Julian Heitz, MD: radiation oncologist
TOPIC: Breast Cancer & Radiation Advances
Monday, October 10, 2011
Laura Lawson, MD: breast surgeon
News notes via www.webmd.com
Breast Cancer STATISTICS
- About 1 in 8 women in the United States (12%) will develop invasive breast cancer over the course of her lifetime.
- In 2010, an estimated 207,090 new cases of invasive breast cancer were expected to be diagnosed in women in the U.S., along with 54,010 new cases of non-invasive (in situ) breast cancer.
- About 1,970 new cases of invasive breast cancer were expected to be diagnosed in men in 2010. Less than 1% of all new breast cancer cases occur in men.
- From 1999 to 2006, breast cancer incidence rates in the U.S. decreased by about 2% per year. One theory is that this decrease was partially due to the reduced use of hormone replacement therapy (HRT) by women after the results of a large study called the Women's Health Initiative were published in 2002. These results suggested a connection between HRT and increased breast cancer risk.
- About 39,840 women in the U.S. were expected to die in 2010 from breast cancer, though death rates have been decreasing since 1990. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness.
- For women in the U.S., breast cancer death rates are higher than those for any other cancer, besides lung cancer.
- Besides skin cancer, breast cancer is the most commonly diagnosed cancer among U.S. women. More than 1 in 4 cancers in women (about 28%) are breast cancer.
- Compared to African American women, white women are slightly more likely to develop breast cancer, but less likely to die of it. One possible reason is that African American women tend to have more aggressive tumors, although why this is the case is not known. Women of other ethnic backgrounds — Asian, Hispanic, and Native American — have a lower risk of developing and dying from breast cancer than white women and African American women.
- In 2010, there were more than 2.5 million breast cancer survivors in the U.S.
- A woman's risk of breast cancer approximately doubles if she has a first-degree relative (mother, sister, daughter) who has been diagnosed with breast cancer. About 20-30% of women diagnosed with breast cancer have a family history of breast cancer.
- About 5-10% of breast cancers can be linked to gene mutations (abnormal changes) inherited from one's mother or father. Mutations of the BRCA1 and BRCA2 genes are the most common. Women with these mutations have up to an 80% risk of developing breast cancer during their lifetime, and they are more likely to be diagnosed at a younger age (before menopause). An increased ovarian cancer risk is also associated with these genetic mutations. In men, about 1 in 10 breast cancers are believed to be due to BRCA2 mutations and even fewer cases to BRCA1 mutations.
- About 70-80% of breast cancers occur in women who have no family history of breast cancer. These occur due to genetic abnormalities that happen as a result of the aging process and life in general, rather than inherited mutations.
- The most significant risk factors for breast cancer are gender (being a woman) and age (growing older).
What Are the Symptoms of Breast Cancer?
The symptoms of breast cancer include:
- Lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
- A mass or lump, which may feel as small as a pea.
- A change in the size, shape, or contour of the breast.
- A blood-stained or clear fluid discharge from the nipple.
- A change in the feel or appearance of the skin on the breast or nipple (dimpled, puckered, scaly, or inflamed).
- Redness of the skin on the breast or nipple.
- A change in shape or position of the nipple
- An area that is distinctly different from any other area on either breast.
- A marble-like hardened area under the skin.
What Are the Types of Breast Cancer?
The most common types of breast cancer are:
Invasive ductal carcinoma . This cancer starts in the milk ducts of the breast. Then it breaks through the wall of the duct and invades the fatty tissue of the breast. This is the most common form of breast cancer, accounting for 80% of invasive cases.
Ductal carcinoma in situ (DCIS) is ductal carcinoma in its earliest stage (Stage 0). In situ refers to the fact that the cancer hasn't spread beyond its point of origin. In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue. If untreated, ductal carcinoma in situ may become invasive cancer. It is almost always curable.
Infiltrating (invasive) lobular carcinoma. This cancer begins in the lobules of the breast where breast milk is produced, but has spread to surrounding tissues or the rest of the body. It accounts for about 10% of invasive breast cancers.
Lobular carcinoma in situ (LCIS) is cancer that is only in the lobules of the breast. It isn't a true cancer, but serves as a marker for the increased risk of developing breast cancer later, possibly in both breasts. Thus, it is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.
In addition, there are several other less common types of breast cancer.
What Are the Stages of Breast Cancer?
Early stage or stage 0 breast cancer is when the disease is localized to the breast with no evidence of spread to the lymph nodes (carcinoma in situ).
Stage I breast cancer: The cancer is two centimeters or less in size and it hasn't spread anywhere.
Stage IIA breast cancer is a tumor smaller than two centimeters across with lymph node involvement or a tumor that is larger than two but less than five centimeters across without underarm lymph node involvement.
Stage IIB is a tumor that is greater than five centimeters across without underarm lymph nodes testing positive for cancer or a tumor that is larger than two but less than five centimeters across with lymph node involvement.
Advanced breast cancer (metastatic) results after cancer cells spread to the lymph nodes and to other parts of the body.
Stage IIIA breast cancer is also called locally advanced breast cancer. The tumor is larger than five centimeters and has spread to the lymph nodes under the arm, or a tumor that is any size with cancerous lymph nodes that adhere to one another or surrounding tissue.
Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall or internal mammary lymph nodes (located beneath the breast and inside the chest).
Stage IIIC breast cancer is a tumor of any size that has spread more extensively and involves more lymph node invasion.
Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to places far away from the breast, such as bones, lungs, liver, brain, or distant lymph nodes.
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.
Local treatments are used to remove, destroy, or control the cancer cells in a specific area, such as the breast. Surgery and radiation treatment are local treatments.
Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy; hormone therapy such as tamoxifen; aromatase inhibitors such as Arimidex, Aromasin, Femara; and biologic therapies such as Herceptin are systemic treatments. A patient may have just one form of treatment or a combination, depending on her needs.
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:
- Annual screening mammography starting at age 40 or 50. Breast cancer experts don't agree when women need to begin getting mammograms. Ask your doctor.
- Women in high-risk categories should have screening mammograms every year and typically start at an earlier age. MRI or ultrasound screening can also be given in addition to mammograms. Discuss the best approach with your doctor.
- Have your breast examined by a health care provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can complement mammogram.
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:
- Personal preferences.
- Overall health.
- Stage of the breast cancer, including whether cancer has spread to the lymph nodes.
- The type of cancer and whether the cancer is an aggressive type.
- Whether she has gone through menopause.
- Whether the cancer she has depends on female hormones to grow. If it is "sensitive" to the female hormones, then the cancer is called "estrogen-receptor positive" (ER positive). If not, it is ER negative. This can usually be determined by testing a tissue sample in the lab.
- The presence of other markers suggestive of aggressive cancer behaviors, such as progesterone receptors and the HER2 oncogene.
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.
6 Facts about Mammosite Balloon Procedure
10 Questions to Ask the Radiation Oncologist
- What different types of radiation therapy are there?
- Does radiation affect fertility?
- What are the risks and side effects?
- Where do I go for radiation therapy?
- How long does each session last?
- How many weeks does treatment last?
- Does radiation therapy make me radioactive?
- What should I avoid during treatment?
- Should I change my diet or lifestyle?
10. Does radiation therapy affect having breast reconstruction?