Breast Cancer is a very complex disease. There’s invasive and non-invasive. Hormone receptive and triple negative. Medullary, mucinous, papillary, tubular, cribriform, lobular. In situ, metastatic…

If you’re diagnosed with breast cancer, you may care more about treatment options and survival rate than the type of cancer you have. But you should know that each type has its own preferred treatments and rate of survival.

As it’s Breast Cancer Awareness Month, we want to talk about the risk factors for breast cancer, best ways to prevent if you are at risk, symptoms, and all of your treatment options so you can prepare yourself if you discover you have breast cancer.

As always, if you are diagnosed with breast cancer or think you have symptoms, you should talk with your doctor and see a breast cancer specialist to determine your best course of action.

 

What is a Carcinoma?

Carcinoma is a type of cancer cell that begins in the tissues of the skin or lining of an organ. In the case of breast cancer, it begins in the breast tissue lining of the milk ducts or lobes. Most breast cancers are carcinomas.

The two main categories of breast cancer are noninvasive (contained within one area) and invasive. Invasive breast cancers represent nearly 80% of breast cancer. It’s possible to have both invasive and noninvasive tumors in the breast. They would be treated as invasive.

Ductal Carcinoma in situ (DCIS) is the most common noninvasive breast cancer. Breaking that down, ductal means the cancer is found in the breast duct. In situ means that it’s contained in that area (the duct) and has not spread (or metastasized).  DCIS is very treatable with a high survival rate at 98-99%. But, it’s important to catch it early, as DCIS can spread to other areas of the breast, lymph nodes, or other organs if not detected and treated in its early stages.

Treatment for noninvasive breast cancer is normally a lumpectomy (where they remove the tumor in the breast), followed by radiation therapy.

While highly curable, DCIS has a 15-30% chance of recurring or developing in the other breast. DCIS is detected by breast self-examinations and screening mammograms. If abnormalities are suspected from screenings, a diagnostic mammogram can confirm cancer.

Breast cancer can also begin in the lobules (glands that produce breast milk). Lobal carcinoma in situ or (LCIS) is technically not a breast cancer and rarely treated. However, it is an indication that you may develop breast cancer (DCIS or invasive) in the future. LCIS is not detected through a mammogram or self-examination, but through a biopsy performed for another reason, like a suspicious lump found in a mammogram or breast exam.

Invasive breast cancers have cells that invade other areas of the breast, lymph nodes, or other organs. The most common form is invasive ductal carcinoma, or IDC.  It begins in the ducts, but then spreads to the fatty tissue outside of the ducts.

Surgery is generally recommended for IDC, but there are different types of surgeries and you should know all your options.

Invasive breast cancers are also detected through regular breast exams and mammograms Further tests to confirm cancer include diagnostic mammogram, biopsies, breast MRI, or ultrasound.

While the prognosis for noninvasive is higher, IDC has between and 83% and 90% survival rate. Again, early detection results in faster treatment and higher survival rate.

Chemotherapy is usually recommended after surgery to kill any cancer cells that may have spread.

 

Lumpectomy or Mastectomy?

The thought of losing a breast or both can be just as overwhelming as a breast cancer diagnosis. But total mastectomy is just one of the options when considering surgery to remove your tumor.

For most early-detected breast cancers, where the tumor is still relatively small, a lumpectomy, or breast conserving surgery followed by radiation therapy is offered. With a lumpectomy, the surgeon removes only the tumor inside the breast. Several weeks of radiation will likely follow the surgery and there are additional risks with radiation.

If your tumor is larger than what can be safely removed with a lumpectomy, your doctor may recommend a mastectomy of the breast with the cancer.

Here are the most common types of mastectomy:

  • A simple, or total mastectomy is where the entire breast is removed, including the nipple, areola, and skin surrounding the breast.
  • Modified radical mastectomy; this involves the removal of breast tissue and lymph nodes. Finally,
  • Radical mastectomy involves the removal of breast tissue, lymph nodes, and the chest (pectoral) muscles under the breast. Because there are other options offered today, radical mastectomies have become rare, but still offered in cases where there is no other option because of tumor growth or stage of cancer.

No matter which type of mastectomy you have, you may still be able to have reconstructive surgery to rebuild your breast. Sometimes they do this during the mastectomy surgery, but often it’s done later.

Some women decide even if the cancer is in only one breast, to have a double mastectomy, due to risks of the cancer spreading to the other breast, or for cosmetic reasons.

Depending on your type of cancer, size of tumor, and whether it’s spread, your physician will help you determine the best option for you.

If you have an ER/PR receptive tumor, meaning that the cancer cells are fed by estrogen or progesterone, then hormone therapy, usually in the form of oral medication, and sometimes injection, may reduce the size of your tumor so that a lumpectomy becomes an option. Another type, HER2 positive breast cancer, where the cells make too much the protein HER2 also respond to drug therapies. Chemotherapy prior to surgery may shrink your tumor as well.

 

Are You at Risk of Getting Breast Cancer?

There isn’t any one known cause for getting breast cancer. However, several factors, biological and environmental, can put you at risk for developing breast cancer.

Sex – Being a woman automatically puts you are higher risk for breast cancer than a man, although men can get the disease as well, it’s about 100 to 1.

Family History and Genetics – If you have a family member, mother, grandmother, or sister, with breast cancer, that increases your risk.  Especially if there is a genetic mutation in the breast cancer genes (BRC1 and BRC2).

If you have a family history of breast or ovarian cancer, or there is a known genetic mutation in your family, speak with your doctor about your elevated risk and preventative measures you can take now.

Age – The risk of developing breast cancer increases with age, especially after age 55.

Ethnicity – Caucasian women are slightly higher at risk than other ethnicities; but African American women are prone to more aggressive triple-negative breast cancer.

Radiation Exposure – If you have any type of radiation treatment to the chest or face before the age of 30, you may be at higher risk to develop breast cancer later in life.

Dense Breast Tissue – Women with denser breast tissue have a higher risk of getting breast cancer. And, denser tissue is more difficult to detect during a mammogram or self-exam.

Menstrual Years – Girls who began menstruating before age 12 and those women who entered menopause after the age of 55 are both at higher risk.

Pregnancies and breastfeeding – Women who have either never had a full-term pregnancy or had their first child after the age of 30 are at slightly higher risk of breast cancer than a woman who has her first child before the age of 30.

Also, women who have never breastfed, or have breastfed for less than six months are at a slightly higher risk.

It’s thought that the fewer menstrual periods a woman has in her life, the lower her chance of developing breast cancer. So, more pregnancies and longer time breast feeding means a longer period without a menstrual cycle, and less time for your body to produce estrogen from ovulation.

There are also preventable factors that lead to a higher risk such as obesity, sedentary lifestyle, eating a diet high in sugar and simple carbohydrates, and smoking.

 

How Can I Lower My Risk of Breast Cancer?

While some things like genetics and family history cannot be changed, there are many things you can do to lower your risk of breast cancer, even if you aren’t at high risk.

  • Maintain a Healthy Weight – Post-menopausal obesity is one of the biggest risks for developing breast cancer in older women. As we age, our estrogen levels decrease until the ovaries no longer produce estrogen (menopause). However, estrogen is produced in fat cells and the increase in estrogen from fat increases your risk of developing breast cancer.
  • Daily Exercise is one of the best ways to lower your risk of getting breast cancer at any age. 30 minutes a day or moderate exercise at least 5 days a week is recommended by the American Cancer Society. If you cannot exercise going for a daily 20-minute walk is beneficial and proven to reduce your risk of breast cancer.
  • Stand Up – If you sit for long periods of time, get up and move every thirty minutes or at least every hour. Extended sitting has been known to increase the risk for developing several types of cancer, including breast cancer.
  • Quit Smoking – Smoking increases your risk of many cancers and health issues.
  • Alcohol – Limit alcohol consumption
  • Eating a healthy diet – Insulin and estrogen are linked to higher risks of breast cancer, so limiting sugar and simple carbohydrates will lower insulin and estrogen levels, lowering your risk of developing breast cancer.
  • Early Detection – Although not all breast cancers show up definitely through a breast exam or screening mammogram, they may show abnormalities which can become cancer. You should perform self-exams monthly and your doctor will recommend mammograms based on your age and risk.

While there is no single cause for developing breast cancer, some women are at higher risk. Maintaining a healthy weight, eating a healthy diet and getting plenty of exercise are the best things you can do to lower your risk.

If you have a family history of breast cancer or other risks, talk to your doctor and make sure you get regular screenings based on your age and risk factors.

Identifying breast cancer in the early stages, no matter what type you have, is your best chance at survival. There are many treatment options if you do have breast cancer. Talk with your physician about the best options for you.

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