Breast Cancer Treatment, Part 2

by National Cancer Institute

(Page 2 of 9)

What Causes Breast Cancer?

Medical researchers are learning about what happens inside cells that may cause cancer. They have identified changes in certain genes within breast cells that can be linked to a higher risk for breast cancer. Breast cells contain a variety of genes that normally work cooperatively with a woman's natural hormones, diet, and environment to keep her breasts healthy. Certain genes routinely keep breast cells from dividing and growing out of control and forming tumors. When these genes become altered, changes occur and a cell no longer can grow correctly.

Genetic changes may be inherited from a parent or may accumulate throughout a person's lifetime. Breast cancer usually begins in a single cell that changes from normal to malignant over a period of time. Presently, no one can predict exactly when cancer will occur or how it will progress. When breast cancer is diagnosed - even if detected at the earliest stage - it is not yet possible to predict which cancer cells will be treated successfully and which will continue to grow and spread quickly to other parts of the body.

What is known:

• You should not feel guilty. You haven't done anything wrong in your life that caused breast cancer.
• You cannot "catch" breast cancer from other women who have the disease. It is not contagious.
• Breast cancer is not caused by stress or by an injury to the breast.
• Most women who develop breast cancer do not have any known risk factors or a history of the disease in their families.

Who Gets Breast Cancer?

Every woman has some chance of developing breast cancer during her lifetime. As women get older, their chances increase. Breast cancer is the most frequently diagnosed cancer in women in the United States today, other than skin cancer. Even though breast cancer is more common in older women, it also occurs in younger women and even in a small number of men.

Gene Testing

Medical researchers are now able to look within cells, and are making new discoveries that explain how genes are related to cancer and other diseases. They have identified specific genes linked to breast cancer and other cancers that run in families. Tests are becoming available for women and family members who choose to find out if they have inherited the genetic changes that increase their risk for cancer. There is still much uncertainty involved with gene testing. If you or your family members are considering testing, your doctor or a genetics counselor can give you guidance and help you make an informed decision. It's important to consider carefully the benefits, risks, limitations, and the far-reaching consequences of gene testing.

Making a Decision About Treatment

The only way to find out for sure if a breast lump or abnormal tissue is cancer is by having a biopsy. The suspicious tissue that is removed by a surgeon or radiologist during a biopsy is examined under a microscope by a pathologist who makes the diagnosis. If your biopsy result is positive, it means that the tumor or tissue from the suspicious area contains cancer and you will need treatment. Information on the following pages can help you understand the various treatments that are available and decide what is best for you. It is safe to begin treatment up to several weeks after diagnosis. This gives you time to:

• Have a complete study of your breast tissue and tests of other parts of your body.
• Get other opinions about your diagnosis and the suggested treatment plan.
• Talk with each of the specialists who will be on your treatment team.
• Call your health insurance plan before treatment begins.
• Call NCI's Cancer Information Service at 1-800-4-CANCER for the most up-to-date, accurate breast cancer treatment information.
• Contact breast cancer organizations to find support groups near you.
• Talk with other women who have had breast cancer and have gone through treatment.
• Prepare yourself and loved ones for your treatment.

Remember, you don't have to face breast cancer alone - there are knowledgeable and caring people who can help you.

Are All Breast Cancers Alike?

Breast cancer is a complex disease. All cases are not the same. Once breast cancer has been found, more tests will be done to find out the specific pattern (description) of your disease. This important step is called staging. The following chart explains the stages. Knowing the exact stage of your disease will help your doctor plan your treatment. Your doctor will want to know:

• The size of the tumor and exactly where it is in your breast.
• If the cancer has spread within your breast.
• If cancer is present in your lymph nodes under your arm.
• If cancer is present in other parts of your body.

Breast Cancer in situ - DCIS and LCIS

Many breast cancers being found are very early cancers known as breast cancer in situ or noninvasive cancer. Most of these cancers are found by mammography. These very early cell changes may become invasive breast cancer. Two types of breast cancer in situ are:

DCIS (ductal carcinoma in situ), which means that abnormal cells are found only in the lining of a milk duct of the breast. These abnormal cells have not spread outside the duct. They have not spread within the breast, beyond the breast, to the lymph nodes under the arm, or to other parts of the body. There are several types of DCIS. If not removed, some types may change over time and become invasive cancers. Some may never become invasive cancers. (DCIS is sometimes called intraductal carcinoma.)

LCIS (lobular carcinoma in situ), which means that abnormal cells are found in the lining of a milk lobule. Although LCIS is not considered to be actual breast cancer at this noninvasive stage, it is a warning sign of increased risk of developing invasive cancer. LCIS is sometimes found when a biopsy is done for another lump or unusual change that is found on a mammogram. Patients with LCIS have a 25 percent chance of developing breast cancer in either breast during the next 25 years.

Microcalcifications are very small specks of calcium that can't be felt, but can be seen on a mammogram. They are formed by rapidly dividing cells. When they are clustered in one area of the breast, this could be an early sign of breast cancer in situ. About half of the breast cancers found by mammography appear as clusters of microcalcifications. The other half appear as lumps.

About the Author

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