Breast Cancer

What is it?

Symptoms

Causes

Diagnosis

Treatment

Prevention

What is it?

Breast cancer is cancer arising in breast tissue. Cancer is simply a group of abnormal cells that have abnormal growth patterns.

Each month, a woman's breasts go through temporary changes associated with menstruation, and a lump may form.  While the vast majaority of these growths are not cancerous, any lump should be examined immediately.  

Lumps are most common in the lobules -- small sacs that produce milk -- or the ducts that carry milk to the nipple.  But they occasionally start in other tissue.  The two main categories of breast cancer are lobular and ductal carcinomas. 

Breast cancer usually begins with the formation of a small, confined tumor. Some tumors are benign, meaning they do not invade other tissue; others are malignant, or cancerous. Malignant tumors have the potential to metastasize, or spread. Once such a tumor grows to a certain size, it is more likely to shed cells that spread to other parts of the body through the bloodstream and lymphatic system. Different types of breast cancer grow and spread at different rates; some take years to spread beyond the breast, while others move quickly.

Men can get breast cancer, too, but they account for less than one-half of one percent of all cases.  Among women, breast cancer is the most common cancer and the second leading cause of cancer deaths -- behind lung cancer.

If eight women were to live to be at least 85, one of them would be expected to develop the disease at some point during her life.  Two-thirds of women with breast cancer are over 50, and most of the rest are between 39 and 49. 

Fortunately, breast cancer is very treatable if detected early. Localized tumors can usually be treated successfully before the cancer spreads; and in nine in 10 cases, the woman will live at least another five years.  Experts usually consider a five-year survival to be a cure. 

Once the cancer begins to spread, getting rid of it completely is more difficult, although treatment can often control the disease for years.  Improved screening procedures and treatment options mean that at least seven out of 10 women with breast cancer will survive more than five years after initial diagnosis, and half will survive more than 10 years. 

Symptoms

In its early stages, breast cancer usually has no symptoms. As a tumor develops, you may note the following signs:

• A lump in the breast or underarm that persists after your menstrual cycle; often the first apparent symptom of breast cancer, breast lumps are painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
• Swelling in the armpit.
• Although lumps are usually painless, pain or tenderness in the breast can be a sign of breast cancer.
• A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.
• Any change in the size, contour, texture, or temperature of the breast; a reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
• A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation, or ulceration; scaling of the nipple is symptomatic of Paget's disease, a localized cancer.
• Unusual discharge from the nipple that may be clear, bloody, or another color. It's usually caused by benign conditions but could be due to cancer in some cases.
• A marble-like area under the skin.
• An area that is distinctly different from any other area on either breast.

Causes

Although the precise causes of breast cancer are unclear, we know what the main risk factors are. Still, most women considered at high risk for breast cancer do not get it, while many who do have no known risk factors.  Among the most significant factors are advancing age and a family history of breast cancer.  Risk increases slightly for a woman who has had a benign breast lump and increases significantly for a woman who has previously had cancer of the breast or the ovaries. 

A woman whose mother, sister, or daughter has had breast cancer is two to three times more likely to develop the disease, particularly if more than one first-degree relative has been affected.  Researchers have now identified two genes responsible for some instances of familial breast cancer -- called BRCA1 and BRCA2.  About one woman in 200 carries it.  Having the gene predisposes a woman to breast cancer but does not ensure that she will get it.

Generally, women over 50 are more likely to get breast cancer than younger women, and African-American women are more likely than Caucasions to get breast cancer before menopause.

A link between breast cancer and hormones is gradually becoming clearer. Researchers think that the greater a woman's exposure to the hormone estrogen, the more susceptible she is to breast cancer. Estrogen tells cells to divide; the more the cells divide, the more likely they are to be abnormal in some way, possibly becoming cancerous.

A woman's exposure to estrogen and progesterone rises and falls during her lifetime, influenced by the age she starts and stops menstruating, the average length of her menstrual cycle, and her age at first childbirth.  A woman's risk for breast cancer is increased if she starts menstruating before age 12, has her first child after 30, stops menstruating after 55, or has a menstrual cycle shorter or longer than the average 26-29 days.  Current information indicates that the hormones in birth control pills probably do not increase the risk.  Some studies suggest that taking hormone replacement therapy after menopause may increase risk, especially when taken for more than 5 years.  The jury is still somewhat out on this matter though.  Heavy doses of radiation therapy may also be a factor, but low-dose mammograms pose almost no risk.

The link between diet and breast cancer is debated. Obesity is a noteworthy risk factor, and drinking alcohol regularly -- more than a couple of drinks a day -- may promote the disease. Many studies have shown that women whose diets are high in fat are more likely to get the disease. Researchers suspect that if a woman lowers her daily calories from fat -- to less than 20%-30% -- her diet may help protect her from developing breast cancer.

Diagnosis

Diagnosis of breast cancer usually is comprised of several steps, including examination of the breast, mammography, possibly ultrasonography or MRI, and, finally, biopsy. Biopsy is the only definitive way to diagnose breast cancer.

Examination of the Breast

• A complete breast examination includes visual inspection and careful palpation (feeling) of the breasts, the armpits, and the areas around your collarbone.During that exam, your examiner may palpate a lump or just feel a thickening.

Mammography

• Mammograms are x-rays of the breast that may help define the nature of a lump. Mammograms are also recommended for screening to find early cancer.
  
• Usually, it is possible to tell from the mammogram whether a lump in the breast is breast cancer, but no test is 100% reliable.
• A mammogram alone is often not enough to evaluate a lump. Your doctor will probably request additional tests.
  
• All breast lumps need to be clearly defined as benign or should be biopsied.

Ultrasound

• Ultrasound of the breast is often done to evaluate a breast lump.
  
• Ultrasound waves create a "picture" of the inside of the breast.
  
• It can demonstrate whether a mass is filled with fluid (cystic) or solid. Cancers are usually solid, while many cysts are benign.
  
• Ultrasound might also be used to guide a biopsy or the removal of fluid.

MRI

• MRI may provide additional information and may clarify findings which have been seen on mammography or ultrasound.
  
• MRI is not routine for screening for cancer but may be recommended in special situations.

Biopsy

• The only way to diagnose breast cancer with certainty is to biopsy the tissue in question. Biopsy means to take a very small piece of tissue from the body for examination and testing by a pathologist to determine if cancer is present.
  
• If a cancer is diagnosed on biopsy, the tissue will be tested for hormone receptors. Receptors are sites on the surface of tumor cells that bind to estrogen or progesterone. In general, the more receptors, the more sensitive the tumor will be to hormone therapy. There are also other tests (for example, measurement of HER-2/neu receptors) that may be performed to help characterize a tumor and determine the type of treatment that will be most effective for a given tumor.

Treatment

There are two major goals of breast cancer treatment:

1) To rid the body of the cancer as completely as possible.
2) To prevent cancer from returning.

How Is Treatment Determined?

The type of treatment recommended to you by your cancer specialist/doctor will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells and the stage or extent of the disease. Your doctor usually considers your age and general health as well as your feelings about the treatment options.

Be sure to discuss your treatment options with your cancer specialist/doctor.

What Are the Types of Breast Cancer Treatment?

Breast cancer treatments are local or systemic.

Local treatments are used to remove, destroy or control the cancer cells in a specific area, such as the breast. They include:

• Surgery, either mastectomy or lumpectomy also called breast conserving therapy or partial mastectomy) with or without lymph node removal.
• Radiation therapy

Systemic treatments are used to destroy or control cancer cells all over the body. They include:

• Chemotherapy which uses drugs to to kill cancer cells. Side effects can include nausea, hair loss, early menopause, hot flashes, fatigue and temporarily lowered blood counts.
• Hormone therapy , including tamoxifen, and the aromatase inhibitors Arimidex, Aromasin and Femara. Hormone therapy uses drugs to prevent hormones, especially estrogen, from promoting the growth of breast cancer cells that may remain after breast cancer surgery. Side effects can include hot flashes and vaginal dryness.
• Biological Therapy such as Herceptin, works by using the body's immune system to destroy cancer cells. Herceptin targets breast cancer cells that have high levels of a protein called HER2.

Systemic therapy can be given after local treatment (adjuvant therapy) or before (neoadjuvant therapy). Adjuvant therapy is used after local treatments to kill any cancer cells that remain in the body and may be in other parts of the body.

A patient may have just one form of treatment or a combination, depending on her needs.

Prevention

The most important risk factors for the development of breast cancer are sex, age, and genetics. Because women can do nothing about these risks, regular screening is recommended in order to allow early detection and thus prevent death from breast cancer.

• Check your breasts once a month, three to five days after your menstrual period ends. Have a thorough medical checkup once a year, and have mammograms every one to two years if you are aged 40 or older. Beginning at 50, yearly mammograms are recommended. Start mammograms earlier if you have a family history of breast cancer.
• Build your diet around fruit, vegetables, grains, and fish.
• If you use contraception, ask your doctor about the pros and cons of birth control pills. 
• If you are near or in menopause, ask your doctor if you should use hormone replacement therapy to treat menopause symptoms. Studies suggest that hormone replacement can increase the risk of breast cancer.  You and your doctor can make this decision based on your risk of breast cancer.

 

Sources: WebMD, eMedicineHealth