Breast cancer


What is breast cancer?

One in every eight women will face breast cancer in her lifetime. In fact, it’s the second-most frequently diagnosed cancer in women, with more than 225,000 new cases of invasive breast cancer diagnosed in the U.S. each year. In addition, approximately 2,300 such cases are also expected in men.

Breast cancer occurs when cells in the breast separate and begin to grow without normal control to form a malignant tumor which can spread to other areas of the body. As the tumor grows, a lump may form under the skin of the patient – a warning sign that should be brought to the attention of a professional immediately.

At ETMC we believe the way to fight this disease is by arming as many people as possible with the most advanced diagnostic tools available. We believe in giving our mothers, wives, sisters and neighbors the best in breast care.

Signs and symptoms of breast cancer

Women and men should pay close attention to their breasts and make note of any changes that occur over time. Regular self-examination is important to check for lumps, changes to the skin and other changes such as

  • Unexplained changes in size and/or shape
  • Swelling or shrinkage of the breast – especially on one side
  • Slightly inward or inverted nipples
  • Dimpling on the breast
  • Scaly, red and sometimes swollen skin around the breast, areola or nipple
  • Enlargement of pores in the skin surrounding the breast
  • Nipple becoming more tender than before
  • Clear or bloody discharges coming from the nipple

Risk factors for breast cancer

Potentially modifiable factors associated with increased breast cancer risk include weight gain after the age of 18, being overweight or obese (for postmenopausal breast cancer), use of MHT (combined estrogen and progestin), physical inactivity and alcohol consumption. In addition, recent research indicates that long-term, heavy smoking also increases breast cancer risk, particularly among women who start smoking before their first pregnancy. The International Agency for Research on Cancer has concluded that there is limited evidence that shift work, particularly at night, also is associated with an increased risk of breast cancer.

Other factors associated with increased breast cancer risk include high breast tissue density (the amount of glandular tissue relative to fatty tissue measured on a mammogram), high bone mineral density (women with low density are at increased risk for osteoporosis), Type 2 diabetes, certain benign breast conditions (such as atypical hyperplasia), and lobular carcinoma in situ. High-dose radiation to the chest for cancer treatment also increases risk. Reproductive factors that increase risk include a long menstrual history (menstrual periods that start early and/or end later in life), recent use of oral contraceptives or Depo-Provera, never having children and having one’s first child after age 30.

Risk also is increased by a family history of breast cancer, particularly having one or more affected first-degree relatives (though most women with breast cancer do not have a family history of the disease). Inherited mutations (alterations) in the breast cancer susceptibility genes BRCA1 and BRCA2 are very rare in the general population (much less than 1 percent), but account for 5 to 10 percent of all female breast cancers, an estimated 5 to 20 percent of male breast cancers and 15 to 20 percent of familial breast cancers.

Factors associated with a decreased risk of breast cancer include breastfeeding, regular, moderate or vigorous physical activity and maintaining a healthy body weight. Two medications – tamoxifen and raloxifene – have been approved to reduce breast cancer risk in women at high risk. Raloxifene appears to have a lower risk of certain side effects, such as uterine cancer and blood clots; however, it is only approved for use in postmenopausal women.

Screenings for breast cancer

Digital mammography

Breast cancer screening for women at average risk includes clinical breast exam and mammography. A mammogram is a specific type of breast exam used to aid in the early detection and diagnosis of breast diseases in women. This quick medical exam uses a noninvasive X-ray targeted to each breast, producing pictures that your doctor can use to identify and treat any abnormal areas, possibly indicating the presence of cancer.

ETMC Breast Centers use the Selenia digital mammography system from Hologic, which incorporates revolutionary imaging technology that provides exceedingly sharp images in less time than traditional mammography methods. This same digital technology is also available on the ETMC Mobile Mammography Unit.

Because mammography often can detect breast cancer at an early stage, treatment is more effective. Early detection with mammography saves lives and increases treatment options. For most women at high risk of breast cancer, annual screening using magnetic resonance imaging (MRI) in addition to mammography is recommended.

Current guidelines from the American College of Radiology, the American Cancer Society, and the Society for Breast Imaging recommend that women receive annual screening mammograms starting at age 40 – even if they have no symptoms or family history of breast cancer.

Early detection tips

  • Perform monthly breast self-exam starting at age 20.
  • Begin clinical breast exams every three years beginning at age 20 and annually after age 30.
  • Become familiar with the normal look and feel of your breasts and see your doctor if change occurs.
  • Have a baseline mammogram at age 35 to 40.
  • Have annual mammograms beginning at age 40.

Breast ultrasound

A breast ultrasound also may be performed as an additional procedure after a mammogram for patients who have dense, fibrocystic tissue that may obscure a breast lesion. The procedure is completed in a room specifically designed for this procedure. Breast ultrasound is not uncomfortable and is completed in approximately 30 minutes. The radiologist discusses the results of the assessment exam after reviewing the images, and the results are forwarded to the primary physician. Normal activity can be resumed after the procedure.

Breast MRI

Magnetic Resonance Breast Imaging is another supplemental tool used to help diagnose breast cancer. It is often used to investigate breast problems first detected by mammography or other imaging exams. Younger women at high risk of breast cancer may also benefit from screening, as determined by a strong family history or a mutated breast cancer gene.

Unlike mammography, which uses low-dose X-rays to image the breast, MRI uses powerful magnetic fields and radio waves to create images of the breast. To begin the exam, the patient is positioned on a special table inside a large tube where a magnetic field is created by a magnet. Each total MRI exam is comprised of a series of sequences with each lasting from two to 15 minutes.

Benefits of breast MRI

  • Can image breast implants and look for leaks or ruptures
  • Used effectively in dense breasts
  • Can help determine what type of surgery is needed (lumpectomy or mastectomy)
  • May detect breast cancer recurrences and residual tumors after lumpectomy
  • Can locate primary tumor where the cancer has spread to the lymph nodes
  • Can spot small abnormalities
  • May be useful in screening women at high risk for breast cancer

Stereotactic breast biopsy

A stereotactic breast biopsy is a procedure in which several samples of tissue are obtained from the breast. This permits a tissue diagnosis to distinguish between benign breast abnormalities and those that are cancerous.

The procedure takes place in a specially equipped room at the ETMC Breast Center. The room contains digital breast imaging equipment and an examination table that allows for precise positioning. This is a preferred method of tissue sampling because it permits diagnosis without the trauma or scarring of an open biopsy. The physician discusses the procedure and reviews the mammography images prior to beginning the biopsy. A local anesthetic is administered. A small skin nick is made into the area to be biopsied. Several tissue samples are obtained and sent to pathology. Every effort to assure patient comfort is made during the procedure. The outpatient procedure takes approximately 60 minutes, and normal activities can be resumed upon completion of the biopsy.

A dressing is applied to the biopsy site after completion of the procedure. Post-procedure care is explained and at-home instructions are reviewed. The pathology report is obtained in 48 hours. ETMC Breast Centers make every effort to expedite the results to the physician and the patient. If the pathology is benign, it is recommended that a follow-up mammogram be completed in months. If the biopsy is diagnosed as breast cancer, the woman and her physician will discuss treatment options.

Treatment for breast cancer

Breast cancer treatment is determined on a case-by-case basis. Our team of experts at the ETMC Cancer Institute work together to help formulate detailed treatment plans to help fight breast cancer with advanced treatment and therapy modalities as well as personalized support services.

For more information regarding breast cancer, schedule an appointment with an ETMC First Physician.