Breast Cancer

Invasive breast cancer is the most commonly diagnosed malignancy in women after skin cancers.  The American Cancer Society estimates that approximately 192,370 new cases were in the United States during 2009. During the same time period, 40,170 women were expected to die from invasive breast cancer, making it the second most frequent cancer killer of American women. Although the incidence of invasive breast cancer has risen steadily during the past several decades, breast cancer–related mortality has begun to decline in recent years. This is due to both high screening rates and the use of and improvements in systemic adjuvant therapy.

 Frequently Asked Questions

Q: How is breast cancer detected?

A:  The goal of screening exams for early breast cancer detection is to find cancers before they start to cause symptoms. Screening refers to tests and exams used to find a disease, such as cancer, in people who do not have any symptoms. Early detection means using an approach that allows earlier diagnosis of breast cancer than otherwise might have occurred. Breast cancers that are found because they are causing symptoms tend to be larger and are more likely to have already spread beyond the breast. In contrast, breast cancers found during screening exams are more likely to be smaller and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the prognosis (outlook) of a woman with this disease. Most doctors feel that early detection tests for breast cancer save many thousands of lives each year, and that many more lives could be saved if even more women and their health care providers took advantage of these tests. Following the American Cancer Society's guidelines for the early detection of breast cancer improves the chances that breast cancer can be diagnosed at an early stage and treated successfully.

Q: How is breast cancer diagnosed?

A:  There are several means to diagnose breast cancer.  Listed below are the most common.

• Mammogram.  A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality.  Current evidence supporting mammograms is even stronger than in the past. In particular, recent evidence has confirmed that mammograms offer substantial benefit for women in their 40s. Women can feel confident about the benefits associated with regular mammograms for finding cancer early. However, mammograms also have limitations. A mammogram can miss some cancers, and it may lead to follow up of findings that are not cancer.

• Breast ultrasound.  Ultrasound uses sound waves to produce images of structures deep within the body. Your doctor may recommend an ultrasound to help determine whether a breast abnormality is likely to be a fluid-filled cyst rather than a breast tumor.

• Breast magnetic resonance imaging (MRI).  An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye.  There is no evidence right now that MRI will be an effective screening tool for women at average risk. While MRI is more sensitive than mammograms, it also has a higher false-positive rate (it is more likely to find something that turns out not to be cancer). This would lead to unneeded biopsies and other tests in many of the women screened.

• Removing a sample of breast cells for testing (biopsy).  A biopsy to remove a sample of the suspicious breast cells helps determine whether cells are cancerous or not. The sample is sent to a laboratory for testing. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer and whether the cancer cells have hormone receptors.

Q: What are increased risk factors associated with breast cancer?

A: Things that can increase your risk of breast cancer include:

• Being female.  Women are much more likely than men are to develop breast cancer.

• Increasing age.  Your risk of breast cancer increases as you age. Women older than 60 have a greater risk than do younger women.

• A personal history of breast cancer.  If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.

• A family history of breast cancer.  If you have a mother, sister or daughter with breast cancer, you have a greater chance of being diagnosed with breast cancer. Still, the majority of people diagnosed with breast cancer have no family history of the disease.

• Inherited genes that increase cancer risk.  Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most common gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.

• Radiation exposure.  If you received radiation treatments to your chest as a child or young adult, you're more likely to develop breast cancer later in life.

• Obesity.  Being overweight or obese increases your risk of breast cancer.

• Beginning your period at a younger age.  Beginning your period before age 12 increases your risk of breast cancer.

• Beginning menopause at an older age.  If you began menopause after age 55, you're more likely to develop breast cancer.

• Having your first child at an older age.  Women who give birth to their first child after age 35 may have an increased risk of breast cancer.

• Postmenopausal hormone therapy.  Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer.

• Drinking alcohol.  Drinking alcohol may increase the risk of breast cancer.

Q: What are the symptoms of breast cancer?

A: Common symptoms of breast cancer include:

• A breast lump or thickening that feels different from the surrounding tissue

• Bloody discharge from the nipple

• Change in the size or shape of a breast

• Changes to the skin over the breast, such as dimpling

• Inverted nipple

• Peeling or flaking of the nipple skin

• Redness or pitting of the skin over your breast, like the skin of an orange

Q: What is Her2 and therapy for it?

A: HER2/neu(also known as ErbB-2) stands for "Human Epidermal growth factor Receptor 2" and is a protein giving higher aggressiveness in breast cancers. Since the discovery that the HER2 receptor is overexpressed in a large number of EBCs, it has been pursued for targeted therapies. The most clinically advanced of these targeted therapies is the monoclonal humanized anti-HER2 antibody trastuzumab. The impact of trastuzumab on patients with EBC is significant—approximately one quarter of women diagnosed with EBC are found to have HER2-positive disease. HER2-positive tumors are also associated with a more aggressive nature and carry a high risk of relapse and death resulting from metastatic disease. Incorporation of trastuzumab with chemotherapy for the adjuvant treatment of EBC has been investigated in several clinical trials.

Q:  What are BRAC1 & BRAC2?

A: Approximately 10 percent of breast cancers are linked to gene mutation passed through family members. A number of inherited defective genes that can increase the likelihood of breast cancer have been identified. The most common are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which increase the risk of both breast and ovarian cancer.  If you have a strong family history of breast cancer or other cancers, blood tests may help identify defective BRCA or other genes. Consult with your doctor for a referral to a genetic counselor who can review your family health history and discuss the benefits, risks and limitations of genetic testing with you.

Q: Do I have a choice of treatment?

A:  There are several options for the treatment of breast cancer, depending on your age, the size and location of the tumor, the stage of the disease (i.e., whether it has spread to other organs) and your general health. You may also have concerns regarding the treatment process and potential side effects; therefore, it is essential that you and your doctor discuss all available options leading to the development of a treatment plan that is specifically tailored to your needs and circumstances.  Here are a few common treatments:

       (1)  Surgery-  For most patients, surgery is the first step in their breast cancer treatment.  A surgical procedure to take out the tumor, (the medical term is “resection”), is the only way to completely remove it from the body.  Other forms of cancer treatment are designed to destroy or stop the growth of cancer cells, but do not actually remove the tumor from your body. There are two main categories of breast cancer surgeries: Lumpectomy (also known as breast conservation surgery or breast conservation therapy) and Mastectomy.

      (2)  Radiation Therapy- In this type of treatment, beams of radiation are targeted on the tumor site to destroy the cancer cells while preserving the healthy surrounding tissue.  The two main kinds of radiation therapy are external beam radiation and internal beam radiation, both of which can be used to treat breast cancer.  With external beam radiation, the radiation is generated by equipment outside of your body.  With internal beam radiation, known as brachytherapy, the radiation source is placed inside the body.  Patients with breast cancer who are treated at Riverside can receive internal radiation in the form of Mammosite® technology, a relatively new but well established therapy that reduces the duration of treatment time when compared to conventional radiotherapy.  You and your physician will discuss what type of radiation, if any, is right for your treatment. 

       (3)  Chemotherapy-  This type of treatment uses cancer-fighting drugs (inlcuding chemotherapy medications) to treat tumors through a systemic approach – meaning that the medicine travels throughout the body, unlike radiation and surgery which are directed to a single site.  Depending on the particular type of medication, the drug may be taken by mouth in pill form or delivered directly into the bloodstream through an IV.  These medications are often very strong, and can have unpleasant side effects. You and your medical oncologist will decide what combination, or regimen, of medications is right for you.

      (4)  Anti-hormonal therapy-  Like other medical treatments, hormone therapy is a systemic treatment.  It is most often used to help prevent a recurrence of breast cancer, but it can also be used to treat more aggressive cancers. Anti-hormonal therapy works by blocking naturally occurring hormones that can enhance some tumor cells.  Depending on the diagnosis, you and your physician may discuss anti-hormonal treatment as a possible therapy.

     (5)  Targeted Therapy-    Type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapies being studied in the treatment of breast cancer.  Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as adjuvant therapy.  Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which sends growth signals to breast cancer cells. About one-fourth of patients with breast cancer have tumors that may be treated with trastuzumab combined with chemotherapy.  Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used in combination with other anticancer drugs as adjuvant therapy.  Lapatinibis a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used to treat patients with HER2-positive breast cancer that has progressed following treatment with trastuzumab.

This information is intended for patient education and information only. It does not constitute advice, nor should it be taken to suggest or replace professional medical care from your physician. Your treatment options may vary, depending upon medical history and current condition. Only your physician and you can determine your best option.