Breast cancer is the most common cancer among women, after nonmelanoma skin cancer. Over the past 50 years, the number of women diagnosed with the disease has increased each year. Today, approximately 1 in almost every 8 women (13.4%) will develop breast cancer in her lifetime. Breast cancer is the second-leading cause of cancer death in women after lung cancer — and is the leading cause of cancer death among women ages 35 to 54. The American Cancer Society estimates that in 2005, approximately 211,240 women will be diagnosed with invasive breast cancer and approximately 40,410 will die. Although these numbers may sound frightening, research reveals that the mortality rate could decrease by 30% if all women age 50 and older who need a mammogram had one.
As a woman I firmly believe that we cannot wait until the doctors diagnose us with a frightening disease, such as breast cancer and hope for a miracle cure. It is up to each individual to educate themselves, understand what breast cancer is, how it is caused and how we can help ourselves, so the chances of getting breast cancer is increasing low.
How does breast cancer begin?
First, I would like to explain to you how breast cancer begins. The cells in our breasts normally reproduce only when new cells are needed. Sometimes, cells in a part of the body grow and reproduce out of control, which creates a mass of tissue called a tumor. If the cells that are growing out of control are normal cells, the tumor is called benign which means not cancerous. If however, the cells that are growing out of control are abnormal and they do not function like the body’s normal cells, the tumor is called malignant which means the tumor is cancerous.
Cancers are named after the part of the body from which they originate. Breast cancer originates in the breast tissue. Like other cancers, breast cancer can infect and grow into the tissue surrounding the breast. It can also travel to other parts of the body and form new tumors, a process called metastasis.
The medical field is still unsure what causes breast cancer; they do know that certain risk factors may put you at higher risk of developing it. A person’s age, genetic factors, personal health history and diet all contribute to breast cancer.
The Risk Factors:
Reasonably higher risk
Getting older. Your risk for breast cancer increases as you age. About 77% of women diagnosed with breast cancer each year are over age 50, and almost half are age 65 and older. Consider this: In women 40 to 49 years of age, there is a one in 68 risk of developing breast cancer. In the 50 to 59 age group, that risk increases to one in 37.
Direct family history. Having a mother, sister or daughter (”first degree” relative) who has breast cancer puts you at higher risk for the disease. The risk is even greater if your relative developed breast cancer before menopause and had cancer in both breasts. Having one first-degree relative with breast cancer approximately doubles a woman’s risk, and having two first-degree relatives increases her risk 5-fold. Having a male blood relative with breast cancer will also increase a woman’s risk of the disease.
Genetics. Carriers of alterations in either of two familial breast cancer genes called BRCA1 or BRCA2 are at higher risk. Women with an inherited alteration in either of these genes have up to an 80% chance of developing breast cancer in their lifetime.
Breast lesions. A previous breast biopsy result of atypical hyperplasia (lobular or ductal) increases a woman’s breast cancer risk by 4 to 5 times.
Somewhat higher risk
Distant family history. This refers to breast cancer in more distant relatives such as aunts, grandmothers and cousins.
Previous abnormal breast biopsy. Women with earlier biopsies showing any of the following have a slight increased risk: fibroadenomas with complex features, hyperplasia without atypia, sclerosing adenosis and solitary papilloma.
Age at childbirth. Having your first child after age 30 or never having children puts you at higher risk.
Early menstruation. Your risk increases if you got your period before age 12.
Late menopause. If you begin menopause after age 55, your risk increases.
Weight. Being overweight (especially in the waist), with excess caloric and fat intake, increases your risk, especially after menopause.
Excessive radiation. This is especially true for women who were given radiation for postpartum mastitis, received prolonged fluoroscopic X-rays for tuberculosis or who were exposed to a large amount of radiation before age 30 — usually as treatment for cancers such as lymphoma.
Other cancer in the family. A family history of cancer of the ovaries, cervix, uterus or colon increases your risk.
Heritage. Female descendents of Eastern and Central European Jews (Ashkenazi) are at increased risk.
Alcohol. Use of alcohol is linked to increased risk of developing breast cancer. Compared with nondrinkers, women who consume one alcoholic drink a day have a very small increase in risk, and those who have 2 to 5 drinks daily, have about 1.5 times the risk of women who drink no alcohol. Alcohol is also known to increase the risk of developing cancers of the mouth, throat, and esophagus.
Race. Caucasian women are at a slightly higher risk of developing breast cancer than are African-American, Asian, Hispanic and Native American women.
Hormone Replacement Therapy (HRT). Long term use of combined estrogen and progesterone increases the risk of breast cancer. This risk seems to return to that of the general population after discontinuing them for 5 years or more.
Low risk
Pregnancy before age 18.
Early onset of menopause.
Surgical removal of the ovaries before age 37.
Factors not related to breast cancer
Fibrocystic breast changes.
Multiple pregnancies.
Coffee or caffeine intake.
Antiperspirants.
Underwire bras.
Abortion or miscarriage.
Breast implants.
Only 5-10% of breast cancers occur in women who developed cancer because it is in their family heritage. Most women who get cancer have no direct family history of the disease. The risk for developing breast cancer increases as a woman get older.
THE WARNING SIGNS
The warning signs of breast cancer include:
Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
A mass or lump, which may feel as small as a pea.
A change in the size, shape or contour of the breast.
A blood-stained or clear fluid discharge from the nipple.
A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly or inflamed).
Redness of the skin on the breast or nipple.
An area that is distinctly different from any other area on either breast.
A marble-like hardened area under the skin.
These changes may be found when performing monthly breast self-exams. By performing breast self-exams, you can become familiar with the normal monthly changes in your breasts.
Breast self-examination should be performed at the same time each month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month.
How to Perform a Self – Examination:
How to Perform a Breast Self-Exam:
In the mirror:
Stand undressed from the waist up in front of a large mirror in a well-lit room. Look at your breasts. Don’t be alarmed if they do not look equal in size or shape. Most women’s breasts aren’t. With your arms relaxed by your sides, look for any changes in size, shape or position, or any changes to the skin of the breasts. Look for any skin puckering, dimpling, sores or discoloration. Inspect your nipples and look for any sores, peeling or change in the direction of the nipples.
Next, place your hands on your hips and press down firmly to tighten the chest muscles beneath your breasts. Turn from side to side so you can inspect the outer part of your breasts.
Then bend forward toward the mirror. Roll your shoulders and elbows forward to tighten your chest muscles. Your breasts will fall forward. Look for any changes in the shape or contour of your breasts.
Now, clasp your hands behind your head and press your hands forward. Again, turn from side to side to inspect your breasts’ outer portions. Remember to inspect the border underneath your breasts. You may need to lift your breasts with your hand to see this area.
Check your nipples for discharge (fluid). Place your thumb and forefinger on the tissue surrounding the nipple and pull outward toward the end of the nipple. Look for any discharge. Repeat on your other breast.
In the shower
Now, it’s time to feel for changes in the breast. It is helpful to have your hands slippery with soap and water. Check for any lumps or thickening in your underarm area. Place your left hand on your hip and reach with your right hand to feel in the left armpit. Repeat on the other side.
Check both sides for lumps or thickenings above and below your collarbone.
With hands soapy, raise one arm behind your head to spread out the breast tissue. Use the flat part of your fingers from the other hand to press gently into the breast. Follow an up-and-down pattern along the breast, moving from bra line to collarbone. Continue the pattern until you have covered the entire breast. Repeat on the other side.
Lying down
Next, lie down and place a small pillow or folded towel under your right shoulder. Put your right hand behind your head. Place your left hand on the upper portion of your right breast with fingers together and flat. Body lotion may help to make this part of the exam easier.
Think of your breast as a face on a clock. Start at 12 o’clock and move toward 1 o’clock in small circular motions. Continue around the entire circle until you reach 12 o’clock again. Keep your fingers flat and in constant contact with your breast. When the circle is complete, move in one inch toward the nipple and complete another circle around the clock. Continue in this pattern until you’ve felt the entire breast. Make sure to feel the upper outer areas that extend into your armpit.
Place your fingers flat and directly on top of your nipple. Feel beneath the nipple for any changes. Gently press your nipple inward. It should move easily.
Repeat steps 9, 10 and 11 on your other breast.
Cancerous tumors are more likely to be found in certain parts of the breast over others. If you divide the breast into 4 sections, the approximate percentage of breast cancers found in each area are (in clockwise pattern):
41% upper, outer quadrant
14% upper, inner quadrant
5% lower, inner quadrant
6% lower, outer quadrant
34% in the area behind the nipple
Almost half occur in the upper outer quadrant of the breast, towards the armpit. Some physicians refer to this region as the “tail” of the breast and encourage women to examine it closely.
If you detect a lump go immediately to your doctor. Changes in your breast that should be checked by your doctor include:
An area that is distinctly different from any other area on either breast.
A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
A change in the size, shape or contour of the breast.
A mass or lump, which may feel as small as a pea.
A marble-like area under the skin.
A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly or inflamed).
Bloody or clear fluid discharge from the nipples.
Redness of the skin on the breast or nipple.
The most common types of breast cancer are:
Invasive ductal carcinoma. This cancer starts in the milk ducts of the breast. Then it breaks through the wall of the duct and invades the fatty tissue of the breast. This is the most common form of breast cancer, accounting for 80% of invasive cases.
Ductal carcinoma in situ (DCIS) is ductal carcinoma in its earliest stage (stage 0). In situ refers to the fact that the cancer hasn’t spread beyond its point of origin. In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue. If untreated, ductal carcinoma in situ may become invasive cancer. It is almost always curable.
Infiltrating (invasive) lobular carcinoma. This cancer begins in the lobules of the breast where breast milk is produced, but has spread to surrounding tissues or the rest of the body. It accounts for about 10% of invasive breast cancers.
Lobular carcinoma in situ (LCIS) is cancer that is only in the lobules of the breast. It isn’t a true cancer, but serves as a marker for the increased risk of developing breast cancer later, possibly in both breasts. This is why it is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.
The Stages of Breast Cancer:
Early stage or stage 0 breast cancer is when the disease is localized to the breast with no evidence of spread to the lymph nodes (carcinoma in situ).
Stage 1 breast cancer: The cancer is two centimeters or less in size and it hasn’t spread anywhere.
Stage 2A breast cancer is a tumor smaller than two centimeters across with lymph node involvement or a tumor that is larger than two but less than five centimeters across without underarm lymph node involvement.
Stage 2B is a tumor that is greater than five centimeters across without underarm lymph nodes testing positive for cancer or a tumor that is larger than two but less than five centimeters across with lymph node involvement.
Advanced breast cancer (metastatic) results after cancer cells spread to the lymph nodes and to other parts of the body.
Stage 3A breast cancer is also called locally advanced breast cancer. The tumor is larger than five centimeters and has spread to the lymph nodes under the arm, or a tumor that is any size with cancerous lymph nodes that adhere to one another or surrounding tissue.
Stage 3B breast cancer is a tumor of any size that has spread to the skin, chest wall or internal mammary lymph nodes (located beneath the breast and inside the chest).
Stage 3C breast cancer is a tumor of any size that has spread more extensively and involves more lymph node invasion.
Stage 4 breast cancer is defined as a tumor, regardless of size, that has spread to places far away from the breast, such as bones, lungs, liver, brain or distant lymph nodes.
How Breast Cancer is Diagnosed
During your regular physical examination, your doctor will take a careful personal and family history and perform a breast exam and possibly one or more other tests:
Mammography
Ultrasonography
Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue.
After the sample is removed, it is sent to a lab for testing. A pathologist — a doctor who specializes in diagnosing abnormal tissue changes — views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is (ductal or lobular carcinoma) and whether it has spread beyond the ducts or lobules.
Laboratory tests such as hormone receptor tests (estrogen and progesterone) can show whether the hormones help the cancer to grow. If the test results show that hormones help the cancer grow (a positive test), the cancer is likely to respond to hormonal treatment. This therapy deprives the cancer of the estrogen hormone.
Breast cancer diagnosis and treatment are best accomplished by a team of experts working together with the patient. Each patient needs to evaluate the advantages and limitations of each type of treatment, and work with her team of physicians to develop the best approach.
How Breast Cancer is Treated
If the tests find cancer, you and your doctor will develop a treatment plan to eradicate the breast cancer, to reduce the chance of cancer returning in the breast, as well as to reduce the chance of the cancer traveling to a location outside of the breast. Treatment generally follows within a few weeks after the diagnosis.
The type of treatment recommended will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells and the stage or extent of the disease. Your doctor usually considers your age and general health as well as your feelings about the treatment options.
Breast cancer treatments are local or systemic.
Local treatments are used to remove, destroy or control the cancer cells in a specific area, such as the breast. Surgery and radiation treatment are local treatments.
Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormone therapy such as tamoxifen, and biologic therapies like Herceptin, are systemic treatments. A patient may have just one form of treatment or a combination, depending on her needs.
What Happens After Treatment?
Following local breast cancer treatment, the treatment team will determine the chances that the cancer will recur outside the breast. This team usually includes a medical oncologist, who is a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with the surgeon, may advise the use of tamoxifen or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.
How You Can Protect Yourself from Breast Cancer
Follow these three steps for early detection:
Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35 and a screening mammogram every year after age 40. Mammograms are an important part of your health history. If you go to another healthcare provider, or move, take the film (mammogram) with you.
Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes.
Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram.
This article contains a lot of information and it may be overwhelming so some individuals but remember the more we know about the disease the better we can protect ourselves and decrease the chances of getting breast cancer. Remember, it’s better to be safe than sorry.
Stacey Chillemi is the managing editor for the magazine UZURI. She is the author of Epilepsy You’re Not Alone; Live, Learn, and Be Happy with Epilepsy; Epilepsy and Pregnancy: What Every Women Should Know; the children’s book My Mommy Has Epilepsy and My Daddy Has Epilepsy ; and two collections of poetry, Keep the Faith and Eternal Love. She has recently been featured in Woman’s World Magazine and the New Jersey Star Ledger. Her website is http://www.authorsden.com/staceydchillemi