Breast Cancer

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• QHow is breast cancer caused by environmental hazards?

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  A Dr. Robert A. Wascher, MD , Surgery, answered on behalf of Cancer Treatment Centers of America (CTCA)

  As discussed in Dr. Wascher’s bestselling book, A Cancer Prevention Guide for the Human Race, breast cancer is associated with the largest number of known risk factors of any type of cancer.  Some of these risk factors (such as age, gender, family history, dense breast tissue, and the genes we are born with) cannot be modified. However, other known breast cancer risk factors can be avoided, or at least minimized, including combination (progesterone and estrogen) hormone replacement therapy medications, obesity, physical inactivity, alcohol intake, unnecessary medical x-rays, and smoking.  
  Other breast cancer risk reduction strategies to consider include decreasing your consumption of red meat and processed meats, scheduling your first planned pregnancy before age 30, and breastfeeding each of your babies for at least a year.
  Additionally, adhering to current breast cancer screening recommendations, including breast exams performed by an experienced health care provider and screening mammograms, can increase the likelihood of detecting new breast cancers at an early stage, when the disease is most curable.
  For additional detailed information on evidence-based approaches to cancer prevention and screening, including breast cancer, readers are referred to Dr. Wascher's book, A Cancer Prevention Guide for the Human Race.  Additional evidence-based cancer prevention information is also available on Dr. Wascher's website (www.doctorwascher.com)
   
   
   
   

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• QWhat increases my risk for metastatic or recurrent breast cancer?

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  A Cancer Treatment Centers of America (CTCA) answered

  Anyone can get metastatic breast cancer. Factors that may increase risk include:

  • Gender: Women are at greater risk than men for developing metastatic breast cancer.
  • Lymph node involvement: Among women with cancer in their lymph nodes during their first diagnosis, 30–60% eventually get metastatic disease.
  • Number of positive lymph nodes: Having several lymph nodes that contain cancer cells at the time of first diagnosis is associated with a greater risk of eventually developing metastatic disease.
  • Tumor size: Larger tumor size when cancer was first diagnosed is associated with a greater risk of metastatic disease.
• QWhat are the risk factors for papillary carcinoma?

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  A Cancer Treatment Centers of America (CTCA) answered

  Anyone can get papillary breast carcinoma. Factors that may increase risk include:

  • Gender: Although papillary carcinoma is occasionally found in men, the disease is more common among women.
  • Age: Papillary carcinoma is usually diagnosed in women between the ages of 62 and 67.
  • Menopause: This type of breast cancer is more common among postmenopausal women.
  • Race: Non-white women are more likely than white women to have a papillary carcinoma.
• QIs breast cancer hereditary?

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  A Dr. Shayma M. Kazmi, MD , Oncology, answered on behalf of Cancer Treatment Centers of America (CTCA)

  Approximately 10% of all breast cancers may be hereditary. Most of these are associated with BRCA1 or BRCA2 hereditary mutations. Usually, young age at cancer development (less than 45), the type of cancer (triple negative), 1st degree family relative or more than 1 second degree family relative would all be alerts to a possible hereditary phenomenon and testing would be offered.

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• QWhat is stage 3 breast cancer?

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  A Cancer Treatment Centers of America (CTCA) answered

  Also called locally advanced cancer, in stage 3 breast cancer, the tumor in the breast is more than two inches in diameter across and the cancer is extensive in the underarm lymph nodes, or has spread to other lymph nodes or tissues near the breast. Stage 3 breast cancer is divided into subcategories known as stage 3A, stage 3B, and stage 3C.
  
  Stage 3A – This stage is defined by either of the following:

  • The tumor measures larger than five centimeters.
  • There is significant involvement of lymph nodes. The nodes clump together or stick to one another or surrounding tissue.

  Stage 3B – This stage is defined by either of the following

  • Cancer has spread to tissues near the breast, such as the skin or chest wall. The tumor may range in size.
  • Underarm lymph nodes or those beneath the breast under the ribs may be affected.

  Stage 3C – Cancer may or may not be in the breast and may have spread to the breast skin or chest wall. Cancer permeates lymph nodes around the collarbone and may also be in the lymph nodes surrounding the breast bone.
  
  Women with stage 3 breast cancer may have chemotherapy and/or targeted therapies first in order to shrink the tumor to make surgery possible. After surgery, women may have chemotherapy, targeted therapy, hormone therapy or a combination of treatments to help prevent recurrence.
• QWhat is ductal carcinoma?

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  A Cancer Treatment Centers of America (CTCA) answered

  Ductal carcinoma is breast cancer that begins in the milk ducts. When this type of breast cancer is confined to the ducts, it is called ductal carcinoma in situ, or DCIS. When the tumor has spread to the surrounding breast tissue, it is called invasive ductal carcinoma, or IDC. DCIS may or may not become IDC.
  
  DCIS is the most common type of noninvasive breast cancer, with about 60,000 new cases in the United States each year. About 1 in every 5 new breast cancer cases is ductal carcinoma in situ.
  
  Women with DCIS are at higher risk for having cancer return following treatment, although the chance of a recurrence is under 30%. Most recurrences occur within 5 to 10 years after the initial diagnosis, and may be invasive or noninvasive. DCIS also carries a heightened risk for developing a new breast cancer in the other breast. A recurrence of DCIS is not life threatening, but will require additional treatment.
  
  The type of therapy selected may affect the likelihood of recurrence. Treating ductal carcinoma in situ with a lumpectomy (breast-conserving surgery) without radiation therapy carries a 25–35% chance of recurrence. Adding radiation therapy to the treatment decreases this risk to approximately 15%. Currently, the long-term survival rate for women with DCIS is nearly 100%.
  
  DCIS is divided into several subtypes, mainly according to the appearance of the tumor. These subtypes include micropapillary, papillary, solid, cribriform and comedo.
• QWhat are the types of stage 1 breast cancer?

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  A Cancer Treatment Centers of America (CTCA) answered

  Stage 1 is divided into two categories:

  • Stage 1A: The tumor measures 2 cm or smaller (about the size of a pea or shelled peanut), and has not spread outside the breast.
  • Stage 1B: Small clusters of cancer cells measuring no more than 2 mm, are found in the lymph nodes, and either there is no tumor inside the breast, or the tumor is small, measuring 2 cm or less.

  The survival rate for stage 1A breast cancer may be slightly higher than for stage 1B. However, all women with stage 1 breast cancer are considered to have a good prognosis.
  
  At stage 1, TNM designations help describe the extent of the disease. (In the TMN system, T describes the size of the original tumor; lymph node -- N -- indicates whether the cancer is present in the lymph nodes; and metastasis -- M -- refers to whether cancer has spread to other parts of the body.) For example, there may or may not be cancer cells in the lymph nodes, and the size of the tumor may range from 1 cm to 2 cm. Most commonly, stage 1 breast cancer is described as:

  • T: T1, T2, T3 or T4, depending on the size and/or extent of the primary tumor.
  • N0: Usually, cancer has not spread to the lymph nodes
  • M0: The disease has not spread to other sites in the body
• QWhat are the risk factors for breast cancer?

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  A Dr. Virginia Chiantella, MD , Surgery, answered on behalf of StoneSprings Hospital Center

  

  Many women don't understand their individual risk for breast cancer and need appropriate screening. Learn more from Virginia Chiantella, MD, from StoneSprings Hospital Center in this video.

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• QDoes diet affect my breast cancer risk?

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  A Carolyn Lammersfeld, MS , Integrative Medicine, answered on behalf of Cancer Treatment Centers of America (CTCA)

  The American Institute for Cancer Research and the American Cancer Society have published evidence-based reports that outline how diet may affect cancer risk, including breast cancer. The evidence summarized in these guidelines suggests that body weight, physical activity, alcohol consumption, and intake of processed meats may affect breast cancer risk. In order to reduce risk, recommendations include:

  • achieving and maintaining a healthy body weight
  • being physically active for 150 minutes per week
  • drinking no more than 1 alcohol containing beverage in a day, if you drink at all
  • avoiding processed meats

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• QWhat are the risk factors for lobular carcinoma in situ (LCIS)?

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  A Cancer Treatment Centers of America (CTCA) answered

  Anyone can get lobular carcinoma in situ (LCIS). Factors that may increase risk include:

  • Gender: Because male breasts do not have lobules, men rarely develop lobular carcinoma.
  • Age: LCIS is more common among women in their early 40s who have not been through menopause.
  • Family history: Having several female relatives who have had breast cancer, especially those with a mutation of the BRCA2 gene.
  • Hormone replacement therapy (HRT): Combination estrogen-progestin after menopause may increase a woman’s risk of developing DCIS.