Breast Cancer Awareness
Rucker MD Plastic Surgery Clinic
BREAST CANCER AWARENESS
The actual cause of breast cancer is not known, however, the American Cancer Institute suggests that approximately one in every four women will undergo a breast biopsy to evaluate a suspicious breast mass in her lifetime. Of this group, 12% will develop some variant of breast cancer. Five to ten percent of these breast cancers are inherited (genetically passed), 20%-30% will be familial (more common in certain families), and 55%-75% will be sporadic or new cancers that develop spontaneously.
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A tremendous amount of promising research is under way to determine the cause of breast cancer and to establish effective ways to prevent it. Anything that INCREASES your chance of developing breast cancer is called a risk factor.
Anything that REDUCES your risk of developing breast cancer is called a protective factor. Although you can control many risk factors, remember that doing so does not guarantee zero risk. It is also important to keep in mind that many women who have a particular risk factor for breast cancer never develop it.
The first risk factor is hormonal and is due to an increased exposure to the hormone estrogen. This excessive exposure may be because of menarche (menses younger than 12 years old), nulliparity (lack of pregnancy), late menopause (menses stops after age 50), age of first born after the age of 30, five years of combined estrogen/progesterone hormone replacement therapy and lastly obesity.
There are also nonhormonal factors, which may increase the risk of developing breast cancer. It is well documented that increased age causes a higher risk of breast cancer, as well as a positive family history of breast cancer. If the mother or daughter of the patient develops breast cancer, then that individual is probably at a 2-3 times greater risk of developing a breast cancer at a later date. The risk factor, however, decreases in a woman with distant relatives who have breast cancer (cousins, aunts, grandmother). Other nonhormonal risk factors are a breast biopsy, which reveals the presence of abnormal cells, or cancer cells found in a previous biopsy. Radiation exposure and excessive alcohol usage are also nonhormonal risk factors for breast carcinoma.
There are no definitive ways to decrease the occurrence of breast cancer; however, the drug tamoxifen has shown promise in decreasing the incidence of breast cancer by 49% in high-risk patients. This drug effectively blocks estrogen receptors, thereby decreasing the estrogen exposure to the individual. Also, prophylactic mastectomy, or removal of the breast before cancer develops, decreases the risk by 90% in high-risk patients.
There are many ways of diagnosing breast cancer, the most common being self-examination. A second option would be to have a yearly exam by a health professional; these exams occurring every 3 years between the ages of 20-40 and every year after the age of 40. Mammograms, or radiologic evaluation of the breast, are the best available technique for detecting breast carcinoma; however, this technique can miss the presence of a tumor 10% of the time. Currently, most centers recommend yearly mammograms after the age of 40. Genetic testing should be done in coordination with genetic counselors because of the fact that 80% of inherited breast cancers have BRCA-1 or BRCA-2 gene mutation seen in the DNA. Other useful imaging techniques are ultrasound, which is extremely helpful in differentiating solid from fluid lesions, and MRI, which is used as an additional screening method in high-risk patients.
Following the finding of a breast mass on examination or during a mammogram, a biopsy is usually recommended. The goal of the biopsy is to obtain breast tissue that may be examined for malignant features. The various biopsy techniques depend on whether the breast mass can be felt (palpable) or not felt (nonpalpable) on physical examination. For the nonpalpable lesion, the technique involves a stereotactic core biopsy, which uses either a computer or mammogram machine to guide a needle to the biopsy site for examination. The second way to detect or biopsy a nonpalpable lesion is using a wire localized excisional biopsy where a radiologist uses a computer, mammogram, or ultrasound device to place a guidewire by the abnormal area. The surgeon then follows this to the point of the abnormal tissue and then surgically removes the abnormal breast tissue. Both procedures are usually outpatient and under a local anesthetic. If the lesion is palpable, or can be felt, a fine needle aspiration can be performed, or a core biopsy or direct excision of the mass can be done, usually under a local anesthetic on an outpatient basis.
The breast is a gland designed to make milk. The lobules in the breast make the milk, which then drains through the ducts to the nipple. The breast is composed of 15 to 20 of these lobules, which then terminate into major ducts that open up into the nipple.
Noninvasive: Whereby the cancer cells have not invaded surrounding tissue.
The 2 types of noninvasive cancers are:
Ductal carcinoma in situ - which occurs in 5%-10% of breast cancers, or
Lobular carcinoma in situ - which occurs in 2%-5% of breast cancers.
Invasive: Whereby the cancer cells have invaded the surrounding tissue.
The 2 types of invasive cancers are:
Ductal carcinoma - which occurs in 60%-75% of breast cancers, begins in the ducts and is the most common type of breast cancer.
Lobular carcinoma - which occurs in 10% of breast cancers.
To read more on the stages of breast cancer, click here.
Local treatment refers to anything that is targeted to a specific area of the body—such as the breast, the lymph nodes, the lungs—as opposed to the whole body. Treatment to the lymph nodes near the breast is also sometimes referred to as "regional" treatment, because the nodes lie in the region surrounding the breast.
The whole breast can be treated by mastectomy or breast preservation therapy:
Mastectomy involves removal of the entire breast. Mastectomy may be followed by radiation to the area where the breast used to be.
Breast preservation therapy removes the breast cancer by lumpectomy (also called "wide resection," "partial mastectomy," or "quadrantectomy") and is also followed by radiation to the remainder of the breast tissue.
Your team of doctors will most likely recommend a particular sequence of treatment. Here is the most common "pathway":
Usually surgery is first.
If chemotherapy is going to be part of your care, it often goes second.
Radiation usually follows surgery and chemotherapy (when chemotherapy is given).
Tamoxifen or other hormonal (anti-estrogen) therapy is most commonly started after the other treatments have been given.
There are many exceptions to this sequence, however. For women with stage III or IV disease, chemotherapy may be given first to shrink large tumors and address cancer in the rest of the body, before major surgery. Some centers or clinical studies give chemotherapy and radiation together (not separately). There are also many other variations in timing and sequence.
Following the above noted procedures, an oncologist would then advise patients of the options for further treatment after surgery is completed. This is usually based on the stage of the disease.
A new technique called a sentinel lymph node biopsy has been developed to help locate the lymph nodes during surgery. This technique is based on using a radioactive material, or blue dye, injected into the breast prior to surgery. The surgeon then uses the uptake of this radioactive dye to identify the lymph nodes during surgery that may be suspicious for containing the spreading cancer. This helps guide the surgeon to the most likely node that may harbor cancer, thereby allowing him to biopsy these for the evaluation of cancer spread. This procedure is helpful in that it limits the more aggressive armpit dissection, which may be required, and it lowers postoperative complications like nerve injury and arm swelling.
Whatever your age, marital status, sexual activity or orientation, you can't predict how you will react to the loss of a breast. How important is re-creating your breast to you? Can you live with "take-off-and-put-on" alternatives? Do you need surgical breast reconstruction to feel whole, again? What about timing? The Breast Reconstruction section of the Breast Restorative Center helps you understand your options AND sort through the medical and personal issues you should consider.
Detailed description is in the Breast Reconstruction section of the Restorative Breast Center
Giving your body the nutrients it needs—is important for everyone. When combined with exercising and maintaining a healthy weight, eating well is an excellent way to help your body stay strong and healthy. Current research findings suggest that physical activity, a healthy diet, and a healthy weight can help reduce the risk of getting breast cancer for the first time or having a breast cancer come back. A healthy diet—one with a variety of foods that includes lots of fruits and vegetables and regular protein—gives you the reserve of nutrients you need to keep your strength up while you're fighting breast cancer. These reserves also help rebuild your body's tissues and keep your immune system strong to help fight off infection. Plus, a healthy diet can help you cope with treatment side effects. There is evidence that some cancer treatments actually work better in people who are eating enough calories and protein. While you're having breast cancer treatment, it's more important than ever that you eat a healthy diet.
Lymph edema (pronounced lim-fe-DEE-ma) is a side effect that can begin during or after breast cancer treatment. It isn't life threatening, but it can last over a long period of time. This condition involves swelling of the soft tissues of the arm or hand. The swelling may be accompanied by numbness, discomfort, and sometimes infection.
There's no reliable way to find out your level of risk for lymphedema, but by taking proper precautions you CAN greatly reduce your chances of developing this complication. Lymphedema of the arm is an accumulation of lymph fluid in the soft tissues of the arm, with accompanying swelling (also called edema). To understand how it happens, you have to know a little bit about how blood and lymphatic fluid move around your body. You can think of lymphedema as a plumbing problem: Veins and lymphatic channels are like pipes and drains that can handle the normal load of lymphatic fluid. If lymph nodes and channels are removed, there might not be enough pipes and drains to handle all the fluid. Some women have mild lymphedema, which is hardly noticeable. Some develop moderate lymphedema that may be noticeable, tends to persist, and gets worse when aggravated. Others have severe lymphedema that is very uncomfortable and even disabling. For all of these cases, there are treatments that can help ease the discomfort and reduce the swelling.
Ways to Avoid Lymphadema. Prevention is the best tool against arm lymphedema. Learn the warning signs and the precautions to take. Make these guidelines and a heightened awareness a regular part of your life. Skin care is your first line of defense. Since the skin acts as a barrier to infection, any disruption of the skin can spell trouble. Burns, chafing, dryness, cuticle injury (such as hangnails), cracks, cuts, splinters, and insect bites are immediate risks for infection.
For women affected by breast cancer, overcoming pain can be a major part of dealing with the disease and its treatment. Pain is a common side effect of treatment and also a side effect of cancer, however there are ways to manage the pain. Consult your physician if your pain continues to limit your daily activity.
The immune system responds immediately when your body encounters any threat, such as a virus or injury. In response to such threats, the immune system produces a generalized, non-specific reaction known as inflammation. This response is like an army artillery attack: Shells burst all over, damaging and killing all varieties of bacteria, viruses, and other microorganisms that happen to be in range—including some of the body's own cells.
If you're in the midst of breast cancer treatment, your body is in a war against cancer. It needs all its resources to fight the disease, so it shuts down your energy for other activities that would take away your strength from the battle. Fatigue is the result.
Even many years after your initial treatment is over, you should be checked regularly so your doctors can monitor your health and make sure you're continuing to do well. If you're taking hormonal therapy or any other long-term treatment, you'll also want to check in with your doctor to monitor any side effects.
Another important way to take care of yourself in the long term, and another reason to keep in touch with your doctor, is to stay informed about new treatment developments. Thanks to ongoing research by experts all over the world, breakthroughs in breast cancer treatment are happening all the time. It's always possible that a new advance can help you stay strong and healthy long into the future.
There is a potential for complications in any operative procedure.* The most common being infection, scarring and sensation changes. During your consultation a detailed discussion of these potential risks will be given to you.
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*DISCLAIMER: Cosmetic and reconstructive surgery results can and will vary significantly between patients. Risks, potential complications, and/or permanent scarring are inherent with any surgical procedure. Before-and-after photographs are NOT guarantees that your results will be the same as or similar to another patient. Any and all information should be discussed in full detail with your surgeon prior to any procedure as the information found on this website is not a substitute for a personalized consultation and examination. Material on this website may include the views or opinions of other patients, parties, or specialists; external website links are not endorsements or under the control of Rucker MD Plastic Surgery Clinic.
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