Breast Cancer

Breast cancer is a malignant tumor that develops from cells in the breast. It is the second leading cause of cancer death among women in the United States. Although rare, men can also develop breast cancer.
Some risk factors for breast cancer may include:

Age: Most breast cancers develop in adults over the age of 50.

Family history: The chance of developing breast cancer increases when immediate family members have had breast, ovarian or prostate cancer.

Personal history: Women who had cancer in one breast have an increased risk of developing cancer in another area of that same breast or in the other breast.

Breast Cancer

Reproductive history: Women who began menstruating before 12, who experienced menopause after 55, who were pregnant for the first time after age 30 or never had children can be at an increased risk.

Alcohol: Consumption of alcohol can slightly increase a woman’s chance of developing breast cancer.

Weight: Being overweight is linked to a higher risk of breast cancer.

Medical History:

  • Taking a hormonal replacement therapy can increase the chance of developing breast cancer.
  • A person may have a higher risk of being diagnosed with breast cancer if they have received radiation to the chest or breast, before the age of 30.

Signs & Symptoms

Signs and symptoms are different for each patient. It’s important to discuss any questions or concerns you may have with your physician. They may include:
  • Abnormal lump in the breast or underarm.
  • Skin changes to the breast such as redness, scaliness, thickening, swelling or tenderness.
  • Changes in the nipple such as pain, nipple turning inward or abnormal discharge.

Screening & Diagnostic Testing

Women are encouraged to discuss their personal and family history with their physicians to best determine when breast screening should begin and to determine the type of screening. For women of average risk, the National Comprehensive Cancer Network recommends a mammogram annually beginning at the age of 40. If you have a family history of cancer, your screening may start at an earlier age.
A complete physical exam and medical history should be done. The exam will check for any unusual physical signs. A complete medical history is also important to fully understand a person’s health habits, family history, previous illnesses, and past exposure. Additional testing may include:
  • Imaging: Mammogram, MRI, Ultrasound
  • Biopsy

Mammograms: 2D vs 3D - What’s the difference?

3D mammogram (tomosynthesis) is a newer technology that is quickly becoming the standard of care for breast imaging especially when breast tissue is dense. The test can give radiologists a higher resolution, “slice by slice” view of the breast making it possible to see cancers that may have been missed otherwise. It has also been shown to reduce the amount of false positives, resulting in fewer women being called back for additional testing.
Conventional 2D mammogram however is still a very good technology in detecting breast cancer and has been shown to lower death rates from the disease.
Radiation exposure with 3D mammograms is slightly higher than the dose used with 2D mammogram, but both tests have received FDA approval for safe levels of radiation.
While the Affordable Care Act stipulates preventative care at no out-of-pocket costs on most health plans, including annual screening mammography from age 40, not all insurance companies cover the additional cost of a 3D Mammogram. You should confirm with your insurance carrier to see if a 3D mammogram is covered by your plan.
Overall, improvements to early detection have resulted in lowering breast cancer death rates by 40% from 1989 - 2016.

Types of Breast Cancer

There are many different types of breast cancer, and how they are classified depends on where the cancer develops and if it has spread. Noninvasive or In Situ cancers are still contained where they first developed and have not spread to other tissues in the body. Invasive breast cancers spread to surrounding breast tissue. When the breast cancer travels to other parts of the body, it is known as metastatic breast cancer.

Ductal carcinoma in situ (DCIS)

DCIS is a noninvasive cancer that is contained within the lining of the breast milk ducts and has not spread to any surrounding tissues. While it isn’t considered to be life-threatening, it can increase a person’s risk of developing an invasive breast cancer. Without treatment, DCIS can become an invasive breast cancer which can spread to other breast tissue, and potentially to lymph nodes and other organs in the body.

Lobular carcinoma in situ (LCIS)

LCIS is not considered to be a cancer. Cells contained in the lobules, which are the milk producing glands in the breast, look like cancer, but they don’t grow through the walls of the lobules. A person diagnosed with LCIS should be watched closely because their risk of having an invasive breast cancer later is much greater.

Invasive ductal carcinoma (IDC)

Like DCIS, this invasive breast cancer forms in the breast’s milk ducts, but it has spread beyond the duct walls into the surrounding breast tissue. Invasive ductal carcinoma, also called Infiltrating Ductal Carcinoma is the most common type of breast cancer. It can become metastatic, spreading to the lymph nodes and other areas in the body.

Invasive Lobular Carcinoma (ILC)

This invasive cancer starts in the milk-producing glands (lobules) and can be much harder to detect. Women who have this type of cancer can develop the disease in both breasts. While extremely rare, men can also be diagnosed with this disease.
Both Invasive Ductal Carcinoma and Invasive Lobular Carcinoma are the most common types of invasive breast cancer.
Less common types of cancer include:

Inflammatory Breast Cancer (IBC)

The symptoms for this type of cancer are different than other breast cancers. Inflammation including swelling and redness, not caused by an injury or infection may be present. IBC can also cause a thickening of the skin on the breast, creating the appearance of pitting; similar looking to the skin of an orange. These symptoms are caused by cancer cells that interfere or block the lymph vessels in the skin.

Paget disease of the nipple

This rare type of cancer starts in the breast ducts and spreads to the skin of the nipple and areola, the dark circle around the nipple.

Phyllodes tumor

Phyllodes tumors are rare breast tumors. These tumors develop in the connective tissue (stroma) of the breast. For the most part, the tumors are benign, but excisional biopsies are done to remove the entire tumor, which is the only way to be certain if it is benign, or malignant. Having this type of tumor does not increase a person’s risk for developing another type of breast cancer, but careful monitoring is necessary because tumors can reoccur after surgery.

Angiosarcoma

Angiosarcoma is a cancer that starts in the cells of muscles, fat or the lining of blood or lymph vessels, and can affect both breast tissue and the skin of the breast, as well as other areas of the body. This may be caused by prior radiation exposure. It can look like a skin infection, a bruise, or a lesion that does not heal. The disease can spread so patients should be closely monitored after treatment.

Metastatic Breast Cancer

Breast cancer that has spread to lymph nodes and other parts of the body is called metastatic breast cancer, also called Stage IV. It is common for the cancer to spread to the bones, lungs or liver, but it can also spread to the brain or other organs in the body. Even though a breast cancer spreads to another organ, it is still considered to be breast cancer, as opposed to a new type of cancer.

Hormone Receptors

Some breast cancer cells test positive for a type of hormone receptor which are actually proteins that are found in the inner and outer surfaces of the cells. If present, these receptors attach themselves to either estrogen or progesterone hormones, and the hormones fuel the growth of the breast cancer.
ER-positive breast cancers have estrogen receptors, and PR-positive breast cancers have progesterone receptors. Oncologists can order tests on tissue samples of tumors taken from the breast to identify if a receptor is present, so they will know how to correctly treat the disease. Some cancer treatments can work by blocking the receptors’ ability to attach to hormones, which can stop the cancer from growing and spreading to surrounding tissues in the breast, or other parts of the body.
Oncologists will also test HER2/neu levels in breast cancer tumors. HER2/neu is a protein that is on the outside of all breast cells. If the levels are found to be higher than normal, the breast cancer is referred to as HER2-positive, and these cancers have more aggressive growth, and can spread faster. If the levels are lower than normal, the cancer is categorized as HER2-negative.
When the cancer is diagnosed as HER2-positive, it can be treated more successfully with drugs that specifically target this protein. HER2-negative cancers do not respond to this type of treatment.

Triple Negative Breast Cancer

Triple negative breast cancer does not have hormone receptors. Unlike other types of breast cancer, it is not dependent on hormones for growth and the cancer cells don’t over-produce the HER2 protein.
The name triple negative refers to breast cancer that is estrogen receptor negative (ER-), progesterone receptor–negative (PR-), and HER2 receptor-negative (HER2-). It is a more complex disease, and the medications used to block the estrogen and progesterone hormones and the HER2 protein are not as effective in treating it. There are however, a number of other chemotherapy drugs that are used, usually in combination with both surgery and radiation.

While anyone can be diagnosed with this type of cancer, it is typically seen in a younger population of women (under age 50). Both African American and Hispanic populations and people with a BRCA1 gene mutation are at a greater risk.

Triple negative breast cancer is more aggressive, more likely to spread and has a higher incidence of recurrence.

Breast Reconstruction

For women that have had a mastectomy as part of their beast cancer treatment, breast reconstruction may be an option. Breast surgeons and plastic surgeons work together to decide on the best treatment plan, and will advise if it is possible, and whether the reconstruction can be done at the same time as the mastectomy, or if it should be done later.
For women who are candidates for breast reconstruction, there is no right or wrong answer; it is a personal choice. The decision should be made after careful discussion with their surgeon, and after they fully understand potential benefits and risks.
For those women who are not a candidate or decide against reconstruction, some may choose to use a breast prosthesis to help them feel more comfortable and confident with their appearance after their mastectomy, while other women don’t choose either option.

Helpful Patient Resources:

We understand that receiving a cancer diagnosis can be a very scary and it is an emotional time for the patient and their families. It is very important to discuss any questions or concerns you may have with your oncologist. We highly recommend that if you do any research about your disease, that you do so only with reputable sources. For your convenience, we’ve listed some below.

National Cancer Institute:

American Cancer Society

Sarcomahelp.org