Breast cancer overview

Breast cancer is the most common cancer in women, after skin cancer. It is a malignant (cancerous) tumor. Breast cancer begins when the cells that makeup the breast tissue divide uncontrolled and cause a tumor to form. When breast cancer spreads, it commonly spreads to the lymph nodes near the breast, and when it spreads beyond the lymph nodes, it usually spreads to the bones, lungs and liver.

Breast anatomy

The breast is made of glands that make milk called lobules, small tubes that carry the milk to the nipple called ducts, and fatty tissue, blood vessels and lymph. 75% of all breast cancer cases begin in the cells of the milk ducts. It is called ductal carcinoma. The second most common is Lobular carcinoma.

A rare, but important cancer of the breast is called inflammatory breast cancer, where there is no lump and the breast appears red and swollen, and warm. It is more malicious than the other main types of breast cancer, and is often mistaken for an infection.

Most breast lumps are benign, not cancerous, and do not spread.

Types of Breast Cancer

  1. Ductal carcinoma comes in two types:

  • In situ (DCIS) is a precancerous condition located within the milk ducts. Under certain conditions DCIS can evolve to become breast cancer. It is often discovered on a mammogram.
  • Invasive ductal carcinoma (IDC) is the most common breast cancer. It starts in the duct and invades the breast tissues, and nearby lymph nodes.
  1. Lobular cancer starts in the lobules and comes in two types:

  • Lobular carcinoma in situ(LCIS). LCIS is not cancer, but is a risk factor for developing invasive breast cancer.
  • Invasive Lobular carcinoma (ILC) starts in the milk glands, and spreads to the breast tissue and nearby lymph nodes, and other parts of the body.

Breast cancer subtypes:

  1. Hormone receptor positive- the cancer is expressing estrogen receptors (ER) and progesterone (PR) receptors, meaning these cancers depend on these hormones in order to grow. Hormone receptor positive cancer is most frequent in postmenopausal women. 60-75% of all breast cancers have estrogen and progesterone receptors.
  1. HER2 positive- these cancers depend on a gene to grow. The gene is named the human epidermal growth factor receptor 2. These cancers tend to grow more quickly, but there are several effective drugs for this subtype.
  1. Triple negative- when a tumor doesn’t express ER, PR and/or HER2, it is called Triple Negative- and makes up about 15% of cases of invasive breast cancer. This subtype grows more quickly that HER2 positive, and hormone receptor positive ER and PR. But, it is very sensitive to chemotherapy. Triple- negative is more common in young women, and especially in young black women.All metastatic breast cancers are a type of triple negative breast cancer. Triple negative is the most common type of breast cancer diagnosed in women with the BRCA1 mutation.
  1. BRCA 1 &2 are inherited gene mutations that increase the risk of breast and ovarian cancer. Together these mutations account for about 25% of hereditary cancers, and 10% of all breast cancers. A positive test means the patient has an increased risk of breast cancer.

Risk factors:

  • Being a woman
  • Risk increases with age
  • Genetic risk-BRCA1& BRCA2
  • Family history- if the patient has a family history, genetic testing for BRCA genes is recommended.
  • White, African American
  • Dense breast tissue
  • Benign breast changes
  • Women who began menstruation before age 12 or post-menopausal women over 55
  • Radiation treatments at some point in their lives
  • Women who have no children or have them after age 30
  • Alcohol is directly linked to an increased risk of breast cancer
  • Obesity is also linked to higher risk

Symptoms include a lump or mass that is painless and hard, swelling of the breast, skin irritation or dimpling, breast pain, nipple pain, nipple turning inward, redness, thickening of the skin and nipple discharge.

Diagnosis includes breast exam, mammogram and ultrasound. A biopsy may be needed. A Needle Biopsy is the approach used, and simply removes cells from the breast. It is usually done with ultrasound guidance. Additionally, when lymph nodes under the arm are swollen, a needle biopsy may be needed.

Laboratory examination

The extracted cells and tissue are examined in a lab to determine if it is cancer. If so, the lab will grade the tumor giving a grade of 1-3. Low grade means the tissue looks more like normal tissue, but is not. Low grade numbers mean it is a slow-growing cancer. This grading system predicts the prognosis or outcome for the patient. The lab will also test for the subtypes HER2, BRCA1&2, ER+ and ER-.

Treatment

Primary types are surgery, radiation, chemotherapy, hormone therapy, targeted therapy and bone –directed therapy.

It is physically and emotionally challenging to a deal with a cancer diagnosis, and the treatments required. The surgeons and their teams at BASS Medical Centers understand and support patients on their journey. Patients can expect respectful, compassionate care, skilled, highly- qualified surgeons, and state-of-the-art-technology to help them recover their health.

At BASS Medical Centers, our multi-specialty group is dedicated to your health and well being. Choosing the right surgeon to perform your surgery is one of the most important decisions a patient can make. We have offices San Francisco and the East Bay, California to serve our patients. Find the location convenient to you. Then call BASS Medical Group to schedule a consultation and learn about your condition, get answers to your questions and receive professional, quality care.