"I was devastated. This disease was so dreaded and frightening. I thought it would change my life forever, and I was discouraged. I felt my body had somehow betrayed me. I exercise and eat well; I am healthy. It seemed so unfair. I felt it was beyond my ability to cope." These are the words of a recently widowed woman who contracted breast cancer in 2010.
The news that you have cancer is dreadful wherever in the body the cancer may be, but there is something frighteningly intimate for a woman to find cancer in her breast. This is one of the many stories of women shattered, frightened, and overwhelmed when first being told they have breast cancer.
One in eight women in the United States will be diagnosed with breast cancer at some point in her lifetime. The first signs are often found by women themselves, as was the case for this woman. She noticed a lump and went to have it checked out. There are many symptoms, according to the National Breast Cancer Foundation
ranging from a lump or thickening near the breast or underarm area to unexplained change in the size or shape of the breast.
for further signs and symptoms.
It goes without saying that a woman should have a checkup immediately on finding any possible symptoms. However, ideas differ on when women should start regular breast cancer screening. The recommendation used to be to have a mammogram each year after the age of 40. But now some say 45 or even fifty and only every two years. Presently at the Mayo Clinic
, doctors offer annual mammograms to women age 40 and older, but they say this is a matter of personal preference. They recommend that women and their doctors "discuss the benefits, risks, and limitations of mammograms and decide together what is best. Balancing the benefits of screening with the limitations and risks is a key part of deciding when to begin mammograms and how often to repeat them."
The risk of mammograms is that they are not perfect. Normal breast tissue can hide a tumor and give a false negative. Or a mammogram can show an abnormality that looks like cancer but isn't, thus giving a false positive. This is why self-examination is important. Sometimes another form of breast imaging is called for. Also, it is quite common for a biopsy to be ordered.
A breast biopsy removes tissue or fluid from the suspicious area. These cells are then examined and tested to check for the presence of breast cancer. The biopsy is the diagnostic procedure that can
definitely determine if the area in question is cancerous.
How widespread is breast cancer? The American Cancer Society estimates that nearly 250,000 new cases are expected to be diagnosed among women in the U.S. in 2016, as well as more than 60,000 additional cases of "in situ" breast cancer. "Ductal carcinoma in situ" is the presence of abnormal cells inside a milk duct in the breast. It is considered the earliest form of breast cancer and is non-invasive, meaning it has not spread out of the milk duct to other parts of the breast. It is not life-threatening but it does require treatment.
The median age at time of diagnosis is 61, meaning half the women diagnosed with breast cancer are younger than 61 and half are older. Incidence increases with age. There is some evidence to suggest that the incidence of breast cancer varies slightly according to race and ethnicity. The American Cancer Society estimates that over 40,000 women in the U.S. will die from breast cancer in 2016, though death rates have been decreasing since 1989, especially for women under 50. The only other cancer responsible for the deaths of more women in the U.S. is lung cancer. The most recent statistics show that there are more than 2.8 million U.S. women with a history of breast cancer.
According to the American Cancer Society, many risk factors can increase your chance of developing breast cancer, but it is not yet known exactly how some of these risk factors cause cells to become cancerous. Hormones seem to play a role in many cases of breast cancer, but just how this happens is not fully understood.
Breast cells become cancerous because of mutations in DNA. Five to 10 percent
of breast cancers are thought to be inherited, but most DNA changes related to breast cancer are acquired in the breast cells during the woman's lifetime. These may result from various factors; however, the causes of these acquired mutations are still unknown, and most breast cancers have several acquired gene mutations.
Cancer Treatment Centers of America lists the following risk factors that, in addition to genetics, might cause breast cancer: aging, obesity, not having children or having them late, high breast density, a menstrual history that started early and lasted late, a sedentary lifestyle, heavy drinking, using birth control pills, hormonal therapy, cancer-causing chemicals, and radiation exposure. Some of these are only slightly correlated with breast cancer, and none of them has been demonstrated to be a direct cause. They are "risks," which means their presence can increase the possibility of getting breast cancer.
The Mayo Clinic suggests the following will help reduce the risk of breast cancer: limit your alcohol consumption, refrain from smoking, keep your weight under control, breast-feed your children, limit the dose and duration of any hormone therapy you receive, avoid exposure to radiation and to environmental pollution, and eat a healthy diet.
Once a diagnosis is made, there is a complex system of five stages used to determine the nature and severity of the cancer. The stages are 0, I, II, III, and IV; they are based on the size of the cancer, whether it is invasive, whether it is in the lymph nodes, and whether it has spread beyond the breast to other parts of the body.
For instance in stage 0 there is no evidence of cancer cells. This is the "in situ" breast cancer referred to above. In stage IA, there is a small tumor in the breast that is 2 cm or less in size. In stage IB, there are small groups of cancer cells in the lymph nodes, no larger than 2 mm. There may also be a tumor smaller than 2 cm in the breast. At the other end of the spectrum is stage IV, which means there is invasive cancer in the breast and nearby lymph nodes that has spread beyond the breast and the lymph nodes to other organs of the body and has metastasized. The stages in between represent sizes and degrees of invasion between these extremes.
There is a wide range of treatments for breast cancer, and they are used depending on the size and location of the tumor or cancer cells. The general categories of treatment are: surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. It is not uncommon for a woman to receive more than one type of treatment.
However, in the past 20 years, knowledge of this disease has exploded, resulting in great improvements in treatment. According to Dr. Dennis L. Citrin of Cancer Treatment Centers of America
, 20 years ago mastectomies were frequent. Now most women with early stage breast cancer can be treated with breast-conserving surgeries, by removing the tumor and a small surrounding area of healthy tissue.
Radiation treatment has also advanced. In a process called intraoperative radiation therapy, a dose of radiation is given at the same time as the surgeon takes out the tumor. That may be all the patient needs. There is also external beam radiation therapy, where a focused dose of radiation conforms to the shape of the tumor, causing less damage to the surrounding tissue and resulting in improved appearance and fewer side effects.
In chemotherapy, there are now drugs that specifically attack the protein that is present in 20 percent of breast cancers. These medications are less toxic and less likely to cause side effects. Further testing and diagnosis are more sophisticated. Researchers can determine the mutation of the tumor and design an individual treatment plan.
Each treatment plan takes into account the stage of the tumor, the tumor's type, genomic markers, the patient's age, general health, and preferences, the patient's menopausal status, and the presence of inherited mutations.
As everyone knows from the stories patients tell, there are sometimes very unpleasant side effects to the various treatments. Common ones are loss of hair, pain or nausea after surgery, fatigue, hot flashes, and joint pain. There can also be headaches, numbness, dental issues, lymphatic fluid accumulating in the tissues, bone loss, and other less fr
equent effects. A team of experts working together is important for good and effective treatment.
It is important that women newly diagnosed with breast cancer know the many treatment options and the major advances. Treatment today is so different from where it was 20 years ago. The prognosis for many patients is so much better.
According to the American Cancer Society
the five-year survival rate for women with stage II breast cancer is about 93 percent. The five-year survival rate for women with stage III breast cancer is about 72 percent. Breast cancers that have spread to other parts of the body are more difficult to treat and often have a bleaker outlook. Metastatic or stage IV breast cancers have a five-year survival rate of about 22 percent, yet there are still many treatment options for women in this stage.
The stats on breast cancer are often given in this five-year interval. For instance, the 93 percent survival rate means that of 100 people with that stage of breast cancer, 93 will live at least five years. But these stats are estimates and cannot predict what will happen for any individual. Many people live far longer than five years. Thus these stats cannot tell a woman how long she will live, but they may help her have a sense for how successful her treatment might be. These survival rates are rising and will likely continue to rise as more effective treatments are found.
Because breast cancer is so prevalent, it is often in the news and is the focus of some high-profile efforts at awareness and fundraising. The Susan G. Komen organization has raised many millions of dollars for breast cancer research and treatment, as has the American Cancer Society. Across the country there are runs and walks to raise money. The color pink and the iconic pink ribbon have become symbols of breast cancer. Each fall during Breast Cancer Awareness month, the National Football League, in partnership with the American Cancer Society, features pink products for sale, and coaches, players, and referees wear pink game apparel. A portion of the proceeds from the sale of merchandise goes for cancer research, and the NFL emphasis raises awareness in a population that might not otherwise be interested in learning about breast cancer.
Though this NFL sponsorship seems to give a picture of strong powerful men coming to the support of women at a moment of great vulnerability, a little known fact is that men can also contract breast cancer, although the statistics are much lower. The American Cancer Society estimates there will be about 2,600 new cases of invasive breast cancer diagnosed in men in 2016, and about 440 men will die from the disease. A man's lifetime risk of getting the disease is about 1 in 1,000. The symptoms in men are similar to those in women, but men delay much longer in seeking treatment so their cancer has often already spread. According to WebMD
, breast cancer rarely occurs in men under age 35 with the highest incidence between 60 and 70. Though men don't have breasts like women, they do have small amounts of breast tissue, and because there is so little breast tissue, cancer can spread more quickly.
Now let us return to the woman who was devastated, who felt her body had betrayed her, who was faced with something beyond her ability to cope, but who survived. She writes, "Gradually my thoughts shifted: I realized as unreal and unfair as it seemed, I did have cancer and I wanted to fight. I was ready to fight the fear and fight the invasion of cancer cells in my body. I became determined ... I stopped thinking of chemotherapy and radiation as my enemy and began thinking of them as my weapons in the fight."
Her cancer was stage II, but it was aggressive. Treatment included a mastectomy, radiation, and chemotherapy. She was surrounded by a highly competent team of doctors and medical professionals as well as her family. She suffered many side effects, but her care team helped her manage them, and her son gave her constant support. At the end, a breast-reconstruction expert took her through several surgeries. When the last one was complete, she asked if she could do a cartwheel. He gave her permission and there in the corridors of the medical center and to the delight of the medical staff she turned four cartwheels. Since September 2011, she has been cancer free.