Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
Breast cancer is the illness that many women fear most, though they’re more likely to die of cardiovascular disease than they are of all forms of cancer combined.
Still, breast cancer is second only to lung cancer as a cause of cancer deaths in American women. Although rare, breast cancer can also occur in men.
Earlier the diagnosis of breast cancer usually meant radical mastectomy which involved the removal of the entire breast along with underarm lymph nodes and skin and muscles underneath the breast. Today, radical mastectomy is rarely performed. Instead, there are more and better treatment options, and many women are candidates for breast-sparing operations.
The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer.
Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.
Age and health history can affect the risk of developing breast cancer. Anything that increases the chance of getting a disease is called a risk factor. Risk factors for breast cancer include the following:
- Treatment with radiation therapy to the breast/chest.
- Older age.
- Menstruating at an early age.
- Older age at first birth or never having given birth.
- A personal history of breast cancer or benign (noncancer) breast disease.
- A family history, mother or sister with breast cancer.
- Breast tissue that is dense on a mammogram.
- Taking hormones such as estrogen and progesterone.
- Drinking alcoholic beverages.
- Being white.
Metastatic Breast Cancer
Metastatic breast cancer is considered to be the most dreadful disease. This type means that breast cancer that has not just come back, but has made its way through the bloodstream and spread to other organs of the body, such as the bones, liver, or brain. Breast cancer spread may be present at first diagnosis or after recurrence.
Metastatic breast cancer women can live for years with the disease under control. For these women, living with a diagnosis of metastatic breast cancer is like living with a chronic disease. It can go into remission, be active sometimes and not others, or move quickly. It frequently involves trying one treatment after another; ideally with breaks in between treatments when one feel good. The goal of treatment is to help to feel as well as possible and to let live a longer life.
No one can tell how long one will live with metastatic disease. That’s because every woman’s experience is different. Some women live for more than a decade. Others live for just a few seasons. But new and more effective treatments keep being developed. This means that patients may do much better today with metastatic disease than someone who had it only a few years ago.
In this phase of breast cancer, the treatment goal is to extend life as long as possible with the best quality of life possible. This means relieving symptoms and putting breast cancer into remission with the fewest side effects.
Metastatic breast cancer responds best if:
- The cancer has not spread to any organs, such as the liver, lung, and brain.
- If it has spread throughout the body, no more than three organs or parts of the body are involved (the fewer the better).
- Estrogen and/or progesterone hormone receptors are present in these cancer cells.
- There’s no evidence that the tumor has stopped responding (become resistant) to hormonal therapy, Herceptin or chemotherapy.
Breast Cancer Causes
Breast cancer causes are a bit specific. The most common type of breast cancer begins in the milk-producing ducts, but cancer may also occur in the lobules or in other breast tissue.
In most cases, it isn’t clear what triggers abnormal cell growth in breast tissue, but doctors do know that between 5 percent and 10 percent of breast cancers are inherited. Defects in one of two genes, breast cancer gene 1 (BRCA1) or breast cancer gene 2 (BRCA2), put the person at greater risk of developing both breast and ovarian cancer.
Inherited mutations in the ataxia-telangiectasia mutation gene, the cell-cycle checkpoint kinase 2 (CHEK-2) genes and the p53 tumor suppressor gene also make it more likely that one will develop breast cancer.
Yet most genetic mutations related to breast cancer aren’t inherited but instead develop during the lifetime. These acquired mutations may result from radiation exposure i.e. women treated with chest radiation therapy in childhood, for instance, have a significantly higher incidence of breast cancer than do women not exposed to radiation.
Mutations may also develop as a result of exposure to cancer-causing chemicals, such as the polycyclic aromatic hydrocarbons found in tobacco and charred red meats.
In the long run, establishing a link between genetic mutations and cancer is just the first step. Now researchers are trying to learn if a relationship exists between genetic makeup and environmental factors that may increase the risk of breast cancer. Although these studies are still preliminary, breast cancer eventually may prove to have a number of causes.
Symptoms of Breast Cancer or Sign of Breast Cancer
Knowing the symptoms of breast cancer or sign of breast cancer may help save the life. When the disease is discovered early, the more treatment options and a better chance for long-term recovery are possible.
Most breast lumps aren’t cancerous. Yet the most common sign of breast cancer for both men and women is a lump or thickening in the breast. Often, the lump is painless. Other symptoms of breast cancer or sign of breast cancer include:
- A spontaneous clear or bloody discharge from the nipple
- Retraction or indentation of the nipple
- A change in the size or contours of the breast
- Any flattening or indentation of the skin over the breast
- Redness or pitting of the skin over the breast, like the skin of an orange
Stage of Breast Cancer
After the confirmation of breast cancer (diagnosis), tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
Staging is the process used to find out whether the cancer has spread within the breast or to other parts of the body. The information gathered from the staging process determines the stage of breast cancer. It is important to know the stage in order to plan treatment.
The following are the stage of breast cancer:
Stage 0 (carcinoma in situ)
There are 2 types of breast carcinoma in situ:
- Ductal carcinoma in situ (DCIS) is a noninvasive, precancerous condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive.
- Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.
In stage I, the tumor is 2 centimeters or smaller and has not spread outside the breast.
In stage IIA:
- No tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or
- The tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
- The tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.
In stage IIB, the tumor is either:
- Larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
- Larger than 5 centimeters but has not spread to the axillary lymph nodes.
In stage IIIA:
- no tumor is found in the breast, but cancer is found in axillary lymph nodes that are attached to each other or to other structures; or
- the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are attached to each other or to other structures; or
- the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that may be attached to each other or to other structures.
- In stage IIIB, the cancer may be any size and:
- Has spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); and
- May have spread to lymph nodes within the breast or under the arm.
In stage IIIC, the cancer:
- has spread to lymph nodes beneath the collarbone and near the neck; and
- may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.
Stage IIIC breast cancer is divided into operable and inoperable stage IIIC.
In operable stage IIIC, the cancer:
- is found in 10 or more of the lymph nodes under the arm; or
- is found in the lymph nodes beneath the collarbone and near the neck on the same side of the body as the breast with cancer; or
- is found in lymph nodes within the breast itself and in lymph nodes under the arm.
In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone and near the neck on the same side of the body as the breast with cancer.
In stage IV, the cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.
Breast Cancer Treatment
There are different types of breast cancer treatment for patients with the disease. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial.
A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate breast cancer treatment is a decision that ideally involves the patient, family, and health care team.
Four types of standard treatment for breast cancer are used:
Surgery for Breast Cancer
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:
- Lumpectomy: A surgical procedure to remove a tumor (lump) and a small amount of normal tissue around it.
- Partial mastectomy: A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.
Other types of surgery include the following:
- Total mastectomy: A surgical procedure to remove the whole breast that contains cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
- Modified radical mastectomy: A surgical procedure to remove the whole breast that contains cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
- Radical mastectomy: A surgical procedure to remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Radiation therapy for Breast Cancer
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the breast cancer being treated.
Chemotherapy for Breast Cancer
Chemotherapy uses drugs to destroy cancer cells. The doctor may recommend chemotherapy following surgery to kill any cancer cells that may have spread outside the breast. Treatment often involves receiving two or more drugs in different combinations. These may be administered intravenously, in pill form or both. Patient may have four to eight treatments spread over three to six months.
The side effects may include hair loss, nausea, vomiting and fatigue. These occur because chemotherapy affects healthy cells, especially fast-growing cells in the digestive tract, hair and bone marrow and as well as cancerous ones. Not everyone has side effects, however, and there are now better ways to control some of them.
New drugs can help prevent or reduce nausea, for example. Relaxation techniques, including guided imagery, meditation and deep breathing, also may help. In addition, exercise has been shown to be effective in reducing fatigue caused by chemotherapy.
Hormone therapy for Breast Cancer
Hormone therapy is most often used to treat women with advanced (metastatic) breast cancer or as an adjuvant treatment — a therapy that seeks to prevent a recurrence of cancer — for women diagnosed with early-stage estrogen receptor positive cancer.
Estrogen receptor positive cancer means that estrogen or progesterone might encourage the growth of breast cancer cells in the body. Normally, estrogen and progesterone bind to certain sites in the breast and in other parts of the body. But during this treatment, a hormonal medication binds to these sites instead and prevents estrogen from reaching them. This may help destroy cancer cells that have spread or reduce the chances that the cancer will recur.
New types of treatment are being tested in clinical trials. These include the following:
Sentinel lymph node biopsy followed by surgery.
Sentinel lymph node biopsy is the removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye are injected near the tumor.
The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
Breast Cancer Prognosis and Survival Rate
Breast Cancer Prognosis and Survival Rate depend on various factors. A number of factors are used to determine successful treatment and the possibility for a cure. This includes the following:
- The location of the tumor and how far it has spread.
- Whether the tumor is hormone receptor-positive or negative.
- Genetic factors.
- Tumor size and shape.
- Rate of cell division.
- Certain biologic markers.
The good news is that women are living longer with breast cancer, and at this time more than two million American are survivors. Survivors must live with the uncertainties of possible recurrent and some risk for complications from the treatment itself.
If the breast cancer recurs after treatment, most develop within five years.
However, 25% of recurrences and half of new cancers in the opposite breast occur after five years. It should be noted that one study suggested that the risk factors for a first breast cancer do not necessarily place a woman at any higher risk for recurrence. (Women with a first cancer, however, do have a higher risk for a new cancer in the opposite breast. The outlook for such new cancers is independent from those of the first one.)
Location of the Tumor
The location of the tumor is a major factor in outlook:
- If the breast cancer is ductal carcinoma in situ (DCIS) or has not spread to the lymph nodes, the five-year survival rates with treatment are up to 98%. It should be noted, however, that the cancer recurs in between 9% and 30% of such node-negative cancers. Recurrence is a potentially life-threatening problem, even if the disease relapses locally in the same breast.
- If the lymph nodes contain cancer cells then survival rates fall. If the tumor is larger than 5 cm or there is widespread involvement in the lymph nodes, it is sometimes referred to as locally advanced. In such cases, the survival rate drops to about 75% and below.
- If the cancer has metastasized and spread through the blood stream to other sites (most often the lung, liver and bone), the average survival time for patients treated with chemotherapy is between one and two years (with some patients living for many years). And new combinations of drugs are improving these averages.
Researchers have recently predicted survival. Overall 10 year survival figures for women diagnosed in the past few years are estimated to be 72 out of every 100 (72%). And they also predict that 64 out of every 100 women diagnosed recently with breast cancer (64%) will live for at least 20 years.
If breast cancer is going to come back, it is most likely to do so within the first 2 years. With some other types of cancer, one is likely to be cured if the cancer has not come back within 5 years. Unfortunately, breast cancer can come back 10 or 20 years after first diagnosed. But, it is still true that the more time that passes since the diagnosis, the less likely it is that the cancer will come back.
Statistics say that the number of women dying from breast cancer has gone down by 20% in the past 10 years in the UK. Of course this is probably due to a number of reasons. Overall, for those women whose breast cancers were picked up during screening, 93 out of every 100 (93%) lived for at least 5 years after their diagnosis. And 88 out of every 100 (88%) lived for at least 10 years after their diagnosis.