October is National Breast Cancer Awareness Month

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Breast cancer:

In the U.S., breast cancer is the second most common cancer in women after skin cancer. It can occur in both men and women, but it is rare in men. Each year there are about 100 times more new cases of breast cancer in women than in men.

First, the facts:

• One in eight women in the United States will be diagnosed with breast cancer in her lifetime.
• Breast cancer is the most commonly diagnosed cancer in women.
• Breast cancer is the second leading cause of cancer death among women.
• Each year it is estimated that more than 250,000 women in the U.S. will be diagnosed with breast cancer and more than 40,000 will die.
• Although breast cancer in men is rare, more than 2,000 men will be diagnosed with breast cancer and more than 450 will die each year.
• On average, every 2 minutes a woman is diagnosed with breast cancer and 1 woman will die of breast cancer every 13 minutes.
• Over 3.3 million breast cancer survivors are alive in the U.S. today.

Known risk factors

Cancer grows when a cell’s DNA is damaged, but why or how that happens is still unknown. It could be genetic, environmental, or a combination of the two. There are certain established risk factors that are associated with breast cancer.

• Getting older. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.
• Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.
• Early menstrual period. Women who start their periods before age 12 are exposed to hormones longer, raising the risk for breast cancer by a small amount.
• Late or no pregnancy. Having the first pregnancy after age 30 and never having a full-term pregnancy can raise breast cancer risk.
• Starting menopause after age 55. Like starting one’s period early, being exposed to estrogen hormones for a longer time later in life also raises the risk of breast cancer.
• Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.
• Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.
• Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
• Using combination hormone therapy. Taking hormones to replace missing estrogen and progesterone in menopause for more than five years raises the risk for breast cancer. The hormones that have been shown to increase risk are estrogen and progestin when taken together.
• Taking oral contraceptives (birth control pills). Certain forms of oral contraceptive pills have been found to raise breast cancer risk.
• Personal history of breast cancer. Women who have had breast cancer are more likely to get breast cancer a second time.
• Personal history of certain non-cancerous breast diseases. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
• Family history of breast cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
• Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (like for treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.
• Women who took the drug diethylstilbestrol (DES), which was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.
• Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.
• Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer, and night shift working also may increase breast cancer risk.

Detection:

Every person should know the symptoms and signs of breast cancer, and any time an abnormality is discovered, it should be investigated by a healthcare professional. Most people who have breast cancer symptoms and signs will initially notice only one or two, and the presence of these symptoms and signs do not automatically mean that you have breast cancer. By performing monthly breast self-exams, you will be able to more easily identify any changes in your breast.  Be sure to talk to your healthcare professional if you notice anything unusual.

Some warning signs of breast cancer are:

• New lump in the breast or underarm (armpit).
• Thickening or swelling of part of the breast.
• Irritation or dimpling of breast skin.
• Redness or flaky skin in the nipple area or the breast.
• Pulling in of the nipple or pain in the nipple area.
• Nipple discharge other than breast milk, including blood.
• Any change in the size or the shape of the breast.
• Pain in the breast.

Diagnosis:

• Breast ultrasound. A machine that uses sound waves to make detailed pictures, called sonograms, of areas inside the breast.
• Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.
• Magnetic resonance imaging (MRI). A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.
• This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy). For more information, see Having a Breast Biopsy: A Review of the Research for Women and Their Families.

Treatment 

Medical Team

Once diagnosed, you will work with a group of cancer specialists which may include:

• A medical oncologist
• A surgical oncologist
• A radiation oncologist
• A care-manager/caseworker
• Your healthcare team may also include an oncology nurse and a registered dietitian

Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. People with breast cancer often get more than one kind of treatment.

• Surgery. An operation where doctors cut out cancer tissue.
• Chemotherapy. Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines given in your veins, or sometimes both.
• Hormonal therapy. Blocks cancer cells from getting the hormones they need to grow.
• Biological therapy. Works with your body’s immune system to help it fight cancer cells or to control side effects from other cancer treatments.
• Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer cells.

Doctors from different specialties often work together to treat breast cancer. Surgeons are doctors who perform operations. Medical oncologists are doctors who treat cancer with medicine. Radiation oncologists are doctors who treat cancer with radiation. For more information, visit the National Cancer Institute’s Breast Cancer Treatment Option Overview. This site can also help you find health care services.

Clinical Trials

Clinical trials use new treatment options to see if they are safe and effective. If you have cancer, you may want to take part. Visit the sites listed below for more information.

• NIH Clinical Research Trials and You (National Institutes of Health)
• Learn About Clinical Trials (National Cancer Institute)
• Search for Clinical Trials (National Cancer Institute)
• gov (National Institutes of Health)

Complementary and Alternative Medicine

Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples. Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor about the risks and benefits before you start any kind of complementary or alternative medicine.

Breast cancer in men:

Breast cancer may occur in men. Men at any age may develop breast cancer, but it is usually detected (found) in men between 60 and 70 years of age. Male breast cancer makes up less than 1% of all cases of breast cancer.

• Male breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
• A family history of breast cancer and other factors can increase a man’s risk of breast cancer.
• Male breast cancer is sometimes caused by inherited gene mutations (changes).
• Men with breast cancer usually have lumps that can be felt.
• Tests that examine the breasts are used to detect (find) and diagnose breast cancer in men.
• If cancer is found, tests are done to study the cancer cells.
• Survival for men with breast cancer is similar to survival for women with breast cancer.
• Certain factors affect prognosis (chance of recovery) and treatment options.

Risk Factors

• Being exposed to radiation.
• Having a disease linked to high levels of estrogen in the body, such as cirrhosis (liver disease) or Klinefelter syndrome (a genetic disorder.)
• Having several female relatives who have had breast cancer, especially relatives who have inherited changes in the BRCA1 or BRCA2 genes or in other genes that increase the risk of breast cancer.
• Mutations (changes) in other genes.

Signs & Symptoms

Lumps and other signs may be caused by male breast cancer or by other conditions. Check with your doctor if you notice a change in your breasts.

Tests that examine the breasts are used to detect (find) and diagnose breast cancer in men:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
• Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.
• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.
• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
• Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. The following are different types of biopsies:
  • Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid using a thin needle.
  • Core biopsy: The removal of tissue using a wide needle.
  • Excisional biopsy: The removal of an entire lump of tissue.

Survival

Survival for men with breast cancer is similar to that for women with breast cancer when their stage at diagnosis is the same. Breast cancer in men, however, is often diagnosed at a later stage. Cancer found at a later stage may be less likely to be cured. Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis and treatment options depend on the following:

• The stage of the cancer (whether it is in the breast only or has spread to other places in the body).
• The type of breast cancer.
• Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
• Whether the cancer is also found in the other breast.
• The patient’s age and general health.

Treatment Options:

• There are different types of treatment for men with breast cancer.
• Five types of standard treatment are used to treat men with breast cancer:
  • Surgery
  • Chemotherapy
  • Hormone therapy
  • Radiation therapy
  • Targeted therapy
  • Treatment for male breast cancer may cause side effects.

For more information about male breast cancer:

• Breast Cancer Home Page
• Drugs Approved for Breast Cancer
• Hormone Therapy for Breast Cancer
• Targeted Cancer Therapies
• Genetic Testing for Hereditary Cancer Syndromes
• BRCA1 and BRCA2: Cancer Risk and Genetic Testing

 

Good news:

The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute provides information on cancer statistics in an effort to reduce the cancer burden among the U.S. population. Rates for new female breast cancer cases have been stable over the last 10 years. Death rates have been falling on average 1.8% each year over 2005-2014. (SEER Cancer Stat Facts: Female Breast Cancer. National Cancer Institute. Bethesda, MD,)

Most of us know someone who is affected by breast cancer which means we are all affected by breast cancer. This month, show your support by participating in the many events and activities that take place throughout the country to help raise breast cancer awareness. For more information about breast cancer, visit the National Cancer Institute.

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