Breast Cancer

Description

1. Breast cancer, the most common type of cancer in women, is second only to lung cancer as a cause of cancer death among women. It is the leading cause of death for women aged 35 to 50 in the United States. An individual woman's risk of developing breast cancer in this country is about 1 in 10.
2. More than 180,000 women are diagnosed with breast cancer each year. The United States has a very high rate of breast cancer relative to many other countries. Though many factors may play a role, a clear cause, such as diet, has not been found.

3. When cancer arises in breast tissue and spreads (metastasizes) outside the breast, cancer cells are often found in the lymph nodes under the arm. If the cancer has reached these nodes, it means that cancer cells may have spread to other parts of the body-other lymph nodes and other organs, such as the bones, liver, or lungs. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor.


Risk factors

1. Family history of breast cancer in mother, sister, or daughter
2. Previous endometrial (uterine) cancer
3. Previous breast cancer
4. Carrier of BRCA1 or BRCA2 genes (especially prominent in Ashkenazi Jews)
5. Menstrual periods started before age 12
6. Menopause after age 50
7. No children
8. Estrogen replacement therapy



Symptoms

1. Breast lump
2. Nipple discharge
3. Retracted nipple
4. Red/inflamed nipple
5. Breast enlargement
6. Breast shrinkage
7. Breast becomes hard
8. Bone pain
9. Back pain



Diagnosis

1. Examination
2. Breast lump
3. Nipple discharge
4. Skin changes on breast
5. Hardened breast
6. Enlarged lymph glands
7. Above clavicles (collar bone)
8. Armpits
9. Sides of center bone in chest
10. Mammogram
11. Ultrasound
12. Bone Scan-checks for spread to bones
13. CAT scan/MRI to check for spread to brain
14. Tests:
# Needle aspiration
# Mammatome test:
special type of needle biopsy with special x-ray techniques to localize deep lumps
# Open surgical biopsy: Lump is removed and sent to lab for analysis.
# Lymph node dissection: Multiple lymph nodes are removed to check for cancer spread.
# Sentinel lymph node dissection: A new technique in which only a few lymph nodes need to be biopsied rather than the traditional lymph node dissection.



Similar conditions

1. Fibroadenoma
2. Fibrocystic breast disease
3. Breast abscess



Treatment

1. Breast cancer treatment depends on three major factors: A) if a woman is pre- or postmenopausal, B) the extent that breast cancer has spread, and C) cell type of the breast cancer. Extent of spread of the cancer can be explained in the following categories: 1) localized to the breast, 2) spread to the lymph nodes, 3) spread to muscle deep in the breast, 4) spread to the other breast, and 5) spread to other organs such as bone or brain. In terms of cell types, there are more aggressive and less aggressive cell types. In addition, there are receptors on the cells (for example estrogen-receptors) that make a breast cancer more responsive to treatment. Specific treatments are as follows:
2. Lumpectomy with radiation treatment
3. Modified radical mastectomy: removal of breast, muscles below it and lymph glands in axilla
4. Ovarian ablation: This treatment makes the ovaries inactive so they do not produce hormones that may stimulate breast cancer growth. This is not commonly done, but new medical literature suggests it may be helpful in some cases.
5. Medications:
6. Tamoxifen
7. CMF chemotherapy



Prevention

1. Monthly self-breast examination
2. Yearly exam by a physician
3. Mammograms: Baseline at 35-40 years old, every 1-2 years between age 40 and 49 depending on risk factors, and every year after age 50. Mammograms may be recommended in certain high-risk younger women.
4. Vitamin D: There is some evidence that Vitamin D may offer protection against breast cancer. A dose of 400 I.U. daily is appropriate.
5. Tamoxifen: Some studies have shown Tamoxifen to prevent breast cancer in high-risk women. Tamoxifen does have side effects, including rare serious eye problems and an increased risk of endometrial cancer.