Breast Cancer

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About Cancer
Cancer: What It Is

What is Breast Cancer?

Breast cancer is a malignant or potentially life-threatening tumor. Not all breast lumps or tumors are malignant. According to the National Women's Health Information Center, most lumps are benign or non-cancerous, although any unusual lump should always be examined by a doctor.

Men can develop breast cancer; however, the disease by far occurs more in women. In fact, it's estimated by the National Institutes of Health (NIH) that one in eight women will develop breast cancer in their lifetime.

Who is at risk?

The American Cancer Society (ACS) and NIH say several factors indicate a woman is at a higher risk of developing breast cancer:

Age. The risk of developing breast cancer increases with age. Some 77% of new diagnoses of breast cancer each year are in women over the age of 50.
Personal medical history. Women with a history of breast cancer in one breast have a three- to four-times higher risk of developing a new cancer in the other breast. Women with a history of benign breast growths are at a higher risk. A previous breast biopsy showing atypical hyperplasia (an irregular pattern of cell growth) also indicates an increased risk of developing breast cancer, as does a diagnosis of lobular carcinoma in situ (LCIS) which is abnormal cells found in the lobules of the breast.
Breast density. The National Cancer Institute (NCI) says cancer is more likely to occur in breasts that have a lot of lobular and ductal tissue (that is, dense tissue) than in breasts with a lot of fatty tissue. In addition, when breasts are dense, it is more difficult for doctors to see abnormal areas on a mammogram.
Estrogen. According to NCI, evidence suggests that the longer a woman is exposed to estrogen (estrogen made by the body, taken as a drug, or delivered by a patch), the more likely she is to develop breast cancer.
Radiation exposure. NCI says women whose breasts were exposed to radiation during radiation therapy before age 30, especially those who were treated with radiation for Hodgkin's lymphoma, are at an increased risk for developing breast cancer.
Family history. You have a higher risk of developing breast cancer if a close relative has had the disease.
Lifestyle. NIH says studies have shown that the use of alcohol may be linked with a higher risk of breast cancer. In addition, some studies have linked obesity with a potentially higher risk. And while the final word is not yet in, still other studies have indicated that a healthy lifestyle, including exercise and a diet low in fat, especially saturated fat, is linked with a reduced rate of breast cancer.
Other risk factors. Women who started menstruating at an early age (before age 12), who have had no children or didn't have their first child until after age 30, or who didn't go through menopause until after age 50 have a slightly higher risk of developing breast cancer.
Research also continues into genetic mutations, specifically mutations in the genes BRCA1 and BRCA2 which have been linked to an increased risk of developing both breast and ovarian cancer.

Breast Examination

How to perform a Breast Self-Exam:

Check breasts one week after your period.
Lie flat with a pillow or folded towel under your right shoulder.
Raise your right arm overhead, feeling for lumps using the finger pads of the three middle fingers of your left hand.
Check tissue between the breast and armpit.
Repeat on the left side.
Stand in front of a mirror, scanning your breasts for shape or size changes, irregularities, nipple discharge or redness.
Discuss anything you find with your doctor.

What to Look For

Breast Cancer Symptoms:

Swelling of part of the breast
Skin irritation or dimpling
Nipple pain or inverted nipples
Redness or scaliness of the nipple or breast skin
A nipple discharge other than breast milk
A lump in the underarm area

Mammography

A mammogram is a special x-ray of the breast. Mammography can detect lumps and other forms of breast disease that may be too small to be felt by an experienced examiner. This early detection is your best opportunity for a total cure. X-ray equipment dedicated exclusively to performing mammograms is used. This allows us to use x-ray levels that are three to nine times lower than normal x-ray levels.

The American Cancer Society recommends that women have a baseline mammogram between the ages of 35 and 40 and receive a mammogram yearly after age 40. Women at high risk should have mammograms more often. Risk factors for women include:

Increased age
If she has never had children
If she had her first child after age 30
Cigarette smoking
High-fat diets

Remember, however, that 80% of breast cancers occur in women with no risk factors. One in eight American women will develop breast cancer in her lifetime. Another woman is newly diagnosed with the disease every three minutes. Three steps to early detection are:

Breast self exams every month beginning at age 18
Clinical breast exams by a health care professional every three years between the ages of 18 and 39, and every year from age 40
Screening mammograms annually from age 40
Mammography services are located at the following Catholic Health System sites:

For more information on Imaging and Radiology services offered at the Catholic Health System, click here.

Types of Breast Cancer

Each breast has 15 to 20 sections called lobes. Within each lobe are many smaller lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Cancer can start in any of these areas. NCI says the most common type of breast cancer is ductal carcinoma. It begins in the lining of the ducts. Another type of breast cancer, called lobular carcinoma, arises in the lobules. A much less common type of cancer called Paget's disease of breast is a slowly growing cancer that starts in the milk ducts of the nipple.

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan the best treatment. The following stages are used for breast cancer, according to NCI:

Stage 0 (carcinoma in situ)
There are 2 types of breast carcinoma in situ:
- Ductal carcinoma in situ (DCIS) is a very early breast cancer that may develop into an invasive type of breast cancer (cancer that has spread from the duct into surrounding tissues).
- Lobular carcinoma in situ (LCIS) is not cancer, but rather a marker or indicator that identifies a woman as having an increased risk of developing invasive breast cancer (cancer that has spread into surrounding tissues). It is common for both breasts to be affected.
Stage I
In stage I, the cancer is no larger than 2 centimeters (about 1 inch) and has not spread outside the breast.
Stage IIA
In stage IIA, the cancer is either:
- no larger than 2 centimeters (about 1 inch) but has spread to the axillary lymph nodes (the lymph nodes under the arm); or
- between 2 and 5 centimeters (1 to 2 inches) but has not spread to the axillary lymph nodes.
Stage IIB
In stage IIB, the cancer is either:
- between 2 and 5 centimeters (1 to 2 inches) and has spread to the axillary lymph nodes (the lymph nodes under the arm); or
- larger than 5 centimeters (about 2 inches) but has not spread to the axillary lymph nodes.
Stage IIIA
In stage IIIA, the cancer is either:
- smaller than 5 centimeters (about 2 inches) and has spread to the axillary lymph nodes (the lymph nodes under the arm), and the lymph nodes are attached to each other or to other structures; or
- larger than 5 centimeters and has spread to the axillary lymph nodes and the lymph nodes may be attached to each other or to other structures.
Stage IIIB
In stage IIIB, the cancer has either:
- spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); or
- spread to lymph nodes inside the chest wall along the breastbone.
Stage IV
In stage IV, the cancer has either:
- spread to other organs of the body, most often the bones, lungs, liver, or brain; or
- spread to the lymph nodes in the neck, near the collarbone.

What do I do if I have Breast Cancer?

Treatments

If cancer is present, treatment will depend on where the cancer is and whether it is invasive or has spread to nearby tissue. There are two basic types of treatment for breast cancer, local and systemic. NCI says you can have one or both types of treatment.

Local treatments are used to remove or destroy breast cancer in a specific area. NCI says surgery is the main local therapy for breast cancer. Surgical options include mastectomy (removal of the entire breast), as well as breast conserving treatments such as partial mastectomy (removal of a portion of the breast) or lumpectomy (removal of the tumor and only a small amount of surrounding tissue). During surgery, some of the lymph nodes (small bean-shaped organs that are part of the immune system may also be removed. This will be done to determine if the cancer has spread. When surgery is used, a doctor may recommend radiation as well, especially after breast-conserving surgery, to destroy any breast cancer cells that may remain in the area. You should discuss all the options with your doctor and consider obtaining a second opinion before making a final decision.

Systemic treatments affect cells throughout the body. Systemic treatments can be used to shrink a tumor before local therapy, they can be used after other treatments to prevent reoccurrence, or they can be used to treat cancer that has spread. Examples of systemic therapy include chemotherapy, hormonal therapy, and biological therapy. Chemotherapy for breast cancer is usually a combination of drugs, according to NCI. The drugs may be given in a pill or by injection. Biological therapy is a treatment designed to enhance the body's natural defenses against cancer.

Hormonal therapy may be used if tests show that hormones are helping the cancer to grow. Hormonal therapy deprives the cancer cells of estrogen. Examples include surgery to remove the ovaries, and drugs. NCI says some drugs can reduce the risk of breast cancer, but also have potentially serious side effects such as endometrial cancer and blood clots in major veins.

The type of treatment will vary for every woman. It will depend on many factors including but not limited to:

age
general health
size and location of the tumor
type of cancer
size of the breast

One of the most important considerations in treatment is the size of the tumor and if the cancer has spread - once again a good reason for early detection.