What is Breast Cancer?
Breast cancer is a malignant tumor that starts in the cells of the breast.
A typical woman's breast is made up of:
- Lobules (glands that produce breast milk)
- Ducts (small tubes that carry milk from the lobules to the nipple)
- Fatty and connective tissue
- Blood vessels
- Lymph vessels
Most breast cancers begin in the cells that line the milk ducts (ductal carcinoma), while some breast cancers start in the cells lining the lobules that produce the milk (lobular carcinoma). Sarcomas and lymphomas start in cells of the other tissues in the breast.
Click here to download our mini-brochure on breast cancer and treatment options.
The lymph system of the breast
The lymph system is one of the main ways breast cancer spreads. Lymph nodes are small tissues that contain a certain kind of immune system cell that fight infections. Lymph nodes are connected by vessels. Breast cancer cells can travel in lymphatic vessels and begin to grow in lymph nodes. If cancer cells have spread to lymph nodes, there is a higher chance that the cells have also spread to other places in the body.
Benign Breast Lumps
Most breast lumps are benign and not cancer. Benign breast tumors are abnormal growths caused by the combination of cysts (fluid-filled sacs) and fibrosis (scar-like tissue). These abnormal growths can make the breasts feel lumpy and in some people there is a slightly cloudy nipple discharge.
Common Breast Cancer terminology:
Carcinoma: Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas). Carcinoma is a cancer that begins in the lining layer of the breast.
Adenocarcinoma: An adenocarcinoma is a type of cancer that starts in the glandular tissue that makes and secretes a substance.
Sarcoma: Sarcomas of the breast are rare and are cancers that start from connective tissues such as muscle tissue, fat tissue or blood vessels.
How many women get breast cancer?
According to the American Cancer Society:
- Breast cancer is the most common cancer among women in the United States, other than skin cancer.
- It is the second leading cause of cancer death in women, after lung cancer.
- The chance of a woman having invasive breast cancer during her life is about 1 in 8.
- The chance of dying from breast cancer is about 1 in 36.
- Breast cancer death rates have been decreasing over the past years and there are more than 2.8 million breast cancer survivors in the United States.
Risk factors for breast cancer
While there is no specific cause or reason for why breast cancer develops, certain risk factors can be linked to the disease.
- Age at first menarche
- Genetics / Family history
- Certain benign breast problems in the past
- Lack of Exercise
- Breastfeeding history
- Dense breast tissue
There is no way to prevent breast cancer, but if it is detected early, the odds of living a long healthy life dramatically increase, due to the cancer being at a much more treatable stage.
According to the American Cancer Society, “Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. Starting at age 40, women should have a CBE by a health professional every year.” It is also advisable to get regular physical activity and eat a healthy diet.
A mammogram is an x-ray of the breast. The breast is pressed between 2 plates to flatten and spread the tissue. The picture is taken in a couple of seconds. The breast and plates are repositioned and then another picture is taken. The whole process takes about 20 minutes.
A clinical breast exam (CBE) is an exam of your breasts by a health expert such as a doctor, nurse practitioner, nurse, or physician assistant. The area under both arms where lymph nodes are located will also be checked.
It is important for women to be aware of how their breasts normally look and feel and report any changes to a doctor. As a result we recommend that women do a BSE each month. A breast self-exam (BSE) is a step-by-step approach to checking your breasts for changes.
For highly detailed imaging of a breast to check and diagnose a region for possible abnormalities or cancer, the doctor may elect to do an MRI. An MRI (magnetic resonance imaging) scan uses magnets and radio waves to produce very detailed, cross-sectional images of the body. For a breast MRI, you will lie inside a narrow tube, face down on a special platform. The platform has openings for each breast that allow the image to be taken without pressing on the breast. Contrast material may be injected into a vein to help the MRI show more details of the breast tissue and the scan can take up to an hour.
Self-screening breast exam
For detailed information on how to do breast self-exam from the American Cancer Society, click HERE.
Also, click HERE for an instructional video about how to do a self- exam.
Signs and symptoms of breast cancer
Because more women are routinely having their mammograms done once a year, we are now seeing an increase in the number of breast cancers found before they cause any symptoms. According to the American Cancer Society, “The most common symptom of breast cancer is a new lump or mass. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and rounded or even painful. So it's important to have anything new or unusual checked by a doctor.”
Other symptoms of breast cancer can be:
- Swelling of part of the breast
- Skin irritation or dimpling
- Breast pain
- Nipple pain
- Redness or scaliness of the nipple or breast skin
- fluid or bloody nipple discharge
Although these symptoms do not necessarily mean breast cancer, it is important to have them checked out by your doctor.
Breast Cancer Diagnosis
If you’ve learned that you may have breast cancer or a lump that needs removal, it is important to find a physician who specializes in the treatment of breast cancer.
For instance, there are many surgeons who perform breast cancer surgery, but few really specialize in breast cancer.
It is crucial to choose a surgeon who specializes in breast surgery for the following reasons:
- Surgical Expertise: Research shows that patients, who are operated on by surgical specialists who perform a large volume of breast cancer surgeries, have a higher survival rate than patients who go to non-specialized surgeons.
- Preservation of the breast: Breast surgeons are more up to date on the latest surgical techniques. What this means for the patient is that a breast surgeon will focus on preserving the breast tissue, where possible, to lessen the cosmetic deformity of the breast.
Maximizing the survival of
the patient, along with the resultant aesthetic appearance of the breast following breast
surgery is of utmost importance to the surgeon who specializes in breast cancer surgery.
Types Of Treatment for Breast Cancer
The main types of treatment for breast cancer are:
- Surgery — Most women with breast cancer will have some type of surgery to treat the main breast tumor and to remove as much of the cancer as possible.
- Breast-conserving surgery (BCS) — Breast-conserving surgery, which is commonly referred to as a lumpectomy, removes only a part of the breast depending on the size and place of the tumor and other factors. The removed tissue from surgery is examined for cancer cells close to the edges, and if found, the patient might need more surgery or even a mastectomy. Mastectomy is surgery that removes the entire breast. All of the breast tissue is removed, sometimes along with other nearby tissues. Many women choose to have their breasts reconstructed after a mastectomy as soon as possible. Reconstructive or breast implant surgery is done to restore the way the breast looks. You should talk to a plastic surgeon before your operation if you are having breast surgery and are wanting breast reconstruction after the mastectomy.
- Radiation — Radiation therapy is treatment with high-energy rays or particles that kill cancer cells. Radiation therapy may be used to kill cancer cells remaining in the breast, chest wall, or underarm area after surgery. Radiation to the breast is often needed after breast-conserving surgery. It is usually given after any chemotherapy. Radiation treatment is like getting a regular x-ray but for a longer time. Treatment is usually given 5 days a week, for six weeks. Each radiation treatment lasts only a few minutes and is painless.
- Chemotherapy — Chemotherapy is the use of adding cancer-killing drugs into your bloodstream to help kill any cancer cells that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which leads to side effects. The side effects of chemo depend on the type of drugs used, the amount given, and the length of treatment.
You could experience some of these short-term side effects:
- Hair loss
- Loss of appetite
- Nausea and vomiting
You could experience some of these long-term side effects:
- Menstrual changes
- Nerve damage
- Heart damage- (if drugs were used for a long time or in high doses)
- Hormone therapy — Cancers that have hormone receptors in the cells are called hormone receptor-positive. In breast cancer cases, female hormone estrogen promotes the growth of the cancer, so drugs are administered to stop estrogen from telling cells to grow and divide. Hormone therapy for breast cancer works by blocking the effects of estrogen or lowering estrogen levels. It can be used to help reduce the risk of the cancer coming back after surgery. It is also helpful in treating advanced breast cancer.
- Targeted therapy — Targeted therapy for breast cancer involves using newer ‘targeted drugs’ that do not work the same as standard chemotherapy drugs and often have different and less severe side effects. As researchers have learned more about the gene changes that can cause cancer, they have been able to develop newer drugs that are aimed right at these cancer cells, while doing minimal damage to normal cells.
- Genomic therapy — This therapy technique involves the scientific expertise of examining each tumor or cancer area in detail to determine gene-expression profiles, which then guide the physician toward the most effective treatment option targeted to your specific cancer. Genomic therapy is a personalized medicine approach that attacks the specific causes of certain cancers.
- Bone-directed therapy — When cancer spreads to the bones, it can weaken them and even lead to the bones breaking causing extreme pain. Drugs like bisphosphonates and denosumab can help prevent those problems. Bisphosphonates can strengthen bones that have been weakened by invading breast cancer cells and reduce the risk of pain, fractures, breaks or osteoporosis. Denosumab is newer drug that can also be used to help reduce the risk of problems from breast cancer that have spread to the bone. It is given as an injection, used to prevent osteoporosis twice a year.
- Follow-up care — After your treatment is over, ongoing follow-up care is needed to watch for treatment side effects and to check for cancer that may have come back or spread. During these visits, your doctors will ask about any symptoms you may have and perform a physical examination. These visits will be scheduled more often at first, and then less often as time goes by. Unless you have had both breasts removed, you will get regular mammograms. Blood tests and imaging studies will only be ordered as needed. Making lifestyle changes to improve your health, over the long term, after breast cancer treatment and recovery is important. These lifestyle changes include: maintain a better diet, stop smoking, exercise more often, reduce stress and take the time to get proper rest in order to allow your body to recover.