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Cancer |
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CANCER : Breast
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Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women. While the majority of new breast cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump or change in consistency of the breast tissue can also be a warning sign of the disease. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages. With advances in screening, diagnosis, and treatment, the death rate for breast cancer has declined by about 20% over the past decade, and research is ongoing to develop even more effective screening and treatment programs. |
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Risk factors for breast cancer; |
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Research has shown that women with certain risk factors are more likely than others to develop breast cancer. Studies have found the following risk factors for breast cancer: |
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| Age: |
The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause.
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| Personal history of breast cancer: |
A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
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| Family history: |
A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
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| Certain breast changes: |
Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer. |
| Gene changes: |
Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2 and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. |
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Reproductive and menstrual history: |
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The older a woman is when she has her first child, the greater her chance of breast cancer.
- Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
- Women who went through menopause after age 55 are at an increased risk of breast cancer.
- Women who never had children are at an increased risk of breast cancer.
- Women who take menopausal hormonal therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.
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| Race: |
Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women. |
| Radiation therapy to the chest: |
Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin’s Lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life. |
| Breast density: |
Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer. |
| Being overweight or obese after menopause: |
The chance of getting breast cancer after menopause is higher in women who are overweight or obese. |
| Lack of physical activity: |
Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
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| Drinking alcohol: |
Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer. |
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Diagnostic Procedures |
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Clinical breast exam |
If you have a lump, your doctor will feel its size, shape, and texture. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.
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Diagnostic mammogram |
Diagnostic mammograms are x-ray pictures of the breast. They take clearer, more detailed images of areas that look abnormal on a screening mammogram.
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Ultrasound |
The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. This exam may be used along with a mammogram.
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Magnetic resonance imaging |
MRI makes detailed pictures of breast tissue.
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Biopsy |
Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. Some suspicious areas can be seen on a mammogram but cannot be felt during a clinical breast exam. Doctors can use imaging procedures to help see the area and remove tissue. Such procedures include ultrasound-guided, needle-localized, or stereotactic biopsy. The various methods include Fine-needle biopsy, core biopsy and surgical biopsy.
The most common type of breast cancer is ductal carcinoma. Abnormal cells are found in the lining of the ducts. Lobular carcinoma is another type. Abnormal cells are found in the lobules.
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Additional tests |
| If you are diagnosed with cancer, your doctor may order special lab tests on the breast tissue that was removed. These tests help your doctor learn more about the cancer and plan treatment: |
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| Hormone receptor test: |
This test shows whether the tissue has certain hormone receptors. Tissue with these receptors needs hormones (estrogen or progesterone) to grow. |
| HER2 test: |
This test shows whether the tissue has a protein called human epidermal growth factor receptor-2 (HER2) or the HER2/neu gene. Having too much protein or too many copies of the gene in the tissue may increase the chance that the breast cancer will come back after treatment. |
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Sentinel node Lymphscintigraphy |
| The procedure is used for detection of sentinel lymph nodes in patients with breast cancer. These are the nodes that serve as a kind of catch basin for drainage of the lymph system and are the nodes most likely to harbor cancer cells if the disease has spread. |
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PET CT Scan: |
A PET CT scan is normally not used for initial diagnosis but for staging,monitoring therapy and follow-up after treatment. |
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Bone Scan: |
A bone scan is normally used to rule cancer spread to the bones for staging and in follow-up. |
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Tumour markers: |
| CA 15.3, CEA and CA-125 |
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Breast Cancer Staging: |
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| The stage is based on the size and spread of the tumor. Staging may involve x-rays and lab tests. |
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| Stage 0 |
Is carcinoma in situ.
- Lobular carcinoma in situ (LCIS):
Abnormal cells are in the lining of a lobule. LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer for both breasts.
- Ductal carcinoma in situ (DCIS):
Abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated.
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| Stage I |
Is an early stage of invasive breast cancer. The tumor is no more than 2 centimeters and cancer cells have not spread beyond the breast. |
| Stage II |
Is one of the following:
- The tumor in the breast is no more than 2 centimeters . The cancer has spread to the lymph nodes in the axilla.
- The tumor is between 2 and 5 centimeters. The cancer may have spread to the lymph nodes in the axilla.
- The tumor is larger than 5 centimeters, but has not spread to the lymph nodes in the axilla.
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| Stage III |
May be a large tumor, but the cancer has not spread beyond the breast and nearby lymph nodes. It is locally advanced cancer. |
| Stage IIIA |
Is one of the following:
- The tumor in the breast is smaller than 5 centimeters. The cancer has spread to axillary lymph nodes that are attached to each other or to other structures.
- The tumor is more than 5 centimeters across. The cancer has spread to the axillary lymph nodes.
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| Stage IIIB |
Is one of the following:
- The tumor has grown into the chest wall or the skin of the breast.
- The cancer has spread to lymph nodes behind the sternum.
- Inflammatory Breast cancer is a rare type of Stage IIIB breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast.
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| Stage IIIC |
Is a tumor of any size. It has spread in one of the following ways:
- The cancer has spread to the lymph nodes behind the sternum and axilla.
- The cancer has spread to the lymph nodes under or above the collarbone.
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| Stage IV |
Is distant metastatic cancer. The cancer has spread to other parts of the body. The most common sites are the bones, liver, lungs, and brain
Recurrent Cancer is cancer that has come back (recurred) after a period of time when it could not be detected. It may recur locally in the breast or chest wall. Or it may recur in any other part of the body, such as the bone, liver, or lungs. |
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Treatment methods
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Women with breast cancer have many treatment options. These include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. Most women receive more than one type of treatment.
The choice of treatment depends mainly on the stage of the disease. Your doctor can describe your treatment choices and the expected results. You may want to know how treatment may change your normal activities. You may want to know how you will look during and after treatment. You and your doctor can work together to develop a treatment plan. |
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