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Causes - Signs - Symptoms - breast Tumors
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Breast Cancer - Signs - Symptoms - Causes - Treatment
Risk Factors For Breast Cancer Discovering breast cancer (a lump in her breast, a sign of breast cancer), is probably one of a woman's greatest fears. Fortunately, eight out of ten lumps are benign, or in other words, non-cancerous. However, if a woman should discover breast cancer through a persistent lump in her breast or any seemingly-abnormal changes in her breast tissue , it is very important that she see a physician immediately to find out if it is truly breast cancer. If the lump is malignant the prognosis is much improved if it is discovered early. This is why monthly self-exams for breast cancer, regular visits to the doctor and regularly scheduled mammograms may be helpful. Carcinoma of the breast is the most common malignant condition among women and has the highest fatality rate of all cancers affecting women. At some time during her life, 1 in every 8 women in the USA will develop a cancerous condition of the breast. Breast cancer has increased from about 1 in 15 in 1977. In the USA the risk of developing it is 12.64% by age 95, and the risk of dying from the disease is about 3.6% (approximately 40,000 annually). Much of this risk is incurred beyond the age of seventy-five. Risk Factors in Order of Importance 1) Mother had bilateral breast tumors diagnosed prior to
menopause. It should be noted that artificial menopause prior to age 35 and childbearing prior to age 18 may provide some protection from these types of masses. The risk is increased if there is a family history of the disease. If a woman's parent or sibling has the cancerous disease it doubles or triples a woman's risk of developing it. If a more distant relative than a parent or sibling has the disease it increases the risk only very slightly. In some studies it was demonstrated that the risk was higher in women with relatives who had bilateral breast cancer or that had it diagnosed earlier in life (before menopause). When two or more of a woman's parents or siblings have the disease the risk can be up to 5 or 6 times greater. Women who use oral contraceptives have an extremely small increase in the risk of developing the tumors (about a 0.00005% increase - ie., 5 more cases per 100,000 women). The increased risk most often occurs during the period of time the women are actually taking the oral contraceptives. The increase in risk lessens during the 10-year period after they stop taking the contraceptives. Also, women who begin using oral contraceptives before the age of 20 have the greatest increase in the risk of developing carcinoma. Even so, this increased risk is still extremely low. In addition, women who use estrogen replacement therapy after menopause appear to have an increased risk of developing the disease. It is even more increased after 10 or 20 years of estrogen usage although it is still less than double the risk. Women with an early initial menstrual period, a late menopause, or a first pregnancy after age 30 are at increased risk. It is interesting to note that women with a first pregnancy after the age of 30 are even at a higher risk of developing these types of cancerous tumors than those who have never borne a child. It has been speculated that diet may play a part in increasing the risk of development. Diet may play a role in either causing the tumors or increasing the growth rate of the disease itself, but this has not ever been proven conclusively. Also, women who are extremely overweight after menopause are at a greater risk. Symptoms and Signs Between 80% and 90% of all masses are first discovered by self-examination, or accidentally by the patient, as a lump in the breast tissue. In the other 10% to 20% of victims they will show one or more of the following symptoms: a history of breast pain without any noticeable lumps, breast enlargement, or a thickening in the breast tissue itself. Normally during physical examination a lump (mass) distinctly different from the surrounding tissue will be present. In benign disorders there may be some diffuse (spread out) fibrotic (fibrous) changes found in one quadrant (a quarter of a breast). In benign disorders this would most often be in the upper outer quadrant. If there is a slightly firmer thickening of only a single bosom it may be a sign of malignancy. More advanced cancerous masses are characterized by one or more of the following: fixation of the mass to overlying skin on the breast, by the presence of nodules or ulcers in the breast skin, or by an exaggeration of the usual skin markings resulting from swelling due to an obstruction of the lymphatics (lymphedema). If lymph nodes are fixed or diseased in either the area of the underarm/armpit (axillary region) or above or below the collar bone (supraclavicular or infraclavicular regions), surgery is not likely to cure the disease. Particularly virulent (powerful and infectious) are inflammatory breast tumors. This usually causes inflammation in a large area which also causes an enlargement of the affected area. Often there is no detectable mass or lump. It should be noted here that routine mammography reduces the mortality rate by about 25% to 35% in women greater than 50 years old who have no symptoms. However, there is a disagreement over whether women in the 40 to 50 year age group should receive annual mammograms. The ACS states that annual mammograms should be performed each year while the NCI says every one to two years. And the American College of Physicians says that the benefits of mammography are uncertain at this age and does not recommend periodic mammography. Diagnosis If a malignant tumor is suspected during physical examination, biopsy should be performed since diagnosis can be only be made by obtaining tissue for microscopic examination. Before doing a biopsy a mammogram may be helpful to determine if there are other areas that should also be biopsied. The biopsy can also serve as a baseline for future reference and comparison. But the decision to perform a biopsy should never be altered due to the findings of the mammogram. Fine-needle aspiration (drawing out by suction) and cytologic (ie., cell) evaluation may be enough to confirm a tumor or mass. If the tissue from a suspicious mass or lesion is negative, a more definitive procedure should be performed: either needle or incisional biopsy if the mass is large, or excisional biopsy if the suspected tissue is small in size. Also, stereotactic biopsies (a needle biopsy performed during mammography) are now being used for increased accuracy in diagnosis. At present this method appears to be at least as safe and as accurate as the traditional biopsy procedures. Most biopsies are fairly routine and can be performed using only a local anesthetic. Treatment To a large degree, the treatment of choice depends on the age of the patient and the extent of the disease. Palliative treatment (relieving the pain without curing the disease) is all that can be hoped for when there is evidence of substantial involvement of axillary (underarm - armpit), supraclavicular (above the collar bone), or internal mammary lymph nodes or of wider metastatic spread. Metastatic spread normally refers to a spread of the disease by the lymphatics or the bloodstream. When there is no evidence of this spread (or, at most, signs of minimal involvement of the axillary lymph nodes on the affected side), the usual treatment of choice is radical mastectomy which is the removal of the involved breast, the pectoral muscles which are beneath the affected side, and the contents of the axilla on the involved side. Modified radical mastectomy is becoming increasingly accepted as an alternative to the conventional radical mastectomy for the treatment of all primary operable fatty tissue tumors. The modified radical mastectomy removes all of the breast tissue as in the radical mastectomy, but does not remove the greater pectoral muscle. This eliminates the need for a skin graft. Survival time is the same whether a modified radical mastectomy or a radical mastectomy was performed. The difference is that with the modified radical mastectomy reconstruction surgery is considerably easier since the greater pectoral muscle is still in place. Radiation therapy administered after mastectomy reduces the incidence of local recurrence on the chest wall and in the regional lymph nodes. However, it should be noted that this does not improve the overall length of survival. For this reason radiation therapy is now being performed less often. Survival rates for patients treated with modified radical mastectomy or for patients treated with breast-conserving surgery (lumpectomy (surgical removal of the tumor), wide excision (cutting out the affected tissue), partial mastectomy (partial excision of the tissue), or quadrantectomy(removal of one quadrant)) in conjunction with radiation therapy appear to be the same for at least the first 20 years after surgery. The main advantage of breast-conserving surgery with radiation therapy is cosmetic. It should be noted that this advantage might not exist if the malignant tumor is large in relation to the breast tissue because total removal of the tumor mass along with removal of some extra normal tissue surrounding the tumor is necessary for long-term control of the disease. Some physicians use chemotherapy in an effort to shrink the tumor before removing the lump. Current data suggests that shrinking the tumor first with chemotherapy does not compromise a patient's survival which allows some women the opportunity to have breast-conserving surgery instead of mastectomy. Treatment of Metastatic Disease The breast cancer tumor may metastasize (spread by the lymphatics or bloodstream) to almost any organ in the body. However, the most common areas of metastasis are the lungs, liver, bone, lymph nodes, skin (mostly in the region of the chest surgery), central nervous system, and scalp. Since the metastasis often occurs many years after the treatment of this disease, any symptoms should cause one to seek further examination. In the event that aggressive treatment becomes ineffectual, care should become palliative (relieving pain and suffering). Tumors in Men Men develop breast cancer only 1% as often as women. More often this disease progresses to an advanced stage in men because it is not usually suspected or checked for. Treatment for men is very much the same as for women and the prognosis and survival rates are also nearly identical in men and women. If you are interested in learning more you can go to the NCI's Publications Locator page for publications. Clinical Trials Information: Find a Clinical Trial Email Information: Contact the ACS Phone: 1-800-4-CANCER (1-800-422-6237), 9:00 a.m. to 4:30 p.m. local
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