A womans risk of developing breast cancer significantly increases if a first-degree relative (sister, aunt, mother) has been diagnosed. Approximately 25-50% of women diagnosed with breast cancer have a history of it occurring in their family.
However, 90% of breast cancers are not hereditary, but rather linked to genetic abnormalities that occur as a result of aging and lifestyle. The highest risk factors for breast cancer are gender and age, and breast cancer deaths are much higher than those from other forms of cancer, except lung cancer.
Symptoms of Breast Cancer
The signs and symptoms of breast cancer are different in every woman, however there are common warning signs that should never be ignored. Even if one or more of the following symptoms are experienced, it does not mean a diagnosis of breast cancer is imminent.
Here are some of the most common symptoms that may occur:
- A mass or lump
- A retracted or scaly nipple
- Dimpling of the skin on the breast
- Bloody or clear discharge from the nipple
- Pain in the breast(s)
Different Types of Breast Cancer
The most common forms of breast cancer begin at the milk duct or in the lobes of milk-producing glands. Where the cancer originated is confirmed by examining the cells under a microscope. Common types of breast cancer include:
In-situ breast cancer (Ducal Carcinoma In-Situ, DCIS): this is a non-invasive form of cancer in which the cells have not migrated to other locations in the body. The most common form of breast cancer is confined to in or around the milk ducts and with the right treatment, in-situ breast cancer has an excellent prognosis.
Invasive ductal carcinoma (IDC): this form accounts for approximately 70% of all cases of breast cancer. The cancer cells may remain localized or may spread through the body via the lymph nodes or bloodstream.
Invasive lobular carcinoma (ILC): Though less common than invasive ductal carcinoma, this form of breast cancer occurs in a similar manner. It begins in the milk-producing glands and can spread to distant locations in the body. With this form, no lump is found, but rather a fullness or thickening in the breast occurs.
It is worth noting that there are uncommon forms of breast cancer as well, including:
- Inflammatory breast cancer
- Ductal Carcinoma: tubular, papillary, medullary and mucinous
- Adenoid cystic carcinoma
- Phyllodes tumor
- Paget's disease of the breast
- Metaplastic breast cancer
These types of breast cancer might not have begun in the breast, however, can occur in the supporting tissue of the breast, fibrous connective tissue, lymphatic system and blood vessels. Additionally, some forms of tumors do not begin in the breast but can be indicative of a cancer that has spread from another part of the body, but has become metastatic in the breast.
Treatment Options for Breast Cancer
In recent times, there has been many advances in the area of breast cancer treatment, in the past there were one or two favorable options, but now there is a complex menu of treatment options available. The type of treatment options utilized, will depend on which form of breast cancer presents and how advanced the illness has become.
Surgery for Breast Cancer
The normal first line treatment option for breast cancer is surgery. Whether or not to be a candidate for surgery is a discussion that will take place between the patient and doctors. To be eligible for surgery, a doctor will first have to determine the characteristics of the cancer, developmental stage and long-term prognosis.
- A lumpectomy (removal of lymph nodes and any lumps) versus a mastectomy (complete removal of all breast tissue)
- Breast reconstruction is the rebuilding of a breast after a mastectomy or lumpectomy.
- Prophylactic mastectomy is sometimes done as a preventative measure for women who are at a higher risk of developing breast cancer.
- Prophylactic ovary removal is another preventative surgery done to lower the amount of estrogen in the body, which makes it more difficult for the action of estrogen to stimulate breast cancer development.
After breast cancer surgery, women will experience a number of surgery-related side effects such as a shift in weight, tightness of the skin, changes in sensation, phantom breast sensations and lymphedema (swelling). Some less common side effects that may be encountered are poor wound healing, bleeding or an allergic reaction to the anesthesia used during surgery.
According to researchers from Harvard University, women who are in their 40's and undergo breast cancer surgery are at a higher risk of relapsing. The study itself is highly controversial because researchers based their studies on computer data rather than laboratory findings. But, the study may mark the start of a new way of understanding as to why and how cancer spreads.
Radiotherapy Treatment for Breast Cancer
Radiation treatment or radiotherapy, is a highly effective targeted tool in the treatment of breast cancer. Radiotherapy treatment can reduce a relapse of breast cancer by as much as 70%, is easily tolerated and the side effects are localized to the area treated.
There are two main categories of radiation therapy:
- External radiation: the most common type of radiation used, is typically administered after a lumpectomy or mastectomy.
- Internal radiation: less common method for providing radiation. Currently being reviewed for use after a lumpectomy.
The worst and most common forms of side effects from radiation involve the areas of skin being targeted. Side effects include; a mild to moderate redness, itching, burning and peeling, which most patients liken in similarity to a sunburn.
Of course each patient will have a different reaction or reactions to receiving radiation. Other side effects of radiation that may be experienced are; discomfort in the armpit, chest pains, fatigue, heart problems (breathing difficulty, rapid or irregular heart beat, coughing, swelling in legs and feet, feelings of dizziness or weakness and fatigue), lowered white blood cell count and lung problems.
Radiation is commonly given over a period of 5-days per week and for up to 7-weeks. Contrary to popular belief, treating cancer with radiation does not result in hair loss, unless the head is targeted. Many of the side effects of radiation will subside with time, and treatment with radiation greatly decreases the recurrence of breast cancer after surgery.
Hormonal Therapy For Breast Cancer Treatment
Hormonal therapy for breast cancer treatment is NOT the same thing as hormone replacement therapy (HRT). Hormonal therapy is initiated on the premise of working against hormone-receptor-positive breast cancer. The medication works in two ways; by lowering the levels of estrogen in the body and blocking the action of estrogen in the body.
Some of the most common types of hormonal therapies used for the treatment of breast cancer include; aromatase inhibitors (to cease estrogen production in post-menopausal women), selective estrogen receptor modulators (selectively inhibits or stimulates estrogen-like action in various tissues) and estrogen receptor downregulators (block the effects of estrogen in breast tissue).
Which hormonal therapy is applicable will depend upon several factors, such as:
- Menopausal status
- Stage of breast cancer
- HER2 status (these genes produce a protein that acts as a receptor on a cell surface and as a receptor, is sensitive to a growth factor and signals cancer growth)
- History of blood clots
- History of arthritis
- Personal risk of ovarian and/or uterine cancer
- Side effects experienced
Side effects of each hormonal therapy are radically different and will be discussed between patient and physician. Below is a list containing the individual side effects of each medication.
- Bone/joint pain
- Osteoporosis and bone thinning
- Nausea and vomiting
- Hot flashes
- Weakness and fatigue
- Dizziness, drowsiness
- Weight gain
- Increased cholesterol levels
Selective Estrogen Receptor Modulators (SERM)
- Bone/joint pain
- Hot flashes
- Increase sweating
- Blood clots and stroke
- Endometrial cancer
- Increase in bone/tumor pain
- Mood swings and depression
- Hair thinning
- Dry skin
- Decreased libido
- Leg cramping
- Flu-like symptoms
- Hypercalcemia (excess calcium in the blood)
- Vaginal discharge/bleeding
- Vision problems and/or dry eyes
Estrogen Receptor Downregulators (ERD)
- Nausea and/or vomiting
- Hot flashes
- Constipation and/or diarrhea
- Sore throat
- Back/stomach/abdominal pains
- Pain at injection site
In some cases of breast cancer, it is medically necessary to induce ovarian shutdown. Or a physician may recommend surgical removal of the ovaries in post-menopausal women. However, for peri-menopausal women ovary removal or induction of shutdown through medication, is not recommended. Removal or shut down of the ovaries is only effective in women who have not yet gone through menopause.
Medications used to halt estrogen production in the ovaries are:
- Zoladex® (pharmaceutical chemical name: goserelin)
- Lupron® (pharmaceutical chemical name: leuprodile)
Both of these medications are luteinizing hormone-releasing hormone agonists (combine with a receptor on a cell and initiates a reaction or activity produced by a binding substance). These medications are designed to halt estrogen production of the body and are given in an injection form on a monthly basis. Once the medications are stopped, the body begins to produce estrogen again. Women of child-bearing age after completing breast cancer treatment might want to consider these medications in lieu of surgical removal of the ovaries.
Biological Therapy for Breast Cancer Treatment
The concept of biological therapy for the treatment of breast cancer is to utilize the body's own hormonal or immune system in the fight against cancer cells, while allowing the healthy cells to remain intact. A biological approach to cancer treatment is designed to minimize the side effects associated with the traditional methods of treating cancer.
One strategy of biological therapy is to attack or block the action of cancer cells. An antigen is a substance that prompts the body to produce antibodies as a form of immune response. Antibodies can either be naturally manufactured or made artificially.
Another form of biological treatment used in breast cancer involves the use of medications composed of small molecules that disrupt the hormonal or chemical pathways used for growth by cancer cells. One of the disadvantages of antibody treatment is that generally, it is only administered via an injection, while small molecule treatment can be ingested in pill form.
Types of antibody treatment used in cancer treatment that are currently being researched are as follows:
- Antiogenesis inhibitors: these types of antibodies are used to prevent the growth of new cancer cells, by cutting off oxygen and nutrients.
- Signal transduction inhibitors: these antibodies block the signals which cancer cells use to divide and reproduce, which halts cancer growth.
Side effects of biological therapy include, but are not limited too; allergic reactions, nausea, vomiting, fever, chills, breathing difficulties, swelling, weakness or dizziness. If the side effects experienced include a temperature greater than 100º F, accompanied by fever and chills, bleeding from the gums, a “swollen throat, persistent cough, changes in bladder function or changes in gastrointestinal function, a cancer patient is directed to get into contact with their doctor immediately.
Breast Cancer Prognosis
In regards to the prognosis for those who are diagnosed with breast cancer, the long-term outlook depends on several factors such as; the location of the tumor, how far the tumor has spread, whether or not the the tumor is hormone-receptor positive or negative, tumor shape and size, rate of cell division and biological precursors.
The incidents of people who survive breast cancer are increasing every year and currently, there are more than 2 million women in the United States who are in remission. With the proper medical treatment, lifestyle changes and medications, the survival rate for breast cancer survival is significantly increased.