As we enter October, we officially kick off Breast Cancer Awareness Month. Yet beyond fundraising and awareness efforts like races and wearing pink, educating yourself and others about the cause itself is critical, and perhaps the most important thing you can do.
We spoke with Margaret Flowers, PhD. Director, Scientific Communications and Grants at the Breast Cancer Research Foundation (BCRF) to find out exactly what we all need to know about breast cancer.
The first step to fully understanding the disease lies in understanding what cancer itself is. “Cancer refers to a collection of diseases in which cells begin to divide and grow out of control,” Flowers explains. “This growth is the result of mutations or other alterations in genes that control these processes. In solid tissues (lung, liver, breast, etc.) this growth can result in the formation of a solid tumor, which is simply a mass of abnormal cells. Malignant tumors are those that break through—or invade—normal tissue barriers or spread to other tissues.” Universally, the term "cancer" tends to refer to a malignancy that could potentially be life threatening, especially if untreated.
When it occurs in the breast, she continues, “Breast cells grow out of control and form a tumor. Breast cancer can begin in different parts of the breast, but most often it begins in the breast ducts—thin tubes that carry milk from the milk-producing lobules to the nipple during nursing. Breast cancer can also begin in the lobules of the breast.”
It’s incredibly important to remember that men can get breast cancer as well.
As far as types of breast cancer, if it spreads to nearby tissues, it is considered invasive while, “in situ breast cancers (ductal or lobular carcinoma in situ [DCIS/LCIS, respectively) are precancerous lesions comprised of abnormal cells that have not spread or invaded local tissues,” Flowers says. “Other less common forms of breast cancer include inflammatory breast cancer, Paget's disease, and phyllodes tumor.”
You’ve probably heard many times that as women get older, mammograms are strongly encouraged. At your annual gyn checkups, you’ve most likely had a breast exam or have been taught how to do a self-exam. These are all essential in detecting breast cancer, while as early breast cancer sometimes has no symptoms at all. Flowers advises that a woman “knowing what is normal for her breast is important in self-monitoring.”
As far as early signs or symptoms, Flowers describes, “In some cases the first sign will be an unusual lump in the breast that she or her doctor will feel,” while other signs and symptoms, according to the American Cancer Society, include swelling of all or part of the breast, skin irritation or dimpling, breast pain, nipple pain or the nipple turning inward, redness, scaliness, or thickening of the nipple or breast skin, a nipple discharge other than breast milk, or a lump in the underarm area.
Flowers advises that any woman experiencing any unusual or out of the ordinary breast symptoms or changes should report their concerns to their ob/gyns immediately. Similarly, a man experiencing any abnormal lumps in his breast or nipple area should never ignore it either.
There are a few ways that a breast cancer diagnosis can be made, and confirmed. “Breast cancer is typically confirmed with a biopsy, either surgically removing a piece of tissue or using a needle to extract cells from the affected area,” Flowers says. “In some cases, a surgical biopsy may include lymph node tissue, which can provide more information about the stage of the cancer. A pathologist will examine the biopsy(ies) under a microscope to look for physical characteristics of cancer, and stain the tissue with dyes that can detect specific markers.”
Luckily, breast cancer is often treatable. Treatments range from invasive surgeries to what’s called systemic therapies or targeted therapies.
“Treatment for breast cancer usually begins with surgery, often followed by radiation,” Flowers says. “This is referred to as local therapy because it only treats the breast area where the cancer occurred,” while systemic therapies—also known as adjuvant therapies—are delivered to the whole body either through an IV or oral drugs. This therapies ideally work to prevent cancer from reoccurring, working to kill cancer cells that may have spread to other areas outside the breast.
Sometimes, systemic therapies are given prior to surgery too, in an attempt to reduce the size of a tumor. When this happens, it’s called neoadjuvant therapy.
In regard to systemic treatments and therapies, they’re based on the individual type of cancer present, and are unique to each patient’s specific needs. Treatment plans will largely depend on factors including the stage of disease, size of tumor, and other individual factors. “Patients should find out about all their treatment options, discuss pros and cons, understand potential short–and long-term side effects, and get a second opinion,” Flowers says.
Flowers suggests that patients also keep clinical trials in mind as well, as “these are not just for patients with late stage disease.” She recommends BreastCancerTrials.org as a great resource for patients seeking clinical trial information.
“While there is no sure way to prevent breast cancer, there are ways we can reduce our risk,” says Flowers. The American Cancer Society makes the following recommendations:
• Achieve and maintain a healthy weight. Studies show that increased body weight and weight gain increase the risk of breast cancer after menopause.
• Be physically active. This will help support your healthy weight goals but has other benefits as well. Try to get at least 150 minutes of exercise a week (or 30 minutes a day).
• Limit or avoid alcohol. Even moderate alcohol consumption increases breast cancer risk. The ACS recommends no more than one alcoholic beverage a day. That's 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor.
• Hormone therapy after menopause can increase the risk of breast cancer. Women should discuss the pros and cons of estrogen replacement hormone therapy with their doctor.
As far as other risk factors are concerned, Flowers explains, “A woman's age is the most prominent risk factor for breast cancer. Most breast cancers occur in women over 50. Among different races, white women in the U.S. have had the highest incidence rates, but the most recent data from the American Cancer Society showed an increase in incidence among African American women that brings the incidence in black women in line with that of white women.”
In regard to mortality, the CDC reports that, “While deaths due to breast cancer have decreased for both groups, black women are more likely to die from breast cancer than white women. American Indian and Alaska Native women have the lowest incidence and mortality rates, followed by Asian and Pacific Islander women and Hispanic women.
You may have heard or experienced firsthand the notion that family history and genetics are factors in having a heightened risk for breast cancer. But surprisingly, Flowers advises, “Eight out of 10 women who get breast cancer do not have a family history.”
In fact, she continues, “Less than 10 percent of breast cancers are due to an inherited factor—a gene mutation inherited from a parent, but those who do inherit a mutation in a breast cancer susceptibility gene (the most common are BRCA1 and BRCA2) have a significantly increased risk of breast and ovarian cancer.”
According to the U.S. Preventive Services Taskforce, genetic testing is recommended when the following situations exist in a woman's family history:
• Breast and ovarian cancers in the same woman or same family;
• Breast cancer that is diagnosed before the age of 50;
• Breast cancers in both breasts in the same woman;
• Two or more BRCA1 or BRCA2 types of cancer in the family;
• Male family members who have had breast cancer;
• Ashkenazi Jewish ancestry.
“We have made tremendous progress in the treatment of breast cancer over the last 25 years as evidenced by the estimated 3.5 million breast cancer survivors in the U.S., but we are still faced with many challenges,” Flowers reflects.
Unfortunately, despite the progress, metastatic breast cancer is still incurable and, about 30 percent of women diagnosed with early stage breast cancer will go on to be diagnosed with metastatic disease.
As we enter Breast Cancer Awareness month, it’s important to know what still needs to be done. “We can prevent drug resistance by matching the right drug to the right patient—this is what we mean by precision medicine,” Flowers elaborates. “We're learning how to do this with molecular profiling of tumors, but there is still a lot we need to learn to be successful.”
Early detection, too, is key, as is finding better treatments. “We can stop metastasis by detecting it early,” she says. “We're learning how to do this with liquid biopsies—a blood test that can detect tumor cells and tumor DNA in the blood of patients. We can stop it by finding better treatments for less common breast cancers, like triple negative, invasive lobular cancer and inflammatory breast cancer. These are challenging diseases to study because there are just fewer patients.”
Though curing breast cancer is an uphill battle, Flowers remains positive.
“We can stop it. And we must.”
For brides who want to use their registry to donate to breast cancer research (or to donate in general) head to the Breast Cancer Research Foundation's Web site for more info. You can also check out Brides Against Breast Cancer, which will be donating 200 dresses during the month of October to brides who have been affected by breast cancer.