Christopher Dolinsky, MD and Christine Hill-Kayser, MD
Affiliation: Abramson Cancer Center of the University of Pennsylvania
What is the breast?
The breast is a collection of glands and fatty tissue that lies between the skin and the chest wall.
The glands inside the breast produce milk after a woman has a baby.
Each gland is also called a lobule, and many lobules make up a lobe.
There are 15 to 20 lobes in each breast.
The milk gets to the nipple from the glands by way of tubes called ducts.
The glands and ducts get bigger when a breast is filled with milk,
but the tissue that is most responsible for the size and shape the breast is the fatty tissue.
There are also blood vessels and lymph vessels in the breast.
Lymph is a clear liquid waste product that gets drained out of the breast into lymph nodes.
Lymph nodes are small, pea-sized pieces of tissue that filter and clean the lymph.
Most lymph nodes that drain the breast are under the arm in what is called the axilla.
What is breast cancer?
Collections of cells that are growing abnormally or without control are called tumors.
Tumors that do not have the ability to spread throughout the body may be referred to as“benign” and are not thought of as cancerous.
Tumors that have the ability to grow into other tissues or spread to distant parts of the body are referred to as “malignant.”
Malignant tumors within the breast are called “breast cancer”.
Theoretically, any of the types of tissue in the breast can form a cancer,
cancer cells are most likely to develop from either the ducts or the glands.
These tumors may be referred to as “invasive ductal carcinoma”
(cancer cells developing from ducts), or “invasive lobular carcinoma”(cancer cells developing from lobes).
Sometimes, precancerous cells may be found within breast tissue,
and are referred to as ductal carcinoma in-situ (DCIS) or lobular carcinoma in-situ (LCIS).
DCIS and LCIS are diseases in which cancerous cells are present within breast tissue,
but are not able to spread or invade other tissues. DCIS represents about 20% of all breast cancers.
Because DCIS cells may become capable of invading breast tissue,
treatment for DCIS is usually recommended. In contrast, treatment is usually not needed for LCIS.
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What are the signs of breast cancer?
Unfortunately, the early stages of breast cancer may not have any symptoms.
This is why it is important to follow screening recommendations.
As a tumor grows in size, it can produce a variety of symptoms including:
* lump or thickening in the breast or underarm
* change in size or shape of the breast
* nipple discharge or nipple turning inward
* redness or scaling of the skin or nipple
* ridges or pitting of the breast skin
These symptoms do not always signify the presence of breast cancer,
but they should always be evaluated immediately by a healthcare professional.
Am I at risk for breast cancer?
Breast cancer is the most common malignancy affecting women in North America and Europe.
Close to 200,000 cases of breast cancer were diagnosed in the United States in 2001.
Breast cancer is the second leading cause of cancer death in American women behind lung cancer.
The lifetime risk of any particular woman getting breast cancer is about 1 in 8 although
the lifetime risk of dying from breast cancer is much lower at 1 in 28.
Men are also at risk for development of breast cancer,
although this risk is much lower than it is for women.
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The most important risk factor for development of breast cancer is increasing age.
As any woman ages, her risk of breast cancer increases.
Risk is also affected by the age when a woman begins menstruating (younger age may increase risk),
and her age at her first pregnancy(older age may increase risk).
Use of exogenous estrogens, sometimes in the form of hormone replacement treatment (HRT) may increase breast cancer risk,
but use of oral contraceptives most likely does not increase risk.
Family history is very important in determining breast cancer risk.
Any woman with a family history of breast cancer will be at increased risk for developing breast cancer herself.
Furthermore, known genetic mutations that increase risk of breast cancer are present in some families;
these include mutations in the genes BRCA1 and BRCA2.
Between 3% to 10% of breast cancers may be related to changes in one of the BRCA genes.
Some factors associated with breast cancer risk can be controlled by a woman herself.
Use of hormone replacement therapy (HRT), drinking more than 5 alcoholic drinks/ week,
being overweight, and being inactive may all contribute to breast cancer risk.
These are called modifiable risk factors.It is important to remember that even someone without
any risk factors can still get breast cancer.
Proper screening and early detection are our best weapons in reducing the mortality associated with this disease.
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How can I prevent breast cancer?
The most important risk factors for the development of breast cancer, such as age and family history,
cannot be controlled by the individual. Some risk factors may be in a woman’s control; however.
These include things like avoiding long-term hormone replacement therapy, having children before age 30,
breastfeeding, avoiding weight gain through exercise and proper diet,
and limiting alcohol consumption to 1 drink a day or less.
For women already at very high risk due to family history,
risk of developing breast cancer can be reduced by about 50% by taking a drug called Tamoxifen for five years.
Tamoxifen has some common side effects (like hot flashes and vaginal discharge),
which are not serious and some uncommon side effects (like blood clots, pulmonary embolus, stroke,
and uterine cancer) which are life threatening. Tamoxifen isn't widely used for prevention,
but may be useful in some cases. Use of Tamoxifen for prophylactic reasons should be considered carefully
by an individual and her doctor, as its use is very individualized.
Secret from we:
What screening tests are available?
The earlier that a breast cancer is detected, the more likely it is that treatment can be curable.
For this reason, we screen for breast cancer using mammograms, clinical breast exams, and breast self-exams.
Screening mammograms are simply x-rays of the breasts.
Each breast is placed between two plates for a few seconds while the x-rays are taken.
If something appears abnormal, or better views are needed,
magnified views or specially angled films are taken during the mammogram.
Mammograms often detect tumors before they can be felt and they can also
identify tiny specks of calcium that could be an early sign of cancer.
Regular screening mammograms can decrease the mortality of breast cancer by 30%.
The majority of breast cancers are associated with abnormal mammographic findings.
Woman should get a yearly mammogram starting at age 40 (although some groups recommend starting at 50),
and women with a genetic mutation that increases their risk or a strong
family history may want to begin even earlier. Many centers are now making use of digital mammograms,
which may be more sensitive than conventional mammography.
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Between the ages of 20 and 39, every woman should have a clinical breast exam every 3 years;
and after age 40 every woman should have a clinical breast exam done each year.
A clinical breast exam is an exam done by a health professional to feel for lumps and
look for changes in the size or shape of the breasts. During the clinical breast exam,
you can learn how to do a breast self-exam. Every woman should do a self breast exam once a month,
about a week after her period ends. About 15% of tumors are felt but cannot be seen by regular mammographic screening.
What are the treatments for breast cancer?
Surgery
Chemotherapy
Radiotherapy
Hormonal Therapy
Biologic Therapy
Replacement Therapy
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Clinical trials are extremely important in furthering our knowledge of this disease.
It is though clinical trials that we know what we do today, and many exciting new therapies are currently being tested.
Talk to your doctor about participating in clinical trials in your area.
This article is meant to give you a better understanding of breast cancer.
Use this knowledge when meeting with your physician, making treatment decisions,
and continuing your search for information. You can learn more about breast cancer
on OncoLink through the related links mentioned in this article.
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