What is Breast Cancer?

While most people are familiar with the idea and repercussions of breast cancer, not everyone may know what exactly breast cancer is or how it comes to be.

Kinds of Breast Cancer

Put simply, breast cancer is the continued growth of abnormal cells in the area of the breast. This area can include the ducts (that carry milk), lobules (that produce milk), and connective tissue (that holds everything together. Most breast cancers start in the lobules or ducts. And while this does mean cancers appear in the area that we traditionally think of as the breast, it includes the underarms as well.

But there is not one single type of breast cancer. And sometimes, the types overlap.

Invasive Ductal Carcinoma

With invasive ductal carcinoma, cancer cells start in ducts and spread out into the surrounding breast tissue. If it continues to spread to other parts of the body, it metastasizes.

Invasive Lobular Carcinoma

Invasive lobular carcinoma starts in the lobules and spreads to nearby breast tissue. This cancer can also metastasize.

Less Common Types

There are many other kinds of breast cancers, though most are less common. Medullary breast carcinoma starts similarly to invasive ductal, but grows slowly and only rarely spreads to the lymph nodes.

Mucinous or colloid carcinoma is a variation on invasive ductal carcinoma. However, the cancer cells float in mucin, an ingredient in the body’s natural mucus.

Paget’s Disease of the nipple originates with cancer cells collecting in and around the nipple, traditionally the ducts there. From there, it can spread to the areola and further.

Inflammatory breast cancer is also a variation on invasive ductal carcinoma. It is generally accompanied by symptoms of inflammation such as swelling, dimpling, and redness.

Triple-Negative breast cancer does not have the three common receptors found in breast cancers. These receptors are for estrogen, progesterone, and HER2 (human epidermal growth factor). Without the receptors, some methods of treatment are not available.

Ductal carcinoma in situ, or DCIS, is considered either the earliest stage of breast cancer or pre-cancer that is likely to lead to breast cancer. Cancerous cells are forming in the ductal lining, but they have not spread.

How Breast Cancer Spreads

Breast cancer cells start in ducts, lobules, and breast tissue. However, they can spread to the lymph nodes, raising the odds of metastasis–cancer cells spreading through the lymph system and the rest of the body. The more lymph nodes that have cancer cells, the more likely metastasis is. However, metastasis is not an inevitability. Some people with cancer cells in their lymph nodes do not have metastases. And, unfortunately, metastasis can occur despite there currently being no cancer cells in the lymph nodes.

What Are Breast Cancer Symptoms?

There are several possible changes to the breast that can be noticed in regular–monthly is recommended–self-breast checks. Keep an eye out for any changes to your regular breast shape, texture, or color. Some changes that may indicate the need to visit a doctor are:

  • A lump in the breast or armpit
  • Swelling or change in size to any part of the breast.
  • Discharge of any kind that is not milk coming from the nipple (including blood)
  • Puckering of the nipple/Inversion of the nipple
  • Flaky skin or redness around the nipple or the breast
  • Dimpling of the skin (like the skin of an orange) on the breast
  • Pain in any part of the breast

Any one of the symptoms on its own does not mean you have breast cancer. They could indicate an infection or changes due to hormonal shifts. However, if the signs continue or you are concerned, bring them to the attention of your doctor.

Risk Factors

There is no one sign that someone will or won’t get breast cancer, but there are some risk factors that can raise your chances. Some of these factors are genetic factors, while others come from a person’s lifestyle.

Some of the factors that cannot be reduced are:

  • Gender–being a woman increases your risk
  • Age–risk increase with age
  • Dense breasts–they are harder to see through on a mammogram, making early detection more difficult
  • Family history–the risk is increased if a close family relative (mother, sister, daughter) has had breast cancer
  • Personal history–previous breast conditions or breast cancer increase risk
  • Certain gene mutations–BRCA1 and BRCA2, as well as other mutations, can increase risk
  • Radiation exposure–while this may come from many sources, even medical treatment, it could potentially be a risk factor.
  • Starting your period young
  • Starting menopause older

Can Risk be Reduced?

Some potential risk factors come from lifestyle practices and can be adjusted for. Some of these factors are:

  • Alcohol–drinking in excess can increase risk
  • Obesity–obesity can increase your risk, particularly after menopause
  • Taking hormones–certain forms of hormone replacement therapy (progesterone and estrogen, primarily) can increase risk when taken for over five years after menopause. Some birth control pills can also increase breast cancer risk
  • Not having children or having them at an older age can increase risk.
  • Excercise–by not exercising, breast cancer risk can increase. Maintaining a healthy exercise schedule for yourself, you can lower your risk.

Prevention

The best way to prevent breast cancer in yourself is to maintain the risk factors that you can. Beyond that, keep yourself familiar with your breasts with a monthly breast self-check. More than anything, this keeps you familiar with the size, texture, and sensation of your breast so that you might be more likely to notice a change should one appear.

Also, speak with your doctor about breast cancer screening. They know the best time to start screening and will help you to the next steps if there are any concerns. Checking in on your breasts yourself, having your doctor check, and having regular screenings will help you be prepared and catch anything early should there be any signs of breast cancer to find.

Dr. Gorman

Valerie J. Gorman, MD, FACS, works to ensure that her patients are informed and receive a personalized approach to cancer treatment and breast cancer surgery. If you have questions about breast cancer or how it is treated, she or the team at Texas Breast Center in Waxahachie are happy to help answer your questions.

Dr. Gorman is board certified by the American Board of Surgery and serves as Medical Director of Surgical Services and Chief of Surgery at Baylor Scott & White Medical Center – Waxahachie.


New Study Associates Dairy Milk Intake With Increased Breast Cancer Risk

A recent study by the researchers at Loma Linda University Health has discovered a link between dairy milk and an increased risk of breast cancer. The study called Dairy, soy, and risk of breast cancer: those confounded milks was published to the International Journal of Epidemiology.

The study used a participation group of 52,795 North American women with a mean age of 57.1 years who were all free of breast cancer. The study then followed them for nearly eight years, taking into account their diets, demographics, family history, and other factors. A food frequency questionnaire, or FFQ, was used to estimate the women’s dietary intake. In contrast, a baseline questionnaire covered the other factors, including physical activity, hormonal and other medication use, alcohol consumption, reproductive and gynecological history, and breast cancer screening.

How much dairy milk?

At the end of the study period, the participation group yielded 1,057 new breast cancer cases. Using the FFQ, the study revealed that there is “fairly strong evidence that either dairy milk or some other factor closely related to drinking dairy milk is a cause of breast cancer in women,” according to Gary E. Fraser, MBChB, Ph.D., first author of the paper. He continued, “Consuming as little as 1/4 to 1/3 cup of dairy milk per day was associated with an increased risk of breast cancer of 30%. By drinking up to one cup per day, the associated risk went up to 50%, and for those drinking two to three cups per day, the risk increased further to 70% to 80%.”

While the particular fat content of the dairy milk–skim versus whole, etc.–had a minimal variation, when compared to minimal or no milk intake, high consumption of dairy milk and dairy calories were associated with a higher risk of breast cancer. Cheese and yogurt yielded no critical associations.

However, there was no clear association found between soy products and breast cancer. Fraser noted that “the data predicted a marked reduction in risk associated with substituting soy milk for dairy milk. This raises the possibility that dairy-alternate milks may be the optimal choice.”

One suggested reason for the link between dairy milk and breast cancer is the sex hormone content of dairy milk. Because cows are lactating when their milk is collected, approximately 75% of a dairy herd is usually pregnant. Breast cancer in women is hormone-responsive. Therefore, taking in this additional level of hormones could cause a higher blood level of it, and then insulin-like growth factor-1, which is thought to increase the risk of breast cancer, as well as other cancers.

Does Dairy Cause Cancer?

Does dairy cause cancer? There is certainly no proof of that being the case. But now there is some evidence of a link between dairy and breast cancer. “This work suggests the urgent need for further research,” Fraser said. “Dairy milk does have some positive nutritional qualities, but these need to be balanced against other possible, less helpful effects.

Risks

It is, however, worth remembering that just because an association was found does not imply causation. The numbers are just strong enough to keep researchers watching the intake of dairy, even when other factors were removed. And while Fraser stated that, “By drinking up to one cup per day, the associated risk went up to 50 percent, and for those drinking two to three cups per day, the risk increased further to 70 to 80 percent,” even that does not mean you are increasing your risk to 50% or 80% by drinking milk.

The 50% increased risk of breast cancer is a 50% increase to your current risk. If the average woman has a 1/8 chance of being diagnosed with breast cancer, that gives her approximately a 12% chance to increase the risk of breast cancer by 50% would only bring her risk up to a total of 18%. The 80% increased risk of drinking milk products 2-3 times a day would bring the total risk up to 21.6% risk of breast cancer. And while that certainly isn’t the happiest number to think about, it is certainly not as frightening as a jump to 80% risk would be.

Fraser and the rest of the researchers who worked on the study advise taking a look at current dietary guidelines, taking this increased risk of breast cancer with dairy intake into account.

If you have any questions about your risk, or possible next steps, Dr. Gorman and the Texas Breast Center are happy to help.


Breast Self Exam: What to Look For

Last month was breast cancer awareness month, a time to highlight the importance of cancer screening and breast health. The Center for Disease Control has named breast cancer as the most common cancer for women in the United States. Approximately 12% (that is, 1 in every eight women) will be diagnosed with invasive breast cancer over her lifetime.

These statistics shift depending on other factors like age, race, and certain genetic factors. For example, African-American women are far more likely to be diagnosed with triple-negative breast cancer than women of other races, and to die of breast cancer of any kind. Asian, Native American, and Hispanic women tend to have lower risks of developing breast cancer, though they should still be aware of the signs and symptoms.

Why is Breast Cancer Screening Important?

In September of 2019, the American Cancer Society announced a new stance on breast self-exams. They stated that self-checks do not tend to reveal any early signs of cancer when women are also getting their scheduled breast cancer screening mammograms and regular checks by their health professionals. That’s not to say that people do not come to their doctors after spotting changes in their breasts. However, these changes are often noticed during dressing or bathing.

Despite this announcement, breast checks can still provide valuable insight. It is easiest to spot changes in your breast if you are familiar with it in the first place. If you are doing a regular breast self-exam, you will be ready to catch anything out of the ordinary–whether that be during your exam or while getting dressed.

How to do a Breast Self-Exam

There are two basic steps to a breast check. You’ll want to examine the breasts by looking and by feeling. Both of these steps can be further broken down from there. Try to do all parts of the exam on the same day and around the same time in your cycle every time: a week after your period ends is a standard time to do it. If you don’t get a period, set a date every month to do your breast self-exam.

Look

For the looking portion of the check, you will want to stand in front of a mirror. You will be standing in a few different poses and looking at a few different angles–front, right, and left.

In each of your poses, you will want to look at a few factors. Make a note of the shape of your breasts, especially in comparison to one another. It is far from unusual for one to be larger than the other, but sudden or drastic changes in size should not happen. Keep an eye out for a change in the usual vein patterns in your breasts. If the veins have increased or expanded significantly, you may want to speak with your doctor. Symptoms display in your nipples if they are consistently itchy, red, swollen, scaly, inverted, or are producing discharge. Finally, check the skin on your breasts for dimpling, redness, rash, puckering, or anything that could be considered like an orange peel. These could all be signs of something happening beneath the surface.

The best way to look for all of these symptoms is to examine your breasts from all angles. First, face the mirror with your arms down at your sides. Turn to the left and the right to check both sides of each breast. Next, place your hands on your hips with your elbows out to your sides, keeping your shoulders up and back. Repeat the pattern of front, left, and right. This same pose can be done hunched forward. This adjustment allows the breasts to hang so that you can see the underside.

Now, raise your arms straight above your head. You can clasp them together or leave them in a superman pose, but try to remember what you have done in previous breast exams so that you know what to expect. Once you have made a thorough observation, lean forward at the hips so that your breast hang forward again, keeping your arms above your head.

Make a note of anything you find that is different from normal and keep an eye on it. Many symptoms we attribute to breast cancer can also be symptoms of things like PMS, a swollen lymph node due to another infection, or many other factors, though, so observe first. However, if you have strong concerns, don’t hesitate to call your health professional for answers.

Feel

To start the feeling check, you will want a comfortable and flat place to lie down. You will lay flat on your back with your right arm up behind your head (if you are starting with your right breast). The goal is to get your breasts as flat as possible.

Once you are in a comfortable position, you will want to start feeling along the outer edge of your breast, near your armpit. You will want to use the pads of your fingers rather than your fingertips and move in small, smooth circles. Perform each circle at more than one pressure–light, medium, and firm–between the size of a dime and a quarter. By varying the amount of pressure, you can check more of the breast tissue. Move in a slow, up and down pattern across until you have covered the entire breast. Another option is to start at the nipple and perform your press checks in a spiral outwards. So long as you have a pattern to ensure you cover the entire breast and become familiar with it, this should be sufficient. Try to follow the same pattern every time you do your breast self-exam.

Once you have finished your exam lying down, it is best to give your breasts an exam while standing or sitting up as well. You will use the same pattern you have established for yourself, using firm, medium, and light pressure and the pads of your fingers to feel for anything unusual in the breast tissue you might have missed while lying down.

When is a Breast Lump Cancer?

It’s not entirely uncommon to find some kind of lump or bump when doing your breast self-exam. Hormones, infections, and other causes can cause temporary lumps that you may detect during your monthly checks. There are common attributes that a cancerous lump will have, though none are a guarantee. If you are concerned about anything you find, have your doctor examine it as well.

Your fingers can detect the most common criteria for a cancerous lump during your breast self-exam. The lump will be a firm, painless mass. The edges are sometimes irregular. If you have a lump that is getting larger over time, that may also be a cause for concern.

Of course, each case is unique. Some cancerous lumps may be painful or soft, and some may feel perfectly round. They can be more challenging to detect in people with more dense breast tissue or scar tissue on their breast–for example, those who have had previous breast surgery. These denser tissues can also make it somewhat more difficult for mammograms to detect cancer. People with dense breast tissue or scar tissue should be particularly familiar with their breasts so that they can detect changes early.

What Causes Breast Cancer?

While there is no one singular cause of breast cancer, there are several risk factors that could increase the likelihood of a diagnosis. Some are environmental factors that may be controlled, while others are physical characteristics or part of your history.

Gender, race, age, and genetics are all potential risk factors. Women are more likely to develop breast cancer, and this risk increases once they reach the age of 55. Some genes, like the BRCA1 and the BRCA2 genes, can be passed through generations and are considered a potential cause. If a first-degree relative (a daughter, sister, or mother) has or had breast cancer, your risk doubles. Because of the importance of hormones as a risk factor, your menstrual history may also be a factor. Those who started their period early–before the age of twelve–may have an increased risk.

Some risk factors are situational or environmental. Tobacco and alcohol use can increase your risk, especially in younger patients, as can being overweight or obese. Some previous benign or noncancerous breast conditions may influence your risk later on. Hormone use, such as hormone replacement therapy, both current and in the past, can increase your risk. One risk factor that is easier to lower is living a sedentary. Exercising regularly will decrease your risk of developing breast cancer.

Breast Self-Exam Results

The primary purpose of a breast self-exam is to help you to familiarize yourself with your breasts. If you know what the skin, muscle, and tissue feel like on a typical day, then you will be better prepared to notice anything abnormal should something come up.

These tests are not a reason to avoid getting a mammogram or having a physician examine you, especially if you are among those with risk factors. If you do come across something in one of your breast self-exams that has you concerned, bring it up with your doctor, or with Dr. Gorman at the Texas Breast Center. As a surgeon specializing in surgical oncology and surgical diseases in the breast, she can help you understand whether your lump, change in skin texture, or any change is a cause for concern. And, if it is, she and her team will help you set up a treatment plan.

Valerie J. Gorman, MD, FACS, is board certified by the American Board of Surgery and serves as Chief of Surgery and Medical Director of Surgical Services at Baylor Scott & White Medical Center – Waxahachie. Her goal is to ensure that all of her patients have an informed, personalized approach to breast surgery and cancer treatment.


Birth Control and Breast Cancer: What’s the Connection?

contraception and breast cancerLate in 2017, the media picked up on a study published in the New England Journal of Medicine that linked hormonal contraceptives, like the pill and some intrauterine devices (IUDs), with a higher risk of breast cancer.

After hearing this news, you might be concerned about whether your family planning choices might increase your cancer risk. Here’s what I explain to my patients.

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