BREAST CANCER

What Is Breast Cancer? The breast is made up of 15-20 sections called lobes. Within each lobe there are lobules, which consist of cells that are able to produce milk. Ducts connect these parts of the breast to each other and lead the milk produced to the nipple. Breast cancer is the uncontrolled growth of cells in the breast, particularly cells within the lobules and the ducts. These cells are malignant, meaning they have the potential to invade the surrounding tissue and spread to other parts of the body, such as the brain, lungs, liver and bones. Unlike malignant cells, cells of a benign mass in the breast do not invade or spread to other tissue, although the mass does grow locally; benign masses are not called cancers. Masses comprised of malignant or benign cells are both called tumours. Thus a breast tumour does not necessarily mean breast cancer. Breast cancer is one of the most common type of cancer among women, second only to skin cancer. A North American or Western European woman who lives to the age of eighty has a 1 in 9 chance of developing invasive breast cancer, while a woman from Asia has only one-fifth the risk that a Western woman has. However, studies have shown that Asian women who live in western countries have identical risks for invasive breast cancer as their western counterparts. Men can also get breast cancer; however, it is much less common.

What Are The Risk Factors For Breast Cancer?  Age is a significant risk factor for breast cancer. As a woman ages, she is at an increased risk. It is rare for a woman under 35 to develop breast cancer, since the majority of these cancers occur in women over 50. The risk is especially high for women over 60. Another risk factor is a family history of breast cancer, since certain genes (e.g. BRCA1 and BRCA2) have been linked to familial cases of breast cancer. The type of breasts that a woman has is also a risk factor. Women greater than 45 years with breast tissue that is very dense (as can be seen by a mammogram - an x-ray procedure specifically designed for the breasts) are at increased risk. Women who have had radiation therapy during childhood, especially for conditions such as Hodgkin’s disease, are also more likely to develop breast cancer. A woman’s reproductive pattern is also an important influence. Women who have children late in life (after the age of 30), women who start menstruation early (before the age of 12), have late menopause (after the age of 55), who have never had children, or have taken hormone replacement therapy or oral contraceptives are all at increased risk. Environmental factors, such as a diet high in fat, have been theorized to contribute to the development of breast cancer; however there have been no conclusive data to support this.

What Are The Signs And Symptoms Of Breast Cancer?  The overwhelming majority of breast cancers are detected by women themselves discovering they have a lump in a breast. You should be concerned about cancer if a breast lump is in a fixed position, hard and irregular; if there is swelling; if the skin surrounding the lump is dimpled; if there is noticeable redness; or if there are any changes in the nipple such as retraction, ulceration or discharge. Women can also complain of breast pain, an increase in the size of one breast, or sensing a thickening of the breast. It important to contact your physician if you notice any of these signs. In most cases it is not cancer, but it is important to exclude cancer as a cause.

With What Can Breast Cancer Be Confused?  There are other breast diseases, collectively known as benign breast disorders, which produce lumps in the breast. In fact, these benign (non-cancerous) breast tumours are more commonly the cause of breast lumps than breast cancer. The most common benign breast disorder is mastalgia, which consists of pocketed collections of fluid known as cysts. In premenopausal women, these cysts are more prominent just before menstruation and are considered an aspect of the premenstrual syndrome (PMS). Another cause of benign tumours are fibroadenomas. These non-cancerous growths generally develop in teenagers and can be surgically removed if it makes the woman uncomfortable.

What Can You Do To Prevent Breast Cancer?  It is recommended that all women conduct  self-exams of their breasts every month. To learn more about how to do a self-exam, a pamphlet on breat self-examination is available from the Canadian Cancer Society (www.cancer.ca). It is also recommended to have a breast exam done by a physician during one’s annual physical exam. For women over 50, mammography should also be done annually. The National Cancer Institute recommends that for women between the ages of 40 and 50, mammography be done every 1 to 2 years. However, for this age group, there is no uniform consensus whether mammography is beneficial or not.

How Is Breast Cancer Diagnosed? If you detect a lump in your breast or if you have any concerns about breast cancer, see your family physician as soon as possible. The doctor will perform a breast exam in the office, and if there is any evidence indicating the lump may be cancerous, a series of tests can be done. The first utilizes a fine needle to attempt to determine if there is fluid in the mass; this procedure is called fine needle aspiration. If there is fluid and the fluid is not bloody, there is a low chance that the lump is cancerous. If it is a solid mass, or if there is blood in the fluid, the next step is to do a mammogram and then a biopsy of the breast tissue. Even if the mammogram shows no sign of breast cancer, a biopsy is still recommended. The biopsy, in which a small sample of breast tissue is taken for analysis under the microscope, is the gold standard in diagnosing breast cancer. Most biopsies can be performed using local anesthetic. According to the results of the biopsy, the physician will discuss the patient’s options, as described immediately below.

How Is Breast Cancer Treated? There are four main approaches to treating breast cancer. These include surgery, radiation therapy, chemotherapy and hormonal therapy. Patients may have only one type of treatment, or a combination of treatments, depending how advanced their cancer is. Surgery is the most common type of treatment and varies from a mastectomy, where the entire affected breast is removed, to lumpectomy, where only the tumour and surrounding tissue is removed. Studies have shown that lumpectomy (a less invasive procedure) combined with radiation therapy is just as effective as mastectomy. Radiation therapy uses beams of high energy to kill cancer cells. Radiation therapy alone, or in combination with chemotherapy or hormonal therapy, is sometimes used before surgery to help shrink the tumour. Chemotherapy also attempts to kill the cancer cells; however, in this case, toxic chemicals that prevent the cancer cells from reproducing are used. Chemotherapy is given in cycles, and can require frequent visits to the hospital. Hormonal therapy targets the cancer cells by preventing the hormones that the cancer cells require to grow from reaching these cells. This treatment can include the use of drugs that prevent functional hormones from reaching cancer cells, or the removal of the ovaries (the organs that produce these hormones). The treatments listed above have numerous side effects. Surgery runs the risk of producing post-operative pain, discomfort and potential damage to the nerves in the area. Invasive surgery such as a mastectomy involves the removal of an organ with which many women define their femininity. Thus it is important to consider how you would feel with the loss of a breast, and to discuss with your physician the options available to you, which range from cosmetic padding to reconstructive surgery. Radiation therapy has side effects which include fatigue, local skin irritation, and permanent skin discoloration. The breast may also be more sensitive after radiation. It is important that you are not pregnant while receiving radiation, since it can result in birth defects. With chemotherapy, the side effects are specific to the type of drug used. In general, however, most anti-cancer drugs cause hair loss, loss of appetite, nausea, vomiting, diarrhea and mouth sores. Patients also find that they bruise easily, are more likely to get infections and take longer to stop bleeding. All these side effects are related to the fact that these drugs target cells that grow rapidly, such as cancer cells. However, they do not distinguish cancer cells from other rapidly growing cells that are normal to the body, such as cells of the skin, hair, and digestive tract. Hormonal therapy can produce hot flashes, vaginal discharge or irritation and irregular periods. It is more easy for women to become pregnant, thus birth control is recommended.