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.

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.

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 Screenings

Mammography false alarms linked with later tumor risk
The American Cancer Society recommends breast cancer screenings for women who are in good health starting at age 40. But, a growing number of researchers have questioned the benefits of annual mammograms since 2009 when the United States Preventive Services Task Force first recommended that screening be done every two years and be generally restricted to women aged 50 to 74.
Now, a new study shows women with mammograms that produce false positives have a heightened risk of being diagnosed with breast cancer years later, but the reason why this is–is uncertain.
An increased risk of breast cancer among women with false positive mammograms has been reported before. The new sturdy attempts to estimate the extra risk while taking into consideration that doctors may have missed the cancer in the previous diagnosis. According to the lead author in the new study, physician mistakes regarding missing cancers are only is a small percentage of the increased risk.
A mammogram is considered false positive when it suggests possible breast cancer but additional screenings or a biopsy fails to find it. The increased risk of breast cancer occurring, does not explain most of false-positive mammograms. Radiologists reread the original mammograms and found that doctors had actually missed the cancer in 72 of the 295 women, for a false-negative rate of 1.5 percent. Even after taking those missed cancers into account, however, the researchers found that women with false-positive mammograms were still 27 percent more likely to be diagnosed with breast cancer years later, compared to women with only negative test results.
The risk was slightly higher in women who had surgical biopsies that turned out to be negative. The risk of a false-positive test over 10 mammograms ranges from 58 percent to 77 percent in the U.S.
There are those that wonder if there is an inherent biology of the breast makes it suspicious and it puts a woman at higher risk, but no one knows for sure.
Should women who get false-positive mammograms be followed more closely by their doctors, or if false-positive patients should be screened differently.
Some now believe that the excess rate of breast cancer among women who have had false-positive mammograms points to the need to personalize screening programs for women.
A risk calculator app, to guide women in deciding how often to get mammograms, is being developed at the University of California. The calculator considers a range of factors, including age, race, previous breast cancer, family history and breast density. The average five-year breast cancer risk for a 50-year-old white woman with no prior family history of breast cancer is 1.25 percent, the calculator shows. It ranges from less than 1 percent, to 2.70 percent, depending upon breast density, for the same woman with a history of a prior breast biopsy, regardless of whether the biopsy was positive or negative.
Getting a mammogram every other year instead of annually did not increase the risk of advanced breast cancer in women ages 50 to 74, according to a study that was published last year. The recommendation to reduce the frequency and delay the start of mammography screening was based on research showing the risk of false-positive results – which needlessly expose women to the anguish of a possible breast cancer diagnosis and the ordeal of further testing – outweighed the benefits of detecting cancers earlier.