Objective of This Article
This article summarizes the key information of breast cancer risk factors, symptoms, breast cancer stages and
treatment. By understanding the underlying causes and risk factors for breast cancer, hopefully one is able to lower
the risk by adjusting his or her lifestyle.

Breast Cancer Stages
Most breast cancer starts in the milk duct, some start in the lobules (milk-producing glands), and the rest starts in
other tissues. A tumor can be noninvasive or invasive.

A noninvasive breast cancer (carcinoma in situ) is a tumor that has not spread beyond where it began. It can be
"ductal carcinoma in situ" (confined to the ducts) or "lobular carcinoma in situ" (confined to the lobules). Lobular
carcinoma in situ is not a true cancer, but it may lead to getting cancer later.

An invasive tumor has spread beyond where it started, and there are three stages of invasiveness including localized,
regional and distant stages. In localized stage, the tumor is confined within the breast. In regional stage, the tumor has
spread to the tissue surrounding the breast, e.g. lymph nodes. In distant stage, the tumor has spread away from the
breast to other tissues or organs. [X]

Breast Cancer Staging
The process used to find out whether the cancer has spread within the breast or to other parts of the body is called
breast cancer staging. Breast cancer is grouped into 5 stages from 0 to IV, based on the tumor size, nodal status (if
lymph nodes are involved) and metastasis (if the tumor has spread).

In Stage 0, the cancer cells are confined in the duct or lobule where they started.

In Stage I, the tumor is small, about 2 cm or less in diameter. Cancer cells are not in the lymph nodes or outside of the
breast.

In Stage II, the tumor grows to 2-5 cm (about 1-2 inches). Cancer cells appear in the lymph nodes. Or, the tumor
grows bigger than 5 cm wide, but the lymph nodes are still negative.

In Stage III, the tumor has grown larger than 5 cm wide, and cancer spreads to lymph nodes. Or, cancer spreads to
multiple lymph nodes, chest wall and skin.

In Stage IV, the breast cancer is metastatic. The cancer has spread to somewhere in the body. [X]

Tests
To determine the type of breast cancer, doctor takes a biopsy of the tumor. Knowing the details about the tumor helps
the doctor understand how quickly the cancer might grow, the stage of the cancer and what treatments may be best.
Typically, doctors want to know patients' hormone receptor status and HER2 status. It has been known that estrogen
and progesterone play an important role in the growth of some types of cancers. An estrogen-receptor-positive tumor
is called "ER+", and a progesterone-receptor-positive tumor is called "PR+". It has been shown that hormonal therapy
is useful for ER+ and PR+ tumors. Similarly, HER2 status also influences the selection of treatments.

The information gathered from the staging process determines the stage of the disease. It is important to know the
stage in order to plan treatment. Chest x-ray, CT scan, Bone scan and PET scan may also be used in the staging
process. [X]

Breast Cancer Risk Factors
Understanding the risk factors may help lower the risk of the cancer development. The risk factors for the breast
cancer include female gender, aging, personal history of breast cancer, family history of breast cancer, genetic factors
(cancer causing mutations in BRCA1 (BReast CAncer gene 1) and BRCA2 (BReast CAncer gene 2), and hormonal
factors (as earlier age at first period, later age at birth of first child, later age at menopause, having no children).  [X]

Research Findings about risk factors for breast cancer and Breast Cancer Prevention
1. Women who drink alcohol daily up until their first full-term pregnancy have a 13% greater lifetime risk of breast
cancer. [1] Ethanol in alcoholic beverages is carcinogenic to humans and causes several cancers (oral cavity,
pharynx, larynx, esophagus, colorectum, liver and female breast). [3]

2. Though overweight, obesity have been considered as important risk factors of breast cancer in Chinese female
population, [7] there is inconsistent support if obesity is a risk factor for breast cancer. However, it is also possible that
obesity creates a physiological setting that meaningfully alters cancer treatment efficacy. Further, obesity may also
increase risk for common adverse treatment effects, including breast cancer-related lymphedema, fatigue, poor health-
related quality of life, and worse functional health. [2]

3. Mammographic breast density is a well-recognized risk factor for breast cancer. [5] Adherence to Mediterranean
diet and current use of multivitamin-multimineral supplements could be inversely associated with mammographic
density and may suggest a protective effect against breast cancer, whereas high alcohol consumption was associated
with increased mammographic density. [6] This could be one of the reasons why scientists consider alcohol is a risk
factor for breast cancer.

4. A study of New Zealand on population attributable risks for modifiable lifestyle factors and breast cancer in New
Zealand women concluded six modifiable lifestyle factors for breast cancer. These were obesity, lack of physical
activity, high alcohol intake, oral contraceptive use, hormone replacement therapy (HRT), and delayed first birth. The
authors further suggested the preventive strategies for reducing the risk of breast cancer and they were lifestyle
changes to reduce obesity, promoting regular physical activity, reducing HRT use, and avoiding high alcohol intake.
Strategies that encourage regular physical activity and reduce obesity could also have other benefits, such as
reduced risks of cardiovascular disease and diabetes. [8]

Supplement
Intake of certain types of supplements may help lower the risk for breast cancer, on the other hand, intake of another
type of supplements may increase the risk of breast cancer. Here is an illustration: 1. Regular consumption of
Lactobacillus casei Shirota  and isoflavones since adolescence was found to be inversely associated with the
incidence of breast cancer in Japanese women. [4] 2. Scientists from Hong Kong Chinese University found that water
extracts of dong quai stimulated the growth of estrogen receptor-positive (MCF-7) breast cancer cells and augmented
the estrogen receptor-negative (BT-20) breast cancer cell proliferation. [9.] Thus, one must first discuss with their
medical doctors before taking any health supplements or herbs.


Breast Cancer Treatment
Once a patient has been diagnosed with breast cancer, surgery is done to remove as many of the cancer cells in the
body. The surgery may remove the entire breast (mastectomy) or remove only the tumor and some normal tissue
around it (lumpectomy). To prevent recurrence, patients are needed to receive adjuvant therapies. Adjuvant
treatments typically include chemotherapy, radiation, hormonal therapy and targeted biological therapy.

Surgical treatment
Most patients with breast cancer have surgical treatment to remove the cancer from the breast. There are different
types of the surgery. 1. The breast-conserving surgery is an operation to remove the cancer but not the breast itself,
basically, it has two types - lumpectomy and partial mastectomy. Lumpectomy is a surgery to remove a tumor (lump)
and a small amount of normal tissue around it. While, partial mastectomy (segmental mastectomy) is a surgery to
remove the part of the breast that has cancer and some normal tissue around it. The lining over the chest muscles
below the cancer may also be removed. 2. Total mastectomy (or simple mastectomy) is a surgical treatment to remove
the whole breast that has cancer. 3. Modified radical mastectomy is a surgical treatment to remove the whole breast
that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of
the chest wall muscles. 4. Radical mastectomy (halsted radical matectomy) is a surgical treatment to remove the
breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. [X]
Chemotherapy may be given before surgery to remove or shrink the tumor before the surgery.

Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or
keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside
the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in
needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is
given depends on the type and stage of the cancer being treated.

Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by
stopping them from dividing.

Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from
growing. However, the hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries.
Treatment to stop the ovaries from making estrogen is called ovarian ablation. Hormone therapy with tamoxifen is
often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has
spread to other parts of the body). Hormone therapy with an aromatase inhibitor is given to some postmenopausal
women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone
estrogen to grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from
turning androgen into estrogen.

Targeted therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells
without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapies
used in the treatment of breast cancer. PARP inhibitors are a type of targeted therapy being studied for the treatment
of triple-negative breast cancer.

Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of
immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help
cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them
from spreading. Monoclonal antibodies may be used alone or to carry drugs, toxins, or radioactive material directly to
cancer cells.

Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which
sends growth signals to breast cancer cells. Tyrosine kinase inhibitors are targeted therapy drugs that block signals
needed for tumors to grow. Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and
other proteins inside tumor cells. It may be used to treat patients with HER2-positive breast cancer that has
progressed following treatment with trastuzumab. PARP inhibitors are a type of targeted therapy that block DNA repair
and may cause cancer cells to die. PARP inhibitor therapy is being studied for the treatment of triple-negative breast
cancer.

High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -
forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or
bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored
stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and
restore) the body’s blood cells.
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Reference
[1] Young women who drink alcohol daily face higher breast cancer risk: study New York Daily News, Online Publication September 1,
2013 [2] Schmitz KH, et al, Impact of Obesity on Cancer Survivorship and the Potential Relevance of Race and Ethnicity. J Natl Cancer
Inst. 2013 Aug 29 [3] Scoccianti C, et al, Recent evidence on alcohol and cancer epidemiology. Future Oncol. 2013 Sep;9(9):1315-22. [4]
Toi M. et al, Probiotic Beverage with Soy Isoflavone Consumption for Breast Cancer Prevention: A Case-control Study. Curr Nutr Food Sci.
2013 Aug;9(3):194-200. [5] Masala G, et al, Glycemic Index, Glycemic Load and Mammographic Breast Density: The EPIC Florence
Longitudinal Study.  PLoS One. 2013 Aug 7;8(8):e70943. [6] Voevodina O et al, Association of Mediterranean diet, dietary supplements
and alcohol consumption with breast density among women in South Germany: a cross-sectional study. BMC Public Health. 2013 Mar 7;
13:203. [7] Zhang Q, et al, A meta-analysis on overweight, obesity and the risk of breast cancer in Chinese female population Zhonghua
Yu Fang Yi Xue Za Zhi. 2013 Apr;47(4):358-62. [8] Hayes J et al, Population attributable risks for modifiable lifestyle factors and breast
cancer in New Zealand women. Intern Med J. 2013 Jul 30 [9] Lau CB, Ho TC, Chan TW, Kim SC., Use of dong quai (Angelica
sinensis) to treat peri- or postmenopausal symptoms in women with breast cancer: is it appropriate? Menopause. 2005
Nov-Dec;12(6):734-40

[X] www.cancer.gov

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breast cancer risk factors, prevention, causes, stages, signs, symptoms and
treatment. 2013
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Herbal / Dietary Supplements / Foods that may lower the risk of certain types of cancer: Avocados Banana,
Bitter Melon, Brown Seaweed, Capsicum, Cauliflower, Celery, Chlorophyll, Cordyceps, Curcumin, Dandelion, Ellagic
acid, Oldenlandia, Falcarinol, Fenugreek, Feverfew, Fish Oil, Forskolin, Galangal, Garlic, Gotu Kola, Green Tea, Grape
Seed Extract, Honokiol, Orange, Isothiocyanates, Linseed Oil, Limes, Lycopene, Maitake, Milk Thistle, Onion, Peony,
Phellinus, Quercetin, Pterostibene, Pycnogenol, Reishi, Rhubarb, Saffron, Stinging Nettle, Sweet Potatoes, and more.
(Please read the warning section)

Please note that most of the studies related to these herbs/supplements were done in test-tube or animals. It is unclear
if they are effective in human body. Patients must discuss with their doctors for the right treatment.