Breast Cancer

Click here for a video overview:
Understanding Breast Cancer, https://www.youtube.com/watch?v=KyeiZJrWrys
The function of the breast is to make milk. Milk is formed in the lobules within the breast and then moves
through tube-like structures called ducts to the nipple. Breast cancer arises when cells that line either the
ducts or lobules, become abnormal, grow out of control and form tumors.
Breast cancer is the second most common cancer in women after skin cancer, affecting 1 in 8 women. It
can also occur in men but less commonly, only 1 in 1,000.
MOST COMMON TYPES OF BREAST CANCER
 Ductal carcinoma in situ (or DCIS) – Cancer that is inside the duct, has not invaded
surrounding tissue and is less likely to spread. Occasionally invasive carcinoma may be
discovered on excision after only DCIS was seen on biopsy
 Invasive ductal carcinoma – The most common type of invasive breast cancer, approximately
75-80%.
 Invasive lobular carcinoma – The second most common type of breast cancer, accounting for
approximately 10%.
 Lobular carcinoma in situ (or LCIS) – Abnormal growth of cells in the lobules. Often co-exists
with invasive lobular carcinoma

SIGNS OF BREAST CANCER
 Lump in the breast
 Change in size or shape of the breast
 Nipple changes (inversion)
 Nipple discharge (clear or bloody)
 Skin changes (redness or dimpling)

RISK FACTORS FOR BREAST CANCER
 Old age
 Dense breasts
 Prior breast cancer
 Family member with breast cancer
 Inherited gene mutation (BRCA1 and BRCA2)
 Ashkenazi Jewish ancestry
 Excessive alcohol use
 Obesity
TYPES OF SCREENING FOR BREAST CANCER
 Breast self-exam – monthly self-exam of breasts and armpits for changes (see signs of breast
cancer above)
 Clinical breast exam – performed by your primary care physician
 Mammogram

Additional studies (including breast ultrasound, MRI and biopsy) may be warranted based on the findings
at examination and mammogram.
BREAST BIOPSY
A small amount of tissue, called a “biopsy”, is taken from a suspicious area of the breast using a needle
guided by radiology. The biopsy is sent to an anatomic pathology laboratory, such as Naples Pathology
Associates, to be processed and examined by a pathologist. A pathologist is a physician who is specialty-
trained and board-certified to analyze tissues using a microscope and to perform additional tests if
needed in order to diagnose cancers and other conditions.
Included in the pathologist’s biopsy report:
 Disease process – Presence or absence of cancer in the biopsy
 If cancer is present, the report will state

1. Type of Cancer (ductal is the most common, followed by lobular)
2. Grade of Cancer (graded from 1 to 3; grade 1 is the most similar to normal tissue and
   the least aggressive; the higher the grade the poorer the prognosis)
3. Estimated size of the tumor
4. Estrogen receptor (ER) and Progesterone receptor (PR) status – Tests to determine the
   presence or absence of hormone receptors on the surface of the tumor cells
5. Her2-neu expression – Test to determine the presence or absence of a mutation that
   can be targeted with specific chemotherapy

TREATMENT OF BREAST CANCER
Breast cancer treatment is based on the type of cancer found, ER, PR, and Her2neu results, and the
stage of the cancer. The stage is determined by the size of the tumor and spread (or lack thereof) of the
tumor through the body.
Treatment may include one or more of the following:
Surgery
 Lumpectomy – limited removal of tumor and rim of surrounding normal tissue
 Simple mastectomy – removal of entire breast
 Modified radical mastectomy – removal of breast and lymph nodes in armpit
 Mastectomy with reconstruction – restores the appearance of the breast following surgery
 These may also include lymph node sampling

• Sentinel lymph node biopsy: Procedure that aids in determining if cancer has spread to lymph
  nodes
• Axillary node dissection: Removal of lymph nodes in armpit
  Radiation therapy – A beam of radiation energy directed at the tumor to destroy cancer cells. This is
  usually done following surgery and chemotherapy.
  Chemotherapy – Drugs, given as pills or intravenously, used to kill cancer cells
   Neoadjuvant chemotherapy: Given prior to surgery to shrink the tumor
   Adjuvant chemotherapy: Given after surgery to prevent recurrence
   Palliative chemotherapy – To control metastatic breast cancer
  Types of chemotherapy drugs
   Hormone therapy – Given if the tumor contains estrogen or progesterone receptors. They act to
  prevent recurrence of tumor and inhibit the growth of possible metastatic tumor. The drugs
  include Tamoxifen and aromatase inhibitors.

 Targeted therapy – Drugs that specifically attack tumor cells, such as Trastuzumab that blocks
the Her2 receptor, inhibiting cancer cell growth.
 Combination treatments
ADDITIONAL RESOURCES
Susan G. Komen Foundation –
https://ww5.komen.org/AboutBreastCancer/ToolsandResources/ToolsResources.html
Mayo Clinic –
https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470
Support –
https://ww5.komen.org/uploadedFiles/_Komen/Content/What_We_Do/Resources_we_Offer/2017%20Bre
ast%20Cancer%20Helpline%208.5×11%20(002).pdf
Breast Self-Awareness –
https://youtu.be/w5Dbo_ZaVCA