Battling Breast Cancer
You find a lump in your right breast. That breast is swollen and hard and double the size of the left one. You suspect you could have breast cancer.
Breast cancer is cancer that forms in the cells of the breast. After skin cancer, breast cancer is the most common diagnosed cancer in women in the United States. Both men and women are susceptible to breast cancer, but it is more common in women.
In the United States, breast cancer is the second leading cause of cancer death in women after lung cancer and it is the leading cause of death among women ages 35 to 54. Only 5 to 10 percent of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The majority of breast cancer cases are “sporadic” meaning there is no definitive gene mutation.
Statistics show that non-Hispanic White women have a slightly higher chance of developing breast cancer than women of any other race/ethnicity. Though the incidence for non-Hispanic Black women is almost as high.
Non-Hispanic Black women in the U.S. have a 39 percent higher risk of dying from breast cancer at any age. They are twice as likely to get triple-negative breast cancer as White women. This cancer is aggressive and difficult to treat. However, it’s really among women with hormone positive disease where Black women have worse clinical outcomes despite comparable systemic therapy. Non-Hispanic Black women are less likely to receive standard treatments. In addition, there is increasing data on discontinuation of adjuvant hormone therapy by those who are poor and underinsured.
According to the Cleveland Clinic, in women under the age of 45, breast cancer is found more often in non-Hispanic Black women than in non-Hispanic White women.
Signs and symptoms of breast cancer may include a breast lump or thickening that feels different than the surrounding tissue; change in size, shape, or appearance of a breast; changes to the skin over the breast, such as dimpling; a newly inverted nipple; peeling, scaling, crusting, or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin; and redness or pitting of the skin over the breast, like the skin of an orange.
Breast cancer occurs when some breast cells begin to grow abnormally. Those cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.
Breast cancer will begin with the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.
Researchers have identified certain hormonal, lifestyle, and environmental factors that may increase your risk of breast cancer. But it’s not clear why some people who have no risk factors develop cancer, while others with those risk factors don’t. It is likely a complex interaction of genetic makeup and your environment.
A number of inherited mutated genes that increase the likelihood of breast cancer have been identified. The most well-known are breast cancer gene 1(BRCA 1) and breast cancer gene 2 (BRCA 2), both of which significantly increase the risk of both breast and ovarian cancer.
If you have a strong family history of cancer, your doctor may recommend a blood test to help identify specific mutations in BRCA or other genes that are being passed down through your family.
Your doctor may suggest seeing a genetic counselor who can discuss the benefits, risks, or limitations of genetic testing to assist you with decision-making.
The four most common types of breast cancer are:
· Infiltrating (invasive) ductal carcinoma which starts in the milk ducts of the breast and breaks through the walls of the duct and invades the surrounding tissue in the breast. This is the most common form of breast cancer.
· Ductal carcinoma in situ where the cancer hasn’t spread yet and is still confined to the milk duct area. If left untreated, ductal carcinoma can become invasive. It is almost always curable.
· Infiltrating (invasive) lobular carcinoma which begins in the lobules of the breast where the breast milk is produced, but has spread to surrounding tissues in the breast. It accounts for 10 to 15 percent of breast cancers. This cancer is difficult to diagnose with mammograms.
· Lobular carcinoma in situ which is a marker for cancer only in the lobules of the breast. It isn’t a true cancer, but a marker for the increased risk of developing breast cancer in one or both of the breasts. It is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.
Cancer can form in other parts of the breast but these type of cancers are less common. They may include angiosarcoma which begins in the cells that make up the lining of blood and lymph nodes; inflammatory breast cancer which is caused by obstructive cancer cells in the skin’s lymph vessels; Paget disease of the breast or Paget disease of the nipple which affects the skin of the nipple and areola (the skin around the nipple); and phyllodes tumors which begins in the breast connective tissue called the stroma.
Then there’s the staging process of breast cancer. There are two types of staging, anatomic and prognostic. Anatomic is defined by the parts of the body the cancer is found. The prognostic helps communicate how likely the patient is cured of the cancer assuming the appropriate treatment is given.
The anatomic staging system is as follows:
Ø Stage 0 breast disease where the disease is localized to the milk ducts
Ø Stage I breast cancer is smaller than 2 cm across and hasn’t spread anywhere including no involvement in the lymph nodes
Ø Stage II breast cancer where the tumor is less than 2 cm across but has spread to the underarm lymph nodes (IIA), or the tumor is between 2 and 5 cm (with or without spreading to the lymph nodes) or the tumor is larger than 5 cm and hasn’t spread to the lymph nodes under the arm (both IIB).
Ø Stage III breast cancer is referred to as locally advanced breast cancer. The tumor is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue (IIIA). Stage IIIB breast cancer is a tumor any size that has spread to the skin, chest wall, or internal mammary lymph nodes (located beneath the breast and inside the chest).
Ø Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to areas away from the breast, such as bones, lungs, liver, or brain.
Breast cancer is diagnosed through a number of ways. Your doctor will perform a breast exam to check both breast and lymph nodes under the arm. Then a mammogram will be run to screen for breast cancer. If an abnormality is discovered on the screening mammogram, then a diagnostic mammogram will be performed. A breast ultrasound may be performed to see if whether a breast lump is a solid mass or fluid-filled cyst. A biopsy is done in order to diagnose the breast cancer.
During the biopsy, your doctor uses a specialized needle device guided by X-ray or another imaging test to extract a core of tissue from the suspected area of cancer. Often a small metal marker is left at the site within your breast so the area can be easily identified on future imaging tests. A biopsy sample is analyzed to determine the type of cells involved in the breast cancer, the aggressiveness of the cancer, and whether the cancer cells have hormone receptors or other receptors that influence your treatment options.
Your doctor may also run a breast magnetic resonance imaging test (MRI) to create pictures of the interior of your breast. Before the breast MRI, you receive an injection of dye. Unlike other types of imaging tests, an MRI doesn’t use radiation to create these images.
Your doctor will then work on staging your cancer or the extent of the cancer in your body. Tests and procedures used to stage breast cancer may include blood tests, mammograms, breast MRI, bone scan, computerized tomography scan (CT) and positron emission tomography (PET) scan. Not all women need all these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances, taking into account the new symptoms you may be experiencing.
Your treatment options are based on the type of breast cancer, its stage and grade, size, and whether the cancer cells are sensitive to hormones. Most women undergo surgery for breast cancer and many receive additional treatment after the surgery such as chemotherapy, hormone therapy, or radiation. Chemotherapy may be used before surgery in certain instances.
The breast cancer journey is one that can be overwhelming and complex. It is helpful to talk with a specialist and other women who have similar experiences. Don’t be afraid to lean on those that love and care for you.
Making changes to your daily life may help lower your risk of breast cancer but try to ask your doctor about breast cancer screening; become familiar with through breast self-exam; drink alcohol in moderation; exercise regularly; limit postmenopausal hormone therapy; maintain a healthy weight; and choose a healthy diet.
