Breast Cancer

By Harvard Health Publications Posted: Mon., Jul. 31, 2006 , 9:08 pm EDT

Topics: health, disease, hospital, breast cancer, petition More

What Is Breast Cancer?

Breast cancer is a type of uncontrolled growth of abnormal cells that can develop in one of several areas of the breast, including the ducts that carry milk to the nipple, the lobules (small sacs that produce milk) and the nonglandular tissue.

The main forms of invasive breast cancer are:

Invasive ductal carcinoma — This type of breast cancer develops in the milk ducts and accounts for about 75% of cases. It can break through the duct wall and invade the breast's fatty tissue, then spread (metastasize) to other parts of the body through the bloodstream or lymphatic system.
Invasive lobular carcinoma — This type of breast cancer accounts for about 15% of cases and originates in the breast's milk-producing lobules. It also can spread to the breast's fatty tissue and other places in the body.
Medullary, mucinous and tubular carcinomas — These are three slow-growing types of breast cancer that represent about 8% of all breast cancers.
Paget's disease — This type represents about 1% of breast cancers. It starts in the milk ducts of the nipple and can spread to the areola (dark circle around the nipple). Women who get Paget's disease usually have a history of nipple crusting, scaling, itching or inflammation.
Inflammatory carcinoma —This type accounts for about 1% of all cases. Of all breast cancers, inflammatory carcinoma is the most aggressive and difficult to treat, because it spreads so quickly.

As more women have regular mammograms, doctors are also detecting many more noninvasive or precancerous conditions before they become full-blown cancer. These conditions include:

Ductal carcinoma in situ (DCIS) — DCIS occurs when cancer cells fill the ducts but haven't spread through the walls into fatty tissue. Nearly all women diagnosed at this early stage can be cured. Without treatment, about 25% of DCIS cases will lead to invasive breast cancer within 10 years.
Lobular carcinoma in situ (LCIS) — LCIS is less of a threat than DCIS. It develops in the breast's milk-producing lobules. LCIS doesn't require treatment, but it does increase a woman's risk of developing cancer in other areas of both breasts.

Breast cancer is the second most common cancer (after skin cancer) in U.S. women, with approximately 211,000 cases expected to be diagnosed in 2005. It causes the death of more than 40,000 women each year, and is the second leading cause of cancer death in women. A woman's risk of developing breast cancer increases with age; more than three out of four breast cancer cases occur in women over age 50. Other risk factors include:

A family history of breast cancer
A prior history of breast cancer or certain other abnormalities of the breast tissue
Increased exposure to the female hormone estrogen in any of three ways: having a first menstrual period before age 13, entering menopause after age 51 or using estrogen replacement therapy
Never having been pregnant, or having a first pregnancy after age 30
Being overweight, especially after menopause
Drinking alcohol (cancer risk doubles with three or more drinks per day)
Having a sedentary lifestyle with little regular exercise

Although breast cancer is much more common in women than in men, about 1,700 new cases of breast cancer are diagnosed each year in men in the United States, with 460 deaths.

Symptoms of Breast Cancer

Symptoms of breast cancer include:

A lump or thickening in the breast or under the arm
A clear or bloody discharge from the nipple
Crusting or scaling of the nipple
Inverted nipples
Redness or swelling of the breast
Dimpling on the breast skin resembling the texture of an orange
A change in the contours of the breast, such as one being higher than the other
A sore or ulcer on the skin of the breast that does not heal

Diagnosis of Breast Cancer

Your doctor will ask about factors that increase your risk of breast cancer, especially a family history of the illness. He or she also will look for the symptoms described above, including a lump or thickening in the breast, nipple inversion or discharge, swelling or changes in breast contour, redness or dimpling of breast skin, and enlarged lymph nodes in the armpit.

If your doctor discovers a lump in your breast during a physical examination or your screening mammogram detects an area of abnormal breast tissue, your doctor will recommend an evaluation for breast cancer. In some cases, the next step is an ultrasound examination to confirm whether the lump is a solid tumor or a fluid-filled, noncancerous cyst. If the lump is solid, your doctor probably will recommend a breast biopsy, which means breast tissue will be removed for laboratory testing. Sometimes, your doctor will recommend a biopsy without doing an ultrasound first. Several types of breast biopsy are currently available, including fine-needle biopsy, core biopsy, stereotactic needle biopsy and surgical biopsy, which involves the removal of all or part of the breast lump.

The biopsy will confirm whether or not you have breast cancer. Depending on the specific type of biopsy, and whether neighboring lymph nodes were also removed and examined, the biopsy report also may clarify the extent of cancer spread, whether the tumor cells are estrogen-receptor positive or negative, and whether there are too many copies of the HER-2 gene in the cancer cells. This information will help determine the type of recommended treatment.

Expected Duration of Breast Cancer

Breast cancer will continue to grow and spread until it is treated.

Prevention of Breast Cancer

Although there are no guarantees, you can take some steps to help prevent breast cancer:

Don't smoke.
Maintain a healthy weight.
Exercise regularly.
Limit your use of alcohol. If you drink, you may be able to decrease your risk of breast cancer by taking a folate supplement.
Follow a healthy diet low in fat and high in cruciferous vegetables (broccoli, Brussels sprouts and cauliflower).
(HL – official recommendation has been to neither encourage or discourage self breast exam)Have your doctor examine your breasts every three years if you are under age 40 and every year if you are over 40.
Have regular mammograms. Mammograms can detect breast cancer two to five years before a tumor becomes large enough to be felt as a lump. Although the specific frequency of mammograms is controversial, many experts still recommend annual mammograms for women older than 40.

Also, researchers have found mutations in two genes — BRCA1 and BRCA2 — that are associated with hereditary breast cancer. Women who believe they may be at especially high risk of hereditary breast cancer should consult with a genetic counselor prior to testing.

Treatment of Breast Cancer

Treatment for breast cancer almost always begins with a decision about the type of surgery. The two options are removing the entire breast (mastectomy) or removing only the cancerous lump and a small amount of healthy tissue around it (lumpectomy). Following surgery, your doctor may recommend radiation therapy, chemotherapy, hormonal therapy or a combination of therapies. The additional therapies improve risk of cancer recurrence and spread.

Radiation therapy, sometimes called radiotherapy, almost always is recommended after lumpectomy to destroy any cancer cells left behind and to prevent the cancer from returning. Without radiation therapy, the odds of the cancer returning increase by about 25%.

The need for chemotherapy depends on how much the cancer has spread. In some cases, chemotherapy will be recommended before surgery to shrink a large tumor so that it can be removed more easily. Chemotherapy is almost always necessary if cancer returns.

Hormonal chemotherapy usually is recommended when the pathology report shows that the cancer is estrogen-receptor positive. In hormonal chemotherapy, the drug used most often is tamoxifen (Nolvadex). Tamoxifen locks estrogen out of breast cancer cells that are estrogen-receptor positive, which may reduce the cancer recurrence rate by up to 30%.

The aromatase inhibitors offer another form of hormonal therapy. These drugs, including anastrazole (Arimidex), exemestane (Aromasin), and letrozole (Femara), work in a different way on estrogen-receptor positive tumors. They decrease the amount of estrogen in the body by blocking estrogen production in all other tissues except the ovaries. These drugs are most useful in menopausal women, since the ovaries stop making estrogen after menopause.

The treatment for DCIS (ductal carcinoma in situ) is lumpectomy usually followed by radiation therapy or simple mastectomy with limited lymph node dissection. A mastectomy may be recommended if DCIS occurs in more than one location or if the tumor cells look especially worrisome on biopsy. Though mastectomy sometimes still is done for DCIS, lumpectomy with radiation also is commonly done. In some women, lumpectomy without radiation also may be effective.

LCIS itself doesn't lead directly to cancer. No treatment is required. However, because women with this condition are at higher risk for developing cancer in other areas of their breasts, they should have regular mammograms and breast exams by a physician. To decrease breast cancer risk, some women have opted for hormonal therapy such as tamoxifen.

When To Call A Professional

Call your doctor immediately if you find a lump or abnormal thickening in your breast. Also call your doctor if you notice a nipple is inverted, discharge from a nipple, a swelling in your breast or a change in breast contour, or redness or dimpling of breast skin.

Prognosis

Early diagnosis significantly improves the outlook for women with breast cancer. If the tumor is small and confined to the breast, more than 90% of women survive for at least 5 years after the diagnosis. However, if the disease spreads throughout the body before diagnosis, the 5-year survival rate drops to less than 20%.

Additional Info

National Cancer Institute (NCI) Public Inquiries Office Suite 3036A 6116 Executive Blvd., MSC 8322 Bethesda, MD 20892-8322 Phone: (301) 435-3848 Toll-Free: (800) 422-6237

American Cancer Society (ACS) 1599 Clifton Rd., NE Atlanta, GA 30329-4251 Toll-Free: (800) 227-2345

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