Breast Cancer

Breast cancer is a disease in which cancer cells form in the tissues of the breast. The breast is made up of lobes and ducts. Each breast has 15-20 sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules and bulbs are linked by thin tubes called ducts. 

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collar bone and in the chest.

Breast cancer occurs in two broad categories: Noninvasive and invasive.

• Noninvasive (in situ) breast cancer: cancerous cells remain in a particular location of the breast without spreading to surrounding tissue, lobules or ducts.
• Invasive (infiltrating) breast cancer: cancerous cells break through normal breast tissue barriers and spread to other parts of the body through the bloodstream and lymph nodes.

The most common type of breast cancer is ductal carcinoma which begins in the cells of the duct. Cancer that begins in the lobes or lobules is called lobular carcinoma. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red and swollen. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also look dimpled like the skin of an orange.

RISK FACTORS:

1. Family history of breast cancer in first degree relative (mother, daughter or sister)
2. Inherited changes in the BRCA1 and BRCA2 genes or in other genes that increase the risk of breast cancer
3. Drinking alcoholic beverages
4. Breast tissue that is dense on a mammogram
5. Exposure of breast tissue to estrogen made by the body
   1. Menstruating at an early age
   2. Older age at first birth or never having given birth
6. Starting menopause at a later age
7. Taking hormones such as estrogen combined with progestin for symptoms of menopause
8. Taking oral contraceptives (“the pill”)
9. Obesity
10. A personal history of benign (non-cancer) breast disease
11. Being white
12. Treatment with radiation therapy to the breast/chest

Breast cancer is sometimes caused by inherited gene mutations. Hereditary breast cancer makes up about 5% to 10% of all breast cancer. Women who have certain gene mutations, such as BRCA1 or BRCA2 mutations have increased risk of breast cancer.

SYMPTOMS OF BREAST CANCER:

Breast cancer may cause any of the following signs and symptoms. Check with your doctor if you have any of the following problems.
A lump or thickening in or near the breast or in the underarm area.

1. A change in the size or shape of the breast
2. A dimple or puckering in the skin of the breast
3. A nipple turned inward into the breast
4. Fluid, other than breast milk from the nipple, especially if it is bloody
5. Scaly, red, or swollen skin on the breast, nipple or areola (the dark area of skin that is around the nipple)
6. Dimples in the breast that looks like the skin of an orange
7. There are other conditions that are not breast cancer that may cause these same symptoms

The stage of breast cancer is one of the most important factors in evaluating treatment options. Our cancer doctors use a variety of diagnostic tests to evaluate breast cancer and develop the appropriate treatment plan for you.

Stage 0 noninvasive, carcinoma in situ breast cancer – There is no evidence of cancer cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.

Stage I breast cancer – In stage I, the tumor measures up to two centimeters and no lymph nodes are involved.

Stage II (invasive) breast cancer _- In state II, the tumor measures between two to five centimeters, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer.

Stage III (locally advanced) breast cancer – In stage III, the tumor in the breast is more than two inches in diameter across and the cancer is extensive in the underarm lymph nodes, or has spread to other lymph nodes or tissues near the breast.

Stage IV (metastatic) breast cancer – In stage IV, the cancer has spread beyond the breast, underarm and internal mammary lymph nodes to other parts of the body near to or distant from the breast.

TREATMENT:

Different types of treatment are available for patients with breast cancer. Some treatments are standard, and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatments become the standard treatment. Radiation can reduce the risk of breast cancer recurrence by about 70%. Despite what people may fear, radiation therapy is relatively easy to tolerate and its side effects ae limited to the treated area.

Six types of standard treatment for breast cancer include:

1. Surgery
2. Sentinel lymph node biopsy followed by surgery
3. Radiation Therapy
4. Chemotherapy
5. Hormone therapy
6. Targeted therapy

Anything that lowers your chance of getting a disease is called a protective factor. Protective factors for breast cancer include the following:

1. Taking the following:
   1. Estrogen-only hormone therapy after a hysterectomy
   2. Selective estrogen receptor modulators (SERMs)
   3. Aromatase inhibitors
2. Less exposure of breast tissue to estrogen made by the body:
   1. Early pregnancy
   2. Breastfeeding
   3. Late menstruation
   4. Early menopause
3. Getting enough exercise
4. Having any of the following procedures:
   1. Risk-reducing mastectomy (surgery to remove one or both breasts)
   2. Risk-reducing oophorectomy (surgery to remove the ovaries)
   3. Ovarian ablation