What is Breast Cancer?
In the U.S., breast cancer is the second most common cancer in women after skin cancer; 1 in 8 women will develop breast cancer in her lifetime. Breast cancer 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.
The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Breast cancer can also begin in the cells of the lobules and in other tissues in the breast. Ductal carcinoma in situ is a condition in which individual cancer cells are found in the lining of the ducts but they haven’t spread outside the duct.
Breast cancer cells that have clumped together to form a mass is called invasive or infiltrating breast cancer. Invasive breast cancer has the potential to spread, but just because the cancer cells have joined to form a mass does not necessarily mean that it has spread to the lymph nodes or other areas of the body.
Inflammatory breast cancer is a very rare and aggressive form of breast cancer in which the breast looks red and swollen and feels warm because the cancer cells block the lymph vessels in the skin.
Breast Conditions We Treat
Benign Breast Disease
Breast masses or lumps can be caused by many things including cysts, normal dense breast tissue, benign (noncancerous) tumors such as fibroadenomas and most phyllodes tumors, hematomas (or bruising from trauma), and cancers. Since there are so many causes for breast lumps, it is important to check your breasts each month for changes and report any changes to your doctor right away. Often a lump will be checked by physical examination and a mammogram and/or ultrasound. This will help determine the treatment needed.
Breast pain is very common. There are many different causes for breast pain. Most often it is caused by hormonal stimulation of the glandular tissue in the breast. Pain can change over time along with the menstrual cycle (called cyclical pain). Other causes for breast pain include infection, trauma, and less commonly cancer. Common treatments for breast pain include cutting down on caffeine intake, low-fat diet, some herbal supplements, and oral evening primrose oil. Breast pain with redness of the breast and/ or fever, or breast pain that does not go away or is associated with a lump should always be reported to your doctor.
The most common type of nipple discharge is physiologic due to the lining of the milk duct shedding cells, just like our dry skin or hair. Physiologic discharge can be white, yellow, green or black. It is usually from both nipples. Other common causes of nipple discharge include cysts, hormonal imbalance, papillomas (growths in ducts), and ductal carcinoma in situ. New nipple discharge should always be reported to the doctor especially if it is from one side, happens spontaneously, and is clear or bloody. Often the first steps in determining the cause for the discharge include a physical examination and imaging such as a mammogram, ultrasound and possibly MRI. Treatment is based on clinical and imaging findings and can include observation, follow-up imaging, biopsy and in some cases surgery.
Gynecomastia is enlargement of one or both male breasts. This is common and can be seen in up to 66% of elderly men. It can be caused by certain medications, drug use, alcohol use, liver disease, and diseases such as testicular insufficiency as well as renal disease and hyperthyroidism. Sometimes the cause is unknown. Sometimes the swelling of the breast can be painful. Men with new onset gynecomastia should discuss the condition with their doctors to determine if any workup is needed. Sometimes blood work and/or imaging can be done to confirm the diagnosis. Often treatment is symptomatic. If there is significant enlargement of the breast sometimes surgery is indicated.
Fibrocystic breast disease:
Fibrocystic breast disease is a term used to describe dense glandular breasts that have frequent cysts that come and go. It is very common especially in young women. The breasts feel hard and lumpy sometimes like a bag of pebbles. It can cause breast pain or tenderness that changes with the menstrual cycle. It is very important to do self breast exams if you have fibrocystic breast disease because physical examination is difficult. The more familiar you are with your breast, the better you will be able to detect a change. Remember to report all changes to your doctor.
Mastitis is an infection of the breast tissue. It can happen during breast feeding (most commonly). If it happens when the patient is not breast-feeding, we often check for a cause for the mastitis. This is usually done with imaging of the breast such as a mammogram, ultrasound or MRI. The imaging can also check for an abscess (collection of pus) that may need to be drained or aspirated. Often mastitis is treated with antibiotics, warm compresses, support of the breast, and pain medicine as needed. If mastitis happens while breast-feeding, it is important to continue feeding or pumping to empty the milk from the breast.
Genetic Predisposition to Cancer:
1 in 8 women will develop breast cancer in their lifetime. Genes are made of DNA. Some genes tell our body how to make molecules or cells. Others make certain cells or parts of cells grow faster or tell damaged cells to die. Sometimes there is a problem in a gene and it no longer functions correctly. When genes do not work properly, they can cause cancer to grow. Cancer is the uncontrolled growth of a damaged cell.
Only about 5 to 10 percent of all breast cancers are associated with inherited genetic mutations (damaged genes). BRCA1, BRCA2, and PALB-2 are among the most common genes that are associated with an increased risk in both breast and ovarian cancer. Genetic testing (a blood test or saliva test) can be done to see if a patient has a gene that increases his or her risk of developing cancer. If the patient does have an abnormal gene, often times there are options to help reduce risk such as increased screening – with imaging or increased examinations, taking medicines to reduce risk, or surgery, such as removal of the breasts or ovaries (prophylactic mastectomy or oophorectomy) prior to the cancer developing.
Family History of Breast Cancer:
1 in 8 women will develop breast cancer in their lifetime. Having a first degree relative with a history of breast cancer, like your mother or sister, doubles your risk of developing breast cancer. 15-20% of women with breast cancer will report a family history of breast cancer. Family history of breast, ovarian, prostate, pancreatic, colon, and stomach cancers in relatives on your mother’s side or father’s side can sometimes mean that there is a gene that is not working correctly and is increasing the family members’ risk of developing cancers. It is always important to report family history of any cancer to your doctor. This will help the doctor determine if increased screening or genetic testing is right for you.
High Risk Screening:
The average lifetime risk for the development of breast cancer in a woman to the age of 90 is 12%. Being high risk is defined as having a lifetime risk of 20-25% or greater. There are many things that can increase the risk of developing breast cancer such as family history, genetic abnormalities, prior abnormal breast biopsies (ones with atypical cells), personal history of breast cancer, obesity, alcohol use, and prolonged postmenopausal hormone use. Increased screening with clinical breast exams, mammograms, and sometimes ultrasounds and MRIs are recommended depending on a patient’s individual risk.
Paget’s Disease of the Breast:
Paget’s disease of the breast is a condition where the skin of the nipple and areola develops eczema-like changes. The skin can look dry, scaly, red, or shiny. Often it is associated with cancer deeper in the breast. It is diagnosed with the biopsy of the skin.
Ductal Carcinoma In Situ:
Ductal carcinoma in situ (DCIS) is a condition in which individual cancer cells are found in the lining of the ducts but they haven’t spread outside the duct. This is called Stage 0 breast cancer. It has a 10 year survival rate that approaches 100% when treatment recommendations are followed.
Lobular Carcinoma In Situ:
Lobular carcinoma in situ (LCIS) is also known is lobular neoplasia. It is not technically classified as cancer. Instead it is a high risk factor for the development of cancer in either breast at any time. It can sometimes be found in association with a current cancer in the same breast or the opposite breast. Treatment usually requires excision to make sure there is no invasive cancer near the LCIS. Chemoprophylaxis (medications to reduce the risk of developing cancer in the future) can also be given.
Invasive Ductal Carcinoma:
The most common type of breast cancer is ductal carcinoma, which begins in the cells of the milk ducts. Breast cancer cells that have clumped together to form a mass is called invasive or infiltrating breast cancer. Invasive breast cancer has the potential to spread, but just because the cancer cells have joined to form a mass does not necessarily mean that it has spread to the lymph nodes or other areas of the body. The earlier an invasive cancer is found, the easier it is to treat. Invasive cancer is usually treated with surgery and sometimes with chemotherapy and/or radiation.
Invasive Lobular Carcinoma:
Breast cancer can begin in the cells of the lobules and in other tissues in the breast. Breast cancer cells that have clumped together to form a mass is called invasive or infiltrating breast cancer. Invasive breast cancer has the potential to spread, but just because the cancer cells have joined to form a mass does not necessarily mean that it has spread to the lymph nodes or other areas of the body. The earlier an invasive cancer is found, the easier it is to treat. Lobular carcinoma is harder to detect on a mammogram and can sometimes only be seen on an ultrasound or MRI. It is often found as a lump.
Inflammatory Breast Cancer:
Inflammatory breast cancer is a very rare and aggressive form of breast cancer in which the breast looks red and swollen and feels warm because the cancer cells block the lymph vessels in the skin. It is usually treated with chemotherapy, surgery and radiation.
Male Breast Cancer:
About 1% of breast cancers are male. Although a positive family history is reported by 15 to 20 percent of women and men with breast cancer only 5 to 10 percent of all breast cancers are associated with inherited genetic mutations (genes that do not work correctly). Male breast cancers are much more likely to be associated with genetic abnormalities. BRCA1 and BRCA2 are among the most common genes that have been associated with both breast and prostate cancer. The most common signs of male breast cancer include a new lump, nipple inversion, or bloody nipple discharge. Male breast cancer is treated similarly to female breast cancer – often with surgery, and sometimes with chemotherapy and radiation.