What is Breast Cancer

Breast cancer is a malignant cancerous growth that begins in the tissues of the breast. Breast cancer is the most common cancer in women, but it can also appear in men.  Breast cancer affects one in eight women in the U.S. Cancer occurs as a result of abnormal changes in the genes responsible for regulating the growth of cells and keeping them healthy.  Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out.   A changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.  Breast cancer is always caused by a genetic abnormality.  However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. 
About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process.   Breast cancer is a malignant tumor that has developed from cells in the breast.  Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple.  In situ is a Latin phrase meaning in place, or in this instance, it means the abnormal cells are contained in one place (not spread into other tissue.)  DCIS does not always progress to invasive cancer, where the cells invade breast tissue outside the ducts. DCIS accounts for 85-95% of breast cancers.

What is the Best Age to Begin Mammograms?

Regular mammograms can help detect breast cancer early but the suggested age to begin doing mammograms is more confusing than ever.
A few years ago, a government taskforce recommended that women begin regular mammograms at 50 instead of 40.  Now, a new study contradicts that advice by saying starting mammograms sooner could dramatically cut the number of breast cancer deaths.
Researchers at Harvard University found that 71 percent of breast cancer patients had not had a mammogram prior to diagnosis and half were under 50 years old, which seems to support the American Cancer Society’s recommendation that women get yearly mammograms once turning 40.   The changing recommendations are confusing for many women and some say that it’s difficult to keep up with the constant changes.
For those who are not at high risk of breast cancer, clinical breast exams are recommended every two to three years starting in your 20s; however, those with family members who have been diagnosed may wish to speak with their doctor about a more aggressive screening option.

Chemotherapy

The use of chemotherapy for the treatment of cancer began in the 1940’s with the use of nitrogen mustard.  In the attempt to discover what is effective in chemotherapy, many new drugs have been developed and tried since then. Chemotherapy is used most often to describe drugs that kill cancer cells directly, and these drugs are sometimes referred to as “anti-cancer” drugs.
Today’s chemotherapy uses more than 100 drugs to treat cancer.  There are even more chemo drugs still under development and investigation.  Various chemotherapy drugs are available to treat breast cancer.  Breast cancer chemotherapy is made of powerful drugs that target and destroy fast-growing breast cancer cells.  The drugs may be used individually or in a combination to increase the effectiveness of the treatment.  Breast cancer chemotherapy is frequently used along with other treatments for breast cancer, such as surgery.  Chemotherapy may also be used as the primary treatment when surgery isn’t an option.  Chemotherapy can help you live longer and reduce your chances of recurrence. It also carries the risk of side effects.  Some of the side effects are temporary and mild but others more serious, and sometimes permanent.  Your doctor can help you decide whether chemotherapy for breast cancer is a good choice for you.  Chemotherapy drugs are given intravenously or orally for treating breast cancer.  The drugs enter the blood stream and travel to all parts of the body, thus reaching cancer cells that may have spread beyond the breast.
Chemotherapy is given in cycles of treatment; and the entire chemotherapy treatment generally lasts several months to one year, depending on the type of drugs given.  A period of recovery is granted after the chemotherapy is finished.
Your doctor considers a number of factors to determine whether and what kind of chemotherapy would be of benefit to you.  The higher your risk of recurrence or metastasis, the more likely chemotherapy will be of benefit. In some cases, characteristics of the breast cancer itself may suggest other more beneficial treatments.  Discuss your own treatment goals and preferences with your doctor.
Factors commonly considered include:
Tumor size and grade. The more advanced the tumor, the more likely chemotherapy may be useful in destroying any stray cancer cells.
Lymph node status. If breast cancer cells were found in your lymph nodes during or before surgery, this is an indication of a higher risk of metastasis and thus an indication for chemotherapy.
Age. Some studies suggest that breast cancer which occurs at a young age is more aggressive than is breast cancer that develops later in life. Thus, doctors may opt for adjuvant chemotherapy when treating younger women to decrease the chances of the cancer spreading to other areas of the body.
Previous treatments. Whether you’ve had chemotherapy before may affect your current treatment regimen.
Chronic health conditions. Certain health problems, such as heart disease or diabetes, may affect your choice of chemotherapy drugs.
Hormonal status. If your breast cancer is sensitive to the hormones estrogen (ER) and progesterone (PR), hormone therapy — with drugs such as tamoxifen, fulvestrant (Faslodex) or aromatase inhibitors (Arimidex, Femara, Aromasin) — may be a better option for post-surgical adjuvant therapy or they may be considered in addition to chemotherapy.
HER2 status. If your breast cancer produces (expresses) too much of a growth-promoting protein known as human growth factor receptor 2 (HER2), your doctor may recommend drugs that specifically target this protein — trastuzumab (Herceptin), lapatinib (Tykerb) — in addition to chemotherapy.

Breast Cancer and Ductal Carcinoma in situ

Typically, breast cancer screenings are performed to catch the disease in the early stages. If the disease is found, either through screening or recognized signs and symptoms, further tests are performed to determine the extent of the disease.
In 2011, 288,130 new cases of invasive breast cancer were diagnosed in women in the U.S. Almost 25% of all new breast cancers diagnosed in the United States are Ductal carcinoma in situ.
What is Ductal carcinoma in situ?
Ductal carcinoma in situ (DCIS) is also known as intraductal carcinoma. DCIS is a relatively new diagnosis and is a term used to describe cells that are growing inappropriately inside the ducts of the breast.  Those cells look like cancer cells under the microscope.  They are abnormal cells that have not spread into the surrounding fatty breast tissue or to any other part of the body.  They are totally confined to the duct and therefore non-invasive.
DCIS began being diagnosed more readily when mammography became a routine part of medical care.   More than 24% of all new breast cancers diagnosed in the United States are DCIS.
How do cancer cells work?
Most breast cancers arise in cells that line the ducts and lobules of the breast.  When cells in the lining of breast ducts are growing inappropriately, it’s called hyperplasia.  When they grow inappropriately and do not appear normal under the microscope, they are called atypical hyperplasia.
Are DCIS cells the same as cancer cells?
DCIS cells are different than actual cancer cells.  They lack the biological capacity to metastasize or spread elsewhere in the body, like cancer cells do.  So are you wondering why DCIS cells fall into the category of cancer cells?
Some DCIS cells can change genetically and become true cancers, and you should not ignore a DCIS diagnosis because science doesn’t know yet which DCIS cells will change and become invasive–and which will remain DCIS.
Are you diagnosed DCIS?
If you are diagnosed with DCIS it is important to know how aggressive or risky your cell type is because there are different kinds of DCIS.  For example, Comedo-carcinoma considered to be an early stage of breast cancer, is considered more aggressive and high-grade than cribiform, which is considered low-grade.  By defining the type of DCIS, it’s easier to define your treatment options, which in turn affects whether DCIS becomes invasive breast cancer.
A diagnosis of DCIS depends on the pathologist, and the diagnosis may be controversial.  Therefore, second, independent opinions are always important.
Whether your doctor refers to DCIS as cancer or pre-cancer, it requires careful treatment and follow-up to avoid the possibility of an invasive breast cancer developing.
Stay abreast of your health with daily self examination and regular check-ups.

To Mammo or Not To Mammo; That’s the Question

Most of the women who undergo routine mammogram screenings for breast cancer will never actually derive any real benefit from the radioactive procedure, but the majority of those who end up testing positive for tumors as a result of mammography will undergo needless treatments for malignancies that never would have led to any health problems.
These unsettling findings from a review recently published in the journal, The Lancet, found that for every woman whose life is supposedly saved as a result of early detection, three others undergo invasive surgery, toxic chemotherapy, or immune-destroying radiation treatments for benign tumors that never would have resulted in fatality.
This shocking information represents one more setback for the practice of mammography, which is still touted by the mainstream medical system as the premier method by which women have the best chance of not dying from breast cancer.  Not only are women not being told about the significant radaioactive risks associatied with getting mammograms, but they are also not being told that the procedure often detects noncancerous tumors.
According to the review of the study done in the U.K., 1,307 women avoid dying from breast cancer every single year in the U.K. as a result of being screened for breast cancer.  But another 3,971 women every year also end up opting for unnecessary, expensive, and highly-toxic treatment procedures for benign tumors as a result of mammography, which causes many of them to suffer irreparable damage to their immune health.
According to a similar study released early this year from Norway, as many as 25 percent of the breast cancers detected by mammography would have never even caused any health problems during the women’s lifetimes.  At the same time, mammography alsofails to detect as many as 10% of harmful breast turmors, indicating that it is a highly unreliable, and very toxic, breast cancer detection method that needs to be effectively phased out of mainstream use.
“Once you’ve decided to undergo mammography screening, you also have to deal with the consequences that you might be over-diagnosed,” says Dr. Metter Kalager, a breast surgeon at Telemark Hospital in Norway about the widespread problem of breast cancer over-diagnosis. “By then, I think, it’s too late. You have to get treated.”
The truth is that we’ve exaggerated the benefits of screening and we’ve ignored the harms.  Mammography helps some people but it leads others to be treated unnecessarily.

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• Breast Cancer
• My Breast Cancer Journey Blog

June 8, 2013

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Breast Cancer Surgery

Breast cancer surgery is the mainstay of breast cancer when the tumor is localized. Patients are roughly divided into high risk and low risk cases, and each risk category follows different rules for therapy. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy, and immune therapy. Management of breast cancer is undertaken by a multidisciplinary team based on national and international guidelines.
Depending on the staging and type of the tumor, your surgeon may recommend a lumpectomy. Lumpectomy techniques are increasingly utilized for breast-conservation cancer surgery. Studies indicate that for patients with a single tumor smaller than 4 cm, lumpectomy may be as effective as a mastectomy. If the entire breast needs to be removed, that’s called a mastectomy.
For the following reasons, a mastectomy may be the preferred treatment in certain instances:
Two or more tumors exist in different areas of the breast.
The breast has previously received radiotherapy.
The tumor is large relative to the size of the breast.
The patient has had a connective tissue disease which can complicate radiotherapy.
The patient lives in an area where radiotherapy is inaccessible.
The patient is apprehensive about the risk of local recurrence after lumpectomy.
Standard practice requires the surgeon to establish that the tissue removed in the operation has margins clear of cancer, indicating that the cancer has been completely excised. If the removed tissue does not have clear margins, further operations to remove more tissue may be necessary.

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Metastatic Cancer

A primary cancer is the original tumor that develops within the body.  Localized cancer means that the cancer is confined to the original site.  Regional spread means the cancer has either grown into surrounding tissues or nearby lymph nodes.  Metastatic cancer occurs when cancer spreads from the original tumor to a new part of the body.  For example, breast cancer can form a new tumor in a different part of the body such as the bones.  The cancer cells in the second tumor are the same as the cells in the primary cancer.  They are breast cancer cells–not bone cancer cells. So the second cancer is called metastatic breast cancer or secondary tumor.  The term metastatic cancer is usually only used for cancer that has spread to distant organs or distant lymph nodes.
As cancer cells divide, they can invade and grow directly into surrounding tissue or structures.  But, they can also break off from the original tumor and enter the bloodstream or lymphatic system.  All cancers have the potential to spread, and cancer can spread almost anywhere in the body.  The most common sites of metastases are the bone, brain, liver, and lung.Whether metastases will develop depends on many factors such as the type of cancer, the grade of the cancer, the length of time the cancer has been present, and the location of the primary tumor.  Some types of cancer tend to spread to certain parts of the body.  For instance, breast cancer most often spreads to the bones, liver, lung, or brain.  Colorectal cancer tends to spread to the liver.  Lung cancer often spreads to the brain, bones or liver. Prostate cancer tends to spread to the bones.
Low-grade cancer cells are less aggressive and are less likely to metastasize.  High-grade cancer cells are more aggressive and are more likely to metastasize.  The risk of metastasis increases the longer a tumor is in the body and the ability of the cancer cells to create a blood supply in a new location because a cancerous tumor needs to set up a blood supply to grow.Each type of cancer has a particular way that it spreads.  Many metastases develop in the first area of blood vessels that cancer cells come to after leaving the primary tumor.  When cancer cells leave the primary tumor, the lungs are one of the first places metastatic cells can be carried to by the bloodstream.  This may explain why metastases form in the lungs.
Some people may have no or few symptoms related to their metastasis.  Therefore, a metastatic cancer may only be discovered during a routine examination or test.  Symptoms of metastatic cancer will depend on the particular location and size of the metastasis.Regular checkups and reporting new symptoms are the best ways to detect metastatic cancer early.  Diagnostic tests will be done if the signs and symptoms of metastatic cancer are present, if the result of a follow-up test is abnormal or if the doctor suspects a metastasis. The types of tests done will depend on the area of the body where doctors suspect the cancer has spread.

Breast Cancer and High Blood Pressure

A recent study showed that women who had been taking calcium-channel blockers to treat high blood pressure for more than 10 years were 2.5 times more likely to have breast cancer, compared with women who did not use blood pressure medication, or who used other types.  However, it should be cautioned that the study is preliminary and further studies are needed before recommendations are made.  So, continue taking your medications but the findings are interesting, to say the least.
About 1,900 women with breast cancer participated in the study, as well as about 850 women with no cancer who served as the control group.  The researchers didn’t find a link between an increased breast cancer risk and other types of high blood pressure medications, such as beta-blockers or diuretics, according to the study published in the Journal of the American Medical Association.
Medications for treating high blood pressure, called antihypertensives, are the most commonly prescribed drugs in the United States.  An estimated 678 million prescriptions were filled in 2010, including 98 million prescriptions for calcium-channel blockers, the researchers said.
A professor in epidemiology at Boston University noted in an editorial that this is not the first time that the specter of a link between [calcium-channel blockers] and breast cancer risks have risen.
But previous studies had yielded mixed results. They did not have a sufficient number of participants, or did not investigate long-term use of antihypertensives.  The professor said that the study “is a very well-done study and therefore there appears to be a hypothesis that now needs to be confirmed.”  She also said that the study isn’t at a stage where women should be panicking about taking these drugs. The study shows a link, but does not prove a cause-and-effect relationship between the drugs and breast cancer.
Calcium-channel blockers work by slowing the movement of calcium into muscle cells, which dilates blood vessels, reduces the force of the heart’s contractions and slows the heartbeat.  Doctors may consider how the patient responds to different medications, and their other conditions.  There are people who don’t tolerate some of the other classes of medications, and respond well to calcium-channel blockers.
However, if patients are concerned, and because there are several classes of hypertensives, patients can certainly discuss their options with their physician, and look into alternative blood pressure treatments.  Be sure to discuss your concerns with your doctor.
The next step in the current research would be to look at more groups of people who take blood pressure medications, as well as to better understand the underlying mechanism by which the calcium-channel blockers may affect cancer risk, the researchers said.
Antihypertensives only came on the market in the past few decades, so there has not been sufficient number of long-term users of these medications.
We are now getting to the point where we have enough people who’ve been exposed to these medications for long periods of time to evaluate such long-term potential risks.

What Is The Difference Between IBC and Recurrent Breast Cancer?

What is inflammatory breast cancer?  The breast looks red and swollen and feels warm when inflammatory breast cancer occurs.  The redness and warmth occur because the cancer cells block the lymph vessels in the skin.  The skin of the breast may also show a pitted appearance. Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.  Treatment of inflammatory breast cancer may include the following:  Systemic chemotherapy.  Or systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy.  Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.  Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment may also be a treatment.
What is recurrent breast cancer?  Recurrent breast cancer is cancer that has recurred (come back) after it has been treated.  The cancer may come back in the breast, in the chest wall, or in other parts of the body.
Treatment of recurrent breast cancer in the breast or chest wall may include surgery (radical or modified radical mastectomy), radiation therapy, or both.  Systemic chemotherapy or hormone therapy may also be applied and a clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy may be used.

New Categorization for Cancers??

Cancers are categorized according to the tissue in which they originated, such as breast, bladder or stomach cancer. But tissues are composed of different types of cells.
Recently, researchers examined tumor samples of 12 different cancer types and concluded that the diagnosis would improve in about 10% of cancer cases if they tumors were defined by the cellular and molecular features, rather than the tissues in which they tumors originated. This would mean more accurate diagnosis in about 1 in 10 people.
The researchers reported particularly significant findings in bladder and breast cancers. At least three different subtypes of bladder cancer were identified, including one that was nearly identical to a form of non-small cell lung cancer called lung adenocarcinoma, and another most similar to squamous-cell cancers of the head and neck and of the lungs. Bladder cancer patients in treatment have often responded very differently when treated with the same systemic therapy for their seemingly identical cancer type, and the new findings may explain why that is.
The researchers confirmed known differences between two forms of breast cancers called basal-like and luminal. But they also discovered that these differences are significant and that basal-like breast cancers, commonly referred to as triple-negative, are a distinct class of tumor. Basal-like cancers are highly aggressive and more common among black and younger women.
Basal-like cancers do arise in the breast but, on the molecular level they have more in common with ovarian cancers and cancers of squamous-cell origin than with other subtypes of breast cancer. This is the first time ever anyone has been able to point to important molecular features shared by basal breast cancer. They also found that different cancer types have very similar immune signatures, a factor that may be relevant clinically with the rise of new immune therapies.
Further research could reveal that as many as 30 to 50 percent of cancers need to be reclassified, according to researchers.

Pink Washing

Pink washing has bothered me for many years now but I haven’t publicly complained about the over-saturation of pink ribbons until now.
Some breast cancer survivors, such as myself, craft pink ribbon products for breast cancer awareness. We’ve been through the breast cancer battle and we have a true desire to help others navigate the muddied waters of breast cancer. We breast cancer survivors aren’t large corporations with tons of money backing us. Nor do we have huge funds for marketing strategies. We are merely a group of women who know what’s up–and we attempt to help those who are afraid or don’t understand how to go forward after receiving a breast cancer diagnosis.
The disgust with pink washing seems to come from large corporations who spend millions per year on “public health education” or “administrative costs.” Case in point: a well-known charitable organization shows board members “reported salaries” as being less than $100,000 per person per year. But the company’s records neglect to mention the huge bonus that is paid per person. In particular, one vice president received a bonus or over $400,000.
It seems that directors of some charitable “non-profit” organization make more than most doctors, lawyers, or even politicians. You need to also see where the rest of the annual revenue goes because the wording is tricky.
And, if the charitable organization has a catch phrase, you really have to wonder how much money that organization paid for that catch phrase.
These campaigns for breast cancer awareness and breast cancer education are great forms of advertising for the organizations that are already making millions from the breast cancer patients/survivors.
Now, if these so-called charities were intent on using the funds to find a cure for breast cancer, I think the process would be farther along; wouldn’t it? Or am I being naive? I mean there’s plenty of public health education and there’s a huge emphasis on the importance of screening for early detection of breast cancer.
So, ask yourself if the charitable organizations with the loudest voices have your well-being at heart or if their bottom line is the profit the company takes away from the breast cancer campaign.
Unfortunately, we’re in the era of Big Pharma and there are giant charities that rely on Big Pharma by supplying them with money that will create a toxic cure for all cancer patients. But that’s all in the small print; and at least one major charitable organizations holds stock in a pharmaceutical company. Coincidentally, the pharmaceutical company makes educational grants to the charitable giant.
The duplicity is disgusting.
We’re locked into supporting charities that advertise finding a cure for breast cancer but they’re actually promoting breast cancer via chemotherapy drugs, which will keep us locked into a cycle of toxic cancer treatments.
I’ve been a breast cancer survivor for nearly 20 years now and I’ve seen everything. I’ve seen pink cupcakes and pink cakes, pink watches, pink galas, and pink sweat suits. I’ve seen football players speak on behalf of breast cancer patients and their personal breast cancer trials. I’ve heard the breast cancer charities with their representatives speak on t.v. about their good intentions, their fundings, etc.
There is one constant with breast cancer: breast cancer is a scary, tricky business. You need to personally be aware and be careful about where you give your money and what goes into your body.
If you’re tired of the pink washing and these million dollar companies, you can react by keeping your money or buying local—or buy from someone who has had a breast cancer experience—not some faceless company that has the money to promote breast cancer awareness.
And, if you’ve been recently diagnosed with breast cancer, you’ll find lots and lots of conflicting reports out there.
Go to your local hospital’s library. You can begin your breast cancer journey by reading about breast cancer there. That was the beginning of my own personal journey.
Breast cancer is a difficult road with lots of conflicting advice. As one friend told me, “Be careful because there are a lot of voices out there”. Make certain that you’re supporting the voice that supports you. I wish you well.

Deciding between Lumpectomy and Mastectomy

When a woman is faced with breast cancer, there are two choices available: lumpectomy and mastectomy.
Lumpectomy is less invasive than mastectomy and it allows a woman to save her breast. Mastectomy involves removal of the entire breast.
Most women, when offered the choice between the two, prefer the less invasive lumpectomy Generally, lumpectomy results in a good cosmetic look. And, if you want to keep your breast, you may decide to have lumpectomy followed by radiation.  However, in rare cases, when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted.  There are types of reconstructive surgery available for both lumpectomy and mastectomy.  If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
Research shows that women who live in the United States are more likely to have mastectomies than women who live in other countries.  In the Midwestern and southern parts of the U.S., mastectomies are very common.
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for women with only one site of cancer in the breast and a tumor under 4 centimeters.  Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Lumpectomy has a few potential disadvantages:
Radiation therapy is likely to be scheduled for 5 to 7 weeks of radiation therapy– 5 days per week after lumpectomy surgery to make sure the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly your reconstruction options after surgery.  Radiation therapy also may affect your options for later surgery to lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the cancer after lumpectomy than after mastectomy.  However, local recurrence can be treated successfully with mastectomy.
The breast cannot safely tolerate additional radiation if there is a recurrence in the same breast after lumpectomy.  This is true for either a recurrence of the same cancer, or for a new cancer.  If you have a second cancer in the same breast, your doctor will usually recommend that you have a mastectomy.
One or more additional surgeries may be needed after your initial lumpectomy.  During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue around it (called the margins).  A pathologist looks to see if cancer cells are in the margins.  If there are cancer cells, more tissue needs to be removed until the margins are free of cancer. Ideally, this is all done during the lumpectomy, but analyzing the margins can take about a week.  So sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery (called a re-excision) is needed.
Some women may want the entire breast removed because it provides a greater peace of mind regarding the recurrence of breast cancer.  Radiation therapy may still be needed, depending on the results of the pathology.
Mastectomy means that the woman will have a permanent loss of her breast and that she will have to have additional surgeries if she chooses to have her breast reconstructed. A mastectomy takes longer than a lumpectomy and is more extensive. It also has more post-surgery side effects and a longer recuperation time.
The choices are personal so be sure to weigh your decision carefully after you’ve talked with your doctor.

PALB2 Gene Mutations

Last year, actress Angelina Jolie allowed the public to see into her private life when she announced that she underwent a prophylactic mastectomy after testing positive for a BRCA mutation. Mutations in the same genes also increase the risk of ovarian cancer.
Now, research shows that another gene, PALB2, when mutated, results in a one in three chance of developing breast cancer by age 70. This makes the mutated PALB2 nearly as a high a risk for breast cancer as the BRCA1 or BRCA2 mutations. PALB2 (Partner And Localizer of BRCA2) binds to and co-localizes with BRCA2 in DNA repair. But mutations in PALB2 have been identified in approximately 1-2% of familial breast cancer and 3-4% of familial pancreatic cancer cases. Researchers found that women who carried rare mutations in PALB2 had on average a 35 percent chance of developing breast cancer by the time they were 70 years old. The risks were highly dependent on family history of breast cancer and other factors of course, but knowing what your own breast cancer risks are is important. BRCA1 and BRCA2 are widely known as breast cancer risk genes. Women with a mutation in one or both often decide to have their breasts removed so they do not develop the disease.
The PALB2 mutation doesn’t make people certain to develop cancer, but it’s another piece of information to help women make proper informed choices about how they may help to minimize their own risk. Breast cancer is the most common cancer in women worldwide.

Breast Cancer and Latina Women

Despite increased breast cancer awareness outreach efforts in Latina communities since the Nation Cancer Institute (NCI) report in its Cancer Bulletin (vol. 4/no. 15, April 17, 2007), breast cancer is still the most commonly diagnosed cancer in Latina women in 2013.

Recent studies and statistics show that, when compared to white women, Latinas have lower breast cancer rates.   But, they are more likely than whites to be diagnosed at a later stage, when the cancer is more advanced and harder to treat.

Even with an early diagnosis,  Latina women are more likely to have tumors that are larger and harder to treat than white women; and they also seem to get breast cancer at younger ages.  Researchers are not sure why these differences happen.

In 2007, NCI reported that despite equal access to health care services, differences persist in the size, stage, and grade of breast cancer for Hispanic women compared with non-Hispanic white (NHW) women. The study compared 139 Latina women and 2,118 NHW women with breast cancer who were all established members of the Kaiser Permanente Colorado health plan. The Latina women were diagnosed at a younger age; at a later stage of disease; with larger, higher grade tumors; and with less treatable estrogen-and progesterone-negative tumors, reported the investigators led by Dr. A. Tyler Watlington at the University of Colorado Health Sciences Center.

“The results of this study confirm those of many previous studies that breast cancer presents differently in Latina women,” the researchers noted.

“Previous research has suggested that the differences may be due to socioeconomic factors, especially lack of or inadequate health insurance and less access to care among low-income Latina women. However, the current study shows that “these differences were apparent even among a group of Latina women with equal access to care and similar health care utilization,” researchers added.

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When a woman is faced with breast cancer, there are two choices available: lumpectomy and mastectomy.
Lumpectomy is less invasive than mastectomy and it allows a woman to save her breast. Mastectomy involves removal of the entire breast.
Most women, when offered the choice between the two, prefer the less invasive lumpectomy Generally, lumpectomy results in a good cosmetic look. And, if you want to keep your breast, you may decide to have lumpectomy followed by radiation.  However, in rare cases, when a larger area of tissue needs to be removed, lumpectomy can cause the breast to look smaller or distorted.  There are types of reconstructive surgery available for both lumpectomy and mastectomy.  If you need to have a large area of tissue removed and two breasts of matching size are very important to you, you and your doctor will need to decide which surgery is best for your situation.
Research shows that women who live in the United States are more likely to have mastectomies than women who live in other countries.  In the Midwestern and southern parts of the U.S., mastectomies are very common.
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for women with only one site of cancer in the breast and a tumor under 4 centimeters.  Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Lumpectomy has a few potential disadvantages:
Radiation therapy is likely to be scheduled for 5 to 7 weeks of radiation therapy– 5 days per week after lumpectomy surgery to make sure the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly your reconstruction options after surgery.  Radiation therapy also may affect your options for later surgery to lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the cancer after lumpectomy than after mastectomy.  However, local recurrence can be treated successfully with mastectomy.
The breast cannot safely tolerate additional radiation if there is a recurrence in the same breast after lumpectomy.  This is true for either a recurrence of the same cancer, or for a new cancer.  If you have a second cancer in the same breast, your doctor will usually recommend that you have a mastectomy.
One or more additional surgeries may be needed after your initial lumpectomy.  During lumpectomy, the surgeon removes the cancer tumor and some of the normal tissue around it (called the margins).  A pathologist looks to see if cancer cells are in the margins.  If there are cancer cells, more tissue needs to be removed until the margins are free of cancer. Ideally, this is all done during the lumpectomy, but analyzing the margins can take about a week.  So sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery (called a re-excision) is needed.
Some women may want the entire breast removed because it provides a greater peace of mind regarding the recurrence of breast cancer.  Radiation therapy may still be needed, depending on the results of the pathology.
Mastectomy means that the woman will have a permanent loss of her breast and that she will have to have additional surgeries if she chooses to have her breast reconstructed. A mastectomy takes longer than a lumpectomy and is more extensive. It also has more post-surgery side effects and a longer recuperation time.
The choices are personal so be sure to weigh your decision carefully after you’ve talked with your doctor.

Breast Cancer and Exercise

Research shows that exercise can reduce the risk of breast cancer recurrence, as well as reducing the risk of developing breast cancer if you’ve never been diagnosed.
A 2010 review concluded that exercise is safe during and after all breast cancer treatments as long as you take any needed precautions and keep the intensity low.  It improves physical functioning, quality of life, and cancer-related fatigue.  There also is evidence that exercise can help breast cancer survivors live longer and lead a more active life.
Exercise can lower your risk of breast cancer recurring, as well as help you maintain a healthy weight, ease treatment side effects, boost your energy, and more!

Inflammatory breast cancer tends to be diagnosed at younger ages when compared to other cancers; and it’s more common and diagnosed at younger ages in African-American women than in white women.  The median age at diagnosis in African-American women is 54 years, compared with a median age of 58 years in white women.  It’s also  more common in overweight women than in women of normal weight.
Often times, treatments such as tamoxifen aren’t effective against inflammatory breast tumors because they are hormone receptor negative.   Inflammatory breast cancer can strike men as well as women, but usually it strikes at an older age.    Remember that inflammatory breast cancer is a very rare, but aggressive type of cancer and it’s important to always notice any changes in your breast whether you’re a male or female.  Because this disease is so relatively rare, people with inflammatory breast cancer are encouraged to enroll in clinical trials in which new treatments are being tested simply to take any advantage such medicine or techniques may offer in conjunction with those currently in use.   This disease accounts for only one to five percent of all breast cancers diagnosed in the United States.  Typically there’s no lump to be felt, and the disease escapes diagnosis until it has progressed to stage III or IV, at which point it has already spread only to nearby lymph nodes, stage III,---or to other tissues as well, stage IV.
Inflammatory breast cancer usually progresses rapidly, often in a matter of weeks or months.  Symptoms include swelling and redness that affect a third or more of the breast.  The skin of the breast may also appear pink, reddish purple, or bruised.  In addition, the skin may have ridges or appear pitted, like the skin of an orange.  These symptoms are caused by the buildup of lymph fluid  in the skin of the breast.   This fluid buildup occurs because cancer cells have blocked lymph vessels in the skin, preventing the normal flow of lymph through the tissue.  Sometimes, the breast may contain a solid tumor that can be felt during a physical exam, but, more often, a tumor cannot be felt.
Other symptoms include a rapid increase in breast size; sensations of heaviness, burning, or tenderness in the breast, or a nipple that is inverted.   Swollen lymph nodes may also be present under the arm, near the collarbone, or in both places.
Inflammatory breast cancer can be difficult to diagnose.  Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram.  In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult.   Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis or another form of locally advanced breast cancer.
There are published guidelines to help you choose the best course of treatment and how the disease is diagnosed.

Including men in breast cancer trials

The FDA wants drug companies to include men in breast cancer clinical trials because there’s surprisingly limited knowledge on male treatment methods.
Male breast cancer doesn’t have the activists or advocates like female breast cancer has.  Male breast cancer is a less known and less spoken about breast cancer than female breast cancer.  It’s one hundred times less common among men than among women.
In 2014, an estimated 2,360 men in the United States will be diagnosed with invasive breast cancer, resulting in about 430 deaths.   But the limited pool of victims has heightened the burden on those affected.   Males comprise about 1% of the diagnosed breast cancer cases in the United States each year and they are seldom included in clinical trials and research. 
“Men have historically been excluded from breast cancer trials,” said Dr. Tatiana Prowell, a breast cancer scientific lead at the FDA’s Office of Hematology & Oncology Products, on the FDA’s website this past June. “We are actively encouraging drug companies to include men in all breast cancer trials unless there is a valid scientific reason not to.”
“There’s more of a stigma for men to report anything in their breast,” Dr. Meyers said. “[Men] aren’t really thinking ‘breast cancer’ when they feel a lump.”
It’s possible that successful treatment of breast cancer could differ between males and females  but that isn’t truly known because of the lack of males in clinical trials.
Male exclusion is particularly problematic at a time when many modern and promising breast cancer drugs are available only through clinical trials.   There’s an uncertainty also regarding  the hormonal involvement in breast cancer.
While the survival rate, stage-for-stage, is similar for males and females, men do face a unique set of problems, Dr. Meyers continued. “The biggest problem with male breast cancer is not being aware [until] a later stage. In addition, because males do have less breast tissue, if the tumor is not picked up right away there might be a greater risk of locally advanced breast cancer—which carries a poor prognosis.”
Increased male enrollment in clinical trials might redress another issue, too: awareness. “There’s more of a stigma for men to report anything in their breast,” Dr. Meyers said. “[Men] aren’t really thinking breast cancer when they feel a lump, and they’re sometimes embarrassed by it.
The FDA is trying proactively steering drugmakers to include males in the clinical trials, and that’s something that is not seen very often, particularly in oncology

Lymphedema

Lymphedema occurs when too much lymph collects in any area of the body.  Lymph is a clear thin fluid that circulates throughout the body to remove wastes, bacteria, and other toxins from the body’s tissues; and edema is the buildup of excess fluid.  Lymphedema is a potential side effect of breast cancer surgery and radiation therapy that can appear in some people during the months or sometimes years after treatment ends.
If lymphedema develops in people who’ve been treated for breast cancer, it usually occurs in the arm and hand, and sometimes it affects the breast, underarm, chest, trunk, and/or back
Many women with breast cancer have had at least two or three lymph nodes removed under the arm– depending upon which procedure as done.  If you’ve had a sentinel lymph node biopsy they’ve probably removed two or three nodes, but if you’ve had an auxillary lymph node dissection, the number can be significantly higher.  If the cancer has spread, it has most likely moved into to those underarm lymph nodes first because they drain lymph from the breast.   Surgery and radiation can cut off or damage some of the nodes and vessels through which lymph moves, and over time, the flow of lymph can overwhelm the remaining path ways, and the result is a backup of fluid into the body’s tissues.
Doctors believe that when the lymph system is disrupted by breast cancer treatments, the body compensates and adapts by finding another way to get rid of toxins, extra fluids, and proteins.
With fewer lymph nodes as a result of breast cancer, the proteins and wastes do not get filtered out of the lymph as efficiently as they once did.  Gradually, waste and fluid can build up in the tissues of the arm, hand, breast, chest, or trunk.  One or more of these areas may be affected. The result is typically mild lymphedema, which can get worse if it’s not treated.  Typically, with those who develop lymphedema, the symptoms generally appear within 3 years after surgery– although many cases appear 3-5 years after treatment.  (There aren’t longer term studies to estimate the risk after five years, but there are existing cases of lymphedema developing many years or even decades after treatment.)
Sometimes, first symptoms are sometimes triggered by a specific event, such as overuse of or injury to the arm.  If your lymphatic system is already having a hard time keeping up with the processing of fluids and toxins, a single event that sends more blood pumping through your arm than usual can trigger the body into lymphedema.  More blood means more fluid in the tissues, which also means more lymph entering the lymphatic system.  Even a cut, even a very small one,  allows bacteria to get into the hand or arm.  The lymph drains to the underarm lymph nodes that are responsible for straining out the bacteria and setting your body’s immune system into action. But fewer nodes are now available to do this work, so the immune response is slower. The bacteria have the chance to start multiplying in the lymph fluid — a perfect environment because it’s filled with nutrients they can thrive on.  The cut gets infected and the lymphatic system is even more overwhelmed.  The lymph has so much debris in it that it starts to clog the system. The fluid can’t get where it needs to go and starts pooling in the tissue.

Targeting Breast Cancer

A new component, which is a protein that stimulates the immune system to attack HER2-positive breast cancer cells, has been added to a nanoscale drug. This drug can carry a variety of weapons and sneak into cancer cells to break them down from the inside has a new component.  The multi-pronged approach directly attacks cancer cells and blocks the growth of cancer-supporting blood vessels and stimulates an anti-tumor immune response.
The research team, led by scientists at the Nanomedicine Research Center, part of the Maxine Dunitz Neurosurgical Institute in the Department of Neurosurgery at Cedars-Sinai Medical Center, conducted the study in laboratory mice with implanted human breast cancer cells.  Mice receiving the drug lived significantly longer than untreated counterparts and those receiving only certain components of the drug.
Drugs often injure normal cells as a side effect, but this drug is unlike other drugs that target cells from the outside.  This new therapy consists of multiple drugs chemically bonded to a “nanoplatform” that functions as a transport vehicle.
HER2-positive cancers, which consists of approximately 25% to 30% of breast and ovarian cancers  tend to be more aggressive and less responsive to treatment  because the overactive HER2 gene makes excessive amounts of a protein that promotes cancer growth.  Herceptin is an antibody to the HER2 gene.  Herceptin naturally seeks out this protein, and so the research team used key parts of Herceptin to guide the nanodrug into HER2-positive cancer cells.  This commonly used drug is often effective for a while; but many tumors become resistant within the first year of treatment and the drug can injure normal organs it contacts.
A ‘fusion-gene’ was genetically prepared that consists of an immune-stimulating protein, interleukin-2, and a gene of Herceptin.  Interleukin-2 activates a variety of immune cells but is not stable in blood plasma and does not home specifically to tumor cells.  By attaching the new fusion antibody to the nanoplatform, the scientists were able to deliver Herceptin directly to HER2-positive cancer cells, at the same time transporting IL-2 to the tumor site to stimulate the immune system.  Attaching IL-2 to the platform helped stabilize the protein and allowed us to double the dosage that could be delivered to the tumor.
The researchers also attached other components, such as molecules to block a protein (laminin-411) that cancer cells need to make new blood vessels for growth.
The nanodrug, Polycefin, is in an emerging class called nanobiopolymeric conjugates, nanoconjugates or nanobioconjugates.  They are the latest evolution of molecular drugs designed to slow or stop cancers by blocking them in multiple ways.  Polycefin is intended to slow their growth by entering cells and altering defined targets.   The new version also stimulates the immune system to further weaken cancers.
One of the researched commented that they believe this is the first time a drug has been designed for nano-immunology anti-cancer treatment.
More study is needed to confirm the findings, improve the effectiveness of this approach and shed light on the anti-cancer mechanisms at work, but it appears that the nanobioconjugate may represent a new generation of cancer therapeutics in which we launch a multipronged attack that directly kills cancer cells, blocks the growth of cancer-supporting blood vessels and stimulates a powerful antitumor immune response.  Previous animal studies have found the nanodrug to be a safe and efficient delivery platform.
Nano researchers manipulate substances and materials at the atomic level, generally working with substances smaller than 100 nanometers.  . A human hair is 80,000 to 100,000 nanometers wide. Cedars-Sinai’s nanoconjugate is estimated to be about 27 nanometers wide.