MEDICAL MONDAYS: News Notes
Laura Lawson, MD: breast surgeon
Carl Willis, MD: medical oncologist
TOPIC: Medical & Surgical Treatments for Breast Cancer
Monday, October 4, 2010
News notes via www.webmd.com
Breast Cancer FACTS
First, let's find out how breast cancer begins. Cells in the body normally divide (reproduce) only when new cells are needed. Sometimes, cells in a part of the body grow and divide out of control, which creates a mass of tissue called a tumor. If the cells that are growing out of control are normal cells, the tumor is called benign (not cancerous). If however, the cells that are growing out of control are abnormal and don't function like the body's normal cells, the tumor is called malignant (cancerous).
Cancers are named after the part of the body from which they originate. Breast cancer originates in the breast tissue. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast. It can also travel to other parts of the body and form new tumors, a process called metastasis.
What Causes Breast Cancer?
We do not know what causes breast cancer, although we do know that certain risk factors may put you at higher risk of developing it. A person's age, genetic factors, personal health history, and diet all contribute to breast cancer risk.
Who Gets Breast Cancer?
Breast cancer is the most common cancer among American women, after skin cancer. Today, approximately 1 in almost every 8 women (13.4%) will develop breast cancer in her lifetime. Breast cancer is the second-leading cause of cancer death in women after lung cancer -- and is the leading cause of cancer death among women ages 35 to 54. The American Cancer Society estimates that in 2009, approximately 192,370 women will be diagnosed with invasive breast cancer and approximately 40,610 will die. Although these numbers may sound frightening, research reveals that the mortality rate could decrease by 30% if all women age 50 and older who need a mammogram had one.
Only 5% to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The majority of breast cancer cases are "sporadic," meaning there is no direct family history of the disease. The risk for developing breast cancer increases as a woman ages.
What Are the Symptoms of Breast Cancer?
The symptoms of breast cancer include:
What Are the Types of Breast Cancer?
The most common types of breast cancer are:
In addition, there are several other less common types of breast cancer.
What Are the Stages of Breast Cancer?
How Is Breast Cancer Diagnosed?
During your regular physical exam, your doctor will take a careful personal and family history and perform a breast exam and possibly one or more other tests:
Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue.
After the sample is removed, it is sent to a lab for testing. A pathologist -- a doctor who specializes in diagnosing abnormal tissue changes -- views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is (ductal or lobular carcinoma) and whether it has spread beyond the ducts or lobules (invasive).
Laboratory tests such as hormone receptor tests (estrogen and progesterone) can show whether the hormones help the cancer to grow. If the test results show that hormones help the cancer grow (a positive test), the cancer is likely to respond to hormonal treatment. This therapy deprives the cancer of the estrogen hormone.
Breast cancer diagnosis and treatment are best accomplished by a team of experts working together with the patient. Each patient needs to evaluate the advantages and limitations of each type of treatment, and work with her team of physicians to develop the best approach.
How Is Breast Cancer Treated?
If the tests find breast cancer, you and your doctor will develop a treatment plan to eradicate the breast cancer, to reduce the chance of cancer returning in the breast, as well as to reduce the chance of the cancer traveling to a location outside of the breast. Treatment generally follows within a few weeks after the diagnosis.
The type of treatment recommended will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells and the stage or extent of the disease. Your doctor usually considers your age and general health as well as your feelings about the treatment options.
Breast cancer treatments are local or systemic.
What Happens After Treatment?
Following local breast cancer treatment, your doctors will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with the surgeon, may advise the use of tamoxifen or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.
How Can I Protect Myself From Breast Cancer?
Follow these three steps for early breast cancer detection:
Choosing the Right Breast Cancer Treatment
The primary treatment for breast cancer is surgery to remove the cancer. There are three main types of surgery:
Breast cancer patients with early-stage cancer may opt for breast-conserving surgery -- either a lumpectomy -- removal only of the "lump" of tumor as well as the normal breast tissue closely surrounding the tumor, or partial mastectomy -- removal of the tumor and a larger portion of surrounding breast tissue. This is usually followed by radiation therapy.
If the cancer is advanced or if there is a high risk of recurrence, the surgeon may recommend a mastectomy, which is complete removal of the breast. The woman should also be informed about her options for breast reconstruction, which sometimes is done right after mastectomy.
At the time of surgery, most patients also have either axillary node dissection or sentinel node biopsy to see if breast cancer has spread to the lymph nodes. These procedures remove lymph nodes from the armpit to test them for cancer cells. Sentinel node biopsies have largely replaced axillary node dissection.
Surgery is often combined with additional treatments, known as adjuvant therapy, to destroy any remaining cancer cells. Sometimes, the additional treatment may be given before surgery (called neoadjuvant therapy) when the breast cancer has been found to have already spread widely. These methods of treatment include:
Treatment for breast cancer will depend on a woman's:
Most doctors who treat cancer patients in the U.S. follow national guidelines set by the National Comprehensive Cancer Network (NCCN) or the American Society of Clinical Oncology (ASCO), which have helped improve patient care. Still, treatment will vary from one doctor to the next or from one hospital to the next, depending on the woman's needs and circumstances.
Breast Cancer Treatment With Chemotherapy
Chemotherapy refers to the use of anti-cancer drugs to kill breast cancer cells. The doctor who determines which drugs will be used, and in what dosage is known as an oncologist. Chemotherapy can be used for three major purposes: