Breast cancer begins in the lobules or ducts and is categorized as being either ‘in situ’ or invasive. In situ cancer has not grown beyond the origination point. Invasive cancer is cancer that has grown beyond the point of origin into other areas of the breast or body.
Breast Cancer Statistics
It is estimated that 1 in 8 women in the United States will develop breast cancer during their lives. White women are more likely to develop breast cancer but the mortality rate is higher among African American women. Trends for newly diagnosed cases of breast cancer have remained stable since 2002; however death rates have been falling by almost 2% per year. The latest data available from the National Cancer Institute indicates that the 5 year breast cancer survival rate is now almost 90%.
There is estimated to be 235,000 new cases of cancer diagnosed this year with 2,360 of these being male.
Other symptoms of breast cancer are:
- Sudden discharge from the nipple
- Itchy, scaly rash on the nipple
- Swelling or redness
- Change in shape or size of a breast
- Puckering or dimpling of the skin on the breast
- Pain in one spot that does not go away
These symptoms can be due to other factors but must be thoroughly checked out by a breast specialist to properly identify the source of these symptoms.
The strongest risk factors for breast cancer are one’s sex and one’s age. Breast cancer is 200 times more common in women than men and 400 times more common in women age 50 than women age 20.
Some women do have additional risks:
- Caucasian and Jewish women have the highest incidence of breast cancer;
- Women of color have a lower rate of breast cancer but a higher mortality;
- Asian women have the lowest risk of breast cancer.
It is interesting to note that genetics and environment are connected in the development of breast cancer. Once Asian women move to the United States, their risk of getting breast cancer rises for every year of residence.
Women with a history of breast cancer have a lifetime increased risk of getting another breast cancer. Due to this increased risk, these women must continue to be monitored closely for the duration of their lives for early signs of a recurring or new cancer life. Five year survival history is very encouraging but not completely foolproof. Women with a history of breast cancer may develop a second cancer or a recurrence of the original cancer after more than 20 years. It is vital to know your risks so that you can modify what you can, and monitor what you cannot.
BRCA 1 and BRCA 2 Genes
Although less than 10 percent of women with breast cancer have this gene, there is an extremely high risk of developing breast, ovarian, colon, lung and pancreatic cancers for those who test positive for these genes. As unwelcome as this result is, knowledge of this risk factor opens the door to the various preventative treatment options available. Aggressive surveillance in the form of diagnostic imaging, physical exam and blood work is indicated. Another preventative treatment is the use of Tamoxifen anti-hormone drug therapy, which controls hormone receptors in cells. Surgery may also be indicated to proactively remove the site of a future cancer.
Since the majority of women who get breast cancer do not have the BRCA gene mutation, absence of it does not guarantee that you will not get breast cancer. Discussion with a breast cancer specialist will determine whether or not you should be tested for the mutation and what your treatment options are, should you carry the mutation.
Dense and Cystic Breasts
Nulliparity means a woman has never had children. Pregnancy interrupts the hormone cycle and decreases the risk of breast cancer, particularly if a woman has her children before age 30. Women who have never had children, and to a lesser extent, those who have had children later in life, have a slightly increased risk of developing breast cancer. The younger a woman starts menstruating and the older a woman enters into menopause is relative to the risk of developing breast cancer. The longer one is exposed to hormones increases the risk of breast cancer. Hormones clearly play a role.
Regular moderate EXERCISE (30 minutes 3 times a week) has been shown to decrease the risk of breast cancer independent of weight loss.
Normal breast tissue contains estrogen and progesterone hormone receptors. The closer a breast cancer resembles normal breast tissue, the more favorable and less aggressive that tumor is. All breast cancers are evaluated for estrogen and progesterone receptors. Tumors are also evaluated for the number of cells that are dividing (Ki67) and how much they look like normal breast tissue. The lower the Ki67, and the fewer cells dividing, the better.
“HER2/neu” is a gene found in a small percentage of breast cancers (10-20%) that indicates an aggressive cancer which generally always requires intravenous chemo therapy in addition to a specific anti-HER2/neu drug like Herceptin.
The pathologist also looks for vascular (blood vessels) and lymphatic “invasion” in which tumor cells are traveling outside the mass. Absence of vascular or lymphatic invasion is favorable.
After lumpectomy or mastectomy, MARGINS are included in the pathology report confirming whether or not all the cancer has been removed. Lymph nodes are analyzed for cancer involvement as part of the analysis.
All this information is included in the pathology reports. Some may be on the biopsy report with the remainder on the final surgical report. Ask your surgeon or oncologist to review this information with you so you have an understanding of your personal tumor characteristics. This will help you better understand and participate in the decisions regarding your breast cancer treatment.