Breast Cancer
What is breast cancer?
Each year, approximately 200,000 American women are diagnosed with cancer of the breast. In the USA, thirteen percent of all women (one out of every eight) will develop invasive breast cancer. Women in North America have the highest rates of breast cancer in the world.
Breast cancer is also diagnosed in more than 1,000 American men each year.
Each breast consists of glands that produce milk, ducts designed to carry milk to the nipple, and supportive tissue which connects and supports the ducts and the glands. Breasts also contain vessels which carry blood and vessels which carry lymph. Lymph is a clear, watery, fluid drained from body tissues. It acts to remove bacteria from the tissues and carry white cells (cells that fight infections) to the blood. Lymph nodes filter the lymph and store special cells that can trap cancer cells or bacteria.
Cancer is any disease in which abnormal cells grow out of control and have the potential to spread to other parts of the body. The type of cancer depends on the kind of breast cell that becomes malignant (or cancerous). The most common types of breast cancer are Ductal Carcinoma and Lobular Carcinoma. Ductal Carcinoma is cancer of the tubes (ducts) that carry milk to the nipple. Lobular carcinoma is a disease of the glands which make milk. An “in situ” cancer is one that hasn’t spread to lymph nodes or other parts of the body.
Most small in situ tumors can be successfully treated without major surgery. The earlier breast cancer is diagnosed the greater the chance of survival.
Key points:
1. Breast cancer is a serious condition that affects many Americans.
2. The majority of patients with early stage disease can be treated successfully.
3. Although rare, breast cancer occurs in men.
Symptoms
Some breast cancers do not have any symptoms at all, especially in very early stages. When symptoms are present, they may include:
- Lump(s) in the breast, chest area, or armpit
- Thickening of the breast without a definite lump
- Pain, warmth or redness
- Nipple discharge, nipple bleeding, or nipple bending
- Changes in the breast position, size, shape or skin
Although these symptoms are usually caused by non-cancerous conditions, it is important to be evaluated to prove that cancer is not present.
Many patients with breast cancer have no complaints and the condition is discovered because of a routine examination or routine mammogram. Often times, SELF BREAST EXAMS DONE BY PATIENTS EVERY MONTH lead to the discovery of breast cancer.
Key points:
1. Any change in the breast may be a sign of breast cancer and should be discussed with your physician.
2. Most breast symptoms are not due to cancer.
3. Many breast cancer patients have no symptoms and are diagnosed during a checkup or after a screening mammogram. Even if no symptoms are present it is important to be evaluated for signs of early disease.
4. Breast cancer can be detected by monthly self-exams that include an examination of the armpits, nipples, entire breast and the area under the collarbones.
Risk Factors
A “risk factor” is anything that increases the chance of developing a disease. There are several known risk factors for breast cancer. The most significant risk factor is prior history of breast cancer.
Other risk factors include:
Family history: Having a close blood relative with breast cancer, or with ovarian cancer.
Genetics: Abnormality in one of the breast cancer genes (e.g. BRCA-1 and BRCA-2)
Age: Risk of breast cancer increases with age.
Breast disease: Including certain non-cancerous breast conditions.
Ethnicity: Women of Caucasian ancestry are more likely to be diagnosed with breast cancer than women of other races. In the United States, women of African ancestry are more likely to die from breast cancer than women of other races. Breast cancer is the most common cause of cancer death in Latinas.
More menstrual cycles: First period at an early age (<11y) or menopause at a late age (>55y). Women who have children later in life, who have very few children or who do not have children at all also may have an increased risk of breast cancer.
Obesity: In women who have experienced menopause, being overweight increases the risk of breast cancer. Lack of exercise increases risk for all women.
Alcohol: Excessive drinking.
Certain exposures: Because some forms of breast cancer need female hormones to grow, hormone replacement treatment and hormonal birth control may increase the risk of breast cancer. Exposure to ionizing radiation increases likelihood of developing breast cancer.
Some studies also show that having had an abortion in the past may possibly lead to an increased risk of breast cancer.
Key points:
1. The most important risk factors for breast cancer are personal history, family history, age and abnormalities of a breast cancer gene.
2. Family history of ovarian cancer may indicate an increased chance of developing breast cancer.
3. Some risk factors can be eliminated. These include: lack of exercise, obesity, tobacco use, and excessive alcohol consumption.
How is it Diagnosed?
Many cases of advanced breast cancer can be prevented through screening. Screening includes annual mammograms when appropriate, self-breast awareness and physician breast exams.
Mammogram: After age 40 years, mammograms should be performed once every year. If certain risk factors are present, a woman may be asked to begin mammograms earlier or have them more frequently.
Clinical Breast Exam: After age 20, a woman should have her breasts examined at least every 1-3 years.
Self Breast Exam: It is important for every woman to be familiar with her breasts to be able to detect any changes. One way to do this is to perform monthly self examinations. It is important to check under the arm, under the collar bone and around the nipple. It is also useful to examine the breasts in the mirror to look for any obvious changes.
Persons who are at high risk for disease may also benefit from additional screening methods such as MRI or ultrasound. When a lump has been found, a biopsy is required.
Biopsy: Definitive diagnosis requires a biopsy of the area suspected to be cancerous. A biopsy is the removal of cells to examine them under a microscope. The biopsy can be performed in the doctor’s office or in an operating room. All or part of the tumor will be removed.
If abnormal cells are found, further testing will be done to determine the specific type of cancer and whether it requires hormones to grow. It will also be necessary to determine to what extent the disease has spread- the cancer “stage.”
Stages of breast cancer range from stage 0, which is very early stage or pre-cancer, to stage 4 where the cancer has spread to other parts the body (e.g. bones, brain, lungs, or liver).
Key points:
1. Breast cancer screening plays an important role in early diagnosis.
2. Mammograms can find tumors when they are small and therefore most likely to be successfully treated.
3. A biopsy is required to confirm a suspected diagnosis of cancer or to prove that a suspicious tumor is benign (not cancer.)
Treatment
Therapy for breast cancer is individualized and is based on factors including the disease stage, patient age, menstrual history and medical history. All illnesses and prior cancer treatment will be taken into account. Treatments are often used in combination and include:
Surgery: An operation is usually required to remove all of the cancerous tissue. Lymph nodes may also be removed to determine if abnormal cells have spread outside of the main area of the cancer. The extent of the surgery depends on the stage. A lumpectomy removes the tumor and a small surrounding area. A mastectomy removes part or all of the affected breast(s).
Chemotherapy: For some patients, chemotherapy will be required. These medications kill the cancer cells which cannot be seen and may have spread throughout the body. Chemotherapy may also be used to shrink large tumors. Several different medications are typically used in combination. Some common chemotherapy drugs include: doxorubicin (Adriamycin), epirubicin (Ellence), docetaxel (Taxotere), paclitaxel (Taxol), cyclophosphamide, capecitabine (Xeloda), 5 fluoro-uracil (5 FU), vinorelbine (Navelbine), and gemcitabine (Gemzar). Side effects may include diarrhea, mouth irritation (mucositis), low white blood cell count (e.g. neutropenia), and hair loss (alopecia). These are just some examples, but your doctor will decide which treatment option is right for you.
Radiation: Radiation therapy uses high-energy X-rays to kill cancer cells. It is sometimes useful to treat an area from which a tumor was removed or to shrink a tumor prior to surgery.
Hormonal therapy: Some cancers grow better when exposed to hormones. Drugs can be given to prevent the cancer cells from getting the hormones which they need to grow. One example is the anti-estrogen pill tamoxifen.
Biological therapy: These treatments use the body’s immune system to help fight the cancer. An example is trastuzumab (Herceptin), an antibody that can kill certain types of breast cancer cells.
YOUR DOCTOR WILL DECIDE WHICH TREATMENT OPTIONS ARE BEST FOR YOU.
The newest treatment plans are usually available to patients through clinical trials. These trials test new combinations of therapies or new ways of using certain treatments. Some of the most recent clinical trials can be found at http://www.cancer.gov/clinicaltrials.
Key points:
1. Treatment for breast cancer depends on the disease stage.
2. Different types of treatment often need to be combined to increase the chance of a cure.
Complications
Breast cancer, even with early diagnosis and appropriate treatment, can recur or spread to other parts of the body (metastasize). Complications can also result from any of the recommended treatments, such as fatigue or hair loss from chemotherapy, or skin burns from radiation.
Tips for patients
- There is no proven way to prevent breast cancer.
- Risk reduction can be accomplished by maintaining general health.
- Some specific behaviors associated with lowered risk include: A healthy weight, consumption of no more than one alcoholic beverage daily, exercise, avoidance of cigarette smoke, reduced dietary fat.
- Hormonal replacement therapy and other forms of hormones like oral contraceptives should be avoided due to the possible increased risk of breast cancer. This should be discussed with your doctor.
- It is important for women to be familiar enough with their breasts to be able to detect changes. Periodic self-examination allows women to identify breast abnormalities early.
- A doctor’s breast exam can find small tumors and should be performed at least once every three years in young women and more frequently in older women.
- Mammograms are another key component in breast cancer screening; discuss when to start and how often to repeat with your physician.
References:
Brennan et. al. “Management of early breast cancer” Aust Fam Physician. 2005 Sep;34(9):755-60.
Guray et. al. “Benign Breast Diseases: Classification, Diagnosis, and Management”
The Oncologist, Vol. 11, No. 5, 435-449
Morantz, C. “ACS guidelines for early detection of cancer.” Am Fam Physician. 2004 Apr 15;69(8):2013.
www.cancer.gov
www.cancer.org
www.cdc.gov
www.abortionbreastcancer.ca/theresearch.htm
Copyroght 2007 MD Kiosk
