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.

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.

Accelerated Partial Radiation

Have you heard of accelerated partial radiation before?
Women who are diagnosed with early-stage breast cancer often choose to have the cancer removed by lumpectomy, and they usually have radiation therapy after surgery as well.   Radiation therapy after lumpectomy lowers the risk of the cancer recurring and it makes lumpectomy as effective as mastectomy.  Radiation can be delivered to the entire breast, whole-breast radiation, or to just the area of the breast where the cancer was located, partial-breast radiation.  Traditional whole-breast radiation typically lasts 5 days a week for 4 to 6 weeks; and the unintentional exposure of nearby healthy tissue (lungs or heart, for example) to is a factor to consider as well.
One of the newer ways to deliver radiation is accelerated partial-breast radiation.   This is a new technique that delivers a more focused and intense  therapy over a shorter period of time.
3-D conformal external beam radiation (3DCRT) is one type of accelerated partial-breast radiation.  3DCRT starts with a planning session.   A special MRI or CAT scan of the breast is done and is used to map out small treatment fields for the area at risk.  The type and distribution of radiation is designed to maximize the dose to the area that needs to be treated and avoid or minimize radiation to tissue near the area.  The radiation is delivered with a linear accelerator, the same machine used in traditional whole-breast radiation, twice a day for 1 week.
A study has found that women diagnosed with early-stage breast cancer and had 3DCRT after lumpectomy had worse cosmetic results than women who got traditional whole-breast radiation after lumpectomy.  The study was published online on July 8, 2013 by the Journal of Clinical Oncology.
In the RAPID trial, researchers randomly assigned 2,135 women diagnosed with either early-stage breast cancer or DCIS to get either 3DCRT (1,070 women) or whole-breast radiation (1,065 women) after lumpectomy.  Before they received any radiation therapy, all the women were assessed by a trained nurse using a cosmetic rating system for breast cancer.  After radiation therapy, the women were again assessed by a trained nurse at 2 weeks, 3 months, 6 months, 12 months, and then once a year.
The rating system compared the treated and untreated breast for:

• size and shape
• location of the nipple and areola
• how the surgical scar looked
• whether or not there was an enlargement of small blood vessels on the skin
• overall appearance of the breasts

The researchers then compared cosmetic results and side effects between the two types of radiation.
The researchers found that women who had 3DCRT had worse cosmetic results than women who had whole-breast radiation:

• Before radiation, 18.9% of women who would get 3DCRT had fair or poor cosmetic results compared to 17% of women who would get whole-breast radiation.
• Three years after radiation, 29% of women who had 3DCRT had fair or poor cosmetic results compared to 16.5% of women who got whole-breast radiation.
• Five years after radiation, 32.8% of women who had 3DCRT had fair or poor cosmetic results compared to 13.4% of women who got whole-breast radiation.

Looking at side effects, the researchers found that women who had 3DCRT were more likely to have telangiectasia and breast induration (hardening or thickening of the skin) than women who had whole-breast radiation.  About a quarter of the women in both groups had mild to moderate pain after radiation.  Very few women in either group had severe pain.
While other ongoing studies have suggested that accelerated partial-breast irradiation is safe, none of these other studies have reported on cosmetic results.  Since the cosmetic results and side effects were worse with 3DCRT than whole-breast radiation, the researchers recommended that 3DCRT not be routinely used unless it’s part of a clinical trial.  More research with long-term follow-up is needed so doctors know for sure that accelerated partial-breast irradiation is a good alternative to whole-breast radiation.
If you’ve been diagnosed with early-stage breast cancer and lumpectomy followed by radiation therapy will be part of your treatment, ask your doctor about the radiation therapy options that make the most sense for your unique situation, including:

• the characteristics of the cancer (size, location, lymph node involvement)
• your personal preferences
• the experience level and results of the doctors who will administer your radiation therapy

Breast Cancer Facts

In the United States:

• Breast cancer is the most common cancer among American women after skin cancer.
• About 232,670 new cases of invasive breast cancer will be diagnosed in women in 2014.
• About 62,570 new cases of ductal carcinoma in situ (DCIS) will be diagnosed in women (DCIS is non-invasive and the earliest form of breast cancer) in 2014.
• About 40,000 women will die from breast cancer in 2014.
• The five-year relative survival rate for female invasive breast cancer patients has improved from 75 percent in the mid-1970s to 90 percent today.
• The five-year relative survival rate for women diagnosed with localized breast cancer (cancer that hasn’t spread to lymph nodes or outside the breast) is 98.5 percent. In cancer that has spread to nearby lymph nodes (regional stage) or to distant lymph nodes or organs (distant stage), the survival rate falls to 84 percent or 24 percent, respectively.
• There are more than 2.8 million breast cancer survivors in the U.S., including women still being treated and those who have completed treatment.