About Breast Cancer
The most common cancer among women in the United States, breast cancer is a disease in which cancer cells grow in the breast tissue. A normal breast consists of glandular tissue called lobes; these lobes are sectioned off into lobules, which produce milk that is carried to the nipple by small ducts. All this tissue is surrounded by fatty and connective tissue, as well as blood and lymph vessels.
Cancer occurs when cells in the body divide without control or order, eventually forming a growth or tumor. Malignant growths can invade nearby tissues, including the lymph nodes, at which point the cancer can spread to other parts of the body. The lymph nodes associated with breast cancer are in the armpit, above the collarbone, and in the chest.
Types of Breast Cancer
There are many types of breast cancer found in women, including the following:
- Ductal carcinoma in situ (DCIS): Early stage cancer confined to the ducts. This type has a high cure rate.
- Lobular carcinoma in situ (LCIS): Most doctors consider the finding of LCIS to be incidental. While it is not cancer, women with LCIS seem to have a 7-10 times increased risk of developing some form of breast cancer (usually infiltrating lobular carcinoma) within 20 years.
- Infiltrating ductal carcinoma: A cancer that starts in the ducts of the breast and spreads into surrounding tissues. This is the most common type of breast cancer in women.
- Infiltrating lobular carcinoma: A cancer that starts in the lobules of the breast and spreads into surrounding tissues.
- Medullary, mucinous, and tubular carcinomas: These are three relatively slower-growing types of breast cancer.
- Inflammatory carcinoma: A rare and aggressive form of breast cancer that can be difficult to treat. This cancer invades the lymphatic vessels of the skin and can be very extensive. It is very likely to spread to the local lymph nodes.
Symptoms of Breast Cancer
When breast cancer first develops, there may be no symptoms, but as the cancer grows it can cause the following changes. Although these symptoms may also be caused by other, less serious health conditions, anyone experiencing these should see a doctor.
- One or more lumps in the breast which may or may not be painful
- One or more lumps in lymph nodes near the breast, under your arm, or collarbone which may or may not be painful
- Thickening in or around the breast
- A change in the size or shape of the breast
- Nipple discharge or tenderness, or the nipple inverted into the breast
- Ridges or pitting of the breast skin, like the skin of an orange
- A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)
Risk Factors for Breast Cancer
While the causes of breast cancer are unclear (they may involve a combination of genetic and environmental factors) a number of risk factors have been identified. Breast cancer is more common in Caucasian women, aged 50 years and older. Other factors that may increase the risk of breast cancer include the following. However, studies show that most women with known risk factors do not get breast cancer, and many women who get breast cancer have none of these risk factors except age.
- Personal history of breast cancer
- Family members with breast cancer
- Changes in breast tissue, such as atypical ductal hyperplasia, radial scar formation, and lobular carcinoma in situ (LCIS)
- Genetic mutations, such as BRCA1, BRCA2, and others
- Being overweight, particularly after menopause
- Increased exposure to estrogen over a lifetime through factors such as: early onset of menstruation, late onset of menopause, having children late or not at all, absence of breast-feeding, and hormone replacement therapy
- Increased breast density—more lobular and ductal tissue and less fatty tissue
- Radiation therapy before the age of 30
- Excessive alcohol use
Diagnosing Breast Cancer
The doctor will begin by asking about symptoms and medical history then conduct a physical exam, including a breast exam, and order blood tests. Additional tests may include:
- Imaging studies, which help diagnose and evaluate the extent of the cancer, such as mammography, ultrasound, CT scan, or PET/CT scan
- Biopsy ,in which a sample of breast tissue and/or the adjacent lymph node is removed and evaluated in a laboratory for cancer
If cancer is present, further tests may be needed to learn about the type of cancer, which may include:
- Blood tests, which look for tumor markers or genetic mutations
- Tissue evaluation, which look for estrogen and progesterone receptors, and the presence of HER2/neu and Oncotype DX
The physical exam combined with all other test results will help to determine the stage of cancer, which is used to develop the optimal treatment plan. Like other cancers, breast cancer is staged from I-IV. Stage I is a very localized cancer, while stage IV indicates a spread to other parts of the body.
Treatments for Breast Cancer
Cancer treatment varies depending on the stage and type of cancer. A combination of therapies is most effective. The Dubin Breast Center provides a full range of treatment options, including the following:
- Surgery: The goal of surgery is to remove the tumor(s) and any affected tissue.
- Radiation Therapy: Radiation therapy is the use of radiation to kill remaining cancer cells and reduce the risk of local/regional recurrence.
- Chemotherapy: Chemotherapy uses drugs to kill remaining cancer cells. It may be given in many forms including pill, injection, or IV.
- Medications: Medications such as the following may also be used in conjunction with chemotherapy:
- Biologic therapy, which uses medications or substances made by the body to treat cancer by increasing or restoring the body's natural defenses against cancer.
- Targeted therapy, which treats specific characteristics of cancer cells by altering how the body responds to them. For example, medications can block the growth of new blood vessels or block chemical signals that allow cancer cells to grow and function.
- Hormone blocking therapy, which takes advantage of the fact that estrogen binds to the cells in many types of breast cancers, stimulating them to grow and divide. Anti-estrogen drugs prevent the binding of estrogen, which stops the cells’ growth.
Dubin Breast Center
The Mount Sinai Hospital
1176 5th Avenue
New York, NY 10029
For Appointments and Information
Tel: 855-TO-DUBIN (863-8246) or
Tel: 212-241-3300 option 1
Tel: 212-241-3300 option 2
Breast Reconstruction (plastic surgery)
Tel: 212-241-3300 option 3
Breast Health Resource Program (psychosocial support)