Definition

     Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Over the course of a lifetime, one in eight women will be diagnosed with breast cancer.

Risk Factors

• Family history of breast cancer in mother, sister, daughter, or if two or more close relatives have the disease
• Risk increases as women get older
• Previous endometrial (uterine) cancer
• Previous breast cancer, atypical changes, and previous breast disease
• Carrier of BRCA1 or BRCA2 genes (especially prominent in Ashkenazi Jews); however, only 5-10% of all breast cancers may be due to genetic defects or changes.
• Menstrual periods started before the age of 12
• Menopause ended after age 50
• No children
• Estrogen hormone replacement therapy
• Alcohol, high fat in diet, increased fiber diet, smoking, obesity, and having previous ovarian or Colon Cancer
• African-Americans and Hispanics may have a worse prognosis than whites.

Symptoms

• Breast lump or breast mass noted upon breast exam -- usually painless, firm to hard and usually with irregular borders

• Lump or mass in the armpit

• A change in the size or shape of the breast

• Abnormal nipple discharge

  • Usually bloody or clear-to-yellow or green fluid

  • May look like pus (purulent)

• Change in the color or feel of the skin of the breast, nipple, or areola

  • Dimpled, puckered, or scaly

  • Retraction, "orange peel" appearance

  • Redness

  • Accentuated veins on breast surface

• Change in appearance or sensation of the nipple

  • Pulled in (retraction), enlargement, or itching

• Breast pain, enlargement, or discomfort on one side only

• Any breast lump, pain, tenderness, or other change in a man

• Symptoms of advanced disease are bone pain, weight loss, swelling of one arm, and skin ulceration

Stages of Breast Cancer

• STAGE 0. In Situ ("in place") disease in which the cancerous cells are in their original location within normal breast tissue. Known as either DCIS (ductoral carcinoma in situ) or LCIS (lobular carcinoma in situ) depending on the type of cells involved and the location, this is a pre-cancerous condition, and only a small percentage of DCIS tumors progress to become invasive cancers. There is some controversy within the medical community on how to best treat DCIS.

• STAGE I. Tumor less than 2 cm in diameter with no spread beyond the breast

• STAGE IIA. Tumor 2 to 5 cm in size without spread to axillary (armpit) lymph nodes or tumor less than 2 cm in size with spread to axillary lymph nodes

• STAGE IIB. Tumor greater than 5 cm in size without spread to axillary lymph nodes or tumor 2 to 5 cm in size with spread to axillary lymph nodes

• STAGE IIIA. Tumor smaller than 5 cm in size with spread to axillary lymph nodes which are attached to each other or to other structures, or tumor larger than 5 cm in size with spread to axillary lymph nodes

• STAGE IIIB. The tumor has penetrated outside the breast to the skin of the breast or of the chest wall or has spread to lymph nodes inside the chest wall along the sternum

• STAGE IV. A tumor of any size with spread beyond the region of the breast and chest wall, such as to liver, bone, or lungs

     Many additional factors besides staging can influence the recommended treatment and the likely outcome. These can include the precise cell type and appearance of the cancer, whether the cancer cells respond to hormones, and the presence or absence of genes known to cause breast cancer.

Screening and Diagnostics

• Examination

1. Mammograms

2. Ultrasound

3. CT Scan/MRI to check for spread to the brain

1. Needle aspiration

2. Mammatome test -- special type of needle biopsy with special X-Ray techniques to localize deep lumps

3. Open surgical biopsy -- when a lump is removed and sent to the lab for analysis

4. Lymph node dissection -- multiple lymph nodes are removed to check for the spread of cancer

5. Sentinel lymph node dissection -- a new technique in which only a few lymph nodes need to be biopsied

Treatment

• Surgery may consist only of breast lump removal (lumpectomy ), or partial, total, or radical mastectomy, usually with the removal of one or more lymph nodes from the armpit (axilla). Special procedures to find the most likely lymph nodes to which cancer may have spread (sentinel nodes) are often used.

• Radiation therapy can be directed at the tumor, the breast, the chest wall, or other tissues known or suspected to have remaining cancer cells.

• Chemotherapy is often used to kill cancer cells that may still remain in the breast or that may have already spread to other parts of the body.

• Biologicals are an entirely new type of anti-cancer drug. Biologicals can be used alone or with chemotherapy. Trastuzumab (Herceptin) is an example of this class of drugs. It affects how cancer cells function and grow. Some 20 - 25% of breast cancers respond to trastuzumab. Trastuzumab is not chemotherapy, but it may be combined with chemotherapy. Recent studies show that adding trastuzumab to chemotherapy or treating with trastuzumab after chemotherapy helps prevent the cancer from coming back and can make people who had HER2-positive breast cancer live longer.

• Hormonal therapy with tamoxifen is used to block the effects of estrogen that may otherwise help breast cancer cells to survive and grow. Most women with breast cancers which express estrogen or progesterone on their surface benefit from treatment with tamoxifen. A new class of medicines called aromatase inhibitors, such as Aromasin, have been shown to be as good or possibly even better than tamoxifen in women with stage IV breast cancer.

Prevention

     Many risk factors cannot be controlled. Some experts in the field of diet and cancer agree that changes in diet and lifestyle may reduce the incidence of cancer generally.