Breast cancer is a disease characterized by abnormal or uncontrollable growth of breast cells. The cancer often starts in the cells of the lobules, the milk-producing glands, or in the ducts, which are passages for draining milk from the lobules to the nipple. Occasionally, breast cancer may start in the stromal tissues, such as the fibrous and fatty connective tissues of the breast. When left unchecked, breast cancer can spread beyond the breast through lymph and blood vessels to other parts of the body.
Kinds of breast cancer
Breast cancer is classified according to the breast cells which have become cancerous. The most common kinds are:
- Invasive ductal carcinoma: Begins in the ducts of the breast and spread to other tissues of the breast.
- Invasive ductal breast cancer can also metastasize (spread) to other parts of the body outside the breast.
- Invasive lobular carcinoma: Begins in the lobules of the breast and spreads to surrounding breast tissues.
- Invasive lobular cancer also can spread to other areas of the body outside the breast.
Less common kinds of breast cancer include medullary cancer, Paget’s disease, inflammatory breast cancer and mucinous cancer.
How common is breast cancer?
While both men and women can have breast cancer, the disease is far more common in women. In fact, breast cancer is the leading cause of death in American women ages 45-55, the second most commonly diagnosed cancer in American women after skin cancer and the second most frequent cause of cancer deaths in women after lung cancer. About 12 percent of all American women will develop invasive breast cancer at some point in their lifetime, with at least 220,000 invasive and 60,000 noninvasive cases being diagnosed in the United States every year.
More than 40,000 women and over 500 men die of breast cancer in the U.S. each year. Nevertheless, because of increased screening and earlier and improved treatment of breast cancer, chances of survival have improved significantly with breast cancer deaths decreasing by more than 30 percent over the last three decades.
Breast cancer risk factors
Studies have found that the risk of having breast cancer increases due to a number of factors. For instance, you are at greater risk if you are a woman in her 50s or older, since most breast cancers occur in that age range. Nonetheless, having some risk factors does not necessarily mean you will have the cancer. In fact, you may develop breast cancer even without any apparent risk factors. Likewise, most women usually have some risk factors but do not get breast cancer.
Risk factors for breast cancer include:
- Getting older, particularly being 50 years old or more.
- Inherited mutations (changes) to certain genes.
- Early menstrual period, especially having periods before reaching 12 years.
- Never pregnant or late pregnancy (after age 30).
- Beginning menopause after age 55.
- Being obese or overweight after menopause.
- Family history of breast cancer, such as a sister, mother, daughter or several family members having had the cancer.
- Using certain oral contraceptives.
- Hormone replacement therapy with progesterone and estrogen.
- Drinking alcohol and being physically inactive.
- Previous radiation therapy.
- Personal history of breast cancer or of certain non-cancerous breast diseases.
Symptoms of breast cancer
Breast cancer symptoms vary from one person to another, with some people having no symptoms at all. Initially, breast cancer may show no symptoms because the developing lump may be too small to feel or to cause noticeable unusual changes. In such cases, detecting the cancer requires a mammogram (breast X-ray). But breast cancer also may produce a new mass or lump in the breast which can easily be felt by touch. A hard, painless lump with uneven edges is more likely to be breast cancer. Or breast cancer also may develop as a soft, tender and rounded mass in the breast.
The most common breast cancer symptoms include:
(a) Change in appearance, size or shape of the breast.
(b) A mass, lump or thickening in the breast that feels different from surrounding tissue.
(c) Redness, peeling, pitting, flakiness or scaliness in the breast or nipple area.
(d) Breast pain.
(e) Irritation or dimpling of the skin in nipple area or any part of the breast.
(f) Swelling of part or the entire breast.
(g) Nipple turning inward or nipple pain.
(h) Nipple discharge that is not milk, including blood.
(i) A lump or mass in the underarm.
These symptoms also may indicate that you have other conditions, such as a cyst or infection. You should see a doctor right away so the problem is quickly diagnosed and treated.
Diagnosis of breast cancer
Treatments for breast cancer give better outcomes when the cancer is detected early. So it is important to start screening early, particularly after age 40, to ensure the cancer is detected as soon as possible. Ways of diagnosing breast cancer include:
- Breast self-examination: Early signs of breast cancer may be detected through breast self-examination. A breast self-exam means looking at and feeling your breasts. You only need to stand in front of a mirror and look for changes in shape, symmetry or dimpling. Breast self-exam also may be done in a shower where you use soap to smooth the skin and apply some pressure to check for lumps and changes in the breast. Talk to your doctor about any unusual or new lump you detect. Nevertheless, since experts do not agree on whether and when every woman should do breast self-exams, it is important to speak with your doctor before you start the self-exams.
- Mammogram (Breast X-ray) Screening: Early detection of breast cancer is effectively done using mammograms. A mammogram is simply an X-ray of the breast commonly used to screen for breast cancer. It can detect any lumps 2 years before you or your doctor can find them by hand. Women should have regular mammograms after age 40, while those having a family history of the cancer or other risk factors should have at least one screen each year after reaching age 45.
- Doctor breast exam: If you suspect a problem with your breasts, you should have them examined by a doctor. The doctor will feel both the breasts and lymph nodes (in the armpits) for lumps and other abnormalities.
- Diagnostic mammogram: Any abnormalities detected via a mammogram screen or breast exam can be further evaluated using a diagnostic mammogram. This is a more detailed breast X-ray, often achieved through digital mammography or 3-D mammography.
- Breast ultrasound: Sound waves are used to produce images of the deep structures of the breast, enabling the doctor to know whether the lump is a fluid-filled cyst or a solid mass.
- Magnetic resonance imaging (MRI): This scan provides detailed pictures of the breast.
- Biopsy: To confirm breast cancer, the doctor may choose to remove a fluid or tissue from the breast for examination under the microscope. Collected samples are sent to a pathology laboratory where experts analyze them to determine whether the cells are cancerous or not. The analysis provides answers on the types of cells involved, the grade (aggressiveness) of the cancer and any cell receptors that may influence treatment.
Treatment of breast cancer
There are several ways of treating breast cancer and your doctor will choose your treatment options depending on cancer type, cancer size, cancer stage and grade, and whether the cancerous cells are hormone sensitive. Likewise, your doctor will consider your overall health, any other conditions you have and your own treatment preferences. Most people with breast cancer undergo one or more kinds of treatment, but the major options are surgery, chemotherapy, hormone therapy and radiation therapy. During the treatment of breast cancer, doctors with different specializations such as radiation oncologists, medical oncologists and surgeons usually work together to develop plans and discuss the most effective treatment options for every case. This improves treatment outcomes.
Common treatments include:
1. Breast cancer surgery
There are many possible surgical procedures for breast cancer. Your doctor will discuss with you what is appropriate for your condition. The options include:
(a) Lumpectomy (removal of the tumor): Also called wide local excision or breast-sparing surgery, lumpectomy is focused on removing the tumor and only a small margin or portion of surrounding healthy tissue. The procedure is recommended for smaller breast tumors.
(b) Mastectomy (removal of entire breast): In some breast cancer cases, the best option is to remove the entire breast tissue. In simple mastectomy, the entire breast tissue, including ducts, lobules, fatty tissue and a portion of the skin (like nipple and areola) are removed. In skin-sparing mastectomy, the nipple and the skin over the breast may be spared, depending on the size and location of the tumor.
(c) Sentinel node biopsy (removing a few lymph nodes): A limited number of lymph nodes are removed to check whether the tumor has spread to them. If no cancer is detected in the extracted nodes, the remaining lymph nodes are spared.
(d) Axillary lymph node dissection (removal of several lymph nodes): This procedure is performed if cancer has been detected in the lymph nodes removed during the sentinel lymph node surgery.
(e) Contralateral prophylactic mastectomy (removal of both breasts): For women at very high risk, the occurrence of cancer in one breast may increase the chances of cancer in the other. This may necessitate the removal of both breasts, including the healthy one. Nevertheless, since most women with cancer of one breast rarely develop the disease in the other breast, it is important to discuss your cancer risk level and the benefits and risks involved in contralateral mastectomy before the healthy breast is removed.
2. Radiation therapy
Radiation therapy (radiotherapy) refers to the use of high-energy beams such as protons, gamma rays and X-rays to kill cancer cells. Often, radiation is done with a large machine located outside the body which aims the energy beams at the affected breast. This is called external beam radiation. Alternatively, a radioactive material may surgically be placed inside the body, a procedure called brachytherapy. External beam radiation is often used after lumpectomy to eradicate early-stage breast cancer. Radiation therapy to the chest wall is recommended after a mastectomy procedure for larger breast cancers or for cancers that have reached the lymph nodes.
External beam radiotherapy options for breast cancer include:
(a) Three-dimensional conformal radiotherapy (3D-CRT): Multiple radiation fields are combined to deliver a precise radiation dose to the tumor while preserving surrounding healthy tissue. Radiation is given in a series of sessions for 5 days a week (Monday to Friday) for 5-8 weeks. Each session is less than 30 minutes.
(b) Intensity-modulated radiotherapy (IMRT): Uses advanced technology to map the tumor, calculate accurate radiation dose and deliver radiation dosage that conforms to the tumor size, shape and location. The delivery is very precise and surrounding healthy tissues are spared. Radiation is given in a series of sessions for 5 days a week (Monday to Friday) for 5-8 weeks. Each session is less than 30 minutes.
(c) Accelerated partial breast irradiation (APBI): External 3D conformal radiation is given to only a portion (part) of the breast for 4-5 days.
Chemotherapy refers to the use of drugs to kill breast cancer cells. If your breast cancer has a huge risk of recurring or spreading to other parts of the body, certain drugs may be prescribed to minimize the risk. This is called adjuvant chemotherapy. Similarly, chemotherapy for breast cancer may be given prior to surgery, particularly in women with very large breast tumors. The goal of chemotherapy before surgery is to shrink the tumor to a size that can be easily removed via surgery. Chemotherapy is also commonly used when breast cancer has already spread outside the breast and to other parts of the body. This helps to relieve the symptoms and control the cancer.
4. Hormone-blocking therapy
Breast cancers that are sensitive to certain hormones can be treated using hormone therapy. Such cancers are usually referred to as progesterone receptor positive (PR-positive) and estrogen receptor positive (ER-positive) cancers. Hormone treatments may be given before or after surgery (or other treatments) to minimize the chance of recurrence. For cancers that have spread widely, hormone therapy can shrink and control further growth while relieving symptoms.
Hormone therapy options include:
(a) Selective estrogen receptor modulators (SERMs): Drugs that prevent estrogen from attaching to receptors found on cancer cells. They slow tumor growth and kill cancer cells. Examples include raloxifene, tamoxifen and toremifene.
(b) Aromatase inhibitors: Drugs that stop the production of estrogen after menopause. They are effective only in women who have reached menopause. Examples include letrozole, exemestane and anastrozole.
(c) Drugs that cause destruction of estrogen receptors: They block the estrogen receptors on cancer cells and signal the destruction of the receptors. An example is the drug fulvestrant which is recommended for postmenopausal women.
(d) Drugs that prevent ovarian hormone production: These are drugs used to stop ovaries from making estrogen. They are used to treat breast cancer in postmenopausal women. Surgical removal of the ovaries is an alternative to these drugs.
5. Targeted drugs
These are drugs that attack specific abnormalities in breast cancer cells. Examples of targeted drugs for breast cancer are everolimus, palbociclib, lapatinib, ado-trastuzumab, pertuzumab and trastuzumab. When abnormalities in the cancer cells have been exploited, the cells die and are removed naturally from the body.
Why choose Bay Regional Cancer Center?
At Bay Regional Cancer Center, we provide people diagnosed with breast cancer with a multidisciplinary, team-based approach to cancer treatment. Patients get the opportunity to talk with medical oncologists, surgical oncologists, radiation oncologists, plastic surgeons, gynecologists, nurses and social workers, and have their pathology slides and mammograms read in one day. We provide comprehensive, effective and minimally invasive treatment options, endeavoring to preserve the breasts through radiation therapy and lumpectomy when possible. We are a listening and caring partner that will help you to overcome your condition. For more information visit the site, Bay Regional Medical Center.