Breast Cancer

• What is Breast Cancer?
• Breast Cancer Risk Factors
• Symptoms of Breast Cancer
• Signs/Tests for Breast Cancer
• Breast Cancer Treatment
• Can you prevent Breast Cancer?
• Breast Cancer Prognosis

Breast Cancer - Overview

Breast cancer is a cancer that starts in the tissues of the breast and are potentially life-threatening malignancies that develop in one or both breasts. There are two main types of breast cancer:

1. Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type. It may progress to invasive cancer if untreated.
2. Lobular carcinoma starts in the parts of the breast, called lobules, that produce milk.

In rare cases, breast cancer can start in other areas of the breast. The structure of the female breast is important in understanding this cancer:

• The interior of the female breast consists mostly of fatty and fibrous connective tissues.
• It is divided into about 20 sections called lobes.
• Each lobe is further subdivided into a collection of lobules, structures that contain small milk-producing glands.
• These glands secrete milk into a complex system of tiny ducts. The ducts carry the milk through the breast and converge in a collecting chamber located just below the nipple.
• Breast cancer is either noninvasive (referred to as  in situ , confined to the site of origin) or invasive (spreading).

Breast cancer may be invasive or noninvasive. Invasive means it has spread from the milk duct or lobule to other tissues in the breast. Noninvasive means it has not yet invaded other breast tissue. Noninvasive breast cancer is called "in situ."

Risk Factors of Breast Cancer

About 12% of women will develop invasive breast cancer in their lifetime. Each year in the United States, about 207,000 women are diagnosed with invasive breast cancer and about 54,000 women are diagnosed with pre-invasive breast cancer. (Although breast cancer in men is rare, about 2,000 American men are diagnosed each year with invasive breast cancer.)

About 40,000 American women die from breast cancer each year. Breast cancer death rates have declined significantly since the 1990s, especially for women younger than age 50. The earlier that breast cancer is diagnosed, the earlier the opportunity for treatment. In the United States, there are currently more than 2.5 million breast cancer survivors.

Risk factors for breast cancer include:

• Age and gender -- Your risk of developing breast cancer increases as you get older. Most advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer than men.
• Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease.
• Genes -- Some people have genes that make them more likely to develop breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. If a parent passes you a defective gene, you have an increased risk for breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.
• Menstrual cycle -- Women who got their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

Other risk factors include:

• Alcohol use -- Drinking more than 1 - 2 glasses of alcohol a day may increase your risk for breast cancer.
• Childbirth -- Women who have never had children or who had them only after age 30 have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.
• DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s - 1960s.
• Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy with estrogen for several years or more.
• Obesity -- Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.
• Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a much higher risk for developing breast cancer. The younger you started such radiation and the higher the dose, the higher your risk -- especially if the radiation was given during breast development.

Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and pesticides.

Symptoms of Breast Cancer

Early breast cancer usually does not cause symptoms and are usually painless. Often the first symptom is the discovery of a hard lump, this is why regular breast exams are important. As the cancer grows, symptoms may include:

• Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
• Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange
• Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus

Men can get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.

Symptoms of advanced breast cancer may include:

• Bone pain
• Breast pain or discomfort
• Skin ulcers
• Swelling of one arm (next to the breast with cancer)
• Weight loss

Signs and Tests of Breast Cancer

The most important test a woman can do to identify breast cancer is to perform monthly self-examinations and make yearly mammography appointments . When you visit your primary care doctor, bring up the topic of breast cancer and discuss your potential risk factors and symptoms. Then, your doctor will perform a physical exam, which includes both breasts, armpits, and the neck and chest area.

Tests used to diagnose and monitor patients with breast cancer may include:

• Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram
• Breast ultrasound to show whether the lump is solid or fluid-filled
• Breast biopsy , using methods such as needle aspiration,  ultrasound-guided ,  stereotactic , or  open .
• CT scan to see if the cancer has spread
• Mammography to screen for breast cancer or help identify the breast lump
• PET scan
• Sentinal lymph node biopsy to see if the cancer has spread.

If your doctor learns that you do have breast cancer, more tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.

Breast cancer stages range from 0 to IV. The higher the staging number, the more advanced the cancer.

Treating Breast Cancer

The three major treatments of breast cancer are surgery , radiation , and drug therapy . No one treatment fits every patient, and combination therapy is usually preferred. The choice is determined by many factors, including the age of the patient, menopausal status, the kind of cancer (ductal verses lobular), its stage, and whether or not the tumor contains hormone receptors.

However, surgery forms a part of nearly every patient's treatment for breast cancer. The initial surgical intervention is often a lumpectomy , the removal of the tumor itself. In the past, mastectomy (the removal of the breast) was the standard treatment for nearly all breast cancers. Now, many patients with early-stage cancers can choose breast-conserving treatment, or lumpectomy followed by radiation, with or without chemotherapy .

For invasive breast cancer, studies indicate that lumpectomy or partial mastectomy combined with radiation therapy works as well as a modified radical mastectomy.

• Read more about:  Lumpectomy ,  Mastectomy ,  Radiation therapy .

Any or all of these therapies may be used separately or, most often, in different combinations. For example, radiation alone or with chemotherapy or hormone therapy may be beneficial before surgery, if the tumor is large. Surgery followed by radiation and hormone therapy is usually recommended for women with early-stage, hormone-sensitive cancer. There are numerous clinical trials investigating new treatments and treatment combinations. Patients, especially those with advanced stages of cancer, may wish to consider enrolling in a clinical trial .

Recurrent breast cancer is considered to be an advanced cancer. In such cases, the disease has come back in spite of the initial treatment. Most recurrences appear within the first 2 - 3 years after treatment, but breast cancer can recur many years later. Treatment options are based on the stage at which the cancer reappears, whether or not the tumor is hormone responsive, and the age of the patient. Between 10 - 20% of recurring cancers are local. Most recurrent cancers are metastatic. All patients with recurring cancer are candidates for clinical trials.

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 for a period of time. All women will continue to have blood tests, mammograms, and other tests after treatment.

Can you prevent 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.

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)

Always talk to your healthcare provider before making any decisions regarding breast cancer prevention. Your doctor will help you evaluate your true risk factors, and the best treatment plan if you are diagnosed with cancer.

Life After Breast Cancer - prognosis

Breast cancer is the second most lethal cancer in women. ( Lung cancer is the leading cancer killer in women.) The good news is that early detection and new treatments have improved survival rates. Unfortunately, women in lower social and economic groups still have significantly lower survival rates than women in higher groups.

Women are now living longer with breast cancer. Breast cancer mortality rates have declined by about 25% since 1990. This decline may be due to better screening and better treatment options. However, survivors must live with the uncertainties of possible recurrent cancer and some risk for complications from the treatment itself.

Recurrences of cancer usually develop within 5 years of treatment. About 25% of recurrences and half of new cancers in the opposite breast occur after 5 years.

If you experience any symptoms of breast cancer, call your healthcare provider immediately for a full evaluation.