Breast cancer

Overview

Breast cancer is a type of cancer that begins in the tissues of the breast. Besides skin cancers, breast cancer is the most frequently diagnosed cancer in women. Habitual screening mammograms should be routine for women who don't have any breast cancer symptoms. Mammograms can detect early variations in breast tissue and help catch breast cancer in its earliest, most curable stages.

Types of breast cancer

Breast cancer types include:

  • The most common type begins in the lining of the ducts and is called ductal carcinoma. Ductal carcinoma insitu has not spread beyond the milk duct into surrounding tissue. Invasive ductal carcinoma is a cancer that has spread through the wall of the milk duct and has begun to invade the tissues of the breast
  • Another common type, lobular carcinoma, occurs in the lobules (milk-producing glands). Lobular carcinoma insitu is when the cancer remains inside the lobule and has not spread to surrounding tissues. Invasive lobular carcinoma begins in the milk-carrying ducts and spreads beyond them.
  • Paget's disease is a rare form of breast cancer that starts in the glands in or underneath the skin. It is often identified by irritated, red patches on the skin. The patches can appear in sweat glands, in the groin or near the anus. Paget’s disease originates from breast duct cancer, therefore the eczema-like cancer typically appears around your nipple.
  • Inflammatory breast cancer is a rare, invasive breast cancer (a type of cancer that begins in one area and then spreads deeper into the tissues of that area). Typically, there is no lump or tumor; instead this cancer gives the skin of the breast a red look and a warm sensation. The breast skin also has a thick and bumpy appearance, similar to an orange peel.
  • Triple negative breast cancers are those that don’t have estrogen receptors and progesterone​ receptors, and do not have additional amounts of the HER2 protein on the surface of the cancer cells. These breast cancers are common in younger women and in African-American women. They have a tendency to spread faster than other types of breast cancer.
  • Phyllodes tumors are rare breast tumors that contain two types of breast tissue: stromal (connective) tissue and glandular (lobule and duct) tissue. When breast cancer spreads outside the breast, cancer cells can be found in the lymph nodes under the arm. When cancer has reached these nodes, it could mean that cancer cells have spread to other parts of your body. Cancer that spreads is still the same disease and has the same name as the primary, or original cancer. When breast cancer spreads, it is referred to as metastatic breast cancer, despite the fact that the secondary tumor is in another organ. This can also be referred to as "distant" disease.

Causes and risk factors

Although the exact cause of breast cancer isn’t known, there are factors that contribute to your risk:

  • Family history
  • Inherited genes – Certain genes that increase the risk of breast cancer can be passed on from your parents. The most frequent cause of hereditary breast cancer is an inherited mutation found in the BRCA1 and BRCA2 genes. The lifetime risk of breast cancer for families with BRCA1 mutations can be as high as 80 percent, whereas BRCA2 risks can be around 45 percent.
  • Radiation exposure

Symptoms

Women should see their doctor when they experience symptoms such as:

  • A lump or thickening in or near the breast or in the underarm area
  • Changes in the breast size or shape
  • A dimple or puckering in the breast skin

Be aware that these symptoms could be due to conditions other than breast cancer, so it’s best to see a doctor right away. A woman must see a doctor immediately if they have any of these symptoms, even if a mammogram is negative.

Breast cancer diagnosis and testing

The first step in making a diagnosis of breast cancer is education. Knowing the right time to self-exam and addressing any concerns in a timely manner is key for early detection, which leads to earlier treatment. Your doctor’s first step in the diagnostic process is usually a physical, which is when a doctor examines the breasts and surrounding areas to detect enlarged lumps, nodules, swelling or thickening of breast tissue.

Specialists use a variety of tests, typically outpatient procedures, to deliver an accurate breast cancer diagnosis, including:

  • Screening mammogram – As you age, our experts believe it is vital to get a screening mammogram every year. This is a crucial step toward early detection of breast cancer.
  • Diagnostic mammogram – Our Breast Cancer Center provides the most advanced diagnostic mammograms for women with current symptoms or previous breast cancer.
  • 3D mammography (digital breast tomosynthesis) – The Breast Cancer Center uses emerging 3D technology to detect lesions and reduce false alarms.
  • Full field digital mammography (FFDM) ­­­– FFDM produces exceptionally sharp digital images with less radiation exposure.
  • Ultrasonography – High-frequency sound waves determine if a mass is benign or suspicious
  • MRI Scan (magnetic resonance imaging) – A powerful magnet, radio waves and computer imaging combine to create highly detailed 3D breast tissue images.
  • CT or CAT Scan (computerized axial tomography) – A combination of X-rays and computer technology produces detailed 3D images to determine whether the cancer has spread.
  • PET scan (positron emission tomography) – Small amounts of radioactive sugar are injected to highlight cancer and see whether it has spread.
  • Bone scan – An injection of low-level radioactive material helps detect if breast cancer has spread to the bones.
  • Biopsy – Choosing from different types of biopsies, a doctor takes a tissue sample for further examination under a microscope by a pathologist to determine the type of cancer.
  • Lab tests – If breast cancer is discovered, additional tests will be given to gather additional information about the cancer:
  • Hormone receptor tests measure the amount of estrogen and progesterone receptors that are in the cancer tissue. More estrogen and progesterone receptors than normal mean the cancer may grow more quickly. The test results show whether treatment to block estrogen and progesterone may stop the cancer from growing.
  • Genetic tests measure the activity of genes and whether certain proteins are evident in tissue. These tests determine whether the cancer will spread more quickly and narrow down options for treatment.

 

Treatment options

Northwell Health takes a comprehensive approach to treating breast cancer at the dedicated Breast Cancer Center, a part of the Northwell Health Cancer Institute, which has achieved accreditation by the National Accreditation Program for Breast Centers (NAPBC). The multidisciplinary team of specialists has unparalleled experience diagnosing and treating a high volume of breast cancers at one of the largest cancer programs in the New York metro area. It offers specialized therapies available at only a few cancer centers in the nation.

One of the most progressive breast cancer centers in the country, available treatments and services include:

  • Complete breast cancer screening, diagnostic imaging, diagnosis, treatment, follow-up and assessment of cancer risks at one convenient location
  • An emerging technology in breast cancer screenings is 3D mammography (digital breast tomosynthesis), which is used on a case sensitive basis
  • Least-invasive breast cancer procedures, including breast-conservation surgery
  • Intensity-modulated radiation therapy (IMRT) that precisely targets breast tumors while protecting healthy tissue nearby, partial breast radiation therapy and accelerated schedules of radiation therapy
  • Advanced breast reconstruction techniques
  • Dedicated breast care navigator to help manage issues resulting from breast cancer and breast cancer treatment
  • Support groups
  • Genetic counseling for women at risk of breast cancer or who have had breast cancer, which may have a hereditary basis

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