Early Breast Cancer early stage breast cancer prevention and breast cancer treatment health and wellness guide
Starting on today's date of is a good time to be more concerned about breast health. Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer.
No one knows why some women get breast cancer, but there are a number of risk factors you cannot change including:
- Age - the chance of getting breast cancer rises as a woman ages
- Genes - there are two genes, BRCA1 and BRCA2, that greatly increase the risk. Women who have family members with breast or ovarian cancer should be tested.
- Personal factors - beginning periods before age-12 or going thru menopause after 55
Other risk factors include being overweight, using hormone replacement therapy (a.k.a. menopausal hormone therapy), using birth control pills, drinking alcohol, not having children or having your first child after age-35 or having unusually heavy breasts.
Symptoms and signs of early breast cancer may include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. Breast self-exam and mammography can help find breast cancer early and when it's most treatable. Treatments may consist of radiation, lumpectomy, mastectomy, chemotherapy and hormone therapy.
What is Breast Cancer - what Type do I have?
Cancer is a disease in which cells become abnormal and form more cells in an uncontrolled way. With breast cancer, the cancer begins in the tissues that make up the breasts. The cancerous cells may form a mass of tissue called a malignant tumor. The cells of a malignant tumor may spread to other parts of the body and threaten life. (Benign tumors are abnormal growths that are not cancer. The cells of a benign tumor do not spread to other parts of the body and do not threaten life.)
Most common types of breast cancer are:
- Lobular carcinoma — Cancer that begins in the glands of the breast that make milk. These milk-making glands are called lobules. About 1 in 10 breast cancers are this type.
- Ductal carcinoma — Cancer that begins in the milk ducts of the breast. Milk ducts are thin tubes that carry milk from the lobules to the nipple. About 8 in 10 breast cancers are this type.
In addition, there are two types of breast tumors that are not cancer but increase the risk of breast cancer:
- Ductal carcinoma in situ (DCIS) — DCIS is a condition in which abnormal cells are found in the lining of breast ducts. These cells have not spread outside the duct to the surrounding breast tissue. But some cases of DCIS become breast cancer over time. So DCIS is sometimes called Stage 0 breast cancer. Since it’s not possible to know which cases of DCIS will become breast cancer, it’s important to get treatment for DCIS. Women with DCIS often are treated with breast-sparing surgery and radiation therapy. Radiation therapy lowers the chance that DCIS will come back or develop into breast cancer. If a large area of DCIS is found or it is found in more than one location, some women will choose to have a mastectomy. Underarm lymph nodes usually are not removed in the treatment of DCIS. The drug tamoxifen, which stops the growth of breast tumors that depend on estrogen, is also sometimes used in the treatment of DCIS. Tamoxifen may decrease the risk of a breast cancer developing in the same breast after treatment or in the opposite breast.
- Lobular carcinoma in situ (LCIS) — LCIS is a condition in which abnormal cells are found in breast lobules. In contrast with DCIS, there is no evidence that the abnormal cells will become cancerous. However, having LCIS means that a woman has an increased risk of developing breast cancer in either breast. Despite this increased risk, most women with LCIS will never get breast cancer. Most women with LCIS are followed closely with regular checkups and mammograms. Some women choose to take tamoxifen to decrease their risk of developing breast cancer. Rarely, women with LCIS choose to have both breasts removed as a preventive measure, but most doctors think this approach is inappropriate.
How Breast Cancer Spreads
If cancer spreads to other parts of the body, it’s called metastasis (muh-TASS-tuh-siss). Unfortunately, breast cancer can easily spread to other parts of the body in 3-ways:
- Invading nearby healthy tissue, such as in chest wall.
- Invading the lymphatic system. This system, which is part of the immune system, contains a network of lymph nodes (small, bean-shaped glands) and lymph vessels (thin tubes) that are found throughout the body. Lymph vessels carry a fluid called lymph to the lymph nodes, where it is filtered and checked for signs of infection and disease. Cancer cells can enter into lymph vessels in the breast and travel to the lymph nodes and other parts of the body. The first place breast cancer usually spreads is to the lymph nodes under the arms, called axillary lymph nodes. That is why after breast cancer has been diagnosed, the underarm lymph nodes are often removed and examined to see if breast cancer has spread.
- Invading blood vessels in the breast. Cancer cells can travel through the blood stream to other parts of the body, such as the lungs or bones.
When cancer cells spread, they can cause tumors to grow in other parts of the body. Breast cancer that forms tumors in other parts of the body, such as the lungs, is still breast cancer. The good news is that most breast cancers can be found and treated and do not come back in distant parts of the body.
Early-Stage" Breast Cancer
Breast cancer is categorized as Stage I, II (A or B), III (A, B, or C), or IV. The stage is based on the size of the tumor and whether the cancer has spread. Stages I, IIA, IIB, and IIIA are considered "early-stage" breast cancer and refer to cancers that may have spread to nearby lymph nodes but not to distant parts of the body.
Treatment for Early-Stage Breast Cancer
Treatment of early-stage breast cancer often involves more than one approach. Surgery is usually the first step. Most women with early-stage breast cancer have a choice between 2 surgical treatments:
- Breast-sparing surgery, followed by radiation therapy — Breast-sparing surgery, also called breast-conserving surgery, includes lumpectomy and partial (or segmented) mastectomy. With lumpectomy, the tumor and some surrounding normal tissue are removed. With partial mastectomy, a portion of the breast containing the tumor is removed. Women who have breast-sparing surgery usually have lymph nodes under the arm removed. This may occur during the breast-sparing surgery or at a later time. Breast-sparing surgery keeps the breast intact — looking a lot like it did before surgery.
- Mastectomy — With simple (total) mastectomy, the surgeon removes the whole breast that has cancer and possibly some of the lymph nodes under the arm. With modified radical mastectomy, the whole breast, plus many of the lymph nodes under the arm, the lining over the chest muscles, and, sometimes, part of the chest wall muscles are removed.
The goal of both surgeries is to remove all of the cancer from the breast. The doctor will also want to find out if the cancer has spread to nearby lymph nodes. With axillary lymph node dissection (ALND), some or all of the lymph nodes under your arm are removed. With sentinel lymph node (SLN) biopsy, a substance is injected near the tumor that allows the doctor to see which lymph node the substance flows to first. This is the sentinel lymph node. It is the first lymph node the cancer is likely to spread to. The sentinel lymph node is removed and looked at under a microscope. If cancer is not found, the other lymph nodes may be left in place. If cancer is found, more lymph nodes may be removed.
The lymph node status, along with test results, helps the doctor know what other treatments, called adjuvant (AY-juh-vuhnt) therapy, might also be prudent. The goal of adjuvant therapy after surgery is to kill any cancer cells that might be elsewhere in the body and to keep cancer from recurring.
Survival Rates for Early-Stage Breast Cancer
In deciding which type of surgery to have for early-stage breast cancer, the choice is not between saving your breast and saving your life. Women with earlystage breast cancer who have breast-sparing surgery live just as long as those who have mastectomy. A woman’s life expectancy is the same no matter which surgical choice she makes.
When women are told that the survival rates of both approaches are the same, they might be surprised or skeptical. Some women assume that breast cancer won't return if the whole breast is removed. However, some breast tissue is left behind even after mastectomy, and cancer can recur in that tissue or on the nearby chest wall. For women with early-stage breast cancer who choose breast-sparing surgery, research clearly shows that radiation therapy after surgery lowers the risk of recurrence. The risk of cancer returning in the same breast is low. Yet, even if breast cancer does recur in the same breast, that does not reduce a woman's chances for a healthy recovery. As was already noted, the chance of survival is not affected by the choice of surgery. However, a recurrence in the same breast could require more surgery, and a woman may decide to have a mastectomy at that time.
The type of surgery does not affect the risk of cancer in the healthy breast or elsewhere in the female body.
How to Decide which Surgery is right for me?
The choice may not be an easy one to make. You should consider the medical opinions of the team of doctors involved in your care. Your doctors will consider many factors, including your overall health, in making recommendations and can explain the risks and benefits of each approach. Speaking with several doctors might also help you in your decision-making. For instance, a plastic surgeon can explain how different reconstruction methods might affect the look and feel of your breast. A radiation oncologist might help put the risk of recurrence in perspective. And of course, your feelings matter too. Ample discussion with doctors and loved ones will help you to sort through all these factors and come to a decision you can be content with.
The following sections provide a more in-depth look at breast-sparing surgery and mastectomy. This early-stage-breast-cancer information can help females make a choice about surgical treatment.
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