Breast cancer

Signs and symptoms of Breast Cancer

Breast cancer typically produces no symptoms when the tumor is small and most treatable. There- fore, it is important for women to follow recommended screening guidelines to detect breast cancer at an early stage. Larger tumors may become evident as a breast lump, which is often painless. Less common symptoms include persistent changes to the breast, such as thickening, swelling, distortion, tenderness, skin irritation, redness, scaliness, or nipple abnormalities, such as ulceration, retraction, or spontaneous discharge. Breast pain is more likely to be caused by benign conditions and is not a common early symptom of breast cancer.

Breast Cancer Facts

An estimated 232,670 new cases of invasive breast cancer are expected to be diagnosed among women in the US during 2014; about 2,360 new cases are expected in men. Exclud- ing cancers of the skin, breast cancer is the most frequently diagnosed cancer in women. The dramatic decrease in the breast cancer incidence rate of almost 7% from 2002 to 2003 has been attributed to reductions in the use of menopausal hormone therapy (MHT), previously known as hormone replacement therapy, following the publication of results from the Women’s Health Initiative in 2002. This study found that the use of com- bined estrogen plus progestin MHT was associated with an increased risk of breast cancer, as well as coronary heart dis- ease. From 2006 to 2010, the most recent five years for which data are available, breast cancer incidence rates were stable. In addition to invasive breast cancer, 62,570 new cases of in situ breast cancer are expected to occur among women in 2014. Of these, approximately 83% will be ductal carcinoma in situ (DCIS). In situ breast cancer incidence rates were also stable from 2006 to 2010.

Deaths by breast cancer:

An estimated 40,430 breast cancer deaths (40,000 women, 430 men) are expected in 2014. Breast cancer ranks sec- ond as a cause of cancer death in women (after lung cancer). Death rates for breast cancer have steadily decreased in women since 1989, with larger decreases in younger women; from 2006 to 2010, rates decreased 3.0% per year in women under 50 years and 1.8% per year in women 50 and older. The decrease in breast cancer death rates represents improvements in early detection and treatment, and possibly decreased incidence.

Risk factors of breast cancer:

Potentially modifiable factors associated with increased breast cancer risk include weight gain after the age of 18, being overweight or obese (for postmenopausal breast can- cer), use of MHT (combined estrogen and progestin), physical inactivity, and alcohol consumption.
In addition, recent research indicates that long-term, heavy smoking also increases breast cancer risk, particularly among women who start smoking before first pregnancy. The International Agency for Research on Cancer has concluded that there is limited evidence that shift work, particularly at night, is also associated with an increased risk of breast cancer.
Other factors associated with increased breast cancer risk include high breast tissue density (the amount of glandular tis- sue relative to fatty tissue measured on a mammogram), high bone mineral density (women with low density are at increased risk for osteoporosis), type 2 diabetes, certain benign breast conditions (such as atypical hyperplasia), and lobular carcinoma in situ. High-dose radiation to the chest for cancer treatment also increases risk. Reproductive factors that increase risk include a long menstrual history (menstrual periods that start early and/ or end later in life), recent use of oral contraceptives or depoprovera, never having children, and having one’s first child after age 30. Risk is also increased by a family history of breast cancer, particularly having one or more affected first degree relatives (though most women with breast cancer do not have a family history of the disease). Inherited mutations (alterations) in the breast cancer susceptibility genes BRCA1 and BRCA2 are very rare in the general population (much less than 1%), but account for 5%-10% of all female breast cancers, an estimated 5%-20% of male breast cancers, and 15%-20% of familial breast cancers.
Scientists now believe that most familial breast cancer is due to the interaction between lifestyle factors and more common variations in the genetic code that confer a small increase in breast cancer risk. Individuals with a strong family history of breast and/or certain other cancers, such as ovarian and colon cancer, should consider counseling to determine if genetic testing is appropriate. Prevention measures may be possible for individuals with breast cancer susceptibility mutations. Studies show that removal of the ovaries and/or breasts considerably decreases the risk of breast cancer in BRCA1 and BRCA2 mutation carriers; however, not all women who choose this surgery would have developed breast cancer.
Women should receive counseling before undergoing surgical procedures for breast cancer prevention. Factors associated with a decreased risk of breast cancer include breastfeeding, regular moderate or vigorous physical activity, and maintaining a healthy body weight.
Two medications – tamoxifen and raloxifene – have been approved to reduce breast cancer risk in women at high risk. Raloxifene appears to have a lower risk of certain side effects, such as uterine cancer and blood clots; however, it is only approved for use in postmeno- pausal women.

Early detection of breast cancer:

Breast cancer screening for women at average risk includes clinical breast exam and mammography. Mammography can often detect breast cancer at an early stage, when treatment is more effective. Numerous studies have shown that 10 Cancer Facts & Figures 2014 early detection with mammography saves lives and increases treatment options.
Steady declines in breast cancer mortality among women since 1989 have been attributed to a combination of early detection and improvements in treatment. Mammography is a very accurate screening tool for women at both average and increased risk; however, like any medical test, it is not perfect. Mammography will detect most breast cancers in women without symptoms, though the sensitivity is lower for younger women and women with dense breasts. For these women, digital mammography or ultrasound imaging in combination with standard mammography may increase the likelihood of detecting cancer.
Mammography also results in some overdiagnoses, which is the detection of cancer that would neither have caused harm nor been diagnosed in the absence of screening. Most women with an abnormal mammogram do not have cancer. Lesions that remain suspicious after additional imaging are usually biopsied for a definitive diagnosis.
For most women at high risk of breast cancer, annual screening using magnetic res- onance imaging (MRI) in addition to mammography is recommended, typically starting at the age of 30. (For more information, see Breast Cancer Facts & Figures at cancer.org/sta- tistics.) Concerted efforts should be made to improve access to health care and encourage all women 40 and older to receive regular mammograms.

Treatment of Breast Cancer

Treatment: Taking into account tumor size, extent of spread, and other characteristics, as well as patient preference, treat- ment usually involves breast-conserving surgery (surgical removal of the tumor and surrounding tissue) or mastectomy (surgical removal of the breast). Numerous studies have shown that for early breast cancer (cancer that has not spread to the skin, chest wall, or distant organs), long-term survival is similar among women treated with breast-conserving surgery plus radiation therapy and those treated with mastectomy. Women undergoing mastectomy who elect breast reconstruction have several options, including the materials used to restore the breast shape and the timing of the procedure.
Underarm lymph nodes are usually removed and evaluated during surgery to determine whether the tumor has spread beyond the breast. In women with early stage disease, sentinel lymph node biopsy, a procedure in which only the first lymph nodes to which cancer is likely to spread are removed, has a lower chance of long-term side effects (e.g., lymphedema, arm swelling caused by the accumulation of lymph fluid) and is as effective as a full axillary node dissection, in which many nodes are removed.
Treatment may also involve radiation therapy, chemotherapy (before or after surgery), hormone therapy (e.g., selective estro- gen response modifiers, aromatase inhibitors, ovarian ablation), and/or targeted therapy. Postmenopausal women with early stage breast cancer that tests positive for hormone receptors.

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