What is Breast Cancer?

A woman’s breast is made up of glands that make breast milk (lobules), ducts (small tubes that carry milk from the lobules to the nipple), fatty and connective tissue, blood vessels, and lymph (pronounced limf) vessels. Most breast cancers begin in the cells that line the ducts (ductal cancer), some begin in the lobules (lobular cancer), and the rest in other tissues.

Breast cancer is the most common type of cancer in women, with approximately one in nine women developing the disease in her lifetime. Although breast cancer is known to affect women, it also can be equally devastating to men. Male breast cancer accounts for 1% of all diagnosed breast cancer.

Breast cancer is a disease in which cancerous cells are found in the tissues of the breast. These cancerous cells continue to grow and eventually form into a lump known as a tumor.

Although more than 80% of breast lumps are not cancerous, a process known as a biopsy is the only way to know for sure. A biopsy requires the doctor to remove a small sample of tissue and examine it under a microscope and check for cancerous cells.

Breast cancer affects more American women than any other type of cancer. There were about 100,000 new cases diagnosed in 1985, and in 1994, over 180,000 new cases were confirmed. One reason given to this dramatic rise is that more women are receiving diagnostic tests for breast cancer. However, other reasons for the long-term increase in breast cancer are not yet fully understood.

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Why is breast cancer a concern for American Indian women?

While there is less data available for Native American women, overall cancer survival rates for Native Americans are lower than the Anglo population. Like the Hispanic population, Native Americans differ culturally and linguistically from the majority of Americans. These differences, combined with lack of access to healthcare, impact of culture and use of traditional healers are possible explanations of these findings.

http://www.azcc.arizona.edu/prevent/Breast-cancer02.htm

Many Native American women fail to consider this fact and simply label breast cancer as a “white man’s” disease.  Although it is true that white women have a higher incidence of breast cancer—approximately 93.3 cases per every 100,000—Native American women have a lower survival rate!

Native American women have the poorest five-year survival rate of any race—which is 21.7 cases per every 100,000. The low survival rate that plagues American Indian women can be related to the late detection of breast cancer.

• American Indian women are diagnosed with breast cancer at the same rate as the overall population, but die from it much more frequently.
• Breast cancer is the second largest cause of cancer deaths among women of all ages.
• The five-year survival rate for Native American women is approximately 46.2%, which is much lower compared to non-native women who have a survival rate of 85%.   Much of this lower percentage rate has to do with the lack of early detection measures such as proper mammography equipment.

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What causes breast cancer?

Although breast cancer is the leading cause of cancer deaths for women between the ages of 35 and 54, the causes of breast cancer are unknown. However heredity does play a role in the development of breast cancer. The DNA in your cells carries the heredity information that you received from your parents. Recently, researchers with the aid of powerful new technologies have been able to examine the cells of the human body to probe the very genes where the real action of breast cancer takes place.

In 1994, a gene was located and sequenced that has been shown to be changed in 5% of the 180,000 breast cancer patients. Relatives of breast cancer patients who carry this modified gene have a higher rate of developing breast cancer in their lives. Tests are being developed to determine who has this gene long before any cancer appears. Even with these tests, scientists still do not have a way of directly treating the defective genes. Although researchers are investigating the possible roles of heredity, environment, lifestyles, and diet, it's still not clear what causes most breast cancer or how to prevent it.

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What are some of types of breast cancer?

There are many types of breast cancer, though some of them are very rare. Sometimes a breast tumor can be a combination of these types and to have a mixture of invasive and in situ cancer.

• Ductal carcinoma in situ (DCIS): This is the most common type of non-invasive breast cancer. DCIS means that the cancer is only in the ducts. It has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. Often the best way to find DCIS early is with a mammogram.
  
  
• Lobular carcinoma in situ (LCIS): This condition begins in the milk-making glands but does not go through the wall of the lobules. Although not a true cancer, having LCIS increases a woman's risk of getting cancer later. For this reason, it's important that women with LCIS to follow the screening guidelines for breast cancer (these are discussed later in this document).
  
  
• Invasive (infiltrating) ductal carcinoma (IDC): This is the most common breast cancer. It starts in a milk passage or duct, breaks through the wall of the duct, and invades the tissue of the breast. From there it can spread to other parts of the body. It accounts for about 8 out of 10 invasive breast cancers.
  
  
• Invasive (infiltrating) lobular carcinoma (ILC): This cancer starts in the milk glands or lobules. It can spread to other parts of the body. About 1 out of 10 invasive breast cancers are of this type.
  
  
• Inflammatory breast cancer (IBC): This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, inflammatory breast cancer (IBC) makes the skin of the breast look red and feel warm. It also gives the skin a thick, pitted appearance that looks a lot like an orange peel. Doctors now know that these changes are not caused by inflammation or infection, but by cancer cells blocking lymph vessels in the skin. The breast may become larger, firmer, tender, or itchy. IBC is often mistaken for an infection in its early stages. Because there is no defined lump, it may not appear on a mammogram, which may make it even harder to catch it early. It usually has a higher chance of spreading and a worse outlook than invasive ductal or lobular cancer.

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What are the risk factors for breast cancer?

While all women are at risk for breast cancer, the factors listed below can increase a woman’s chances of having the disease.

Controllable Risk Factors:

• Not Having Children or Having Them Later in Life- Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant more than once and at an early age reduces breast cancer risk.

• Birth control pills- It is still not clear what part birth control pills might play in breast cancer risk. Studies have found that women who are using birth control pills have a slightly greater risk of breastcancer than women who have never used them. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. It’s a good idea to discuss the risks and benefits of birth control pills with your doctor.

• Postmenopausal Hormone Therapy (PHT)- Postmenopausal hormone therapy (also known as hormone replacement therapy or HRT), has been used for many years to help relieve symptoms of menopause and to help prevent thinning of the bones (osteoporosis). There are 2 main types of PHT. For women who still have a womb (uterus), doctors generally prescribe estrogen and progesterone (known as combined PHT). Because estrogen alone can increase the risk of cancer of the uterus, progesterone is added to help prevent this. For women who no longer have a uterus (those who've had a hysterectomy), estrogen alone can be prescribed. This is commonly known as estrogen replacement therapy (ERT).

• Combined PHT-  It has become clear that long-term use (several years or more) of combined PHT increases the risk of breast cancer and may increase the chances of dying of breast cancer. The breast cancer may also be found at a more advanced stage, perhaps because PHT seems to reduce the effectiveness of mammograms. Five years after stopping PHT, the breast cancer risk seems to drop back to normal.

• ERT- The use of estrogen alone does not seem to increase the risk of developing breast cancer much, if at all. But when used long-term (for more than 10 years), some studies have found that ERT increases the risk of ovarian and breast cancer.

• Breast-feeding and Pregnancy- Some studies have shown that breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1½ to 2 years. This could be because breast-feeding lowers a woman’s total number of menstrual periods, as does pregnancy. One study found that having more children and breast-feeding longer could reduce the risk of breast cancer by half.

• Alcohol- Use of alcohol is clearly linked to an increased risk of getting breast cancer. Women who have 1 drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink.

• Being Overweight or Obese- Being overweight or obese is linked to a higher risk of breast cancer, especially for women after change of life and if the weight gain took place during adulthood. Also, the risk seems to be higher if the extra fat is in the waist area. But the link between weight and breast cancer risk is complex, and studies of fat in the diet as it relates to breast cancer risk have often given conflicting results. The American Cancer Society recommends you maintain a healthy weight throughout your life and avoid gaining too much weight.

• Exercise- Studies show that exercise reduces breast cancer risk. The only question is how much exercise is needed. One study found that as little as 1 hour and 15 minutes to 2 and a half hours of brisk walking per week reduced the risk by 18%. Walking 10 hours a week reduced the risk a little more. The American Cancer Society suggests that you exercise for 45 to 60 minutes 5 or more days a week.

Uncontrollable Risk Factors:

• Gender- Simply being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.

• Age- The chance of getting breast cancer goes up as a woman gets older. About 2 out of 3 women with invasive breast cancer are age 55 or older when the cancer is found.

• Genetic Risk Factors- About 5% to 10% of breast cancers are thought to be linked to changes (mutations) in certain genes. The most common gene changes are those of the BRCA1 and BRCA2 genes. Women with these gene changes have up to an 80% chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk as well.

• Family History- Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother’s or father’s side of the family. Having a mother, sister, or daughter with breast cancer about doubles a woman’s risk. (It's important to note that 70% to 80% of women who get breast cancer do not have a family history of this disease.)

• Personal History of Breast Cancer- A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from the first cancer coming back (recurrence).

• Race- White women are slightly more likely to get breast cancer than are African-American women. But African American women are more likely to die of this cancer. At least part of the reason seems to be because African-American women have faster growing tumors. Asian, Hispanic, and American Indian women have a lower risk of getting breast cancer.

• Abnormal Breast Biopsy- Certain types of abnormal biopsy results can be linked to a slightly higher risk of breast cancer.

• Menstrual Periods- Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer.

• Earlier Breast Radiation- Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer.

• Treatment with DES- In the past, some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of losing the baby (miscarriage). Recent studies have shown that these women (and their daughters who were exposed to DES while in the womb), have a slightly increased risk of getting breast cancer.

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What can you do to prevent getting breast cancer?

Unfortunately, breast cancer is unpreventable, but if detected early enough it can be cured. Early detection of the cancerous growth are the most effective and successful ways to increase survival from a breast cancer diagnosis. A woman might reduce her risk somewhat by changing those risk factors that can be changed.

• Genetic Testing- There are tests that can tell if a woman has certain changed (mutated) genes linked to breast cancer. With this information, women can then take steps to reduce their risk. Genetic counseling is strongly recommended before a woman has these tests and before she makes any decisions about preventive measures. Recently the U.S. Preventive Services Task Force made recommendations for genetic testing. They recommended that only women with a strong family history be evaluated for genetic testing for BRCA mutations. This group is only about 2% of adult women in the United States.

• Breast Cancer Chemoprevention- Chemoprevention is the use of drugs to reduce the risk of cancer. Several drugs have been studied for use in lowering breast cancer risk. The drug tamoxifen has already been used for many years as a treatment for some types of breast cancer. Now several studies have shown that women at high risk for breast cancer are less likely to get the disease if they take tamoxifen. Another drug, raloxifene, has been approved to help reduce breast cancer risk in women past menopause who are at high risk for breast cancer.

• Preventive (prophylactic) mastectomy- For the few women who are at very high risk for breast cancer, this surgery (a double mastectomy) may be an option. In this operation both breasts are removed before there is any known breast cancer. While this operation removes nearly all of the breast tissue, a small amount remains. So although this operation greatly reduces the risk of breast cancer, the disease can still develop in the breast tissue that remains after surgery. To date, this has been a rare problem.

• Preventive ovary removal (prophylactic oophorectomy)- Women with a certain gene change (BRCA mutation) who have their ovaries removed may reduce their risk of breast cancer by half or more. This is because taking out the ovaries removes the main sources of estrogen in the body.

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What are the signs/symptoms of breast cancer?

Generally, early breast cancer does not cause pain. Even so, a woman should see her health care provider about breast pain or any other symptom that does not go away.

Common symptoms of breast cancer include:

• A change in how the breast or nipple feels
  You may experience nipple tenderness or notice a lump or thickening in or near the breast or in the underarm area.

• A change in how the breast or nipple looks
  This could mean a change in the size or shape of the breast or a nipple that is turned slightly inward. In addition, the skin of the breast, areola or nipple may appear scaly, red or swollen or may have ridges or pitting that resembles the skin of an orange.

• Nipple discharge

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How can breast cancer be detected?

Step 1. Self Breast Exam (BSE)

• Starting at age 20, a woman should exam her own breasts every month for changes.

Step 2. Clinical Breast Exam (CBE)

• Starting at age 20, a woman should see her health care provider every year for regular breast exams.

Step 3. Mammogram

• Starting at age 40, a woman should get a screening mammogram every year. A mammogram is a special x-ray of the breast.

For more guidelines on screenings, go to the American Cancer Society at http://www.cancer.org and to the National Cancer Institute at http://www.cancer.gov.

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What treatments are available for breast cancer?

You need to see a doctor if you notice changes in your breast. Not all breast cancers or breast cancer patients are alike; therefore treatment will vary with the individual.
An individual's chance for recovery depends upon a number of factors such as:

• The stage of the cancer (whether it is just in the breast or has spread to other parts of the body)
• The type of breast cancer
• The certain characteristics of the cancer cells
• Your age and weight
• Menopausal status
• Overall state of health

Treatments for early breast cancer can include:

• lumpectomy: limited surgery which removes the cancer but not the entire breast. (picture)
• mastectomy: surgical removal of the breast. (picture)

Additional treatment may include:

• chemotherapy: cancer drugs are given to the patient to kill cancer cells.
• hormone therapy: drugs to reduce certain hormones that the cause the cancer to grow.
• biological therapy: using the body's own immune system to fight cancer. Interferon and Interlukin.
• bone marrow transplantation are new methods that are currently being tested in clinical trials.

Often, two or more methods are used in combination.

An individual with breast cancer should fully review all of the options with a physician before deciding upon the proper treatment program.

Once breast cancer has been found, more tests are conducted to see if the cancer has spread from the breast to other parts of the body. The spreading of cancer in this manner is called metastasis. Doctors need to know the stage of the disease - how large the tumor is, and if there are cancer cells beyond the breast - to plan the proper treatment.

Listed below are the basic stages of breast cancer:

Stage I - The cancer is no wider than 2 centimeters and has not spread outside the breast.
Stage II - The tumor is more than 2 cm but less than 5 cm in the greatest dimension.
Stage III - Tumor is more than 5 cm in the greatest dimension.
Stage IV- Tumor of any size with growth extending to the chest wall or skin.

Even after an individual has been treated for breast cancer, it is possible for the cancer to come back (recur). However in most cases, the cancer can be treated, but usually cannot be cured, once the breast cancer has spread to other parts of the body.

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