Breast Cancer - what we should know?

Many of you might have known that October is breast cancer awareness month. But the sad reality is that many of us know very little about breast cancer.

What if each one of us find some information about breast cancer and share it here. It might be an easy and enjoyable way of learning more about the disease that affects so many women.

Sharing it in the Q&A format might be easier for folks to read. Lets keep each posting short and readable!

What do you all think?

Kavya

Kavya - this is a great idea!. Here is my contribution...

Breast Cancer: Who's at Risk?

No one knows the exact causes of breast cancer. Doctors can seldom explain why one woman gets breast cancer and another does not.

Doctors do know that bumping, bruising, or touching the breast does not cause breast cancer. And breast cancer is not contagious. No one can "catch" this disease from another person.

However, research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is anything that increases a person's chance of developing a disease. Studies have found the following risk factors for breast cancer:

• Age: The chance of getting breast cancer goes up as a woman gets older. A woman over age 60 is at greatest risk. This disease is very uncommon before menopause.
• Personal history of breast cancer: A woman who has had breast cancer in one breast has an increased risk of getting this disease in her other breast.
• Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer, especially at a young age (before age 40). Having other relatives with breast cancer on either her mother's or her father's side of the family may also increase a woman's risk.
• Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia or lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
• Genetic alterations: Changes in certain genes (BRCA1, BRCA2, and others) increase the risk of breast cancer. In families in which many women have had the disease, genetic testing can sometimes show the presence of specific genetic changes. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. The Cancer Information Service can provide printed material about genetic testing.
• Reproductive and menstrual history:
  • The older a woman is when she has her first child, the greater her chance of breast cancer.
  • Women who began menstruation (had their first menstrual period) at an early age (before age 12), went through menopause late (after age 55), or never had children also are at an increased risk.
  • Women who take menopausal hormone therapy (either estrogen alone or estrogen plus progestin) for 5 or more years after menopause also appear to have an increased chance of developing breast cancer.
  • Much research has been done to learn whether having an abortion or a miscarriage affects a woman's chance of developing breast cancer later on. Large, well-designed studies have consistently shown no link between abortion or miscarriage and the development of breast cancer.
• Race: Breast cancer occurs more often in white women than Latina, Asian, or African American women.
• Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
• Breast density: Older women who have mostly dense (not fatty) tissue on a mammogram (x-ray of the breast) are at increased risk of breast cancer.
• Taking DES (diethylstilbestrol): DES is a synthetic form of estrogen that was given to some pregnant women in the United States between about 1940 and 1971. (DES is no longer given to pregnant women.) Women who took DES during pregnancy have a slightly increased risk of breast cancer. This does not yet appear to be the case for their daughters who were exposed to DES before birth. However, as these daughters grow older, more studies of their breast cancer risk are needed.
• Being obese after menopause: After menopause, women who are obese have an increased risk of developing breast cancer. Being obese means that the woman has an abnormally high proportion of body fat. Because the body makes some of its estrogen (a hormone) in fatty tissue, obese women are more likely than thin women to have higher levels of estrogen in their bodies. High levels of estrogen may be the reason that obese women have an increased risk of breast cancer. Also, some studies show that gaining weight after menopause increases the risk of breast cancer.
• Physical inactivity: Women who are physically inactive throughout life appear to have an increased risk of breast cancer. Being physically active may help to reduce risk by preventing weight gain and obesity.
• Alcoholic beverages: Some studies suggest that the more alcoholic beverages a woman drinks, the greater her risk of breast cancer.

Other possible risk factors are under study. (These studies are described in the section Research on Causes.)



Many risk factors can be avoided. Others, such as family history, cannot be avoided. It is helpful to be aware of risk factors. But it is also important to keep in mind that most women who have these risk factors do not get breast cancer.

Also, most women who develop breast cancer have no history of the disease in their family. In fact, except for growing older, most women with breast cancer have no strong risk factors.

Still, a woman who thinks she may be at risk of breast cancer should discuss this concern with her health care provider. The health care provider may suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

Hi Kavya and others,

I am giving u some information regarding staging of breast cancer and survival rates. I was going thru some sites for information as my mother had advanced stage III breast cancer 2 years ago. It was really a horrible experience with chemotherapy and all its side effects. But by God's grace she is alright now and I still keep on visiting sites and provide information for her. Hope this is useful info for all of u.

Regards,
jaya

What is Staging?

Staging is the process physicians use to assess the size and location of a patient’s cancer. Identifying the cancer stage is one of the most important factors in selecting treatment options. Several tests may be performed to help stage breast cancer including clinical breast exams, biopsy, and certain imaging tests such as a chest x-ray, mammogram, bone scan, CT scan, and MRI scan. Blood tests are used to evaluate a woman's overall health and detect whether the cancer has spread to certain organs often follow imaging tests.

To stage cancer, the American Joint Committee on Cancer first places the cancer in a letter category using the TNM classification system. Cancers are designated the letter T (tumor size), N (palpable nodes), and/or M (metastasis):

T: Tumor Size



The letter T followed by a number from 0 to 4 describes the tumor's size and whether it has spread to the skin or chest wall under the breast. Higher T numbers indicate a larger tumor and/or more extensive spread to tissues surrounding the breast.

• TX: Tumor cannot be assessed
• T0: No evidence of a tumor
• Tis: Cancer may be lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS) or Paget’s disease)
• T1: Tumor is 2 cm or less in diameter
• T2: Tumor is between 2 and 5 cm in diameter
• T3: Tumor is more than 5 cm in diameter
• T4: Tumor is any size, has attached itself to the chest wall and spread to the pectoral (chest) lymph nodes

N: Palpable Nodes



The letter N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, whether the affected nodes are fixed to other structures under the arm.

• NX: Lymph nodes cannot be assessed (lymph nodes were previously removed, etc.)
• N0: Cancer has not spread to lymph nodes
• N1: Cancer has spread to the movable ipsilateral axillary lymph nodes (underarm lymph nodes on same side of breast cancer)
• N2: Cancer has spread to ipsilateral (same side of body as breast cancer) lymph nodes fixed to one another or to other structures under the arm
• N3: Cancer has spread to the ipsilateral mammary lymph nodes or the ipsilateral (same side of body as breast cancer) supraclavicular lymph nodes

M: Metastasis



The letter M followed by a 0 or 1 indicates whether or not the cancer has metastasized (spread) to distant organs (i.e., the lungs or bones) or to lymph nodes that are not next to the breast, such as those above the collarbone.

• MX: Metastatis cannot be assessed
• M0: No distant metastasis to other organs
• M1: Distant metastatis to other organs

Numerical Stages of Breast Cancer

The stage of a breast cancer describes its size and the extent to which it has spread. The staging system ranges from Stage 0 to Stage IV.

Staging Breast Cancer
Stage	Tumor Size	Lymph Node Involvement	Metastasis (Spread)
I II III IV	Less than 2 cm Between 2-5 cm More than 5 cm Not applicable	No No or in same side of breast Yes, on same side of breast Not applicable	No No No

Stage 0 or "in situ:" The term "in situ" literally means "in place." Stage 0 cancer is a contained cancer that has not spread beyond the breast ductal system. Fifteen to twenty percent of breast cancers detected by clinical examinations or testing are in Stage 0 (the earliest form of breast cancer). Two types of Stage 0 cancer are lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS).

LCIS: indicates high risk for breast cancer. Many physicians do not classify LCIS as a malignancy and often encounter LCIS serendipitously (by chance) on breast biopsy while investigating another area of concern. While the microscopic features of LCIS are abnormal and are similar to malignancy, LCIS does not behave as a cancer (and therefore is not treated as a cancer). LCIS is merely a marker for a significantly increased risk of cancer anywhere in the breast. However, bilateral simple mastectomy may be occasionally performed if LCIS patients have a strong family history of breast cancer. More likely, LCIS patients are closely monitored with physician performed clinical breast exams every four months in addition to yearly mammography. Some patients may be given the drug tamoxifen to help prevent the development of breast cancer.

DCIS: the cancer cells are confined to milk ducts in the breast and have not spread into the fatty breast tissue or to any other part of the body (such as the lymph nodes). DCIS may be detected on mammogram as tiny specks of calcium (known as microcalcifications) 80% of the time. Less commonly DCIS can present itself as a mass with calcifications (15% of the time); and even less likely as a mass without calcifications (<5% of the time). Breast biopsy is used to confirm DCIS. Standard DCIS treatment is breast-conserving therapy (BCT): lumpectomy followed by radiation treatment or mastectomy. To date, DCIS patients have chosen equally among lumpectomy and mastectomy as their treatment option, though specific cases may sometimes favor lumpectomy over mastectomy or vice versa. Click here for more information on how to treat DCIS.

Stage I: The primary (original) cancer is 2 cm (approximately ? inch) or less in diameter and has not spread to the lymph nodes. Stage I breast cancer treatment usually consists of:

• Breast conserving therapy (BCT): lumpectomy (removal of cancerous lump and Small margin of surrounding normal tissue) and axillary node dissection (removal of underarm lymph nodes) followed by radiation

• Or modified radical mastectomy (removal of the affected breast) and axillary node dissection. Click here for more information on mastectomy.

Stage IIA: The primary tumor is between 2 and 5 cm in diameter and has not spread to the lymph nodes.

Stage IIB: The primary tumor is between 2 and 5 cm in diameter and has spread to the axillary (underarm) lymph nodes; or the primary tumor is over 5 cm and has not spread to the lymph nodes.

Common treatment for Stage II breast cancer is usually the same as Stage I treatment (lumpectomy and axillary node dissection or modified radical mastectomy), though radiation therapy is often necessary if the tumor is large or has already spread to the lymph nodes.

Stage IIIA: Primary breast cancer of any kind that has spread to the axillary (underarm) lymph nodes and to axillary tissues. Standard Stage IIIA breast cancer treatment is modified radical mastectomy with or without breast reconstruction. Lumpectomy may be performed if the tumor may be cut free with one incision. Radiation and systemic therapy such as chemotherapy or hormonal therapy often follows surgery. If the tumor is large, neoadjuvant chemotherapy (combination of anticancer drugs administered prior to surgery to shrink the size of a tumor) may be provided, with or without hormonal therapy.

Stage IIIB: The primary breast cancer is any size, has attached itself to the chest wall, and has spread to the pectoral (chest) lymph nodes. Stage IIIB treatment often begins with neoadjuvant chemotherapy to reduce the tumor’s size. Lumpectomy or modified radical mastectomy followed by chemotherapy, radiation, or chemotherapy plus hormonal therapy are standard treatments.

Stage IV: The primary cancer has spread out of the breast to other parts of the body (such as bone, lung, liver, brain). The treatment of Stage IV breast cancer focuses on extending survival time and relieving symptoms. Systemic treatment (treatment that affects the entire body) such as chemotherapy, hormonal therapy or both is often recommended. Radical mastectomy or the use of the drug tamoxifen may provide symptom relief in some cases.

Stage	Tumor (T)	Node (N)	Metastasis (M)
Stage 0	Tis	N0	M0
Stage 1	T1	N0	M0
Stage IIA	T0	N1	M0
	T1	N1	M0
	T2	N0	M0
Stage IIB	T2	N1	M0
	T3	N0	M0
Stage IIIA	T0	N2	M0
	T1	N2	M0
	T2	N2	M0
	T3	N1, N2	M0
Stage IIIB	T4	any N	M0
	any T	N3	M0
Stage IV	any T	any N	M1

Part III



Survival rates of breast cancer

Breast Cancer Survival Rate by Stage

Health care professionals are able to be predict a patient’s survival rate based on the determined stage of breast cancer. The following chart is an approximate survival rate for each stage of breast cancer. Percentages will vary depending on individual medical situations, etc.

Stage	5-year Relative Survival Rate
0	100%
I	98%
IIA	88%
IIB	76%
IIIA	56%
IIIB	49%
IV	16%

Source: American Cancer Society

A five-year survival rate refers to the average number of patients who are still alive five years after diagnosis with a specific stage of breast cancer. After seven years, the survival rate decreases for each stage. The average Stage I breast cancer survival rate is 92%. The Stage II survival rate is 71%, Stage III survival rate is 39%, and the Stage IV survival rate is 11%.

It is important to remember that these survival rates are based on averages. Some women with advanced breast cancer live significantly longer than seven years. Researchers are constantly developing new treatment alternatives to prolong breast cancer survival.

Inflammatory Breast Cancer

Inflammatory breast cancer is the appearance of inflamed breasts (red and warm) with dimples and/or ridges caused by the infiltration of tumor cells into the lymphatics. Inflammatory breast cancer can sometimes be difficult to distinguish between benign (non-cancerous) conditions (such as mastitis) and inflammatory malignancy (cancerous conditions). Though rare, inflammatory breast cancer may spread quickly to other parts of the body.

Treatment of inflammatory breast cancer treatment is generally quite similar to the treatment of Stage IIIB or IV breast cancer. In addition, patients usually undergo chemotherapy, hormonal therapy and/or radiation treatment. Patients who respond positively to systemic treatment may be candidates for mastectomy.

Paget’s Disease of the Nipple

Paget’s disease of the nipple is a rare form of breast cancer that begins in the milk ducts and spreads to the skin of the nipple and areola. The skin may appear crusted, red, or oozing. Prognosis is better if nipple changes are the only sign of the breast disease and no lump is felt.

Recurrence of Breast Cancer

Women who experience a recurrence of breast cancer after lumpectomy are often treated simply by mastectomy (with or without breast reconstruction).

If cancer reoccurs after mastectomy, additional surgery may be necessary to remove tumors near the mastectomy site, followed by radiation therapy. Chemotherapy and/or hormonal therapy may also be administered.



Alternative treatment options for recurrent breast cancer include:

• Hormone therapy
• Surgery and/or radiation therapy if cancer is confined to one area and is operable
• Entry into a clinical trial testing new chemotherapy or hormonal drugs, or biological therapy

Removal of the ovaries (oophorectomy) is also a possible treatment option for recurrent breast cancer, though the procedure is rarely performed in the United States.

Hi,

Here is my contribution...I picked this up from The World's Healthiest Foods.

What should you eat "more" to avoid the risks of breast cancer?

One’s risk for breast cancer is related to one's lifetime exposure to estrogen-like substances. the types of fats you eat and levels of other nutrients in your diet may greatly influence how your body processes estrogen-like substances, which clearly affect the risk for breast cancer.

Eat more

• Cold water fish such as salmon, tuna, herring, mackerel and halibut for their beneficial omega 3 fatty acids
• Eggs
• Olive oil
• Turmeric
• Soy foods
• Flaxseeds
• Legumes
• Sea vegetables
• Organically grown Brassica vegetables including broccoli, kale, mustard greens and Brussels sprouts
• Fresh fruit, especially cranberries and citrus
• Apples

Avoid well done meat, polyunsaturated fats, caffeine-containing foods and beverages and alcohol.

I would like to share this info on green tea

First of all, what is green tea? Just like black tea, it comes from the Camellia sinensis plant. Black tea is fermented and green tea is not (oolong tea is partly fermented). Green tea is very popular in China and Japan and is gaining favour in other nations too. They have been drinking green tea for health reasons for over 5,000 years in Asia.



Some of the various chemical compounds in green tea:

• polyphenols and flavonoids
• alkaloids, such as caffeine and theobromine
• carbohydrates
• tannins
• minerals, such as fluoride and aluminum

When it comes to cancer treatment and prevention, it's the polyphenols that are important. Green tea has higher amounts of these chemicals than black tea because the fermentation process alters their composition. Of all the different polyphenols, one seems to stand out above the rest. EGCG (epigallocatechin gallate) is a very powerful antioxidant and is believed to be an important player in the therapeutic qualities of green tea. How it works is still unclear, but it may inhibit cell-replication enzymes (preventing cancer growth) as well as other cellular processes that are too complicated to get into.

In various studies, rats with breast tumors were given green tea to drink and compared to similar rats that only drank water. The green-tea-rats had reductions in tumor size, and new tumors were slower to develop. There don't seem to have been any studies on humans yet.

For humans to gain any health benefits, you would need to drink around 3-4 cups every day (without milk or sugar). For people who are at-risk for developing cancer, it might be a worthwhile avenue to pursue. I think for the everyday person, that's a lot of tea to drink. You can also get your green tea in capsule form, but there have been no studies done on the effectiveness of such pills.

A major concern with drinking so much tea is the caffeine. Though there is less caffeine in tea than in coffee, it does start to add up when drinking large volumes. But can you switch to decaf? The answer is, maybe. It all depends on how your chosen tea is decaffeinated. Tea that has been decaffeinated with a solvent (such as Ethyl Acetate) is going to have a much lower level of EGCG, than a tea that has been processed with a water/carbon dioxide method. Water decaffeinated tea will retain almost 95% of its EGCG.

So there is one more good reason for us women to drink green tea. I read that green tea might also help against prostate cancer, but that's another article altogether.

Have read some time ago that wearing a bra 24hrs. a day is bad and can eventually lead to breast cancer !! How true is this ??