Breast Cancer

Breast Cancer

Other than skin cancer, breast cancer is the most common type of cancer among women in the United States. This year, more than 215,000 women nationwide will be diagnosed with breast cancer, and more than 40,000 will die from the disease. Each year, about 1,300 men in this country learn they have breast cancer.


The Breasts
The breasts are glands that can make milk. Each breast sits on chest muscles that cover the ribs. Each breast is divided into sections called lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes, called ducts, to the nipple. Fat fills the spaces between the lobules and ducts.


The breasts also contain lymph vessels, which carry a clear fluid called lymph. The lymph vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are found near the breast under the arm, above the collarbone, in the chest behind the breastbone and in many other parts of the body. The lymph nodes trap bacteria, cancer cells or other harmful substances that may exist in the lymphatic system.

Understanding Cancer
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body. Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place. Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Not all tumors are cancerous. Tumors can be benign or malignant:
Benign tumors are not cancerous.
Usually, benign tumors can be removed, and they seldom grow back.
Cells from benign tumors do not spread to tissues around them or to other parts of the body.
Malignant tumors are cancerous.
Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
Malignant tumors can often be removed, but they can grow back.
Cells from malignant tumors can invade and damage nearby tissues and organs.

Cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how cancer cells spread from the original cancer (primary tumor) to form new tumors in other organs. The spread of cancer is called metastasis. When breast-cancer cells enter the lymphatic system, they may be found in lymph nodes near the breast.

The cancer cells also may travel to other organs through the lymphatic system or bloodstream. When cancer spreads (metastasizes), the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are breast-cancer cells. The disease is metastatic breast cancer, not bone cancer. It is treated as breast cancer, not as bone cancer. Doctors sometimes call the new tumor "distant" or metastatic disease.

Breast Cancer: Who is at Risk?

No one knows the exact causes of breast cancer. Physicians can seldom explain why one woman gets breast cancer and another does not. We do know that bumping, bruising or touching the breast does not cause breast cancer. Cancer is not contagious.

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is anything that increases a person's chance of developing a disease.

Studies have found the following risk factors for breast cancer:

Age: The chance of getting breast cancer goes up as a woman gets older. A woman over age 60 is at greatest risk. This disease is very uncommon before menopause, but it does occur in women younger than 30.

Personal history of breast cancer: A woman who has had breast cancer in one breast has an increased risk of getting this disease in her other breast.

Family history: A woman's risk of breast cancer is higher if her mother, sister or daughter had breast cancer, especially at a young age (before age 40). Having other relatives with breast cancer on either her mother's or her father's side of the family may also increase a woman's risk.

Reproductive and menstrual history: The older a woman is when she has her first child, the greater her chance of breast cancer.

Women who began menstruation (had their first menstrual period) at an early age (before age 12), went through menopause late (after age 55) or never had children also are at an increased risk.

Women who take menopausal hormone therapy (either estrogen alone or estrogen plus progestin) for 5 or more years after menopause also appear to have an increased chance of developing breast cancer.

Race: Breast cancer occurs more often in white women than Hispanic, Asian or African-American women.

Alcoholic beverages: Some studies suggest that the more alcoholic beverages a woman drinks, the greater her risk of breast cancer.

A woman who thinks she may be at risk of breast cancer should discuss this concern with her health-care provider. The health-care provider may suggest ways to reduce the risk, and can plan an appropriate schedule for checkups.

Breast cancer can bring more stress to your life. Learn how to do a breast self-exam and do it monthly.

Breast Cancer Screening

A woman should talk with her health-care provider about her personal risk of getting breast cancer. She should ask questions about when to start and how often to be checked for the disease. These decisions, like many other medical decisions, should fit each woman's particular needs.

Screening for cancer before there are symptoms is important. It can help doctors find and treat cancer early, making treatment more likely to be effective. Your health-care provider may suggest screening tests to check for breast cancer before any symptoms develop.

Screening Mammogram
A mammogram is used to find breast cancer early. Women in their 40s and older should have mammograms every 1 to 2 years. Screening mammograms can often show a breast lump before it can be felt. They also can show a cluster of very tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be signs of cancer.

If the physician sees an abnormal area on the mammogram, the woman may need to have more pictures taken. Also, the woman may need to have a biopsy. A biopsy is the only way to tell for sure if cancer is present.

Mammograms are the best tool doctors have to find breast cancer early. However, it is wise for a woman to keep in mind that mammograms (as well as dental X-rays and other routine X-rays) use very small doses of radiation.

Breast Exam
During a clinical breast exam, the health-care provider feels the breasts while the woman is standing or sitting up and lying down. The woman may be asked to raise her arms over her head, let them hang by her sides or press her hands against her hips.

The health-care provider looks for differences between the breasts, including unusual differences in size or shape. The skin of each breast is checked for a rash, dimpling or other abnormal signs. The nipples may be squeezed to see if fluid is present.

Using the pads of the fingers to feel for lumps, the health-care provider checks the entire breast, the underarm and the collarbone area, first on one side, then on the other. A lump is generally the size of a pea before anyone can feel it. The lymph nodes near the breast may be checked to see if they are swollen. A thorough clinical breast exam may take 10 minutes.

Breast Self-Exam
It’s important for women to perform monthly breast self-exams to check for any changes in their breasts. Keep in mind when you do this exam that each woman's breasts are different, and that changes can occur because of your menstrual cycle, pregnancy, menopause or if you are taking birth-control pills or other hormones. It is normal for the breasts to feel a little lumpy and uneven. Some women have "lumpy breasts," so they really need to know what feels normal for them. Also, it is common for a woman's breasts to be swollen and tender right before or during her period.

Women who notice anything unusual during a breast self-exam or at any other time should contact their health-care provider.


Symptoms

Breast cancer can cause changes that women should watch for:

* A change in how the breast or nipple feels
* A lump or thickening in or near the breast or in the underarm area
* Nipple tenderness
* A change in how the breast or nipple looks
* A change in the size or shape of the breast
* The nipple is turned inward into the breast
* The skin of the breast, areola or nipple may be scaly, red or swollen. It may have ridges or pitting so that it looks like the skin of an orange.
* Nipple discharge (fluid)

Although early breast cancer usually does not cause pain, a woman should see her health-care provider about breast pain or any other symptom that does not go away. Most often, these symptoms are not cancer, but it is important to check with the provider so that any problems can be diagnosed and treated as early as possible.

Diagnosis
If a woman has a breast-related change, her doctor must determine whether it is due to breast cancer or some other cause. The woman will have a physical exam in which the doctor will ask about her personal and family medical history. She may have a mammogram or another imaging procedure that makes pictures of tissues inside the breast.

Ultrasonography
Using high-frequency sound waves, ultrasonography (ultrasound) can often show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer).

Magnetic Resonance Imaging
In magnetic resonance imaging (MRI), a powerful magnet linked to a computer is sometimes used to make detailed pictures of tissue inside the breast. The doctor can view these pictures on a monitor and can print them on film. MRI may be used along with a mammogram.

Biopsy

Often, fluid or tissue must be removed from the breast to help the doctor learn whether cancer is present. This is called a biopsy. For the biopsy, the doctor may refer the woman to a surgeon or breast-disease specialist.

Sometimes a suspicious area that can be seen on a mammogram cannot be felt during a clinical breast exam. The doctor can use imaging devices to help see the area to then obtain tissue. Such procedures include ultrasound-guided, needle-localized or stereotactic biopsy.

Doctors can remove tissue from the breast in different ways:

Fine-needle aspiration: The doctor uses a thin needle to remove fluid and/or cells from a breast lump. If the fluid appears to contain cells, it goes to a lab, where a pathologist uses a microscope to check for cancer cells. If the fluid is clear, it may not need to be checked by a lab.


Core biopsy: The doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy.

Surgical biopsy: In an incisional biopsy, the surgeon removes a sample of a lump or abnormal area. In an excisional biopsy, the surgeon removes the entire lump or abnormal area. A pathologist examines the tissue for cancer cells.

If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. It begins in the lining of the ducts. Another type, called lobular carcinoma, begins in the lobules.

A woman who needs a biopsy may want to ask her doctor the following questions:
* What kind of biopsy will I have and why?
* How long will it take? Will I be awake? Will it hurt? Will I have anesthesia? If so, what kind?
* How soon will I know the results?
* What are the chances of infection or bleeding after the biopsy?
* If I do have cancer, who will talk with me about treatment?

Talk to your physician about any concerns you have. Make him take the time with YOU!

Don't hesitate to get a second opinion.

Learn how to do a breast self-exam and do it monthly.

Read about breast cancer and breast cancer screening. It can save your life, or your mother's life, or someone else's.