Breast Cancer Basics
The National Cancer Institute (NCI) explains that, "Cancer is a group of many related diseases that begin in cells. The body is made up of many types of cells, which normally grow and divide only when the body needs more cells. This orderly process keeps our bodies healthy. However, sometimes cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor." Benign tumors pose no threat to one's health. Malignant tumors, however, are life threatening.
A malignant tumor is cancer
As the NCI explains, " The cells within these tumors are abnormal. They divide without control or order and can invade and damage nearby tissue and organs. In a malignant tumor, cancer cells can also break away and enter the bloodstream. This is how cancer spreads from the original site to form new tumors in other organs. The spread of cancer is called "metastasis."
Breast cancer is the most common cancer effecting women. There are four types, two of which are named for the location of the breast in which the cancer develops.
Ductal and lobular cancer
Each breast has 15 to 20 sections called lobes. These contain smaller sections called lobules. Lobules end in dozens of tiny bulbs, which enable women to produce milk. Thin tubes called ducts, which lead to the center of the nipple, connect the lobes and lobules. Ductal is the most common form of breast cancer and is found in the cells of the breast ducts. Lobular cancer begins in the breast lobes or lobules, and often affects both breasts.
Inflammatory breast cancer
This is a rare type of breast cancer in which the breast is warm, red and swollen, appearing inflamed. The skin of the breast may also show signs of ridges or slightly elevated patches that look pitted. This form of breast cancer tends to spread quickly.
Hereditary breast cancer
From 5 to 10 percent of all breast cancer cases are hereditarily based. Genes within the cells of our bodies carry all hereditary information from our parents and previous generations. Women whose mothers have had breast cancer can carry these defective genes and, therefore, are more likely to develop breast or ovarian cancer.
Breast Cancer Prevention and Detection
While all women are potentially susceptible to developing breast cancer, some women are at a much higher risk than others. According to the National Cancer Institute, risk factors include:
- Age and Race. Breast cancer is rare in women under 35 years of age. Women over 50 are most likely to develop breast cancer, and the risk is especially high for women over 60. Breast cancer is also more likely to occur in Caucasian women. It is less common among African American and Asian women.
- Personal History of Breast Cancer. Women who have had breast cancer face an increased risk of developing cancer in their other breast.
- Family History. The risk of developing breast cancer is increased if a woman's mother, sister, or daughter has had breast cancer, especially at an early age.
- Certain Breast Changes. Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ may increase risk.
- Genetic alterations. Frequently, breast cancer affects whole families, with many women in a family contracting the disease. Gene testing can sometimes show the presence of specific gene changes that increase the risk of breast cancer.
- Estrogen. Evidence suggests that the longer a woman is exposed to estrogen (made by the body, taken as a drug, or delivered via skin patch), the more likely she is to develop breast cancer.
- Late Childbearing. Women who have their first child after the age of 30, are at a higher risk for developing breast cancer.
- Breast Density. Breasts that are "dense", with a high proportion of lobular and ductal tissue are more likely to develop cancer. When breasts are dense, it is also more difficult to see abnormal areas on a mammogram.
- Radiation Therapy. Women whose breasts were exposed to radiation, before age 30, especially those treated with radiation for Hodgkin's Disease, are at an increased risk for developing breast cancer. The younger the treatment, the higher the risk.
Breast Cancer Detection
In its early stages, breast cancer usually does not cause pain and, in fact, there can be no physical symptoms at all. As it develops, however, breast cancer can cause certain changes in the breasts that are alerts to the presence of a problem. These include:
- A lump or "thickening" in or near the breast, or the underarm
- Change in breast size and/or shape
- Nipple discharge and/or tenderness, or the nipple pulled back (inverted) into the breast
- Ridges or skin pitting (appearance like the skin of an orange)
- A change in the way the breast skin looks and/or feels (i.e. swelling, warm, red, scaly)
According to the National Cancer Institute, mammograms are the most effective tool to detect breast cancer. Most doctors recommend that women in their forties and older have mammograms every year.
A mammogram is a special kind of x-ray, which is used to detect breast changes in women who have no signs of breast cancer. Mammograms can often detect a lump before it can be felt, and can show small deposits of calcium. Most calcium deposits are benign, but the presence of small clusters of calcium may be an early sign of cancer.
The use of mammograms alone does have limitations. A mammogram can sometimes miss some cancers, or find things that, upon further investigation, are not tumors. Accuracy is also subject to potential human errors made by those reading them. Researchers are exploring ways to make mammograms more accurate, such as using computers to read the mammogram. According to Newton-Wellesley Hospital radiologist, Marla Polger, M.D., "Digital mammography may prove beneficial in the diagnosis of breast tumors".
Other techniques for detection are also now being used in conjunction with mammograms. As Dr. Polger explains, "The use of breast ultrasound in the evaluation of any palpable mass has improved the detection of breast tumors. There is potential for improved detection of breast cancer using ultrasound and MRI, especially in screening dense breasts." According to the NCI, research is also being done in the area of Positron Emission Tomography (PET) to produce detailed images of breast tissues.
The Women's Imaging Center at Newton-Wellesley Hospital specializes in a full spectrum of diagnostic breast procedures including mammography, breast ultrasound, and biopsy. Magnetic Resonance Imaging (MRI) of the breast is also utilized as a helpful adjunct to mammography and ultrasound in select cases. Obstetric and gynecologic ultrasound and bone densitometry are also featured services provided at the Center. For an appointment, call