Breast Cancer Reconstruction Surgery Options: What You Might Not Know

February 9, 2012 By Leave a Comment

When women with breast cancer need to have a mastectomy (removal of a breast), they sometimes consider reconstructive surgery. A plastic surgeon performs the surgery and tries to rebuild the breast so that it is similar to its previous shape and size. There are many factors that contribute to someone’s decision to have reconstruction surgery. In the end, it is a decision that has to feel right for the patient themselves.

In the early detection of breast cancer, long ago, women were more conservative about the appearance of their breast, although it was still a self-esteem issue. Clothing was not as revealing and society’s view of breast cancer, along with the breast in general, was taboo. We also know more about breast cancer and treating the disease than we did in the past. Breast reconstruction surgery is just one of the choices women have today as a result of greater knowledge.

In the past, doctors thought that removing the entire breast was the only way to get rid of breast cancer. That is why mastectomies were more common. Present day, we have the option to have surgeries which only remove part of the breast. These surgeries are called lumpectomies, segmental mastectomies, or breast conservation surgery.

Amongst women who chose breast reconstruction, their reasons very. Although they mostly have the surgery for aesthetic reasons, looks and self-image can greatly affect their inner strength, especially after the struggle of breast cancer. Without reconstruction surgery, they have to use an external prosthesis inside the bra to compensate for the missing breast, and many do not feel as secure when nude. However, the difference between the healthy breast and the reconstructed breast is still noticeable when nude.

Breast reconstruction surgery should not be an impulsive decision. Women should always discuss their options as well as the pros and cons of surgery with their doctors. The process does not always involve one simple operation; multiple surgeries may be necessary. There are also risks involved. And it is not guaranteed that the reconstructed breast will fully improve one’s self-esteem. The look and feel of the breast after surgery may also be cause for embarrassment if it does not look like the other breast. Women need the support of loved ones when considering the surgery, but again, they need to do it for themselves.

There are a couple types of reconstruction surgery: immediate breast reconstruction and delayed breast reconstruction. Immediate reconstruction is performed during the mastectomy. This means one less surgery since the breast is already opened and therefore fewer scars.  More surgery may be needed down the road, however.

Delayed breast reconstruction is when the surgery is performed after the mastectomy. Since some women need radiation after their mastectomy to ensure any remaining cancer cells are killed, this may be a better choice than immediate reconstruction. It is advised to only perform breast reconstruction surgery after radiation treatments have ended, since radiation after reconstruction is problematic.

The decision to have reconstructive breast surgery is not an easy one to make. Women have to take their overall health into consideration. Are they healthy? Is their a chance the cancer could still be in the breast? Is there enough extra body tissue to reconstruct the breast? Will insurance cover the procedure? Do I want the implant to be the same size as the other breast?

For many women, breast cancer reconstruction is merely a blip on their radar due to the fact that they are dealing with other issues related to cancer in general. It may seem ridiculous to consider a surgery to improve their appearance when their health is at risk. They may also not want to have yet another surgical procedure if it is not necessary for improving their health. Also, not all surgeries are a complete success; some women do not like the appearance when completed. The feeling of the reconstructed breast is also different; the skin on the breast sometimes has little feeling compared to the other breast.

A woman who decides to have breast reconstruction surgery needs to find a plastic surgeon that is board-certified and has experienced. Breast cancer doctors and surgeons typically give recommendations. The way to determine if a surgeon is board-certified is to get in touch with the ASPS (American Society of Plastic Surgeons).

Not only does a woman have to find a plastic surgeon, but they have to ask a plethora of important questions. As with any doctor’s appointment, writing down questions as they arise before the appointment is a great idea. Some people bring friends or family members with them so that there is one extra person to remember the conversation. Discussions can involve a lot of new terminology and can also be flustering to someone who has a lot of decisions to make.

Before having any surgery, it is advised to get a second opinion from another doctor. Due to the emotional as well as physical implications of breast reconstruction surgery, advice of loved ones may even be more valuable. The good thing is that breast reconstruction is not an urgent procedure. Making a decision based on values and good information is more valuable than having an impulsive reconstruction surgery.

Some women wonder if reconstruction affects the chance of cancer returning to the breast. According to studies, it does not. For cases of returning breast cancer, the reconstructed breast should not interfere with radiation or chemotherapy. The implant does not hide returning breast cancer either; is still noticeable and detectable in mammograms and self-breast exams. There are mammogram technologists who know what to look for in a reconstructed breast.

Breast cancer can be a brutal experience by itself; not to mention the added stress of removing an entire breast. Clothing does not fit the same way it did before, and a woman’s sense of sexuality may be compromised. For many women, breast reconstruction surgery is not just a physical transformation, but an emotional transformation. It helps them come back to the life they had pre-cancer.

Filed Under: Breast Cancer Facts Tagged With: , , , ,

Breast Cancer Stages: Breast Cancer’s Many Stages and Symptoms

February 3, 2012 By 2 Comments

Most forms of breast cancer begin as a type of carcinoma (which is a cancer of the cells that line all of the tissues in the body) that originates in either the ducts that bring breast milk over to the nipple or in the lobules, where breast milk is produced. While the ducts are the most common source of cancer formation, breast cancer can and will form anywhere in the breast or surrounding tissues.

Once cancer has been found, doctors need to determine where the disease is at in terms if progression and scope. In order to ascertain what stage a cancer may be, doctors refer to a system called TNM. In this system, the “T” stands for the size of the tumor – whether it is large or small; the “N” stands for whether or not nearby lymph nodes have been affected and diseased with cancer as well; and the “M” stands for metastasis, which determines if the cancer is spreading, where it is spreading, and how aggressively it is spreading.

  • TX indicates that the tumor is not able to be either be measured or found.
  • T0 indicates there is no hard any evidence of a principal tumor.
  • Tis indicate the cancer is “in situ” – in other words, the tumor has not yet begun to invade surrounding breast tissue.
  • T1, T2, T3, T4: This number system is based on the size of the tumor and the extent to which it has invaded the surrounding tissues. The bigger the number, the bigger the tumor or the more it has invaded and metastasized.
  • MX indicates metastasis is not able to be be measured or located.
  • M0 indicates there is no far-reaching metastasis, only localized metastasis.
  • M1 indicates that far-reaching metastasis is present.

Stage Zero

Stage Zero breast cancer is the very beginning stages of the disease. It is also known as ductal or lobular carcinoma in situ. Cancer at this stage of the game has not moved or metastasized to any other areas of the body other than where it originated. This is the same reason that Stage Zero cancer is also known as a non-invasive cancer.

Stage I

Stage I breast cancer is deemed invasive because it has invaded another area of tissue – this is true even if the newly affected area is in immediate proximity to the place of origin. Additionally, if the cancerous tumor is 2 centimeters in size or less, and if there is no lymph-node involvement, then it still qualifies as Stage 1 cancer.

Stage II

Stage II breast cancer has two sub-stages: stages, IIA and IIB.

In order to qualify for the first, one of the following must be true:

  • There is no cancer found in the actual tissue of the breast, but cancer cells have been detected found in the nearby underarm lymph nodes.
  • There is a tumor that measures 2 centimeters (or smaller) that has spread to nearby lymph nodes.
  • There is a tumor measuring between 2 and 5 centimeters located in the breast tissue that has not spread to the neighboring lymph nodes.

In order to qualify for the second sub-stage, one of the following must be true:

  • There is a tumor measuring between 2 and 5 centimeters that has spread to the lymph nodes.
  • There is a tumor measuring more than 5 centimeters that has not spread to the lymph nodes.

Stage III

Stage III breast cancer, like Stage II, is broken into sub-stages.

In order to qualify for Stage IIIA, one of the following must be true:

  • There may be no cancer found in the breast, but there are cancer cells located in the armpit lymph nodes and/or in the lymph nodes near the collarbone.
  • There is a tumor in the breast tissue that has also spread to nearby lymph nodes.

In order to qualify for Stage IIIB, one of the following must be true:

  • A tumor of any size in the breast tissue that has spread to the chest or to the skin of the breast and/or has spread to armpit lymph nodes or any other lymph nodes near the collarbone.
  • Inflammatory breast cancer is present.

In order to qualify for Stage IIIC, one of more of the following must be true:

  • There may or may not be cancer in the breast itself, but if a tumor is present it can be any size and will also have spread to the chest or the breast’s skin, as well as to the nearby lymph nodes in either the armpit of collarbone.

Stage IV

The final stage of breast cancer is Stage IV, which occurs when the breast cancer has passed through each previous stage and has aggressively metastasized to different parts of the body. Treatment of this form of breast cancer usually focuses on merely relieving the symptoms that are already present. In occasional cases, an especially aggressive form of breast cancer can spread to other areas of the body without first spreading to nearby lymph nodes. In some cases, breast cancer that advances like this may be able to seep into the blood stream as well.

No matter what stage of cancer you or someone you know may be facing, your pathology report and any additional tests you may have had will provide information about the breast cancer stage you are experiencing. It should also indicate whether or not the cancer has spread and what parts of the body may also be affected.

After this determination, your doctor will be able to create a treatment plan that is unique to your situation. If your cancer requires a biopsy or even a tumor removal surgery, there is a very good chance that they will also take a look at the nearby lymph nodes to check for cancer cells, since that is the most common path that metastasizing breast cancer takes. At this point your doctor will likely call for additional blood or imaging tests to determine where else the cancer may have spread to and to get a better handle on how aggressive the cancer is becoming. This will aid in determining an exceptionally tailored treatment and recovery plan.

Filed Under: Breast Cancer Facts, Featured Slider Tagged With: , , , , , , , , , ,

Breast Cancer Estrogen: What you might not know about Breast Cancer and Estrogen

September 7, 2011 By Leave a Comment

Estrogens are basically molecules which have jobs in the female body. They boost the development of female characteristics and allow for sexual reproduction. Unfortunately, the same estrogens that help a woman develop can be responsible for breast cancer. There is a lot of science involved in relating estrogen to cancer. This article may help you understand the relationship between estrogen and breast cancer.

Women naturally produce estrogens which are steroid molecules. Estradiol and estrone are the two most present forms in a woman’s body, produced and secreted by the ovaries as well as other organs and the adrenal glands. Not only are estrogens considered steroid molecules, but they are also hormones. This means that their job is as a signaling molecule, interacting with other cells in the body in different ways. The two main organs (although there are others) affected by these signaling molecules are the breast and uterus.

The way that estrogen works when interacting with tissues such as the breast and uterus, is by binding to estrogen receptors. Estrogen receptors are protein molecules inside the cells of the breast, uterus, and other organs which receive estrogen. The interesting thing about estrogen receptors is that they have a specific area which will only bind to estrogens; no other molecules can bind to that part of an estrogen receptor.  Remember, only organs which are targets of estrogen and contain estrogen receptors will receive the estrogen when it passes through the bloodstream.

The main affect of estrogen in some organs and tissues is to cause cell proliferation, meaning growing and dividing of cells. For example, when a woman becomes pregnant, estrogen makes the cells of the milk glands proliferate, preparing the breast for milk production. Although this purpose of estrogen is beneficial, it can also be a harmful molecule.

The most serious complication from estrogen is that although it can promote cell proliferation when there is a job to do (milk production) it can also promote cell proliferation in the form of harmful tumors, cancer.  When there is damage (mutations) to the DNA in genes which regulate the growth and division of cells, cancer results.

The reasons for these mutations vary. Some are inherited and some are caused by chemicals such as those in cigarette smoke. Others are simply caused by spontaneous mistakes which occur prior to cell division. It is important to know that estrogen does not cause cancer directly, and it is not a bad thing to have in our bodies. It does stimulate proliferation of cells though. So if there are cancerous cells in a woman’s body, sometimes estrogen may promote their growth.

Because of the fact that estrogen can sometimes aid the development of breast cancer, consideration of estrogen blockers has been involved in breast cancer research. If there was a medication a woman could take which prevents estrogen from meeting the cancerous cells, this could aid in its treatment. Therefore, scientists have developed antiestrogen drugs.

Antiestrogens bind to estrogen receptors in the breast so that the estrogen molecules are not able to bind to them. Think of an estrogen receptor as a chair and an antiestrogen is taking a seat on that chair so that estrogen molecules produced in the body cannot bind to them. If they cannot bind to the estrogen receptor, they cannot promote proliferation of cancerous cells.

Other drugs called, aromatase inhibitors, are used to halt the growth of breast tumors. It works by lowering the amount of estrogen in a woman’s body so that estrogen sensitive breast tumors cannot grow. There are different types of breast tumors and an estrogen sensitive breast tumor uses estrogen to help it grow. A natural substance in a woman’s body called, aromatase, is used by the ovaries and other tissues in the body to create estrogen. Aromatase inhibitors do not stop the ovaries from producing estrogen, but they do prevent other tissues from producing it, thus lowering the overall amount of estrogen in the body. This type of drug usually used in women post-menopause since their ovaries are not producing estrogen any longer.

Since the early 1980’s, it has been believed that certain oral contraceptives may cause an increased risk of breast cancer in women. There are two types of oral contraceptives commonly used in the United States. The more common of the two is called a “combined oral contraceptive” because it contains a combination of two man-made types of female hormones which work in the same way as estrogen and progesterone.  The other type of oral contraceptive which is available in the United States is referred to as the minipill. This minipill does not have estrogen, only a certain type of progesterone.

Medical research has suggested that some types of cancer rely on the sex hormones which occur naturally in women’s bodies in order to grow and develop. Because oral contraceptives affect a woman’s sex hormones, scientists have been studying a link between cancer risk and use of oral contraceptives. Although the research has not always been consistent, and oral contraceptives are still being prescribed in the United States, there has been an interesting discovery: While the use of oral contraceptives tends to reduce the risk of ovarian and endometrial cancers, the opposite is true with breast cancer. Using oral contraceptives tends to increase a woman’s risk of breast cancer.

So far we have mentioned estrogen receptor-positive breast cancers. However, not all cancerous breast cells have estrogen receptors. Those breast cancers are considered to be estrogen receptor-negative. Those cancers are not promoted by estrogen.

As you can see, breast cancer is a complex disease, with different types and different risk factors. If you have breast cancer, you need to discuss the role in which estrogen plays, if any, with your doctor.  The use of oral contraceptives should be discussed with your doctor as well. A woman with a lower risk of breast cancer may be advised not to worry about the effects of estrogen in their body.

Filed Under: Breast Cancer Facts Tagged With: , , , , ,

Breast Cancer Facts: The Truth About This Prevalant Disease

September 7, 2011 By Leave a Comment

Breast cancer is a confounding disease. In the United States, breast cancer accounts for approximately 25% of all cancers in women. It is the second leading cause of death by cancer in women overall, with lung cancer being the main cause. There is a 1 in 35 chance that a woman’s death will be caused by breast cancer. Although researchers have been making significant progress in the fight against cancer, there is still much to be done.

Female incidences of breast cancer decreased by approximately 2% each year, between 1998 and 2007. This is after rates had been increasing for over twenty years. Although it is good news, the decrease was only seen in women over 50 years old. The decrease may have also been partially due to a publication by the Women’s Health Initiative in 2002 which stated a link between hormone therapy and increased risk of breast cancer and heart disease.

Causes of Breast Cancer

If a woman has an immediate relative (mother or sister) who was diagnosed with breast cancer, their risk of getting the disease almost doubles. Approximately 25% of women who were diagnosed with breast cancer have a family history of breast cancer. The remaining approximate 75% of cases in women occur when there is no family history of it. The reason for cases without a family history usually involves the aging process and genetic abnormalities as opposed to inherited mutations.

A small percentage (between 5 and 10 percent) of breast cancers in women can be linked to gene mutations inherited by one’s parents. BRCA1 and BRCA2 gene mutations are the most common. A woman who has this mutation is 80% more likely than a woman who doesn’t have it, to develop breast cancer during her lifetime. These women are also more likely to be diagnosed with breast cancer before menopause. Also associated with the genetic mutations is an increased risk of ovarian cancer.

Types of Breast Cancer

If a doctor suspects their patient has breast cancer, they then have to determine what type it is. They do this by performing a biopsy, a medical procedure in which tissue or cells are removed from the body and analyzed. The doctor will then determine whether the cancer is invasive or noninvasive in order to further determine if it may have spread (metastasized) to other areas outside the breast. Noninvasive breast cancer is also called, in situ breast cancer. In these cases, the cancerous cells have remained in the place they originated. Invasive breast cancer is also called infiltrating breast cancer because it has infiltrated and invaded the surrounding tissues of the breast and maybe even other parts of the body.

Where breast cancer originates, determines its behavior and its most effective treatment options. Breast cancer can originate in several areas. Ductal carcinoma is cancer that originates in the milk ducts and is the most common type. Lobular carcinoma starts in the breast lobules which facilitate breast milk production. The lobules and ducts are connected. Sarcoma is a rare form of breast cancer which originates in the connective tissue of the breast, which is made of muscles, blood vessels, and fat. Phyllodes tumors and angiosarcoma are examples of sarcomas.

Death rates

African American women are more likely than white women to die from breast cancer despite the fact that white women show higher rates of breast cancer. Studies have shown that aggressive tumors and poorer expected outcome are found in African American women. Another racial group more likely than white women to die from breast cancer is Hispanic or Latina women.

Sometimes certain racial groups are less likely than white women to get proper breast cancer screening. This means that it gives the time for breast cancer to grow and for diagnosis at later stages. The diagnosis at a later stage increases one’s chance of dying from breast cancer. Although on the decrease since 1990, almost 40,000 women in the United States alone were expected to die of breast cancer in 2010.

Survival rates

The percentage of individuals who are alive five years after the time of breast cancer diagnosis determines their survival rate. The least likely ethnic group to survive after five years of breast cancer diagnosis is African American women. There is a variation in survival rates among ethnicities, possibly due to the differences in the practices of breast cancer screenings. Also contributing to the difference in survival rates was the stage the cancer was in when it was diagnosed, the biology of the tumor, and treatment method used.

The five year survival rate for White women as well as Asian women is 91%. Hispanic, Latina, and Pacific Islander women have an 86% survival rate. A bit lower in percentage are American Indian and Alaska Native women with an 84% survival rate. The lowest survival rate of 79% belongs to African American women.

Breast Cancer and the Future

The American Cancer Society has released estimates for breast cancer in the United States for 2011. They state that in women, approximately 230,480 new cases of invasive breast cancer will be diagnosed. An expected 57,650 new cases of non-invasive breast cancer, carcinoma in situ, will be diagnosed. The amount of women who are expected to die as a result of breast cancer is approximately 39,520.

There are ongoing studies to determine a possible link to genetics and increased mortality from breast cancer. Currently, there is a better chance of survival from the disease than there were years ago since there are improved treatment options with many more medical treatment breakthroughs hopefully on the horizon. Also, routine mammograms and breast exams are encouraged, thus helping to detect the cancer at early stages.

There is some good news sprouting from the negative. Death rates from breast cancer in woman under 50 years old have been decreasing. Early screening and detection, as well as increased awareness and better treatment have aided the decline. As of 2010, over 2.5 million survivors of breast cancer were estimated in the United States alone.

Filed Under: Breast Cancer Facts Tagged With: , , , , , ,

Male Breast Cancer: The Unspoken Demographic

September 5, 2011 By Leave a Comment

Male breast cancer is very real and can be just as life threatening as female breast cancer. Over one thousand men are predicted to be diagnosed with the disease every year. Typically, there is less hope that treatment of male cases of breast cancer will lead to recovery. This is because of the fact that men usually wait longer to report their symptoms than women do, allowing the disease to spread. All men have breast tissue and cancer can form in that tissue. More common in older males, men of any age can get male breast cancer.

Male breast cancer symptoms include:

  • A lump, often painless, in the breast tissue.
  • Puckering, scaling, redness, or dimpling of the skin that covers the breast.
  • Redness of the nipple or other changes in the nipple.
  • Nipple discharge.

It is important for men to see their doctor if they have symptoms that worry them.

Cause of Male Breast Cancer

The cause of male breast cancer is unclear. Similar to female breast cancer, it happens when certain breast cells grow abnormally, dividing quickly. The dividing and accumulation of those cells create a tumor which may in turn spread to other tissue, lymph nodes, or other body parts.

Types of Male Breast Cancer

  • One type of male breast cancer is ductal carcinoma, which starts in the milk ducts. It is the most common type.
  • Another type starts in the milk-producing glands. This is known as lobular carcinoma and is rare since men do not have many lobules in their breast tissue.
  • A third type is, Paget’s disease of the nipple which occurs when cancer starts in the breast ducts and spreads to the nipple.

Breast Cancer Risk

Sometimes men can inherit genes from their parents which increase their breast cancer risk. Usually, genes help prevent breast cancer because they make proteins that prevent cells from growing abnormally. However, when genes have mutated, it puts people at an increased risk for the disease. Other factors which can increase one’s risk of male breast cancer include:

  • Older age, specifically 60 to 70 years.
  • Men who drink excessive amounts of alcohol have an increased risk of breast cancer.
  • Men who take drugs with estrogen in them have an increased risk of breast cancer.
  • Men who have close family members with breast cancer have an increased risk of getting the disease.
  • Men who have liver disease risk the chance that their male hormones may have been reduced while female hormones may have been increased. This can increase their risk of breast cancer.
  • Men who are obese have an increased risk of breast cancer since more fat cells mean more estrogen, thus more risk of breast cancer.
  • Men who have been subjected to radiation exposure are at an increased risk for developing breast cancer.

Seeing the Doctor

If someone notices worrisome symptoms, they should see a doctor. If the doctor suspects breast cancer, they may refer the patient to an oncologist (a doctor specializing in cancer treatment). There are some things a patient should do to prepare for this meeting.

  • When scheduling the appointment, verify whether there are any dietary restrictions to take before the appointment for any testing which may occur.
  • Record all symptoms they are experiencing, even if they seem unrelated.
  • List all medications and vitamins they are taking.
  • Write down any questions or concerns.

Diagnosing Male Breast Cancer

Certain tests may be conducted if a doctor suspects breast cancer, including:

  • A doctor will use their fingertips to examine the breast tissue for lumps and examine the rest of one’s body to see if the cancer has spread. This is known as a clinical breast exam.
  • A doctor may take an x-ray of the patient’s breast tissue, known as a mammogram.
  • If there is an abnormality discovered as a result of the mammogram, a breast ultrasound may be performed. Sound waves are used to create images of structures in one’s body.
  • If a patient is experiencing nipple discharge, the doctor may test it for cancerous cells by collecting a sample of the discharge and studying it under a microscope.
  • A breast biopsy may be taken, by using a needle to take cells from the tissue for testing.

Stages of Breast Cancer

Determining the cancer’s stage also helps determine possible options for treatment.

The stages of male breast cancer are:

  • Stage I is when the tumor is less than two centimeters in diameter and has not spread.
  • Stage II is when the tumor is up to five centimeters in diameter and may have possibly spread to the lymph nodes. Stage II is also the stage to describe when the tumor is larger than five centimeters but no cancer cells have been discovered in the lymph nodes.
  • Stage III is when the tumor could be larger than five centimeters in diameter, involving several lymph nodes.
  • Stage IV is the most severe and is when cancer has spread to the brain, lungs, or other organs.

Surgery

Surgery may be advised to remove the breast tumor and the tissue surrounding it. These procedures include:

  • A mastectomy, in which a surgeon removes all of the breast tissue.
  • A modified radical mastectomy involves the removal of all of the breast tissue, as well as surrounding lymph nodes. This is the most common amongst men with breast cancer.
  • A sentinel lymph node biopsy involves removing one lymph node which is then tested for cancer. If no cancerous cells are found, the chance is good that the breast cancer has not spread past the breast tissue.

Types of Therapy

Four types of therapy often used to kill cancer cells are:

  • Radiation Therapy which uses high-energy beams (like x-rays) to kill the cancer cells.
  • Chemotherapy is a treatment involving the administering of drugs which kill the cancerous cells. Often, two or more drugs are combined and given intravenously, or by the form of a pill, or a combination of the two methods.
  • Hormone therapy may be considered if a physician thinks that the cancer uses the body’s hormones to aid in its growth.

Filed Under: Breast Cancer Facts Tagged With: , , , , , ,

Breast Cancer’s Courageous History

September 5, 2011 By Leave a Comment

Breast cancer is an ancient disease, recorded in most periods of history, identifying itself in the form of small lumps or large tumors. Despite the fact that breast cancer is so prominent, its discussion before the 1970’s was rare, often only mentioned in medical journals. This may be due to the taboo nature of the disease, as the breast has carried certain expectations in the past. Women with the disease used to feel ashamed to discuss its nature openly. Today, however, breast cancer has a noticeable presence in society. Activism for the fight against breast cancer has been successful since the 1990’s when the pink ribbon, the symbol of breast cancer, was created. Its current presence in politics and in our general culture plays a large role in finding a cure.

Greece and Ancient Egypt’s Systemic Theory

The first people to notice breast cancer were ancient Egyptians, over 3,500 years ago. In ancient documents, they described conditions and symptoms of breast cancer which matched modern day descriptions. One common description is the lack of a cure. In 460 B.C., moving from Egypt to Greece, Hippocrates considered breast cancer to be a humoral disease. This meant that the body had four “humors” consisting of yellow bile, black bile, phlegm, and blood. Those four humors mimicked the four building blocks of nature, fire, earth, air, and water.  If that system of humors was not balanced, sickness or even death could occur. Hippocrates believed that cancer was caused when there was too much black bile (melonchole) in the system, since breast tumors were often hard and sometimes black fluid would erupt from the skin. His name for cancer was karkinos, “crab” in Greek, because the tumors had extensions which looked like the legs of a crab. In the days of Hippocrates, surgery to remove the tumors was often times unsuccessful, since patients who kept the tumors lived longer than those who had them removed.

The Eighteenth Century and Surgery

By the late 18th century, the humoral theory became less popular. Jean Astruc, a French physician, performed a demonstration to disprove the theory. He cooked both a slice of beef and a piece of breast cancer tissue, and chewed them. He said that both tasted the same and that the tumor piece did not have above normal amounts of acid or bile.   People believed him and the search for a new origin continued, with many arguing that the origin was of sexual nature. Other causes were also believed, including depression, sedentary lifestyle, lack of children, even curdled milk. With all of this uncertainty, one they agreed upon was that it was a localized disease.

Physicians with this theory believed that the presence of a tumor did not necessarily mean cancer and that if it was cancer, it could be removed before it spread. This is the theory that led to the radical mastectomy procedure.

William Halstead’s Radical Mastectomy

By the mid-nineteenth century, anesthesia, antiseptics, biology, and blood transfusions all made surgery possible and the majority of physicians thought that was the only cure. Also, the public started to trust the medical field more. A physician named William Halstead made radical breast surgery a standard practice for a century or so. He did more than remove the breast, pectoralis major, and axilla nodes; he removed both breast muscles. This radical mastectomy was done because he worried about spreading the diseased cells with his own hands during surgery.

Until the 1940s, this was the most popular procedure amongst breast cancer patients. Halstead performed hundreds of them. This was not a flawless procedure, however. Women were disfigured afterward, had chronic pain, and experienced swelling in their arms due to the fact that their lymph nodes were removed and could no longer process circulatory fluids in an efficient manor.

Twentieth-Century Surgical Procedures

In 1895, a Scottish surgeon named George Beatson found that removing the ovaries from a patient made her breast tumor shrink. This “prophylactic oophorectomy,” involved performing a radical mastectomy as well as removal of the ovaries. With no way for surgeons to determine which tumors had estrogen receptors, the results were unpredictable and the procedure was considered as a last resort. Starving the tumor by removing the ovaries only worked on a temporary basis. Tumors always came back because the body would compensate for the lack of estrogen by secreting substances similar to estrogen from the adrenal glands and pituitary glands. After this discovery, adrenalectomies (to remove adrenal glands) and hypophysectomies (to remove the pituitary gland) began. Not only were there horrible side effects (vision problems, personality changes, and cognitive problems) but the tumors always returned.

A Fresh Start: No More Halstead Mastectomy

In 1955, George Crile disproved Halstead’s theory that breast cancer was localized. Crile believed that it spread throughout the body. Helping Crile’s theory was Bernard Fisher who revised the Hippocrates theory by arguing that cancer cells affected the lymphatic and circulatory systems, making surgery ineffective. Fisher found that a more simple breast-conserving procedure with radiation or chemotherapy following it were more effective than a radical mastectomy.  This theory challenged the primary role of a surgeon in regards to breast cancer treatment.  Still, doctors were reluctant to stop performing radical mastectomies until modern feminism erupted with the sexual revolution.

Physicians started to hypothesize about were breast cancer started and in the 1990’s a wide range of suspects were considered. By 1995, the number of deaths from breast cancer started to decline and less than 10% of women with breast cancer had a mastectomy. Also, scientists contributed to advances in breast cancer research by locating the genes which cause breast cancer: BRCA2and ATM.

21st Century Hope

Breast cancer is such a complex disease that finding a cure sometimes seems impossible. Despite this lack of confidence in finding a cure, the public’s perception of the disease has changed for the better. However, it is no longer seen as a sexual disease and women have support on an economic, medical, and political scale.

Filed Under: Breast Cancer Facts Tagged With: , , ,

Types of Breast Cancer: How Many Types of Breast Cancers Are There?

September 4, 2011 By Leave a Comment

There are different types of breast cancers. Once your doctor suspects breast cancer, because of certain symptoms you are experiencing or because of an examination, he or she needs to determine the cancer type. They do this by performing a biopsy, a medical procedure in which tissue or cells are removed from the body and analyzed. X-rays and other imaging tests can detect abnormal masses but they cannot indicate whether or not there are cancerous cells in the mass. A biopsy is the only way to diagnose whether there are cancerous cells or not.

Types of Biopsy Procedures

  • A bone marrow biopsy may be recommended if it is suspected your bone marrow may be compromised by cancer. Blood cells are produced in bone marrow, which is the sponge-like material inside of bones. Analyzing bone marrow samples could indicate what is causing certain problems. The procedure involves drawing a sample of the marrow from the hipbone with a long needle. However, other bones may be used instead. These biopsies are used to diagnose a wide variety of blood diseases including lymphoma, leukemia, and myeloma, although not always cancerous.
  • An endoscopic biopsy involves the use of a flexible, thin tube with a light at the end of it used to see different parts inside the body. The tube is used as a vehicle for the passage of special tools which can take samples of tissue for analyzing. The patient may receive an anesthetic depending on the type of endoscopic biopsy which in turn depends on where the affected area is located. A cytoscopy involves collecting tissue from inside the bladder. A bronchoscopy is used to collect tissue from inside the lungs. A colonoscopy is used to collect tissue from inside the colon.

Needle biopsies are procedures in which a special needle is used to take cells from a suspicious area. Usually, the procedure is used for tumors which can be felt through the skin, such as enlarged lymph nodes and lumps in the breast. Following are examples of needle biopsy procedures:

  • Fine-needle aspiration. Via fine-needle aspiration, a thin, long needle with a syringe is inserted into the area needing attention. Fluid is drawn out to be analyzed.
  • Core needle biopsy is used for the extraction of a tissue column via a larger needle with a cutting tip at the end.
  • Vacuum-assisted biopsy. A suction device aids in the extraction of fluid by a needle when a larger fluid sample is needed.
  • Image-guided biopsy. When an imaging procedure such as computerized tomography, X-ray, magnetic resonance imaging, or an ultrasound is combined with a needle biopsy, the result is an image-guided biopsy. This procedure allows access to areas which cannot be felt through the skin including internal organs.
  • A surgical biopsy may be performed when the aforementioned procedures have been inconclusive or when cells in question are not accessible using those procedures. A surgeon makes an incision in the skin so they can access cells in a particular area. Surgical biopsies are used to remove breast lumps or lymph nodes.  Two types of surgical biopsies include incisional biopsies (in which only part of abnormal area of cells is removed) and excisional biopsies (in which the entire abnormal cell area is removed).

Biopsy Analysis and Results

After being diagnosed with breast cancer, your doctor will learn the specifics of the tumor using the tissue sample from the biopsy. After the tissue sample is acquired, it is sent to a lab for analysis. It may then be chemically treated, or it may be frozen and then divided into extremely thin sections which are then put on slides, stained, and studied under microscope by a pathologist. Results of the analysis help doctors determine if the cells are cancerous. If so, the results of the biopsy can also determine the origination of the cancer in one’s body, thus the type of cancer. The information obtained through the biopsy also helps determine what treatment options may be most appropriate for your specific case.

The aggressiveness of a cancer case is called the cancer’s grade, and a biopsy helps determine this. Sometimes expressed as a number between 1 and 4, grade is determined by the appearance of cancerous cells under a microscope. Low grade cancers (grade 1) are usually least aggressive while high grade cancers (grade 4) are usually most aggressive. The grade, sometimes combined with other tests, can help determine whether or not to use an aggressive treatment option.

The amount of time it takes to analyze the biopsy samples depends on the type. During a surgical biopsy, a pathologist will examine the sample and have the results available immediately. In most cases, however, results are available within a couple days.

Determining Breast Cancer Type

Your doctor will have to determine whether your cancer is invasive or noninvasive in order to further determine if it may have invaded other areas outside the breast.

  • Noninvasive breast cancer is also called, in situ breast cancer. In these cases, the cancerous cells have remained in the place they originated. Ductal carcinoma in situ, or DCIS, is confined to the milk duct lining and is the most common noninvasive breast cancer. This is sometimes referred to as, stage zero cancer.
  • Invasive breast cancer is also called infiltrating breast cancer because it has infiltrated and invaded the surrounding tissues of the breast and maybe even other parts of the body. Stages 1 through 4 are all stages of invasive breast cancer.

Where breast cancer originates determines its behavior and its most effective treatment options. Breast cancer can originate in any of the following areas.

  • Ductal carcinoma is cancer that originates in the milk ducts and is the most common type.
  • Lobular carcinoma starts in the breast lobules which are for breast milk production. The lobules are connected to the ducts.
  • Sarcoma is a rare form of breast cancer which originates in the connective tissue of the breast, made of muscles, blood vessels, and fat. Phyllodes tumors and angiosarcoma are examples of sarcomas.
Filed Under: Breast Cancer Facts Tagged With: , , , , , ,

Breast Cancer Radiation: The Truth About Radiation

September 4, 2011 By Leave a Comment

Radiotherapy, or radiation therapy, is an effective and highly targeted way to deplete any cancer cells remaining in the breast after surgery to remove them. It can reduce the risk of reoccurrence by approximately 70%. Radiation is easily tolerated by most, limiting any side effects to the area being treated. An oncologist, a physician specializing in radiation therapy, oversees radiation treatments.

A high energy beam is used to cause damage to cancer cells with radiation therapy. It is a special kind of high energy beam which the human eye cannot see, but they are powerful enough to damage the DNA of cancer cells, although they also kill some healthy cells. Healthy cells, however, are able to repair themselves and survive.

One of the two ways that radiation is delivered to the treatment area is by a linear accelerator, a machine that can deliver radiation outside of the body. The other way is via extremely small pieces of material which are able to apply radiation beams from inside of the body.

Hypothermia may sometimes be recommended with radiation therapy because it is may increase the sensitivity of cancerous cells. With hypothermia, an energy source is used to heat the cancerous cells to extremely high temperatures. It is not available everywhere, however, and is still being studied.

The word, “radiation” has been given a bad reputation and therefore sometimes feared by patients. The type of radiation found in nuclear reactors and bombs has no connection to therapeutic radiation, which is generally safe.

Why is Radiation Necessary?

Removing cancer from a breast comes with no guarantee that it will not reoccur. Because of this radiation is an important tool, it often successfully reduces the risk of the cancer coming back. Tiny cancer cells cannot be seen or felt during surgery and testing thus those remaining and unseen cells may eventually grow.

After a lumpectomy (a procedure used to remove lumps in the breast) people who have been treated with radiation have lived longer and remained free of cancer longer than those who have not been treated with radiation. In studies, those women who hadn’t been treated with radiation had a greater risk (60%) of cancer returning in that breast. Research has also shown that women who have small cancerous tumors even benefit from radiation after a lumpectomy is performed.

After The Lumpectomy

Radiation therapy is often recommended to lumpectomy patients. The combination of lumpectomy and radiation therapy is often referred to as breast preservation surgery.  Radiation of the whole breast after a lumpectomy is usually recommended if the breast cancer is at an early stage, smaller than 4 centimeters, specific to one site, and removed with clear margins.

After a Mastectomy

A mastectomy is the removal of the entire breast. After mastectomy, radiation therapy is often recommended as an effort to destroy any cancerous cells left at the site since it is not easy to remove every single cell of the breast tissue. The decision is made based on your individual pathology report. If any of the following factors are a concern, radiation therapy may be recommended:

  • The cancer is at least 5 centimeters.
  • The lymph channels and the blood vessels of the breast have been invaded by the cancer.
  • The removed cancerous tissue has a positive resection margin.
  • Four or more lymph nodes in post-menopausal women were involved OR, at least 1 lymph node was involved for pre-menopausal women.
  • The skin has been invaded by the cancer.

Between 20 and 30% of patients are considered to be at a high risk for recurrence after having a mastectomy. Radiation could reduce the risk by approximately 70%. Patients are considered to be in the “gray zone” when the cancer’s characteristics increase their risk. Those patients’ risk of recurrence is moderate. Because those patients want to make sure they have done everything in their power to treat the disease, they may chose to go ahead with radiation therapy.

When Radiation is Not an Option

  • Radiation is not an option if a patient has already had radiation in the specific area.
  • It is not an option if a patient has a connective tissue disease because the disease can make a patient sensitive to radiation’s side effects.
  • If a patient is pregnant, radiation is not an option.
  • A patient unwilling to comply with the commitment of radiation therapy (daily schedule and distance to treatment center) is not a candidate.

Timing of Radiation Treatments

A patient’s individual situation determines the timing of radiation treatment. It may follow other forms of treatment or be given to the patient immediately following surgery to remove the cancer. Examples of treatment sequences are:

  • surgery, then radiation, and then possible hormonal therapy
  • surgery, then chemotherapy, then radiation, and then possible hormonal therapy
  • chemotherapy, then targeted therapy or hormonal therapy, then surgery, then radiation, and then possible hormonal therapy

How the above order is decided depends on the individual case. Typically, surgery is usually followed by chemotherapy, which is then followed by radiation. Radiation and chemotherapy are not usually given simultaneously. The time between chemotherapy treatments can range from two to four weeks between the last dose of chemotherapy and the beginning of radiation. With anthracycline chemotherapy the wait between the last dose and the beginning of radiation is one month. The same is true with ellence chemotherapy. With taxane chemotherapy the wait between the last dose and the beginning of radiation is anywhere between two and three weeks. The same is true for abraxane chemotherapy.

If your treatment plan does not include chemotherapy radiation will probably be advised after surgery. Once again, the timing depends on which type of radiation you will receive. The most common type of radiation is external beam radiation, starting usually between three and six weeks after having surgery. Partial breast radiation follows surgery immediately. Intraoperative radiation is given during surgery, it occurs in the operation room once the cancerous tissues have been removed and before the skin incision has been closed.

Filed Under: Breast Cancer Facts Tagged With: , , , , ,

Breast Cancer: What is the National Cancer Institute?

September 4, 2011 By Leave a Comment

The National Cancer Institute, also known as NCI, is one of 27 Institutes and Centers forming the National Institutes of Health, known as NIH. The Department of Health and Human Services oversees the NIH. The NCI is located on the NIH campus in Bethesda, Maryland. There are also two satellite offices located in the cities of Rockville and Frederick, Maryland. As of July, 2010, the director of the NCI was Dr. Harold Varmus. The NCI was established by Congress on August 6, 1937 to be an independent research institute. The Public Health Service Act, enacted on July 1, 1944, made the NCI an operating division of the NIH. In an effort to broaden the purpose and responsibilities of the NCI, Congress amended the Public Health Service Act with the National Cancer Act of 1971. This act was created with an intention to more effectively carry out the national efforts against cancer.  The National Cancer Institute Act defined the NCI’s initial responsibilities as the following:

  • Conduct and oversee cancer research.
  • Review and appoint grant applications, thus supporting research projects on the causes, diagnosis, treatment, and prevention of cancer.
  • Collect, study, and disseminate the results of various cancer research, conducted both in the United States and in other countries.
  • Instruct and train in the topics of cancer diagnosis and cancer treatment.

The National Cancer Act of 1971 expanded the responsibilities of the NCI when the National Cancer Program was created. The program was to be overseen by the NCI. The same act also broadened the NCI’s international projects. Cancer research by qualified foreign nationals in other countries was to be supported. Also to be supported was research collaborated by both American and foreign participants, including their training both abroad and in the United States.

Further expanding the dissemination of the NCI was the Public Health Service Act. The act was created to provide informational and educational programs for both the public and for patients so that they can take the proper steps to achieve the following:

  • Reduce the risk of cancer.
  • Make people aware of the techniques available for early cancer detection and to teach the appropriate use of those techniques.
  • Help people to emotionally deal with cancer.
  • Provide information as to long-term survival techniques.

The Public Health Service Act in return expected the NCI to continue and expand programs which provided both physicians and the public with state of the art information regarding the treatment of specific types of cancer. They were also to identify any clinical trials which might not only help patients but also advance the knowledge of various types of cancer treatment.

Since its inception in 1937, the NCI has created a network of community and regional cancer centers, cancer specialists, clinical researchers, and outreach groups. There are many dedicated volunteers who include themselves in the network as well. The NCI has also created an infrastructure for discovery, consisting of support mechanisms, various organizations, and networks which link scientist to valuable resources, facilities, and useful information. A foundation for various research activities encompassing all aspects of cancer has been provided by this infrastructure, including; biology, physiology, genetics, epidemiology, prevention, screening, detection, diagnosis, treatment, palliative care, and survivorship. Highly skilled research in cancer control as well as behavioral and population sciences are also supported by the massive infrastructure of the NCI, as they support their training programs. Because of this support, scientific advances in cancer research of all areas are made each year.

Every year, the NCI provides the President and Congress with their best judgment regarding how much funding is needed in an effort to make the most rapid attack on cancer. The budget for the NCI in the fiscal year of 2010 was approximately 5.1 billion dollars. Most of those dollars were used for the granting of funds and contracts to various universities. Cancer centers, medical schools, research labs, and the private companies within the United States and approximately 60 other countries were also included in the budget. Research which was conducted at the NCI was supported with the remaining balance.

There are many cancer research projects funded by the NCI. The Radiological Physics Center in Houston, TX and the Quality Assurance Review Center in Providence, RI are two of the NCI’s largest known grants. Also known as the RPC, the Radiological Physics Center oversees the aspects of its studies related to physics. Since 1968, it has been funded consistently by the NCI. There is a specific radiotherapy protocol and the RPC is there to guide institutions regarding the protocol process. Known as the QARC, the Quality Assurance Review Center assures quality in radiotherapy as well as management of diagnostic imaging to cooperative groups sponsored by the NCI. The QARC conducts radiotherapy reviews and has been supported by the NCI since 1980. They receive radiotherapy data from approximately 1,000 hospitals worldwide. Since incepted in 1977, the QARC has reviewed more than 30,000 cases. The University of Massachusetts Medical School shares a strategic affiliation with the QARC.

Progress in the fight against cancer is being made thanks to the collaborative efforts of both cancer researchers throughout the world and the NCI scientists. Supporting their efforts are examples of research intended to invoke a more broad conversation regarding the Nation’s investment in further cancer research. Since 1937 the NCI has helped aid our understanding of cancer. We know it as a set of diseases, complex in nature, requiring much investigation.

In the United States alone, the rate of new cases of cancer has been declining since 1999. Overall, the rate of deaths due to cancer has bean on the decline for more than 10 years. This shows that there have been advancements in treatment and technology, thus leading to more effective tools for the understanding of cancer. In 2007, more than 11 million survivors of cancer were living in the U.S. Cancer survivors are living longer than ever before and with a better quality of life due to constant research of dedicated individuals.

Filed Under: Breast Cancer Facts Tagged With: , , , , , ,

Breast Cancer Statistics: The Top Disease Statistics

September 3, 2011 By Leave a Comment

Second to skin cancer, breast cancer is the cancer diagnosed most commonly in women living in the United States. This accounts for approximately 25% of all cancers in women. The second leading cause of death by cancer in women is breast cancer, with lung cancer being the main cause. The most significant risk factors for breast cancer are gender (female) and increased age. There is a 1 in 35 chance that a woman’s death will be caused by breast cancer. Female incidences of breast cancer decreased by approximately 2% each year, between 1998 and 2007. This is after rates had been increasing for over twenty years. Although it is good news, the decrease was only seen in women over 50 years old. The decrease may have also been partially due to a publication by the Women’s Health Initiative in 2002 which stated a link between hormone therapy and increased risk of breast cancer and heart disease. Unlike the incident rates, death rates in woman under 50 years old have actually been declining. Early screening and detection, as well as increased awareness and better treatment have aided the decline. As of 2010, over 2.5 million survivors of breast cancer were estimated in the United States alone.

Causes of Breast Cancer

If a woman has an immediate relative (mother or sister) who was diagnosed with breast cancer, their risk of getting the disease almost doubles. Approximately 25% of women who were diagnosed with breast cancer have a family history of breast cancer. The remaining approximate 75% of cases in women occur when there is no family history of it. The reason for this involves the aging process and genetic abnormalities as opposed to inherited mutations.

A small percentage (between 5 and 10 percent) of breast cancers in women can be linked to gene mutations inherited by one’s parents. BRCA1 and BRCA2 gene mutations are the most common. A woman who has this mutation is 80% more likely than a woman who doesn’t have it, to develop breast cancer during her lifetime. They are also more likely to be diagnosed with breast cancer before menopause. Also associated with the genetic mutations is an increased risk of ovarian cancer.

Invasive Breast Cancer

Invasive breast cancer is also called infiltrating breast cancer because it has infiltrated and invaded the surrounding tissues of the breast and maybe even other parts of the body. Stages 1 through 4 are all stages of invasive breast cancer.

Some statistics regarding invasive breast cancer:

  • In women, it was expected that over 207,000 new cases of the invasive type were to be diagnosed in 2010.
  • In men, it was expected that almost 2,000 new cases of the invasive type were to be diagnosed in 2010. Of all new breast cancer cases, only less than 1% occurs in men.

Breast Cancer and Race

The racial group developing breast cancer at the highest rate is white women. Among women under 40 years of age, however, African American women have a higher incidence of breast cancer.  Their tumors tend to be larger than those of white women as well. Also tending to have larger tumors than white women but lower incidences of breast cancer are Hispanic and Latina women. An Asian woman migrating to the United States is six times more likely to develop breast cancer than if they did not migrate. Ten years of living in the United States increases their risk of breast cancer by 80%.  The good news is that between 1999 and 2006, there was a slight decline in incidence rates of breast cancer for Asian American, Pacific Islander, and white women. However, incidence rates for African American, Hispanic, Latina, Alaska Native, and American Indian women mostly remained unchanged.

Death rates

African American women are more likely than white women to die from breast cancer despite the fact that white women show higher rates of breast cancer. Studies have shown that aggressive tumors and poorer expected outcome are found in African American women. Another racial group more likely than white women to die from breast cancer is Hispanic or Latina women. Sometimes certain racial groups are less likely than white women to get proper breast cancer screening. This means that it gives the time for breast cancer to grow and for diagnosis at later stages. The diagnosis at a later stage increases one’s chance of dying from breast cancer. Although on the decrease since 1990, almost 40,000 women in the United States alone were expected to die of breast cancer in 2010.

Survival rates

The percentage of individuals who are alive five years after time of breast cancer diagnosis determines their survival rate. The least likely ethnic group to survive after five years of breast cancer diagnosis is African American women. The five year survival rates for other ethnic groups are as follows:

  • White women and Asian women have a 91% survival rate.
  • African American women have a 79% survival rate.
  • Hispanic, Latina, and Pacific Islander women have an 86% survival rate.
  • American Indian and Alaska Native women share an 84% survival rate.

The reason for the variation in survival rates may be due to the differences in the practices of breast cancer screenings. Also contributing to the difference in survival rates was the stage the cancer was in when diagnosed, the biology of the tumor, and treatment method used.

Breast Cancer and the Future

The American Cancer Society has released estimates for breast cancer in theUnited Statesfor 2011. They state that in women, approximately 230,480 new cases of invasive breast cancer will be diagnosed. An expected 57,650 new cases of non-invasive breast cancer, carcinoma in situ, will be diagnosed. The amount of women who are expected to die as a result of breast cancer is approximately 39,520.

There are ongoing studies to determine a possible link to genetics and increased mortality from breast cancer. Currently, there is a better chance of survival from the disease since there are improved treatment options. Also, routine mammograms and breast exams are encouraged, thus helping to detect the cancer at early stages.

Filed Under: Breast Cancer Facts Tagged With: , , , , , ,
« Older Posts