A Patient’s Guide to Breast Cancer
Signs and Symptoms
Not every case of breast cancer will have signs and symptoms noticeable to the patient straight away. This is why routine screening, i.e. regularly scheduled mammograms, are considered by many doctors to be critical to improving survival rates of the disease. However, some breast cancers do show themselves. If you notice any of the following signs, as outlined by the Memorial Sloan Kettering Cancer Center, see your doctor right away:
- “A lump or thickness in or near the breast or under the arm
- Unexplained swelling or shrinkage of the breast, particularly on one side only
- Dimpling or puckering of the breast
- Nipple discharge (fluid) other than breast milk that occurs without squeezing the nipple
- Breast skin changes, such as redness, flaking, thickening or pitting that looks like the skin of an orange
- A nipple that becomes sunken (inverted), red, thick or scaly”
There are many factors that contribute to whether you’ll develop breast cancer in your lifetime. The primary risk for any cancer is age – the older you are, the more chances you’ll have a cell develop genetic mutations that could eventually grow into cancer. This is true for breast cancer, too, which affects more older women than it does younger women. The National Cancer institute reports that the median age at diagnosis among breast cancer patients is 62 years.
Genetics have also been shown to play a role in whether you’ll develop breast cancer. Genetic mutations on the BRCA1 and BRCA2 gene have gotten a lot of attention over the past 10 years or so as being the primary source of genetically-based cases of breast cancer, but other genetic mutations can also lead to the development of cancer. Certain ethnicities, in particular Ashkenazi Jews, have a higher rate of BRCA1 and BRCA2 gene mutations. A strong family history of breast, ovarian or prostate cancer could also point to a genetic component and may lead you to pursue genetic testing to get a better understanding of your individual risk.
Other individual variations in the amount of estrogen your body produces and the duration of that exposure can factor into whether you develop breast cancer. This is why your doctor will likely ask how old you were when you started menstruating, when you entered menopause, whether you’ve had children and whether you breastfed any children you did have. Taking birth control pills, getting pregnant later in life or not getting pregnant at all may also slightly increase your risk of developing breast cancer. Studies have also shown that exposure to certain chemicals in the environment, a lack of exercise and poor diet can play a role in the development of breast cancer.
Mammography is the most common tool currently used to diagnose breast cancer. A mammogram is an X-ray of the breasts that creates an image that is then reviewed by a radiologist. This doctor is looking for suspicious lumps or growths that will show up as a whiter spot against a darker background. The Susan G. Komen organization reports that mammography has an 84 percent success rate. Other diagnostic tools include:
- Digital mammography. This is also an X-ray, but the image is rendered digitally rather than on film.
- Digital tomosynthesis. This tool creates a three-dimensional image, allowing the radiologist to look at cross sections of the breast, rather than the entire breast all at once.
- Ultrasound. Ultrasound technology uses sound waves to create images of the breasts and any masses within them without the use of radiation. It’s often used as a follow up to a mammogram with an abnormal finding.
- MRI. Molecular resonance imaging uses magnetic fields and radio waves to create an image of the breast. This is usually used only as a secondary screening tool after something abnormal shows up on a mammogram.
- Molecular breast imaging. MBI uses an injected radioactive isotope to light up cancerous growths on an image created with a molecular camera. It has a higher success rate for finding cancers in women with very dense breasts, but some concerns persist about the amount of radiation the patient’s body is exposed to during the procedure.
Each modality has its pros and cons, but the good news is that these days, there are several different ways your doctor can get a picture of what’s going on inside your breasts that may aid in the early diagnosis of breast cancer.
The U.S. Preventive Services Task Force currently recommends that all women age 50 to 74 have a biennial screening mammogram. The American Cancer Society recommends women of average risk start annual screening at age 45. Neither group currently recommends that women conduct monthly breast self-exams, but advocate that women should be aware of their breasts and remain vigilant of any changes.
Most people think of breast cancer as a single disease, but in fact, there are several different types of breast cancer you may end up facing in your lifetime. They can be classified into two broad categories: noninvasive and invasive. For noninvasive cancer, the Cancer Treatment Centers of America website reports that “cancerous cells remain in a particular location of the breast, without spreading to surrounding tissue, lobules or ducts.”
With invasive breast cancers, “cancerous cells break through normal breast tissue barriers and spread to other parts of the body through the bloodstream and lymph nodes,” reports Breastcancer.org, an educational website. Invasive ductal carcinoma, in which cancer cells grow in the milk ducts, is the most common form of breast cancer, according to the American Cancer Society.
Invasive breast cancers are further categorized by the shape and location of the tumor. In addition, the cancer will be classified based on how it is fed by the body, with the majority of breast cancers being considered estrogen receptive (ER) – that is they’re fed by estrogen.
Because there are many different types of breast cancer, the approach your doctor takes to treating yours will be highly individualized. Treatments can include:
- Surgery. Your doctor may prescribe a:
- Lumpectomy, in which the cancerous tissue is removed from the breast but most of the breast is left intact.
- A mastectomy, in which the entire breast is removed. The surgeon may also remove some nearby lymph nodes.
- A bilateral mastectomy, in which both breasts are removed, along with nearby lymph nodes.
- Radiation. Radiation therapy uses targeted, high-energy light and X-rays to kill cancer cells where they grow. It’s used in certain breast cancer cases to kill cancer cells, but not all.
- Endocrine therapy. Endocrine therapy is drug-based regimen that suppresses the hormones that feed the cancer. Tamoxifen is one of the most commonly prescribed anti-estrogen drugs and an example of this type of treatment.
- Chemotherapy. Chemotherapy is a drug-based way of killing cancer cells wherever they may be in the body, and it’s notorious for having deleterious side effects, such as hair lossand nausea. Nevertheless, chemotherapy can be a highly effective, systemic way of ridding the body of cancer. It’s sometimes used before surgery to shrink a tumor, or after to kill any cancer cells that may have been left behind
- Immunotherapy. One of the newer forms of treatment is highly targeted immunotherapy. This type of treatment leverages your body’s own ability to fight cancer naturally. It may have fewer side effects for some people, but not everyone responds well to immunotherapy. This highly personalized approach will likely become more popular in the future as medical science learns more about how to use the immune system to fight cancer where it grows.
The type of treatment you’ll receive is based not only on the type of cancer you have, but also on your preferences and what the doctor thinks will work best for your body and your individual situation.
Breast cancer is a complex disease that can have wide-ranging impacts on your health and many different aspects of your life. Available screening, treatments and our understanding of the various diseases that constitute breast cancer continue to evolve. For more information, please read on with our in-depth series that covers many different aspects of this common disease.
Article By: Elaine K. Howley