Since the town is painted pink this month for breast cancer awareness, I decided to make it the topic of this month’s MedBlog. As a primary care physician (and a female), it is a topic that I have a particular interest in and discuss with my patients often. Despite the fantastic efforts of advocacy groups such as the Komen Foundation and The American Cancer Society there remains a lot of confusion regarding screening recommendations and many “untruths” surrounding the diagnosis of breast cancer. I would like to go over the basics and dispel some of the more common myths in this post.
What is breast cancer?
Let me start by reviewing some of the basics of cancer. There are exceptions to my descriptions below and I provide some links at the bottom of this article if anyone is interested a more detailed explanation. The human body is made of trillions of cells which come together to form tissues and organs. Everything that a cell does is based on a blueprint or genetic code (DNA) which can be damaged over time by errors during cell reproduction (when the cell is making copies of itself) or by external factors (like certain viruses, chemicals and so on). Some cancers are also inherited, meaning individuals were born with the errors in their DNA. Our cells are designed to either repair any damaged DNA or die off. A cancer cell does not follow the normal rules of the cell cycle and continues to duplicate itself, in many cases eventually forming a tumor. Not all tumors are cancerous but the ones given this designation have the potential to invade surrounding tissue or metastasize (spread to other distant parts of the body). One of the complicated issues surrounding cancer screening and treatment is that these cells vary widely in both their potential to grow and spread and in how rapidly they are able to do so. We will go over this in more detail in an upcoming blog on prostate cancer.
There are different types of breast cancers that are labeled based on the kind of tissue that they arise from. Carcinomas are what we find most often in the breast and derive from cells that form the lining of the milk ducts or that begin in the secretory glands or lobules. Ductal and lobular carcinomas can be further designated “in situ” meaning the abnormal cells have not begun to spread to surrounding tissue. Unfortunately the most common forms of breast cancer diagnosed have already begun to spread and are called “invasive” or “infiltrating” carcinomas. Inflammatory breast cancer is a more rare form which usually presents with skin changes that mimic infection (mastitis).
Check out this graphic which dispels some common myths about breast cancer.
(New Graphic Coming soon.)
How is breast cancer diagnosed?
Breast cancer can be discovered when a lump is found by a woman or her doctor. Often a mammogram and ultrasound are ordered at that time. Many cancers are discovered during routine screening mammograms. A breast biopsy may be needed if the imaging appears abnormal. This is usually performed by a radiologist under x-ray guidance and the sample is evaluated by a pathologist to determine if there are any atypical cells indicative of cancer.
If cancer cells are found, the sample will be checked for certain proteins – HER2 and hormone receptors (estrogen and progesterone). This will help the oncologist to determine how best to treat the cancer. It is also important to determine how much of the breast has been affected and if any distant tissues including the lymph nodes in the armpit (axillary lymph nodes) have any evidence of cancer invasion. This process is called staging.
What is the treatment for breast cancer?
The treatment for breast cancer varies widely depending on the patient’s pathological results and will generally include surgical removal of the cancerous tissue (mastectomy or lumpectomy) and possibly chemotherapy, radiation and/or endocrine therapy (if the cancer is hormone-sensitive). This decision is usually made by the patient, her breast surgeon/plastic surgeon and her oncologist.
What can I do to reduce my risk of developing breast cancer?
About 200,000 women in the United States are diagnosed with breast cancer each year. However, not all women have the same risk of developing breast cancer during their lifetime. Studies have shown that certain factors, called risk factors, increase the likelihood that a woman will develop breast cancer. Many of these risk factors are not reversible, but some can be modified.
Just because one may have risk factors does not mean that it is inevitable that they will acquire breast cancer. Instead, assessing one’s risk should help the patient and her doctor determine what screening is needed and how often to perform these screening measures. Breast cancer can also occur in women with no risk factors.
The three strongest risk factors for breast cancer are increasing age, family history and personal history of breast cancer. Other less prominent risk factors are dense breasts, radiation exposure (especially in the chest), biopsy abnormalities, menarche (first period) at or before 11 yrs old, menopause at age 55 yrs or older, women who have never given birth, women who have their first child after age 30, women who have never breastfed, obesity, hormone replacement therapy, and regular alcohol consumption.
The most important thing to remember from this article is that EARLY DETECTION IS KEY. Even if you cannot modify your risk factors, you can still make sure that you follow the screening guidelines so that any abnormality is caught early. Most experts recommend annual breast exams by your doctor and annual mammograms after 50. Screening in the 40’s is controversial currently and you should talk to your doctor about your individual risk factors so that you can make an informed decision about how often to get a mammogram. We no longer recommend monthly self exams but more “breast self awareness”. Meaning, be familiar with what your breasts feel like. Understand that the breast tissue may change with one’s menstrual cycle and if a lump or change in your breast (change in skin color or texture, nipple discharge or change in appearance of nipple) persists for more than 2 weeks, see your doctor.
Here are some additional resources that provide more detail regarding breast cancer and breast health:
• The American Cancer Society has a fantastic website with extensive resources regarding breast and many other cancers.
• US Preventative Services Task Force statement on breast cancer screening recommendations (updated in 12/09).
• Resources for those in Lubbock area who cannot afford a mammogram.
Look for my next post which will be a video blog. This first entry will be of me answering your health questions. Send me an email of your question or topic request at firstname.lastname@example.org. No question is off limits and requests are kept confidential.