Overview
Over 180,000 American women are diagnosed with invasive breast
cancer in the United States every year. It is also the leading
cause of cancer in females around the world. In fact, approximately
one in ten American women will develop breast cancer over the
course of a life-time. The number of new cases diagnosed annually
has increased steadily over the years, but is likely that this
reflects improved screening methods and diagnosis coupled with
the aging of the population. Breast cancer occurs most frequently
over the age of fifty years, and the risk continues to increase
until it reaches age 75. It is estimated that one in thirty
American women will die from this disease, although earlier
diagnosis and better treatment appear to be favorably impacting
survival. Breast cancer is the second leading cause of cancer
death in women, after lung cancer and it is the leading cause
of cancer death among women aged 40 to 55 years. While it is
known that white women are more likely to develop breast cancer
than are African-American women, statistics show that African-American
women are more likely to die of this cancer. Although we do
not have all the answers on why African-American women die more
from breast cancer than white women, there is no question that
lower rates of screening strategies, coupled with the lack of
persuasive information in the African-American community are
partly to be blamed. We hope that this web site will be part
of the solution.
What
causes breast cancer?
Breast cancer appears to be caused by multiple factors. There
is now very good evidence for the existence of a sub-set that
of breast cancer that is caused by a specific genetic defect
that can be inherited. This group is relatively small, representing
less than 5% of all breast cancers. They are characterized by
the fact that several family members develop the disease. In
the absence of such a cluster, genetic screening is not warranted.
Environmental factors are also thought to play a role, and include
exposure to radiation, and the peculiar finding that breast
cancer appears to be more common in affluent societies. Finally,
there are clearly hormonal factors that affect the incidence
of breast cancer. For unknown reasons, early onset of menses
(early menarche), delayed first pregnancy, not having any pregnancies
(nulliparity), and late onset of menopause all seem to increase
the risk of developing breast cancer.
Types
of breast cancer-
While there are several different types of breast cancer, about
ninety five percent of them belong to one of three main types.
In fact, 80% of breast cancers are of the invasive ductal variety.
The key thing to remember is that there are two major groupings
that have implications for treatment and survival. The first
grouping separates them into:
· Carcinoma-in-situ
· Invasive cancer
Carcinoma-in-situ refers to cancer that is felt to have not
started the process of invading nearby and distant tissues,
unlike the invasive form. Because of this difference, the carcinoma-in-situ
has a much better prognosis than the invasive cancer. It also
easier to treat and usually does not require radical surgery
or cancer fighting medications (chemotherapy). The other major
grouping involves the separation of the cancer types into those
that carry receptors for female hormones and those that do not.
Those with receptors are sensitive to a medication called tamoxifen
that has greatly improved the outlook for patients with breast
cancer.
What
are the early signs of breast cancer?
Most cases of breast cancer are diagnosed as a result of the
patient or her doctor feeling a suspicious lump in the breast.
With widespread mammography becoming available, an increasing
number of people with no symptoms are being diagnosed following
a routine mammogram examination. Other symptoms include pain
in the breast, a discharge from the nipple that may or may not
be bloody, changes to the skin of the breast, or swollen lymph
glands. The important thing to keep in mind is that any unusual
changes to your breasts need to be reported to your doctor promptly.
Can
breast cancer be prevented?
There are no specific measures to prevent breast cancer for
the vast majority of women who do not have a specific genetic
defect. Recommendations to limit dietary fat have been studied
and are no longer considered to have any bearing on incidence.
There is some evidence that taking estrogen replacement pills
for more than five years modestly increase risk. People with
genetic markers for breast cancer risk should be followed carefully.
Some elect to have prophylactic bilateral breast removal with,
or without reconstructive surgery. Such an option must be carefully
discussed with your doctor before proceeding.
Screening
guidelines
Breast cancer represents a dramatic example of a cancer that
can be positively impacted by screening programs. It clearly
saves lives in women over the age of fifty. All women from late
adolescence should form the habit of monthly breast self-examination
(BSE) to detect any lumps. Although most breast lumps are not
cancerous, it is extremely important to find any lump early
enough so that it can be tested for cancer cells. If cancer
cells are detected, early intervention increases the chances
of a cure since the cancer is less likely to have spread. Timing
of when to perform the BSE is also important. For postmenopausal
women, the last day of each month or the first day of each month
is suggested since one of these days is usually the easiest
to remember. For premenopausal women, it is recommended that
the BSE be done one week after the first day of each menstrual
cycle, when the breast is less swollen and sensitive. Breast
self-examination accompanied by mammography is recommended every
one to two years in women over the age of 50 years. The use
of mammogram under the age of 50 years remains controversial
for women with average risk of developing breast cancer. While
it is clear that no studies have documented any benefits for
patients less than forty years old, patients between ages 40
to 49 years may elect to have periodic mammogram. Patients who
are particularly at risk due to genetic or other reasons should
begin screening earlier and have it as frequently as yearly.
Discuss your own specific situation with your doctor, taking
care to make all the facts available to him. Other form of breast
imaging are not appropriate for screening, but may be used to
further evaluate suspicious areas.
Treatment
options for breast cancer
The main treatment modalities include surgery, radiation therapy,
chemotherapy (including hormonal therapy), and a combination
of two or more of these measures. Surgery to remove the entire
breast and other under-lying tissues used to be the main-stay
of treatment for all but the very early tumors. With several
studies documenting equivalent results when less disfiguring
surgery is combined with other modes such as radiation or chemotherapy,
women now have more options for treatment. For those tumors
with receptors for female hormones, tamoxifen has become a crucial
part of the treatment regimen. Tamoxifen has a number of side
effects, including increased risk of forming blood clots, so
be sure to discuss the side effects of all the medications you
are given with your doctor.
Can
breast cancer be cured?
Carcinoma-in-situ can be cured by removing the breast without
removing any other under-lying or close by structures. More
advanced cancer is associated with a risk of recurrence. Taking
tamoxifen for five years appears to reduce the likelihood of
recurrence. Other cancer fighting chemicals are also given through
the veins for the same reason. The longer the disease-free interval
following the initial treatment, the greater the likelihood
of cure.
Where
can I get information and help regarding breast cancer?
An excellent one-stop source of information is the American
Cancer Society. They can also refer you to other resources.
The toll-free number is 1-800-686-4357.
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Breast Cancer