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. ___________________________________________________________________________________ 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 ____________________________________________________________________________________ |