What is it?

Breast cancer is the abnormal growth and uncontrolled division of cells in the breast. Cancer cells can invade and destroy surrounding normal tissue, and can spread throughout the body via blood or lymph fluid (clear fluid bathing body cells) to start a new cancer in another part of the body. Breast cancer is the most common malignancy among American women, with 183,000 new cases a year and about 46,000 annual deaths. There are several types of breast cancer, distinguished mostly by their rate of growth and tendency to spread to other organs. Breast cancer often spreads to surrounding lymph nodes under the armpit, under the sternum (breastbone), and under the clavicle (collarbone).

Who gets it and what are its causes?

Every woman is at risk for breast cancer. As a woman ages, her risk of developing breast cancer rises dramatically regardless of her family history. The breast cancer risk of a 25 year-old woman is only one out of 19,608; by age 45, it is one in 93. In fact, 80% of all breast cancers are found in women over age 50.

Breast cancer also affects more than 1,000 men in this country each year. Symptoms, diagnosis, treatments and living with the disease apply to men as well as to women. Experts do not recommend routine screenings for men. Men account for less than 5% of cases, where in contrast, women face a one in eight lifetime risk of developing breast cancer.

There are a number of risk factors for the development of breast cancer. Family history of breast cancer in a mother or sister, early onset of menstruation and late menopause, reproductive history in regard to women who had no children or have children late in life, women who have never breastfed and those with a history of abnormal breast biopsies. However, more than 70% of women who get breast cancer have no known risk factors. In addition, some studies suggest that high fat diets, bottle feeding instead of breastfeeding or using alcohol may contribute to the risk profile.

Not all lumps detected in the breast are cancerous. Many are benign and require only the removal of the lump. While having several risk factors may boost a woman’s chances of having breast cancer, the relationship of factors is complex. The precise causes of breast cancer are unknown. The best way to assess breast cancer risk is by having clinical exams or doing monthly self-examinations to detect any lump at an early stage. The second is to have a regular mammogram. You may also seek risk assessment consultation at one of the breast cancer centers located throughout the United States.

What are the symptoms?

Early detection and treatment are extremely important in curing breast cancer. The warning signs and symptoms of breast cancer could include the following:

  • Change in the size or shape of the breast
  • Lump or thickening of tissue in the breast or armpit
  • Dimpled or pulling of the skin over the breast
  • Nipple discharge
  • Retraction of the nipple
  • Scaliness of the nipple
  • Pain or Tenderness
  • Abnormality on a mammogram

Diagnosis

When breast cancer is found and treated early, the chances for survival are better. Women can take an active part in the early detection of breast cancer by having regular screening mammograms, clinical breast exams (breast exams performed by health professionals) and by performing monthly breast self-exams.

Treatment

Mammogram - More than 90% of all breast cancers are detected by a mammogram (a low-dose x-ray of the breast). Mammography remains the best way of detecting signs of breast cancer. A baseline mammogram should be done by age 35, so that a normal x-ray can be used to compare future mammograms, even when there is no reason to believe there is a lump or cyst. Mammograms for women between the ages of 40 and 50 should be at the direction of her physician. An annual mammogram is recommended for women over the age of 50, and for most women with have suspicious breast lumps.

Radiation - This treatment is used after the cancer has been removed. The doctor may recommend radiation to destroy or shrink any remaining breast cancer cells. Radiation stops the cancer cells from dividing. It works especially well on fast-growing tumors. Unfortunately, it also stops some types of healthy cells from dividing. Healthy cells that divide quickly, like those of the skin and hair, are affected the most. This is why radiation can cause fatigue, skin problems and hair loss.

Chemotherapy - Breast cancer surgery may be followed by chemotherapy, even in the earliest stages. Chemotherapy is administered either by injection of a blood vessel or orally. It is usually given in cycles, followed by a period of times for recovery and then followed by another course of drugs. Treatment time may range between four to nine months.

There may be significant side effects with some types of chemotherapy, including nausea and vomiting, temporary hair loss, mouth sores, vaginal sores, fatigue, weakened immune system and infertility. However, chemotherapy for early breast cancer uses medications that cause few side effects.

Hormone therapy - The growth of some breast cancer cells may be slowed by using the drug tamoxifen. If given each day as a pill, tamoxifen travels throughout the bloodstream, affecting all cells in the body. Tamoxifen treatment lasts between two to five years. Research suggests that tamoxifen may lower the chance that a breast cancer can return by between 25% and 35%.

Side effects of tamoxifen may include a slightly higher risk of endometrial cancer (cancer in the lining of the uterus). The risk increases if the drug is taken for more than five years. Other side effects include menopause-like symptoms like weight gain, hot flashes and mood swings.

Other possible hormone treatments include the use of estrogens, androgens and progestins. In rare cases, surgeons may suggest removal of the ovaries in pre-menopausal women as a way of eliminating the main source of estrogen, which can boost the growth of some breast tumors.

Stem cell treatment-This is used to treat advanced breast cancer. First, stem cells from the patient’s bone marrow or blood must be removed. The doctor can use very high doses of chemotherapy or radiation to kill cancer cells. Because this also kills healthy white blood cells, which will leave the patient vulnerable to infection, the stem cells are then replaced to restore the body’s ability to fight infection.

Surgical Treatment

Breast biopsy - A breast biopsy is the removal of breast tissue for examination by a pathologist. This can be accomplished surgically, or by withdrawing tissue through a needle.

A needle biopsy removes part of the suspicious area for examination. There are two types, aspiration biopsy (using a fine needle), and large core needle biopsy. Either of these may be called a percutaneous (procedure done through the skin) needle biopsy.

The fine needle biopsy uses a very thin needle to withdraw fluid and cells that can be studied. This can be done in your physician’s office. No specialized equipment is needed. However, the use of an ultrasound helps to insure the guidance of the needle and that the specimen is taken from the right place..

A large core needle biopsy uses a larger diameter needle to remove small pieces of tissue, about the size of a grain of rice. It can be done in a clinic or hospital. Ultrasound or x-ray is used for guidance of a large core needle biopsy.

A biopsy is recommended when a significant abnormality is found, either on physical examination and/or by an imaging test. Examples of abnormality can include a breast lump felt during physical examination and/or by an imaging test. It may also include a breast lump felt during a physical self-examination or tissue changes noticed from a mammogram test.

Before a biopsy is performed, it is important to make sure that the threat of cancer cannot be disproved or ruled-out by a simpler, less invasive examination. It may be obvious that a lump is harmless when examined by an ultrasound.

Mastectomy-The surgical removal of the breast for the treatment or prevention of breast cancer.

There are four types of mastectomies: partial mastectomy, or lumpectomy, in which the tumor and surrounding tissue is removed; simple mastectomy, where the entire breast and some axillary lymph nodes are removed; modified radical mastectomy, in which the entire breast and all axillary lymph nodes are removed; and the radical mastectomy, where the entire breast, axillary lymph nodes, and chest muscles are removed.
The size, location, and type of tumor are very important when choosing the best surgery to treat a woman's breast cancer. The size of the breast is also an important factor. A woman's psychological concerns, and her lifestyle choices should also be considered when decisions are made..

The severity of a cancer is evaluated according to a complex system called Staging. This takes into account the size of the tumor, and whether it has spread to the lymph nodes, adjacent tissues and/or distant parts of the body. A mastectomy is usually the recommended surgery for more advanced breast cancers. Women with earlier stage breast cancers, who could have breast-conserving surgery (lumpectomy), may decide to have a mastectomy.

There are many factors that make a mastectomy the treatment of choice for a patient. A large tumor is often an indication of a later stage of breast cancer, when the removal of the entire breast is recommended. In addition, large tumors are difficult to remove with good cosmetic results. This is especially true if the woman has small breasts. Very rapidly growing breast cancers are usually treated with a mastectomy. Sometimes multiple areas of cancer are found in one breast, making removal of the whole breast necessary. A cancer that has already attached itself to nearby tissues, such as the skin or chest wall, is most likely to be removed with a mastectomy.

Breast conserving surgery may be attempted, but may be unsuccessful. The surgeon is sometimes unable to remove the tumor with a sufficient amount or margin of normal tissue surrounding it. The entire breast needs to be removed in this situation. Recurrence of breast cancer after a lumpectomy is another indication for mastectomy.

Radiation therapy is almost always recommended following a lumpectomy. If a woman is unable to have radiation, a mastectomy is the treatment of choice. Pregnant women cannot have radiation therapy, for fear of harming the fetus. A woman with certain collagen vascular diseases, such as systemic lupus erythematosus or scleroderma, would experience unacceptable scarring and damage to her connective tissue from radiation exposure. Any woman who has had therapeutic radiation to the chest area for other reasons cannot tolerate additional exposure for breast cancer therapy. Diminished lung capacity due to other diseases also makes a woman a poor candidate for radiation therapy.

Prophylactic mastectomy, or removal of the breast to prevent future breast cancer, is controversial. Women with a strong family history of breast cancer and/or who test positive for a known cancer-causing gene may choose this option. Patients who have had certain types of breast cancers that are more likely to recur may elect to have the unaffected breast removed. Although there is some evidence that this procedure can decrease the chances of developing breast cancer, it is not a guarantee. It is not possible to be certain that all breast tissue has been removed. There have been cases where breast cancers have occurred after both breasts have been removed..

The decision to have mastectomy or lumpectomy should be carefully considered.

It is important that the woman be fully informed of all the potential risks and benefits of different surgical treatments before making a choice.