Breast Cancer

By Jessica Liermann
 What should you know about breast cancer?
● Aside from skin cancer, breast cancer is the most common cancer in women
● It is the second leading cause of cancer death among women
● About 220,000 cases are diagnosed in women and about 2,000 in men every year in the US
● Each year about 40,000 women and 400 men in the United States die from breast cancer
● Although men can also get breast cancer, risk is relatively low
● White and Black women are at greater risk for developing breast cancer
● Risk increases with age
● A woman has about a 1 in 8 chance of developing breast cancer sometime during her life
● Average age of onset for women is 50+, but it can affect younger women
● In the United States, about 11% of all new cases are found in women younger than 45
● Average age of onset for men is 60-70 years old
● Early detection can save lives!

cdc.gov, 6/15/16 & cancer.gov, 7/24/17

 So, what is breast cancer?
● When cells located in the breast become abnormal and grow uncontrollably,
forming a tumor
● There are different types of breast cancer which are recognized by the cells
within the breast that are affected
● Breast cancer can be benign or malignant
● Malignant breast tumors may eventually spread to other parts of the body if
not treated

cancercenter.com, 7/24/17
 Breast Cancer Types
● The breast is made up of 15-20 lobes
● Each lobe has smaller sections called
lobules
● Lobules have small glands that produce
milk
● Breast milk flows from the lobules
through thin tubes called ducts to the
nipple
● Ductal carcinoma is the most common
type of breast cancer
● Lobular carcinoma is the second most
common
cancer.gov, 7/24/17
photo: https://commons.wikimedia.org/wiki/File:Breast_and_adjacent_lymph_nodes.jpg
 Ductal Carcinoma
● Ductal carcinoma in situ (DCIS)
○ In situ= in original place
○ Accounts for 1 of every 5 new
diagnoses
○ Earliest stage of breast cancer
○ Can lead to invasive cancer
○ Usually does not cause lump in
breast, but can be found by
mammograms
○ May cause breast pain and bloody
discharge from nipple
○ Treatment usually includes a
lumpectomy (tumor and some of
breast is removed) and radiation
webmd.com, 7/21/15
● Invasive ductal carcinoma (IDU)
○ Invades other parts of the body
○ Accounts for 80% of all invasive breast
cancers in women and 90% in men
○ May cause hard, immovable lump in
breast and nipple may become inverted
○ Physical exam and mammogram may be
used to diagnose
○ Additional tests are done to see where it
has spread
○ Treatment usually includes surgery
(lumpectomy or mastectomy) followed by
chemotherapy or radiation
○ Chemo targets cells throughout entire
body while radiation focuses only on the
cancer
 Lobular Carcinoma
● Lobular carcinoma in situ (LCIS)
○ Often multiple lobules are affected
○ Doesn’t spread, but 20-40% of women
with LCIS will develop a separate
invasive breast cancer
○ Doesn’t cause lumps and often only
diagnosed by a biopsy
○ Does not need immediate treatment
○ Those at increased risk of breast cancer
may opt to take medicine or undergo
surgery as preventative measures
webmd.com, 7/21/15
● Invasive lobular carcinoma (ILB)
○ Second most common form of invasive
breast cancer
○ May not cause lump, but may feel a
thickened area/hardening in part of
breast
○ Often occurs in area above nipple
towards armpit
○ Diagnosed by mammogram
○ Additional tests may be needed to see
where it has spread
○ Treatment usually includes surgery
(lumpectomy or mastectomy) along
with chemo and/or radiation
 Ductal vs. Lobular

*Abnormal cells found in the breast duct lining *Abnormal cells found in the loubles

photo:https://www.cancer.gov/news-events/ca photo:https://www.pinterest.com/pin/685391637
ncer-currents-blog/2015/dcis-low-risk 010348617/?lp=true
 How breast cancer affects the body
● Some of the earliest effects are lumps or masses located in the breast
● Changes may occur to the breast surface, as well as the nipple
● Discharge from the nipple may result
● Pain can also occur
● If not detected early, the most common places for breast cancer to spread are
the brain, bones, liver, and lungs
● People who suffer from breast cancer experience similar systemic effects as
those who suffer from other types of cancer, such as extreme fatigue and lack
of energy
● Nausea, lack of appetite, and sudden weight loss may also be experienced

livestrong.com, 8/16/13
 What to look for...
● New lump in the breast or underarm (armpit)
● Thickening or swelling of part of the breast
● Irritation or dimpling of breast skin
● Redness or flaky skin in the nipple area or breast
● Pulling in the nipple or nipple area
● Nipple discharge other than breast milk, including blood
● Any change in size or shape of breast
● Pain in the breast
*Important:
A lump does not necessarily indicate breast cancer
Additionally, some breast cancers do not cause lumps
Therefore, if you experience any of the above symptoms you may want to talk to your doctor

cdc.gov, 6/15/16
photo:http://www.top10homeremedies.com/news-facts/do-you-know-the-warning-signs-of-breast-cancer.html
 Who is at risk?
● Genetic factors ● Avoidable factors
○ Older age ○ Radiation therapy to the breast or chest
○ Caucasian or Black woman ○ Obesity
○ Early menstruation (before 12) ○ Poor diet
○ Late menopause (after 55) ○ Drinking alcohol
○ Personal/family history of breast cancer ○ Sedentary lifestyle
○ Dense breast tissue ○ Having your first child at an older age
○ Changes within the BRCA1 and BRCA2 ○ Never having given birth
genes ○ Taking hormone therapy for
menopause

*Only about 5-10% of breast cancer cases are attributed to heredity

cancer.gov, 7/24/17 & nationalbreastcancer.org, 7/23/17

 How to prevent breast cancer
● Talk to your doctor about breast cancer screening
○ Clinical breast exams
○ Mammograms
● Perform self-exams on a regular basis
○ Look for any new changes
● Drink alcohol in moderation
○ Limit to less than one drink/day
● Stay active
○ At least 30min./day
● Limit hormone therapy
● Eat a healthy diet
● Preventative surgery is also an option for those
who are at high risk

mayoclinic.org, 8/16/16
photo: https://www.pinterest.com/weeneec/positive-quotes/?lp=true
 Stages of breast cancer
● Knowing the stage of the cancer can provide better treatment options, thus a
better outcome
● Things to consider prior to determining the stage:
○ Size of the tumor
○ Number of lymph nodes affected
○ Location of affected lymph nodes
○ Signs of metastasis

● Staging ranges from 0-4

nationalbreastcancer.org, 7/23/17 photo:http://niagarabreastcancer.org/breast-cancer-stages/

 Stage 0-1
● Earliest detection of breast cancer
● Stage o:
○ Abnormal cells confined to one area
○ Usually in the ducts or lobules
○ Can spread if left untreated
● Stage 1A:
○ Small tumor (peanut size)
○ Has not spread to lymph nodes
● Stage 1B:
○ Small cluster of lymph nodes affected
○ May or may not have small tumor as well
● Both are highly treatable with a 5-year relative survival rate of 100%
nationalbreastcancer.org, 7/23/17
photo:http://www.nationalbreastcancer.org/breast-cancer-stage-0-and-stage-1
 Stage 2A & B
● Cancer has spread, but still confined to localized
region
● Stage 2A: one of the following is present
○ No tumor but lymph nodes are affected
○ Small tumor (less than 2cm.) and lymph nodes are affected
○ Small tumor (2-5cm.), no sign of affected lymph nodes
● Stage 2B: one of the following is present
○ Small tumor (2-5cm.) and lymph nodes are affected
○ Tumor present (bigger than 5cm.)
● Very treatable with a 93% 5-year relative survival
rate

nationalbreastcancer.org, 7/23/17 & cancer.org, 7/23/17

photo: http://www.nationalbreastcancer.org/breast-cancer-stage-2
 Stage 3A, B, & C
● Advanced cancer that has spread past localized region to nearby tissues
● Stage 3A: one of the following present
○ Small tumor (less than 2cm.), affected lymph nodes (4-9)
○ Tumor (bigger than 5cm.), small cluster of affected lymph nodes
○ Tumor (bigger than 5cm.), affected lymph nodes (1-3)
● Stage 3B: all of the following present
○ Tumor (can be any size)
○ Affected lymph nodes
○ Swelling/inflammation of chest wall or breast skin
● Stage 3C: no tumor or tumor of any size with one of the following:
○ Many affected lymph nodes (10+)
○ Affected lymph nodes near collar bone
○ Affected lymph nodes near underarm or breastbone
● Can be treated with a 5-year relative survival rate of 72%
nationalbreastcancer.org, 7/23/17 & cancer.org, 7/23/17
 Stage 4: Metastatic Cancer
● Similar to stage 3, but cancer has
metastasized
● Other areas of the body are affected:
○ Bones
○ Brain
○ Lungs
○ Liver
● Considered incurable
● More difficult to treat with a 22%
5-year relative survival rate

nationalbreastcancer.org, 7/23/17 & cancer.org, 7/23/17

photo:https://emedtravel.wordpress.com/2012/10/09/the-four-stages-of-breast-cancer/
 What causes breast cancer?
● Research has yet to uncover the exact cause
● However, normal breast cells can become cancer due to mutations
within the cell’s DNA
● Some mutations are inherited, while others are acquired
● Most cases of breast cancer result from acquired mutations of DNA
● Thus, the change takes place sometime during a women’s life
● Damage to a cell’s DNA leads to damaged genes
● A damaged or “bad” gene can lead to cancer
● Several acquired gene mutations are involved in breast cancer
● These mutations may result from radiation or cancer-causing
chemicals, but the cause of most acquired gene mutations is still
unknown
nationalbreastcancer.org, 7/23/17 & cancer.org, 8/18/16
 Gene mutations associated with breast cancer
● BRCA1 and BRCA2 gene mutations are the most
common cause of hereditary breast cancer
● Normally, these genes make proteins that help
keep cells from growing abnormally
● Once mutated, these genes cannot stop the cell
from growing out of control, leading to cancer
● For BRCA1 mutations, a person has up to an
80% increased risk factor, with an average risk
between 55-65%
● A person with a BRCA2 mutation has a 45%
increased risk factor
● These two mutations are often found in younger
women and more commonly found in Jewish
people
cancer.org, 8/18/16
● Other known gene mutations linked to breast
cancer include:
○ ATM~causes ataxia-telangiectasia
○ TP53~causes Li-Fraumeni syndrome
○ CHEK2~causes Li-Fraumeni syndrome
○ PTEN~causes Cowden syndrome
○ CDH1~hereditary diffuse gastric cancer
○ STK11~can cause Peutz-Jeghers
syndrome
○ PALB2~interacts with the protein made
by the BRCA2 gene
● All of these genetic mutations can increase a
person’s risk for breast cancer
● However, simply having a mutation does not
mean a person will develop cancer
 Treatment
● Depends on the type of breast cancer and
how far it has spread
● Several treatment options are available:
○ Surgery
○ Chemotherapy
○ Hormonal/Biological therapy
○ Radiation
○ Targeted drugs
○ Alternative medicine/Palliative care
● Complications can result from surgery
● Surgery along with additional treatment ● Risks include pain, bleeding, infection, and
such as, chemotherapy, hormone therapy or lymphedema
radiation are the primary treatments used ● After surgery some women choose to have
for breast cancer reconstruction or prosthesis

cdc.org, 6/15/16 & mayoclinic.org, 8/16/16

photo:http://breastcancerhelp.net/lumpectomy-vs-mastectomy-is-there-a-right-choice/
 Side effects of treatment
● Many treatments for breast cancer can cause side effects which include:
○ Anemia
○ Lymphedema
○ Appetite Loss
○ Memory/concentration problems
○ Bleeding and bruising
○ Mouth/throat problems
○ Constipation
○ Nausea and vomiting
○ Delirium
○ Nerve problems
○ Diarrhea
○ Pain
○ Edema
○ Sexual and fertility problems
○ Fatigue
○ Skin and nail changes
○ Hair loss
○ Sleep problems
○ Infection
○ Urinary/bladder problems

cancer.gov, 4/5/16
 Latest Research
● Researchers are working hard to discover better ways to
prevent, treat, and ultimately cure breast cancer
● Some fields of research include:
○ Gene variation and its effect on breast cancer
○ Dietary supplements and reduction of risk
○ Targeted drug therapy and treatment
● According to the Cancer Research Institute, preclinical
and clinical studies show that immunotherapy treatments
provide promising results
● 3 immunotherapy drugs have been approved and several
others are being tested
● Other treatments currently being tested are oncolytic
virus therapies, antibodies, adjuvant immunotherapies,
and cytokines
cancer.org, 8/18/16 & cancerreaserch.org,7/25/17
photo:http://praavahealth.com/blog/immunotherapy-paving-the-way-for-cancer-treatment-/35
 Clinical Trials
● Many clinical trials are underway for breast cancer
● To learn more or to find the closest one near you, simply visit
○ NIH Clinical Research Trials and You (National Institutes of Health)
○ Learn About Clinical Trials (National Cancer Institute)
○ Search for Clinical Trials (National Cancer Institute)
○ ClinicalTrials.gov (National Institutes of Health)

cdc.org, 6/15/16
 Is there hope?
● Although the battle to find a cure for breast ● They also provide many resources to anyone
cancer continues, there are more than 3.5 who has been diagnosed with breast cancer
million breast cancer survivors in the US today! and help them along the way, so that no one
● This is larger than any other group of cancer has to fight alone
survivors
● Many breast cancer foundations exist
● One worth mentioning is the Susan G. Komen
foundation, which to date has:
○ Funded more than $920 million in
research
○ Funded more than $2.0 billion in medical
care, community and provider education,
and psychosocial support
○ Served millions in over 60 countries
worldwide
komen.org, 6/5/17 photo:http://www.komenminnesota.org/
References
American Cancer Society https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html
last updated 8/18/16

Cancer Research Institute https://www.cancerresearch.org/we-are-cri/home/cancer-types/breast-cancer 7/25/17

Cancer Treatment Centers of America http://www.cancercenter.com/breast-cancer/learning/ 7/24/17

Centers for Disease Control and Prevention https://www.cdc.gov/cancer/breast/basic_info/index.htm last updated 6/15/16

Livestrong http://www.livestrong.com/article/23300-breast-cancer-affect-body/ last updated 8/16/13

Mayo Clinic http://www.mayoclinic.org/diseases-conditions/breast-cancer/manage/ptc-20208035 last updated 8/16/16

National Breast Cancer Foundation http://www.nationalbreastcancer.org/breast-cancer-stages 7/23/17

National Cancer Institute https://www.cancer.gov/types/breast last updated 4/5/16

Susan G. Komen Foundation http://ww5.komen.org/AboutBreastCancer/QualityofLifeTopics/SurvivorshipTopics/SurvivorshipTopics.html last

updated 6/5/17

WebMD http://www.webmd.com/breast-cancer/ductal-carcinoma-invasive-in-situ#2 last updated 7/21/15