Breast cancer is the most common cancer and the second leading cause of cancer death in women in the United States. The good news is that since 1990, the death rates have been steadily declining. Unfortunately, we do not know what causes most breast cancers, but it is thought that there is a relationship to changes in the cell’s genetic material. These changes can be associated with lifestyle, but can also be due to age and other factors. About 5% to 10% are thought to be related to heredity, caused from genetic changes inherited from a parent.
If breast cancer is found early enough, there may be no symptoms. However, as the cancer cells grow, the breast can change in how it looks and/or feels. Some of the more common symptoms may include:
• a change in the size or shape of the breast
• a lump or thickening in the breast or under the arm
• abnormalities of the nipple, such as a discharge or a turning inward
• a dimpling or puckering of the breast skin
• red, scaly, or swollen skin on the breast or nipple.
These symptoms may not be related to cancer, or could be caused by another condition, but a health care provider should be contacted as soon as possible for a persistent abnormality so that the problem can be evaluated, diagnosed and treated.
Screening can be done to help find cancers early when there are no symptoms. If the breast cancer is found early, there is a better chance of being cured. Screening for breast cancer includes monthly self breast exam and awareness, clinical breast exams (exam by a health care professional), mammograms (an x-ray of the breast), sometimes an ultrasound, and in some cases breast MRI. Decisions about screening should be made with the health care provider.
Mammography can detect even small cancers which are not detectable by the physical clinical exam. The American Cancer Society recommends annual mammograms beginning at age 40, and Bay Medical offers the newest state-of-the-art technology in the area in digital mammography. This new system produces sharper images in less time and requires less compression for increased comfort during the exam.
If an abnormality is found during screening, the only way to tell for sure if cancer cells are present is to remove the tissue for microscopic examination (a biopsy). A biopsy may be ordered by one of the following ways:
• fine-needle aspiration – a thin needle removes the cells from the lump,
• core biopsy – a wide needle is used to remove a tissue sample,
Bay Medical is the site of the Mammotome®, a vacuum assisted needle biopsy system that uses computer imaging (x-ray, ultrasound, or MRI) to obtain the sample. It is a highly accurate procedure that provides enough sample to ensure accurate diagnosis.
• surgical biopsy – removal of a tissue sample by an
o incisional biopsy which removes part of the abnormal area
o excisional biopsy which removes all of the abnormal area.
The main goal of surgery for breast cancer is to remove the cancer and assess the stage of disease. The stage of disease is determined by the cell type, tumor size, and the spread of the cancer cells, and this will determine the type of treatment that is recommended. In a lumpectomy only the tumor with an edge of the normal tissue surrounding the cancer cells is removed. A simple or total mastectomy involves removal of the entire breast. The modified radical mastectomy includes the removal of the breast and lymph nodes under the arm, whereas the radical mastectomy includes the removal of the underlying chest wall muscle and is much less common.
Outpatient radiation therapy may be recommended to kill any remaining cancer cells in the breast, chest wall, or under the arm after the surgery or to reduce the size of the tumor before the surgery. After a lumpectomy, radiation therapy is almost always recommended, and sometimes it is recommended after a mastectomy.
Radiation therapy kills cancer cells using high-energy rays. The most common form used for breast cancer is external radiation therapy where the rays come from a large machine outside the body. For this daily outpatient treatment which usually lasts 4-6 weeks, Bay Medical offers one of the newest technologies available, the RapidArc®. This form of therapy delivers treatments that are precisely delivered to the tumor, while sparing surrounding healthy tissue. Also available at Bay Medical is the MammoSite® system, a form of internal radiation therapy, also called brachytherapy. This is designed to deliver radiation from within the tumor site. Following lumpectomy, the surgeon inserts a small balloon through a very small incision with tube to the area where the cancer was removed. This tube is used to insert a tiny radiation source into the balloon for very brief, twice daily treatments. This treats only the tissue that directly surrounded the cancer. These treatments are administered for five days and then the tube and balloon are removed. This form of radiation therapy is only recommended for women with small tumors that have been detected fairly early.
Chemotherapy uses anticancer drugs which travel through the bloodstream and is give intravenously or by mouth to kill the cancer. Biologic and hormone therapy may also be in the treatment plan. These are forms of systemic therapy and may be given before surgery to shrink the tumor, or after the surgery to kill any cancer cells that may have gone undetected to other parts of the body. This is typically provided in the physician’s office (medical oncologist) as an outpatient.