About Breast Cancer
Breast cancer is the most common cancer in women in the United States.
It is the second leading cause of cancer deaths among women, second to lung cancer.
Currently there is no known prevention for breast cancer. However, earlier detection with yearly screening mammography and better treatments has produced a significant decline in breast cancer deaths. There has been about a 27% decline from 1990 – 2005.
Facts About Breast Cancer
Following are some facts about breast cancer:
- The chance of a woman in the United States developing breast cancer over an 80 year life span is 1 in 8.
- The risk of developing breast cancer increases with age.
- American Cancer Society estimates 226,870 new cases of breast cancer in women in 2012. It estimates that 39,510 women will die from breast cancer in 2012.
- Men can develop breast cancer; male incidence is 1:100 of female rate.
- Caucasian women are slightly more likely to develop breast cancer than women of any other race.
- African American women are more likely to develop aggressive breast cancers and to die from breast cancer than Caucasian women.
- About 5-10% of breast cancer is thought to be caused by inherited abnormal genes, usually the BRCA 1 and BRCA 2 genes.
- Early detection leads to the most successful treatment.
Development of Breast Cancer
Breast cancer is a condition where breast cells become abnormal and multiply uncontrollably. Cancer is caused by some combination of external (tobacco, chemicals, radiation), and internal factors (hormones, inherited mutations). These factors may promote the development of cancer by causing a malfunction in genes that control cell growth and division. Most cancers arise from damage to these genes occurring during one’s lifetime
The abnormal cells can spread beyond the site of origin to other areas of the body. If this spread is not controlled, this can lead to death.
Types of Breast Cancer
There are two main types of breast cancer, ductal and lobular. Ductal carcinoma accounts for the majority of breast cancer, approximately 70–80%.
- Ductal carcinoma in situ (DCIS) is the early form of ductal carcinoma. The abnormal cells are confined to the milk ducts. DCIS is graded based on the appearance of the nuclei of the cells as low grade, intermediate grade and high grade. The higher the grade, the more aggressive the cancer. The more aggressive the cancer, the greater the possibility that the cancer will become invasive by the time of surgery. This type of breast cancer is most commonly found on screening mammography looking like calcifications but can look like a lump. There is currently not a method to determine if or when these cells will become invasive. Consequently, the standard of care is to undergo surgical therapy and usually radiation therapy.
- Invasive ductal carcinoma (IDC) is the form of ductal carcinoma where the cells have grown through the duct walls and into the surrounding breast tissue. This does not mean that there is cancer in the lymph nodes or elsewhere in the body (metastases) but there is a greater risk of metastases depending on the size at the time of diagnosis. This type of breast cancer can show on a mammogram as a mass, distortion or as a lump. The standard of care is to undergo surgical and radiation therapy and if indicated chemotherapy.
- Lobular carcinoma in situ (LCIS) is not considered cancer but is a high risk marker for the development of breast cancer in either breast at some time in the future.
- Invasive lobular carcinoma comprises about 10–15% of breast cancers. The abnormal cells begin in the lobules of the breast where milk production occurs. This type of breast cancer grows by finger like infiltrations into the surrounding tissue and can present as a thickening or mass. It may not develop a mass or lump like IDC more commonly does. It can be more difficult to detect either by palpation or on a mammogram.
- Other types of Infiltrating Breast Cancer
- Tubular carcinoma: low grade form of IDC
- Medullary carcinoma
- Mucinous (colloid) carcinoma
- Papillary carcinoma
- Inflammatory breast cancer (IBC): a form of IDC that presents as skin thickening and reddening.
- Paget Disease: a form of breast cancer that presents with nipple changes, crusting, weeping, possibly discharge.
- High Risk/Premalignant Conditions
- Atypical duct hyperplasia (ADH) is considered a pre-cancer with a risk of developing into a breast cancer. Currently there is no way to determine when or if these cells will evolve into a breast cancer. If there is a significant # of abnormal cells and an MRI is abnormal, then the current standard of care is to surgically remove this tissue.
- Atypical lobular hyperplasia (ALH) and lobular carcinoma in situ (LCIS) are high risk markers for the possibility of developing a breast cancer in the future. Surgical therapy is not always recommended. We recommend MRI imaging to evaluate both breasts to make sure there is not a more significant condition in either breast.
Staging of Breast Cancer
Staging involves determining the extent of spread of the disease at the time of diagnosis. It is vital to assist in the choice of therapy and providing a prognosis for cure. The following are considered in staging:
- Size and extent of the primary tumor (T)
- Presence or absence of lymph node involvement (N)
- Presence or absence of distant spread of the disease, know as metastasis (M
Molecular properties of tumors are also becoming better understood and assist in therapy planning and prognosis counseling.
Risk Factors and Symptoms
Risk Factors for Breast Cancer
- Never given birth to a live infant
- Having first child after age 30
- Late menopause
- Early onset of menstruation
- Prior high risk breast biopsy
- Previous chest radiation therapy
- Dense breast tissue
- High bone mineral density (BMD)
- Inadequate exercise
- Hormone replacement therapy
- Environmental factors such as pollution
- Alcohol use
Hereditary Breast Cancer
Breast cancer can be caused by a specific hereditary cancer syndrome. The most common of these is called Hereditary Breast and Ovarian Cancer Syndrome and is caused by mutations in the BRCA1 and BRCA2 genes. Genetic counseling/testing is available through the genetic counseling program at Invision Sally Jobe.
Risk factors for hereditary breast and ovarian cancer include any of the following in a patient or their family:
- Female breast cancer prior to age 50 (or at any age, if Ashkenazi Jewish descent)
- Male breast cancer
- Ovarian cancer
- Two or more of these cancers in a person or family
Know Your Risk for Breast Cancer
The genetic counseling program at Invision Sally Jobe provides patients with a personalized assessment of their breast cancer risk, as well as individualized recommendations for cancer screening and prevention. Each patient who comes to Invision Sally Jobe for any type of breast imaging exam receives this initial assessment. After the exam, any relevant recommendations are communicated to their referring doctor as part of the imaging report, as well as to the patient directly via a separate letter. Patients who have already had breast cancer are evaluated as well to determine whether their cancer may be related to a hereditary breast cancer syndrome. If you have a higher-than-average risk for breast cancer, you have many options available, including supplemental breast cancer screening (with breast MRI screening or screening breast ultrasound, genetic counseling/testing , and/or chemoprevention.
Symptoms of Breast Cancer
The most common sign of breast cancer in women is an abnormality identified on a screening mammogram. The most common symptom is a lump that is usually painless. Other symptoms include:
- Thickening or swelling
- Spontaneous, clear or bloody discharge from a single duct opening from the nipple
- Retraction or indentation of the nipple
- Skin retraction or dimpling on the breast
- Change in the size or shape of the breast
- Redness, scaliness, pitting, or thickening of the skin or nipple
- Lump in the armpit (axilla)
Diagnosis and Treatment
Diagnosing Breast Cancer
The following breast exams are used for diagnosing breast cancer. Your physician will determine which exam or exams are appropriate for you.
- Breast Ultrasound
- Breast MRI
- Breast Biopsy
- 3D Mammogram
Treating this Condition
While there are several treatment options for breast cancer, there are no radiology procedures for treating breast cancer.