The maze of breast cancer diagnostic paths and treatment options can be daunting; especially at a time when the emotional impact of a diagnosis can be overwhelming.
Western Surgical Group’s hope is that you will find comfort and confidence in the caring hands of our talented team. Our expertly trained dedicated surgical specialists work side by side with oncologists, pathologists, radiologists and your primary care providers to provide you a positive experience and the best possible outcome.
It’s a collaborative approach that puts you at the center of everything we do.
We’ll listen. We’ll answer questions. And, we’ll provide you a clear road map for your entire treatment process. We look forward to seeing you.
DEFINING BREAST DISEASE
Each year, thousands of women receive abnormal mammogram reports and require further investigation to identify the irregularity and rule out cancer. An abnormal mammogram will result in your care provider recommending further imaging scans and possibly a biopsy procedure. It is important to note that for over 80 percent of these women the diagnosis will be a benign (non-cancerous) breast condition.
It is also important to note that today’s national statistics indicate that breast cancer is being detected earlier than ever before, with outcomes for early stage cancers resulting in a five year survival rate of 98 percent.
Breast cancer is a common type of cancer in women. About 1 in 8 U.S. women (about 12.4%) will develop invasive breast cancer over the course of her lifetime. It is a malignant (cancerous) tumor that begins from the cells in the breast. Breast cancer can rarely develop in men, as well. There are several different types of breast cancer, and they may develop in any part of the breast. Early detection and treatment is very important because some forms of breast cancer are treatable. Advancements in early detection methods and more tolerable cancer treatments have helped to reduce the number of breast cancer related deaths and improve quality of life.
RISK FACTORS FOR BREAST CANCER
The risk of breast cancer increases gradually as a woman gets older. This disease is uncommon in women under the age of 35. All women age 40 and older are at risk for breast cancer. However, most breast cancers occur in women over the age of 50, and the risk is especially high for women over age 60.
Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.
Risk factors include:
- Age: The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.
- Genetic factors:. Inherited mutations to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.
- Early menstrual period: Women who start their periods sooner, before age 12 are exposed to hormones longer, raising the risk for breast cancer by a small amount.
- Late or no pregnancy: Having the first pregnancy after age 30 and never having a full-term pregnancy can raise breast cancer risk.
- Starting menopause after age 55: Like starting one’s period early, being exposed to estrogen hormones for a longer time later in life also raises the risk of breast cancer.
- Inactivity: Women who are not physically active have a higher risk of getting breast cancer.
- Age and obesity: Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.
- Dense breast tissue: Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
- Hormone therapy: Taking hormones to replace missing estrogen and progesterone in menopause for more than five years raises the risk for breast cancer. The hormones that have been shown to increase risk are estrogen and progestin when taken together.
- Oral contraceptives (birth control pills): Certain forms of oral contraceptive pills have been found to raise breast cancer risk.
- Personal history of breast cancer: Women who have had breast cancer are more likely to get breast cancer a second time.
- Personal history of certain non-cancerous breast diseases: Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
- Family history of breast cancer: A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
- Previous treatment using radiation therapy: Women who had radiation therapy to the chest or breasts (like for treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.
- Women who took the drug diethylstilbestrol (DES), which was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.
- Drinking alcohol: Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.
Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer, and night shift working also may increase breast cancer risk.
TYPES OF BREAST CANCER
Breast cancer classification is determined by the location and cellular type, which is identified via a tissue sample (biopsy).
Understanding the type and stage of breast cancer you have is essential in determining your treatment options.
- Carcinoma in situ: This is an early type of breast cancer that has not spread from where it started, usually in the ducts or lobules.
- Lobular carcinoma in situ (LCIS): LCIS is not a true cancer, but having LCIS increases a woman’s chance of getting cancer. This condition begins in the milk-making glands but does not extend outside of the lobule.
- Ductal carcinoma in situ (DCIS): This type of breast cancer originates in and is confined to the ducts. This is the most common type of noninvasive breast cancer. Almost all women with DCIS can be cured.
- Invasive ductal carcinoma (IDC): This is the most common type of breast cancer. IDC originates in a milk passage or duct and spreads into the fatty tissue of the breast. It is an invasive cancer that can also spread to other parts of the body.
- Invasive lobular carcinoma (ILC): This type of breast cancer originates in the milk glands or lobules and can spread to other parts of the body.
The most common symptom of breast cancer is a new lump or mass. The lump may feel very firm or hard. They are usually painless and have irregular borders. A lump or mass may appear in the breast or armpit.
Your breast may look different. Its size or shape may change. It may appear swollen. The color or texture of your breast, areola, or nipple may change. The skin may appear dimpled, puckered, or retracted in. Your skin may appear scaly, red, or irritated. The symptoms may cause discomfort on just one breast.
Your nipple may be painful and look different. It may turn inward or enlarge. Your nipple may produce an abnormal discharge. An abnormal discharge is fluid other than milk. An abnormal discharge may look bloody, clear to yellow colored, green colored, or purulent, like pus.
Symptoms in men may include a lump, pain, or tenderness.
Symptoms of advanced breast cancer include bone pain, weight loss, swelling of one arm, and skin sores.
Any breast change in women or men should be brought to their doctor’s attention. Your doctor can begin to diagnose breast cancer after reviewing your medical history and conducting a physical examination. You should tell your doctor about your symptoms and risk factors. Your doctor will conduct a clinical breast exam including your breasts, armpits, neck and chest area. Your doctor will look at your breasts to see if they have changed in size or shape. Your doctor will use the pads of his or her fingers to check for lumps or masses. Your doctor may also recommend further tests.
A mammogram is a type of X-ray used to identify breast masses or tumors. For this test, your breast is placed between two plates. The two plates compress your breast to flatten and spread the tissue in order to obtain the best image possible. This test may be uncomfortable, but only for a very brief period of time. A mammogram may only tell if a tumor is present. It cannot tell if a tumor is cancerous or not.
A breast ultrasound is used to determine if a breast lump is solid or fluid filled. It is sometimes used with a mammogram to provide a better look at areas of concern. For this test, an imaging device is gently moved across your skin. Sound waves collected by the device create an image on a monitor for your doctor to examine.
A ductogram or galactogram is used to identify masses inside a duct and the cause of nipple discharge. For this test, a substance is injected into the nipple and an X-ray is taken. The substance outlines the shape of the duct on the X-ray for the doctor to examine.
If cancer is suspected on a mammogram, breast ultrasound, or ductogram, a biopsy will be conducted. A biopsy takes a sample of breast tissue, cells, or fluid for examination. There are several types of biopsies including needle aspiration and surgical biopsy. Needle aspiration uses a fine needle to withdraw fluid out of the lump for testing. Stereotactic core needle biopsies use a thicker needle to remove tissue samples. Surgical biopsies remove all or part of a lump as well as some normal tissue around it. Surgical biopsies are usually done on an outpatient basis.
Stereotactic breast biopsy may be an alternative to open surgical biopsy methods for some women. Stereotactic breast biopsy is used to obtain a tissue sample of suspicious breast tissue for examination for cancer cells. It is especially useful for diagnosing areas of breast tissue that appear suspicious on a mammogram, but that cannot be felt during a clinical breast examination. This short outpatient procedure is performed with local anesthesia. It uses a special mammography machine to pinpoint the suspicious area. A vacuum assisted needle is used to remove the tissue samples. Recovery time is brief and this biopsy method does not distort the breast tissue or make it difficult to read future mammograms. Stereotactic breast biopsy methods are as accurate as traditional biopsy methods.
If your doctor suspects that your cancer has spread from your breasts to other parts of your body, more tests will be ordered. These may include blood tests and imaging tests. A chest X-ray can determine if the cancer has spread to your lungs. A bone scan can determine if the cancer has spread to the bone. Computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans are imaging tests that may also be used. The CT scan is helpful for identifying cancer in the liver and other organs. The MRI scan is used to detect cancer in the brain and spinal cord. A PET scan can check the lymph nodes and other areas of the body for cancer.
If you have breast cancer, your doctor will assign your cancer a classification stage based on the results of all of your tests. Staging describes the tumor and how it has grown or metastasized. Staging also includes the axillary lymph nodes because they are the gateway for spreading cancer to the rest of the body. Staging is helpful for treatment planning and recovery prediction.
There are different systems for staging breast cancer, and you should make sure that you understand the system that your doctor is using. The most common staging system for breast cancer is from the American Joint Commission on Cancer. This system uses the Roman numerals I through IV, with a higher number indicating a more serious cancer. Some of the stages are also divided in to sub-stages labeled A-B.
The stages of breast cancer, according to the American Joint Commission on Cancer are:
- Stage 0: The cancer or pre-cancerous cells are in their original location within normal breast tissue. This includes ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS).
- Stage I: The tumor is smaller than 2 cm. in diameter and has not spread beyond the breast.
- Stage IIA: The tumor is 2 to 5 cm. and has not spread to the axillary lymph nodes or the tumor is less than 2 cm. and has spread to the axillary lymph nodes.
- Stage IIB: The tumor is greater than 5 cm. and has not spread to the axillary lymph nodes or the tumor is 2 to 5 cm. and has spread to the axillary lymph nodes.
- Stage IIIA: The tumor is smaller than 5 cm. and has spread to the axillary lymph nodes that are attached to each other or to other structures, or the tumor is larger than 5 cm. and has spread to the axillary lymph nodes.
- Stage IIIB: The tumor has spread outside of the breast to the skin or chest wall or has spread to the lymph nodes inside the chest wall along the sternum.
- Stage IV: A tumor of any size that has spread beyond the breast and chest wall, such as to the liver, bone, or lungs.
Your doctor will refer you to a medical oncologist and a breast cancer surgeon for treatment. Treatment for breast cancer depends on many factors, including the stage of the cancer and the cancer cell type. Cancer treatments include local treatment, systemic treatment, adjuvant therapy, and neoadjuvant therapy.
Local treatments treat the tumor without affecting the rest of the body. Local treatments include surgery and radiation therapy. Surgery removes the cancer cells from the body. Radiation therapy uses high-energy rays to destroy cancer cells.
Systemic treatments use medications or cancer-fighting drugs to treat cancer. The medications are swallowed or administered directly into the bloodstream. Systemic treatments include chemotherapy, hormone therapy, and immunotherapy.
Adjuvant therapy is used for suspected cancer cells that remain in the body after surgery. In some cases, cancer cells may break away from the main tumor and spread through the bloodstream and start new tumors in other areas. Adjuvant therapy is used to remove these hidden cells. Neoadjuvant therapy includes systemic treatments, such as chemotherapy, that are given before surgery to shrink a tumor.
The goals of treatment for Stage 0 though Stage III breast cancers are to treat the cancer and prevent it from spreading. Stage IV breast cancer is generally not considered curable, and treatments are aimed at preventing symptoms and improving quality of life. Breast cancer surgery and follow up treatments are very individualized. Your doctor will discuss which options are best for you, as well as your expected recovery.