The Cause - How and Why Breast Cancer Spreads
Most people visualize a malignant tumor as steadily growing, and they may assume that if a lump is small, it's an early cancer. This may not be true. Tumor size alone doesn't indicate a cancer's severity.Although most of the time smaller tumors are less likely to have spread, the aggressiveness of a particular cancer is a major factor in how much it spreads. Some small tumors may quickly travel to the lymph nodes, and some large ones may not spread at all.
Another factor is the patient's immune system. By the time a tumor is found, cancer cells may have been present for some years, but the immune system has controlled their proliferation. Experts believe that at some point, in some women, the malignant cells become too numerous for the body's immune system to handle; the cancer then begins to metastasize, or spread.
Cancer treatment today is based on the premise that reducing the number of cancer cells — by removing the tumor and killing cancer cells that have spread to other organs — can turn the tide in favor of the body and its natural defenses.
The risk for most forms of cancer rises with age, and breast cancer is no exception. At age 20, your risk is very low, but by age 50, one in every 36 women will be diagnosed with breast cancer within the next 10 years. The risk continues to rise throughout life
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Risk Factors
Many factors might affect your risk for breast cancer and other diseases. You may be able to control and modify some of these, including:- what you eat
- how much you weight and maintaining a healthy weight
- how much you exercise
- whether you smoke
- whether you drink alcohol or if so, how much or how frequently
- they types of chemical in your environment
- whether you took hormone replacement therapy (HRT) for menopausal symptoms for five years or longer
Making these changes in your life can be quite difficult. But it becomes easier to make these changes when you understand each factor, the importance of the changes, and practical ways to make the changes. And when it comes to the factors that can't be controlled, we'll help you work around them.
Some of the factors that increase your risk for getting breast cancer are things you can't control:
- Age: Just as with many other diseases, the risk of getting breast cancer goes up as you get older. Your average risk of getting breast cancer over your lifetime is 1 in 7, assuming you live to age 90. But each 20 or so years of your life is associated with a different level of risk:
- From birth to age 39, your risk is 1 in 229
- From age 40 to 59, your risk is 1 in 24
- From age 60 to 79, your risk is 1 in 13
- Personal history of breast cancer: If you have had breast cancer already, you are at risk of it coming back. That risk might be low or high, depending on your situation. And you are at higher risk of getting a NEW breast cancer compared to someone else who has never had the disease.
- Family history: Breast cancer in your family can have a significant impact on your risk. But this doesn't ALWAYS mean that you are at high risk just because someone in your family had breast cancer. For example, if your grandmother was diagnosed with breast cancer at age 75, this may not increase your risk of the disease. Your grandmother was most likely just one of the 1 in 13 women who gets breast cancer between the ages of 60 and 79.
- Certain breast changes: Normal breast cells can sometimes get overexcited and start to misbehave. These changes can show up as a lump, thickness, or calcifications on a mammogram. If a biopsy is done, these changes can be seen under a microscope. When the breast duct cells are overactive and appear unusual, the pathology report may describe these findings with the term atypical ductal hyperplasia. An uncontrolled growth of breast cells in the lobule (the part of the breast that makes milk) is called lobular carcinoma in situ or LCIS. (Even though the word “carcinoma” is part of the term LCIS, it is not considered a true cancer.). These two types of breast changes are associated with an increased risk of breast cancer in the future. But these abnormalities are not themselves cancerous.
- Genetic alterations: To date, most inherited cases of breast cancer have been associated with two genes: BRCA1, which stands for BReast CAncer gene one, and BRCA2, or BReast CAncer gene two. The function of these genes is to keep breast cells growing normally and to prevent any cancer cell growth. But when these genes contain abnormalities, or mutations, they are associated with an increased breast cancer risk. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers. Women diagnosed with breast cancer who have an abnormal BRCA1 or BRCA2 gene often have a family history of breast cancer, ovarian cancer, or both. There are also women with a strong family history of breast cancer who might have another kind of genetic abnormality that's not yet been identified. But it's also important to remember that most women with breast cancer have no significant family history of the disease.
- Menstrual history: You have no control over the amount of estrogen that your ovaries produce over time. If you were very young when you got your first period, or you had a late menopause, or both, you have had more years of exposure to estrogen and other hormones produced by your ovaries. Women who had their first period before they were 12 years old or went through menopause after 55 have a higher risk of breast cancer than women with fewer years of exposure to hormones made by the ovaries.
- Race: Breast cancer in the United States occurs more often in white women than Latina, Asian, or African American women. But in women 40 and younger, African American women have the highest risk.
- Radiation therapy to the chest before you were 30 years old: If you had radiation therapy to your chest before you were 30 years old and particularly during adolescence, you may have a higher risk of developing breast cancer. This has been seen in young women receiving radiation to treat Hodgkin's disease. (This does NOT include radiation therapy to treat breast cancer.)
- Breast density: Past research has shown that women with “dense” breasts, which contain more glandular and connective tissue, are more likely to be diagnosed with breast cancer than women whose breasts are less dense (mainly made up of fat tissue). Breast cancer itself is dense and starts from glandular tissue. Estrogen makes breast tissue more dense. So the connection between breast density and breast cancer may be related to higher levels of estrogen in the body. On a mammogram, a cancer is harder to spot in dense tissue than in fatty tissue. That's because the cancer looks a lot like the glandular tissue around it.
- Exposure to DES (diethylstilbestrol): DES is an estrogen-like hormone used in the past to help women prevent miscarriage. Daughters of women who used DES have an increased risk of cancer of the vagina. This drug may also increase the risk of breast cancer in women who used it and in their daughters who were also exposed to it.
- Late pregnancy or no pregnancy: Women who had their first full-term pregnancy after age 30 and women who never had a full-term pregnancy are at higher risk for breast cancer than those who gave birth earlier in life. A full-term pregnancy, which stops your menstrual cycle for nine months, seems to offer protection against breast cancer.
If you weigh uncontrollable factors against those that CAN be changed, you'll see that you can do a lot to lower your risk of breast cancer. And while it's very hard to pin down specific foods or chemicals that are firmly linked to a higher or lower risk of breast cancer, researchers are working hard to find out whatever they can about specific lifestyle and environmental factors that may be within your control.
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Prevention
Breast cancer symptoms vary widely — from lumps to swelling to skin changes — and many breast cancers have no obvious symptoms at all. Symptoms that are similar to those of breast cancer may be the result of non-cancerous conditions like infection or a cyst.
Breast self-exam should be part of your monthly health care routine, and you should visit your doctor if you experience breast changes. If you're over 40 or at a high risk for the disease, you should also have an annual mammogram and physical exam by a doctor. The earlier breast cancer is found and diagnosed, the better your chances of beating it.
The actual process of diagnosis can take weeks and involve many different kinds of tests. Waiting for results can feel like a lifetime. The uncertainty stinks. But once you understand your own unique "big picture," you can make better decisions. You and your doctors can formulate a treatment plan tailored just for you.
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Warning Signs/Early Detection/Symptoms
The first sign of breast cancer is often a painless lump. But early breast cancer is often found on a mammogram before a lump can be felt. Other symptoms of breast cancer may not appear until the cancer is more advanced. These include:
- A thickening in the breast or armpit.
- A change in the size or shape of the breast.
- Changes in the skin of the breast, such as a dimple or skin that looks like an orange peel.
- A change in the nipple, such as scaling of the skin or a nipple that turns in
- A green or bloody fluid that comes from the nipple.
- A change in the color or feel of the skin around the nipple (areola).
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Screenings/Exams
There's a whole world of testing that goes along with taking care of your breasts. No matter where you are on the line between healthy breasts and breast cancer, tests can be nerve-wracking. But they're an indispensable part of:
- finding breast cancer early, when it's most treatable
- helping your treatment team design the treatment that's right for you
- determining the effectiveness of your continuing care
Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
Here's what you should look for:
- breasts that are their usual size, shape, and color
- breasts that are evenly shaped without visible distortion or swelling
- dimpling, puckering, or bulging of the skin
- a nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
- redness, soreness, rash, or swelling
Step 2: Now, raise your arms and look for the same changes.
Step 3: While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge (this could be a milky or yellow fluid or blood).
Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few fingers of your hand, keeping the fingers flat and together.
Cover the entire breast from top to bottom, side to side—from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. Be sure to feel all the breast tissue: just beneath your skin with a soft touch and down deeper with a firmer touch. Begin examining each area with a very soft touch, and then increase pressure so that you can feel the deeper tissue, down to your ribcage.
Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in Step 4.
Breast cancers are as varied as the women affected by them. By looking at the many different characteristics of the cancer, you can size up its "personality" almost the way you analyze another person. Is the tumor small and low-key? Angry, aggressive, and fast-moving? Or is it very large but easy-going? Is its behavior wild and unpredictable, or does it play by the rules?
Many tests and analyses will be done over several weeks to figure out your diagnosis. The most critical test results—for your treatment and your long-term health—will tell you and your doctor:
- whether the cancer is non-invasive or invasive, and
- whether lymph nodes are involved and if so, how many?
- size
- tumor grade
- hormone receptor status
- HER2/neu oncogene overexpression, and
- margins of resection
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Treatments
For well over a century, surgery has been the first line of attack against breast cancer. But things have changed a lot in recent years. Today, the goal is precise, targeted surgery that aims to preserve as much of the healthy breast and surrounding areas as possible. Even mastectomy (breast removal) is a more refined, less drastic option than it was a generation ago.
You may hear many different terms used to describe the kinds of surgery that can be done, but there are really two main options:
- breast-conserving surgery, (commonly known as lumpectomy) in which only the tumor is removed from the breast. This is usually followed by radiation therapy to the remaining breast tissue.
- mastectomy, an operation in which the whole breast is removed. Sometimes radiation is given after mastectomy.
If you have early-stage breast cancer, ask your doctor about the sentinel lymph node dissection as an alternative to traditional lymph node dissection. Find out if you are a good candidate. If you are, ask if your surgeon has a high level of experience with this new technique, before proceeding.
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Breast Cancer in Women under 40
Young women can and do get breast cancer.
In 2008, the American Cancer Society projected 182,460 new cases of breast cancer in females. It was estimated that 10,000 of these women would be under 40 years of age.
Although the incidence of young women with breast cancer is much lower than in older women, young women’s breast cancers are generally more aggressive and result in lower survival rates.
Women with an altered BRCA1 or BRCA2 gene are 3 to 7 times more likely to develop breast cancer than women without alterations in those genes.
Women with an altered BRCA1 or BRCA2 gene also often develop breast cancer at a young age (before age 50).
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Breast Cancer in African American Women
African American young women under the age of 40 have an increased risk of breast cancer. African American women have a higher incidence rate of breast cancer before age 40 than Caucasian women. African American women of all ages have a higher mortality rate from breast cancer than Caucasian women. African American women under 35 are more likely to have basal-like type breast cancer, which is a more aggressive form of breast cancer.
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Male Breast Cancer
Breast cancer in men is a rare disease. Less than 1% of all breast cancers occur in men. In 2005, when 211,400 women were diagnosed with breast cancer in the United States, 1,690 men were diagnosed with the disease.
You may be thinking: Men don't have breasts, so how can they get breast cancer? The truth is that boys and girls, men and women all have breast tissue. The various hormones in girls' and women's bodies stimulate the breast tissue to grow into full breasts. Boys' and men's bodies normally don't make much of the breast-stimulating hormones. As a result, their breast tissue usually stays flat and small. Still, you may have seen boys and men with medium-sized or big breasts. Usually these breasts are just mounds of fat. But sometimes men can develop real breast gland tissue because they take certain medicines or have abnormal hormone levels.
Because breast cancer in men is rare, few cases are available to study. Most studies of men with breast cancer are very small. But when a number of these small studies are grouped together, we can learn more from them.
It's important to understand the risk factors for male breast cancer—particularly because men are not routinely screened for the disease and don't think about the possibility that they'll get it. As a result, breast cancer tends to be more advanced in men than in women when it is first detected.
A number of factors can increase a man's risk of getting breast cancer:
- Growing older
- High estrogen levels
- Klinefelter syndrome
- A strong family history of breast cancer or genetic alterations
- Radiation exposure
If you notice any persistent changes to your breasts, you should contact your doctor. Here are some signs to watch for:
- a lump felt in the breast
- nipple pain
- an inverted nipple
- nipple discharge (clear or bloody)
- sores on the nipple and areola (the small ring of color around the center of the nipple)
- enlarged lymph nodes under the arm
A small study about male breast cancer found that the average time between first symptom and diagnosis was 19 months, or over a year and a half. That's a very long time! This is probably because people don't expect breast cancer to happen to men, so there is little to no early detection.
Earlier diagnosis could make a life-saving difference. With more research and more public awareness, men will learn that—just like women—they need to go to their doctor right away if they detect any persistent changes to their breasts.
If a cancer diagnosis is made, your doctor might recommend more tests. For example, an MRI can show how much cancer is in the affected breast relative to the normal tissue right under and next to the breast cancer. This information may help the surgeon plan the extent of surgery. Plus, an MRI can help evaluate the other breast to see if it's OK. Other tests, such as blood work, chest X-ray, and bone scan, might be done to see if the cancer has spread to other parts of the body.
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Facts gathered from www.breastcancer.org, www.aol.com, and www.americancancersociety.com.
