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Alternative names:
carcinoma of the breast
Definition:
A malignant form of cancer that develops in breast tissue.
Causes, incidence, and risk factors:
The most common type of breast cancer begins in the lining of the
ducts and is called ductal carcinoma. Another type, called lobular
carcinoma, arises in the lobules. For most types of breast cancer
the cause is unknown.
Recently two genes, BRC1 and BRC2 have been implicated in a familial
type of breast cancer. A number of other predisposing factors have
been identified including obesity, early menarche, and delayed or
absent child bearing. Breast cancer may occur in men as well as
women, but is much more common in women. Statistics show that one in
8 or 9 American women will develop breast cancer at some point in
life, based on full life expectancy.
The risk increases exponentially after age 30. The average age of
women diagnosed with breast cancer is 60 years. In general, the rate
of breast cancer is lower in underdeveloped countries and higher in
more affluent countries (with the exception of Japan where the rate
is quite low). In the U.S., whites (especially those of northern
European descent) have a higher incidence compared to non-whites.
However, the incidence in non-whites, specifically blacks, is
increasing, particularly in women under age 60.
Other risk factors include having a family history of breast cancer,
particularly in mother or siblings; a past medical history of breast
cancer , ovarian cancer, uterine cancer, or colon cancer; early
menarche (start of menstruation before age 12) and/or late menopause
(after age 55); no pregnancies or a first pregnancy after age 30;
and radiation exposure. Post-menopausal estrogen therapy and oral
contraceptive use (such as estrogens and progestin oral
contraceptives) were considered possible risk factors, but the
majority of recent studies do not confirm such risk.
Research suggests that a person's diet may affect the chances of
getting some types of cancer. Breast cancer appears to be more
likely to develop in women whose diet is very high in fat. Older
women who are overweight also seem to have a greater risk. Some
scientists believe that a low-fat diet, eating well-balanced meals
with plenty of fruits and vegetables, and maintaining ideal weight
can lower a woman's risk.
There are also studies that suggest a slightly higher risk of breast
cancer among women who drink alcohol. The risk appears to go up with
the amout of alcohol consumed., so women who drink should do so in
moderation.
The possible link between diet and breast cancer is still under
study.
Prevention:
Most of the associated risk factors cannot be controlled, therefore
eliminating a means of primary prevention. However, secondary
prevention, early detection, and appropriate treatment early in the
disease process, may be promoted through routine breast self-exam
beginning around age 20 and screening mammography after age 40.
Additionally, current research studies are evaluating the
effectiveness of the drug tamoxifen in preventing breast cancer in
women with a family history of the disease. Currently, tamoxifen is
used to treat people with breast cancer.
Symptoms:
- breast lump or breast mass
noted upon breast self exam
à - usually painless, firm to hard,
with irregular borders
- lump or mass in the armpit
- a change in the size or shape
of the breast
- nipple discharge, abnormal
- usually bloody or
clear-to-yellow fluid
- may look like pus
(purulent)
- change in the color or feel of
the skin of the breast, nipple, or areola
- dimpled, puckered, or
scaly
- retraction, "orange peel"
appearance
- redness
- accentuated veins on
breast surface
- eventually (with late
disease) skin ulceration
- change in appearance or
sensation of the nipple
- pulled in (retraction),
enlargement or itching
- breast discomfort on one side
only
- breast enlargement on one side
only
- bone pain
- weight loss
- swelling of arm
- breast pain
- breast development in males
Signs and tests:
An examination by the health care provider can confirm the presence
of breast changes noted by the patient. The doctor can tell a lot
about a lump by carefully feeling (palpation) the lump and the
tissue around it. Benign lumps often feel different from cancerous
ones.
- Mammography may help identify
the breast mass.
- Ultrasonography can show
whether the lump is solid or filled with fluid.
- Thermography may also help
identify the mass.
- Needle aspiration or needle
biopsy of the mass will either yield fluid indicating a cyst, or
it will indicate a solid mass which may or may not be cancer.
- needle biopsy removes
cells directly from the mass for evaluation (can be done in
conjunction with the needle aspiration procedure). The
material removed will be sent to a lab.
- Surgical biobsy removes a
portion of the mass for further evaluation.
- incision biopsy involves
surgical removal of a portion of the mass for evaluation.
- excision biopsy involves
surgical removal of the entire mass for evaluation.
STAGES OF BREAST CANCER (from the
American Joint Committee on Cancer):
- 1.tumor less than 2 cm in
diameter, nodes not involved, no distant metastasis
- 2.tumor less than 5 cm in
diameter, nodes not fixed, no distant metastasis
- 3.tumor greater than 5 cm in
diameter, invading the skin, or attached to the chest wall, or
supraclavicular nodes noted, with no distant metastasis
- 4.tumor with distant
metastasis
This disease may also alter the
results of the following tests:
Treatment:
OVERVIEW:
The choice of initial treatment is based upon the extent and
aggressiveness of the disease. Currently breast cancer is viewed as
a systemic disease that requires both local and systemic treatment.
- Local treatment may include
lumpectomy, mastectomy (partial, total, or radical with axillary
dissection) and radiation therapy -- all directed at the breast
and immediately surrounding tissue.
- Systemic treatment includes
chemotherapy and hormonal therapy, which circulate drugs and
hormones throughout the entire body in an attempt to eliminate
cancer cells that may be present in distant parts of the body.
Most women receive a combination of
treatments including surgery, radiation, chemotherapy, and/or
hormonal therapy. Current recommendations for potentially curable
breast cancer usually suggest that the best primary treatment is
partial mastectomy plus axillary dissection and radiation therapy.
MEDICATIONS:
Chemotherapy may be used as additional, systemic treatment in
patients with curable breast cancer. Hormonal adjunctive therapy
includes the use of antiestrogen drugs (such as tamoxifen), which
may be prescribed for individuals found to have estrogen-dependent
cancers.
SURGERY:
Lumpectomy (surgical removal of the lump) with radiation may be
considered for individuals with stage 1 disease. However, axillary
dissection is still recommended with the surgery.
LIFESTYLE CHANGES:
Support groups:
The stress of illness can often be helped by joining a support group
where members share common experiences and problems. See cancer -
support group.
Expectations (prognosis):
The clinical stage of breast cancer is the best indicator for
prognosis (probable outcome). Five-year survival rates for
individuals with breast cancer who receive appropriate treatment are
approximately:
- 85% for stage 1
- 66% for stage 2
- 41% for stage 3
- 10% for stage 4
When the axillary lymph nodes are
involved, the survival rate drops to approximately 40 to 50% at 5
years and probably less than 25% at 10 years.
Complications:
Even with aggressive and appropriate treatments, breast cancer often
metastasizes to distant sites such as the lungs, liver, and bones.
The local recurrence rate is about 5% after total mastectomy and
axillary dissection when the nodes are found not to be involved. The
local recurrence rate is 25% in those with similar treatment found
to have nodal involvement.
Calling your health care provider:
Call for an appointment with your health care provider if:
- symptoms of breast cancer
occur
- if you are a woman, 40 years
or older, and have not had a baseline mammogram performed
- if you are a woman, 35 years
or older, and have a mother or sister with breast cancer, or a
past medical history of prior breast cancer, uterine cancer,
endometrial cancer, ovarian cancer, or colon cancer
- if you are a woman, 20 years
or older, and are unfamiliar with how to perform a breast
self-examination
Healthcentral
2004
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