Breast Cancer

Breast cancer is the most common form of cancer among women in the United States. It is second only to lung cancer in cancer-related deaths. More than 180,000 women are diagnosed with breast cancer per year. In the United States, one out of nine women will develop breast cancer during her lifetime.

The encouraging news is that breast cancer is being detected earlier, while the tumor is very small. The majority of new breast cancers show no signs that the cancer has spread beyond the breast. With prompt treatment, the outlook for women with breast cancer is good. When cancer is detected early, treatment not only saves your life but also your breast.

Breast cancer occurs when certain cells in the breast become cancerous and form a tumor. Breast tumors usually appear in the milk-producing lobules or in the milk ducts that lead to the nipple. Tumors in the breast typically grow very slowly and are undetectable until discovered by mammogram or by feeling a lump.

There are important distinctions in breast cancer and related conditions:

Invasive cancer. Abnormal cells break out of the lobules or ducts and spread into the breast tissue itself. These cells then have the potential to enter into the lymphatics or bloodstream and to spread elsewhere in the body.
Carcinoma in situ, meaning "in place." Abnormal cells are located only inside the lobules or ducts and have not spread to surrounding breast tissue. Often, these cells are precancerous and indicate increased risk of invasive cancer.
Ductal carcinoma in situ. This indicates that an excessive number of cells are growing inside the normally open-spaced milk ducts. This condition is also considered precancerous, and one that increases risk of invasive cancer.
Lobular carcinoma in situ. Sometimes referred to as lobular neoplasia in situ, this condition occurs when abnormal cells proliferate in the normally hollow lobules. Cells are not considered precancerous but the condition does put the patient at risk for invasive cancer.
Hyperplasia. When extra but normal-looking cells appear in the lobules or ducts, the condition is called hyperplasia. Although hyperplasia is noncancerous, the risk for breast cancer doubles. Atypical hyperplasia refers to a condition when there are too many normal and abnormal cells mixed together. The condition is not considered breast cancer, but the possibility for getting the disease is three to five times higher than normal.
Cysts. Not cancerous, cysts are fluid-filled pouches in the breast that most often cannot be felt. A large cyst may feel like a lump.
Fibroadenomas. Found mostly in younger women, these benign "lumps" pose no cancer risk. They are sometimes removed in older women to rule out the possibility of a malignant tumor.

Risk Factors

While many researchers are engaged in unraveling the mysteries of breast cancer, the cause is not yet known. However, certain risk factors are linked to the disease.

Gender and age. Though there are rare incidences of the disease in men, just being a female puts an individual at risk. The older the woman, the greater the risk. Women over 50 account for 75% of all cases.
Family history. Women whose mother, sisters or daughter have had the disease are at double the risk. Having had cancer in one breast increases the chance of getting cancer in the other breast.
Family history. Women whose mother, sisters or daughter have had the disease are at double the risk. Having had cancer in one breast increases the chance of getting cancer in the other breast.
Race factors. White women are somewhat more likely than African-American women to get breast cancer. Death rates among African-American women with breast cancer are higher than with white women, mostly because African American women tend to be diagnosed at a later stage of cancer. Women of Asian, Hispanic and American Indian descent have a lower risk by comparison.
Menstrual history. Women who had their first period before age 12 or who went through menopause after age 50 are at slightly more risk.
Childbirth history. Having never given birth or giving birth after age 30 increases the risk of breast cancer.
Birth control and hormone replacement therapy. There appears to be a slightly greater risk for the disease for women who have used birth control pills as well as for those using hormones to relieve menopause symptoms.
Diet, alcohol, exercise. A high-fat, low-fiber diet and carrying too much weight have been shown to increase the chances of several kinds of cancers. Women who have two to five alcoholic beverages a day are 1.5 times more likely to get breast cancer than those who do not drink alcohol. Regarding exercise, research is ongoing but early indications are that even a small amount can cut the risk.

Symptoms and Diagnosis

Symptoms of breast cancer include a lump or thickening that does not go away, or changes in texture; swelling, dimpling or puckering of the breast; irritated skin; nipple pain or tenderness, and new nipple inversion.

In diagnosing breast cancer, specialists review results from various testing procedures, including mammogram and ultrasound (which helps determine if masses are cancerous). Special X-rays called ductograms can examine the cause of nipple discharge. Various imaging procedures, such as CT, MRI, PET and bone scans, may also provide clues.

The most reliable answers are derived through biopsy, a procedure in which cells are taken from the suspicious area for close examination under the microscope.

Click here for more information on diagnostic techniques.

Treatment

Oncologists consider age, general health, type of cancer and stage of cancer when recommending a course of treatment. Options may include:

Lumpectomy. Surgical removal of the tumor only.
Total mastectomy. Surgical removal of the entire breast.
Modified radical mastectomy. Surgical removal of the entire breast and lymph nodes under the arm.
Axillary lymph node dissection. Lymph nodes from the armpit are removed.
Sentinel node biopsy. Only the first one or two lymph node(s) to which the cancer would have spread is examined. If cancer-free, more invasive surgery is not needed. This is a relatively new procedure.
Breast reconstruction. This elective procedure may be done during the first surgery or at a later time. A woman may decide to wear an external breast prosthesis rather than have breast reconstruction.
Chemotherapy. Powerful drugs are injected into the bloodstream to shrink tumors, kill cancer cells still remaining after surgery, and prevent the disease from coming back. High-dose chemotherapy used with blood stem cell transplantation is sometimes used for patients at advanced stages of the disease.
Radiation. High-energy X-rays are aimed at the breast after surgery to rid the area of any remaining cancer cells.
Hormone therapy. Drugs such as Tamoxifen are given to counteract production of estrogen and progesterone -- sex hormones which can cause cancerous cells to grow and spread.

Most side effects resulting from chemotherapy and radiation are temporary, and in recent years medical experts have developed ways to help patients be more comfortable as they proceed through treatment regimens.

Click here for more information on breast cancer treatments.

Resources at Cedars-Sinai

For more information on women's health matters, any of the programs and services listed, or a referral to a Cedars-Sinai physician or program, call 1-800-CEDARS-1 (1-800-233-2771)