About Breast Cancer

Knowledge can be your key to survival
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Knowledge can be your key to survival

What is breast cancer? It is a malignant tumor (collection of cancer cells) that formed from the cells in your breast. What are the symptoms of breast cancer? Well, we've all heard the word “lump” used to describe something abnormal found in breasts.

Other symptoms might include swelling, dimpling, pain in the breast or nipple or discharge of the nipple. Any of these findings should send you rushing to your physician immediately for diagnosis. How is breast cancer diagnosed? The recommended monthly self-examination many times is the first line of defense.

An annual examination by a physician and a screening mammogram should also be routine. FDA has approved a 3D digital breast mammogram. A “biopsy” can be performed whereby a small section of underlying breast tissue is taken and examined for cancerous cells.

Since our lymph nodes act as filters to trap cancer cells and eliminate them from our body, a pathologist can determine if cancer cells are spreading from the tumor to other areas. What causes breast cancer? Research has determined there are certain cancer risk factors some we can control and some we cannot that increase the development of breast cancer.

Risk factors we can't influence:

• Age. As we age, the risk factor increases.
• Family history of cancer.
• Personal history of breast cancer increases the chances of it recurring.
• Menstruation starting before 12.
• Menopause after the age of 55.
• Race increases overall risk of white women, while African-American women have a more aggressive form when they do develop cancer.
• Oral contraception you may have taken in the last 10 years, or the use of combined hormone therapy after menopause.
• Dense breast tissue.
• Childbirth after age 30 or no children.

Factors that can reduce risk:

• Breastfeeding for 1-1/2 to 2 years.
• Exercising.
• Maintaining a healthy weight.
• Limiting alcohol consumption.
• Not smoking.
• Eating nutritious food.
• Screenings, using mammogram, MRI or ultrasound.
• Prophylactic surgery.

Women with an abnormal BRCA1 or BRCA2 gene may be able to reduce their risk of breast cancer by having their ovaries removed before menopause. This very aggressive surgery could reduce that risk of cancer considerably. One or both healthy breasts and ovaries are removed.

The ovaries are removed because they produce the main source of estrogen in premenopausal women. Post-menopausal women must have both their ovaries and fallopian tubes removed to reduce cancer risk. This surgery is being chosen more frequently by younger women because the younger the age, the more benefit you gain.

Dr. Lillian Chou, of Aurora Breast Center, told me that even though abnormal BRCA1 or BRCA2 genes can put you at greater risk, only about 5 percent of women with breast cancer have this abnormality. (Aurora Breast Center is a local facility for comprehensive diagnosis and treatment of breast cancer. Dr. Chou says they have the only dedicated breast MRI equipment in town.)

PAYMENT RESOURCES

If you have no health insurance, here are some government and private organizations that can help:

• The National Cancer Institute Information Services
• Local department of social services
• Local department of public health
• American Cancer Society
• Susan G. Komen Breast Cancer Foundation
• Free clinics sponsored by local hospitals

What are the different types of breast cancer?

The most common types are ductal carcinoma in situ (DCIS), which has not spread from the duct and has a very high cure rate, and invasive ductal carcinoma, the type of invasive breast cancer 80 percent of patients incur. It starts in the duct of the breast, then grows into the surrounding tissue; invasive lobular carcinoma starts in the glands of the breast.

What is breast cancer “staging” and how is it determined?

Staging is the process used to determine the extent of cancer in the body. A combination of cancer type and stage is used to determine the appropriate therapy and to predict chances for survival. The system for staging used in the United States is known as TNM. The T indicates the size of the tumor. The N describes the spread to the lymph nodes around the breast. And the M indicates whether the cancer has spread to other organs.

The TNM matrix results are then combined into one of five staging groups, ranging from 0 to stage IV. A variety of imaging techniques are also used to determine if the cancer has spread, including chest X-ray, mammogram, computerized topography (CT scan), position emission tomography (PET) and bone scan.

What are treatment options for breast cancer?

Treatment depends upon the type and the staging group of cancer that have been determined. A partial mastectomy is a breast-conserving procedure to remove only part of the breast. A lumpectomy involves the removal of the breast lump and surrounding tissue. In a mastectomy, all of the breast tissue is removed. In radical mastectomy, breast tissue, lymph nodes and the chest wall muscle are removed. If you've chosen to have breast reconstruction, the overlying skin is preserved.

• Radiation therapy destroys cancer cells with high-energy rays. The radiation can be administered by beams focused onto the affected area. Brachytherapy delivers the radiation by implanting little seeds into the breast.

• Chemotherapy treats cancer with medications given either by mouth or by injection. The medications find their way to cancerous cells via the bloodstream. Sometimes an antibody “engineered” to attach itself to the cancer cells is used to try to slow cancer growth and to stimulate your immune system to attack cancer cells more aggressively.

• Hormone therapy can be used to help reduce the chances of the recurrence of cancer after surgery.

What about breast reconstruction?

If you’re undergoing mastectomy surgery, you may choose to have a breast reconstruction by a board-certified plastic surgeon. It is very important to talk with your doctors about restoration and its benefits and risks before your mastectomy.

For example, will you have the reconstruction at the same time or at a later date? Are you a good candidate for reconstruction? Will you want implants or tissue flap? Will your insurance cover all expenses? The American Cancer Society’s “Reach to Recovery” program gives you access to breast cancer survivor volunteers to answer your questions from diagnosis to treatment to breast reconstruction.

At www.cancer.org, you'll find lists of books and guides, including legal and insurance topics. Also listed are other organizations, websites and telephone numbers for reference.