Breast cancer is the most common cancer in women after skin cancer. Breast cancer can occur in men but is very rare. We believe breast cancer develops as normal breast cells continue to acquire mutations, transforming from abnormal cells to pre-cancer cells to cancer cells. Not all masses or tumors are cancers. Breast cancer is a form of uncontrolled cell growth within the breast, usually ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). Breast cancer usually spreads first to the lymph nodes or glands under the arm of the affected breast.
If left untreated, breast cancer may metastasize (spread). A cancer is considered metastatic when it spreads to other organs or tissue from the original site. Spread to the lymph nodes is not considered the same as spread to other parts of the body and does not carry the same prognosis.
The single best tool to catch breast cancer early and thereby improving survival and patient outcome is annual mammograms
. Prior to mammograms most cancers were found at a greater than 2 cm and at more advanced stages. Now most breast cancers are found at under 2 cm.
There are two main types and many different subtypes of breast cancer and each woman's breast cancer is different based on the cancer/pathology and the patient's unique findings and issues. Thus, there are many different treatment options, all focused on local (treating the breast: surgery and radiation) and systemic (treating the entire body: chemotherapy) therapy. An overall care plan will be developed with you and through your multidisciplinary care team, including your surgeon, medical and radiation oncologist, radiologist, nurse navigator, physical therapist and others. The best overall treatment involves a multidisciplinary approach and getting the best out of each specialty.
After breast cancer has been diagnosed, your multidisciplinary care team will work with you to put together a treatment plan specific to your situation, made up of one or more treatments intended to both target the cancer cells and reduce the risk of future breast cancer recurrence.
- Breast Surgery
Surgery is usually the first line of attack against breast cancer. There are a number of different surgical options depending on the stage, type of the cancer, location, genetics and patient preference.
If chemotherapy is going to be part of your care, it is often given following surgery. Chemotherapy is very individualized and uses powerful drugs to target and destroy cancer cells both in and beyond the breast. There are a number of chemotherapy drugs available to treat breast cancer that are used individually or in combination. In some situations chemotherapy may need to be administered before surgery.
- Radiation Therapy
Radiation therapy often follows surgery and/or chemotherapy. About half of all people with cancer receive radiation therapy as part of their treatment. Radiotherapy destroys cancer cells remaining after surgery further reducing the chance of cancer recurrence. When a lumpectomy (removal of the tumor with preservation of the breast) is combined with radiation the survival benefit is the same as mastectomy alone.
- Hormonal Therapy
Hormonal therapy is often started after the other treatments have been given. Tamoxifen or an aromatase inhibitor are given if the cancer is hormone-receptor positive. The most common forms of hormone therapy for breast cancer work either by blocking estrogen from attaching to cancer cells or by decreasing your body's production of estrogen.
Remember that there are exceptions and variations to the sequence above. Your care team will customize a treatment plan for your unique situation.
Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells (including cancer cells) grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type.
Some people have a genetic abnormality that make them more prone to developing breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer, but women with these inherited genetic abnormalities are at a higher risk for breast cancer, ovarian cancer or other cancers. Testing for these abnormal gens can be done through a simple blood test. Please discuss with your doctor if you have a strong family history of breast or ovarian cancer.