Breast cancer- an emerging problem among women

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. It is considered a heterogeneous disease—differing by individual, age group, and even the kinds of cells within the tumors themselves. Obviously no woman wants to receive this diagnosis, but hearing the words “breast cancer” doesn’t always mean an end. It can be the beginning of learning how to fight, getting the facts, and finding hope.
Women in the United States get breast cancer more than any other type of cancer except for skin cancer. It is second only to lung cancer as a cause of cancer death in women.
Each year it is estimated that nearly 200,000 women will be diagnosed with breast cancer and more than 40,000 will die. Approximately 1,700 men will also be diagnosed with breast cancer and 450 will die each year. The evaluation of men with breast masses is similar to that in women, including mammography.

Types of Breast Cancer

Ductal Carcinoma In-Situ (DCIS)

DCIS is a type of early breast cancer confined to the inside of the ductal system.

Infiltrating Ductal Carcinoma (IDC)

IDC is the most common type of breast cancer representing 78% of all malignancies. These lesions appear as stellate (star like) or well-circumscribed (rounded) areas on mammograms. The stellate lesions generally have a poorer prognosis.

Medullary Carcinoma

Medullary carcinoma accounts for 15% of all breast cancer types. It most frequently occurs in women in their late 40s and 50s, presenting with cells that resemble the medulla (gray matter) of the brain.

Infiltrating Lobular Carcinoma (ILC)

Infiltrating lobular carcinoma is a type of breast cancer that usually appears as a subtle thickening in the upper-outer quadrant of the breast. This breast cancer type represents 5% of all diagnosis. Often positive for estrogen and progesterone receptors, these tumors respond well to hormone therapy.

Tubular Carcinoma

Making up about 2% of all breast cancer diagnosis, tubular carcinoma cells have a distinctive tubular structure when viewed under a microscope. Typically this type of breast cancer is found in women aged 50 and above. It has an excellent 10-year survival rate of 95%.

Mucinous Carcinoma (Colloid)

Mucinous carcinoma represents approximately 1% to 2% of all breast carcinoma. This type of breast cancer's main differentiating features are mucus production and cells that are poorly defined. It also has a favorable prognosis in most cases.

Inflammatory Breast Cancer (IBC)

Inflammatory breast cancer is a rare and very aggressive type of breast cancer that causes the lymph vessels in the skin of the breast to become blocked. This type of breast cancer is called "inflammatory" because the breast often looks swollen and red, or "inflamed". IBC accounts for 1% to 5% of all breast cancer cases in the United States.

 Breast Cancer Signs & SYMPTOMS

Common signs & symptoms of breast cancer include:

• A change in how the breast or nipple feels
  You may experience nipple tenderness or notice a lump or thickening in or near the breast or in the underarm area.
• A change in how the breast or nipple looks
  This could mean a change in the size or shape of the breast or a nipple that is turned slightly inward. In addition, the skin of the breast, areola or nipple may appear scaly, red or swollen or may have ridges or pitting that resembles the skin of an orange.
• Nipple discharge

Breast Cancer Risk Factors

While no one knows the exact causes of breast cancer, research has shown that women with certain risk factors are more likely than others to develop the disease.

RISK FACTORS

Risk factors for breast cancer include:

• Age: Half of all women diagnosed are over age 65.
• Weight: Being obese or overweight.
• Diet & Lifestyle: Lack of physical activity, a diet high in saturated fat, and alcoholic intake of more than two drinks per day.
• Menstrual & Reproductive History: Early menstruation or late menopause, having your first child at an older age or not having given birth, or taking birth control pills for more than ten years if you are under 35. 
• Family & Personal History: A family history of breast cancer—particularly a mother, sister. or a personal history of breast cancer of benign (non-cancer) breast disease.
• Medical & Other Factors: Dense breast tissue (often identified by a mammogram), past radiation therapy to the breast or chest area. A history of hormone treatments—such as estrogen and progesterone, or gene changes— including BRCA1, BRCA2, and others.

 

STAGING

Stage 0—Carcinoma in situ

In stage zero breast cancer, atypical cells have not spread outside of the ducts or lobules, the milk producing organs, into the surrounding breast tissue. Referred to as carcinoma in situ, it is classified in two types:

• Ductal Carcinoma In Situ (DCIS)— very early cancer that is highly treatable and survivable. If left untreated or undetected, it can spread into the surrounding breast tissue. 

• Lobular Carcinoma In Situ (LCIS)—not a cancer but an indicator that identifies a woman as having an increased risk of developing breast cancer.

Stage I—Early stage invasive breast cancer

In stage 1 breast cancer, the cancer is no larger than two centimeters (approximately an inch) and has not spread to surrounding lymph nodes or outside the breast.

Stage II

Stage 2 breast cancer is divided into two categories according to the size of the tumor and whether or not it has spread to the lymph nodes:

• Stage II A Breast Cancer—the tumor is less than two centimeters(approximately an inch) and has spread up to three auxiliary underarm lymph nodes. Or, the tumor has grown bigger than two centimeters, but no larger than five centimeters (approximately two inches) and has not spread to surrounding lymph nodes.
• Stage II B Breast Cancer— the tumor has grown to between two and five centimeters (approximately one to two inches) and has spread to up to three auxiliary underarm lymph nodes. Or, the tumor is larger than five centimeters, but has not spread to the surrounding lymph nodes.

Stage III

Stage 3 breast cancer is also divided in to two categories:

• Stage III A Breast Cancer—the tumor is larger than two centimeters but smaller than five centimeters (approximately one to two inches) and has spread to up to nine auxiliary underarm lymph nodes.
• Stage III B Breast Cancer— the cancer has spread to tissues near the breast including the skin, chest wall, ribs, muscles, or lymph nodes in the chest wall or above the collarbone.

Stage IV

In stage 4 breast cancer, the cancer has spread to other organs or tissues, such as the liver, lungs, brain, skeletal system, or lymph nodes near the collarbone.

BREAST CANCER MYTHS

The Myth

Finding a lump in your breast means you have breast cancer.

The Truth

If you discover a persistent lump in your breast or any changes in breast tissue, it is very important that you see a physician immediately. However, 8 out of 10 breast lumps are benign, or not cancerous. Sometimes women stay away from medical care because they fear what they might find. Take charge of your health by performing routine breast self-exams, establishing ongoing communication with your doctor, and scheduling regular mammograms.

The Myth

Men do not get breast cancer.

The Truth

Quite the contrary. Each year it is estimated that approximately 1,700 men will be diagnosed with breast cancer and 450 will die. While this percentage is still small, men should also give themselves regular breast self-exams and note any changes to their physicians.

The Myth

A mammogram can cause breast cancer to spread.

The Truth

A mammogram, or X-ray of the breast, is one of the best tools available for the early detection of breast cancer. It CANNOT cause cancer to spread, nor can the pressure put on the breast from the mammogram. Do not let tales of other people's experiences keep you from having a mammogram. Base your decision on your physician's recommendation and be sure to discuss any questions or concerns with your doctor.

The Myth

Having a family history of breast cancer means you will get it.

The Truth

While women who have a family history of breast cancer are in a higher risk group, most women who have breast cancer have no family history. If you have a mother, daughter, sister, or grandmother who had breast cancer, you should have a mammogram five years before the age of their diagnosis, or starting at age 35.

The Myth

Breast cancer is contagious.

The Truth

You cannot catch breast cancer or transfer it to someone else's body. Breast cancer is the result of uncontrolled cell growth in your own body.However, you can protect yourself by being aware of the risk factors and following an early detection plan.

The Myth

Knowing you have changes in the BRCA1 or BRCA2 gene can help you prevent breast cancer.

The Truth

While alterations in these genes in men and women can predispose an individual to an increased risk of breast cancer, only 5% to 10% of patients actually have this mutation. This is not an absolute correlation. Like your age or having a family history of breast cancer, it's a factor you just can't control. But you can let your physician know, perform regular breast self-exams, and focus on the fact your chances of not having this disease are greater than 90%.

The Myth

Antiperspirants and deodorants cause breast cancer.

The Truth

Researchers at the National Cancer Institute (NCI) are not aware of any conclusive evidence linking the use of underarm antiperspirants or deodorants and the subsequent development of breast cancer.
For more information, please visit:
http://www.cancer.gov/cancertopics/factsheet/Risk/AP-Deo.

FREQUENTLY ASKED QUESTIONS

Can physical activity reduce the risk of breast cancer?

Exercise pumps up the immune system and lowers estrogen levels. With as little as four hours of exercise per week, a woman can begin to lower her risk of breast cancer.

Can a healthy diet help prevent breast cancer?

A nutritious, low-fat diet with plenty of fruits and vegetables can help reduce the risk of developing breast cancer. A high-fat diet increases the risk because fat triggers estrogen production that can fuel tumor growth.

Does smoking cause breast cancer?

At this point in time there is no conclusive link between smoking and breast cancer. However, due to the number of health risks associated with smoking, quitting can significantly increase survival rates.

Can drinking alcohol increase the risk of breast cancer?

One or two drinks a day has been shown to slightly increase the risk of breast cancer. The greater the levels consumed, the higher the risk.

Is there a link between oral contraceptives and breast cancer?

There is an increased risk of breast cancer for women under 35 who have been using birth control pills for more than ten years.

How often should I do a breast self-exam (BSE)?

Give yourself a breast self-exam at least once a month. Look for any changes in breast tissue, such as changes in size, a lump, dimpling or puckering of the breast, or a discharge from the nipple. If you discover a persistent lump in your breast or any changes in breast tissue, it is very important that you see a physician immediately. However, 8 out of 10 lumps are benign, or not cancerous.

Does a family history of breast cancer put someone at a higher risk?

If you have a grandmother, mother, sister, or daughter who has been diagnosed with breast cancer, this does put you in a higher risk group. Have a baseline mammogram at least five years before the age of breast cancer onset in any close relatives, or starting at age 35. See your physician at any sign of unusual symptoms.

Are Mammograms Painful?

Mammography does compress the breasts and can sometimes cause slight discomfort for a very brief period of time. Patients who are sensitive should schedule their mammograms a week after their menstrual cycle so that the breasts are less tender.

How does menstrual and reproductive history affect breast cancer risks?

Women who began their menstrual cycles before age 12, have no children, or had their first child at 30 or older, or began menopause after 55 are at a higher risk.

How Often Should I Go To My Doctor For A Checkup?

You should have a physical every year. If any unusual symptoms or changes in your breasts occur before your scheduled visit, do not hesitate to see the doctor immediately.

What Kind Of Impact Does Stress Have On Breast Cancer?

Although some studies have shown that factors such as traumatic events and losses can alter immune system functions, these studies have not provided any evidence of a direct cause-and-effect relationship between stress and breast cancer. An area currently being studied is whether or not stress reduction can improve immune response and slow progression in women diagnosed with breast cancer.