Breast Cancer

It is the Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male Breast Cancer is rare. Tumors in the breast can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:

Benign Tumors:

  • are rarely a threat to life
  • can be removed and usually don’t grow back
  • don’t invade the tissues around them
  • don’t spread to other parts of the body

Malignant Tumors:

  • may be a threat to life
  • often can be removed but sometimes grow back
  • can invade and damage nearby organs and tissues (such as the chest wall)
  • can spread to other parts of the body

Breast Cancer Cells can spread by breaking away from the original tumor. They enter blood vessels or lymph vessels, which branch into all the tissues of the body. The cancer cells may be found in lymph nodes near the breast. The cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. The spread of cancer is called metastasis.

Risk Factors of Breast Cancer

English: Most common cancers in the United Sta...
English: Most common cancers in the United States 2008. See Epidemiology of cancer (Photo credit: Wikipedia)

Following risk factors for Breast Cancer:

  • Age: The chance of getting Breast Cancer increases as you get older. Most women are over 60 years old when they are diagnosed.
  • Personal health history: Having Breast Cancer in one breast increases your risk of getting cancer in your other breast. Also, having certain types of abnormal breast cells (atypical hyperplasia, lobular carcinoma in situ [LCIS], or ductal carcinoma in situ [DCIS]) increases the risk of invasive breast cancer. These conditions are found with a breast biopsy.
  • Family health history: Your risk of Breast Cancer is higher if your mother, father, sister, or daughter had Breast Cancer. The risk is even higher if your family member had breast cancer before age 50. Having other relatives (in either your mother’s or father’s family) with breast cancer or ovarian cancer may also increase your risk.
  • Certain genome changes: Changes in certain genes, such as BRCA1 or BRCA2, substantially increase the risk of Breast Cancer. Tests can sometimes show the presence of these rare, specific gene changes in families with many women who have had breast cancer, and health care providers may suggest ways to try to reduce the risk of breast cancer or to improve the detection of this disease in women who have these genetic changes.

Also, researchers have found specific regions on certain chromosomes that are linked to the risk of breast cancer. If a woman has a genetic change in one or more of these regions, the risk of breast cancer may be slightly increased. The risk increases with the number of genetic changes that are found. Although these genetic changes are more common among women than BRCA1 or BRCA2, the risk of breast cancer is far lower.

  • Radiation therapy to the chest: Women who had radiation therapy to the chest (including the breasts) before age 30 are at an increased risk of Breast Cancer. This includes women treated with radiation for Hodgkin lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
  • Reproductive and menstrual history:
    • The older a woman is when she has her first child, the greater her chance of Breast Cancer.
    • Women who never had children are at an increased risk of Breast Cancer.
    • Women who had their first menstrual period before age 12 are at an increased risk of Breast Cancer.
    • Women who went through menopause after age 55 are at an increased risk of Breast Cancer.
    • Women who take menopausal hormone therapy for many years have an increased risk of Breast Cancer.
  • Race: In the United States, Breast Cancer is diagnosed more often in white women than in African American/black, Hispanic/Latina, Asian/Pacific Islander, or American Indian/Alaska Native women.
  • Breast density: Breasts appear on a mammogram (breast x-ray) as having areas of dense and fatty (not dense) tissue. Women whose mammograms show a larger area of dense tissue than the mammograms of women of the same age are at increased risk of Breast Cancer.
  • History of taking DES: DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of Breast Cancer. The possible effects on their daughters are under study.
  • Being overweight or obese after menopause: The chance of getting Breast Cancer after menopause is higher in women who are overweight or obese.
  • Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of Breast Cancer.
  • Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of Breast Cancer.

Symptoms of Breast Cancer

Early Breast Cancer usually doesn’t cause symptoms. But as the tumor grows, it can change how the breast looks or feels. The common changes include:

  • A lump or thickening in or near the breast or in the underarm area
  • A change in the size or shape of the breast
  • Dimpling or puckering in the skin of the breast
  • A nipple turned inward into the breast
  • Discharge (fluid) from the nipple, especially if it’s bloody
  • Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin at the center of the breast). The skin may have ridges or pitting so that it looks like the skin of an orange.

You should see your health care provider about any symptom that does not go away. Most often, these symptoms are not due to cancer. Another health problem could cause them. If you have any of these symptoms, you should tell your health care provider so that the problems can be diagnosed and treated.

Diagnosis of Breast Cancer

Your doctor can check for breast cancer before you have any symptoms. During an office visit, your doctor will ask about your personal and family medical history. You’ll have a physical exam. Your doctor may order one or more imaging tests, such as a mammogram. Doctors recommend that women have regular clinical breast exams and mammograms to find breast cancer early. Treatment is more likely to work well when breast cancer is detected early. If an abnormal area is found during a clinical breast exam or with a mammogram, the doctor may order other imaging tests:

  • Ultrasound: A woman with a lump or other breast change may have an ultrasound test. An ultrasound device sends out sound waves that people can’t hear. The sound waves bounce off breast tissues. A computer uses the echoes to create a picture. The picture may show whether a lump is solid, filled with fluid (a cyst), or a mixture of both. Cysts usually are not cancer. But a solid lump may be cancer.
  • MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue.
  • Biopsy. A biopsy is the removal of tissue to look for cancer cells. A biopsy is the only way to tell for sure if cancer is present. You may need to have a biopsy if an abnormal area is found. An abnormal area may be felt during a clinical breast exam but not seen on a mammogram.

Treatment is based on many factors, including:

  • Type and stage of the cancer
  • Whether the cancer is sensitive to certain hormones
  • Whether the cancer overproduces (overexpresses) a gene called HER2/neu

In general, cancer treatments may include:

  • Chemotherapy medicines to kill cancer cells
  • Radiation therapy to destroy cancerous tissue
  • Surgery to remove cancerous tissue — a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures

Hormonal therapy is prescribed to women with ER-positive breast cancer to block certain hormones that fuel cancer growth.

  • An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen-sensitive breast cancer benefit from this drug.
  • Another class of hormonal therapy medicines called aromatase inhibitors, such as exemestane (Aromasin), have been shown to work just as well or even better than tamoxifen in postmenopausal women with breast cancer. Aromatase inhibitors block estrogen from being made.

Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anticancer drugs that target certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). It may be used for women with HER2-positive breast cancer.

Stages of Breast Cancer

Stage Definition
Stage 0 Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue.
Stage I Cancer is 2 centimeters or less and is confined to the breast (lymph nodes are clear).
Stage IIA No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm)
OR
the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes
OR
the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIB The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes
OR
the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIA No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone
OR
the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.
Stage IIIB The tumor may be any size and has spread to the chest wall and/or skin of the breast
AND
may have spread to auxiliary lymph nodes that are clumped together or sticking to other structures or cancer may have spread to lymph nodes near the breastbone.Inflammatory breast cancer is considered at least stage IIIB.
Stage IIIC There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast
AND
the cancer has spread to lymph nodes either above or below the collarbone
AND
the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.
Stage IV The cancer has spread — or metastasized — to other parts of the body.

 

Treatment of Breast Cancer

Cancer treatment may be local or systemic.

  • Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment.
  • Systemic treatments affect the entire body. Chemotherapy is a type of systemic treatment.

Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning (curing). For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.

  • Stage 0 and DCIS — Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS.
  • Stage I and II — Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is the standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery.
  • Stage III — Treatment involves surgery, possibly followed by chemotherapy, hormone therapy, and biologic therapy.
  • Stage IV — Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of these treatments.

After treatment, some women will continue to take medications such as tamoxifen for a period of time. All women will continue to have blood tests, mammograms, and other tests after treatment.

Women who have had a mastectomy may have reconstructive breast surgery, either at the same time as the mastectomy or later.

Prevention of Breast Cancer

Tamoxifen is approved for Breast Cancer Prevention in women aged 35 and older who are at high risk. Discuss this with your doctor.

Women at very high risk for Breast Cancer may consider preventive (prophylactic) mastectomy. This is the surgical removal of the breasts before breast cancer is ever diagnosed. Possible candidates include:

  • Women who have already had one breast removed due to cancer
  • Women with a strong family history of Breast Cancer
  • Women with genes or genetic mutations that raise their risk of Breast Cancer (such as BRCA1 or BRCA2)

Your doctor may do a total mastectomy to reduce your risk of Breast Cancer. This may reduce, but does not eliminate the risk of Breast Cancer.

Many risk factors, such as your genes and family history, cannot be controlled. However, eating a healthy diet and making a few lifestyle changes may reduce your overall chance of getting cancer.

There is still little agreement about whether lifestyle changes can Prevent Breast Cancer. The best advice is to eat a well-balanced diet and avoid focusing on one “cancer-fighting” food. The American Cancer Society’s dietary guidelines for cancer prevention recommend that people:

  • Choose foods and portion sizes that promote a healthy weight
  • Choose whole grains instead of refined grain products
  • Eat 5 or more servings of fruits and vegetables each day
  • Limit processed and red meat in the diet
  • Limit alcohol consumption to one drink per day (women who are at high risk for breast cancer should consider not drinking alcohol at all)

Survival Rate of Breast Cancer

The table below does not divide survival rates by all of the sub stages, such as IA and IB. The rates for these sub stages are likely to be close to the rate for the overall stage.

Stage 5-year
Survival Rate
0 93%
I 88%
IIA 81%
IIB 74%
IIIA 67%
IIIB 41%*
IIIC 49%*
IV 15%

 

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2 Comments Add yours

  1. Mary Stewart says:

    Breast cancer is so alarming nowadays. These is again a reminder to all of us women to take extra care to our health. Proper diet, avoid drinking alcohol or not to drink at all. I’m glad that by doing monthly and yearly checkup can help stop this kind of cancer. Indeed prevention is better than cure.

    1. planbox says:

      I think making people aware of disease and precautions to be adopted is a great service. Thank you for making us more informed on the subject.

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