What is breast cancer?

Breast cancer is characterized by abnormal and uncontrolled division of cells in the breast. These cancerous cells multiply and destroy the normal breast tissue around them, and can also travel to other parts of the body through the bloodstream or the clear lymphatic fluid that bathes cells, causing new cancerous growths in new locations.

The risk of breast cancer is a fact of life for all women. In 2002, more than 200,000 new diagnoses of this disease were made in the US alone. The risk increases with age, regardless of family history. By the time a woman is 85, she has a one in nine chance of gettng breast cancer at some point during the remainder of her life. For a 25-year-old, the risk is 1 out of over 19,500; for a 45-year-old, it has increased to 1 in 93. Eighty percent of these cancers are diagnosed in women 50 and older.

Breast cancer causes and symptoms

The risk factors for developing this type of cancer include:

• Family history: mother or sister with breast cancer
• Early menstruation, late menopause
• Reproductive history: women who have never borne a child, had children late in life, and those who never breastfed are more at risk.
• History of abnormal biopsies of the breast

Over 70% of those diagnosed with breast cancer do not have any known risk factors. A breast cancer gene was identified in 1994, but it’s believed that no more than 5% of cases are caused by this gene.

There have been studies published that implicate high-fat diets, alcohol intake, and avoidance of breastfeeding in increased risk. There may be other factors in the typical Western lifestyle that are responsible for the comparatively high rates of breast cancer in those countries compared to other parts of the world. Two examples may be the aromatic hydrocarbons in tobacco and hydrocarbons found in well-done meats. Another association addressed by researchers has been possible linkage between hormone replacement therapy (HRT) and breast cancer. Early studies pointing in this direction were not seriously received in many quarters, but an important project published in 2003 provided substantial evidence of the risk. The Women’s Health Initiative published results showing that the risk increased even with quite short-term use of HRT using combined estrogen and progestin, with diagnoses being made at a later stage of the disease, and higher than expected numbers of abnormal mammograms. The longer a subject was on HRT, the greater her risk.

Woman need to be aware that many breast lumps are NOT cancerous. These benign lumps need only to be removed. If you have several risk factors you may, statistically, have a greater chance of developing breast cancer, but bear in mind that the disease is not a simple yes-or-no likelihood, but the outcome of complex interactions of factors. Monthly self-exams are the best way to keep track, so that any lump can be found at an early stage of development. Regular mammograms – xrays of the front and sides of the breast – can detect tumors or cysts at very early stages. It’s also a good idea to get a risk assessment consultation at a breast cancer center, of which there are many across the US.

Signs that can indicate breast cancer include:

• Changes to nipple, such as thickening, bleeding, pulling in, or discharge
• Dimpling or reddening of skin over the breast
• Changed size or shape of breast
• Abnormality detected in a mammogram

How is breast cancer diagnosed?

Mammograms (low dose breast x-rays) pick up more than 90% of breast cancers. If a suspicious lump is found, a mammogram should be done to investigate it further. Doctors will order routine screening mammograms in accordance with standard guidelines. Although there has been disagreement in the medical community about the cost effectiveness of regular mammograms for women in their 40s, the majority of doctors concur with current guidelines from the American Cancer Society, for screening mammograms annually or every two years for women 40 to 49 years old, and annually for women 50 and above. Woman whose family history includes close relatives with breast cancer may choose annual mammograms after age 40.

A screening mammography usually includes two x-rays of each breast, one taken from above, one from the side. The technologist looks at the films immediately to see whether they are complete; the radiologist decides if more views or follow-up ultrasounds are needed to make a thorough assessment.

If an irregularity shows up – a mass, changes from earlier mammograms, skin abnormalities, lymph nodes enlarged – more tests may be ordered. The additional test might be an ultrasound scan of the breast, a biopsy or needle sampling of the suspect area, or a consultation with a breast surgeon.

Breast biopsy is the removal of breast tissue so that a pathologist can examine it for abnormal cells. Excisional biopsies surgically remove the whole area around the lump, plus some adjacent tissue; with a very large lump, the excision removes only part of the area for analysis. Needle biopsies can be done in two ways, aspiration needle biopsy and large core needle biopsy. In the first, a very fine needle withdraws fluid and cells from the mass, and in the second a larger-diameter needle takes out small segments of tissue. The analysis of biopsied tissue will show if the lump is noncancerous (benign) or cancerous.

If cancerous cells prove to be present, physicians will remove some lymph nodes from the patient’s underarm area to discover if cancer cells have spread into other parts of the body, and to help guide their decisions for further treatment. Sentinel lymph node biopsy, a new technique, removes only the node that is “first in line” to receive fluid draining from a cancerous area, preserving the other lymph nodes. If there are no cancer cells  in the sentinel node, the cancer has remained local. Testing for cancer cells in lymph nodes gives the physician a reliable indication of what stage of advancement the cancer has reached (“staging” cancer). Breast cancers are rated on a scale from Stage 0 (cancer-free) to Stage IV. This tells the cancer specialist (oncologist) how much the disease has spread. The stages are:

• Stage I. The cancer is no larger than 2 cm and no cancer cells are found in the lymph nodes.
• Stage II. The cancer is no larger than 2 cm but has spread to the lymph nodes or is larger than 2 cm but has not spread to the lymph nodes.
• Stage IIIA. Tumor is larger than 5 cm and has spread to the lymph nodes or is smaller than 5 cm, but has spread to the lymph nodes, which have grown into each other.
• Stage IIIB. Cancer has spread to tissues near the breast or to lymph nodes inside the chest wall, along the breastbone.
• Stage IV. Cancer has spread to skin and lymph nodes near the collarbone or to other organs of the body.

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