Breast Cancer Guide
• What Is Breast Cancer?
|What Is Breast Cancer?
Breast cancer is cancer which starts in the tissues of the breast. It can grow into a lump and if untreated spread to surrounding tissues and eventually other organs in the body. It occurs almost entirely in women but men can develop it too. The breasts (technically called mammary glands) consist of pads of fat within which there is a branching system of ducts. These ducts are designed to carry milk from the milk producing lobules to the nipples. Breast cancer starts when there is abnormal cell growth either in the lining of these ducts or in the lobules themselves (image). Initial abnormalities, as long as they stick to the confines of the ducts or lobules are not considered cancer. They are considered a sort of pre-cancer called hyperplasia. Hyperplasia does not cause lumps so it cannot be detected by a breast examination or mammogram. If the cells continue to grow abnormally they can start to clog the ducts or lobules. At this point they are called lobular carcinoma in situ and ductal carcinoma in situ. This stage can sometimes be detected by a mammogram and occasionally it causes a lump which can be felt. If the abnormal cells break away and start to invade adjoining cells, this is known as invasive cancer. It is at this stage that a malignant lump will start to grow. If the cancerous cells manage to escape the breast altogether through the bloodstream or lymph system they can infect other parts of the body like the lungs and bones. At this stage the breast cancer has metastasized and is most lethal. Scientists now believe that cancerous cells may even leave the breast an earlier stage than previously thought. The immune system destroys them, but it eventually becomes overwhelmed as more and more cells appear. Clinicians divide breast cancer into 5 different breast cancer stages, starting with stage 0 (cell abnormalities confined to lobules or ducts) and ending in stage 4 (cancer has spread to other organs in the body).
Breast cancer is one of the most feared diseases in America. It strikes over 180,000 women a year, killing about 40,000. The cause is unknown and there is the additional distressing prospect of losing a breast. Fortunately early detection rates are improving as are breast cancer treatment methods. Saving most of the breast has become a more viable option in the past 10 years. This means the stress of breast cancer has somewhat switched from the immediate fear of death or disfigurement to instead to worrying about the effects of chemotherapy, surgery or radiation, and living with the concern that the disease may recur. The incidence rate of breast cancer has increased sharply in the United States since the 1940s. In fact breast cancer rates are twice as high now as they were in 1940 and continue to rise by 1 to 2 percent a year. Worldwide, the rates are lower in Asia and Latin America compared to America or Europe. However this is not put down to genetic differences. When Asian or Latin women move to America (or other higher-rate countries), their incidence rate rises with subsequent generations. This is why researchers believe lifestyle factors and environmental exposures must play a role. Women are living longer and starting menarche earlier due to good nutrition which means they are exposed to estrogen for longer (a potential cancer risk). Delayed childbearing, reduced amount of time spent breastfeeding and exposure to environmental toxins probably also play a role. The good news is that the death rates from breast cancer in the developed world are reducing. This is connected to widespread screening (mammography) as well as improved techniques in radiation therapy and chemotherapy.
A woman's breasts change throughout her life, during adolescence, periods, pregnancy and menopause. Only 5 percent of breast cancer cases occur in women under 40 and 25 percent in women under 50. This means age is one of the main risk factors. In relation to breast cancer symptoms, the most classic sign is a breast lump. The lump may be felt with a finger or spotted during a mammogram (images). Most lumps are not cancerous. A cancer lump is usually rock-hard to touch, although to begin with it may be as small as a soft thickening.
Other possible signs include:
Changes in breast appearance:
Breast pain can often be one of the early signs of breast cancer. Breast pain which comes and goes with a menstrual cycle is not a symptom. Persistent pain however should be checked.
It's Not Always Breast Cancer
The following is a list of conditions which are quite common and do not necessarily indicate cancer:
• Mastalgia or severe breast pain.
In the past breast cancer was normally found during a routine medical examination, or just noted by chance if they felt a lump. Today, many cases are discovered by a mammogram screening. An ultrasound diagnostic test of the breasts can be used to examine if a lump is solid or fluid filled (fluid filled lumps are not likely to be cancerous). Radiologists sometimes use computerized detection methods to check suspicious areas for microcalcifications. When a lump has been discovered a biopsy will usually need to be performed. The cells will be examined under a microscope for cancer. The results of the biopsy, physical examination and diagnostic tests (only ordered if a biopsy is positive) will help the doctor determine the stage of cancer growth and the best course of therapy. If there is suspicion that cancer may have spread beyond the breast a CT scan may be ordered. See breast cancer diagnosis for more.
Breast cancer is treated with surgery, chemotherapy, radiation and hormonal therapy. Treatment varies according to the size, nature and stage of the cancer. The woman's age and overall health also need to be taken into account, as well as the convenience and cost of treatment. As there is no one agreed method of treatment, a woman should be prepared to play an active role in deciding her treatment plan. As breast cancer is rarely ever a medical emergency, there is no harm in taking a few weeks to think things over, do some research and talk to other women who have had cancer. Mostly there are 2 decisions you will need to take:
1. Surgery: How much tissue should be removed? Just the cancerous lump itself (lumpectomy - image), a whole segment of the breast (partial mastectomy) or the whole breast (mastectomy - image). If a woman elects only to have the lump removed then radiation will be necessary to eliminate any remaining lurking cancer cells. If the entire breast is removed the woman usually has the option of breast reconstruction surgery or wearing a prosthesis under her clothes (which gives the appearance of a breast). Some women choose to live with their new form as it is.
2. Systemic Therapy: What kind of systemic therapy is necessary (if any)? This is only where it is suspected that cancer cells may have spread to other parts of the body. The options include chemotherapy and hormonal therapy. See Chemotherapy Guide.
Even if a woman is presumed cancer free after treatment, she usually sees a doctor at least every 3 months for 2 years. Assuming no problems arise, this usually becomes every 6 months for another few years and eventually reducing to once a year. See also, alternative treatments for cancer and breast cancer recurrence.
Having cancer in the breasts alone will not kill a person. It is generally only when cancer spreads from the breasts to other vital organs in the body, such as the liver, lungs, bones or brain, that the threat of death is serious. If breast cancer spreads to the lungs for example, it is still known as breast cancer and not lung cancer. Wherever cancer originates in the body it retains that original diagnosis. Breast cancer can end a woman's life by eventually causing organ failure. Once cancer has spread to distant parts of the body it is very difficult to cure. The woman's overall health will be weakened from the disease and possibly also from chemo or radiation. This makes it more difficult for her body to 'bounce back' and cope with the increasing physical burdens of failing organs. She may also become more prone to infections such as pneumonia which will weaken her further. Ultimately palliative care is the only option. This means making her as comfortable as medically possible until the day she passes. For some stats read about the leading causes of death in women and latest health statistics.
Breast self-examination (image) should be a regular part of every woman’s health care routine. Those women over the age of 40 or at high risk of the disease should also have an annual mammogram. Only ever have a mammogram at a facility certified by the American College of Radiology (ACR) as quality control is essential. Contact the American College of Radiology (1-800-227-5463) or the National Cancer Institute (1-800-4-CANCER) to find a certified mammography provider in your area. If you do not have health insurance they may also be able to advise you where to get a low-cost or free mammogram. All women with Medicare who are 40 or older are entitled to one mammogram screening a year. See also, Genetic testing for breast cancer.
A Woman's Age
Breast Tissue Density
Hormone Replacement Therapy
| Other Useful Guides
Recommended Health Screenings For Women: List for all ages.
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