Despite improvements in treatments and early detection, breast cancer remains a huge health concern for women. It is the most common cancer among American women, after skin cancer. Around 1 out of 8 women will be diagnosed with breast cancer during their lifetime and the American Cancer Society estimates that more than 230,000 new cases are diagnosed each year.
Most people in America have had a friend or family member who has developed breast cancer. Others have developed it themselves. Anyone struggling to understand the disease or lower their risk should educate themselves about the types, causes, symptoms, and treatments for breast cancer.
Types of Breast Cancers
Breast cancer is not a homogenous disease. There are several different categories of breast cancer based on where it originates: ductal carcinoma in situ, invasive ductal carcinoma, and invasive lobular carcinoma. Recently, doctors have also begun categorizing it based on its hormone receptor status.
Ductal Carcincoma In Situ
Ductal carcinoma in situ (DCIS) is the most common non-invasive breast cancer. It begins in the breasts’ milk ducts, but doesn’t spread into the surrounding breast tissue. Most cases of DCIS aren’t life threatening, but it’s a sign a more serious problem may be developing. Doctors sometimes refer to it as “pre-cancer” or “pre-invasive” because if left untreated, it increases the chance of developing invasive breast cancer.
Invasive Ductal Carcinoma
Invasive ductal carcinoma is the most common type of breast cancer, accounting for approximately 80 percent of all breast cancers in the United States. It begins in the milk ducts and then spreads out into the surrounding breast tissue. If not treated, it could also spread into the blood or nearby lymph nodes and then to other organs of the body, such as the brain, liver, or lungs.
Invasive Lobular Carcinoma
Invasive lobular cancer is the second most common type of breast cancer. It begins in the milk lobules in the breast and then spreads into the surrounding tissue, lymph nodes, and eventually to other organs. Unlike invasive ductal carcinoma, invasive lobular carcinoma often doesn’t form a noticeable lump. Instead, it changes the texture of the breast itself, making it feel thicker and fuller than before.
Breast Cancer Receptor Status
Another method of classifying breast cancer is to identify its hormone receptor status. Hormone receptors are molecules that bind a specific hormone to a cell. Breast cancer cells with these receptors react to hormones produced by the body, which causes them to grow and multiply. Doctors categorize these cancers based on whether they have the estrogen receptor (ER), the progesterone receptor (PR), or the HER2 receptor. If a cancer doesn’t have any of three receptors, doctors refer to it as triple-negative. Systemic therapy for breast cancer is usually based upon the results of these receptor studies. Once doctors know a cancer’s hormone receptor status, they can combat it using targeted medication.
ER-Positive Breast Cancer & PR-Positive Breast Cancer
ER-positive breast cancer and PR-positive breast cancer account for about 75 percent of all breast cancers. Even patients who are postmenopausal or who have had their ovaries removed still produce these hormones and are still vulnerable to these types of cancer. ER-positive and PR-positive cancers often respond to medical or surgical manipulations of hormones, such as medications that block the access of hormones to the estrogen receptor of tumors or drugs that block the production of estrogen by the body.
HER2-Positive Breast Cancer
HER2 is a gene that produces a protein that stimulates cell growth in normal cells. In about 15-20 percent of patients with invasive breast cancer, this gene is amplified, which causes their cells to grow uncontrollably. HER2-positive breast cancers are very aggressive, but their growth can be hindered by drugs that block the HER2 receptor or halt the production of the HER2 protein.
Triple-Negative Breast Cancer
Triple-negative breast cancers do not have estrogen or progesterone receptors and do not overproduce the HER2 protein. Triple-negative breast cancers are often aggressive and difficult to treat. They’re also more likely to recur than other types of cancer. Approximately 15 percent of breast cancers are triple-negative.
Breast Cancer Treatments
Breast cancer treatments have evolved enormously over the past decades. Today, breast cancer patients have more treatment options and access to targeted therapy, which attacks weaknesses in a cancer’ genetic makeup. However, most breast cancer treatments still involve surgery, radiation therapy, chemotherapy, or some combination of these.
Most women with breast cancer receive some type of surgery. The two most common types of breast cancer surgery are mastectomy and lumpectomy. During a mastectomy, surgeons completely remove one or both breasts. During a lumpectomy, doctors only remove the tumor and a small amount of healthy tissue, allowing women to preserve as much of her breasts as possible. Often, during a lumpectomy, the surgeon will removal one or more lymph nodes as well, to see whether the cancer has spread out of the breast tissue. These operations are called sentinel node sampling. Unlike previous lymph node surgeries, sentinel node sampling only removes the lymph nodes closest to the tumor. This allows surgeons to check the spread of the cancer while preserving as much healthy tissue as possible.
Radiation therapy uses high-frequency energy rays to kill cancer cells. Normally, doctors apply radiation externally, using a highly concentrated beam that targets one specific area of the breast. Recently, doctors have developed new treatment methods that allow them to apply radiation internally, via an injection of radioactive liquid. Internal radiation therapy normally has fewer side effects that external radiation therapy. Doctors usually administer radiation after surgery, to kill any remaining cancer cells and prevent the cancer from recurring. Thank to ongoing research, doctors have begun to identify which patients will benefit the most from radiation therapy and which can safely avoid it.
Chemotherapy uses chemicals to halt or retard the growth of cancer cells. Patients often receive chemotherapy after surgery and radiation therapy, to eliminate the remaining cancer cells in their body and reduce the risk of recurrence. However, oncologists sometimes administer chemotherapy before surgery to shrink a tumor, so surgeons can remove it with a less extensive operation. Chemotherapy is administered in intervals, with recovery periods in between. A normal course of chemotherapy usually lasts 3-6 months.
Breast Cancer Symptoms & Signs
The most common sign of breast cancer is a lump or mass in the breast or armpit. Breast lumps are often visible on a mammogram before they become large enough to be seen or felt. Other breast cancer symptoms include:
Swelling - One breast becomes noticeable larger than the other.
Rash - Red spots or red streaks appear on the surface of the breast.
Dimpling - The surface of the breast feels rough and pitted, like an orange peel.
Changes to the Nipple - They nipple may retract into the breast. The skin around the nipple may also become itchy or dimpled. A scaly redness on the nipple is a sign of Paget’s disease, a rare breast cancer centered on the nipple and areola.
Nipple Discharge - The nipple spontaneously discharges a clear or bloody fluid. Discharge from one spot on the nipple is also worrisome.
Change in Texture - The breast tissue feels fuller or thicker.
Indentations - A noticeable indentation on the breast may be caused by a tumor underneath the skin.
Breast Pain - A pain located in a precise area of the breast that grows steadily more intense.
It is important to remember that these symptoms have multiple causes, many of which are benign. None are sure sign of cancer, but all of them should be examined by a doctor as quickly as possible. Early detection gives patients the best chance of recovery.
Breast Cancer Stages
There are five breast cancer stages: stage 0, I, II, III, and IV. Stages progress is severity. Late stage cancers are larger, have spread through the lymph nodes, and into other organs.
Stage 0 - The patients has a small number of abnormal cells in their milk ducts or lobules, but they have not spread out into any of the surrounding tissue. Not all of the cells may be cancerous at this stage. Cancer cells are easy to treat at this stage, but if left untreated, they can spread and become more dangerous.
Stage I - The abnormal cells in the breast are clearly cancerous, but few in number. They are confined to the ducts or lobules where they first appeared or small groups of cancer cells have spread to nearby lymph nodes.
Stage II - The cancer is still small, but significant growth has occurred and it has begun spreading into the lymph nodes.
Stage III - The cancer has formed a large tumor in the breast or has spread throughout the lymph nodes and into the surrounding breast tissue.
Stage IV - The cancer has metastasized and spread to other organs, such as the brain, liver, or lungs. Though this is the most severe form of breast cancer, modern advances in oncology and chemotherapy have made it possible for an increasing number of women with stage IV breast cancer to recover and live long lives after their diagnosis.
Doctors determine the stage when they make their prognosis. Breast cancer stages aren’t just a way to assess the seriousness of the disease. They’re also a useful guide when developing treatment plans. They let the medical team know what steps need to be taken to curb its growth and eliminate it from the body.