Breast Cancer Statistics
What are your chances of finding a breast lump? Next to skin cancer, breast cancer is the most common cancer in women. While not common in men, the disease does strike men and should not be ignored. In the U.S. in 2002, it was estimated that more than 255,000 women and 1500 men were diagnosed and nearly 40,000 women and 400 men died from the disease.
The incidence in women increases with age, rising sharply after the age of forty. Three quarters of invasive forms of the disease occur in women beyond fifty. The good news is that when symptoms are diagnosed in the early stages, before the disease has substantially 'invaded' the tissue or is still localized to one area, treatment dramatically increases the survival rate, which can be as high as 96 percent. Once spread throughout the breast, the survival rate drops to about 75 percent.
Cancer statistics tell us that one in nine women in the U.S. is diagnosed with this condition. Because all women are at risk of finding a breast lump, public education about the disease cannot be taken lightly. At the same time, statistics based on populations, while useful in underscoring problems and illuminating trends, cannot and should not be used as a predictor for individuals.
Detecting the Early Signs of Breast Cancer
Breast health is important to the physiological and psychological health of both men and women. Therefore, a program of 'preventive' care that includes a self examination is crucial to detecting early signs of breast cancer before symptoms progress. Research suggests that a majority of women do not conduct regular self exams.
When Should the Examination Be Conducted?
One purpose of a breast self exam is to get to know the way each breast normally feels. This allows easier detection of abnormal lumps that may be cancerous, and irregularities such as cyst lumps, which are benign (non-cancerous). Some lumps are not visible with x-ray so the self exam is crucial.
The description 'normal' changes in each phase of a woman's life. Therefore, doctors recommend that women begin performing self exams in their late teens when their breasts are fully matured.
Because physiological changes occur that are linked directly to the menstrual cycle, becoming familiar with normal changes before and after menses is important. Doctors commonly recommend that the breast self exam be performed monthly and at the same time in the menstrual cycle (i.e., two or three days following the cessation of flow). Women with irregular menstrual cycles should perform the self exam on the same calendar day each month.
During pregnancy and following childbirth the breasts change with the onset of milk production and its eventual ebb. For example, during lactation, milk-filled ducts may be felt.
With physiological changes in the mammary glands at menopause, health professionals recommend that the examination be conducted more frequently.
How Do I Conduct a Breast Self Exam?
To carry out the exam, lie on your back, place a pillow under your right shoulder and place your right arm behind your head; this position will flatten the right breast. With your left fingers together and extended, move the three middle finger pads in tiny circles (palpate) across the gland counterclockwise covering the entire region. Feel for cyst lumps.
Repeat twice using a different pressure with each complete coverage. Vary from light pressure to deep pressure. Extend the area of coverage to the armpit, collarbone and shoulder.
Alternate patterns of feel may be used as long as the entire region is covered. You may use longitudinal lines (in the direction of head to foot) or radial lines from the outer margin to the nipple and back to the margin.
Finish the examination by gently squeezing the nipple and checking for a discharge. Finally, repeat this entire examination in the left breast. Click here to see an animated self exam.
Sexual partners may also perceive changes. These should be confirmed with a self exam.
Recognizing the Symptoms
Monitoring Breasts for Change
Having a preventive mindset and taking a proactive approach to monitoring for symptoms of breast cancer applies equally to men and women. While a lump is not always cancerous, having it promptly examined by a health professional is good practice.
An armpit lump or enlarged lymph nodes are not typically associated with a problem in a mammary gland, but it could be a symptom of a problem there. Breast tenderness and nipple discharge may not suggest a tumor but need to be taken seriously and evaluated immediately. Early detection and reporting of these cancer warning signs are critical to early treatment and a good prognosis.
Normal Changes in Female Mammary Glands
Mammary glands undergo changes that are normal. Understanding these changes helps prevent confusion with abnormalities that may occur.
Breast development and maturation is a response to hormonal changes at puberty, during the menstrual cycle, during pregnancy, at childbirth and at menopause. In addition, fat content in mammary glands changes with the body's overall weight gain or loss.
At puberty, mammary glands enlarge with rising estrogen levels. By age 16, on average, they mature with most of the breast being capable of producing milk (glandular). By contrast, in older women, the glandular tissue has shrunk (atrophied) and is replaced by fat.
During menstruation, dramatic changes occur with changing estrogen and progesterone levels. Just prior to menstruation the mammary glands become firm and are tender. Following menstruation, the glands soften and are less tender.
During pregnancy, in preparation for lactation, milk-producing cells proliferate and duct development increases.
Abnormal Changes in Female Mammary Glands
What warning signs should a woman look for? One observation that helps distinguish normal changes from those that are not is that normal physical changes affect both mammary glands similarly. Certain changes in one gland and not the other, such as a lump, breast tenderness or nipple discharge, may be a symptom of breast cancer. If you detect this type of change, contact your health professional immediately.
Symptoms of Breast Cancer
Symptoms include: armpit lumps, enlarged lymph nodes, nipple discharge, mammary lumps, inverted nipples, mammary dimples, mammary swellings, mammary tenderness and prominent veins at the surface of the gland. Persistent breast tenderness may indicate a problem. These are cancer warning signs and should not be ignored.
Lumps are typically firm structures that may not be painful. Any armpit lump, enlarged lymph nodes, or breast swelling should be reported to your doctor. Skin discoloration or texture change should be similarly shared.
The Importance of Self Exams and Consultations
Most symptoms are visually observable and highlight the need for regular self examination. The disease cannot be prevented; however, early detection of cancer warning signs and positive diagnosis dramatically increases the likelihood of successful treatment.
A regular program of self-exams, mammograms, and physical examinations by your doctor is your best defense against the disease spreading.
Diagnosing Breast Cancer
Health professionals use several tools to gather information about a potential cancer. As explained at the symptoms topic below, abnormal changes to a single breast, or the lymphatic system that drains it, could indicate a possible cancer. The breast exam, mammography and biopsy all aid in cancer detection and evaluation.
Abnormalities require evaluation and a medical diagnosis. If cancer is confirmed, the diagnosis will indicate the type and stage. A prognosis can then be made based on this diagnosis and treatment options discussed.
One of the tools used in making a medical diagnosis is mammography, or breast x-ray. The image is the mammogram. The radiologist evaluates the density differences of the mammary gland lobes and surrounding fat.
Of interest to the radiologist is the abnormal mammogram that reveals suspicious structures such as a previously undetected breast lump. An abnormal mammogram might show calcification. A cluster of many tiny calcifications might indicate cancer.
The two types of mammography are screening and diagnostic. Screenings are routinely used to examine individuals who have no evidence of cancer. They consist of two views of each breast.
Most Women Report Little Pain
While routine screening has been shown to reduce breast cancer mortality, patients and physicians report that pain experienced during mammography is one reason why more women do not get screened annually. However, the results of a new study published in the April 14, 2003 issue of Archives of Internal Medicine, indicate that for the vast majority of women (72 percent), the pain is less than that of a mild headache (less than 4 out of 10, with 10 being excruciatingly painful). More importantly, however, of the 200 women who participated in the study, 94 percent said they were "very likely or somewhat likely to get a mammogram next year."
Diagnostic mammography is used to examine a specific area when an abnormality has already been found. It includes special views and additional angles.
Mammography is not failsafe: it sometimes produces false negatives or false positives. In a false negative, the mammogram fails to reveal one or more suspicious lumps. With the false positive, the 'abnormal mammogram' incorrectly indicates the presence of a breast lump.
Possible tumors must always be confirmed with a breast exam. The downside to a false positive is that it can lead to an unnecessary biopsy.
If you have had an implant and are requesting a routine mammogram, be sure the x-ray technicians are experienced in the use of the special techniques required. Ultrasound examinations may be of benefit.
The American Cancer Society recommends mammography every year beginning at age 40. The National Cancer Institute recommends screening mammography every year or two, beginning at age 40.
A clinical breast exam is commonly recommended every 3 years between ages 20 and 39, and annually thereafter.
All organizations recommend monthly breast self-exams beginning at age 20.
Five main biopsy methods are used to obtain tissue suspected of being cancerous. The method used depends upon the size, location, and nature of the suspect lump.
A needle biopsy is the least invasive, is relatively quick and may be done in the surgeon's office. It does not require stitches or leave scars. The needle biopsy is used for cysts and tissue samples. A large biopsy may be required for calcium deposits, in which case a small incision may be required. In this case a needle biopsy may not be as reliable.
Surgical techniques are usually required when a breast lump is indicated but cannot be felt or a calcification is evident on the mammogram. They are also used when lesions are near the chest wall, for multiple lesions, or when masses have many tiny calcifications.
Because large masses are removed, the procedure is followed by a long recovery period and scarring will occur. Surgery is more reliable than a needle biopsy but has the risk of disfigurement.
Types of Breast Cancer
Should a diagnosis of cancer be made, one of the first determinations is a confirmation of its type and stage of development. Common types of breast cancer include carcinoma (the vast majority), sarcoma and inflammatory.
Carcinomas account for nearly 85 percent of all malignancies, while the number of inflammatory cases may be less than one percent. Carcinomas affect the lobes and ducts of the mammary gland. A minority of cases are diagnosed as carcinoma in situ (ductal or lobular carcinoma), meaning that the tumor is localized and subject to complete removal. At the in situ stage, ductal carcinoma or lobular carcinoma are described as non-invasive or pre-malignant. The majority of carcinomas, however, have already begun to spread (metastasize) by the time they are detected.
The in situ condition is sometimes referred to as Stage 0 because the spread has not begun. Patients with this condition have at least a 25 percent chance of developing breast cancer in the next 25 years, although some differences exist between the ductal type and the lobular type. Most often, both types are considered a 'marker' for increased risk.
A malignant tumor that develops in fatty and connective tissue of the mammary gland is called a sarcoma, meaning 'fleshy growth.' Sarcomas may or may not metastasize.
Inflammatory breast cancer is an advanced stage tumor that gives the breast skin an orange peel appearance.
Cancer cells may originate in a mammary gland or elsewhere. When cells from the mammary gland spread and course towards lymph nodes in the periphery of the gland, they are labeled invasive. These cells may leave the nodes and drain laterally towards armpit nodes. From there, they can spread to the nodes in regions of the collar bones, shoulders, ribs and throughout the body where they may take up residence and proliferate as secondary tumors.
Blood leaving the mammary glands in veins may carry cancer cells to the lungs, liver, bone and skin.
Less Common Types
Paget's disease typically exhibits scaly bumps around the nipple or a lesion on the nipple.Paget's disease of the breast is indicative of a less common type characterized by a scaly lesion of the nipple that does not heal or by scaly bumps in the areolar region that persist. About 75 percent of individuals with Paget's disease have a cancer lying beneath a nipple. Paget's disease demands an immediate biopsy and mammogram.
Inflammatory breast cancer is a rare type in which the breast looks as if it is inflamed because of its warmth and orangey-red appearance. The skin may show ridges and dimples similar to an orange peel. This type has the worst prognosis, with a survival rate of only 35 percent.
Cystosarcoma phylloides is the only cancer of the mammary glands that originates in the 'soft' tissues beyond the lobes and ducts. It has the feel of a benign tumor. Cystosarcoma phylloides is much less common than a ductal carcinoma or lobular carcinoma.
Understanding Breast Cancer Stages
Understanding breast cancer staging is critical to early detection and helps with prognosis and proper treatment.
Typically, breast cancer begins as a carcinoma in situ meaning that it is localized in a duct or lobule. Growth rate varies but the 'wild' cells remain together. This describes the earliest of breast cancer stages, Stage 0, and is non-invasive. The prognosis for individuals with a carcinoma in situ is that almost all will be alive after five years provided that the entire tumor is successfully removed.
If the carcinoma in situ is not identified and removed, it is liable to continue growing to Stage I. It is now invasive but is confined to the breast and is less than an inch in diameter. Approximately ninety percent of patients are alive 5 years after diagnosis and treatment.
Stage II is characterized by a combination of tumor size and the distance the disease has spread. Either the tumor is relatively small (approximately one inch) and the disease has spread to lymph nodes in the armpit, or the tumor is larger than 2 inches and the disease has not spread. If the tumor is less than 2 inches, it may or may not have spread. The prognosis is 65 percent survival after 5 years.
Stage III is divided into two stages: IIIA and IIIB.
Stage IIIA development is characterized by a less-than-2 inch tumor where the disease has spread to armpit lymph nodes, and the lymph nodes are attached to other structures or to themselves. Alternatively, the tumor is larger than 2 inches and has spread to armpit nodes.
At Stage IIIB, the disease has spread to the chest wall, ribs and muscles. The skin is also likely to have been invaded. Alternatively, the disease has spread to lymph nodes along the breastbone.
The prognosis for Stage III patients is 45 percent survival after 5 years.
Stage IV is highly advanced where the disease has spread to bones, lungs, liver, brain or other body organs. Alternatively, the cancer has spread to skin and lymph nodes inside the neck, close to the collarbone.
Stage IV offers the lowest probability for survival of any of the stages. The 5-year survival is less than 10 percent. Once it has spread to internal organs, the prognosis is poor.
A cancer is recurrent if, following treatment, there is rejuvenation.
TNM Staging System
TNM stands for Tumor, Nodes, Metastases, a 1992 (updated in 1997) staging classification of the American Joint Committee on Cancer and the International Union Against Cancer. This system may be applied to various organs and helps establish a basis for breast cancer prognosis.
Physicians may apply the concept of breast cancer prognosis to patients with tumors when they are first detected, or even to individuals who demonstrate certain risk factors. The type of tumor and location, for example, help doctors determine the likelihood of success for a specific intervention and, therefore, the likelihood of a tumor recurring.
Breast Cancer Risks and Prevention
While you may not be able to prevent it, you may be able to limit the development and spread (metastasis) of breast cancer. Prevention depends on early identification of a tumor or pre-cancerous cells. It also requires identifying risk factors and monitoring your body.
What are the Risk Factors?
Risk factors include chronological age, abnormal genes, family history, diet and, more recently, use of hormone replacement therapy (HRT) following menopause. You have no control over some of these factors, but others may be managed.
The incidence of the disease rises with age following menopause and is uncommon prior to it. A family history of the disease does not mean you will develop it; however, the odds are significantly greater.
Women using birth control pills run a slightly higher likelihood of developing mammary cancer. After 10 years of not taking birth control pills, the increased risk drops away.
Research on the role of diet has been inconclusive. Some evidence suggests that certain fruits and vegetables help lower the odds and that fish and vegetable oils high in polyunsaturated and monounsaturated fats and antioxidants seem beneficial.
Research suggests that in some cases breastfeeding slightly lowers the breast cancer risk. Whether the cause is breastfeeding itself or something associated with it is not clear. Mastitis, a condition usually associated with breastfeeding, occurs when one or more milk ducts become blocked and a bacterial infection ensues. No evidence indicates that mastitis predisposes a woman to cancer.
The Pesticide Connection
According to the results of a new study from Belgium, the serum concentration of the organochlorine pesticides DDT and HCB were significantly higher in women with breast cancer than in healthy women. In addition, the results also revealed that the concentrations of these pesticides in the blood were not affected by the cancer's response to estrogen. Earlier studies did not conclude that a connection between pesticides and breast cancer existed.
Neither DDT nor HCB are currently used in the US.
Hormone Replacement Therapy (HRT)
HRT and breast cancer is of increasing interest as research begins to show that some women after menopause may be at higher risk. As with birth control pills, hormone replacement therapy or augmentation can significantly affect normal body functions.
The topic is highly controversial because many studies show no increased likelihood while others show an increased risk of breast cancer between 30 percent and 50 percent with long term HRT. Early studies suggested that taking HRT might provide other benefits, including a lower risk of heart disease and hip fracture. But a recent major clinical trial in the U.S. indicates that long-term use of one type of HRT can seriously damage women's health and actually increase heart disease.
If you are considering HRT, how do you resolve the HRT and breast cancer issue? You might begin by assessing your personal risk. If you have a high risk of breast cancer and a low risk of heart disease and hip fracture, perhaps you should not elect for hormone replacement therapy. When the research evidence conflicts, be cautious and discuss HRT options with the members of your professional health team.
A Preventive Attitude
Your mindset towards breast cancer prevention may help or hinder its development. Cancer organizations are unanimous in encouraging women who are over 40 to have an annual exam. They also encourage a monthly self exam. See The Self Exam page on this site for details on how to do it. Maintaining your health and making lifestyle adjustments are key elements of a preventive attitude.
Breast Cancer in Men
Male breast cancer affects less than one percent of men in North America and accounts for less than one percent of all diagnosed breast cancers. The average age for diagnosis is about 63 years—10 years later than for women. Recent literature on the disease indicates that, when matched stage for stage, male and female breast cancer patients have similar survival rates.
Signs of breast cancer in men are comparable to those in women. Most male breast cancer is detected as a lump on one side, under the areola. The lump is typically hard and firmly attached to surrounding tissue. Invasive ductal carcinoma is the most common type, just as it is in women.
Signs also include a nipple discharge or retraction, either of which warrants an immediate diagnosis. Open sores on the skin that become inflamed should be examined as well.
One of the important signs is swollen lymph nodes in the armpits, which occur in about fifty percent of the cases. Sometimes, swollen lymph nodes are the very first sign of a tumor. However, lymph nodes can become swollen for other reasons. A physician should examine any swollen lymph nodes immediately.
The suggestion that male breast cancer is more aggressive than the disease in females may be due to the fact that men seem to respond less favorably to treatment. However, this may be more a function of the relative lateness in life in which a diagnosis is made in men.
Males, too, present difficulties for diagnosticians in that not all swellings are malignancies. Gynecomastia, or the benign development of breast tissue in men, is sometimes mistaken for a malignancy until a biopsy and tissue analysis are completed. Gynecomastia occurs in about one half of the male population in North America at some stage of their lives.
The Risk Factors
As in females, abnormal genes can trigger the disease. Age is also a shared risk factor with most cases of the disease occurring later in life, particularly after the age of 65.
Men with certain conditions may be prone to the disease whereas in women, these conditions don't exist or may not be a factor. For example, those men born with an extra X chromosome (XXY) are at a slightly higher risk for gynecomastia and for developing breast cancer.
Those men who have contracted mumps orchitis after the age of 20 appear to be at greater risk. Increased estrogen levels and decreased testosterone levels may also be linked to an increased incidence of the disease.
A Review: Breast Anatomy and Breast Cancer
Understanding breast anatomy and function helps people recognize abnormal changes more easily. Becoming familiar with their anatomy and how your breasts feel can give you the confidence to monitor for change and communicate more effectively about detected changes.
Each breast is made up of fifteen to twenty lobes surrounded by fat cells and connective tissue. Each lobe is made up of gland cells (lobules) that, in the woman, produce milk.
Under hormonal stimulation, milk flows from lobules into ducts towards sinuses beneath the pigmented region (areola) around the nipple. With stimulation, milk enters the nipple.
Blood vessels supply breasts with nutrients. Waste products are removed by the blood in veins and by lymph in lymph vessels. Cancer cells use blood and lymph vessels to spread to different areas of the body (metastasis).
What is Oncology?
Oncology is the branch of medicine devoted to cancer (from the Greek: o(n)glos = tumor, logos = study). In this specialty are three primary disciplines: medical, surgical or radiation oncology. Some oncologists specialize further into specific types of malignancy; prostate, lung and breast, lymphoma and leukemia are examples. Pediatric oncology is recognized as a separate discipline that incorporates medicine, surgery and radiotherapy.
The two most important factors in prognosis are tumor size and presence or absence of tumor spread. The prognosis progressively worsens as the disease progresses through the four stages of cancer: I through IV. Stage I is a very small tumor that doesn't involve the lymph nodes; it typically has a good prognosis. In Stage IV cancer, distant metastases (tumors in other parts of the body) are evident.
Radiation therapy, chemotherapy and surgery are treatment options. Each of the stages of cancer requires a different treatment regimen.
Glossary of Terms
areola: pigmented area around the nipple
biopsy: removal and examination of tissue for diagnosis
carcinoma: a cancer originating in the skin or tissues that cover or line internal organs (such as in ducts and lobes of the breast)
chemotherapy: oral or intravenous drug used to hinder cancer cell reproduction
cyst: a round, smooth-edged, fluid-filled non-cancerous lump.
lobe: a cluster of gland cells that produce milk
lymph nodes: bean-shaped structures scattered along lymphatic vessels
malignancy: cancerous growth that can invade neighboring tissues, and may metastasize
mammogram: X-ray image of a breast
mastectomy: partial or entire removal of breast
metastasis: spread of cancer cells from their source to other areas of the body
oncologist: physician trained in the treatment and care of cancer patients
radiation therapy/radiotherapy: treatment that uses high-energy radiation
sarcoma: a cancer derived from fat or connective tissue
tumor: a lump formed by a collection of abnormal cells
Treatment Options for Breast Cancer
Once a cancer is diagnosed and an analysis and prognosis are completed, beginning a treatment regimen as quickly as possible is essential. Discuss breast cancer treatments and care options with your oncologist, who is a cancer specialist.
Radiation, surgery and chemotherapy drugs are used to treat breast cancer. Each may be used exclusively or in combination with another therapy. The relatively recent addition of hormonal therapy is indicative of how new approaches are helping oncologists improve survival rates among cancer patients.
Depending on the location of tumors, their type and stage of development, the oncologist will recommend a particular option or present a few options. Before proceeding, you need to be comfortable with the option and may wish to seek additional information and consultation.
Radiation therapy may be used at all stages of breast cancer, alone or in combination with surgery and/or chemotherapy. Used to control or shrink the malignancy and to destroy abnormal cells, radiation is used in more than half of breast cancer treatments.
Chemotherapy is a treatment used for some types of tumors and leukemia, but not at all stages of cancer. It may be used to shrink a malignancy prior to surgery or radiation therapy, when it is too large or too well attached to healthy tissue to be easily removed surgically.
When used following surgery, chemo-therapy is used to destroy potentially remaining abnormal cells, and to extend and improve the quality of life.
Various surgical procedures, ranging from biopsy to radical mastectomy, are involved in breast cancer treatments. Biopsies are used to remove tissue samples to aid in diagnosis and to assess the degree of proliferation of a cancer. Biopsies are also used to remove small structures, such as lymph nodes, that have been invaded by cancer cells. The lumpectomy is a technique used to remove benign tumors or malignant tumors that have not yet metastasized. A lumpectomy also removes a small amount of normal ('marginal') tissue surrounding the tumor.
The oncologist will recommend mastectomy when much of the breast has been invaded. A partial mastectomy is helpful as a control measure if the malignancy has not metastasized beyond the mammary gland. New techniques have made breast reconstruction possible after mastectomy, and are now often considered key to treatment and rehabilitation.
Breast Cancer Surgery: Lumpectomy to Mastectomy
Surgery permits both diagnostic tissue removal and control of cancer when a tumor has not yet metastasized. In cases of metastatic breast cancer, surgery may be performed in combination with other treatments.
Surgery targets specific areas and can be controlled so that a minimum of normal tissue is affected. Depending on the nature and extent of the suspected cancer, surgical options range from breast biopsy (small, localized tumor) to radical mastectomy (entire breast).
Types of Mastectomy
Radical mastectomy may be undertaken in patients with Stage IV metastatic breast cancer where malignant cells have migrated to the breast margin and beyond. When patients have metastatic breast cancer, the goal is to lessen their pain and associated discomfort while extending their life. A partial mastectomy may be performed in early metastasis when there is still a high probability of removing all of the cancer.
Sometimes women who are most at risk choose preventive surgery—prophylactic mastectomy—in the hope of reducing the probability of getting breast cancer. The most severe option is to have radical mastectomy followed by breast reconstruction.
Less radical, subcutaneous prophylactic mastectomy removes much of the breast tissues but keeps the nipples and areola intact. Prophylactic mastectomy is a controversial treatment option, not universally supported by the medical profession.
Biopsies are microsurgeries in which a sample of suspicious tissue is obtained and analyzed for signs of cancer. The four types of biopsies are axillary node dissection, open excisional (lumpectomy), needle aspiration, and sentinel node biopsy. The option chosen will depend on tumor characteristics, location and whether it can be felt by touch.
The lumpectomy is a localized surgery for removal of a breast lump. In a lumpectomy, the targeted breast tissue is cut away in a single piece and removed through a small incision. Analysis will confirm the lump to be a cyst, or a benign or malignant tumor. The result will determine if an additional breast biopsy or other treatment is required.
A second type of breast biopsy is needle aspiration, which is used to remove varying amounts of fluid and tissue from a targeted lump in a single procedure or in a series of procedures. For very small lumps, a "stereotactic" approach can be applied using computer-based imaging to enhance guidance of the biopsy needle.
An axillary node dissection is the removal of a layer of fat containing several lymph nodes from the armpit region. The nodes are then examined to assess how far the cancer has spread.
Sentinel node biopsy is selective removal of the first lymph node in the armpit region that receives lymph fluid from the breast. The first node is removed because of the higher probability that cancer cells will accumulate there before metastasizing to other tissues. Sentinel node biopsy is helpful because analysis of nodal tissue will indicate if cancer has reached the armpit, and will help determine if additional treatment is necessary.
One side effect of lymph vessel and node removal from the axillary region is lymphedema, an accumulation of fluid causing swelling in the arm. Lymphedema can occur immediately following treatment or years later. Because of the very slow drainage of waste products in the area, bacterial infection can accompany lymphedema.
Chemotherapy: Drugs for Breast Cancer
Chemotherapy drugs are used to slow or stop cancer cells from reproducing. Drugs can shrink tumors significantly, thereby controlling the disease. They improve quality of life and extend it.
Chemotherapy drugs are given independently or in combination with other medications or therapies. Drug choice depends on cancer type and cell structure, origin and degree of spreading.
Although beneficial, these drugs can have negative effects such as hair loss. Besides hair loss, common chemotherapy side effects include nausea, mouth sores, diarrhea, fatigue and reduced blood cell counts. Side effects depend on the drug used and on the patient's individual response to it.
When is Chemotherapy Used?
Unlike radiation therapy and surgery, chemotherapy reaches diseased cells throughout the body. This effect is particularly important following radiation therapy or surgery where not all affected cells are destroyed; this is known as adjuvant therapy.
Drugs are also used prior to surgery and radiation therapy to reduce tumor size and lessen tumor attachment to healthy tissue. This is called neoadjuvant chemotherapy.
When metastasis has occurred, drugs are often used to destroy large numbers of cells even when the risk of chemotherapy side effects, like hair loss, nausea, and mouth sores, is high.
Chemotherapeutic drugs are typically administered in successive treatments, each one followed by a recovery period. Treatment can last three to six months, depending on patient health, drugs used and extent of the disease.
Some Chemotherapeutic Drugs
Some of the drugs used in breast cancer treatment are: arimidex, doxorubicin, femara, herceptin, tamoxifen, taxol, taxotere, and xeloda. They vary in their effectiveness, toxicity and suitability.
They are administered in different quantities and for different durations depending on the patient's condition and the oncologist's objectives. Typical methods used are intravenous injection and oral administration.
Some current protocols for breast cancer are outlined below. Talk to your oncologist about specifics of the drug treatment options available to you.
What is palliative therapy?
Palliative therapy reduces the effects of the cancer and helps prolong survival time.
Arimidex is a palliative therapy. Arimidex is used in the treatment of advanced disease in postmenopausal women who have failed to respond to other drugs such as tamoxifen.
Doxorubicin is an antibiotic used for locally advanced cancer. It is used to treat inflammatory breast cancer, as adjuvant therapy and as palliative therapy in cases of metastasis.
Femara is used in palliative therapy. Femara is used to treat postmenopausal patients with advanced cancer.
Herceptin is used in palliative care for patients with metastasis. Herceptin is a form of "immunotherapy" in which monoclonal antibodies target cancer cells. Herceptin is used alone or in combination with Taxol as a first line treatment for some metastatic tumors.
Tamoxifen is used in adjuvant chemotherapy to stop or slow the growth of diseased cells. The hormone estrogen is known to stimulate breast cancer cell reproduction by attaching to affected cells at estrogen receptor sites. Tamoxifen interferes with estrogen binding. It is also used in palliative therapy.
Taxol is used as a follow up to doxorubicin in adjuvant therapy, and as palliative therapy in cases of metastasis.
Taxotere is used alone or in combination with other treatments in cases of locally advanced or metastatic breast cancer.
Xeloda is used to treat metastatic breast cancer. It enters diseased cells and is metabolized into a cancer-killing drug (5-FU). Xeloda can be taken as oral tablets.
Drugs for Metastatic Breast Cancer
The following are some of the drugs used to help combat cancer that has metastasized:
Radiation Therapy for Breast Cancer
Radiation therapy, or radiotherapy, can prolong life and improve its quality by eliminating cancer and relieving symptoms. A majority of cancer patients receive high doses of radiation as part of their breast cancer treatment regimen.
Radiotherapy reduces or eliminates cancer cells. It uses high energy x-rays aimed at tumors or parts of the breast that are sites of numerous diseased cells. Radiation damages DNA so these cells can no longer reproduce.
When is Radiotherapy Used?
Radiation is an important part of breast cancer treatment. Radiotherapy is used prior to surgery to shrink tumors, or following surgery to kill remaining cells. Together with chemotherapy, radiotherapy is effective as a treatment for cancer in its early stages, often eliminating the need for surgery.
Radiotherapy treats secondary breast cancer in the skin, bones and lymph glands, and treats recurring cancer following mastectomy. As a palliative treatment, radiotherapy helps reduce bleeding, relieve pressure and lessen pain and discomfort.
Types of Radiotherapy
External radiation therapy destroys both shallow tumors near the skin, and those that are deep-seated. The radiation oncologist determines the frequency of treatments and the dosage.
When concerned about damage to normal tissues or the length of time required to administer a series of external treatments, the oncologist can use brachytherapy, an internal radiotherapy. Breast brachytherapy can take five days instead of the five to seven weeks for external therapy and offers less radiation side effects.
In brachytherapy, a radioactive source such as cesium or radium is surgically implanted in or near the cancer for as long as required. This gives a high radiation dose to the cancer while reducing exposure to normal tissue.
In a new technique, pellets containing the radioactive source are inserted into the breast for a short time on each day of the treatment and then removed so that the patient is able to interact with other people. One big advantage of brachytherapy over surgery is that a woman is able to keep her breast.
Intensity modulation radiotherapy (IMRT) is an external treatment consisting of many narrow beams intersecting a tumor. This results in a high dose to the tumor, low dosage to healthy tissue and a low rate of radiation side effects. IMRT permits the treatment of tumors that are complex in shape and of considerable size. One advantage of IMRT is that tumors lying close to vital organs can be treated successfully while minimizing loss of organ function.
Hyperthermia therapy utilizes ultrasound or other frequencies to elevate the temperature of cancer cells in a localized area or region of advanced primary cancer. Hyperthermia may be used after mastectomy where there is a recurrence.
Hyperthermia is an effective treatment for those cancers that are heat sensitive, and is even more effective when combined with radiotherapy.
Radiation Side Effects
While high levels of radiation can damage normal tissues, the strategy behind this treatment is that the overall benefit to the patient will be greater. Radiation side effects include: local skin irritation such as reddening and dryness, fatigue, and nausea.
Surviving Breast Cancer
Recent treatment advances and improvements in the breast cancer survival rate are helping cancer patients build a positive outlook and retain their quality of life. While breast cancer incidence is rising in North America, the breast cancer survival rate in men and women has reached an all-time high. The current breast cancer survival rate has two out of three patients living at least five years following diagnosis.
Five-year survival for all cancers combined is 62 percent, up two percent from a year ago and considerably higher than the 51 percent who lived that long with cancer in the early 1980s.
If you have just been diagnosed with breast cancer, or know someone who has, you will begin to understand the trauma and devastation for both the person diagnosed and the immediate family. After the initial shock, you will need time to grasp the situation and accept the challenge of survival.
Although you may feel pain and emotional stress, begin creating a pain management plan. This starts by communicating with others about how you feel, and how they feel, so that you feel less alone and can begin to focus on survival.
Pain management requires that you have current information from reliable sources. You may wish to obtain information on coping strategies, particularly those dealing with depression. Speak with your physician and oncologist about treatment options. Get help to organize your information so you will be more comfortable and confident with the treatment decisions you make.
Pain management includes building an emotional and psychological support network that includes your family, friends, health care team, cancer survivors and breast cancer support groups. A support network can help you work through anger and fear, and the depression that often follows a cancer diagnosis.
Life During Treatment
Anxiety, distress, grief and depression are common side effects of chemotherapy and radiation therapy. You can also expect to experience a loss of appetite.
If you need a radical mastectomy, you will no doubt be concerned with your physical appearance and will want to know about breast reconstruction and suitable clothing. Breast reconstruction options include implanted prosthesis, tissue expansion and flap techniques using layers of muscle and fat. While risky, breast reconstruction can restore a sense of 'wholeness' and return your symmetrical appearance. Mastectomy bras and silicone breast forms are also available.
Chemotherapy patients find chemo caps are helpful. Before, during and after treatment, 'cold caps' are worn to restrict blood flow to hair follicles. This results in minimal hair loss or thinning. During recovery, when there is significant hair loss or patchiness, chemo caps are used to cover the head. They are often knitted or made from soft material. Chemo caps can be stylish, fashionable and a source of humor while your hair is growing back.
Life After Treatment
You will need assistance throughout your life, balancing a sense of hope with continuing sadness. You will never forget the experience and will, no doubt, worry about a recurrence. However, being a self-advocate will increase your self-esteem and quality of life. Taking a proactive approach is much more conducive to survival.