The following guide was developed to help interested parties better understand Breast Cancer as well as the different types, treatments, and research. Please use this guide as an informational tool to help you and/or your loved one better understand the Breast Cancer and how we are all working towards a common goal of finding the best treatment possible.

Breast Cancer Background
Cancer is a group of diseases that cause cells in the body to change and grow out of control. A group of rapidly dividing cells may form a lump or mass of extra tissue called a tumor. Tumors can either be malignant (cancerous) or benign (non-cancerous). Malignant tumors penetrate and destroy healthy body tissues and can break away spreading through the body to grow in other areas. This process is called metastasis. Usually, cancer is named after the body part in which it originated; thus, breast cancer refers to the erratic growth and spreading of cells that originate in the breast tissue.

Types of Breast Cancer
The breast is composed of two main types of tissues: glandular tissues and stromal (supporting) tissues. Glandular tissues house the lobules (milk-producing glands) and the ducts (the milk passages) while stromal tissues include fatty and fibrous connective tissues of the breast. The breast is also made up of lymphatic tissue, which is immune system tissue that removes cellular fluids and waste.

There are several types of tumors that may develop within different areas of the breast. Most are benign, such as fibrocystic changes which may feel lumpy and can cause breast swelling and pain but do not spread and are not life threatening. Malignant tumors are usually hard, painless lumps with irregular edges but some rare cancers are tender, soft and rounded. The most common types of breast cancer are listed below:

Lobular carcinoma in situ (LCIS, lobular neoplasia) is a sharp increase in the number of cells within the lobules of the breast. The term, "in situ," refers to cancer that has not spread past the area where it initially developed. Many physicians do not classify LCIS as breast cancer, but it does increase a woman's risk of developing cancer later in life. Ductal carcinoma in situ (DCIS) is breast cancer at the earliest stage and is confined to the ducts with almost 100% chance of being cured. Infiltrating (invasive) ductal carcinoma (IDC) starts in a duct and penetrates the wall of the duct, invading the fatty tissue of the breast and possibly other regions of the body. IDC is the most common type of breast cancer accounting for nearly 80% of cases. Infiltrating (invasive) lobular carcinoma (ILC) begins in the lobules of the breast but often spreads to other regions of the body. ILC accounts for 10% to 15% of breast cancers.

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Risk Factors
The exact cause of breast cancer is not known, however, there are certain risk factors linked to the disease. Some are due to genetic mutations such as HER2, BRCA1 or BRCA2 genes, which may be inherited or acquired. Only about 10% of breast cancers are caused by this but 50%-60% of women with these inherited gene mutations will develop breast cancer by the age of 70. Women with close blood relatives having the disease are also at greater risk and having a mother, sister or daughter with breast cancer almost doubles the risk. The chance of developing breast cancer increases as a woman gets older and there is a slight increased risk if menstruation started before the age of 12 or menopause began after the age of 50.

Women who have had their first child after they were 30 years old or who have not had children are also slightly more at risk.

There are other risk factors that can be controlled. Most studies suggest that long-term use of hormone replacement therapy (HRT) for menopause symptoms can increase the risk of breast cancer slightly. There is a clear link between the use of alcohol and breast cancer with studies showing that consumption of 2 to 5 alcoholic drinks per day increases the risk one and a half times. There are conflicting studies regarding diet and exercise in relation to breast cancer as well as whether or not breast-feeding has an impact on risk and more research is being done in these areas. Being at risk does not indicate breast cancer and some women with one or more risk factors never develop the disease, while most women who have developed breast cancer did not appear to have any risk factors.

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Symptoms and Diagnosis
The most common symptom of breast cancer is an abnormal lump or swelling in the breast. It is usually painless and hard with irregular borders and may also appear beside the breast or under the arm. Other symptoms may include unexplained breast pain, a change in the size or shape of the breast, abnormal nipple discharge, change in appearance or sensation of the nipple, changes in breast texture, or changes in the skin on or around the breast. Bone pain, weight loss, swelling of one arm and skin ulceration are symptoms of advanced disease.

Breast tumors may be first discovered by the patient as the result of a regular breast self-examination (BSE) or by a routine screening mammogram. Further testing such as a diagnostic mammogram may help identify the breast mass and an ultrasound can show whether the lump is solid or fluid-filled. A needle aspiration or needle biopsy of a lump can also demonstrate if it is fluid-filled and provide material to send to the laboratory for analysis. A surgical biopsy or breast lump removal provides a portion or all of a breast lump for laboratory study.

If breast cancer is diagnosed, additional testing is performed, including chest X-ray and blood tests. Surgery, radiation, chemotherapy, or a combination of these may then be recommended, not only for treatment but also to help determine the stage of disease which is very important to help guide future treatment and follow-up and to give some idea of what to expect in the future.

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Breast Cancer Staging
There is more than one system used to determine how far the cancer has spread but the Tumor-Nodes-Metastases (TNM) staging system is considered to be the most precise. It separately assesses the tumor size (T), whether it has spread to the lymph nodes (N) and any further metastasizing (M). Each letter is followed by a number that further indicates the severity of the cancer.

Traditionally, a less complex system states stages from 0 to IV. The lower the number, the less the cancer has spread. For stage I, II or III cancers, the main considerations are to treat the cancer and to prevent any recurrences. Stage IV breast cancer cannot be cured in most cases and the goal is to improve symptoms and prolong survival.

Many additional factors besides staging can influence the recommended treatment and the likely outcome. The precise cell type and appearance of the cancer, whether the cancer cells respond to hormones, and the presence or absence of genes known to cause breast cancer are all factors to take into consideration.

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Treatments and Side Effects
There are many different treatments and combination of treatments available. Surgery, radiation therapy, chemotherapy and hormone therapy are the most common treatments although some people choose less conventional alternative medicine.

Surgery is performed to remove as much of the cancer as possible, to see whether the cancer has spread, to relieve advanced symptoms or to reconstruct the appearance of the breast. Possible side effects may include changes in arm and shoulder mobility, swelling, numbness and infection. There has been a move away from very aggressive surgery in recent years. Until 20 years ago, there were very few options available and radical mastectomies were widely performed removing the entire breast and all the lymph nodes in the area. A biopsy was usually performed under general anesthesia and if cancer was found, the doctor went ahead with treatment such as a mastectomy while the patient was still asleep. Some women today with a high risk of breast cancer opt for surgical removal of both breasts before any signs of symptoms appear even though there is no way to tell if they will actually develop the disease and there is no guarantee that cancer will not develop anyway in the tissue left behind.

Radiation therapy shrinks or kills cancer cells with high energy rays such as x-rays and can be directed at the tumor, the breast, the chest wall, or other tissues known or suspected to have remaining cancer cells. Some side effects of radiation therapy are swelling or thickening of the breast, vomiting, diarrhea, fatigue and skin irritations resembling sunburn.

Chemotherapy is the use of drugs taken by mouth or intravenously to kill cancer cells. It is administered in cycles, with each period of treatment followed by a recovery period. The total course can last from three to six months and is often more effective using several drugs. Side effects of chemotherapy include hair loss, immune suppression, mouth sores, nausea and fatigue.

In addition to killing cancer cells, very high doses of chemotherapy or radiation will kill blood-producing stem cells in the bone marrow as well. Bone marrow transplantation (BMT) is a very painful procedure that can cause serious side effects. Studies have shown that women who received the high dose therapy did not live longer than women who received standard dose chemotherapy and research is still going on to validate this controversial procedure.

Hormone therapy with hormonal drugs such as Tamoxifen and Raloxifene blocks the effect of estrogen to stimulate tumor growth in some women. Megace blocks the action of progesterone by partially mimicking the hormone and Herceptin is a manufactured antibody that binds to growth factor receptors on the surface of cancer cells to stop them from spreading.

Alternative and complementary treatments for cancer, such as acupuncture, herbs, vitamins and diet are becoming increasingly popular. However, although some can safely be used along with standard medical treatment, others can interfere and cause serious side effects. Alternative or non-traditional therapies are becoming more acceptable as scientific evidence supports their value but they should be used in conjunction with conventional therapy under guidance of a physician.

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Early Detection
Early detection greatly improves the odds of survival. When diagnosed early, breast cancer has a very high five-year survival rate, and patients who reach this stage often go on to live long, healthy lives. Survival rates are lower for cancers that have spread locally, and they are very low for cancers that have metastasized to other parts of the body.

Breast cancer is the second leading cause of cancer-related deaths among women age 35 to 54. An estimated one in eight women are expected to develop breast cancer in their lifetime. Breast cancer rates in the United States are among the highest in the world. The United States alone currently has 3 million breast cancer patients and survivors. Each year, an additional 186,000 women are diagnosed with breast cancer and another 46,000 women die. The mortality rate from breast cancer has decreased however in recent years due to an increased emphasis on early detection and more effective treatments.

At this time, breast cancer cannot be completely prevented, but the risk of developing advanced disease can be greatly reduced by early detection. Medical societies recommend a monthly BSE for all women over the age of 20, a breast exam by a health care professional every three years for women 20-39 years old, and a yearly mammogram for all women 40 and older. Even though a mammogram is considered a very useful screening tool, it is estimated that a tumor has been developing for eight to ten years by the time it is visible on an x-ray. There is an urgent need for a diagnostic test that will determine the presence of cancer at a much earlier stage.

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Ongoing Research
Worldwide research projects and clinical trials are underway as part of the global effort to understand more about the earlier diagnosis and treatment of breast cancer. Studies are attempting to identify possible environmental causes of breast cancer as well as to understand the physical, social and emotional issues confronting breast cancer survivors. New drugs used alone or in combination with other agents are being tested for their effects on preventing or treating breast cancer. Laser techniques that do not leave noticeable scarring are being tested as an alternative to conventional surgery.

Mammography research is focused on both trying to lower radiation dosages as well as using new digital technology to improve tumor resolution. Alternate imaging technologies such as magnetic resonance imaging (MRI) and breast specific positron emission tomography (PET) continue to attempt to enhance the detection of smaller and smaller tumor masses. A possible vaccine is being tested and many biotech companies are intensely involved in trying to identify specific proteins which are uniquely released into a woman's blood stream, urine or nipple fluid by cancer cells as they grow. It is hoped that the ability to detect these protein markers with increasingly better sensitivity would allow physicians to find alternate techniques to diagnose breast cancer other than via imaging modalities used today.

Finally, recent attempts to push the process of earlier detection of breast cancer even further have now focused on developing a biological blood test to assess a woman's risk for breast cancer. Such a biological test has never before been available and would herald a remarkable new approach to breast cancer. Ultimately, such a test should provide the opportunity to significantly improve the survival rate for breast cancer patients by greatly facilitating the early awareness of women at risk for breast cancer.

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