Breast Cancer

Breast Cancer | Lung Cancer | Lymphoma | Prostate Cancer

• Among women, breast cancer is the second most common cancer and the second most common cause of cancer deaths
• Typically, the first symptom is a painless lump, usually noticed by the woman
• Monthly self-examination, yearly breast examination by a doctor, and a yearly mammogram for women who are over 50 or at increased cancer risk are recommended
• If a solid lump is detected, a few cells are removed through a needle or the entire lump is surgically removed and examined (biopsied)
• Breast cancer almost always requires surgery, sometimes with radiation therapy, chemotherapy, other drugs, or a combination
• Outcome is hard to predict and depends partly on the characteristics and spread of the cancer.

Breast cancer is the second most common cancer among women after skin cancer and, of cancers, is the second most common cause of death among women after lung cancer. In 2006, breast cancer was diagnosed in about 213,000 women in the United States. About one fifth of them will die of it.

Most cancer patients show similar patterns of virus and heavy metal burden. Primary among the viruses are Epstein-Barr (ebv), cytomegalavirus (cmv), herpes simplex (hsv-6), papilloma virus (hpv) and, more rarely, coxsackie-B (csv). IF the virus burden remains and is left untreated, it will severely compromise the immune system. Combined anti-virus and heavy metal reduction are the prerequisites for immune restoration. This allows the immune system to begin an assault on the cancer. When this is combined with cancer therapy using conventional medicine and alternative medicine the potential for an effective cancer treatment increases.

Many women fear breast cancer, partly because it is common. However, some of the fear about breast cancer is based on misunderstanding. For example, the statement, “One of every eight women will get breast cancer,” is misleading. That figure is an estimate based on women from birth to age 95. It means that, theoretically, one of eight women who live to age 95 or older will develop breast cancer. However, a 40-year-old woman has only a 1 in 1,200 chance of developing breast cancer during the next year and about a 1 in 120 chance of developing it during the next decade. But as she ages, her risk increases.

Several factors affect the risk of developing breast cancer. Thus, for some women, the risk is much higher or lower than average. Most factors that increase risk, such as age, cannot be modified. However, regular exercise, particularly during adolescence and young adulthood, and possibly weight control may reduce the risk of developing breast cancer. Regularly drinking alcoholic beverages may increase the risk.

Far more important than trying to modify risk factors is being vigilant about detecting breast cancer so that it can be diagnosed and treated early, when it is more likely to be cured. Early detection is more likely when women have mammograms and do breast self-examinations regularly.

Risk Factors for Breast Cancer

Age:

Increasing age is an important risk factor. About 60% of breast cancers occur in women older than 60. Risk is greatest after age 75.

Increasing age is an important risk factor. About 60% of breast cancers occur in women older than 60. Risk is greatest after age 75.

Previous Breast Cancer:

At highest risk are women who have had breast cancer. After the diseased breast is removed, the risk of developing cancer in the remaining breast is about 0.5 to 1.0% each year.

Family History of Breast Cancer:

Breast cancer in a first-degree relative (mother, sister, or daughter) increases a woman's risk by 2 to 3 times, but breast cancer in more distant relatives (grandmother, aunt, or cousin) increases the risk only slightly. Breast cancer in two or more first-degree relatives increases a woman's risk by 5 to 6 times.

Breast Cancer Gene:

Two separate genes for breast cancer (BRCA1 and BRCA2) have been identified in two separate small groups of women. Fewer than 1% of women have these genes. They are most common among Ashkenazi Jews. If a woman has one of these genes, her chances of developing breast cancer are very high, possibly as high as 50 to 85% by age 80. However, if such a woman develops breast cancer, her chances of dying of breast cancer are not necessarily greater than those of any other woman with breast cancer. Women likely to have one of these genes are those who have several close, usually first-degree relatives who have had breast cancer. For this reason, routine cancer screening for these genes does not appear necessary, except in women who have such a family cancer history. The risk of ovarian cancer is increased in families with both breast cancer genes. The risk of breast cancer in men is increased in families with the BRCA2 gene. Women with one of these genes may need to undergo more frequent testing for breast cancer. Or they may need to try to prevent cancer from developing by taking tamoxifen or raloxifene Some Trade Names EVISTA(which is similar to tamoxifen) or sometimes by even having a double mastectomy.

Fibrocystic Changes:

Having only certain types of fibrocystic changes seems to increase risk. These changes include those that require a biopsy to rule out breast cancer or those that make the breasts appear dense on a mammogram. For women with such changes, the risk is increased only slightly unless abnormal tissue structure (atypical hyperplasia) is detected during a biopsy or the women have a family history of breast cancer.

Age at First Menstrual Period, at First Pregnancy, and at Menopause :

The earlier menstruation begins, the greater the risk of developing breast cancer. The risk is 1.2 to 1.4 times higher for women who first menstruated before age 12 than for those who first menstruated after age 14. The later the first pregnancy occurs and the later menopause occurs, the higher the risk. Never having had a baby doubles the risk of developing breast cancer during a woman's lifetime. These factors probably increase risk because they involve longer exposure to estrogen, which stimulates the growth of certain cancers. (Pregnancy, although it results in high estrogen levels, may reduce the risk of breast cancer.)

Prolonged Use of Oral Contraceptives or Estrogen Therapy:

Taking oral contraceptives increases the risk of later developing breast cancer, but only very slightly. Also, the risk is increased mainly for women who started taking them at a young age (such as during their teens) and who have taken them for many years. After women stop taking contraceptives, the risk gradually decreases over the next 10 years to that for other women of the same age.

After menopause, taking hormone therapy that combines estrogen with a progestin for a few years or more increases the risk of breast cancer.

Obesity After Menopause:

Risk is somewhat higher for women who are obese after menopause. However, there is no proof that a high-fat diet contributes to the development of breast cancer or that changing the diet can decrease risk. Some studies suggest that obese women who are still menstruating are less likely to develop breast cancer.

Radiation Exposure:

Radiation exposure (such as radiation therapy for cancer or significant exposure to x-rays) before age 30 increases risk.

Types

Breast cancer is usually classified by the extent of its spread and by the kind of tissue in which the cancer starts.

Carcinoma in situ means cancer in place. It is the earliest stage of breast cancer. Carcinoma in situ may be large and may even affect a substantial area of the breast, but it has not invaded the surrounding tissues or spread to other parts of the body. More than 15% of all breast cancers diagnosed in the United States are carcinoma in situ. It is usually detected during mammography.

Invasive cancer is further classified as follows.

• Localized: The cancer has invaded surrounding tissues but is confined to the breast
• Regional: The cancer has invaded tissues near the breasts, such as the chest wall or lymph nodes
• Distant (metastatic): The cancer has spread from the breast to other parts of the body. Cancer tends to move into the lymphatic vessels in the breast. Most lymphatic vessels in the breast drain into lymph nodes in the armpit (axillary lymph nodes). One function of lymph nodes is to filter out and destroy abnormal or foreign cells, such as cancer cells. If cancer cells get past these lymph nodes, the cancer can spread anywhere in the body. Breast cancer can also spread through the bloodstream to other parts of the body. Breast cancer tends to spread to bones and the brain but can spread to any area, including the lungs, liver, skin, and scalp. Breast cancer can appear in these areas years or even decades after it is first diagnosed and treated. If the cancer has spread to one area, it probably has spread to other areas, even if it cannot be detected right away.

Breast cancer that starts in the milk ducts is called ductal carcinoma. About 90% of all breast cancers are this type. Breast cancer that starts in the milk-producing glands (lobules) is called lobular carcinoma. Breast cancer that starts in fatty or connective tissue, a rare type, is called sarcoma.

Ductal carcinoma in situ is confined to the milk ducts of the breast. It does not invade surrounding breast tissue, but it can spread along the ducts and gradually affect a substantial area of the breast. This type accounts for 20 to 30% of breast cancers. It is detected only during mammography. This type may become invasive.

Lobular carcinoma in situ develops within the milk-producing glands of the breast. It often occurs in several areas of both breasts. Women with this type have a 1 to 2% chance each year of developing invasive breast cancer in the affected or the other breast. This type accounts for 1 to 2% of breast cancers. Usually, lobular carcinoma in situ cannot be seen on a mammogram and is detected only by biopsy.

Invasive ductal carcinoma begins in the milk ducts but breaks through the wall of the ducts, invading the surrounding breast tissue. It can also spread to other parts of the body. It accounts for 65 to 80% of breast cancers.

Invasive lobular carcinoma begins in the milk-producing glands of the breast but invades surrounding breast tissue and spreads to other parts of the body. It is more likely than other types of breast cancer to occur in both breasts. It accounts for 10 to 15% of breast cancers.

Inflammatory breast cancer refers to the symptoms of the cancer rather than the affected tissue. This type is fast growing and often fatal. Cancer cells block the lymphatic vessels in the skin of the breast, causing the breast to appear inflamed: swollen, red, and warm. Usually, inflammatory breast cancer spreads to the lymph nodes in the armpit. The lymph nodes can be felt as hard lumps. However, often no lump may be felt in the breast itself because this cancer is dispersed throughout the breast. Inflammatory breast cancer accounts for about 1% of breast cancers.

Paget's disease of the nipple is a ductal breast cancer. The first symptom is a crusty or scaly nipple sore or a discharge from the nipple. Slightly more than half of the women who have this cancer also have a lump in the breast that can be felt. Paget's disease may be in situ or invasive. Because this disease usually causes little discomfort, women may ignore it for a year or more before seeing a doctor. The prognosis depends on how invasive and how large the cancer is as well as whether it has spread to the lymph nodes.

Rare types of invasive ductal breast cancers include medullary carcinoma, tubular carcinoma, and mucinous (colloid) carcinoma. Mucinous carcinoma tends to develop in older women and to be slow growing. Women with these types of breast cancer have a much better prognosis than women with other types of invasive breast cancer.

Phyllodes breast tumors are relatively rare. About half are cancerous. They originate in breast tissue around milk ducts and milk-producing glands. The tumor spreads to other parts of the body in about 10 to 20% of women who have it.

Characteristics

All cells, including breast cancer cells, have molecules on their surfaces called receptors. A receptor has a specific structure that allows only particular substances to fit into it and thus affect the cell's activity. Whether breast cancer cells have certain receptors affects how quickly the cancer spreads and how it should be treated.

• Estrogen and progesterone receptors: Some breast cancer cells have receptors for estrogen. The resulting cancer, described as estrogen receptor-positive, grows or spreads when stimulated by estrogen. This type of cancer is more common among postmenopausal women than among younger women. Some breast cancer cells have receptors for progesterone. The resulting cancer, described as progesterone receptor-positive, is stimulated by. Breast cancers with estrogen receptors, and possibly those with progesterone receptors, grow more slowly than those that do not have these receptors, and the prognosis is better
• HER2 (HER2/neu) receptors: Normal breast cells have HER2 receptors, which help them grow. (HER stands for human epithelial growth factor receptor, which is involved in multiplication, survival, and differentiation of cells.) In about 20 to 30% of breast cancers, cancer cells have too many HER2 receptors. Such cancers tend to be very fast growing.

Symptoms

At first, breast cancer causes no symptoms. Most commonly, the first symptom is a lump, which usually feels distinctly different from the surrounding breast tissue. In more than 80% of breast cancer cases, women discover the lump themselves. Usually, scattered lumpy changes in the breast, especially the upper outer region, are not cancerous and indicate fibrocystic changes. A firm, distinctive thickening that appears in one breast but not the other may indicate cancer symptoms.

In the early stages, the lump may move freely beneath the skin when it is pushed with the fingers.

In more advanced stages, the lump usually adheres to the chest wall or the skin over it. In these cases, the lump cannot be moved at all or it cannot be moved separately from the skin over it. Women can detect whether they have a cancer that even slightly adheres to the chest wall or skin by lifting their arms over their head while standing in front of a mirror. If a breast contains cancer that adheres to the chest wall or skin, this maneuver may make the skin pucker or one breast appear different from the other.

In very advanced cancer, swollen bumps or festering sores may develop on the skin. Sometimes the skin over the lump is dimpled and leathery and looks like the skin of an orange (peau d'orange) except in color.

The lump may be painful, but pain is an unreliable sign. Breast pain without a lump is rarely due to breast cancer.

Lymph nodes, particularly those in the armpit on the affected side, may feel like hard small lumps. The lymph nodes may be stuck together or adhere to the skin or chest wall. They are usually painless but may be slightly tender.

In inflammatory breast cancer, the breast is warm, red, and swollen, as if infected (but it is not). The skin of the breast may become dimpled and leathery, like the skin of an orange, or may have ridges. The nipple may turn inward (invert). A discharge from the nipple is common. Often, no lump can be felt in the breast.

Screening

Because breast cancer rarely causes symptoms in its early stages and because early treatment is more likely to be successful, screening is important. Screening is the hunt for a disorder before any symptoms occur.

Routine self-examination enables women to detect lumps at an early stage. However, self-examination alone does not reduce the death rate from breast cancer, and it does not detect as many early cancers as routine breast cancer screening with mammography. Women who do not detect any lumps should continue to see their doctor for breast examinations and to have mammograms as recommended. When tumors are detected by self-examination, the prognosis is usually better, and breast-conserving surgery can usually be done rather than mastectomy.

A breast examination is a routine part of a physical examination. A doctor inspects the breasts for irregularities, dimpling, tightened skin, lumps, and a discharge. The doctor feels (palpates) each breast with a flat hand and checks for enlarged lymph nodes in the armpit—the area most breast cancers invade first—and also above the collarbone. Normal lymph nodes cannot be felt through the skin, so those that can be felt are considered enlarged. However, noncancerous conditions can also cause lymph nodes to enlarge. Lymph nodes that can be felt are checked to see if they adhere to the skin or chest wall and if they are matted together.

Mammography: For this test, x-rays are used to check for abnormal areas in the breast. A technician positions the woman's breast on top of an x-ray plate. An adjustable plastic cover is lowered on top of the breast, firmly compressing the breast. Thus, the breast is flattened so that the maximum amount of tissue can be imaged and examined. X-rays are aimed downward through the breast, producing an image on the x-ray plate. Two x-rays are taken of each breast in this position. Then plates may be placed vertically on either side of the breast, and x-rays are aimed from the side. This position produces a side view of the breast.

Mammography is one of the best ways to detect breast cancer early. Mammography is designed to be sensitive enough to detect the possibility of cancer at an early stage, sometimes years before it can be felt. Because mammography is so sensitive, it may indicate cancer when none is present—a false-positive result. About 90% of abnormalities detected during screening (that is, in women with no symptoms or lumps) are not cancer. Typically, when the result is positive, more specific follow-up procedures, usually a breast biopsy, are scheduled to confirm the result. Mammography may miss up to 15% of breast cancers.

Having a mammogram every 1 to 2 years can reduce the rate of death due to breast cancer by 25 to 35% among women aged 50 and older. As yet, no study has shown that regularly having mammograms can reduce the death rate among women younger than 50. However, evidence may be harder to obtain because breast cancer is not common among younger women. Many experts recommend that women aged 40 to 49 have mammograms every 1 to 2 years. All experts recommend yearly mammograms for women aged 50 and older.

The dose of radiation used is very low and is considered safe. Mammography may cause some discomfort, but the discomfort lasts only a few seconds. Mammography should be scheduled at a time during the menstrual period when the breasts are less likely to be tender. Deodorants should not be used on the day of the procedure because they can interfere with the image obtained. The entire procedure takes about 15 minutes.

Diagnosis

When a lump or another abnormality is detected in the breast during a physical examination or by a screening procedure, other procedures are necessary. Mammography is done first if it was not the way the abnormality was detected.

Ultrasonography is sometimes used to help distinguish between a fluid-filled sac (cyst) and a solid lump. This distinction is important because cysts are usually not cancerous. Cysts may be monitored (with no treatment) or drained with a small needle and syringe. Sometimes the fluid from the cyst is examined to check for cancer cells. Rarely, when cancer is suspected, cysts are removed.

If the abnormality is a solid lump, which is more likely to be cancerous, a mammogram followed by a biopsy is done. Often, an aspiration biopsy is used: Some cells are removed from the lump through a needle attached to a syringe. If this procedure detects cancer, the diagnosis is confirmed. If no cancer is detected, removal of an additional piece of tissue (incisional biopsy) or of the entire lump (excisional biopsy) is necessary to be sure that the aspiration biopsy did not miss the cancer. Most women do not need to be hospitalized for these procedures. Usually, only a local anesthetic is needed.

If Paget's disease of the nipple is suspected, a biopsy of nipple tissue is usually done. Sometimes this cancer can be diagnosed by examining a sample of the nipple discharge under a microscope.

A pathologist examines the biopsy samples under the microscope to determine whether cancer cells are present. Generally, a biopsy confirms cancer in only a few women with an abnormality detected during mammography. If cancer cells are detected, the sample is analyzed to determine the characteristics of the cancer cells, such as

• Whether the cancer cells have estrogen or progesterone receptors
• How many HER2 receptors are present
• How quickly the cancer cells are dividing

This information helps doctors estimate how rapidly the cancer may spread and which treatments are more likely to be effective for their cancer patients.

A chest x-ray is taken and blood tests, including a complete blood cell count and liver function tests, are done to determine whether the cancer has spread. If the cancer tumor is large, if the lymph nodes are enlarged, or if women have bone pain, imaging of bones throughout the body (a bone scan) may be done. Computed tomography (CT) of the abdomen is done if liver function is abnormal, if the liver is enlarged, or if the cancer has spread within the breast.

Magnetic resonance imaging (MRI) is often done to evaluate breast cancer after it is diagnosed because MRI can accurately determine how large the tumor is, whether the chest wall is involved, and how many tumors are present.

Staging

When cancer is diagnosed, a stage is assigned to it, based on how advanced it is. The breast cancer stage helps doctors determine the most appropriate treatment and the prognosis. Stages of breast cancer diagnosis may be described generally as in situ (not invasive) or invasive. Stages may be described in detail and designated by a number (0 through IV).

Treatment

Individual breast cancer treatment for breast cancer may vary depending upon the cancer patient and their desire to receive tradition treatment, alternative cancer treatment or integrative breast cancer treatment.  It is vital that persons diagnosed with, or suspected of having breast cancer consult with their health care provider to assure proper evaluation, treatment and interpretation of information contained on this site.

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