Breast Cancer

The chances that a particular breast lump could be cancerous depends on many factors, including past medical history, physical examination, and mammogram and ultrasound results. Age is the biggest risk factor for breast cancer. In other words, most cases of breast cancer occur due to the fact that the risk of breast cancer increases with age. Most women with breast cancer do not have a history of breast cancer. A woman who has a family history of breast cancer is certainly at risk herself, especially if multiple family members are involved, the cases occurred at a young age, or if the cancer involved both breasts of a single family member. A history of nipple discharge or breast pain may also be important.

Breast cancer is increasingly common in the Westernised world. As the most common cancer among women it is understandably feared, and discovering a breast lump can be a traumatic experience. Fortunately, most breast lumps are not cancerous. However, for the minority that are, much research has gone into their management. Surgery has moved away from the radical mastectomies of a few decades ago. Breast reconstruction is often on offer. Chemotherapy and hormonal therapy are additional weapons that doctors have at their disposal.


The early stages of breast cancer may not have any symptoms. This is why it is important to follow screening recommendations. As a tumor grows in size, it can produce a variety of symptoms including:

• lump or thickening in the breast or underarm
• change in size or shape of the breast
• nipple discharge or nipple turning inward
• redness or scaling of the skin or nipple
• ridges or pitting of the breast skin

If you experience these symptoms, it doesn't necessarily mean you have breast cancer, but you need to be examined by a doctor.

How is breast cancer diagnosed and staged?

Once a patient has symptoms suggestive of a breast cancer or an abnormal screening mammogram, they will usually be referred for a diagnostic mammogram. A diagnostic mammogram is another set of x-rays; however, it is more complete with close ups on the suspicious areas. Sometimes, particularly if your doctors think that you may have a cyst or you are young and have dense breasts, you may be referred for an ultrasound. An ultrasound uses high-frequency sound waves to outline the suspicious areas of the breast. It is painless and can often distinguish between benign and malignant lesions.

Depending on the results of the mammograms and/or ultrasounds, your doctors may recommend that you get a biopsy. A biopsy is the only way to know for sure if you have cancer, because it allows your doctors to get cells that can be examined under a microscope. There are different types of biopsies; they differ on how much tissue is removed. Some biopsies use a very fine needle, while others use thicker needles or even require a small surgical procedure to remove more tissue. Your team of doctors will decide which type of biopsy you need depending on your particular breast mass.

Once the tissue is removed, a doctor known as a pathologist will review the specimen. The pathologist can tell if it is cancer or not; and if it is cancerous, then the pathologist will characterize it by what type of tissue it arose from, how abnormal it looks (known as the grade), whether or not it is invading surrounding tissues, and if the entire lump was excised, the pathologist can tell if there are any cancer cells left at the borders (also known as the margins). The pathologist will also test the cancer cells for the presence of estrogen and progesterone receptors as well as a receptor known as HER-2/neu. The presence of estrogen and progesterone receptors is important because cancers that have those receptors can be treated with hormonal therapies. HER-2/neu expression may also help predict outcome. There are also some therapies directed specifically at tumors dependent on the presence of HER-2/nue.

In order to guide treatment and offer some insight into prognosis, breast cancer is staged into five different groups. This staging is done in a limited fashion before surgery taking into account the size of the tumor on mammogram and any evidence of spread to other organs that is picked up with other imaging modalities; and it is done definitively after a surgical procedure that removes lymph nodes and allows a pathologist to examine them for signs of cancer. The staging system is somewhat complex, but here is a simplified version of it:

Stage 0 (called carcinoma in situ)

Lobular carcinoma in situ (LCIS) refers to abnormal cells lining a gland in the breast. This is a risk factor for the future development of cancer, but this is not felt to represent a cancer itself.

Ductal carcinoma in situ (DCIS) refers to abnormal cells lining a duct. Women with DCIS have an increased risk of getting invasive breast cancer in that breast. Treatment options are similar to patients with Stage I breast cancers.

Stage I - early stage breast cancer where the tumor is less that 2 cm across and hasn't spread beyond the breast

Stage II - early stage breast cancer where the tumor is either less than 2 cm across and has spread to the lymph nodes under the arm; or the tumor is between 2 and 5 cm (with or without spread to the lymph nodes under the arm); or the tumor is greater than 5 cm and hasn't spread outside the breast

Stage III - locally advanced breast cancer where the tumor is greater than 5 cm across and has spread to the lymph nodes under the arm; or the cancer is extensive in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast

Stage IV - metastatic breast cancer where the cancer has spread outside the breast to other organs in the body.

Depending on thestage of your cancer, your doctor may want additional tests to see if you have metastatic disease. If you have a stage III cancer, you will probably get a chest x-ray, CT scan and bone scan to look for metastases. Each patient is an individual and your doctors will decide what is necessary to adequately stage your cancer.

In the U nited States, breast cancer is the most common cancer occurring in women (excluding cancers of the skin) and the second most common cause of death from cancer in women after lung cancer. Men can also develop breast cancer, but male breast cancer is rare, accounting for less than 1% of all breast cancer cases. If diagnosed at an early stage, breast cancer has an encouraging cure rate: up to 98% of women diagnosed with localized breast cancer will survive five years after their diagnosis. Even if the cancer is found at a more advanced stage, new therapies have enabled many people with breast cancer to experience the same quality of life as before their diagnosis.