Aging and Breast Cancer

Aging and Breast Cancer

Frequently Asked Questions

The body is made up of many types of cells. Normally, cells grow, divide, and produce more cells as needed to keep the body healthy. Sometimes, however, the process goes wrong. Cells become abnormal and form more cells in an uncontrolled way. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign, which means not cancerous, or malignant, which means cancerous.

Breast cancer occurs when a malignant tumor forms in the breast tissue. The cancer can be found in the breast itself or in the ducts and lymph nodes that surround the breast.

When cancer spreads from its original location in the breast to another part of the body such as the brain, it is called metastatic breast cancer, not brain cancer. Doctors sometimes call this "distant" disease.

Yes. Although breast cancer is primarily a woman's disease, men can get breast cancer too. They can develop it at any age, but they are usually between 60 and 70 years of age when the diagnosis is made. Male breast cancer makes up less than 1 percent of all cases of breast cancer.

One definition of cure is being alive and free of breast cancer for 5 years. If the cancer is found early, a woman's chances of survival are better. In fact, nearly 97 percent of women who discover their breast cancer when it is near the site of origin and still small in size are alive 5 years later.

However, women whose cancer is diagnosed at a late stage, after it has spread to other parts of the body, have only a 23.3 percent chance of surviving 5 years.

Older age is a major risk factor. Three-fourths of all breast cancers occur in women age 50 or older. Having a sister, mother, or daughter who has had breast cancer also increases your risk.

This chart shows what the approximate chances are of a woman getting invasive breast cancer in her lifetime.

When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for. You can help safeguard your health by learning the following warning signs of breast cancer:

• a lump or thickening in or near the breast or in the underarm area.

• a change in the size or shape of the breast.

• ridges or pitting of the breast; the skin looks like the skin of an orange.

• a change in the way the skin of the breast, areola, or nipple looks or feels; for example, it may be warm, swollen, red, or scaly.

• nipple discharge or tenderness, or the nipple is pulled back or inverted into the breast.

Doing a breast self-exam may help a woman detect a lump that might otherwise go unnoticed. However, most health organizations currently recommend clinical breast exams done by a doctor or trained expert, or mammograms, as the most reliable tools for detecting breast cancer.

During a clinical breast exam, a doctor or other health care professional checks the breasts and underarms for lumps or other changes that could be a sign of breast cancer. The doctor can tell a lot about a lump by carefully feeling it and the tissue around it. Benign lumps often feel different from cancerous ones.

Mammography is a simple procedure. A registered technologist takes an x-ray of each breast with a machine that is used only for breast x-rays. It is different from x-ray machines that are used to take x-rays of the bones or other parts of the body. The standard mammogram exam includes two views of each breast, one from above and one angled from the side.

The technologist places the breast between two flat plastic plates. The two plates are then pressed together. The idea is to flatten the breast as much as possible. Spreading the tissue out makes any abnormal details easier to spot with a minimum of radiation. The technologist takes the x-ray, and then repeats the procedure for the next view. The pressure from the plates may be uncomfortable, or even slightly painful, but each x-ray takes less than one minute.

A mammogram can often detect breast changes in women who have no signs of breast cancer. Often, it can find a breast lump before it can be felt. If the results indicate that cancer might be present, your doctor will advise you to have a follow-up test called a biopsy.

Several studies show that mammography screening has reduced the number of deaths from breast cancer. However, some other studies have not shown a clear benefit from mammography. Scientists are continuing to examine the level of benefit that can come from mammography.

For the time being, the National Cancer Institute recommends the following:

• If you are a woman in your 40s, you should have mammography screening every one to two years.

• If you are a woman age 50 and older, you should have mammography screening every one to two years.

• If you are a woman who is at higher than average risk for breast cancer, you should seek expert medical advice about whether to begin screening before age 40 and how often to have screening mammography.

Some women worry about radiation exposure, but the risk of any harm from a mammogram is actually quite small. The doses of radiation used are very low and considered safe. The exact amount of radiation used during a mammogram will depend on several factors. For instance, breasts that are large or dense will require higher doses to get a clear image.

The federal government limits the amount of radiation used for each exposure of the breast to 0.3 rad. A "rad" is a unit of measurement that stands for Radiation Absorbed Dose. In practice, most mammograms deliver just a small fraction of this amount.

If the results of a clinical breast exam or a mammogram indicate that cancer might be present, the doctor will order a follow-up test. The most common follow-up test is called a biopsy. This is a procedure where a doctor removes a small amount of fluid or tissue from the breast to make a definitive diagnosis. A doctor might perform fine needle aspiration, a needle or "core" biopsy, or a surgical biopsy.

Researchers are studying another type of surgical biopsy which removes less breast tissue. It is called an image-guided needle breast biopsy, or stereotactic biopsy. If approved for general use, it would become an important surgical tool. Eighty percent of U.S. women who have a surgical breast biopsy do not have cancer.

You can seek conventional treatment from a specialized cancer doctor, called an oncologist. The oncologist will usually assemble a team of specialists to guide your therapy. Besides the oncologist, the team may include a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others.

Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it. You might also be eligible to enroll in a clinical trial to receive treatment that conventional therapies may not offer.

Clinical trials are research studies on people to find out whether a new drug or treatment is both safe and effective. New therapies are tested on people only after laboratory and animal studies show promising results. The Food and Drug Administration sets strict rules to make sure that people who agree to be in the studies are treated as safely as possible.

Once breast cancer has been found, it is staged. Staging means determining how far the cancer has progressed. Through staging, the doctor can tell if the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment. Staging will let the doctor know

• the size of the tumor and exactly where it is in the breast.

• if the cancer has spread within the breast.

• if cancer is present in the lymph nodes under the arm.

• If cancer is present in other parts of the body

Standard treatments for breast cancer include:

• surgery that takes out the cancer

• radiation therapy that uses high-energy beams to kill cancer cells and shrink tumors

• chemotherapy that uses anti-cancer drugs to kill cancer cells

• hormone therapy that keeps cancer cells from getting the hormones they need to survive and grow.

Surgery, as opposed to chemotherapy or radiation, is the most common treatment for breast cancer. The kind of surgery a woman has is based on the type and stage of the cancer. Most women can choose between breast-conserving surgery that removes the cancer but not the breast, or surgery that removes the entire breast and sometimes the surrounding tissue.

There are two types of breast-conserving surgery -- lumpectomy and partial mastectomy.

• Lumpectomy is the removal of the tumor and a small amount of normal tissue around it. A woman who has a lumpectomy almost always has radiation therapy as well. Most surgeons also take out some of the lymph nodes under the arm.

• Partial or segmental mastectomy is removal of the cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Often, surgeons remove some of the lymph nodes under the arm. In most cases, radiation therapy follows.

Surgery to remove the entire breast and sometimes the surrounding tissue is called a mastectomy. There are three types:

• A total or simple mastectomy is removal of the whole breast. Sometimes the surgeon takes out lymph nodes under the arm as well.

• A modified radical mastectomy is removal of the breast, many of the lymph nodes under the arm, and the lining over the chest muscles. Sometimes, the surgeon removes part of the chest wall muscles, too.

• A radical mastectomy, sometimes called the Halsted radical mastectomy, is removal of the breast, chest muscles, and all of the lymph nodes under the arm. This surgery is used only when the tumor has spread to the chest muscles.

Even if the surgeon removes all of the cancer that can be seen at the time of surgery, a woman may still receive follow-up treatment. This may include radiation therapy, chemotherapy, or hormone therapy to try to kill any cancer cells that may be left. Treatment that a patient receives after surgery to increase the chances of a cure is called adjuvant therapy.

Breast reconstruction, surgery to rebuild a breast's shape, is often an option after mastectomy. Some health insurance plans pay for all or part of the cost of breast reconstruction. Often, they will pay for surgery to the other breast so that both breasts are about the same shape and size.

If you are thinking about reconstruction, you should talk with a plastic surgeon before your mastectomy. Some women begin reconstruction at the same time as they have the mastectomy done. Others wait several months or even years. Although the reconstructed breast will not have natural sensation, the surgery can give you a result that looks like a breast.

The reconstructed breast may be made with the patient's own, non-breast tissue or by using implants filled with saline or silicone gel. The Food and Drug Administration has decided that breast implants filled with silicone gel may be used only in clinical trials. Before making the decision to get an implant, a woman can call the Food and Drug Administration's Center for Devices and Radiologic Health at 1-888-INFO-FDA or 1-888-463-6332 for more information.

Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells and shrink tumors. This therapy often follows a lumpectomy, and is sometimes used after mastectomy. During radiation therapy, a machine outside the body sends high-energy beams to kill the cancer cells that may still be present in the affected breast or in nearby lymph nodes. Doctors sometimes use radiation therapy along with chemotherapy, or before or instead of surgery.

Chemotherapy is the use of drugs to kill cancer cells. A patient may take chemotherapy by mouth in pill form, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called whole body or systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Treatment with chemotherapy can be as short as two months or as long as two years.

Sometimes chemotherapy is the only treatment the doctor will recommend. More often, however, chemotherapy is used in addition to surgery, radiation therapy, and/or biological therapy.

Hormonal therapy keeps cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work. Sometimes it includes surgery to remove the ovaries, which make female hormones. Like chemotherapy, hormonal therapy can affect cancer cells throughout the body.

Often, women with early-stage breast cancer and those with metastatic breast cancer -- meaning cancer that has spread to other parts of the body -- receive hormone therapy in the form of tamoxifen. Hormone therapy with tamoxifen or estrogens can act on cells all over the body. However, it may increase the chance of developing endometrial cancer. If you take tamoxifen, you should have a pelvic examination every year to look for any signs of cancer. A woman should report any vaginal bleeding, other than menstrual bleeding, to her doctor as soon as possible.

Yes. Certain drugs that have been used successfully in other cancers are now being used to treat some breast cancers. For example, some women take the chemotherapy drug paclitaxel in combination with the drugs cyclophosphamide and doxorubicin to help kill tumors that have spread to other parts of the body. This mix of drugs may increase the length of time you will live, or the length of time you will live without cancer. Also, certain drugs like herceptin can help women with specific genetic breast cancer mutations.

Several methods show promise in preventing breast cancer. In October 1998, the Food and Drug Administration approved the drug tamoxifen to prevent breast cancer in high-risk women. Following a large-scale study, researchers found that tamoxifen reduced cancer in high-risk women by 49 percent.

Another method is a type of surgery called preventive or prophylactic mastectomy for women at high risk of breast cancer. It involves removing a breast that is not known to contain cancer in order to reduce a woman's cancer risk.

Some researchers are looking at diet as a possible risk factor for breast cancer. Studies show that women in populations that consume a high-fat diet are more likely to die of breast cancer than women in populations that consume a low fat diet. But scientists still do not know for sure if a diet low in fat will prevent breast cancer, or if any other specific dietary changes will actually prevent cancer.

Some studies point to lifestyle choices that may decrease a woman's risk of breast cancer. Exercise, especially in young women, may decrease hormone levels and contribute to a decreased risk. Breast-feeding also may decrease risk.

Other studies point to lifestyle factors that might increase a woman's risk of developing breast cancer. For instance, women who drink alcohol have a slightly increased risk. Gaining weight after menopause, especially after natural menopause and/or after age 60, also may increase a woman's risk.

Yes. STAR, or the Study of Tamoxifen and Raloxifene, began in 2000 to find out if the drug raloxifene might be better and safer than tamoxifen in reducing a woman's risk of breast cancer. Researchers are also looking at substances called aromatase inhibitors that might also help reduce risk. Aromatase inhibitors prevent the formation of estradiol, which is a female hormone. Women who are post-menopausal and whose breast cancer is hormone-dependent may respond well to this therapy.

New research shows women with early-stage breast cancer who took the drug letrozole, an aromatase inhibitor, after they completed five years of tamoxifen therapy significantly reduced their risk of breast cancer recurrence.

Also, other new research found a test that can predict both the risk of breast cancer recurrence and who is most likely to benefit from chemotherapy such as letrozole.

Some breast cancer patients take part in studies of new treatments. These studies called clinical trials are designed to find out whether a new treatment is both safe and effective. Often, clinical trials compare a new treatment with a standard one so that doctors can learn which is more effective. People with breast cancer who are interested in taking part in a clinical trial should talk with their doctor.

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