October is dedicated to Breast Cancer Awareness Month. Outside of skin cancer, which is prevalent in both men and women, breast cancer is the most common cancer in women. In fact, one in eight women will develop breast cancer in their lifetime. This year alone, about 280,000 new cases of invasive breast cancer (spreading into surrounding tissue) and 48,000 cases of noninvasive breast cancer will be diagnosed in American women, and the disease will take the lives of 42,000 women. Fortunately, due to better screening and early detection, survival rates are steadily increasing.
What Is Breast Cancer?
In normal tissues, cells are created, grow, and die. Cancer occurs when cells do not die at the normal rate and the built-up cells form a tumor. Tumors in the breast tend to grow slowly. When a lump can be felt through the skin, it may have been growing for up to 10 years, although more aggressive tumors can grow much faster.
While 5 to 15 percent of breast cancers begin in the lobules, the spherical-shaped sacs in the breast that produce milk, most breast cancers (50 to75 percent) start in the milk ducts, the canals that carry milk from the lobules to the nipple. The remaining breast cancers begin in other breast tissue.
What Are the Symptoms of Breast Cancer?
A woman may first suspect breast cancer when she feels a lump in the breast, but there are types of breast cancer that do not cause a lump. It is important, therefore, to know all the warning signs, which include:
- A lump or thickening in the breast that feels different from surrounding tissue
- A change in appearance of the breast, including its size and shape
- A change in the skin over the breast that may look like orange peel or dimpling
- Breast or nipple pain
- A newly inverted nipple
- Nipple discharge other than breast milk
- Peeling, scaling, crusting, or flaking of the pigmented area around the nipple (the areola) or breast skin
- Swollen lymph nodes
- Irritation or itchiness
Other health conditions can cause symptoms similar to those listed above. It is important that women contact their physician for a prompt evaluation to determine whether there is a cause for concern and to rule out any other conditions, such as eczema causing skin issues or an infection causing swollen lymph nodes.
How Does Breast Cancer Spread?
Breast cancer spreads when the cancer cells travel to the blood or lymph system and then are carried to other parts of the body. The lymph system is made up of a network of lymphatic vessels that are found throughout the body. The vessels connect to the lymph nodes (small, bean-shaped collections of immune-system cells) and carry lymph fluid away from the breast. When cancer cells are present in the breast, they can enter the lymph vessels and begin growing in the lymph nodes.
Lymph vessels in the breast drain into the following areas of the body:
- Lymph nodes under the arm
- Lymph nodes around the collarbone and below the collarbone
- Lymph nodes inside the chest near the breastbone
Cancer cells that have spread to the lymph nodes can then spread, or metastasize, to other parts of the body. Surgery is often necessary to remove lymph nodes in order to biopsy them and detect the spread. Some women with cancer cells in their lymph nodes do not develop metastases, and some women with no cancer cells in their lymph nodes develop metastases later.
Types of Breast Cancer
Types of breast cancer include the following:
- Ductal carcinoma in situ (DCIS): DCIS is a non-invasive, early, treatable cancer in which abnormal cells have been found in the lining of the breast’s milk duct. The atypical cells have not spread to surrounding breast tissue. This is the most common breast cancer type. (Note: in situ means “in the original place” and refers to the earliest stages of cancer, when it has not spread.)
- Inflammatory breast cancer (IBC): IBC is aggressive and fast growing and occurs when cancer cells infiltrate the skin and lymph vessels of the breast. Typically, no tumor or lump is present.
- Invasive ductal carcinoma (IDC): The abnormal cells formed in the milk ducts spread beyond the ducts and into other parts of the breast tissue. These cells can also spread to other parts of the body.
- Invasive lobular cancer (ILC): ILC begins in the milk glands, or lobules, and spreads to surrounding tissue. It can also spread to other parts of the body through blood and the lymph system. It is the second most common form of breast cancer.
- Lobular carcinoma in situ (LCIS): In this form of cancer, abnormal cells are found in the lobules of the breast, but the atypical cells have not spread outside of the lobules to surrounding tissue.
- Metastatic breast cancer (MBC): Also known as stage 4 breast cancer, MBC indicates that the cancer has spread to other parts of the body, which can include the lungs, liver, bones, or brain.
- Triple negative breast cancer (TNBC): TNBC indicates that the three most common types of receptors known to fuel most breast cancer growth (estrogen, progesterone, and the HER-2/neu gene) are not present in the cancer tumor. Cancer cells have tested negative for hormone epidermal growth factor receptor 2 (HER-2), estrogen receptors, and progesterone receptors.
Less common types in order of risk are:
- Medullary carcinoma makes up about 3 to 5 percent of breast cancer types. A tumor will appear on a mammogram (an X-ray of the chest) but does not always feel like a lump.
- Tubular carcinoma accounts for about 2 percent of breast cancer types and is usually found in women over age 50. The cancer cells have a tubular structure and appear as a spongy collection in a mammogram.
- Mucinous carcinoma (colloid) represents from 1 percent to 2 percent of all breast cancers. Mucus is produced in this type of cancer and the cells are not well defined.
- Paget’s disease of the breast or nipple is rare. It affects the skin of the nipple and sometimes the areola and can coincide with one or more tumors inside the breast. It is frequently misdiagnosed as other diseases that affect the skin conditions of the nipple and areola.
Risks of Getting Breast Cancer
There are many risk factors that may contribute to the illness. They include:
- Getting older—most breast cancers are diagnosed after age 50
- Genetic mutations to the genes BRCA1 and BRCA2 and genetic changes in other genes
- Family history of breast or ovarian cancer
- Personal history of breast cancer or other breast diseases
- Previous treatment using radiation therapy
- Having dense breasts
- Having taken the drug diethylstilbestrol (DES), which was given to some pregnant women between 1940 and 1971, and those whose mothers had taken DES
- Beginning periods before age 12 and beginning menopause after age 55
- Hormone replacement therapy
- Taking hormones, including hormone replacement therapy containing both estrogen and progesterone and using certain oral contraceptives
- Heavy alcohol use
- Not giving birth or not having your first child until age 35 (some accounts say 30)
- Never having breastfed
Breast Cancer in Men
Men also can develop breast cancer, but it is rare. One out of every 100 cases of breast cancer are in men. The most common types of male breast cancer are the same as in women: invasive ductal carcinoma, invasive lobular carcinoma, and ductal carcinoma in situ.
Risks for men are similar to those for women, with the added risks from:
- Klinefelter syndrome, a rare genetic occurrence in which a male has an extra X chromosome
- conditions that affect the testicles, including injury, swelling, or surgical removal
- radiation to the chest
- cirrhosis of the liver, which can lower androgen (male hormone) levels and raise estrogen (female hormone) levels in men.
Reducing the Risk of Breast Cancer
There are many conditions out of a person’s control in acquiring breast cancer, but some risks can be prevented by doing the following:
- limiting alcohol
- not smoking
- controlling weight
- being physically active
- limiting dose and duration of hormone therapy
- avoiding exposure to radiation and environmental pollution
Breast Cancer Screenings
Being vigilant about breast cancer screenings by getting annual clinical breast exams and mammograms to monitor changes can help detect breast cancer early, when survival rates are very good. (Instructions for performing a breast self-exam are available on the National Breast Cancer Foundation website.) Most doctors recommend healthy women get their first mammogram no sooner than age 40. Women with a greater risk of breast cancer may be required to get MRIs (magnetic resonance imaging) or ultrasounds in addition to mammograms.
The American Cancer Society recommends the following:
- women ages 40 to 44 should be given the option to start annual mammograms
- women ages 45 to 54 should get annual mammograms
- women 55 and older should get mammograms every two years or annually
- mammograms should be given as long as a woman remains in good health and has at least a 10-year life expectancy
- women should be familiar with screening limitations, benefits, and potential harms linked to mammograms
Where to Get Help and Support
Susan G. Komen San Diego performs studies to identify gaps in breast health and care access in the county. For help accessing free or low-cost clinical breast exams or mammograms, call 858-573-2760 or email email@example.com.
Komen San Diego also provides financial assistance for breast cancer screenings and for patients undergoing treatment, including help with copays, transportation, food assistance, breast cancer–related medical devices, prosthetics and rent, mortgage, and utilities. Contact Komen’s financial assistance fund through Jewish Family Service at 858-637-3210 or at breastcancersupport@JFSSD.org. for a list of support groups, see the Komen San Diego website.
Other nonprofits in San Diego offering breast cancer assistance include:
- Breast Cancer Angels, 714-898-8900, Debbie@breastcancerangels.org, provides financial and emotional assistance for Orange County, Los Angeles South Bay, and San Diego women undergoing breast cancer treatments and their families
- Cancer Angels of San Diego , 760-942-6346, firstname.lastname@example.org, provides financial assistance to San Diego County residents suffering from stage 4 cancer.
- Shades of Pink Foundation , 858-356-4204, email@example.com, provides temporary monetary assistance to local women experiencing financial distress due to a breast cancer diagnosis or treatment.
Herrick Library Resources
The following resources can be reserved and checked out via curbside pickup or OverDrive, where indicated*:
- Beat Breast Cancer Like a Boss: 30 Powerful Stories, by Ali Rogin: A collection of journalist Rogin’s interviews with 30 women touched by breast cancer, including actress Edie Falco, musician Sheryl Crow, and former governor Christine Gregoire.
- Breast Cancer (2013): This video is part of a series on diseases and is an overview of breast cancer and how it develops, is detected, and is treated.
- Breast Cancer Clear & Simple: All Your Questions Answered, by the American Cancer Society: A thorough resource for the newly diagnosed offering answers to questions women and their families may have on breast cancer and what to expect.
- Breast Cancer Survival Manual: A Step-by-Step Guide for Women with Newly Diagnosed Breast Cancer, by John Link, M.D. et al.: This sixth edition is a comprehensive guide on treatment and care.
- Cancer Vixen: A True Story, by Marisa Marchetto: This graphic novel details one woman’s 11-month ordeal with breast cancer.
- Don’t Stop Believin’, by Olivia Newton-John: Actress, activist, and Grammy-winner Newton-John candidly recounts her life, career, and journey with breast cancer.
- Everybody’s Got Something, by Robin Roberts: With humor and grace, the TV anchor writes about overcoming breast cancer.
- Survival Lessons*, by Alice Hoffman: The best-selling author of Practical Magic reveals how her life changed when she received a breast cancer diagnosis and advises on how to find the joys in life when coping with difficulties.
- Twisting Fate: My Journey with BRCA—From Breast Cancer Doctor to Patient and Back, by Pamela Munster: An oncologist who had advised thousands of women on breast cancer treatments is faced with a diagnosis of her own.
The following entertainment DVDs can be reserved and borrowed through curbside pickup:
- Decoding Annie Parker (2014, rated R): Based on a true story, this drama is about two women, one who ends up proving a genetic predisposition for breast cancer and another who has a family history of the disease and is undergoing breast cancer treatment.
- The Family Stone (2005, PG-13): The Family Stone is a comedy-drama in which a large family gathers one Christmas to, among other story lines, learn that the matriarch’s (Diane Keaton) breast cancer has returned.
- Living Proof (2009, not rated): This Lifetime movie stars Harry Connick Jr. as a real-life doctor who discovers a revolutionary treatment for breast cancer.
- The Long Goodbye (2019, TV-13): A wife and young mother fights a terminal breast cancer diagnosis with grace and dignity.
- Miss You Already (2016, PG-13): Drew Barrymore and Toni Collette star in this film about the relationship between two lifelong friends when one is diagnosed with breast cancer.
- Terms of Endearment (1983, PG-13): This Oscar winner stars Shirley MacLaine and Debra Winger as a too-close-for-comfort mother and daughter who must cope when the daughter experiences terminal breast cancer.
The following magazines carry occasional articles on breast cancer and women’s health and can be accessed via Flipster:
- Women’s Health
Sources: American Cancer Society, American Cancer Society Guidelines for the Early Detection of Cancer, https://www.cancer.org/healthy/find-cancer-early/cancer-screening-guidelines/american-cancer-society-guidelines-for-the-early-detection-of-cancer.html#; American Cancer Society, What Is Breast Cancer?, https://www.cancer.org/cancer/breast-cancer/about/what-is-breast-cancer.html; Centers for Disease Control and Prevention (CDC), Breast Cancer in Men, https://www.cdc.gov/cancer/breast/men/index.htm; CDC, Breast Cancer: What Are the Risk Factors? https://www.cdc.gov/cancer/breast/basic_info/risk_factors.htm; Komen San Diego, https://komensandiego.org/our-impact/; Mayo Clinic, Breast Cancer, https://www.mayoclinic.org/diseases-conditions/breast-cancer/symptoms-causes/syc-20352470; Mayo Clinic, Breast Cancer Prevention: How to Reduce Your Risk, https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/breast-cancer-prevention/art-20044676; Mayo Clinic, Breast Cancer Signs and Symptoms, https://www.cancer.org/cancer/breast-cancer/about/breast-cancer-signs-and-symptoms.html; Medline Plus, Breast Cancer, https://medlineplus.gov/breastcancer.html; National Breast Cancer Foundation, Inc., What Is Cancer?, https://www.nationalbreastcancer.org/what-is-cancer/; Susan G. Komen, What Is Breast Cancer?, https://ww5.komen.org/BreastCancer/WhatisBreastCancer.html
Graphics: Breast Cancer Now, https://breastcancernow.org/information-support/facing-breast-cancer/diagnosed-breast-cancer/primary-breast-cancer; Cleveland Clinic, https://health.clevelandclinic.org/14-questions-about-your-breast-cancer-diagnosis/; World Health Organization, https://www.iarc.fr/news-events/breast-cancer-awareness-month-2020/