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Breast cancer is a disease in which cancer cells grow in the breast tissue. It is the most common cancer in women in the United States. The normal breast consists of glandular tissue called lobes. These lobes are sectioned off into lobules, which produce milk. Milk is carried to from the lobules to the nipple by small ducts. All this tissue is surrounded by fatty and connective tissue, as well as blood and lymph vessels.
Types of breast cancer found in women are:
- Ductal carcinoma situ—Early stage cancer confined to the ducts. This type has a high cure rate.
- Infiltrating ductal carcinoma—A cancer that starts in the ducts of the breast and spreads into surrounding tissues. This is the most common type of breast cancer in women.
- Infiltrating lobular carcinoma—A cancer that starts in the lobules of the breast and spreads into surrounding tissues.
- Medullary, mucinous, and tubular carcinomas—These are three relatively slower-growing types of breast cancer.
- Inflammatory carcinoma—A rare and aggressive form of breast cancer that can be difficult to treat. This cancer invades the lymphatic vessels of the skin and can be very extensive. It is very likely to spread to the local lymph nodes.
- Paget’s disease—A very rare cancer of the areola and nipple. Although Paget’s does not arise from glandular tissue in the breast, it can be associated with both in situ and infiltrating breast cancers.
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Cancer occurs when cells in the body divide without control or order. Eventually these uncontrolled cells form a growth or tumor. The term cancer refers to malignant growths. These growths can invade nearby tissues including the lymph nodes. Cancer that has invaded the lymph nodes can then spread to other parts of the body. The lymph nodes associated with breast cancer are in the armpit, above the collarbone, and in the chest.
It is not clear exactly what causes these problems in the cells, but is probably a combination of genetics and environment.
Breast cancer is more common in Caucasian women, aged 50 years and older. Other factors that may increase your chance of breast cancer include:
- Personal history of breast cancer
- Lobular carcinoma in situ (LCIS)—Women with LCIS appear to have a 7-10 times greater risk of developing some form of breast cancer (usually infiltrating lobular carcinoma) over the next 20 years.
- Family members with breast cancer
- Changes in breast tissue, such as atypical ductal hyperplasia, and radial scar formation
- Genetic mutations, such as BRCA1, BRCA2, and others
- Excess body weight, particularly after menopause
- Consuming a diet that is high in red meat
- Increased exposure to estrogen over a lifetime through:
- Early onset of menstruation
- Late onset of menopause
- No childbearing or late childbearing
- Absence of breast-feeding
- Hormone replacement therapy
- Increased breast density—more lobular and ductal tissue and less fatty tissue
- Radiation therapy before the age of 30 years old
- Excessive alcohol use
Note: Studies show that most women with known risk factors do not get breast cancer. Many women who get breast cancer have none of the risk factors listed above except age.
When breast cancer first develops, there may be no symptoms at all. As the cancer grows, it can cause the following changes:
- One or more lumps in the breast which may or may not be painful
- One or more lumps in lymph nodes near the breast, under your arm, or collarbone which may or may not be painful
- Thickening in or around the breast
- A change in the size or shape of the breast
- Nipple discharge or tenderness, or the nipple inverted into the breast
- Ridges or pitting of the breast skin, like the skin of an orange
- A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)
Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these should see a doctor.
The doctor will ask about your symptoms and medical history. A physical exam will be done. It will include a breast exam and blood tests.
Imaging tests can help diagnose and evaluate the extent of the cancer. Imaging tests include:
- CT scan
- PET/CT scan
Your doctor may need to test your breast tissue and adjacent lymph nodes. A sample will be removed and sent to a lab to look for cancer cells. This can be done with different biopsy types, including:
- Fine-needle aspiration—Removal of fluid and/or cells from a breast lump using a thin needle.
- Needle biopsy —Removal of tissue with a needle from an area that looks unusual on a mammogram, but cannot be felt.
- Surgical biopsy:
- Incisional biopsy—Cutting out a sample of a lump or suspicious area.
- Excisional biopsy—Cutting out all of a lump or suspicious area and an area of healthy tissue around the edges.
If cancer is present, your doctor may order tests to learn about the type of cancer. These may include:
- Blood tests—To look for tumor markers or genetic mutations.
- Tissue evaluation—To look for estrogen and progesterone receptors, and the presence of HER2/neu and Oncotype DX. These are used for developing a treatment plan.
The physical exam combined with all of your test results, will help to determine the stage of cancer you have. Staging is used to guide your treatment plan. Like other cancers, breast cancer is staged from 0-IV. Stage 0 is a very localized cancer, while stage IV indicates a spread to other parts of the body.
Cancer treatment varies depending on the stage and type of cancer. A combination of therapies is most effective. For example, radiation may be used before surgery to shrink the tumor or after to make sure all the cancer has been removed.
Treatment options include:
Finding breast cancer early and treating it is the best way to prevent death from the disease. Breast cancer does not cause symptoms in the early stages. It is important to have screening exams and tests. These steps can help to find the cancer before symptoms appear. The following recommendations are for women with no symptoms who are not high risk for breast cancer:
- Age 40-49—recommendations vary from waiting until age 50 to having the screening every 1-2 years
- Age 50-74—ranges from every 1-2 years
- Clinical breast exam:
- Age 25-39—ranges from 1-3 years
- Age 40 and older—every year
- Breast self-exam is optional for those age 20 and older. Talk to your doctor about the risks and benefits.
If you have an increased risk of breast cancer, you may need to start having mammograms earlier. You and your doctor can decide on the best screening schedule for you. It is important to note that mammograms are the most sensitive test currently used to evaluate the breast, but they will miss 10-15% of breast cancers. Mammograms also have a false positive result about 33% of the time. A false positive result occurs when a test suggests an illness that actually does not exist.
There are 2 medications to prevent breast cancer in high-risk, postmenopausal women. These medications increase your chances of having blood clots and stroke. Talk to your doctor about whether medication is right for you.
If you are at very high risk for breast cancer, surgery to remove your breasts before you get cancer (a procedure called prophylactic mastectomy ) may be an option.