Breast cancer is
the most common malignancy in women. Approximately 175,000 new cases of female breast cancer will be
diagnosed in the United States in 1999, and about 1,300 new cases in males. Breast cancer is the second leading cause of
cancer-related deaths in women after lung cancer. The death rate from breast cancer declined during 1991—1995,
especially in women under age 65. Risk
factors for breast cancer include a personal or family history, menarche (onset
of your period) at an early age, menopause late in life, and taking estrogen for
birth control or hormone replacement.
In-Depth Information
An abnormal
mammogram (x-ray of the breast) often is the first sign of breast
cancer. A breast lump (mass) may also be a sign of breast cancer, but absence
of a mass does not mean cancer is not present. Other signs of more advanced cancer are bloody discharge from the
nipple, thickening of the skin of the breast, turning in of the nipple, and
sometimes swelling under the arm. With the presence of a breast mass, or an
abnormal mammogram, you should have a complete physical examination. Mammograms of both breasts should be
performed. Sometimes a magnified view of
the affected breast is obtained for better visualization. Further studies may include an ultrasound
(imaging study) of the lump to assist in characterizing it. This is followed by a biopsy of the area with a needle,
often times with a wire to assist the surgeon in finding the exact location of the
abnormality. The biopsy usually permits the precise type of breast cancer to
be diagnosed. Other tests may include a complete blood count, liver function studies,
chest x-ray, and CT scan in more advanced cases.
The staging of breast cancer describes how advanced the cancer is at the time of diagnosis. A simplified staging system for breast cancer is as follows:
Stage 0: A pre-cancer called ductal carcinoma in situ
(DCIS) which involves the milk ducts of
the breast, or lobular carcinoma in situ (LCIS) which has a 25% chance of
developing breast cancer in either breast in the next 25 years.
Stage I: The tumor is less
than or equal to 2cm (smaller than 1
inch) in diameter.
Stage IIA: The tumor is greater than 2cm but no larger than 5cm (approximately 2 inches) or has spread to the lymph nodes under the arm.
Stage
IIB: The tumor is 2-5cm in diameter with involvement of the lymph
nodes under the arm, or is more than 5cm in diameter.
Stage IIIA: The lymph nodes under the arm are
involved and are attached to other nearby structures, or the tumor is
greater than 5cm in diameter with involvement of these lymph nodes.
Stage IIIB: The tumor involves the chest wall or
skin of the breast, or is an unusual type of breast cancer called
"inflammatory" where the breast rapidly becomes swollen, warm, and
tender.
Stage IV: The cancer has spread to other
organs such as the lungs, bones, or brain.
The treatment of breast
cancer depends on the stage and subtype of the cancer at diagnosis. Different treatment modalities such as
surgery, chemotherapy, radiation therapy, and hormonal therapy are used in
various combinations and sequences depending on the details of each patient's
case. A mastectomy is the removal of
the breast. Emory surgeons are renowned for their techniques of breast reconstruction. Sometimes the
reconstruction is scheduled at the time of the mastectomy, and in other cases it
may be performed later. A lumpectomy is the removal of only the tumor or
cancer; the rest of the breast remains intact. Several randomized studies
from around the world have shown that lumpectomy followed by radiation therapy
yields the same patient survival rates as mastectomy. An axillary node dissection is the removal
of several lymph nodes, usually at least ten, under the arm; this procedure may
be performed as part of the staging process at the time of lumpectomy or
mastectomy. An alternative to axillary node dissection is sentinel node
biopsy, where the surgeons determine the lymph node that likely would be the
first to be involved by the cancer, and they first remove that node only; if it
contains cancer, the surgeons then will perform an axillary node dissection.
Research & Clinical Trials
At Emory, access to nationwide studies or protocols is readily available. Many of these entail chemotherapy either before surgery to aid in shrinking the tumor or after surgery to prevent further spread of the disease. We have also developed innovative studies that have become protocols for national breast cancer study groups. Click here to visit our Clinical Trials Center.
The Emory Department of Radiation Oncology uses state of the art technology in its treatment of breast cancer. At the time of simulation (planning) before the first radiation treatment, a sophisticated CAT scanner called the AdvantageSim is used. Using this technology, we can direct the x-ray beam to a specific area accurately, while giving a minimal dose to normal structures within the irradiation field. Critical structures that should not be treated are protected. Our article on this technique has been published by the journal Medical Physics. If you wish to read a summary of the article now, please visit NCI’s PubMed and enter "Butker AND 1996" in the text field. You can then click on the highlighted title to bring up the abstract.