Breast Cancer Overview
Obviously no woman wants to receive the diagnosis, but hearing the words “breast cancer” doesn’t always mean an end. It can be the beginning of learning how to fight, getting the facts and finding hope.
In 2010, there were more than 2.5 million breast cancer survivors in the U.S. In reality, about 1 in 8 women in the United States — 12 percent, or about 12 out of every 100 — can expect to develop breast cancer over the course of an entire lifetime.
Breast cancer can begin in different areas of the breast – the ducts, the lobules, or in some cases, the tissue in between. It can be non-invasive, invasive, recurrent, and metastatic breast cancers.
Non invasive – Benign
| Types |
Statistics |
Description |
Risk Category |
| Ductal Carcinoma In Situ (DCIS) |
Most common type of non-invasive breast cancer.According to American Cancer Society – 60,000 cases/year |
Breast cancer that has not spread beyond the milk duct into any normal surrounding breast tissue |
Recurrence – 25% to 30% in those who are treated without surgery. 15 % in those who undergo surgery. |
| Lobular Carcinoma In Situ (LCIS)OR
Lobular Neoplasia - A neoplasia is a collection of abnormal cells, so this is not exactly cancer. But abnormal cells develop – indication of Ca in future |
Uncommon type of Cancer |
The abnormal growth remains inside the lobule and does not spread to surrounding tissues. |
Increases a person’s risk of developing invasive breast cancer later on in life. |
Invasive – Malignant
| Types |
Statistics |
Description |
Risk Category |
| Invasive Ductal Carcinoma (IDC)/ Infiltrating Ductal Carcinoma |
Most common type of breast cancer.80% of total breast cancer |
Cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast |
Eventually spreads to lymph nodes and other parts of body.Invasive ductal carcinoma also affects men. |
| Invasive lobular carcinoma (ILC) |
Second most common type |
Cancer that has broken through the wall of the lobule and begun to invade the tissues of the breast |
ILC tends to occur later in life than IDC — the early 60s. |
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Less common invasive breast cancer
| Tubular Carcinoma of the Breast |
Less than 1-2% of IDC |
Small tube shaped cancer cells, grows slowly |
Mid 40s to late 60s |
| Medullary Carcinoma of the Breast |
Less than 3-5% of IDC |
Tumor is a soft, fleshy mass resembles brain |
Late 40s to early 50s |
| Mucinous Carcinoma of the Breast |
Less than 2-3% |
Tumor “float” in mucin – inner surface of breast |
Late 60s |
| Papillary Carcinoma of the Breast |
Less than 1-2% |
Well-defined border, with small projections |
Late 50s to 60s |
| Cribriform Carcinoma of the Breast |
Less than 5-6% |
Invades stroma in nestlike formations between ducts – lobules |
Found in women after menopause |
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Other: Benign and/or Malignant
| Types |
Statistics |
Description |
Risk Category |
| Inflammatory breast cancer (IBC) |
Rare but aggressive type. 1-5% of all cases |
Usually starts with the reddening and swelling of the breast instead of a distinct lump, worsens quickly. |
Found in younger women, compared to other forms – typically 52 to 57 yrs.Can affect men |
| Male Breast Cancer |
Very rare, less than 1% of all cases. |
Risk factor – older age, radiation exposure, high estrogen level, etc. |
May be benign or malignant |
| Paget’s disease of the nipple |
Less than 5% of all cases. |
It affects the ducts of the nipple first, then spreads to the nipple surface and the areola |
Associated with DCIS or invasive types of cancer.More common in women than men. |
| Phyllodes tumors of the breast |
Less than 1% of all cases |
The tumor cells grow in a leaflike pattern. Tend to grow quickly. |
May be benign, malignant or a borderline tumor.Found in women in 40s |
Written by Vidhi Soni, MD
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Doctors Who Treat Breast Cancer
As your breast cancer is diagnosed, treated and managed, there may be several specialists you are referred to for care. The most common doctors that treat breast cancer patients are listed below:
Primary Care Physician - This doctor is often the patient’s regular doctor and may be the first physician to recommend further tests or procedures to be done by a specialist.
Breast Surgeon - A surgeon skilled in operating on the breast. Breast surgeons often perform biopsies on a tumor found in the breast. They will also remove the tumor or breast if necessary. Some breast surgeons also do reconstructive surgery.
Diagnostic Radiologist - A radiologist utilizes radiologic methodologies to diagnose and treat diseases. This doctor will often perform diagnostic tests, such as mammograms (radiologists).
Medical Oncologist - An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers chemotherapy for malignancy, as well as consulting with surgeons and radiotherapists on other treatments for cancer.
Radiation Oncologists - A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors.
Genetic Counselor - This specialist evaluates a patient’s personal risk factors for breast cancer. A genetic counselor will review a patient’s personal family history and assess cancer patterns. They also look at lifestyle factors to determine a more accurate risk assessment. After, they work with the patient to develop strategies to lessen the likelihood of developing breast cancer.
Plastic Surgeons - A plastic surgeon deals with the repair, reconstruction, or replacement of physical defects of form or function, involving the skin, musculoskeletal system, craniomaxillofacial structures, hand, extremities, breast and trunk, and external genitalia. With breast cancer patients, they often do reconstructive surgery.
Written by Vidhi Soni, MD
How to Prepare for Your Breast Cancer Doctor Visit
Having made your appointment with a healthcare provider to discuss breast cancer, there are certain actions that you need to take in order to maximize the benefit of the doctor visit:
- Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the doctor’s appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Write down your family history of cancer. Note any family members who have had cancer, including how each member is related to you, the type of cancer, the age at diagnosis and whether each person survived.
- Make a list of all medications, as well as any vitamins or supplements that you’re taking.
- Keep all of your records that relate to your cancer diagnosis and treatment. Organize your records in a binder or folder that you can take to your appointments.
- Consider taking a family member or friend along.
Written by Vidhi Soni, MD
Questions to Ask Your Doctor About Breast Cancer
From your initial breast cancer diagnosis throughout your treatment and care, you will have questions to ask your doctor about your cancer. Below in our patient education guide, you will find a list of helpful questions for you and your doctor to discuss so you can make informed decisions about your breast cancer diagnosis.
Question About My Diagnosis
- What type of breast cancer do I have?
- What is the stage of my cancer?
- Can you explain my pathology report to me? Can I have a copy for my records?
- Do I need any more tests?
Questions About My Treatment
- What treatment options are available for me?
- What are the benefits from each treatment you recommend? What are the side effects?
- Will treatment cause menopause?
- How will each treatment affect my daily life? Can I continue working?
- How quickly do I need to make a decision about cancer treatment? What if I don’t want cancer treatment?
- What will cancer treatment cost? Does my insurance plan cover the tests and treatment you’re recommending?
- Should I seek a second opinion? Will my insurance cover it?
- Will I need psychiatrist to calm down my anxiety and fears?
Questions About My Lifestyle & Family
- Are my children have an increased risk of developing breast cancer?
- What will be my lifestyle change, especially in food as I will be having side effects?
- Are there any brochures or other printed material that I can take with me? What websites or books do you recommend?
- How will breast cancer affect my professional life?
Written by Vidhi Soni, MD
Common Tests or Labs to Diagnose Breast Cancer
The biggest misconception of breast cancer is that if one has no symptoms, no lump and no family history, they will never suffer from breast cancer. Fact is that one-third of women diagnosed with breast cancer has/had no risk factor. Therefore, it is very important for women to have regular screening tests.
Lab Tests
| Test |
Why Test? |
What Happens? |
Normal Results |
Biopsy
- Core needle biopsy
- Fine needle aspiration
- Incisional biopsy
- Excisional biopsy
- Vacuum assisted breast biopsy
- FISH(Fluorescence in situ hybridization), IHC(Immuno Histo Chemistry) test
|
The surest way to identify the cancer cell, in this case the breast cancer cells. |
A small, non emergency surgical procedure in which local anesthesia is given and small sample of the lump or suspected area is taken and examined under microscope |
Takes several days to get final result. And several characters of the Ca cells can be identified – size, appearance, growth rate, spreading in to healthy tissues and factors of cancer. |
| Blood Cell Count |
To see whether the blood has normal counts of various blood cells |
Blood is drawn through a syringe, typically from the arm. |
Reduced WBC – increase high risk of infectionRBC – Hemoglobin and Hematocrites if not normal, affects the treatment
Platelets – helpful for clotting to prevent bleeding – important to know before treatment |
| Blood Chemistry |
To measure level of certain substances to determine normal function of various organs |
Blood is drawn through a syringe, typically from the arm. |
- Level of liver enzymes and bilirubin
- Potassium, chloride, urea for kidney
- Calcium level for bone and kidney
- Blood sugar level – for diabetes and steroids
|
| Blood Marker |
To detect cancer activity in blood before and during treatment.Also done after treatment to know the response of the cancer |
Protein material is injected into the blood through arm |
Diagnose the breast cancer cells and determine the spread to the other parts
|
Imaging
| Test |
Why Test? |
What Happens? |
Diagnosis |
| Mammogram |
Most important tool of doctor to diagnose, evaluate and follow up the breast cancer. |
Breast are compressed and placed between two clear plates by technician. Plates are connected to highly specialized camera and two pictures for each breast are taken. |
Can easily diagnose lump of the breastAbnormalities like calcification, cyst and fibro adenomas can be seen in to the pictures. |
| Ultrasound |
Not helpful to diagnose, but helps to compliment the diagnosis from other tests |
Non invasive, sound emitting probe is moved on the breast to conduct the test. |
Benign tumor can be identified as solid lump.Cyst – fluid filed area can be identified. |
| MRI Scan |
Screening high risk women with large breast cancer, gathering more information after suspicion of mammogram/ultrasoundMonitoring recurrence after treatment |
A patient lies on a table that slides inside a large machine. Dye may be injected by syringe into your veins to help make clearer images. |
Various cross sectional images are taken and shows the lump, calcification and cyst. |
| CAT Scan and/or PET Scan |
Doctor may order to assess whether cancer has moved to other parts of body. |
Contrast solution dye is injected in arm, and then the patient is moved into a doughnut shaped machine.X-rays pass throughout the body to take an image |
Gives two-dimensional viewIdentifies large cancer, alteration in lymph nodes, lungs, liver, brain and/or spine |
| Chest X-ray |
Ordered by doctor to identify advanced breast cancer spread to lung, chest.May also be administered after treatment to see effect |
The patient is asked to keep as still as possible for the few seconds it takes for an image to be obtained. |
During chemotherapy and radiation therapy, pneumonia and inflammation of lungs are identified. |
| Bone scan (Scinitigraphy) |
To determine whether breast cancer has travelled to bones. |
Radioactive material is injected in arm, which will be taken up by bone, making cells visible within 2-4 hrs.A special camera is then used to identify suspicious areas. |
Initial diagnosis to determine healthy boneDuring/after treatment used to determine if any joint pain persists or increases |
Physical Examination
| Test |
Why Test? |
What Happens? |
Diagnosis |
| Breast Physical Examination |
Carefully manually performed to find lump or inflammatory signs. |
Physical examination is performed by physician or health professional. |
Lump can be easily palpable; redness heat of inflammation can be easily identified.About 20% of breast cancer can be identified without doing mammogram. |
| BSE – Breast Self Exam |
Regular breast self checking is important to identify any early lumps. |
Physical examination advised to be done at least once a month. |
Try to get acquitted with normal shape of breastAny lump, heaviness or change in appearance of breast needs immediate attention. |
Written by Vidhi Soni, MD
Breast Cancer Treatment Options
Several treatment options for breast cancer exist. There are both surgical and medicinal therapies that may be used in combination.
A physician will choose the treatment plan based on the type of cancer a patient has and what stage it is in.
Surgery
| Name |
Description |
| Lumpectomy |
Breast-conserving surgery is the removal of only the tumor and a small amount of surrounding tissue. |
| Mastectomy |
It is the removal of all of the breast tissue. The muscles under the breast are no longer removed. |
| Lymph Node Removal |
Removal of axillary lymph nodes during mastectomy or in case if cancer has spread outside the milk duct. Some people qualify for a less-invasive surgery. |
| Breast Reconstruction |
The rebuilding of the breast after mastectomy or lumpectomy.Reconstruction can take place at the same time as cancer-removing surgery, or months to years later. |
| Prophylactic Mastectomy |
Preventive removal of the breast to lower the risk of breast cancer in high-risk patients. |
| Prophylactic Ovary Removal |
Preventive surgery that lowers the amount of estrogen in the body, making it harder for estrogen to stimulate the development of breast cancer. |
Therapy
| Name |
Description |
| Chemotherapy |
In early stage breast cancer, standard chemotherapy regimens lower the risk of the cancer coming back.In advanced breast cancer, chemotherapy regimens make the cancer shrink or disappear in about 30-60% of people treated. |
| Radiation Therapy |
Highly effective way to destroy cancer cells in the breast that may stick around after surgery.It reduces the risk of recurrence by 70%. |
| Hormonal Therapy |
Lowers the amount of the hormone estrogen in the body.Blocks the action of estrogen on breast cancer cells. |
| Targeted Therapy |
Targets specific characteristics of cancer cells, such as a protein, that allows the cancer cells to grow in a rapid or abnormal way. |
| Pain Management |
Pain treatment completely depends on the type of pain involved and doctor’s choice based on current health condition. |
Written by Vidhi Soni, MD
