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Tell me more about Breast Cancer

Who's at risk for breast cancer, and what are the major risk factors? Get ready for this one ladies; simply being female, and getting older puts you at the greatest risk for breast cancer. Did you know that only 15% of all cases occur in families with a history of breast carcinoma? That leaves 85% to occur within those of us without any family history of breast cancer, (still feel confident that you don't need your recommended mammogram?!) Nevertheless, if you have a family history, especially in a first-degree relative, (mom, daughter, or sister), and they were premenopausal, you are at significantly increased risk. If you personally have been diagnosed with breast cancer, you are more likely to be diagnosed again before someone else in the general population. Some of the more minor risks associated with breast cancer include: young age of onset of menses/ periods; late age of menopause; bearing your first child after the age of 30; being "over-fat", (this means too high a percentage of body fat, not simply being overweight); excessive alcohol use…

What are some of the signs you should be looking for? A painless lump is the number one physical presentation. However, sometimes a cancer does not read the textbook on how it should present, and so occasionally there will be a lump with pain, or simply new pain without any other accompanying sign or symptom. If there is new-onset nipple inversion, i.e. the nipple is drawn inwards, and it used to stick out, seek medical attention. Look in the mirror for: dimpling; contour changes away from the usual gently rounded- spherical appearance; pink to red skin; swelling; or thickened skin that looks like an orange peel, (this is usually accompanied by heat.) Also, if there is new, spontaneous nipple discharge, and you are not nursing, inform your doctor or breast center.

Currently, we do not know what causes breast cancer therefore we cannot prevent it. However, if we find it early, essentially there is a cure. The latest statistic is that if a cancer is detected when it is under one centimeter in size, (just under 1/2 of inch), there is a 95% survival rate 24 years later. *

Breast cancer is not a single entity. There are over 25 different types! Also, there are very few "pure" breast cancers; by that I mean that most of these tumors actually have a portion of their cells that are of another type. The most common is Invasive Ductal Carcinoma, or Ductal Carcinoma. The most evasive one on the mammogram that now accounts for almost 20% of cases is called Invasive Lobular Carcinoma. (It is not uncommon to have a tumor that is Ducto-Lobular, i.e. contains components of both, like we just talked about.) There are also three different "Grades", or degrees of how "aggressive" the cells look under the microscope. Grade I is the least aggressive, and Grade III is the most aggressive. All kinds of factors play a role in "prognosis," (or "future predictability,") and treatment. The doctors have to take into account the tumor size, type, grade, whether axillary lymph nodes are involved, and secondary factors such as tumor markers/receptors… Certain tumor types are more commonly found bilaterally, or in the other breast as well. Did you know that 60% of breast cancers are multifocal within the breasts? This means that in the majority of cases, there is more than one. What are the implications? Make your doctor or breast center keep searching with different modalities such as ultrasound, or MRI to make sure that there is only one cancer if you or a loved one are diagnosed. Knowing how many cancers are present, and their locations makes a difference in the optimum type of treatment that is available.

Another early type of breast cancer that you may have heard about is DCIS, or Ductal Carcinoma Insitu. This represents a collection of breast cancer cells that have "not invaded", and are staying right where they have formed. There are also three different grades of DCIS, and commonly with an invasive cancer, you will find accompanying DCIS of the same grade. DCIS is also frequently seen by itself. The main treatment for DCIS as well as the invasive cancers is surgery. (In certain instances of very advanced, large cancers, chemotherapy may be administered first, to shrink the tumor/s so that surgery can be safely performed.) DCIS is usually present before there is an invasive cancer, so the idea is that when you find it, you want to remove it before it can become invasive. (No one knows the time line from whence DCIS will become invasive cancer.)

LCIS, or Lobular Carcinoma Insitu is another entity that currently is not felt to represent cancer cells, but is a red flag for greatly increased cancer risk. People with this diagnosis should be carefully observed, and be religious about their mammograms.

What can you do with all of this information? Please, after the age of 30, do monthly self-breast examinations, and have your doctor or a nurse do yearly clinical breast exams. In addition to this, go for your "YEARLY" mammogram after the age of 40. The mammogram can often find cancers and DCIS years before they can be felt. (However, there are 10 - 15% of cancers that are not well seen on the mammogram, and that is where the physical examination comes into play, or for fast growing cancers that develop in the space between the mammograms.) Screening mammography has been proven to reduce breast cancer deaths by over 30%. Remember, you hold the key to possible cure, and that is "early detection".

*The only exception to this is if "casting type" calcifications are also found in the tumor.

Click here to view an interview about the Breast Health Center and why you need to get a mammogram!

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