Breast Cancer Awareness -- September 29, 2008 -- Dr. Laura Lawson & Dr. Paul Rosenblatt - | Nashville News, Weather & Sports

Breast Cancer Awareness -- September 29, 2008 -- Dr. Laura Lawson & Dr. Paul Rosenblatt


Medical Mondays: News Notes
Laura Lawson, MD: Breast Surgeon, Baptist Hospital
Paul Rosenblatt, MD: Radiation Oncology, St. Thomas Hospital
TOPIC: Breast Cancer Awareness & Treatment Options
Monday, September 29, 2008

Breast Cancer Awareness

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also contains blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

Breast cancer is the second leading cause of death from cancer in American women.

Women in the United States get breast cancer more than any other type of cancer except for skin cancer. Breast cancer is second only to lung cancer as a cause of cancer death in women. Breast cancer occurs in men also, but the number of cases is small.

Age and health history can affect the risk of developing breast cancer. Anything that increases your chance of getting a disease is called a risk factor. Risk factors for breast cancer include:

  • Older age.
  • Early age at menarche (menstruation).
  • Older age at first birth or never having given birth.
  • A personal history of breast cancer or benign (non-cancer) breast disease.
  • A mother or sister with breast cancer.
  • Treatment with radiation therapy to the breast/chest.
  • Breast tissue that is dense on a mammogram.
  • Hormone use (such as estrogen and progesterone).
  • Drinking alcoholic beverages.
  • Caucasian race.


Breast Cancer Screening

Different tests are used to screen for cancer.

Some screening tests are used because they have been shown to be helpful both in finding cancers early and decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in some people; it is not yet known if use of these tests will decrease the risk of dying from cancer.

Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person's chance of dying from the disease. For some types of cancer, finding and treating the disease at an early stage may result in a better chance of recovery.

Clinical trials that study cancer screening methods are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.

Three tests are commonly used to screen for breast cancer:

Breast self-exam (BSE)

Breast self-exam is an exam to check your own breasts for lumps or anything else that seems unusual.

Clinical breast exam (CBE)

A clinical breast exam is an exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.


A mammogram is an x-ray of the breast. This test may find tumors that are too small to feel. The ability of this test to find breast cancer may depend on the size of the tumor, the density of the breast tissue, and the skill of the radiologist.

If a lump or other abnormality is found using one of these 3 tests, ultrasound may be used to learn more. It is not used by itself as a screening test for breast cancer. Ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

Other screening tests are being studied in clinical trials.

MRI (magnetic resonance imaging)

MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

MRI tests are used to make decisions about breast masses that have been found by a clinical breast exam or a breast self-exam. MRIs also help show the difference between cancer and scar tissue. MRI does not use any x-rays. Scientists are studying MRI to find out how helpful it is in screening for breast cancer.

Screening clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.


Risks of Breast Cancer Screening

Screening tests have risks.

Decisions about screening tests can be difficult. Not all screening tests are helpful and most have risks. Before having any screening test, you may want to discuss the test with your doctor. It is important to know the risks of the test and whether it has been proven to reduce the risk of dying from cancer.

The risks of breast cancer screening tests include the following:

Finding breast cancer may not improve health or help a woman live longer.

Screening may not help you if you have fast-growing breast cancer or if it has already spread to other places in your body. Also, some breast cancers never cause symptoms or become life-threatening, but cancer may be found on a screening mammogram and treated. It is not known if treatment of these cancers would help you live longer than if no treatment were given, and treatments for cancer may have serious side effects.

False-negative test results can occur.

Screening test results may appear to be normal even though breast cancer is present. A woman who receives a false-negative test result (one that shows there is no cancer when there really is) may delay seeking medical care even if she has symptoms.

One in 5 cancers may be missed by mammography. False-negatives occur more often in younger women than in older women because the breast tissue of younger women is more dense. The size of the tumor, the rate of tumor growth, the level of hormones, such as estrogen and progesterone, in the woman's body, and the skill of the radiologist can also affect the chance of a false-negative result.

False-positive test results can occur.

Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks.

Most abnormal test results turn out not to be cancer. False-positives are more common in younger women, women who have had previous breast biopsies, women with a family history of breast cancer, and women who take hormones, such as estrogen and progesterone. The skill of the doctor also can affect the chance of a false-positive result.

Mammograms expose the breast to radiation.

Being exposed to radiation is a risk factor for breast cancer. The risk of developing breast cancer from screening mammograms is greater with higher doses of radiation and in younger women. For women older than 40 years of age, the benefits of an annual screening mammogram may be greater than the risks from radiation exposure. No matter how old you are, if you have risk factors for breast cancer you should ask for medical advice about when to begin having mammograms and how often to be screened.

Breast Cancer: Breast Reconstruction Surgery

Breast reconstruction can be done right after a mastectomy while you are still under anesthesia, or at a later time. Sometimes women wait because they are not emotionally or medically able to undergo additional surgery, or because they need radiation therapy following their mastectomy. Reconstruction is major surgery that may require more than one procedure. Women should be fully informed about what is involved.

Women have several options in breast reconstruction surgery:

  • Implants involve stretching the skin with a special tissue expander, then inserting a silicone-gel or saline (salt water) implant. Because of safety concerns, in 1992 the U.S. Food and Drug Administration (FDA) banned silicone implants, except for those women participating in approved clinical studies. In 2003, an FDA panel that reviewed 10 years of data recommended the ban be lifted, as long as women were informed before the procedure and were monitored by an outside agency for a decade. The FDA has not yet lifted the ban. For more information, see Breast Implants After Breast Cancer Surgery.
  • Other methods use a woman's own tissue taken from the abdomen or back to create a breast mound to reconstruct the breast. Taking abdominal tissue is called a TRAM flap, which is short for transverse rectus abdominis muscle. Taking tissue from the back is called latissimus dorsi flaps. These procedures require a plastic surgeon who is experienced in this type of surgery.
  • The nipple area can simply be tattooed. Or, nipple reconstruction can be performed, often weeks or months after breast reconstruction. Tissue can be taken from the back or abdominal flap and tattooed to resemble the color of a nipple. In rare cases, the nipple from the original breast can be reattached, but only if the surgeon is convinced that tissue is cancer-free. While reconstruction improves the appearance of the breast, because of a lack of nerve connections, the nipple will not rise or flatten in response to touch or temperature.
  • Breast reconstruction usually does not interfere with chemotherapy. If radiation therapy is needed, some physicians prefer to delay the reconstruction. Complications are not common but may include bleeding, scarring and infection.

Breast Prostheses

Wearing breast prosthesis is an option for women who choose not to have reconstruction after mastectomy or wide local excision. The artificial breast form made from silicone gel fits into a bra cup. At first, the prothesis may be cold and heavy but this feeling usually goes away.


Breast Cancer Treatment

There are two major goals of breast cancer treatment:

1) To rid the body of the cancer as completely as possible.
2) To prevent cancer from returning.


How Is Treatment Determined?

The type of treatment recommended to you by your cancer specialist 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.

Be sure to discuss your treatment options with your cancer specialist.


What Are the Types of Breast Cancer Treatment?

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. They include:

Systemic treatments are used to destroy or control cancer cells all over the body. They include:

  • Chemotherapy which uses drugs to to kill cancer cells. Side effects can include nausea, hair loss, early menopause, hot flashes, fatigue and temporarily lowered blood counts.
  • Hormone therapy , including tamoxifen, and the aromatase inhibitors Arimidex, Aromasin and Femara. Hormone therapy uses drugs to prevent hormones, especially estrogen, from promoting the growth of breast cancer cells that may remain after breast cancer surgery. Side effects can include hot flashes and vaginal dryness.
  • Biological Therapy such as Herceptin, works by using the body's immune system to destroy cancer cells. Herceptin targets breast cancer cells that have high levels of a protein called HER2.

Systemic therapy can be given after local treatment (adjuvant therapy) or before (neoadjuvant therapy). Adjuvant therapy is used after local treatments to kill any cancer cells that remain in the body and may be in other parts of the body.

A patient may have just one form of treatment or a combination, depending on her needs.


Tips to Remember about Choosing Breast Cancer Treatment

Although there are some typical treatment regimens used to treat breast cancer, women do have choices.

  • Be sure to discuss with your doctor all the risks and benefits of each option and how they relate to your own lifestyle.
  • Consider joining a support group to help you address the emotional issues surrounding your diagnosis and in choosing therapy.
  • Ask your doctor about participating in a clinical trial.
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