Breast Cancer information provided by Dr. Vivian L Lindfield of Western New York (WNY) Breast Health.

Cancer is the name for a group of diseases that develop when the body’s cells grow in an uncontrolled way and spread into the body’s tissues. Normally, cells in the body grow and divide in a controlled way.  Sometimes this process gets out of control. When cells grow in an uncontrolled way and spread into the body’s tissues, this is called invasive cancer. The site where the cancer starts is called the primary cancer.  Sometimes cancer cells can break away from the original cancer and travel in the bloodstream or lymphatic system to other parts of the body. If cancer cells from the original cancer start growing in another part of the body, this is called a metastasis (also known as a secondary or advanced cancer).

Lymphatic system: tiny vessels next to blood vessels that collect fluid and waste products from the body’s tissues. Lymphatic vessels are connected by glands called lymph nodes.  Lymph nodes protect the body from infection by removing foreign substances from the body.

Metastasis: the name for cancer that spreads to another part of the body. Also known as a secondary cancer.

To understand what breast cancer is, it helps to know what a breast looks like on the inside.  Breasts are made up of lobules and ducts, surrounded by fatty and connective tissue. The lobules produce breast milk and the ducts carry the milk to the nipple. The lymph nodes closest to the breast are in the armpit (axiliary nodes).  There are also lymph nodes under the breastbone (internal mammary nodes) and in the neck (supraclavicular nodes).

Early breast cancer is cancer that is contained in the breast and may or may not have spread to lymph nodes in the breast or armpit. Some cancer cells may have spread outside the breast and armpit area but cannot be detected. Early breast cancer can develop in the ducts or lobules of the breast. The cancer cells spread outside the ducts or lobules into the breast tissue and may form a lump.  This is called ‘invasive breast cancer’. Sometimes breast cancer cells spread to other parts of the body, such as the bones or the liver. If this happens, the cancer is referred to as a secondary breast cancer, not bone cancer or liver cancer. Other types of breast cancer include:
• ductal carcinoma in situ (DCIS) — non-invasive breast cancer that is confined to the ducts of the breast
• lobular carcinoma in situ (LCIS) — non-invasive breast cancer that is confined to the lobules of the breast
• Paget’s disease of the nipple — rare form of invasive breast cancer that affects the nipple and the area around the nipple (the areola)
• inflammatory breast cancer — rare form of invasive breast cancer that affects the blood vessels in the skin of the breast, causing the
breast to become red and inflamed
• locally advanced breast cancer — invasive breast cancer that has spread to areas near the breast, such as the chest wall.

It is not possible to say what causes breast cancer in an individual. However, some features are more common among women who have developed breast cancer. These features are called risk factors. Having one or more risk factors for breast cancer does not mean you will
definitely develop breast cancer. In fact, many women with breast cancer have no obvious risk factors. Known risk factors for breast cancer include:
• being a woman
• getting older
• inheriting a faulty gene (called a gene mutation) that increases the risk of breast cancer
• having a strong family history of breast cancer.

A strong family history means having three or more first- or second-degree relatives on the same side of the family with breast or ovarian cancer. A family history on your father’s side is just as important as on your mother’s side.

Breast cancer can be found in different ways. You or your doctor may have noticed a change in your breast, or the cancer may have been found after a routine mammogram or after a biopsy for another reason. Your doctors will have done a series of tests to find out whether the change in your breast was due to cancer. These tests will have included a physical examination, imaging tests (for example a mammogram, ultrasound or MRI) and one or more biopsies. Mammogram: a way of examining the breasts using low-dose X-rays.
Ultrasound: a way of examining the breasts and/or the armpit area using high frequency sound waves.
MRI: magnetic resonance imaging — a way of examining the breasts, armpit or chest using magnetic fields.
Biopsy: removal of cells or tissue from the body for examination under a microscope.

Breast cancer is the most common invasive cancer among women. One in 8 women will be diagnosed with breast cancer before the age of 85 years. Breast cancer can occur at any age but is more common in older women. In 2002, about a quarter of women diagnosed with breast cancer were younger than 50 years, about half were 50–69 years and about a quarter were 70 years and older. Men can also develop breast cancer. Breast cancer is much less common in men than in women. One in 763 men will be diagnosed with breast cancer
before the age of 85 years. Breast cancer is more common in men aged 50 years and older.

Early breast cancer can be treated successfully. Most people diagnosed and treated for early breast cancer will not die from the disease.
Some people want to know how likely they are to survive breast cancer. Looking at statistics about other people who have been diagnosed and treated for breast cancer can be helpful. However, it is important to remember that these are overall statistics. Everyone’s situation is different.

Breast cancer survival is measured by counting the number of people who are alive five years after treatment. Most people live much longer than five years, but the statistics are measured in this way. Of all the women diagnosed with breast cancer between 1998
and 2002, over 86% were still alive five years later. This includes women with early breast cancer and those with secondary breast cancer. Survival for women with early breast cancer alone is higher than this. For women with small cancers (10 mm or less in diameter), 5-year survival is almost as high as that for women without breast cancer. In general, survival for men with breast cancer is similar to that for women with breast cancer when the stage of the disease at diagnosis is the same.

After a biopsy or breast surgery, the cells or tissue are sent to a pathologist. The pathologist looks at the cells or tissue under a microscope and writes the results in a pathology report. This will usually take a couple of days. The information in the pathology report will help you and your doctors decide what treatments are best for you. You may find it helpful to keep a copy of your test results. You can also ask for a copy of your pathology report.

Hormone report shows whether your breast cancer is positive or negative for hormone receptors. This will affect whether hormonal therapies are recommended for you. There are two types of hormone receptors — estrogen receptors and progesterone receptors. If there are hormone receptors on your breast cancer cells, your breast cancer is said to be estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+). Hormone receptors: proteins in a cell that allow hormones to bind to the cell. Hormone receptors must be present for the cell growth to be influenced by hormones.

HER2 status report shows whether there are HER2 receptors on your breast cancercells. This is called the HER2 status of your breast cancer cells. This will affect whether treatment with trastuzumab (Herceptin®) is recommended for you. HER2: a protein on a cell that allows a growth factor to bind to the cell, causing the cell to divide. HER2 is also called HER2-neu or c-erbB2. Lymph nodes The report shows whether there are cancer cells in the lymph nodes in your armpit (axilla) or near your breast. This information will usually only
be available after breast surgery and may affect whether chemotherapy is recommended for you. Lymph nodes: glands in the armpit and other areas of the body that protect the body from infection.

Surgical margin - The surgeon will remove the breast cancer and some healthy looking tissue around the cancer. The healthy looking tissue is called the surgical margin. If there are no cancer cells in the healthy looking tissue, it is likely that all the cancer has been removed. In this case, the surgical margin is said to be ‘clear’. This information will only be available after breast surgery. If the surgical margin is not considered to be ‘clear’, you may need to have more surgery. This is important to ensure that all of the cancer is removed.

Grade of breast cancer The grade of the cancer shows how fast the cancer cells are growing. The cancer grade is numbered from 1 to 3. A low grade (Grade 1) means that the cancer is growing slowly. A high grade (Grade 3) means that the cancer is growing more quickly. The higher the grade means the cancer is more active. This means it is more likely that the cancer has spread outside the breast and armpit area. The higher the grade means it is more likely that systemic treatments (treatments that affect the whole body, such as hormonal therapy or chemotherapy) will be recommended.

Stages of breast cancer - Your doctor might talk about the stage of your breast cancer. The stage is a way of summarizing the information from the pathology report. Stages of breast cancer are numbered from I to IV. Early breast cancer may be called Stage I, Stage IIA or Stage IIB (2-5 cm).

Early breast cancer can be treated successfully. For most women, breast cancer will not come back after treatment. Sometimes breast cancer is found later in the same breast or in other parts of the body. Everyone is different and there is no way of telling for sure whether breast cancer will or will not come back. Doctors use the information in the pathology report to work out how likely it is that breast cancer will come back or spread to other parts of the body. The main features known to affect the chance of breast cancer coming back or spreading are listed in the following table. These are general statements based on experience with women who have had breast cancer.