazine - September 2011 - 36

FLYWELL

BY DR. JONATHAN M. SACKIER

“M

Amazons (and how not to be one)

ythical female warriors who excised their right breast to better draw a bow.” In Greek, mazos means breast and “a” suffix equals “to

seeing dimpled skin or a nipple discharge. See your doctor promptly. Diagnostic tests after history and physical include ultrasound to ascertain if the lump is solid or contains fluid. Mammography, although not perfect, may show densities or “shadows,” tiny calcium specks or distorted anatomy. A needle can either withdraw fluid if the lump is a cyst or cells to examine under the microscope. Fancier tests such as molecular breast imaging may be proposed. If a lump is malignant further evaluation will be without.” Although Amazons were probably ascertain if cells have spread elsewhere in the body Scythian, are not artistically depicted breastless, and with blood tests and CT or other scans. If small and Jonathan M. the name derives from another source (ha-mazan self-contained, the lump itself is removed (lumpecSackier attended “fighting together” or “manless”) the former definitomy) possibly also axillary lymph nodes, filtering medical school tion resonates with the dreaded word mastectomy. tissues in the armpit that may harbor cancer cells at Liverpool Willingly removing a breast inspires the question, “leaving the pattern.” Tests on the tumor will define University. “How can one avoid removing a breast?” By avoidjust how off kilter the cells are, whether they view ing breast cancer. estrogen like a rose bush views plant food and to The breast includes skin, nipple, surrounding, darker, are- check out the genetic behavior. Cancer “stage” (size, lymph node, or other metastases) may ola, connective tissue, fat, milk glands, and ducts. Malignant diseases afflict each constituent, duct and gland cancer most dictate additional treatments including radiotherapy to zap commonly. In cancer, deviant cells multiply and behave badly lurking cancer, chemotherapy to kill sneaky emigrating cells, causing breast distortion and destruction, traveling around the or medication to change the hormonal environment so cancer body, landing and starting new colonies (metastases) in armpit cells cannot flourish. Additional therapies such as yoga, aculymph nodes, bones, brain, lungs, liver, and skin. Imagine juve- puncture, and dietary modification may be helpful. Further surgery might be recommended, predicated on tumor type, nile delinquents taking jet fighters up for a spin. Although statistics reveal one in eight women may acquire size, and stage. If mastectomy (removal of the entire breast) is breast cancer, risk is not uniform and of 250,000 cases a year, proposed, discuss reconstruction with your physicians; either 50,000 are less dangerous non-invasive tumors and under 1 per- at the time of surgery or later as several techniques exist. cent afflict men. Yes, men also get this disease. Roughly 40,000 Gary Crump, AOPA’s medical and mythical matters guru told a year die from breast cancer, only lung cancer is more vicious. me that during chemo or radiotherapy, one is disqualified from Risk factors include aging, family history, youthful age of first exercising flight privileges, but re-apply after completing treatmenstrual period, and late menopausal onset, none of which ment. If prescribed Tamoxifen, a common hormone modifier, are under our control. Cancer threat is impacted by behaviors certification can be completed while taking this reasonably such as having children early or breast feeding, which are pro- innocuous drug. Following treatment, including lumpectomy tective, or obesity, a high-fat diet, smoking, or being sedentary, or mastectomy, the FAA wants to see treatment records, curwhich raise the stakes. Oral contraceptive pill use or hormone rent status report, brain MRI, and any other tests performed replacement therapy have variable effect. Stress reduction may to rule out metastases; if there is none beyond regional lymph minimize risk and improve outcomes. nodes, certification is pretty certain. However, if cancer has Underarm shaving and deodorants have been implicated in spread beyond local lymph nodes, the FAA wants three years breast cancer—women practicing this regime had earlier diag- of observation before certification. Thereafter, annual CT and noses. However, such women may be more physically aware, brain MRI along with current status report is required. detecting abnormalities sooner; the evidence is inconclusive. Embark on any treatment regime well-informed. Aviators Debate rages whether breast self-exam (BSE) is useful; oppo- use all available information to plan a flight, so do likewise. Garnents maintaining it inspires unnecessary biopsies. I believe ner second opinions, surf to respected healthcare and patient becoming familiar with your body makes perfect sense and advocacy websites, and ask questions. Cancer is a scary diagrecommend monthly BSE at the same time in the menstrual nosis, but survival is becoming likelier. As a pilot, the captain cycle, reporting changes to your doctor. Annual mammography of your airship, you make life-defining decisions. As captain of is certainly not a female favorite, women find it uncomfortable your lifeship do likewise and prove the apocryphal Amazonian and embarrassing but it helps find early, non-palpable cancers definition wrong. and should be considered after the fortieth birthday. Common symptoms include finding a lump in the breast or underarm, Email the author at jonathan.sackier@aopa.org. 36 • SEPTEMBER
2011

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AOPA Pilot Magazine - September 2011

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