BREAST CANCER

DEFINITION

Breast cancer is cancer of the breast. Cancer (see cancer entry) is a disease in which cells begin to grow rapidly and out of control. Cancer cells can travel through the body by way of blood or lymph nodes. They can then come to rest and start growing in other parts of the body.

DESCRIPTION

Every woman is at risk for breast cancer. The risk varies with age. At age twenty-five, a woman's risk is about 1 in 20,000. At age forty-five, it is 1 in about 100. At age eighty-five, it is more than 1 in 10. About 80 percent of all breast cancers are found in women over the age of fifty.

CAUSES

Researchers do not know how normal cells suddenly become cancerous. Thus, the fundamental cause or causes of breast cancer are still a puzzle. Scientists do know that certain risk factors are related to the development of breast cancer. These factors include:

• Family history of breast cancer occurring in mother or sister.
• Early onset (beginning) of menstruation and late menopause. Menopause is the end of menstruation.
• Reproductive history. Women who have no children or have children late in life have increased risk. Women who have never breast-fed also have increased risk.
• History of abnormal breast biopsies. A biopsy is a medical procedure in which a small sample of tissue is removed for study under a microscope.

The acknowledged risk factors are of limited value, however. More than 70 percent of women who develop breast cancer have no known risk factors.

SYMPTOMS

The primary method of discovering the symptoms of breast cancer is self-examination. Doctors recommend that women learn how to properly examine their breasts and to do so on a regular basis. The purpose is to look for any changes in the breasts. One warning sign of breast cancer may be a lump in the breast or armpit area. The presence of a lump suggests that medical advice should be sought. A lump does not necessarily indicate breast cancer. In many cases, lumps are benign (not cancerous) and can be removed without any lasting harm to the patient.

Other symptoms that may be detected during a self-examination include:

• Thickening in the breast or armpit
• Change in the size, shape, or color of a nipple
• Dimples or redness of the skin on the breast
• Change in size or shape of the breast

The simplest treatment for breast cancer is a lumpectomy, a procedure in which the cancerous lump is removed from the breast. (Illustration by

Peg Gerrity

. Reproduced by permission of

Custom Medical Stock Photo

.)

DIAGNOSIS

The primary medical tool in diagnosing breast cancer is a mammogram. A mammogram is an X-ray photograph of the breast. The American Cancer Society currently recommends that women between the ages of forty and fifty have a mammogram every year or two. The society suggests a yearly mammogram for women over the age of fifty.

The purpose of a mammogram is to find any lumps or other changes in the breast. If such changes are found, additional tests may be necessary. One test is a breast biopsy. The tissue removed during a biopsy can be studied under a microscope, which allows a doctor to determine whether cells in the sample are cancerous or not.

If cancer is found, tests can also be used to determine if the cancer has metastasized (pronounced muh-TASS-tuh-sized). Metastasis (pronounced muh-TASS-tuh-sis) is the process by which cancer cells spread to other parts of the body. Testing for metastasis involves removal of lymph nodes from the armpit. The presence of cancer cells in the lymph nodes suggests that the cancer has begun to spread.

TREATMENT

The treatment used for breast cancer depends on how serious a patient's condition is. Under the best circumstances, the cancer is found at an early stage. It may consist of nothing more than a small lump in the breast. In other cases, it may have developed into a larger lump or begun to metastasize.

The simplest treatment is a lumpectomy, a procedure in which the cancerous lump is removed from the breast. The surgeon also removes some tissue around the lump and some of the lymph nodes under the arm. Removing healthy tissue around the lump ensures that all of the cancer has been removed. Removing the lymph nodes allows the doctor to test for metastasis.

A more serious form of treatment is a mastectomy (pronounced mas-TEK-tuh-mee). A mastectomy may be required if a lump has become quite large or the cancer has spread to the chest muscles. In a mastectomy, the patient's entire breast is removed. In the most extreme conditions, the surgeon may also remove the chest muscles around the breast and all the lymph nodes under the arm. This procedure is called a radical mastectomy. Radical mastectomies are rarely done.

Some women also choose to have reconstructive surgery. In reconstructive surgery, an artificial breast is created to replace the breast removed during a mastectomy. The artificial breast may provide a women with a better sense of self-esteem by restoring her natural shape.

If cancer cells are found in the lymph nodes, more aggressive treatment may be necessary. The presence of these cells suggests that the cancer has begun to spread to other parts of the body. Additional treatments are then needed to kill cancer cells in all parts of the body. Such forms of treatment are known as systemic (for "system") treatments.

Breast cancer cell. (Reproduced by permission of

Kunkel/Phototake NYC

)

Three common forms of systemic treatment include radiation, chemotherapy, and hormone therapy. In radiation treatments, some form of radiation is used to kill any remaining cancer cells in the breast or other parts of the body. The radiation used is similar to X rays, but much more powerful.

Chemotherapy involves the use of certain chemicals known to kill cancer cells. These chemicals are given to the patient either by injection or by mouth. They travel through the body and kill cancer cells wherever they are found. Both radiation and chemotherapy have some serious side effects, including nausea and vomiting, temporary hair loss, mouth or vaginal sores, fatigue, and infertility.

Hormone therapy is a special type of chemotherapy. In one form, it makes use of a natural product known as tamoxifen (pronounced tuh-MOK-sih-fen) to kill cancer cells. Patients take one pill a day for at least two years and sometimes as long as five. Studies show that the use of tamoxifen can lower the chance that breast cancer can return by between 25 and 35 percent.

PROGNOSIS

Survival rates for breast cancer depend very much on the type of cancer found and how early it was diagnosed. In general, cancers that are found earlier are more likely to be treated successfully. Patients who have surgery often return to a normal lifestyle within about a month. Exercises help patients regain strength and flexibility of the arms, shoulders, and chest.

Patients who receive treatment for breast cancer often experience emotional problems. They may become moody or depressed, lose their appetite, or feel unworthy or uninterested in sexual activities. Support groups are available to help women get through the most difficult period after diagnosis and treatment. Support groups consist of other individuals who have experienced the same medical problem and, sometimes, professional counselors.

PREVENTION

There is no way to prevent breast cancer. The best way to deal with the disease is to perform regular self-examinations and have regular mammograms. For women who have had breast cancer, tamoxifen treatments appear to be a promising factor in preventing reoccurrence of the disease.

FOR MORE INFORMATION

Books

Hirshaut, Yashar, and Peter Pressman. Breast Cancer: The Complete Handbook. New York: Bantam Books, 1996.

Kneece, Judy C. Finding a Lump in Your Breast: Where to Go, What to Do. Columbia, SC: Educate Publishing, 1996.

Lauersen, Niels, and Eileen Stukane. The Complete Book of Breast Care. New York: Fawcett Columbine, 1996

Love, Susan, and Karen Lindsey. Dr. Susan Love's Breast Book. Reading, MA: Addison-Wesley, 1995.

Mayer, Musa. Holding Tight, Letting Go: Living with Metastatic Breast Cancer. Sebastopol, CA: O'Reilly & Associates, 1997.

Porter, Margit Esser. Hope Is Contagious: The Breast Cancer Treatment Survival Handbook. New York: Simon & Schuster, 1997.

Stoppard, Miriam. The Breast Book. New York: DK Publishing, 1996.

Periodicals

"Early Detection: The Best Defense." Family Circle (October 31, 1992): p. 107.

Fackelmann, Kathy. "Refiguring the Odds." Science News (July 31, 1993): pp. 76–77.

Organizations

American Cancer Society. 1599 Clifton Road NE, Atlanta, GA 30329. (800) ACS–2345. http://www.cancer.org.

Cancer Care, Inc. 1180 Avenue of the Americas. New York, NY 10036. (800) 813–HOPE. http://www.cancercareinc.org.

National Alliance of Breast Cancer Organizations. 9 East 37th Street, 10th Floor, New York, NY 10016. (888) 80–NABCO.

National Cancer Institute. 31 Center Drive, Bethesda, MD 20892–2580. (800) 4–CANCER. http://www.nci.nih.gov.

National Coalition for Cancer Survivorship. 1010 Wayne Avenue, 5th Floor, Silver Springs, MD 20910. (301) 650–8868.

National Women's Health Resource Center. 2425 L Street NW, 3rd Floor, Washington, DC 20037. (202) 293–6045.

Web sites

Community Breast Health Project at Stanford. [Online] http://www.med.Stanford.EDU:80/CBHP (accessed on October 18, 1999).