Learn about cancer
Breast cancer detection
Currently, mammography is the most effective technology available for breast cancer screening. But, aside from the conventional mammography, there are several techniques that can be used for screening. These techniques are:
The ultrasound, also referred to as sonography, is a technique in which high-frequency sound waves, inaudible for humans, are bounced off tissues and internal organs. The echoes generated produce a picture known as a sonogram. This form of imaging is commonly used to distinguish between solid tumors and cysts. An ultrasound is sometimes also used to examine lumps that are difficult to see on a mammogram. The ultrasound can also be used as part of other diagnostic procedures, such as needle biopsies (the removal of tissue, or fluid, through the use of needles). Ultrasounds are not used for routine breast exams, because this technique is not suitable for detecting early signs of cancer.
Compared to the conventional mammograms, digital mammograms use computerized images instead of x-ray film. Before printed on film, the images are displayed on a monitor, where they can be modified (enhanced, magnified, etc.). The patient won’t notice a difference between the conventional and digital mammogram, as they are both performed using the same procedure. Digital mammography has a few advantages over conventional mammography. As previously indicated the images are electronically stored, this digital aspect of the mammograms makes long-distance consultations easier. There is also an improved accuracy with the digital mammograms, which decreases the number of follow-ups required. Despite these benefits, digital mammography does not increase the number of breast cancer tumors found in women. For more information about mammography, visit our section on mammograms.
CAD (computer-aided detection) is the use of computers to bring suspicious areas on a mammogram to the radiologist’s attention. It is used after the radiologist has done the initial review of the mammogram, and is performed by scanning the mammogram into the computer.
MRI (magnetic resonance imaging) is the creation of detailed pictures of areas inside the body through the use of a magnet, this form of imaging does not use radiation. The MRI of a breast is conducted by placing the patient on her stomach, on a scanning table. The patient’s breasts will hang into a hollow in the table, which contains coils which detect magnetic signals. The table is then moved into a tube-like machine that contains a magnet. The first series of picture are then taken, upon which the patient sometimes receives the contrast agent. The contrast agent can be used to improve the visibility of a tumor. The entire session may take about an hour.
A PET (positron emission tomography) scan is a computerised image of chemical changes taking place in human tissue. Patients are given an injection of a combination of sugar and a small amount of radioactive material. This radioactive sugar helps in locating a tumor, because cancer cells absorb sugar faster than other tissues in the body. After the radioactive substance has been injected, the patients lies still on a table for 45 minutes while she moves through the PET scanner 6 to 7 times. This time period allows the drug to circulate the body, and if a tumor is present the sugar will accumulate in it. PET scans are more accurate in detecting larger and/or aggressive tumors than they are in locating small and/or less aggressive ones.
Electrical Impedance Scanning
Human tissue has different electrical impedance levels (the speed of electricity through material). Breast tissue that is cancerous has a much lower electrical impedance (conducts electricity better) than normal breast tissue. The EIS is done by placing an electrode patch on the patient’s arm, and passing a very small current into the body. The current travels through the breasts, where it is measured by the scanning probe, which is placed over the breast. This gives a computerized image of the breasts; tumors show up as bright white spots on the screen. At this time, mammograms are the most effective tool we have to detect changes in the breast that may be cancer. In women at high risk of breast cancer, researchers are studying the combination of mammograms and ultrasound. Researchers are also exploring positron emission tomography (PET) and other ways to make detailed pictures of breast tissue.
Ductal lavage is an investigational technique for collecting samples of cells from breast ducts for analysis. The physician introduces a salt water solution into a milk duct, through a thin tube which is inserted into the opening of the duct on the surface of the nipple. The doctor then extracts fluids from the duct, which are then checked for indications of cancer.
Breast cancer staging
To plan your treatment, your doctor needs to know how far your breast cancer has developed. The different stages of breast cancer are based on the size of the tumour, and whether the cancer has spread. Staging is done through x-rays, examination of the lymph nodes, and other clinical tests. These tests can show whether the cancer has spread and, if so, to what parts of the body. The stage is often not known until the tumour has been removed.
Breast cancer is most commonly staged on the basis of the American Joint Committee on Cancer (AJCC) TNM System. This system stages breast cancer based on results from either physical exams, biopsies, or imaging tests, plus findings after surgery. The pathologic form of staging is more accurate than the clinical form, because it gives doctors the ability to exam the cancer more extensively.
Breast Cancer Stages:
According to the TNM system there are 5 stages of cancer, stages 0 to IV. Stage 0 being the non-invasive cancer, stage I the least advanced, and stage IV the most advanced.
Stage 0 is referred to as ductal carcinoma in situ (DCIS); it is the earliest form of breast cancer. When a woman is diagnosed with stage 0, the cancer cells have not yet invaded into the surrounding fatty breast tissue.
Lobular carcinoma in situ (LCIS) is sometimes also categorised as stage 0, however, many oncologists do not believe that it is a true form of breast cancer. In LCIS, abnormal cells grow within the lobules, but do not penetrate the lobules’ wall.
Paget disease of the nipple (without a tumour mass) is also categorised as stage 0. In all cases the cancer has not spread to lymph nodes or other tissues.
With stage I the tumour is smaller than 2 cm (3/4 in.) in diameter, and has not spread to the lymph nodes or other, distant, tissue.
There are many classifications for Stage IIA breast cancer, any of the following applies:
- The tumour is less than 2cm in diameter, or not found, and has spread to 1-3 axillary lymph nodes.
The tumour is less than 2 cm in diameter, or not found, and tiny amounts of cancer can be found in internal mammary lymph nodes on sentinel lymph node biopsy.
- The tumour is less than 2 cm in diameter, and has spread to 1-3 axillary lymph nodes, and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
- The tumour is larger than 2 cm but smaller than 5cm in diameter, but has not spread to the lymph nodes.
Similar to stage IIA, stage IIB cancer can have any of the following characteristics:
- The tumour is larger than 2 cm, but less than 5 in diameter. It has also spread to 1-3 axillary lymph nodes and/or tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
- The tumour is larger than 5 cm in diameter but does not grow into the chest wall or surrounding tissue, and has not spread to the lymph nodes.
- The tumour is not more than 5cm in diameter, or cannot be found. It has furthermore spread to 4 to 9 axillary lymph nodes, or it has enlarged the internal mammary lymph nodes.
- The tumour is larger than 5 cm in diameter, but has not grown into the surrounding tissue. It has spread to 1-9 of the axillary nodes, or to internal mammary nodes.
With stage IIIB cancer, the tumour has grown into the chest wall or skin, and one of the following applies:
- It has not spread to the lymph nodes.
- It has spread to 1-3 axillary lymph nodes and/or tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
- It has spread to 4-9 axillary lymph nodes, or it has enlarged the internal mammary lymph nodes.
- Inflammatory breast cancer is also classified as stage IIIB unless it has spread to distant lymph nodes or organs, in which case it would be stage IV.
Stage IIIC tumours are of any size, or cannot be found, and one of the following applies:
- The cancer has spread to 10 or more axillary lymph nodes.
- The cancer has spread to the lymph nodes under the collarbone.
- The cancer has spread to the lymph nodes above the collarbone.
- The cancer involves axillary lymph nodes and has enlarged the internal mammary lymph nodes.
- Cancer involves 4 or more axillary lymph nodes, and tiny amounts of cancer are found in internal mammary lymph nodes on sentinel lymph node biopsy.
The cancer can be any size and may or may not have spread to nearby lymph nodes. It has spread to lymph nodes far from the breast, and distant organs; the most common sites being: the bone, liver, brain, and lung.
Breast cancer myths
Could that sexy underwire bra cause breast cancer? What about that frozen yogurt you just ordered? Or hormone therapy? And how would you know if you had the disease until it was too late anyway? Don’t some studies show that examining your breasts and getting mammograms are useless?
Amid all the rumors and controversies surrounding breast cancer these days, what causes it, how to diagnose and treat it, it’s hard to know what to think. Or do. One thing we can tell you is that being able to separate fact from fiction could make a difference between life and death.
Myth 1 Having a risk factor for breast cancer means you’ll develop the disease
No risk factor either alone or in combination with others means you’ll definitely get breast cancer. There are various factors that may increase your risk of developing the disease. Some of these appear to increase your risk only slightly. They include smoking, drinking (more than 5 alcoholic drinks per week year after year), getting your first menstrual period before age 12, continuing to have periods after age 55, and not having your first full-term pregnancy until after age 30. If you have a number of these, the increase in risk can start to be more meaningful.
That said, even an inherited genetic abnormality in your family doesn’t necessarily mean you’re going to get breast cancer. Abnormalities in the so-called breast cancer genes BRCA1 and BRCA2 are very strong risk indicators. But 20 to 60 percent of women with these inherited abnormalities will not develop breast cancer.
Myth 2 If there is no breast cancer in your family, then you’re not at risk for the disease
Every woman is at risk for breast cancer. So are some men! For any individual woman, an inherited abnormality is the strongest risk factor, but only about 10 percent of all cases of breast cancer are due to inherited abnormalities. About 85 percent of women who develop the disease don’t have a family history. That’s why it’s important for all women to get screened regularly.
Myth 3 Breast cancer is passed only from your mother, not your father
We now know that breast cancer genes can be inherited from your dad’s side of the family. So ask relatives about cases on both sides and in both men and women. About 2,000 cases of male breast cancer are diagnosed in the US each year. In fact, male breast cancer is most closely associated with a BRCA2 abnormality. So if there’s a man in the family who’s had breast cancer, be sure to tell your doctor.
Myth 4 No matter what your risk factors are, you really don’t have to worry about breast cancer until you’re through menopause
The odds of getting the disease do increase as you age. But breast cancer can occur at any age. That’s why all women need to be vigilant. Though experts recommend yearly mammograms starting at age 40, your doctor may suggest that you start even earlier if you have a family history of breast cancer at a young age.
Mammography isn’t the ideal screening test for women younger than 40 because it can’t “see through” their dense breast tissue. So your doctor may also recommend ultrasound or magnetic resonance imaging (MRI). You may be able to enroll in a study of MRI for breast cancer detection for women at increased risk.
Myth 5 Wearing a bra or using antiperspirants and deodorants increases your risk of breast cancer
These are two Internet rumours that never seem to quit. It’s not true that wearing a bra, especially underwire bras, traps toxins by limiting lymph and blood flow in your breasts, increasing risk. There’s also no proof for the claims that antiperspirants and deodorants cause cancer by keeping the body from sweating out the cancer-causing substances that build up in the breasts, or because they contain harmful chemicals that are absorbed through the skin.
Myth 6 If you have small breasts, you’re much less likely to get breast cancer
Size doesn’t matter. Anyone with breasts can get it.
Myth 7 Research shows that using hormone therapy (HT) even for a short period of time, causes breast cancer
Many women were understandably concerned when a major study found that HT combining oestrogen and progestin increased risks of invasive breast cancer slightly. Another study also showed that a combination of therapy boosts breast cancer risk somewhat, however, it was able to offer some reassurance: This risk appeared to return to normal within a year or so after women stopped using the therapy. This seems to be the case for women who’ve been on HT for just months and those who’ve used it for more than 5 years.
One more thing: It’s important to note that no studies have found a boost in breast cancer risk for women using oestrogen-only therapy. This type of therapy is prescribed solely for women who have had hysterectomies, because oestrogen taken alone can cause cancer in the lining of the uterus (endometrial cancer).
Myth 8 Low-fat diet
A number of studies have found that women who live in countries where diets tend to be lower in fat have a lower risk of breast cancer. But the majority of studies focusing on women in the US haven’t found a solid link between dietary fat consumption and breast cancer risk. Why are these finding contradictory? It may be that women in other countries are at lower risk for other reasons: They exercise more, eat less, weigh less, smoke less, or have a different genetic profile or environmental interaction that makes them less susceptible. One thing we do know: Postmenopausal obesity is a risk factor that does put you at risk for breast and other cancers, so it pays to maintain a healthy weight.
As for dairy products, the study results are mixed. But Harvard’s Nurses’ Health Study, a large-scale study of 120,000 women, recently found that premenopausal women who ate a lot of dairy products, especially low-fat and fat-free ones, ran a lower risk of breast cancer. The study found no link between dairy product consumption and breast cancer risk in women who are past menopause.
Myth 9 Mammograms can prevent breast cancer
A 2003 Harris survey of more than 500 women found that about 30 percent thought mammograms could prevent breast cancer. The truth: While mammograms can detect breast cancer, they can’t prevent it.
Myth 10 Some studies actually show mammograms are worthless
Two studies, including a review study done by Danish scientists, did suggest that getting a regular mammogram didn’t lower a women’s risk of dying of breast cancer. But several other studies, including one done by the US preventive Services Task Force, totally disagree. You can maximise the benefit of mammography screening by seeking out the best facilities and staff in your area. Look for the radiology centre that handles the most breast cancer cases in the region. Go to a radiologist who specialises in reading mammograms, and ask, “How many mammograms do you read each year?” More tends to be better. A study in the Journal of the National Cancer Institute found that radiologists who read more than 300 mammograms a month were more accurate.