Breast Cancer

Center for Obstetrics & Gynecology

Breast cancer is second to lung cancer as the leading cause of death among women in the United States

About 1 in 8 women (12.3%) will develop invasive breast cancer over the course of her lifetime. Death rates from breast cancer have been decreasing since 1990. These decreases are thought to be the result of earlier detection from annual screening, treatment advances, and increased awareness. The average age of diagnosis is 61 for women.

Men are susceptible to breast cancer, although the disease is much less common among males. Nearly, 2000 men will be diagnosed annually, and 450 men will die from the disease.

Of the 11.7 million cancer survivors in the United States, 22% or 2,574,000 are female breast cancer survivors. In 2010 it is estimated that 207,090 were diagnosed with invasive breast cancer, 45,908 were diagnosed with in situ disease.

Breast Cancer Risk Factors

The risk for developing breast cancer is not only related to your family history or genes. More than 85% of women diagnosed with breast cancer do not have a family history.

  • Age. Age is the most influential risk factor other than being a woman.
  • Family history. Higher risk for families with a history of breast and/or ovarian cancer.   
  • Hormones. Postmenopausal use of hormones, especially estrogen with progesterone, can increase the risk for breast cancer. Birth control pill intake may increase risk.   
  • Menstrual Cycle. Your risk for breast cancer is higher if you began menstrating before age 12, or underwent menopause after age 55. Women who never had a child is at an increased risk, or if your first child was after age 30.   
  • Being Overweight. Obesity or weight gain especially after menopause increases risk. A diet high in unsaturated fats can increase breast cancer risk.
  • Physical Activity. Sedentary lifestyle, no regular exercise increases risk.   
  • Alcohol Intake. Having more than one alcoholic drink/day increases risk for breast cancer.

Breast Disease & Cancer Diagnosis

If you have an abnormal mammogram, a palpable lump, or another breast concern that is suspicious for breast cancer, further evaluation is needed. It is best to determine if a per-cancerous abnormality or breast cancer is present by biopsy (small sample of tissue) prior to having ultimate surgery.

Stereotactic Biopsy: A biopsy that is performed with mammogram assistance. It can be done in the sitting position or while lying (prone) on your abdomen, the breast will hang and the mammogram plates compress the tissue under the table; a needle biopsy will be done.

Core Biopsy: A core biopsy is done under ultrasound. It will be done while lying supine with ultrasound assistance to identify the area of concern taking multiple cores “strips” of tissue.

Fine Needle Aspirate (FNA): a thin needle, such as when a blood sample is taken, is used and an aspirate of cells is taken. This is the most common way to test lymph nodes in the axilla prior to surgery to determine if cancerous cells are present. An FNA can also be done in the office if a palpable lump in the breast is not seen on imaging.

MRI Biopsy: If an abnormality of the breast is visualized only on MRI then a MRI biopsy will be recommended. Often if an abnormality is seen on MRI then the radiologist may recommend a mammogram and/or ultrasound to see if a biopsy can be done by mammogram or ultrasound first, if the area is not seen and biopsy can not be performed, then a MRI biopsy will be done.

Skin Punch Biopsy: A skin punch biopsy is performed on the breast when there is a possibility that there could be skin involvement with breast cancer. A punch biopsy can be done in the office under local anesthetic, full thickness skin and underlying tissue will be removed, and tested. Often a single stitch and steri-strips will be used to close the skin.  

Surgical Biopsy: A surgical biopsy, is when a patient undergoes surgery in the operating room to make a diagnosis, it is not the first choice to determine a breast disease diagnosis. If a mammogram, ultrasound, or MRI biopsy can be done it is preferred.

Why?

If the abnormality is benign then surgery may not be needed. If the abnormality is cancerous,  if just a core of tissue is removed( stereotactic, ultrasound core, MRI biopsy), that allows for an opportunity for surgical planning to determine which surgical procedures would be appropriate, allows for Tumor Board recommendations, and a more comprehensive approach to cancer treatment. If surgery is needed to make a diagnosis often further surgery is required if margins are involved and/or if lymph nodes need to be removed. A surgical biopsy may be recommended if a woman has a persistent palpable lump/mass and imaging is negative (not seeing the abnormality), or if the radiologist is unable to do a stereotactic/core biopsy based on the position of the abnormality.

Invasive Breast Cancer

Invasive breast cancer can spread outside the membrane that lines the ducts or lobules, invading the surrounding tissues. The cancer cells have the ability to travel to other parts of the body, such as the lymph nodes. Invasive ductal carcinoma (IDC) starts in a milk duct, breaks through the duct walls, and then invades the breast tissue. It is the most common type of breast cancer and accounts for 80% of invasive cancers. Infiltrating lobular carcinoma (ILC) occurs in approximately 10-15% of invasive breast cancers and starts in the lobules or milk glands. There are other less common types such as medullary, mucinous, squamous, and tubular carcinomas.

Breast Cancer Staging

Stage 0: Carcinoma in situ, the cancer has not spread from the site of origin, from the lobule or duct.

Stage I: The microscopic tumor size is 2cm or smaller and does not involve the lymph nodes or has micrometastases to lymph nodes.

Stage IIA: The microscopic tumor size is up to 5 cm and has not spread to axillary nodes; or the tumor is 2 cm or smaller and has spread to axillary nodes; or no tumor is found in the breast but the axillary nodes are positive.

Stage IIB: The microscopic tumor size is greater than 2 cm but less than 5cm, and has spread to the axillary nodes; or the tumor is greater than 5cm but the axillary nodes are negative.

Stage IIIA: No tumor is found in the breast tissue, the axillary nodes are positive and are attached to each other or other structures or the internal mammary nodes may be positive; or the microscopic tumor size can be up to 5 cm and involve the axillary or mammary lymph nodes.

Stage IIIB: The tumor has spread to the chest wall and/or skin of the breast and may have positive axillary lymph nodes that are attached to other structures or involve the internal mammary nodes.

Stage IIIC: No tumor is found in the breast or the tumor can be any size and the lymph nodes are positive above and below the collarbone (infraclavicular and supraclavicular) and may have spread to the internal mammary and axillary nodes.
 
Stage IV: The tumor cells have spread to other organs of the body, commonly the bones, lungs, liver or brain.

For further staging information visit the National Cancer Institute at www.cancer.gov.

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Preparing for your breast biopsy

If a breast biopsy is recommended, here is some helpful information.

Learn more about Preparing for your breast biopsy