Breast Cancer
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.
Physician's Who Treat Breast Cancer
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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