An eye on breast cancer

By MAXWELL ADEYEMI

Body cells reproduce on a regular basis, occasionally, these cells grow and divide out of control and defy the social norm of cell division. The excessive growth creates a mass known as a tumour. If the cells are normal cells, they are referred to as benign tumours, but if the cells are abnormal cells which do not function as the normal cells, they are referred to as malignant tumours. When these abnormal cell divisions occur in the breast, they are called breast cancers.

Breast cancer is the most common cancer among women. Increasing age is the most common risk factor for developing breast cancer, with 66 per cent of breast cancer patients being diagnosed after the age of 55. It is the leading cause of cancer death among women ages 35-54. All women, especially as they age, are at some risk for developing breast cancer. The risks for breast cancer in general aren’t evenly spread among ethnic groups, and the risk varies among ethnic groups for different types of breast cancer.

Types of breast cancer

The most common types of breast cancer are:

Infiltrating (invasive) ductal carcinoma. This cancer starts in the milk ducts of the breast. It then breaks through the wall of the duct and invades the surrounding tissue. This is the most common form of breast cancer, accounting for 80 per cent of cases.

Ductal carcinoma in situ is ductal carcinoma in its earliest stage, or precancerous (stage zero). In situ refers to the fact that the caner hasn’t spread beyond its point of origin. In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue. If untreated, ductal carcinoma in situ may become invasive cancer. It is almost always curable.

Infiltrating (invasive) lobular carcinoma. This cancer begins in the lobules of the breast where milk is produced but has spread to surrounding tissues. It accounts for ten to 15 per cent of breast cancers. This cancer can be more difficult to diagnose with mammograms.

Lobular carcinoma in situ is a marker for cancer that is only in the lobules of the breast. It is possible to occur in both or either breast. Thus, it is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.

Stages of breast cancer

Stage zero breast disease is when the disease is localised to the milk ducts.

Stage 1 breast cancer is smaller than two centimetres across and hasn’t spread anywhere – including no involvement in the lymph nodes.

Stage II breast cancer is one of the following:

The tumour is less than two centimetres across but has spread to the underarm lymph nodes (IIA).

The tumour is between two and five centimetres, with or without spread to lymph nodes.

The tumour is larger than five centimetres and has not spread to the lymph nodes under the arm (both IIB)

Stage III breast cancer is also called locally advanced breast cancer. The tumour is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue (IIIA). Stage IIIB breast cancer is a tumour of any size that has spread to the skin, chest wall, or internal mammary lymph nodes (located beneath the breast and inside the chest).

Stage IV breast cancer is defined as a tumour, regardless of size, that has spread to areas away from the breast, such as bones, lungs, liver or brain.

Risk factors for breast cancer

Alcohol consumption. The risk of breast cancer increases with the amount of alcohol consumed.

Body weight. Being obese increases the risk of breast cancer.

Breast implants. Having silicone breast implants and resulting scar tissue make it harder to distinguish problems on regular mammograms. A rare cancer called anaplastic large cell lymphoma (ALCL) is associated with breast implants.

Choosing not to breastfeed. Not breastfeeding can raise the risk

Using hormone – based prescriptions, such as hormone replacement therapy during menopause for more than five years and taking certain types of birth control pills.

Gender. Although men do get breast cancer, it is far more common in women.

Breast density. You are at a higher risk of breast cancer if you have dense breasts. It can also make it harder to see tumours during mammograms.

Getting older. Aging is a factor. A majority of new breast cancer diagnoses come after the age of 55.

Reproductive factors. These include getting your period before age 12, entering menopause after age 55, having no children, or having your first child after 30.

Exposure to radiation. This type of exposure could result from having many fluoroscopy X-rays or from being treated with radiation to the chest area.

Having a family history of breast cancer. Family history includes having a first degree relative (mother, sister, daughter, father, brother, son) with breast cancer poses a higher risk for you.

Having genetic mutations related to certain types of breast cancer. In terms of genetic mutations, these include changes to genes like BRCA1 and BRCA2.

Having already had breast cancer. The risk is higher for you if you have already had breast cancer and/or certain types of benign breast conditions such as lobular carcinoma in situ, ductal carcinoma in situ or atypical hyperplasia.

Warning signs of breast cancer

• A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.

• A mass or lump which may feel as small as a pea.

• A change in the size, shape, or contour of the breast.

• A blood-stained or clear fluid discharge from the nipple.

• A change in the look or feel of the skin on the breast or nipple (dimpled, puckered, scaly or inflamed).

• Redness of the skin on the breast or nipple.

• An area that is distinctly different from any other area on either breast.

• A marble-like hardened area under the skin.

Diagnosis and tests

Breast examination: During the breast exam, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different (in size, texture, and movement) than benign lumps.

Other relevant and helpful diagnostic tests are:

Digital mammography

Ultrasonography

Biopsy

Scintimammography.

Positron emission tomography.

Magnetic resonance imaging

Treatment

If the tests find cancer, you and your doctor will develop a treatment plan to eradicate the breast cancer, to reduce the chance of cancer returning in the breast, as well as to reduce the chance of the cancer travelling to a location outside of the breast, treatment generally follows within a few weeks after the diagnosis.

The type of treatment recommended will depend on the size and location of the tumour in the breast, the results of lab tests done on the cancer cells and the stage, or extent of the disease.

Contact Dr Maxwell on 363-1807or 757-5411.