Breast Cancer

After skin cancer, breast cancer is the most common cancer among women in this country, affecting 1 in 8 during their lifetime. Men can still be affected by this disease, but it is far less common. For women, an average of 260,000 new cases of invasive breast cancer are diagnosed in the United States each year, along with 63,000 new cases of non-invasive breast cancer. Men will see around 2,500 new cases annually.

Symptoms of breast cancer come in a wide variety, so it’s important for women to know the warning signs and speak with their doctor over any concerns. Although some cancer-like symptoms may be the result of a cyst, infection or other non-cancerous condition, women should still take all symptoms seriously and contact their physician.

Symptoms may include:

Lump or swelling around breast, arm pit or collar bone; changes in breast shape or size; breast dents or indentations; breast redness, itchiness or heat; nipple discharge; breast dimpling; a growing vein in the breast; flat or inverted nipple; rash or skin changes resembling the skin of an orange peel

Risk factors may include:

Being female; increasing age; a personal history of breast conditions or breast cancer; a family history of breast cancer or inherited gene mutations; obesity; smoking and alcohol use; beginning periods before the age of 12; beginning menopause at an older age; giving birth after the age of 30; never having breastfed and/or been pregnant; postmenopausal hormone therapy.

Self-breast exams should be part of every woman’s monthly health care routine, along with annual physician-performed physical exams or mammograms, which are x-ray pictures of the breast. Women are advised to begin annual mammograms at age 40, or earlier if there’s a family history of breast cancer. The earlier breast cancer is detected and diagnosed, the better the chance for a successful outcome.

The various types of breast cancer are divided into two broad categories: invasive (cancer has spread to surrounding tissues) and non-invasive (cancer is confined to point of origin). Breast cancer can begin in different areas of the breast, including the ducts, the lobules or in some cases, the tissue in between.

Certain types of breast cancer are more common than others. These include:

Invasive Ductal Carcinoma (IDC) is the most common type of breast cancer, accounting for nearly 80% of cases. This cancer begins in the milk ducts and has broken through to invade other surrounding tissue. IDC often continues to spread into nearby lymph nodes and then into other parts of the body.

Invasive Lobular Carcinoma (ILC) is the second most common type of breast cancer, accounting for 10-15% of cases. This cancer begins in the milk-producing glands (lobules) and has broken through to invade other surrounding tissue. ILC often continues to spread into nearby lymph nodes and then into other parts of the body.

Ductal Carcinoma in Situ (DCIS) is non-invasive cancer inside the milk ducts. “In Situ” means the cancer is still in its original place and has not spread to any surrounding tissue. Although DCIS isn’t life-threatening, it can increase the risk of developing an invasive breast cancer later.

Lobular Carcinoma in Situ (LCIS) is a non-invasive, abnormal area of growth inside the milk-producing glands (lobules). “In Situ” means the growth is still in its original place and has not spread to any surrounding tissue. Despite its name, LCIS is not a true breast cancer, rather it is an indication that a person is at higher-than-average risk for getting breast cancer at some point in the future. For this reason, some experts prefer the term “Lobular Neoplasia”, neoplasia meaning a collection of abnormal cells.

There are also less common types of breast cancer, making up only 3% of all cases. These types include Inflammatory Breast Cancer, Paget Disease of the Nipple, Phyllodes Tumor and Angiosarcoma.

Just as no two people are exactly alike, no two breast cancers are exactly the same, either. The first step in a breast cancer treatment plan is knowing the specific type of breast cancer, the biology of the tumor. Looking at the genetic makeup of a tumor and profiling it based on its specific genes will help determine the best and most individualized course of treatment.

Hormones often play a critical role in the growth of breast cancer. In the planning of treatment, tests will be run to determine a patient’s hormone receptor status and HER2 status. There are typically four results:

Estrogen-Receptor Positive or Negative (ER+/-) means the cancer cells have (+) or do not have (-) receptors for the hormone estrogen. ER+ results suggest that the cancer cells may receive signals from estrogen that could promote their growth, while ER- suggests no receptors are present and hormonal therapy is unlikely to work.

Progesterone-Receptor Positive or Negative (PR+/-) means the cancer cells have (+) or do not have (-) receptors for the hormone progesterone. PR+ results suggest that the cancer cells may receive signals from progesterone that could promote their growth, while PR- suggests no receptors are present and hormonal therapy is unlikely to work.

HER2 Positive or Negative (Human Epidermal Growth Factor Receptor 2) is a protein that appears on the surface of some breast cancer cells and plays a role in how a healthy breast cell grows, divides and repairs itself. In about 25% of breast cancers, HER2 proteins over-express, making breast cells grow and divide in an uncontrolled way.

Triple-Negative Breast Cancer means the cancer cells test negative for estrogen receptors, progesterone receptors and HER2. This type of cancer will be treated differently than the other types of breast cancer since hormones do not play a role in the cancer’s growth. Between 10-20% of all breast cancers are triple-negative.

Another factor determining a patient’s best course of treatment is knowing how far along the cancer has progressed, or what stage it is in. Staging may involve blood tests, a lymph node biopsy, bones scans or CT scans. Breast cancer staging is shown on a number scale of zero to four or 0-IV.

Stage 0 describes non-invasive cancer or an abnormal growth that has not invaded any neighboring normal tissue

Stage I describes an early stage of invasive breast cancer where cancer cells have invaded breast tissue beyond where the cancer started, but the cells have not spread beyond the breast. Also, tumors are no more than two centimeters.

Stage II describes a tumor with one of the following:

• No more than 2 centimeters and the cancer has spread to the lymph nodes under the arm.
• Between 2 and 5 centimeters and the cancer has not spread to the lymph nodes under the arm.
• Between 2 and 5 centimeters and the cancer has spread to the lymph nodes under the arm.
• Larger than 5 centimeters and the cancer has not spread to the lymph nodes under the arm.

Stage III describes an invasive tumor that can be divided into three subcategories:

IIIA

• No more than 5 centimeters and the cancer has spread to lymph nodes under the arm that are attached to each other or to other structures; or lymph nodes behind the breastbone.
• More than 5 centimeters and the cancer has spread to lymph nodes under the arm that are either alone or attached to each other or to other structures; or lymph nodes behind the breastbone.

IIIB

• Tumor of any size that has spread to the chest wall and/ or skin of the breast and may have caused swelling or lumps.
• May have spread to multiple lymph nodes under the arm; lymph nodes under the arm that are attached to each other or to other structures; or lymph nodes behind the breastbone.
• Inflammatory Breast Cancer is rare and considered at least Stage IIIB. It typically features reddening of a large portion of the breast skin, warmth or swelling of the breast, and cancer cells that have spread to the lymph nodes and may be found in the skin.

IIIC

• Tumor of any size that has spread to the lymph nodes behind the breastbone and under the arm.
• Tumor of any size that has spread to the lymph nodes above or below the collarbone.

Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver or brain. The terms “advanced” and “metastatic” are often used to describe stage IV breast cancer.

After correctly diagnosing breast cancer, through its type, stage and hormone sensitivity, the next step is to plan the most effective course of treatment. There are many different options for breast cancer treatment, but most women begin with surgery. These surgery options can include:

Lumpectomy (or breast-conserving surgery) is the removal of the breast cancer tumor and a small margin of surrounding healthy tissue. This procedure may be recommended for removing smaller tumors.

Mastectomy is the removal of the entire breast tissue, including the lobules, ducts, fatty tissue and possibly the nipple and areola. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common operations for breast cancer.

Sentinel Node Biospy is the removal of a limited number of lymph nodes around the tumor to determine if the cancer has spread to these lymph nodes. If cancer is found in the sentinel lymph nodes, additional lymph nodes may be removed in your armpit.

Many women will receive additional treatment before or after surgery, such as chemotherapy, hormone therapy or radiation.

Chemotherapy is often used to treat early-stage invasive breast cancer to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back. It can also be used for advanced-stage breast cancer to destroy or damage the cancer cells as much as possible. In some cases, chemotherapy is given before surgery to shrink the cancer.

Radiation therapy is a highly targeted and highly effective way to destroy cancer cells in the breast that may stick around after surgery. Despite what many people fear, radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.

Hormonal therapies treat hormone-receptor-positive breast cancers by lowering the amount of the hormone estrogen in the body and by blocking the action of estrogen on breast cancer cells. Estrogen makes hormone-receptor-positive breast cancers grow, so reducing the amount of estrogen or blocking its action can reduce the risk of early-stage hormone-receptor-positive breast cancers coming back after surgery. Hormonal therapies can also be used to help shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers.

Another form of cancer treatment, called Immunotherapy, might also be an option in a breast cancer treatment plan. This form of treatment enlists the body’s own immune system to work harder and smarter to attack cancer cells. As immunotherapies and other targeted therapies evolve and become available, the fight against cancer become stronger and more precise. Always speak with your physician about what course of treatment is right for you.