Breast cancer

Breast cancer is the most common cancer in women, being responsible for almost 20 percent of all cancer deaths in women. It ranks second after lung cancer. Roughly 180,000 women are diagnosed with this disease each year, of which 44,000 will die. With increased awareness and increased use of routine mammograms, more women are diagnosed in the earlier stages of this disease, at which time a cure may be possible. For every 100 women, one man is diagnosed with this disease. The disease is more common in women after age 40. It is also more frequent in women of a higher social-economic class.

Causes and risk factors:

Many factors are known to increase the risk of development of breast cancer:

• Genetic predisposition. A few genetic markers have been linked to development of breast cancer.

• History of breast cancer in a first-degree relative

• History of breast cancer in the same patient, in the opposite breast

• Onset of menstruation in early ages

• Late onset of menopause

• Radiation exposure

• Heavy alcohol consumption

• High fat diet

• Obesity

• First pregnancy after age of 30

• Very tall women

Signs and Symptoms:

More women are now being diagnosed by means of a routine mammogram. Others may feel a lump in the breast or notice abnormal discharge from the nipple, or feel thickness or swelling of the skin or nipple. It is frequently diagnosed by a physician during a routine breast examination.

Any lump in the breast and any mammogram abnormality must be studied very carefully. If any degree of suspicion exists as to the nature of the lump, it should be

biopsied. This may be accomplished by Fine Needle Aspiration, a Core Biopsy or Surgical Biopsy.

Staging:

What is the extent of cancer? How advanced is the cancer? What areas of the body are involved? Has the cancer spread to lymph glands, bones, liver, etc.? Resolving these questions is referred to as staging. These are the most important questions to be answered prior to an effective treatment plan being implemented. The answers to these questions should be obtained by a minimal amount of tests and by least invasive methods. Sentinel Node biopsy is a newer method of evaluating lymph node involvement.

Once the diagnosis is established, the next step is determination of the extent of the disease and appropriate treatment planning. A cancer specialist should be engaged to plan for proper testing and studies. A chest x-ray is always a routine part of workup. Further tests will depend on the findings by the physician and his intuition. Other x-rays, CT scans, Bone scan, MRI study, etc. are performed to determine the extent of the cancer.

Treatment:

Treatment of breast cancer is discussed in a different page. Please click here to go there.

Pattern of Spread, Natural History

If breast cancer is left untreated, or fails to respond to treatment, it will progress in a gradual fashion and may involve any of the following areas or cause any of the following complications:

• Lymph glands

• Bones

• Lungs

• Liver

• Brain

• Pleural cavity

• Pericardial Effusion

• High Calcium levels

• Spinal Cord Compression

Pathological Types

Breast cancer's appearance under microscope is categorized into two major groups with two totally different behavior patterns:

Invasive

breast cancer refers to the most common type of breast cancer, which we have already discussed.

• Infiltrating ducal carcinoma - Most breast cancers are of this type.

• Infiltrating lobular carcinoma- 10% of breast cancers are of this type.

Non-Invasive

breast cancers are significantly less aggressive than regular breast cancers and there are two distinct diseases in this category:

• Lobular carcinoma in situ. This condition is considered to be a marker for increased breast cancer risk. Treatment of this condition is rather controversial and any of the following may be advisable:

  • Follow-up only

  • Participation in a clinical trial

  • Mastectomy or removal of both breasts

• Ductal carcinoma in situ. This condition is being seen more frequently with the increased use of mammograms. The average age of patients with this condition is 55-65 and patients may notice a lump in their breast. There is 30-50% chance of developing invasive breast cancer following this diagnosis. Lumpectomy may be quite adequate in small size tumors, or there might be an indication for breast radiation or using Tamoxifen.

Prognosis

The outcome of breast cancer depends on a variety of factors.

Good prognostic factors are:

• Older age

• Earlier stage of the disease

• Node negative disease

• Estrogen and progesterone receptor positive disease

• Favorable laboratory study of cancer tissue

Poor prognostic factors are;

• Younger age

• Later stage of the disease

• Distant spread of the cancer

• Node positive disease

• Estrogen and progesterone receptor negative disease

• Unfavorable laboratory study of cancer tissue

Family Member issues

First degree relatives of all patients with this cancer should be monitored carefully.  This cancer has a tendency to run in families and be associated with genetic abnormalities, for which they can be tested for.  Family members should consider genetic counseling to determine their risk and possible work up for early detection of the cancer. 

A short review on Breast Cancer