Breast cancer is a terrible disease. Well, ANY cancer is terrible, but breast cancer is the most common in women. Most of us know at least one woman who has battled this terrible disease, but probably several women you know are or have had to deal with breast cancer. We can get some statistics from the American Cancer Society.
From the American Cancer Society's Breast Cancer Guide (You can download a printable pdf from here)
Normal breast cells become cancerous because of changes (mutations) in DNA. Some
DNA mutations are inherited. This means the mutations are in every cell in your body
and can dramatically increase the risk for developing certain cancers. They are
responsible for many of the cancers that run in some families. But most DNA changes related to breast cancer are acquired in breast cells during a woman's life rather than having been inherited.
DNA is the chemical in each of our cells that makes up our genes. Genes have
instructions for how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than how we look. Some genes control
when our cells grow, divide into new cells, and die.
Breast cancer is the most common cancer among American women, except for skin cancers. About 1 in 8 (12%) women in the US will develop invasive breast cancer during their lifetime.
The American Cancer Society's estimates for breast cancer in the United States for 2016 are:
- About 246,660 new cases of invasive breast cancer will be diagnosed in women.
- About 61,000 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer).
- About 40,450 women will die from breast cancer.
After increasing for more than 20 years, breast cancer incidence rates in women began decreasing in 2000, and dropped by about 7% from 2002 to 2003. This large decrease was thought to be because fewer women used hormone therapy after menopause after the results of the Women's Health Initiative were published in 2002. This study linked using hormone therapy to an increased risk of breast cancer and heart diseases. In recent years, incidence rates have been stable in white women, but have increased slightly in African American women.
Breast cancer is the second leading cause of cancer death in women. (Only lung cancer kills more women each year.) The chance that a woman will die from breast cancer is about 1 in 36 (about 3%).
Death rates from breast cancer have been dropping since about 1989, with larger decreases in women younger than 50. These decreases are believed to be the result of finding breast cancer earlier through screening and increased awareness, as well as better treatments.
At this time there are more than 2.8 million breast cancer survivors in the United States. (This includes women still being treated and those who have completed treatment.)
Are you at risk for breast cancer?
I've read loads of references, but I found the American Cancer Society's guide to be more understandable than most. They list many risks for breast cancer:
- Being female (however, men can get breast cancer as well).
- Older age (the majority of cases are women over 55) That's not to say that younger women can't get breast cancer, as I know several; it just means the majority of cases are over age 55.
- Inherited genes (a couple of genes called BRCA1 and BRCA2 show an increased risk for breast cancer.) These genes are inherited from earlier generations. As in most cases, just because you inherited the gene, it doesn't automatically mean you'll get breast cancer, only that your chance is higher.
- Gene Mutations - your own genes are capable of mutation. It doesn't happen often (much less often that the inherited genes above, but it does happen.
- A family history of breast cancer (if someone in your family has had it, you are at an increased risk.
- If you have already had it, your risk is higher (generally coming out of remission to a new occurrence.)
- Race & Ethnicity - White and African-American women have a greater risk than Asian, Hispanic or Native American women.
- Alcohol Consumption - the more you drink, the higher your risk.
- Overweight or Obesity
- Lack of physical activity
- Birth Control drugs
- Hormone Therapy after menopause to lessen the menopausal symptoms.
Causes of breast cancer
So far, there is no conclusive evidence that environmental chemicals or vitamins & diet will contribute to your risk for cancer. Smoking &/or secondhand smoke have not been conclusively shown to cause it either. So far, medical research has not shown exactly what causes cancer.
Breast cancer starts when cells in the breast begin to grow out of control. These cells
usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is
malignant (cancerous) if the cells can grow into (invade) surrounding tissues or spread
(metastasize) to distant areas of the body. Breast cancer occurs mostly in women, but men can get it, too.
Can cancer be prevented?
There is no foolproof way to prevent breast cancer, but medical researchers suggest lessening your chances are a good way to try:
- Stay healthy - lose weight if you are overweight, and don't drink too much alcohol (1 drink per day is considered healthy). Also, increase your physical activity.
- If you have a family history of breast cancer, you should talk to your doctor about some of the drugs that have been shown to decrease the risk of cancer - drugs such as tamoxifen and raloxifene have been shown to reduce the risk, but these drugs can have their own risks and side effects.
- In recent years, some women who have been tested and have the gene mutations described above (BRCA1 and BRCA2) have opted to have preventive surgery. One of the most famous examples is Angelina Jolie, who had a double mastectomy after learning that she had the defective BRCA1 gene. Her mother, grandmother and an aunt have all died from breast cancer or a second cancer.
Tests and Treatment
The most important test for breast cancer is that the woman knows what her breasts are like normally (through monthly breast self-exam) and will know when something doesn't seem right. Abnormalities include:
- A new lump or mass where nothing was felt before
- Swelling of all or part of a breast (even if no distinct lump is felt)
- Skin irritation or dimpling
- Breast or nipple pain
- Nipple retraction (turning inward)
- Redness, scaliness, or thickening of the nipple or breast skin
- Nipple discharge (other than breast milk)
- Swollen lymph nodes near the breast (it's possible for the cancer to spread to the lymph nodes, so be aware of them as well.)
Additionally, women should schedule regular doctor's exams and a mammography.
Specialized tests can be ordered if necessary. They include:
Ultrasound (Sonogram) - Shows shapes and can tell if there is a lump or swelling within the breast, even if it can't be felt. It can also tell if a cyst is fluid-filled or a solid mass.
MRI - An MRI uses magnets and radio waves to outline objects and will make a detailed image of the breast. Combined with an injection of gadolinium, the image can show very small details.
Scintimammography - In this newer test, a slightly radioactive drug called a tracer is injected into a vein. The tracer attaches to breast cancer cells and is detected by a special camera. This technique is still being studied to see if it will be useful in finding breast cancers. Some doctors believe it may be helpful in looking at suspicious areas found by regular mammograms, but its exact role is still unclear. At this time, however, scintimammography should not be used as a replacement for screening mammograms.
Treatment for breast cancer can vary, depending on the extent/size of the cancer, and whether or not it has spread to nearby organs. Treatments include:
Surgery - the extent of surgery, from a lumpectomy (removing only the tumor and a bit of surrounding tissue) to a mastectomy (removal of the breast) depends on the extent of the cancer (how big it is and how far it has spread).
Radiation Therapy - treatment with high-energy rays (such as x-rays) or particles that
destroy cancer cells. There are 2 main types of radiation therapy that can be used to treat breast cancer:
- External beam radiation: This type of radiation comes from a machine outside the
- Internal radiation (brachythera): This type of radiation is placed inside the body for a short time.
Chemotherapy - treatment with cancer-killing drugs that may be given intravenously (injected into a vein) or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Chemo can have many side effects, depending on which drug you take, the dose of drugs given, and the length of treatment. Some of the most common possible side effects include:
Chemo can affect the blood-forming cells of the bone marrow, which can lead to:
- Hair loss and nail changes
- Mouth sores
- Loss of appetite or increased appetite
- Nausea and vomiting
- Increased chance of infections (from low white blood cell counts)
- Easy bruising or bleeding (from low blood platelet counts)
- Fatigue (from low red blood cell counts and other reasons)
Side effects can also include (for certain chemo drugs) - nerve damage, tingling of hands & feet, which might get much worse, extreme fatigue, fertility issues, heart damage and decreased brain function.
Hormone therapy - In some types of cancers, the woman's estrogen tells the cancer cells to multiply. Hormone therapy can counteract some of this by lowering the estrogen levels or blocking the cancer's reaction to the estrogen. However, the medications used in the hormone therapy can cause other side effects that may be severe.
An alternative to hormone therapy is for the woman to have her ovaries removed so the estrogen isn't produced, but this pushes her body into menopause, if she hadn't begun it yet, and that has its own side effects.
These breast cancers are still relatively small and either have not spread to the lymph
nodes or have a tiny area of cancer spread in the sentinel lymph node (the first lymph
node to which cancer is likely to spread).
These breast cancers are larger than stage I cancers and/or have spread to a few nearby
In stage III breast cancer, the tumor is large (more than 5 cm or about 2 inches across) or
growing into nearby tissues (the skin over the breast or the muscle underneath), or the
cancer has spread to many nearby lymph nodes.
Stage IV cancers have spread beyond the breast and nearby lymph nodes to other parts of
the body. When breast cancer spreads, it most commonly goes to the bones, liver, and
lungs. As the cancer progresses, it may also spread to the brain or other organs.
Each progressive stage requires more aggressive treatment, using surgery plus radiation and chemo in various forms. Higher stages require systemic treatment (traveling throughout the body) since it has spread. Your best friend at this point is knowledge, so you need to find out as much as you possibly can about your cancer.
Questions for your doctor (from the ACS Guide)
You may not need to ask all of the following questions, or may have others not listed here, but this list includes many important things you need to know;
When you're told you have breast cancer
When deciding on a treatment plan
- Exactly what type of breast cancer do I have?
- How big is the cancer? Where exactly is it?
- Has the cancer spread to my lymph nodes or other organs?
- What's the stage of the cancer? What does that mean?
- Will I need any other tests before we can decide on treatment?
- Do I need to see any other doctors or health professionals?
- What is the hormone receptor status of my cancer? What does this mean?
- What is the HER2 status of my cancer? What does this mean?
- How do these factors affect my treatment options and long-term outlook (prognosis)?
- What are my chances of survival, based on my cancer as you see it?
- Should I think about genetic testing? What would the pros and cons of testing be?
- How do I get a copy of my pathology report?
- If I'm concerned about the costs and insurance coverage for my diagnosis and
treatment, who can help me?
- How much experience do you have treating this type of cancer?
- Should I get a second opinion? How do I do that?
- What are my treatment choices?
- What treatment do you recommend and why?
- Should I think about taking part in a clinical trial?
- What would the goal of the treatment be?
- How soon do I need to start treatment?
- How long will treatment last? What will it be like? Where will it be done?
- Will any of the treatment be done by other doctors?
- What should I do to get ready for treatment?
- What risks and side effects should I expect?
- What can I do to reduce the side effects of the treatment?
- Should I change what I eat or make other lifestyle changes?
- How will treatment affect my daily activities?
- Will I be able to work during treatment?
- Will I lose my hair? If so, what can I do about it?
- Will I go through menopause as a result of the treatment? Will I be able to have
children after treatment? Would I be able to breastfeed?
- What are the chances the cancer will come back after this treatment?
- What would we do if the treatment doesn't work or if the cancer comes back?
If you need surgery
- Is breast-conserving surgery (lumpectomy) an option for me? Why or why not?
- What are the pros and cons of breast-conserving surgery versus mastectomy?
- How many surgeries like mine have you done?
- Will you have to take out lymph nodes? If so, would you advise a sentinel lymph
node biopsy? Why or why not?
- What side effects might lymph node removal cause?
- Will I need blood transfusions?
- How long will I be in the hospital?
- Will I have stitches or staples at the surgery site? Will there be a drain (tube) coming
out of the site?
- How do I care for the surgery site? Will I need someone to help me?
- What will my breasts look and feel like after my treatment? Will I have normal
feeling in them?
- What will the scar look like?
- Is breast reconstruction surgery an option if I want it? What would it involve in my
- Can I have reconstruction at the same time as the surgery to remove the cancer? What
are the pros and cons of having it done right away or waiting until later?
- What types of reconstruction might be options for me?
- Should I speak with a plastic surgeon about reconstruction options?
- Will I need a breast form (prosthesis), and if so, where can I get one?
- Do I need to stop taking any medications or supplements before surgery?
- When will I need to return for a follow-up visit?
- When should I call your office if I'm having side effects?
Once treatment begins, you'll need to know what to expect and what to look for. Not all
of these questions may apply to you, but asking the ones that do may be helpful.
- How will we know if the treatment is working?
- Is there anything I can do to help manage side effects?
- What symptoms or side effects should I tell you about right away?
- How can I reach you on nights, holidays, or weekends?
- Do I need to change what I eat during treatment?
- Are there any limits on what I can do?
- What kind of exercise should I do, and how often?
- Can you suggest a mental health professional I can see if I start to feel overwhelmed,
depressed, or distressed?
- Will I need special tests, such as imaging scans or blood tests? How often?
- Do I need a special diet after treatment?
- Are there any limits on what I can do?
- Am I at risk for lymphedema (swelling of the arm caused by fluid buildup after lymph node removal)?
- What can I do to reduce my risk for lymphedema?
- What should I do if I notice swelling?
- What other symptoms should I watch for?
- What kind of exercise should I do now?
- What type of follow-up will I need after treatment?
- How often will I need to have follow-up exams and imaging tests?
- Will I need any blood tests?
- How will we know if the cancer has come back? What should I watch for?
- What would my options be if the cancer comes back?
As you can tell, there are no absolute answers. Once a cancer is diagnosed, extensive conferences with one's oncologist are necessary to determine the course of treatment most likely to eradicate the cancer. Many factors (age, health, type and stage of cancer among others) will be discussed to help you and your doctor decide on the best course of treatment. Even with the best doctors and correct course of treatment, it is possible to have a recurrence of breast cancer, or even develop a second cancer (colon, stomach, uterine, ovarian, etc). One of the best ways to avoid breast cancer is to stay healthy and pay attention to your health by scheduling regular exams. Extensive research is also being conducted. Maybe soon we can rid the world of this terrible disease.