A universal problem
Two million six hundred thousand.
That’s how many lives have been affected by breast cancer–in the United States alone.
It is the most common cancer found in women. This year, an estimated 230,000 women in the United States will come to terms with the life-changing event of a breast cancer diagnosis. That’s about one in every eight women. Almost 2,000 men are also diagnosed with breast cancer each year as well.
Breast anatomy and cancer biology
Our bodies are made up of billions of cells, which together form our organs and tissues. The breast is a specialized organ of our body with unique cells that are important to its normal function.
Within the breast are millions of milk producing sacs, called lobules. The milk is carried from the lobules to the nipple through ducts. There are lymphatics which carry normal body fluid called lymph from the breast to lymph nodes, many of which are located in the armpit region.
The cells in our bodies undergo a lifecycle, and after they die, they are replaced by new ones. Occasionally, an abnormal cell may develop, which can grow and reproduce in an abnormal way. These cells produce abnormal growths called tumors. In the breast, the ducts and the lobules are the most common places where a tumor can arise from.
Tumors are classified into benign or malignant. Benign tumors are not considered cancerous in that they do not typically spread outside the breast. Malignant tumors are cancerous, and have the potential of invading and/or spreading to other parts of the body through the lymphatics or blood. Breast cancer that has spread to a different location, such as the bone or brain, is called metastatic.
The biopsy
Sometimes, it is found by detecting an unusual lump in the breast. But more commonly, breast cancer is found after an abnormal finding is detected on a routine screening mammogram.
In either case, the way to tell whether or not a breast lump or an abnormal mammogram finding is benign or malignant is through a biopsy–a procedure where a portion of tissue is removed from the tumor either from a needle or a small surgical procedure. A physician who is specially trained in examining tissue specimens, the pathologist, then examines the tissue under the microscope. If it is determined to be a cancerous tumor, special testing is also done to examine whether or not the tumor has hormone receptors or other special genetic markers; this information will be important later on for treatment purposes.
When a diagnosis of cancer is established, a consultation with a surgeon is made to discuss that the surgical treatment options are. In order to determine what the appropriate treatment options are, a determination is made on how advanced the cancer is, and how far along the cancer has progressed; this is classified as the stage. Depending on the clinical stage, a medical oncologist (who specializes in chemotherapy) and/or a radiation oncologist (who specializes in radiation therapy) may also need to be involved at this point, to help you determine what the different treatment options are.
Treatment: A story of hope
The treatment for breast cancer has come a long way.
Thirty years ago, 75% of women with breast cancer survived their disease for at least five years. The only accepted surgical treatment option at the was mastectomy. And our understanding of the genetic and hormonal influences of breast cancer were extremely limited. Today, the number is nearly 90%. Also, the lumpectomy, a breast-conserving surgery, followed by radiation therapy as become another alternative for women with early stage breast cancer.
Stage is an important factor in determing what treatments are appropriate. Other factors that must be considered are age, and how extensive the cancer is. Additional tests, such as a bone scan or an MRI, may be needed to help answer these questions.
Many breast cancer patients are Stage I, IIA, or IIB. For most of these patients, they can choose between either a mastectomy, or breast conserving therapy. Both have been shown in large randomized studies to have comparable results for appropriately selected patients.
 A lumpectomy is a breast-conserving surgery where the tumor is removed as well as some surrounding tissue. The axillary lymph nodes may also be removed. |
 A modified radical mastectomy removes the breast as well as axillary lymph nodes. |
Some patients cannot have breast-conserving therapy because of:
– Widespread disease that cannot be removed in its entirety by a surgery with an acceptable cosmetic result
– Previous radiation therapy to the breast of chest wall
– Suspsicious or cancerous-appearing microcalcifications that are diffuse across the breast
– Pregnancy
Also, special concern must be undertaken for patients with:
– Tumors larger than 5 cm
– Patients with “positive surgical margins” – meaning, evidence that cancer has been left behind after the surgery
– Patients with an active connective tissue disease (such as scleroderma and lupus)
– Women 35 years old or less, or any premenopausal woman with a known BRCA-1 or BRCA-2 mutation
Patients in this category must carefully discuss their specific situation with their oncologist.
After surgery
The day of the surgery finally arrives, and depending on what is found when they examine your surgical specimens under the microscope — a surgical pathology report — you will then either need to undergo chemotherapy, followed by radiation therapy, or can go directly to radiation therapy.
A closer look at treatment
For a more in-depth look at the treatment pathways for breast cancer, click on the link below.
– Breast Cancer: Treatment