Breast Cancer

What It Is, How It’s Treated and Where to Find Help

What is Breast Cancer?

Breast cancer is a type of cancer or ‘tumor’ that originates in the cells of the breast in women and can also occur in men. Since breast cancer is more common in women, this article deals only with this kind of cancer.

To understand what breast cancer is it is helpful to understand that the female breast consists of many different structures and these include lobules or glands that make milk, ducts that connect these lobules to the nipple and fatty and connective tissue.

Blood vessels and lymph also occur in the breast, however, cancers that occur in the breast are usually found in the ducts, a lower percentage in the lobules and a few that begin in other tissues.

When a tumor forms in the breast, the cancer can spread to other areas in the body via the lymph nodes and vessels. (Lymph vessels carry lymph fluid containing immune system cells and waste to the lymph nodes which are small bean-shaped collections of tissue or ‘lymph’).

The Different Kinds of Breast Cancer

There are several different kinds of breast cancer and they are divided into categories depending on where the cancer originates and whether it stays in one place or can spread to other areas in the body. Despite the technical names given to these cancers, the different types are actually easy to understand and include:

1) Carcinoma in situ

This is an early stage of cancer, which is still confined to the area in which it began. It is confined to the ducts or lobules of the breast and hasn’t spread to other parts of the body.

2) Ductal carcinoma in situ

This is a kind of non-invasive breast cancer that is confined to the ducts and hasn’t spread. Almost all cases of this kind of cancer are curable. It can be detected by a mammogram.

3) Lobular carcinoma in situ:

This condition begins in the milk-making glands or lobules and stays there. It is not a true cancer but may lead to cancerous changes later on. Women who have LCIS are advised to follow the screening guidelines for breast cancer.

4) Infiltrating (invasive) ductal carcinoma

This kind of cancer begins in a milk duct and breaks through the duct wall where it spreads to the fatty tissue of the breast and other areas in the body. This is the most common type of breast cancer and in fact accounts for about 80% of invasive breast cancers.

5) Infiltrating (invasive) lobular carcinoma

Starting in the milk ducts, this cancer can spread to other areas in the body and about 10% of invasive breast cancers are this type of tumor.

What are the Symptoms of Breast Cancer?

The symptoms of breast cancer may include any of the following changes:

• A lump or swelling

• Skin irritation or dimpling

• Nipple pain or the nipple turning inward

• Redness or scalyness of the nipple or breast skin

• Discharge (other than breast milk).

• A lump in the underarm area

These may not be caused by cancer but should be reported to your doctor as soon as they are noticed.

There may be no early, easily detectable symptoms of breast cancer so all women aged 40 or older should have a mammogram (cancer screening by x-ray) done each year for life. The sooner breast cancer is detected the better the eventual outcome.

If the woman is in their 20’s or 30’s a clinical breast exam is recommended every three years to check for any abnormalities. Women of this age should also do breast self-examination on a regular basis.

What Causes Breast Cancer?

Although it is not known for sure what causes breast cancer, several factors may contribute to the development of the disease. Some of these risk factors are things you can’t change, while others are lifestyle related.

Remember that just because you have one or many risk factors for a disease it doesn’t mean you will definitely be affected. There are women who have no risk factors who have breast cancer and others who have all the risk factors that never develop cancer of the breast.

Being female is an obvious risk factor for the disease and even though men can get breast cancer it is about 100 times more common in females.

As you get older your breast cancer risk increases as almost eight out of ten breast cancers are found in women older than 50.

About five to ten percent of breast cancers can be traced to changes or ‘mutations’ in certain genes and the most common are changes in the BRCA1 and BRCA2 genes. Women who have these gene changes have up to an 80% chance of having getting breast cancer during their life.

If a close relative has or had breast cancer you are at a higher risk. Such relatives may be on the mother’s or father’s side of the family. If you have a mother, sister, or daughter with breast cancer your risk of getting breast cancer is doubled.

If you had cancer in one breast you have a higher risk of getting a second cancer in the other breast or in another part of the same breast not to be confused with a recurrence of the first cancer).

White women have a slightly greater risk of getting breast cancer than do African-American women. On the other hand, African Americans are more likely to die of breast cancer because it tends to be found at a late stage and because tumors in these races grow faster.

Biopsy results that are abnormal can give you a slightly higher risk of breast cancer.

If you have had radiation treatment to the chest area, your risk of breast cancer is greatly increased.

Those women who started having periods early i.e. before age 12 or who went through menopause late i.e. after the age of 55 are at greater have a slightly increased risk of breast cancer.

If you were given diethylstilbestrol or DES to lower your chances of losing a baby you have a slightly increased risk of getting breast cancer.

Lifestyle Factors

These are factors over which you have control. Lifestyle related factors thought to increase the risk of breast cancer include not having any children or having them after 30, taking birth control pills or hormone replacement therapy and not breastfeeding your children.

The use of alcohol as also been implicated in breast cancer with women who drink one unit a day having a very small increased risk of breast cancer. If you drink two to five units a day you have about 1½ times the risk of women who don’t drink at all.

Your diet may be important in avoiding breast cancer since being overweight is linked to a slightly increased risk. This is especially so if you gained weight after menopause and during adulthood as well as if the weight gain is in the waist area. It is a good idea to maintain a healthy weight and eat red meat in moderation especially if they are high in fat or processed.

Exercise has also been shown to decrease your risk of breast cancer and as little as 1 ¼ hour to 2½ hours per week of brisk walking has been shown to reduce your risk by 18%.

How is Breast Cancer Treated?

It may not be easy to decide how your breast cancer should be treated as there may be several options available to you. The best solution is to talk to your doctor about your cancer and all the ways it may be managed. It is also recommended to get a second opinion from another doctor before proceeding with treatment.

Any treatment for breast cancer has its pros and cons and of course there are the inevitable side effects to consider. Which one you choose depends on your health, age and the stage of your cancer. Options include:

Surgery

Types of surgery may include:

• Lumpectomy i.e. the removal of the lump and some normal tissue at the site of the tumor. (often combined with radiation therapy

• Partial or segmental mastectomy – This means a bit more of the breast tissue is removed than in a lumpectomy and is usually combined with radiation therapy.

• Simple or total mastectomy – The whole breast is removed but the lymph nodes under the arm or muscle tissue from beneath the breast are left alone.

• Modified radical mastectomy - The whole breast is removed as well as certain lymph nodes under the arm.

• Radical mastectomy – The whole breast is removed as well as the lymph nodes and the chest wall muscles under the breast. It is an uncommon surgery these days as modified radical mastectomy can be effective with less disfigurement and less side effects.

Systemic Treatments

Systemic therapies like chemotherapy, radiation and hormone therapy are also used, sometimes in combination with or before surgery to treat breast cancer. In chemotherapy drugs are given by mouth or into the veins to treat the cancer. This is helpful in cases where the cancer has spread to other organs.

Radiation therapy involves treating the cancer with high-energy ‘x-rays’ to attack and kill or shrink cancer cells. It may be given from outside the body or placed inside the tumor.

Hormone therapy involves taking estrogen blocking substances like tamoxifen, in pill form. It may also be prescribed if you are in a high risk category.

Breast cancer is not necessarily a fatal disease and if you have been diagnosed with the disease you should talk to your doctor about the stage of your illness, treatment goals, options for surgery and any side effects from chemotherapy and radiation.

It is also very important to talk over the very sensitive issue of breast removal which has significant impacts on some women. It may be helpful to talk with other women why have survived or are undergoing treatment for breast cancer such as in a support group.

Please consult the many links on this page for in-depth information and resources that will help you to understand your condition better and more positively.