BREAST CANCER
What is Breast Cancer?
Breast cancer is the most frequently diagnosed cancer in women. More than 180,000 women are diagnosed with breast cancer each year and about 41,000 will die from the disease.
Eighty percent of breast cancer originates in the cells of the tubes (ducts) that connect the milk-producing glands (lobules) to the nipple. Disease found in the ducts is categorized as:
- Ductal carcinoma in situ (DCIS): Cells are confined within the ducts. A high percentage of individuals at this stage can be successfully treated.
- Infiltrating (invasive) ductal carcinoma (IDC): Cancer has invaded the wall of the duct and the fatty tissue of the breast. It has the potential to spread to other parts of the body.
Less frequently, cancer begins in the cells lining the lobules. Disease found in the lobules is categorized as:
- Lobular carcinoma in situ (LCIS): Cells are confined within the lobules. Most LCIS cases do not progress to invasive cancer; however, this condition increases an individual's risk of developing invasive cancer.
- Infiltrating (invasive) lobular carcinoma (ILC): Cancer has spread out of the lobule and into the breast. It has the potential to spread to other parts of the body.
Breast Cancer Risk Factors
- Gender. Individuals who are female have a higher risk of breast cancer then males; of the 176,400 breast cancer diagnoses in 1999 only 1,400 of them were in men.
- Ethnicity. Breast cancer is more common in Caucasian women than it is in black or Asian women.
- Age. It is recognized that your risk for getting breast cancer increases with age; breast cancer is quite rare for women under the age of 35. The majority of breast cancer cases happen in women over the age of 50; with a greatly increased risk in women of 60.
- Personal history. Women who have had breast cancer face an increased risk of getting breast cancer in their other breast.
- Family history. A woman's risk for developing breast cancer increases if her mother, sister, or daughter had breast cancer, especially at a young age.
- Breast changes. Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) may increase a woman's risk for developing cancer.
- Genetic alterations. Changes in certain genes will sometimes increase the risk of breast cancer. In families in which many women have had the disease, gene testing can sometimes show the presence of specific genetic changes that increase the risk of breast cancer. Doctors may suggest ways to try to delay or prevent breast cancer, or to improve the detection of this disease in women who have these changes in their genes.
Some other factors that have been associated with an increased risk for breast cancer are:
- Estrogen. Evidence suggests that the longer a woman is exposed to estrogen (estrogen made by the body, taken as a drug, or delivered by a patch), the more likely she is to develop breast cancer.
- Late childbearing. Women who have their first child late (after about age 30) have a greater chance of developing breast cancer than women who have a child at a younger age.
- Breast density. Breast cancers nearly always develop in lobular or ductal tissue (not fatty tissue). That's why cancer is more likely to occur in breasts that have a lot of lobular and ductal tissue (that is, dense tissue) than in breasts with a lot of fatty tissue. In addition, when breasts are dense, it is more difficult for doctors to see abnormal areas on a mammogram.
- Radiation therapy. Women whose breasts were exposed to radiation during radiation therapy before age 30, especially those who were treated with radiation for Hodgkin's disease, are at an increased risk for developing breast cancer. Studies show that the younger a woman was when she received her treatment, the higher her risk for developing breast cancer later in life.
- Weight. Weight gain after age 18 is associated with an increased risk of post-menopausal breast cancer.
- Physical Inactivity. Indirect evidence exists indicating that there is an inverse relationship between amount of physical activity levels and one's risk of breast cancer.
- Alcohol Consumption. Some studies suggest a slightly higher risk of breast cancer among women who drink alcohol. The relationship between alcohol and breast cancer is consistent among associations of dietary factors and breast cancer risks, and is likely related to alcohol's (beer, wine, and liquor) ability to increase estrogen levels.
Breast Cancer Early Detection
Early detection is imperative to the successful treatment of breast cancer; the more advanced the cancer the harder it is to treat effectively. Women between the ages of 20 and 39 should conduct a breast self-exam monthly in addition to the regular breast exam with their doctor (every three years). Women over the age of 40 should have a mammogram annually in addition to the regular breast exam with their doctor. On average, mammography will detect about 80%-90% of breast cancers in women who have no symptoms.
Treatment
Sentinel Node Biopsy. The standard treatment for breast cancer involves removing the lymph nodes on the affected side to determine if the cancer has spread. Our Center's director, Dr. Armando Giuliano, pioneered an innovative technique called sentinel node biopsy which helps to more accurately determine the stage of the patient's cancer by detecting if it has spread to nearby lymph nodes - without using radical surgery.
By injecting blue dye or radioisotope into the primary tumor and following it to the lymph nodes under the arm, the blue or radioactive node can be removed. This is the same lymph node to which the cancer would have spread if it indeed did spread. By looking at this blue or radioactive lymph node, the stage of the cancer can be determined without radical surgery.
Sentinel node biopsy (lymphatic mapping) identifies, with extraordinary accuracy, the lymph node most likely to contain cancer cells that have migrated from the primary tumor. If that lymph node is cancer-free, it is highly likely that the other lymph nodes are also cancer-free and therefore there is no need to remove them. If that sentinel node is cancerous, then the surgeon and medical oncologist know that more aggressive treatment is required.
Surgery Options
- Lymph node dissection. Through examining the lymph nodes a doctor has a better idea about the possible spread of the cancer throughout your body. If cancer is found in the lymph nodes it is an indication of an increased risk for cancer in other parts of your body.
- Breast conservation surgery. This is only an option in combination with radiation therapy and includes the removal of the tumor with a small amount of the surrounding breast tissue. This specific surgery is known as a lumpectomy. This surgery option is very effective with stage I and II breast cancers.
- Mastectomy. This surgery includes the removal of the whole breast and possibly some lymph nodes. Depending on the extent and type of the breast cancer, then different lymph nodes will need to be removed. In most cases a mastectomy will mean that no radiation therapy is needed.
Radiation therapy. Usually used in conjunction with one of the surgeries listed above. Radiation therapy is a targeted therapy that is designed to kill cancer cells that may still be in the body. It can be used at the site of the original cancer or in areas where the cancer has spread.
Chemotherapy. Unlike the therapies listed above, radiation and surgery, chemotherapy is a systematic therapy, meaning that it targets the whole body. Chemotherapy can be used both before surgery, to reduce the size of the tumor, and after surgery to kill other cancer cells in the body. Chemotherapy works by targeting the cells in your body that are rapidly dividing. Cancer cells grow in a fairly chaotic and rapid manner which is why chemo works against cancer without killing a lot of your non-cancer cells.
Other Therapies. As with any disease or ailment there are always numerous treatments that are possible to combat the disease. The treatments listed above are typically the most commonplace treatments for breast cancer, however depending on your type of cancer there are some other treatments available. Some additional treatments include hormonal therapy, biologic therapy and sometimes even some alternative therapies.