Breast Cancer Risk Factors and Prevention

Prevention of breast cancer is not an actual treatment procedure. It is steps you can take to decrease your chances of getting breast cancer. Avoiding risk factors and increasing protective factors may help prevent breast cancer.

These risk factors include:

Endogenous Estrogens are hormones naturally produced by the female body. Long exposure to this hormone increases the risk of breast cancer. Early menstruation, late menopause and late or not being pregnant over 35 years of age increase estrogens exposure to the breast tissues.

Exposure to frequent radiation therapy, such as chest x-ray, especially for inheritors of breast cancer.
Obesity in mostly post-menopausal women who have not had hormonal replacement therapy

High level of alcohol consumption

Inherited risk of women who inherited certain genes are at high risk. Check to see if your family has a history of breast cancer!

The steps you can take to lower your risk of breast cancer include:

Receiving a yearly mammogram beginning at age 40 years old, or 35 years old if you have a family history of breast cancer.

Frequent safe exercise helps reduce the level of estrogen produced by the body and can help lower breast cancer risk.

Decreasing the breast tissue exposure to estrogen by breast feeding, early menopause, pregnancy etc. would reduce the risk of breast cancer.

Selective Estrogen Receptor Modulators (SERMs) are drugs that act as estrogen on some tissues and block estrogen effects on other tissues. These drugs, Tamoxifen and Raloxifene, are used to strengthen bones in women with decreased bone density (osteoporosis).

Aromatase inhibitors blocks the action of an enzyme called aromatase, which is used to make all of the body's estrogens and decreases its amount. Side effects may include osteoporosis and effects on brain function like memory, talking etc.

Prophylaactic Mastectomy is the removal of both breasts when there are no signs of breast cancer. This is mostly common with inheritors but it is required to get counseling and cancer risk assessment.

Prophylactic Oophorectomy is the removal of the ovaries without the sign of cancer.

Fenretinide is a type of vitamin A called a retinoid. Fenretinide may lower the risk of premenopausal women who have had a history of breast cancer. Some side effects include night blindness, skin disorders. Pregnancy must be avoided while women are taking this drug because the fetus could be harmed.

Some other factors that have not been proven, but may be linked to breast cancer are

abortion, environment, diet, oral contraceptives and active or passive smoking.

Don't forget to talk to your doctor about your personal risk, share your family health history, get screened and make healthy lifestyle choices!

Reference

http://www.cancer.gov/cancertopics/pdq/prevention/breast/Patient/page3#Keypoint4

Dania Lara, Breast Cancer Survivor

Types of Breast Masses (Benign and Malignant)

It’s important to know about the different type of breast masses.  Not all breast lumps are cancerous!  Here is a brief overview of the most common, and not-so common breast masses.

Let’s first take a look at a normal breast:

You can see that the breast is made up of many different types of tissue including fat, ligaments, ducts, and mammary tissue which is where milk is produced.  This area is the functional portion of the breast.  This tissue is made up of “Terminal ductal lobular units” or “TDLUs”.  This is where nearly all breast masses (abnormal breast tissue) develop.  The mass could be either benign (not cancer), or malignant (cancer).

There are many different types of benign breast masses.  Here are some of the most common

Benign Breast Masses

Cysts  

 A cyst is simply a fluid filled sac.  It can be simple, complex (with debris or septations), or sebaceous (filled with oil).  These are very common and typically nothing to worry about!  Sometimes they are removed if they are causing any discomfort.  Some women have many cysts within their breasts, and this can be termed “Fibrocystic breasts”.

Fibroadenoma 

Fibroadenomas are the most common solid breast mass in women over 35 years old.  They too are usually not removed unless they cause discomfort. 

Ductal or Intracystic Papilloma 

 A papilloma is a proliferation (accumulation) of cells.  It can form within a mammary duct or within a cyst.  Commonly, women who develop a papilloma will have bloody nipple discharge.

Lipoma 

 A lipoma is simply a mass made of fat, also known as adipose tissue.

Hamartoma 

A hamartoma is a proliferation of a mixture of fibrous, glandular and fatty tissues.

Fluid collections: Seroma, Hematoma, Abcess

A fluid collection can form within the breast after having any type of breast injury or surgery.

***

There are also different types of malignant breast masses.  Here are some of the most common:

Malignant Breast Masses

Invasive Ductal Carcinoma (IDC) 

Invasive ductal carcinoma is the most common type of breast cancer.   This type of cancer develops within the mammary ducts, but has spread beyond them into surrounding tissues.

Invasive Lobular (ILC) 

Invasive lobular carcinoma forms within the lobules of the breast.   It is the second most common type of breast cancer.  ILC is often difficult to detect on either mammogram or ultrasound. 

Ductal Carcinoma In Situ (DCIS)

DCIS is the non-invasive form of Invasive Ductal Carcinoma.  In other words, this is ductal breast cancer before it has spread.   It is the most common type of non-invasive breast cancer.

   An interesting study was published in November of 2011 which involved Latina women and white women who were recently diagnosed with DCIS.  According to Kaplan et al. (2011), past evidence has suggested that Latinas are less likely to use breast conserving surgery to treat DCIS when compared to white women.  This study aimed to determine why this discrepancy existed.  Women diagnosed with DCIS and living in California were surveyed about how they treated their cancer. Did they completely remove their breast with a mastectomy, or did they try to conserve their breast?  The results of the survey showed that there were no differences in receipt of mastectomy or breast conserving surgery between ethnic groups.  What could this result mean for Latinas?  Feel free to write your thoughts below!

Read the full study here

http://proxy-tu.researchport.umd.edu/login?ins=tu&url=http://search.ebscohost.com.proxy-tu.researchport.umd.edu/login.aspx?direct=true&db=aph&AN=58043739&site=ehost-live

Lobular Carcinoma In Situ (LCIS)

 LCIS is an abnormal area that has formed within the milk producing glands within the breast.  The cancer has not yet spread beyond the glandular tissue.  This is not a true cancer. 

Inflammatory Breast Cancer (IBC) 

Inflammatory breast cancer is very rare and very aggressive.   Signs of IBC included reddening and swelling of the breast.

 Paget’s Disease of the Nipple 

With Paget’s disease, breast cancer develops in or around the nipple.  The nipple becomes scaly, red, and itchy.

Phyllodes Tumors

Phyllodes tumors are also very rare.  Some types are benign and some are malignant.  They tend to grow very rapidly, but rarely spread outside the breast.

Male Breast Cancer
Men can develop breast cancer as well, although it is very rare.

 Metastatic Carcinoma

Cancers within the breast can either originate within the breast (all of the types above), or originate in other parts of the body and spread, or metastasize, to the breast.  Metastatic breast cancers are extremely rare; however, most often come from bones, lungs, intestines, or ovaries.

Other less common types:

Tubular Carcinoma

Medullary Carcinoma

Colloid (mucinous) Carcinoma 

Papillary Carcinoma

Cribiform Carcinoma

Read more about these rare invasive breast cancers, and all of the different types of breast cancers here:

English http://www.breastcancer.org/symptoms/types/

Spanish http://www.breastcancer.org/es/sintomas/tipos/

The following pie chart shows the incidences of each subtype of breast cancer.

References
Breastcancer.org. (2011). Types of breast cancer. Retrieved from http://www.breastcancer.org/symptoms/types/

Iversen, C. B. (2009).  Breast ultrasound registry review [PowerPoint slides]. Baltimore, MD: Johns Hopkins Hospital Schools of Medical Imaging.

Kaplan, C., Nápoles, A., Hwang, E., Bloom, J., Stewart, S., Nickleach, D., & Karliner, L. (2011). Selection of treatment among Latina and non-Latina white women with ductal carcinoma in situ. Journal Of Women's Health (2002), 20(2), 215-223.

Tumor Size

The size of the tumor helps to determine the stage of breast cancer. Doctors measure tumors in centimeters (cm). Everyday items can help you visualize the size of cancer tumors. For example, early-stage tumors may be no more than 1cm or a size of a pea. It is important to get yearly mammograms and do regular breast self exams (BSE) to detect any abnormalities because early tumors can be very small and unnoticeable.

Reference

http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page2

Stages of Cancer

There are 5 stages of cancer: Stage 0, I, II, III, IV and V

Stage 0

Stage 0 is the first stage of cancer. In this stage, there are cells reproducing abnormally. However, these cells have not spread out the milk ducts or elsewhere. 

This stage falls into two different types: 

Ductal carcinoma in situ (DCIS)/intraductal carcinoma or Lobular carcinoma

Ductal carcinoma - abnormal cells appear in the ducts of the breast. 

Lobular carcinoma - develops when abnormal cells appear in the lobes of the breast

Stage I

The tumor is no more than 2 cm (3/4 inch) in diameter.

The cancer has not spread to the lymph nodes. The cancer has not spread outside the breast

Stage II

In Stage II, the breast tumor is larger than a Stage I tumor. However, the cancer has not spread to a distant part of your body. 

If cancer is in Stage II, one of the following is true:

The tumor is 2 to 5cm (3/4 to 2inches) in diameter. The cancer may or may not have spread to the underarm area (axillary) lymph nodes. 

The tumor is more than 5cm (2 inches) in diameter, but the cancer has not spread to your axillary lymph nodes (Picture A).

or 

The tumor is less than 2cm (3/4 inch) in diameter, but the cancer has spread to no more than three of your axillary lymph nodes (Picture B).

Tumor is found in the breast, but breast cancer cells are detected in no more than three of your axillary lymph nodes.

Stage III

Stage III of breast cancer is known as locally or advanced cancer. The cancer may have spread to the lymph nodes near your breast (these are located under your arm or by your collarbone). However, the cancer has not spread to more distant parts of the body.

Stage IV

Stage IV is the most advanced stage of cancer. 

At this point, breast cancer cells have spread to other parts of the body, such as bones, organs or lymph nodes far from your breast. This stage of cancer is also called metastatic breast cancer. 

Reference
    MayoClinic. (2011, August 2). Breast Cancer. Slide show: Stages of breast cancer. Retrieved December 11, 2011, from http://www.mayoclinic.com/health/stage-of-breast-cancer/BR00011 

Rocio Fight

Breast Self Exam (BSE)

Beginning in their 20's, a women should start performing Breast Self Exam (BSE).  Here are some things to kept in mind when performing a BSE:

• Be in an area with good lighting
• Have a mirror available to look for any changes in the breast
• Perform the examination one week after your menstrual cycle (period) each month
• If you no longer have a menstrual cycle (period), pick the same day every month to complete your examination
• Women with breast implants can do BSE as well. Talk to your surgeon to help you identify the ridges of your implants.

Check out this link on how to perform a BSE!

http://www.intelihealth.com/IH/ihtIH/WSIHW000/9103/32859/355794?d=dmtContent

References
Atena Inteli Health. (2011, February 8).  Women's health. Breast self examination. Retrieved December 11, 2011, from http://www.intelihealth.com/IH/ihtIH/WSIHW000/9103/32859/355794?d=dmtContent


American Cancer Society.  (2011, October 4).  Breast cancer: early detection.  Breast awareness and self exam.  Retrieved December 11, 2011, from www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastCancerEarlyDetection/breast-cancer-early-detection-acs-recs-bse