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Breast Cancer

Putting It All Together: Breast Cancer

Tuesday, March 20, 2012 - 10:55

Contributing Author: Guy Slowik FRCS

Here is a summary of the important facts and information related to breast cancer.

  • Breast cancer is the most common cancer among women in the United States. Recent findings indicate that an American woman has a one in eight chance of developing breast cancer during her lifetime.
  • Most breast lumps are not cancerous; they are benign. Most common are fibrocystic changes, in which scar-like (fibrous) tissue combines with fluid-filled sacs called cysts to form lumps. Other benign breast tumors include fibroadenmonas and intraductal papillomas. These tumors do not spread outside the breast to other organs.
  • A breast tumor that can spread to surrounding tissues or organs is considered malignant, or cancerous.
  • There are two major types of breast cancer: lobular carcinoma and ductal carcinoma.
  • Breast cancers can be either invasive (spreading) or noninvasive (generally known as 'in situ' - tumors that are confined to the original site).
  • Paget's disease (cancer of the areola and nipple) and inflammatory carcinoma (a highly malignant cancer) account for nearly all remaining types of breast cancer.
  • Breast cancer cells may break away, travel, and grow within other parts of the body. This process is known as metastasis.
  • If breast cancer is detected at an early stage - for example, before metastasis - it usually can be cured; however, as the disease progresses, there is less possibility of an effective treatment.
  • The exact cause or causes of breast cancer remain unknown. Yet scientists have identified a number of risk factors that increase a person's chance of getting this disease, such as:
    • age
    • previous breast cancer
    • family history of breast cancer
    • genetic mutations
    • certain benign breast diseases
    • alcohol use
    • radiation exposure
    • hormones
  • Some factors may reduce the risk of breast cancer because they have protective or preventive benefits. They include:
    • regular exercise
    • early pregnancy
    • breast-feeding
  • Staging helps to predict how a person with breast cancer will fare over time - that is, it helps the physician to estimate how long the person will live and the risk of cancer recurrence, or relapse. Correspondingly, staging allows the physician to customize breast cancer treatment. In general, the lower the stage, the better the person's prognosis (expected outcome).
  • The treatment of breast cancer is determined by many factors, such as
    • tumor stage
    • tumor type
    • tumor characteristics
    • the person's general health
    • medical conditions that may influence treatment.
    • After breast cancer has been staged, a comprehensive treatment plan will be developed. The treatment plan typically involves some form of surgery to remove as much of the cancer as possible.
  • In addition to surgery, the treatment plan may call for adjuvant (assisting) therapy such as radiation therapy, chemotherapy, and/or hormone therapy.
  • Other treatments that may be used for aggressive or late-stage breast cancers include high-dose chemotherapy with bone marrow transplantation (BMT) or peripheral stem cell transplantation (PSCT), and immunotherapy.
  • Specific characteristics help to determine the risk of breast cancer recurrence (coming back). These include breast cancer:
    • size
    • estrogen and progesterone (ER/PR) receptor status (presence or absence of hormone 'receptors' [lock-like molecules] in cancer cells)
    • phase (whether or not tumor cells are actively dividing)
    • HER2/neu protein status (presence or absence of a protein found in some aggressive breast cancers)
    • grade (indicator of malignant change in the tumor)
    • ploidy (number of sets of genetic material within tumor cells)
  • A recent trend in surgery for early breast cancer is the use of lumpectomy (a breast-saving procedure in which only the tumorous 'lump' is removed), plus radiation therapy. This method spares the breast and has been found to be as effective a mastectomy (complete removal of the breast).
  • Radiation therapy usually is given after breast-conserving surgery, that is, after lumpectomy or partial mastectomy.
  • Chemotherapy typically is delivered in the form of shots or pills. It usually is given as an adjuvant (assisting therapy) to reduce the chance of cancer recurring after surgery, radiation therapy, or both.
  • Adjuvant chemotherapy, like hormone therapy, typically is started after surgery.
  • Neoadjuvant chemotherapy is given before surgery to shrink the breast tumor and make it easier to remove.
  • 'Combination chemotherapy' - a combination of drugs - often is more effective than a single medication. The following drugs frequently are used together during chemotherapy:
    • cyclophosphamide
    • methotrexate
    • 5-fluorouracil
    • Adriamycin® (doxorubicin)
    • tamoxifen
    • Taxol® (paclitaxel)
  • Hormone therapy for breast cancer is based on the observation that cancer cell growth is sped up by estrogen. 'Antiestrogen' medications like tamoxifen (Nolvadex®) and raloxifene are used to counteract this effect.
  • Tamoxifen is likely to be given if a woman's breast cancer is 'ER/PR positive' - that is, it contains estrogen and progesterone receptors.
  • Immunotherapy – treatment that works via the immune system – usually is begun if standard therapies are no longer effective. A monoclonal antibody (immune system molecule) has been developed to recognize and bind with the HER2/neu protein found on the surface of some breast cancer cells. The medication made from this antibody is known as trastuzumab (Herceptin®).
  • About 30% of women with breast cancer suffer from prolonged anxiety and depression, which are natural responses to the loss of a breast or fear of the disease. 
  • Sexual counseling often is helpful for breast cancer patients and their partners. Important topics include:
    • getting used to nudity versus concealment of surgical scars with a prosthesis (breast form) or lingerie;
    • how to have comfortable sex if the treated breast or arm is tender;
    • how to use lubricants to avoid the vaginal dryness and pain associated with menopause;
    • how to perform sensation-focusing exercises; and
    • verbal and nonverbal ways to communicate sexual preferences.

 

Breast Cancer