| Breast
Cancer |
| What
Is Breast Cancer? |
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By
Kari Danziger,
MS, CGC
Reviewed
by Beth Crawford,
MS, CGC
Last
updated August 24, 2011
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It's
hard to find a woman who doesn't worry that one day
she will get breast cancer. However, understanding what
cancer
is and what makes someone at high risk for cancer can
make it easier for a woman to understand her own risk
and find screening and prevention strategies that are
right for her.
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Who Develops Breast Cancer?
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| Breast
cancer is the second most common type of cancer
among women in the United States, following only
skin cancer in frequency. |
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The
American Cancer Society predicts that approximately
180,000 new cases of breast cancer will be diagnosed
and some 43,000 deaths will be attributed to the disease
in the year 2000, making it the second most common type
of cancer among women after skin cancer, as well as
the second leading cause of female cancer-related deaths
after lung cancer.
In
the United States, approximately 11 percent of women
will develop breast cancer by the age of 85, with 80
percent of breast cancer occurring in women age 50 or
older. The majority of cases are reported by women in
their 60s and 70s. Although men can also develop this
kind of cancer, they are at much lower risk, with only
0.1 percent of men developing breast cancer during the
course of their lifetime. A significant percentage of
male breast cancer is believed to be genetic in origin.
It's
important to keep in mind, however, that these statistics
apply to the general population: There are a number
of factors — both environmental and genetic —
that determine an individual's risk for breast cancer.
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Where
Does Breast Cancer Begin?
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All
cancers begin when some cells change and experience
out-of-control growth. Eventually, these cells gain
the ability to invade surrounding tissues. In the case
of breast cancer, this change can occur in any of the
tissues that make up the breasts. Even before breast
cancer develops, a number of noncancerous changes can
occur to cells that may increase a woman's chances of
developing breast cancer. These are called "marker"
conditions because they mark a location that may become
cancerous in the future.
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Types
of Breast Cancer
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Approximately
70 percent of all breast cancer begins in the ducts
(which route milk to the nipple) and 10 percent begins
in the lobules (where milk is made). The remainder of
breast cancer begins in the various other tissues of
the breast.
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Signs
and Symptoms
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are several signs that can indicate breast cancer. A woman
who notices any of these should immediately see her doctor
for an evaluation: |
- Lump
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Swelling
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Skin irritation, dimpling, or thickening
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Nipple pain or sudden inversion of the nipple
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Redness, scaling, or inflammation of the breast or
nipple
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Abnormal discharge
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These
symptoms can can also be associated with benign
breast conditions, so it is important not to panic if
you experience these symptoms. Instead, consult a doctor
for further evaluation.
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It
is important to note however, that breast cancer can
occur without producing any visible or noticeable symptoms.
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Factors
That Increase Risk
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Although
no one knows exactly why breast cancer develops, most
experts believe it can be attributed to a combination
of genetic and environmental factors. It's important
to note, however, that some people may possess certain
risk factors and never develop the disease, while others
may develop the disease in the absence of any known
risk factors.
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Genetic
factors. Just as there are genes
that define traits such as eye and hair color, there
are also genes that increase a person's susceptibility
to diseases such as cancer. In some cases, doctors
know specifically which genes are mutated
and cause cancer in a person's family. In other cases
the specific genes have not yet been identified and
doctors only know that breast cancer runs in a person's
family. The two genes most often associated with inherited
breast cancer — BRCA1 and
BRCA2 — are believed to account
for 5 percent to 10 percent of all cases of breast
cancer. Mutations in these two genes also increase
a woman's risk of other cancers (especially ovarian
cancer).
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By
learning whether you have an inherited risk for breast
cancer, you may learn that you should be considering
different screening and prevention options from those
appropriate for the general population. You may also
learn information that helps other family members understand
their cancer risk.
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Nongenetic factors. Other factors that may increase
a person's risk for breast cancer include:
- Increasing
age
- Exposure
to radiation
- Hormone replacement therapy
- First
childbirth after age 30
- Early
onset of menstruation
- Late
menopause
- Obesity
(especially after menopause)
- A
high-fat diet
- Excessive
alcohol consumption
- Personal
history of breast biopsies or breast disease
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Other
possible risk factors that are being studied include
lack of exercise, smoking, meat consumption , environmental
pollutants, and whether or not a mother breast-fed her
children.
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Screening
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Since
breast cancer is very treatable if caught early, screening
for the disease is an integral part of every woman's
health care. The currently recommended screening regimen
for members of the general population takes advantage
of three tools to identify suspicious lesions: breast
self exams, clinical breast exams, and mammography
(breast X-ray).
For
women who appear to be at increased risk for the disease,
screening may begin at an earlier age, make use of additional
screening techniques, and be performed more frequently.
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Prevention
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Currently
the best advice for women who want to reduce their risk
of developing breast cancer is to limit alcohol consumption,
increase physical exercise, control weight gain, and
follow an age appropriate screening plan.
For women at increased risk, there are a number of other
preventive measures they may want to consider, including
the following:
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- Drugs.
Studies have shown that the drugs tamoxifen and raloxifene
reduce the risk of breast cancer. These drugs are
believed to prevent breast cancer by blocking the
effects of estrogen, which can promote the growth
of breast cancer cells. However, it's important to
note that these medications have a number of potentially
dangerous side effects and thus are not appropriate
for everyone. Before taking any cancer-preventing
drugs, women should discuss the risks and benefits
with their health care providers.
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- Surgery.
Some women who know that they carry mutations in a
breast cancer gene such as BRCA1 or BRCA2, or who
have an extremely strong family history of breast
cancer, may want to consider even more aggressive
approaches to reducing their breast cancer risk. These
include preventive surgeries such as removal of the
breasts (prophylactic mastectomy) and ovaries (prophylactic
oophorectomy). While there's strong evidence to suggest
that these procedures reduce the risk of breast cancer
for some women, the degree of risk reduction may vary
depending on each woman's risk factors and her medical
and family history. Individuals who are considering
these options should carefully weigh their benefits,
risks, and limitations before proceeding with any
type of surgery.
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Treatment
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Breast
cancer treatment depends on the location and size of
the tumor as well as how far the cancer has spread at
the time of diagnosis. In addition, a patient's age,
menopausal status, and overall health all play a role
in determining the best treatment options for an individual.
Although
early-stage cancers can usually be treated surgically,
either by removing a section of the cancerous breast
tissue (lumpectomy) or by removing
one or both breasts (partial or full mastectomy),
chemotherapy
or radiation may also be required
if the cancer cells have spread. Chemotherapy, radiation,
or hormonal treatment may also be used to reduce the
risk that cancer will return locally in the breast,
or in other organs.
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Links
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To
learn more about treatment options for breast cancer,
we recommend the National Institutes of Health Cancer Web site or the National Cancer Institute of Canada.
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References
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Claus,
E.G. et al. (1996).The genetic attributable risk of
breast and ovarian cancer. Cancer. 77(11):2318-24.
Kelsey, J.L. (1993). Breast cancer epidemiology: summary
and future directions.
Epidemiological Reviews. 15:256-263.
Fisher, B. et al. (1998). Tamoxifen for the prevention
of breast cancer: report of the National Surgical Adjuvant
Breast and Bowel Project P-1 Study. JNCI.
90:1371-1388.
Cummings, S.R. et al. (1999). The effect of raloxifene
on risk of breast cancer in postmenopausal women: results
from thh MORE randomized trial. JAMA. 281(23):2189-97.
Hartmann, L.D. et al. (1999). Efficacy of bilateral
prophylactic mastectomy in women with a family history
of breast cancer. N Engl J Med. 340(2)77-84.
Love, S.M. (1991). Dr. Susan Love's Breast Book.
Addison-Wesley, Reading, MA.
Reis,
L.A.G. et al. (2000). SEER Cancer Statistics Review,
1973-1997. National Cancer Institute. Bethesda,
MD.
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