Breast Cancer

BREAST CANCER

Simply put, breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it would help to understand how any cancer develops.

Cancer occurs as a result of transformations, or abnormal changes, in the genes that regulates the growth of cells and keeps them healthy. The genes are found in each cell's nucleus, and acts as the control room of each cell. The cells in our bodies normally, replace themselves through an orderly process of cell growth (healthy new cells take over as old ones die out). However over time, the transformation can turn on certain genes and turn off others in a cell. Due to the turn off, the changed cell gains the ability to keep dividing without control or order, producing more cells like itself and form a tumor.

A tumor can be benign (i.e. not dangerous to health) or will maintain the potential to be dangerous (malignant). Benign tumors are not considered cancerous (i.e. their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body). Malignant tumors are cancerous, if they are left unchecked, they eventually can spread beyond the original tumor to other parts of the body.

Breast cancer refers to a malignant tumor that has developed from cells that are in the breast. Breast cancer usually either begins in the milk-producing glands (the lobules), or the passages that drain milk from the lobules to the nipple cells (the ducts). Less commonly, breast cancer can begin in the fatty and fibrous connective tissues of the breast (stromal tissues).

Anatomy of the Breast

Over time, cancer cells can invade nearby healthy breast tissue and make their way into the small organs that filter out foreign substances in the body (underarm lymph nodes). If cancer cells are able to get into the lymph nodes, they will then have a pathway into other parts of the body. The stages of breast cancers refers to how far the cancer cells have spread beyond the original tumor.

Breast cancer is always caused by a mistake in the genetic material (genetic abnormality). However, only a small percentage of cancers are due to inherited abnormalities from one's parents. A large chunk of breast cancers are due to abnormalities that happen as a result of the aging process and the general wear and tear of life.

There are steps everyone can take to help the body stay as healthy as possible, such as;

• Eating well balanced diet,
• Maintaining a healthy weight,
• Not smoking,
• Limiting alcohol, and
• Exercising regularly

Note however, that while these may have some impact on the risk of getting breast cancer, they cannot eliminate the risk.

Developing breast cancer is not anyone's fault. Feeling guilty, or telling oneself that breast cancer happened because of something one did to him/herself or anyone else did, is not productive.

STAGES OF BREAST CANCER

The stage of a breast cancer is almost always determined by the cancer's characteristics, such as how large it is and whether or not it has hormone receptors. Being able to determine the stage of the cancer helps the doctor to:

• Decide on the best treatment options
• Figure out the likely outcome of the disease
• Determine if certain clinical trials may be a good option
• A breast cancer stage is usually given as a number on a scale of 0 through IV. Stage 0 describes non-invasive cancers that remain within their original location whilst stage IV describes invasive cancers that have spread outside the breast to other parts of the body.

TYPES OF BREAST CANCER

• Angiosarcoma - A rare type of cancer that forms in the lining of the blood vessels and lymph vessels. The lymph vessels, which are part of the immune system, collects bacteria, viruses and waste products from the body and dispose of them.
• Invasive lobular carcinoma - This type of breast cancer begins in the milk-producing glands (the lobules) of the breast. It is Invasive, which means the cancer cells would have broken out of the lobules where they began and have the potential to spread to the lymph nodes and even other areas of the body.
• Recurrent breast cancer - Breast cancer that returns after initial treatment. Although the initial treatment is aimed at eliminating all cancer cells, a few may have evaded treatment and survived. These undetected cancer cells multiply and become recurrent breast cancer. The cancer may come back in the same place as the original cancer (local recurrence), or it may spread to other areas of the body (distant recurrence). Even if it might not be possible to cure in some cases, treatment may control the disease for long periods of time.
• Ductal carcinoma in situ (DCIS) - The presence of abnormal cells inside a milk duct in the breast. DCIS is non-invasive, this means it does not spread out of the milk duct and has quite a low risk of becoming invasive.
• Inflammatory breast cancer - A rare type of breast cancer that develops rapidly and makes the affected breast red, swollen and tender. This type of breast cancer which occurs when cancer cells block the lymphatic vessels in the skin that covers the breast, causing the breast to be reddish, swollen appearance of the breast.

• Paget's disease of the breast - Paget's disease of the breast is a rare form of breast cancer. The disease starts on the nipple and extends to the dark circle of skin around the nipple (areola). Paget's disease of the breast is in no way related to Paget's disease of the bone. This disease occurs most often in women older than 50 years. Most of the women with Paget's disease of the breast have underlying ductal breast cancer, either in situ (which means in its original place) or less commonly, invasive breast cancer. It is only in rare cases that Paget's disease of the breast is confined to the nipple.
• Lobular carcinoma in situ (LCIS) - Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells form in the milk glands (lobules) in the breast, this is not common. LCIS is not cancer by itself, it usually does not show up on mammograms, however being diagnosed with LCIS indicates an increased risk of developing breast cancer. This condition is most often discovered as a result of a biopsy that is done for other reasons. (E.g. a suspicious breast lump).
• Male breast cancer – It may be quite rare but breast cancer does occur in men, even though the condition is most commonly thought of as a disease that affects women. This condition is a rare cancer that forms in the breast tissue of men. Male breast cancer is common among older men, though it can occur at any age. Men that are diagnosed with breast cancer at an early stage stands a good chance for a cure. Based on the patient's particular situation, treatments, such as chemotherapy and radiation therapy, may be recommended. However, treatment typically involves surgery to remove the breast tissue.

CAUSES

It is generally known that breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than normal healthy cells. They continue to accumulate and form lumps or mass. The abnormal growth cells may spread (metastasize) through the breast to the lymph nodes or even to other parts of body.

Often times, breast cancer begins with the cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules or in other cells or tissue within the breast.

Studies have identified that factors concerning hormones, lifestyle and environment may increase the risk of breast cancer. It is not exactly clear why some people who have no risk factors develop breast cancer, yet other people with the risk factors never do. It may be most likely that breast cancer is caused by a complex set of interactions of a person's genetics and his/her environment.

Inherited breast cancer

Health care professionals estimate that up to 10 percent of breast cancers can be linked to gene mutations that are passed through generations of a family.

Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), are notable among some inherited mutated genes that can increase the likelihood of both breast and ovarian cancer.

If the patient has a strong family history of breast cancer or other cancers, the doctor may recommend that the patient undergoes a blood test to help identify specific mutations in BRCA or possibly other genes that are being passed through that family.

SYMPTOMS

Signs and symptoms of breast cancer may include:

• A lump in the breast or thickening that feels different from the surrounding tissue
• Changes to the skin over the breast (e.g. dimpling)
• A newly inverted nipple
• Change in the shape, size or appearance of a breast
• Redness or pitting of the skin over the breast, looking like the skin of an orange
• Peeling, scaling, crusting or flaking of the area of skin surrounding the nipple (areola) or breast skin.

WHEN TO SEE A DOCTOR

Immediately one finds a lump or any other change in the breast, patients must make an appointment with the doctor for prompt evaluation, even if a recent mammogram was normal.

RISK FACTORS

The issue of the exact cause of breast cancer is unclear yet, however, some risk factors makes its occurrence more likely.

It is possible to prevent some of the following risk factors:

• Genetics - People inherit the BRCA1 and BRCA2 genes from their parents. Women who carry these mutations have a higher chance of developing breast cancer, ovarian cancer, or both. Mutations in the TP53 gene also have also been linked to the risk of breast cancer.

A person's chance of developing breast cancer increases if a close relative has or has had breast cancer.

It is recommended strongly that people in the following groups seek genetic testing:

People whose family has a history of breast, ovarian, fallopian tube, or peritoneal cancer

People whose ancestry has a history of breast cancer related to BRCA1 or BRCA2 gene mutations (e.g. people with Ashkenazi Jewish ancestry)

• Age - The risk of breast cancer increases with age. At about age 20 years, the chance of developing breast cancer in the next decade is next to zero%. The percentage chance will go up as the person ages. To the extent that by the age of 70 years, this figure could go as high up as 3.84%.

• A personal history of breast cancer or breast lumps – Women who have suffered from breast cancer previously are more likely to suffer from it again than those who have never had the disease. Some types of noncancerous breast lump increases the chance of developing cancer later. Persons with a history of breast, ovarian, fallopian tube, or peritoneal cancer should enquire about genetic testing.
• Dense breast tissue - Women with more dense breasts are more likely than not, to receive a diagnosis of breast cancer.
• Alcohol consumption - A high rate and regular alcohol consumption plays a big role in breast cancer development. Consistently, studies have revealed that women who drink moderate to heavy volumes of alcohol have a higher risk than light drinkers.
• Estrogen exposure and breastfeeding - Probably due to a person starting their periods earlier or entering menopause at a later than average age, extended exposure to estrogen appears to increase the risk of breast cancer. This could be because between these times, estrogen levels are higher. Breastfeeding, especially for over one (1) year, appears to reduce the chance of developing breast cancer. This is possibly due to the drop in estrogen exposure that follows pregnancy and breastfeeding.
• Body weight - possibly due to increased estrogen levels, women who become overweight after menopause may also have a higher chance of developing breast cancer. High sugar intake may also be a factor.
• Exposure to radiation – Those undergoing radiation treatment for a different cancer may increase the risk of developing breast cancer later in life.
• Hormone treatments – Some other studies have established that oral contraceptives may slightly increase the risk of breast cancer. According to the studies, hormone replacement therapy (HRT), specifically estrogen-progesterone therapy (EPT), is related to an increased risk of breast cancer.

DIAGNOSIS

Tests and procedures used to diagnose breast cancer include:

Breast exam - The doctor will check both breasts and lymph nodes in the armpit, as he/she feels for any lumps or other abnormalities.

• Sampling of breast cells for testing (biopsy) - The only definitive way to make a diagnosis of breast cancer is a biopsy. During this process, the doctor uses a specialized needle device that is guided by X-ray or another imaging test to extract a core of tissue from the suspicious area. . Often times, a small metal marker is left at the site within the breast so that the area can be easily identified for future imaging tests. Biopsy samples will be sent to a laboratory for experts to analyze and determine whether the cells are cancerous. The same sample can also be analyzed to determine the type of cells that are involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence treatment options.
• Mammogram - An X-ray of the breast is called a mammogram. This is commonly used to screen for breast cancer. If an abnormality is detected with a screening mammogram, the doctor may recommend a diagnostic mammogram to further evaluate that abnormality.
• Breast magnetic resonance imaging (MRI) - An MRI machine uses a magnet and radio waves to create pictures of the interior of the breast. Before this imaging test, patient will receive an injection of dye. Unlike other types of imaging tests, an MRI does not use radiation.
• Breast ultrasound – The use of sound waves to produce images of structures deep within the body. This ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst.

Any other test and or procedure(s) that may be used will depend on the situation.

Staging breast cancer

Once breast cancer has been diagnosed, the doctor works to establish the extent (stage) of the cancer. The stage helps to determine the prognosis and the best treatment options.

The information about the stage of cancer may not be known until after breast cancer surgery.

Tests and procedures used to stage breast cancer may include:

• Positron emission tomography (PET) scan
• Breast MRI
• Bone scan
• Mammogram of the other breast to look for signs of cancer
• Blood tests (e.g. a complete blood count)
• Computerized tomography (CT) scan

Not all women will need all of these tests and procedures. The doctor will select the appropriate tests based on the patient's specific circumstances. He will also take into account any new symptoms that is being experienced.

Breast cancer stages range from 0 to IV. Zero (0) indicates cancer that is non-invasive or contained within the milk ducts. Stage four (IV) breast cancer, also referred to as metastatic breast cancer, indicates cancer that has spread to other areas of the body.

TREATMENT

Treatment will depend on several factors, including:

• The cancer's type and stage
• The individual's sensitivity to hormones
• The age, overall health, and preferences of the individual

The main options for treatment include:

• Chemotherapy
• Hormone therapy
• Radiation therapy
• Surgery
• Biological or targeted drug therapy

Factors that will determine the type of treatment a person should have will include the stage of the cancer, other medical conditions, and their individual preference.

Chemotherapy

A doctor may prescribe cytotoxic chemotherapy drugs to kill cancer cells if there is a high risk of recurrence or spread. When a person has chemotherapy after surgery, doctors call it adjuvant chemotherapy. Sometimes, a doctor may choose to administer chemotherapy before surgery to shrink the tumor and make its removal easier. Doctors call this neo-adjuvant chemotherapy.

Hormone blocking therapy

In order to prevent hormone sensitive breast cancers from returning after treatment, doctors use hormone blocking therapy. This therapy may be used to treat estrogen receptor (ER) positive and progesterone receptor (PR) positive cancers. Usually, hormone blocking therapy is administered after surgery. However, it is sometimes used beforehand to shrink the tumor. This type of therapy may be the only option for people who are not suitable candidates for surgery, chemotherapy, or radiotherapy.

Examples of hormone blocking therapy medications may include:

• Ovarian ablation or suppression
• Tamoxifen
• Aromatase inhibitors
• Goserelin, (a luteinizing hormone-releasing agonist drug that suppresses the ovaries).

Hormone treatment may affect fertility.

Radiation therapy

A person may be asked to undergo radiation therapy around a month after surgery. Radiation therapy involves targeting the tumor with controlled doses of radiation that kill any remaining cancer cells.

Surgeries

If surgery is necessary, the type will depend on both the diagnosis and individual preference.

Types of surgery will include:

• Lumpectomy – The removal of the tumor and a small amount of healthy tissue around it. A lumpectomy can help prevent the spread of the cancer if the tumor is small and easy to separate from its surrounding tissue.
• Mastectomy - A simple mastectomy involves removing of the lobules, ducts, fatty tissue, nipple, areola, and most probably some skin. In some instances, a surgeon will also remove the lymph nodes and muscle in the chest wall.
• Sentinel node biopsy - The sentinel lymph nodes are the first nodes to which a cancer can spread. If breast cancer reaches it, then it can spread into other parts of the body through the lymphatic system. Therefore, if the doctor does not find cancer in the sentinel nodes, it might not be necessary to remove the remaining nodes.
• Axillary lymph node dissection - If cancer cells are found in the sentinel nodes, the doctor may recommend the removal of several lymph nodes in the armpit to prevent the cancer from spreading.
• Reconstruction - a surgeon can reconstruct the breast to look more natural after a mastectomy, to help a person cope with the psychological effects of breast removal. The reconstruction of the breast can be done at the same time as the mastectomy or at a later date. A breast implant or tissue from another part of the body may be used.

Biological treatment

Some targeted drugs can destroy specific types of breast cancer. Examples include:

• Herceptin
• Tykerb
• Avastin

Treatments for breast cancer as well as other cancers can have severe adverse effects. Patients should discuss the potential risks with their doctors and also examine ways to minimize the side effects when deciding on a treatment.

OUTLOOK OF BREAST CANCER

Early detection and treatment usually lead to positive outlooks. A patient's outlook with breast cancer will depend on the staging. If breast cancer reaches stage 4 for example, the chances of surviving another 5 years reduces drastically to a very low percentage (27%). Regular checks and screening can help detect symptoms early.  

Regular screening

Specialist healthcare providers recommend yearly screenings for especially women of average risk who are 40 years old and over.

The guidelines for how often women should have breast cancer screening are several and vary. For example, the American College of Radiologists recommend screenings every year, starting from 40 years of age.

Despite the different recommendations, it is generally agreed among most experts that women should discuss with their doctors about breast cancer screening from 40 years of age onward.

PREVENTION

Certain lifestyle decisions can significantly reduce the risk of breast cancer as well as other types. The grim reality is that there is actually no specific or defined way to prevent breast cancer.

The lifestyle decisions may include:

• Maintenance of a healthy body mass index (BMI)
• Avoidance of excessive alcohol consumption
• Following a health-conscious diet (plenty of fresh fruit and green leafy vegetables)
• Getting enough exercise

Preventive surgery is also an option for women at high risk of breast cancer.