Types
of Breast Cancer
There are several types of breast cancer. The
most common one, ductal carcinoma, begins in
the lining of the ducts. Another common type,
called lobular carcinoma, occurs in the lobules.
There are several other less common forms of
breast cancer as well as male breast cancer.
When breast cancer spreads outside the breast,
cancer cells are often found in the lymph nodes
under the arm, which are called the axillary
lymph nodes. If the cancer has reached these
nodes, it may also have spread to other parts
of the body. Cancer that spreads is the same
disease and has the same name as the original,
or primary, cancer. When breast cancer spreads,
it is called metastatic breast cancer, even though
the secondary tumor is in another organ.
Risk
Factors
Certain risk factors increase a woman’s
chance of developing breast cancer although most
women with known risk factors do not get breast
cancer. And many women who get breast cancer
have none of the known risk factors other than
the risk that comes with growing older. These
are some of the known risk factors for breast
cancer:
- Age – The risk of
breast cancer increases as a woman gets older.
Most breast cancers occur in women over the
age of 50 and the risk increases with age.
Breast cancer is uncommon in women under the
age of 35.
- Family History – The
risk of breast cancer increases for a woman
whose mother, sister, or daughter has had the
disease. Between 5 and 10 percent of women
with breast cancer have a hereditary form of
the disease. These women usually develop breast
cancer at a younger age and others in their
family also have had breast cancer.
- Personal History –
Risk factors for breast cancer include starting
to menstruate before the age of 12 or reaching
menopause after 55. The risk is also greater
in women who had their first child after
the age of 30 and those who never had children.
Women who have had breast cancer face an
increased risk of getting new breast cancer
again. Current studies suggest that there
may be a link between diet and breast cancer,
and breast cancer and obesity in older women.
Some recent studies suggest that regular
exercise may decrease the risk of breast
cancer in younger women.
Breast
Cancer Screening Guidelines
Huntington Hospital’s Don Monti Cancer
Center recommends that all women follow American
Cancer Society breast cancer screening guidelines
in order to increase the odds of diagnosing breast
cancer early, when the chances of achieving a
cure are greatest. Women at increased risk due
to a family history or personal history of breast
cancer or genetic predisposition, should discuss
the need for earlier or more frequent exams with
their healthcare providers.
- Yearly mammograms starting at age 40 and
continuing for as long as a woman is in good
health
- Clinical breast examinations (CBE) by a
doctor or nurse should be part of a periodic
health exam, about every three years for women
in their 20s and 30s, and every year for women
over 40
- Women should report any breast change promptly
to their healthcare providers. Breast self-exam
(BSE) should be practiced by women beginning
in their 20s
Mammography – There are
two types of mammograms. A screening mammogram
is a routine x-ray of the breasts when there
are no symptoms of cancer. Diagnostic mammograms
are made when there is reason to think cancer
is present. In many cases, mammograms can show
breast tumors before they cause symptoms or can
be felt. They can also show small deposits of
calcium in the breast. (Although most calcium
deposits are benign, a cluster of very tiny specks
of calcium called microcalcifications may be
an early sign of cancer.) Mammograms should be
interpreted by a radiologist and done only by
specially trained medical staff using approved
machines designed for breast x-rays.
Studies show that yearly mammograms in women
over 40 can save lives. Although mammography
is an effective tool, 10 to 15 percent of breast
cancers will not show up on mammograms. For this
reason, if you have a lump or other abnormality
of your breast you must see a physician even
if the mammogram is normal.
Huntington Hospital has two mammography machines
in the Women’s Health Center. These computerized
machines provide superior image quality.
Click here for more information
on mammography or to make an appointment.
Breast Self-Examination –
Monthly breast self-examination is an important
part of a detection and prevention program
and you should contact your doctor about unusual
changes you notice in your breasts. It is important
to remember that every woman’s breasts
are different and that your breasts can change
because of aging, your menstrual cycle, pregnancy,
menopause, or taking birth control pills or
other hormones.
Signs
and Symptoms of Breast Cancer
The following are the most common symptoms of
breast cancer. However, each individual may experience
symptoms differently. Early breast cancer usually
does not cause pain and may cause no symptoms
at all. And, some breast cancers never cause
symptoms or other indications of a problem. As
the cancer grows, however, it can cause changes
that women and men should watch for, such as:
- a lump or thickening (a mass, swelling,
skin irritation, or distortion) in or near
the breast or in the underarm area
- a change in the size or shape of the breast
- a change in the color or feel of the skin
of the breast, areola, or nipple (dimpled,
puckered, or scaly)
- nipple discharge, erosion, inversion, or
tenderness
It is important to consult a physician when
any of these changes are noticed.
How
is breast cancer diagnosed?
It is important to remember that a lump or other
changes in the breast, or an abnormal area on
a mammogram, may be caused by cancer or by other,
less serious problems.
To determine the cause of any signs or symptoms,
your physician will perform a careful physical
exam that includes a personal and family medical
history as well as determining current overall
health status. In addition, an examination may
include the following:
- palpation - carefully feeling
the lump and the tissue around it - its size,
its texture, and whether it moves easily. Benign
lumps often feel different from cancerous ones.
- nipple discharge examination -
fluid may be collected from spontaneous nipple
discharge and then sent to the lab to be examined
for cancer cells. Most nipple secretions are
not cancer, as an injury, infection, or benign
tumor may cause discharge.
- ductal lavage - a procedure
that collects cells from inside the milk ductal
system, the location where most breast cancers
begin.
- diagnostic mammography -
a diagnostic mammogram is an x-ray of the breast
used to diagnose unusual breast changes, such
as a lump, pain, nipple thickening or discharge,
or a change in breast size or shape.
- ultrasonography –
the use of high-frequency sound waves to generate
an image which gives important information
about a breast lump.
- aspiration or needle biopsy – The
doctor uses a needle to remove fluid or a small
amount of tissue from a breast lump. This procedure
may show whether a lump is a fluid-filled cyst,
which is not cancer, or a solid mass, which
could be cancerous. The tissue sample is sent
to a laboratory to be checked for cancer cells.
- surgical biopsy - a surgeon
removes part or all of a lump or suspicious
area through an incision into the breast. A
pathologist examines the tissue under a microscope
to check for cancer cells.
There are special instruments and techniques
that may be used to guide the needles and to
assist with biopsy procedures. These include,
but are not limited to, the following:
- stereotactic breast biopsy -
stereotactic biopsy finds the exact location
of a breast lump or suspicious area by using
a computer and mammogram results to create
a three-dimensional (3D) picture of the breast.
A sample of tissue is removed with a needle.
- Mammotome® breast biopsy system
(also called vacuum-assisted biopsy) -
a type of tube is inserted into the breast
lump or mass. The breast tissue is gently
suctioned into the tube, and a rotating knife
removes the tissue. In 1999, the US Food
and Drug Administration (FDA) approved the
use of the hand-held Mammotome device.
- ultrasound-guided biopsy -
a technique that uses a computer and a transducer
that sends out ultrasonic sounds waves to create
images of the breast lump or mass. This technique
helps to guide the needle biopsy.
- Sentinel node biopsy –
a procedure used to determine if cancer cells
have spread to other parts of the body. This
surgical procedure may be performed during
the intital diagnostic period to aid in staging
of the breast cancer. This procedure involves
injecting a dye and/or radioactive substance
near the tumor. This injection helps to locate
the lymph node closest to the tumor (sentinel
node) - the one that is most likely to have
cancer cells present if the cancer has spread.
The surgeon removes the lymph node that absorbs
the dye and radioactive substance and sends
it to the pathologist to be examined for
the presence of cancer cells.
Click here for more
information on stereotactic, mammotome, and ultrasound-guided
breast biopsies.
What
is the staging of breast cancer?
When breast cancer is diagnosed, tests will
be done to find out if the cancer has spread
from the breast to other parts of the body. This
is called staging, and is an important step toward
planning a treatment program.
What
are the different stages of breast cancer?
Breast cancer treatment decisions are complex
and can depend on a number of factors. The most
important factor is the stage of the disease,
which is based on the size of the tumor and whether
it has spread.
- Ductal carcinoma in situ,
also called intraductal carcinoma or DCIS,
refers to abnormal cells in the lining of a
duct. The cells have not broken through the
duct or invaded nearby tissue. DCIS has the
potential to become invasive cancer, and invasive
cancer cells can spread. Patients with DCIS
may have breast-sparing surgery followed by
radiation therapy or mastectomy. Underarm lymph
nodes are not usually removed.
- Stage I and Stage II are
early stages of breast cancer. Stage I means
that cancer cells have not spread beyond the
breast and the tumor is no more than three-fourths
of an inch across. Stage II means that cancer
has spread to underarm lymph nodes and/or the
tumor in the breast is more than three-fourths
of an inch across.
- Stage III is also called
locally advanced cancer. It means that the
tumor in the breast is large (more than two
inches across) and involves the lymph nodes,
or the cancer is extensive in the underarm
lymph nodes, or it has spread to other lymph
node areas.
- Stage IV is metastatic
cancer which means the cancer has spread from
the breast to other organs of the body.
Treatments
for Breast Cancer
There are many different treatments for breast
cancer that involve the clinical care of a physician
or other healthcare professionals.
Surgery
Surgery to remove as much of the cancer as possible
is the primary treatment for breast cancer. Today,
women have many surgical options and choices.
An operation to remove the breast is called a
mastectomy. An operation to remove the cancer
and some of the tissue surrounding it is called
breast-conserving surgery. Lumpectomy and segmental
(partial) mastectomy are types of breast-conserving
surgery. These usually are followed by radiation
therapy to destroy any cancer cells that may
remain in the area. In most cases, the surgeon
also removes lymph nodes under the arm to help
determine whether cancer cells have entered the
lymphatic system. First, the surgeon removes
the sentinel node, the lymph node closest to
the tumor and the one that is most likely to
have cancer cells present if the cancer has spread.
If the sentinel node is free of cancer cells,
no other lymph nodes are removed.
A woman who decides to have a mastectomy may
wear a breast form called a prosthesis afterwards.
Some women decide to have reconstructive surgery
using muscle tissue to recreate a breast. Others
may decide to have a breast implant.
Removing the lymph nodes under the arm slows
the flow of lymph fluid. In some women, this
fluid builds up in the arm and hand and causes
swelling, which is called lymphedema. To lessen
the risk of lymphedema, it is important to protect
the arm and hand on the treated side from injury
and receive special instructions for treating
any cuts, scratches, insect bites, or other injuries.
Radiation Therapy
Radiation therapy is the use of high-energy
x-rays to damage cancer cells and stop them from
growing. When this therapy follows breast-sparing
surgery, the treatments are given five days a
week for five to six weeks. At the end of that
time, an extra boost of radiation is often given
to the place where the tumor was removed. Radiation
therapy may also be done prior to surgery to
shrink the tumor. Radiation treatments are painless
and usually last just a few minutes. (more
info)
Mammosite® Radiation Therapy System
for Breast Cancer
Radiation oncologists at Huntington Hospital
also offer radioactive seed implantation in the
treatment of breast cancer. Mammosite® cuts
radiation treatment time from six weeks to one
week while minimizing treatment side effects.
Studies suggest that it is as effective as traditional
radiation of the breast at preventing a recurrence
of cancer.
(click
here for more information about Mammosite
radiation therapy.)
Chemotherapy
Chemotherapy is the use of drugs to kill cancer
cells. Chemotherapy for breast cancer is usually
a combination of drugs given by mouth or by injection.
Chemotherapy is given in cycles: a treatment
period followed by a recovery period, then another
treatment, and so on. Most patients have chemotherapy
in a doctor’s office. (more
info)
Hormone
Therapy
Estrogen is a female hormone. Hormone therapy
is used to keep estrogen-receptor-positive cancer
cells from getting the hormones they need to
grow. This treatment may include the use of drugs
that change the way hormones work or surgery
to remove the ovaries, which make female hormones.
Like chemotherapy, hormone therapy is a systemic
treatment which can affect cancer cells throughout
the body.
Tamoxifen (Nolvadex) is a drug that reduces
and/or stops the effects of estrogen in the body.
It was developed more than 20 years ago and has
been shown to help prevent the development and
recurrence of estrogen-receptor-positive breast
cancer. Tamoxifen is being used as an adjuvant,
or additional, therapy following primary treatment
for early stage breast cancer in pre-menopausal
women. Tamoxifen is taken by mouth in tablet
form and is usually prescribed as a single daily
dose.
Another group of drugs is the preferred treatment
for older women. Called aromatase-inhibitors,
these drugs help lower the amount of estrogen
in post-menopausal women who have had estrogen-receptor-positive
breast cancer.
Click
here to calculate your estimated risk
of developing breast cancer.
Breast
Cancer Risk Assessment Tool
An Interactive Tool for
Measuring the Risk of Invasive
Breast Cancer
The Breast Cancer Risk Assessment Tool is an
interactive tool designed by scientists at the
National Cancer Institute (NCI) and the National
Surgical Adjuvant Breast and Bowel Project (NSABP)
to estimate a woman's risk of developing invasive
breast cancer.
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