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Breast Cancer Information
Colorectal Cancer Information | Prostate Cancer Information | Lung Cancer Information | Breast Cancer Information | Cancer Committee

BREAST CANCER

Definition of breast cancer: Cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

 

The breast is made up of glands (lobules) and ducts.

  • Cancer that starts in the ducts is called ductal carcinoma. Ductal carcinoma in situ (DCIS) is an early cancer that has not spread and infiltrating ductal carcinoma is a more advanced cancer.
  • Cancer that starts in the lobules or glands, is called lobular carcinoma. Lobular carcinoma in situ is an early cancer and a more advanced cancer is infiltrating lobular carcinoma.

          

Each breast also has blood vessels and lymph vessels. Lymph vessels carry lymph fluids and lead to lymph nodes. The lymph nodes are small bean-shaped structures that are found throughout the body. The lymph nodes filter the lymph fluid and store white blood cells that help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest as well as other locations in the body.

Source: National Cancer Institutes

Breast Cancer in the U.S. and Mississippi

In 2009 there will be an estimated 192,370 new cases of female breast cancer and 1,910 new cases of male breast cancer in the United States.  Deaths from breast cancer in 2009 are estimated to be 40,170 females and 440 males.
        
Source: National Cancer Institutes. For more information on breast cancer from the National Cancer Institutes click here.

In Mississippi, it is estimated that 1,630 new cases of breast cancer among women will be diagnosed in the year 2008 and 440 women will die of breast cancer. The 2000-2004 age-adjusted female breast cancer mortality rate for Mississippi was 27.8 per 100,000 population. White women had a lower age-adjusted rate (24.2 per 100,000) than non-white women (35.2 per 100,000). Breast cancer ranks second among cancer deaths in women. Incidence rates have continued to increase, only in those women ages 50 and older since 1980, while mortality rates have declined. The decline in mortality is widely believed to be a direct result of increased use of screening with mammography, which results in early detection and improved treatment.

Source: Mississippi State Department of Health 

Click here to view the Mississippi Comprehensive Cancer Control Plan 2006 - 2011

Breast Cancer at Forrest General Hospital

Breast Cancer is the third leading cancer site with 177 new cases reported by the Forrest General Cancer Registry for 2007.

Symptoms of Breast Cancer

Common symptoms of breast cancer include:

  • A lump or thickening in or near the breast or in the underarm area
  • A change in how the breast or nipple feels
  • \Nipple tenderness
  • A change in how the breast or nipple looks
  • A change in the size or shape of the breast
  • A nipple turned inward into the breast
  • The skin of the breast, areola, or nipple may be scaly, red, or swollen. It may have ridges or pitting so that it looks like the skin of an orange.
  • Nipple discharge (fluid)

Even though early breast cancer usually does not cause pain, a person should see a health care provider for breast pain or any other symptom that does not go away. Symptoms may be caused by other health problems and not related to cancer. However, any woman or man with these symptoms should see a doctor so that if cancer is present it can be diagnosed and treated as early as possible. 

Prevention and Risk Reduction

A risk factor is something that may increase the chance of developing a disease. Risk factors for breast cancer include:

  • Being overweight or obese after menopause. The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
  • Lack of physical activity may increase the risk of breast cancer in women who are physically inactive throughout life. Being active may help reduce risk by preventing weight gain and obesity.
  • Personal history of breast cancer in one breast increases the risk of developing cancer in the other breast.
  • Family history of breast cancer in a mother, daughter, or sister especially if cancer developed in the relative before the age of 40. Breast cancer in other relatives may increase the risk.
  •  Age - As age increases, the risk of breast cancer goes up.
  • Certain breast changes with cells that appear abnormal under a microscope such as atypical hyperplasia or lobular carcinoma in situ.
  • Gene changes in certain genes such as BRCA1, BRCA2, and others increase the risk of breast cancer. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer.
  • Reproductive and menstrual history of a woman may indicate increased risk of breast cancer.  Factors that increase the risk include:
    -  The older a woman is when she has her first child;
    -  Women who had their first menstrual period before age 12;
    -  Women who went through menopause after age 55;
    -  Women who never had children are at an increased risk of breast cancer;
    -  Women who take menopausal hormone therapy with estrogen plus progestin after menopause.
  • Race - Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
  • Radiation therapy to the chest in women before the age of 30 has been associated with an increased risk of breast cancer. The younger a woman is when she has radiation treatment, the higher the risk is of developing breast cancer later in life.
  • Breast density - Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.
  • DES (diethylstilbestrol) was given to some pregnant women in the United States between about 1940 and 1971. It is no longer given to pregnant women. Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
  • Drinking alcohol - Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.

For more information on risk factors for breast cancer, click here.

Screening and Diagnostic Tests

Breast Self Exam (BSE)
 A woman should perform a breast self exam on herself once a month so that she knows how her breasts look and feel and can immediately spot a change if it occurs.

Click here for American Cancer Society instructions on how to perform a Breast Self Exam.

Clinical Breast Exam (CBE)
A clinical breast exam or CBE is a physical examination of the breast by a physician or other health care professional. The breast and under the arm (axilla) is checked visually and by feeling for lumps or other unusual changes.

If you feel a lump or notice a change in the shape, feel, or look of either breast, don't wait, talk to your doctor.  

Mammography
Screening for breast cancer is most often performed through mammography, a specialized x-ray of the breast. A mammogram may identify tumors that are still too small to feel and ductal carcinoma in situ. Factors that affect the ability of a mammogram to accurately find breast cancer include the size of the tumor, the density of the breast tissue, and the skill of the radiologist. 

Where Can I Get a Mammogram?

  • Forrest General Radiology Department - Physicians who read mammograms at Forrest General are board certified Radiologists with education in mammography that meets American College of Radiology (ACR) and Mammography Quality Standards Act (MQSA) guidelines and requirements. Forrest General mammography technicians are certified in Radiologic Technology and Mammography by the American Registry of Radiologic Technologists (ARRT).  The mammography department is ACR and MQSA accredited.
  • 28th Place - click here for more information on 28th Place Women's Center
  • South Mississippi Rural Health Initiative, Inc. Women's Health Center
    62 Old Airport Road, Hattiesburg
    Telephone: 601-544-4550
    Provides clinical breast examinations, mammograms, and Pap tests free of charge to women of specific ages with low incomes.

Most insurance policies will pay for a screening mammogram every 1 to 2 years starting around 40 years of age, more or less, depending on the policy.  Medicare will pay for a screening mammogram once per 12 months.

Ultrasound
Ultrasound is usually not a primary screening test for breast cancer but is often used to learn more about a lump or abnormal area in the breast tissue once identified by clinical breast exam or mammography. Ultrasound uses high-energy sound waves bounced off of internal tissues and organs to make echoes which are then used to develop a picture of the body tissue. Since ultrasonography is not an invasive technology, it is generally a low risk procedure.

MRI (magnetic resonance imaging)
MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. MRI does not use any x-rays. MRIs may be used in women at high risk for breast cancer and may be used as an additional diagnostic tool in others to:

  • Study lumps in the breast that remain after surgery or radiation therapy.
  • Study breast lumps or enlarged lymph nodes found during a clinical breast exam or a breast self-exam that were not seen on mammography or ultrasound.
  • Plan surgery for patients with known breast cancer.

In June 2009, Forrest General was awarded a three-year accreditation in Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) Services by the American College of Radiology (ACR). This accreditation demonstrates a commitment to quality patient care and provides confidence for patients and referring physicians that accredited organizations are the best choice for care.

Biopsy
If a lump is identified in the breast tissue by screening and other tests, you may be referred to a surgeon to a surgeon for a biopsy. A biopsy removes tissue or fluid from the breast to help decide if the lump or abnormal tissue is cancer.  Biopsy procedures may be assisted using ultrasound guidance, needle-localization, or stereotactic techniques.

Doctors can remove tissue from the breast in different ways:

  • Fine-needle aspiration: a thin needle is used to remove fluid from a breast lump. The fluid is examined for cancer cells by a pathologist under a microscope. 
  • Core biopsy:  a thick needle is used to remove breast tissue. A pathologist then checks for cancer cells. This procedure is also called a needle biopsy.
  • Surgical biopsy: a surgeon removes a sample of tissue surgically for a pathologist to analyze for cancer cells. An incisional biopsy takes a sample of a lump or abnormal area.  An excisional biopsy takes the entire lump or area.

Overview of Breast Cancer Treatment

Surgery - Most malignant tumors or growths are removed through surgical procedures. Lymph nodes are usually removed as well so that they can be viewed by a pathologist using a microscope to see if they contain cancer cells. 

  • Breast-conserving surgery is an operation that removes the cancer but not the entire breast. 
  • Lumpectomy is a surgery to remove only the tumor and a small amount of normal tissue around it. 
  • Partial mastectomy is a surgery that removes the part of the breast that has cancer and some normal tissue around it. It may also be called a segmental mastectomy.
  • Total mastectomy removes the whole breast. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after.
  • Modified radical mastectomy removes the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
  • Radical mastectomy removes the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm.
    If a patient has a mastectomy, breast reconstruction (surgery to rebuild a breast's shape after a mastectomy) may be considered and may be done at the time of the mastectomy or later. 
    Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor and is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor and allowed to flow through the lymph ducts to the lymph nodes. The surgeon identifies the first lymph node to receive the substance or dye and then removes this node. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove additional lymph nodes.

Radiation therapy - Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy - Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be administered systemically (injected or infused into the body or taken by mouth) or it may be administered regionally (placed directly into the spinal column an organ, or a body cavity). The way chemotherapy is given depends on the type and stage of the cancer being treated. Chemotherapy given after surgery has been done to remove the cancer is called adjuvant therapy.

Endocrine therapy - Endocrine therapy (also known as hormone therapy) is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. 

Targeted therapy - Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapies being studied in the treatment of breast cancer.

Clinical trials - New types of treatment are being tested in clinical trials all the time. You may wish to participate in a clinical trial. Not everyone will qualify for a clinical trial since each trial has very specific criteria for participants. Your physician will be able to talk with you about clinical trials.

This page contains only an overview of breast cancer diagnosis and treatment. Additional information can be found by clicking on the links to Patient Education and Resources or Health Library. If you have cancer of the breast, your physicians will discuss diagnostic tests and treatments with you in detail.

American Cancer Society's All About Breast Cancer

Information reviewed by Nagen Bellare, M.D., F.A.C.P., Hematology & Oncology, Hattiesburg Clinic, P.A., Forrest General Hospital Medical Director of Oncology, Co-Chair of Cancer Committee

Resources for Women with Breast Cancer

American Cancer Society (ACS)
1-800-ACS-2345 (1-800-22702345)
http://www.cancer.org
A not-for-profit organization that supports cancer research.  ACS offers patients and their families many services including educational programs, support groups, and free booklets.

Breast Cancer Network of Strength
1-800-221-2141
A breast cancer educational resource and breast cancer survivor hotline.  

CancerCare
1-800-813-HOPE (1-800-813-4673)
http://www.cancercare.org/get_help/assistance/index.php
Cancercare is a national nonprofit organization that provides free, professional support services for anyone affected by cancer.

Celebrating Life
http://www.celebratinglife.org
A website for African American women with breast cancer.

Patient Advocate Foundation
1-800-532-5274
http://www.patientadvocate.org
Provides legal and advocacy help with disputing insurance claim denials and offers co-pay relief program that provides financial assistance to eligible patients who are being treatment for breast cancer.

The Pink Ribbon Fund
http://www.pinkribbonfund.org
Assists Pine Belt breast cancer patients with financial support for diagnosis and treatment, as well as quality of life issues resulting from illness.
Contact: Susan Light
601-296-6750

Sisters Network, Inc.
1-713-781-0255
www.sistersnetworkinc.org
Provides outreach and education on the impact of breast cancer in the African American community.

South Mississippi Rural Health Initiative, Inc.Women's Health Center
62 Old Airport Road, Hattiesburg
Telephone: 601-544-4550
Provides clinical breast examinations, mammograms, and Pap tests free of charge to women of specific ages with low incomes.

Susan G. Komen for the Cure
1-877-GO-KOMEN (1-877-465-6636)
http://www.komen.org
A helpline staffed by trained volunteers.

Waiting for a Cure
P.O. Box 17013, Hattiesburg, MS 39404
Hattiesburg: 601-543-5719
Gulf Coast: 228-547-4244
http://www.waiting4acure.org/
E-mail: helping@waiting4acure.org

YWCA
1-202-467-0801
http://www.ywca.org/site/pp.asp?c=djISI6PIKpG&b=297532
Offers ENCOREplus® breast and cervical cancer program that provides outreach, education and screening mammograms to women who are most in need and lack access to breast health services.

 






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