Breast Cancer

Frequently Asked Questions About Breast Cancer

Cancer. A single word that can turn a person's world inside out. The Internet makes getting information about cancer easier than ever. But unverifiable information is abundant in cyberspace. It's important for women to obtain knowledge, not just information. For free accurate, up-to-date, cancer-related explanations from an oncology nurse (weekdays from 8:30 a.m. -4:30 p.m.), or for physician referral information, please call The James Line, 24 hours a day, 7 days a week, at (614) 293-5066 or toll-free at 1-800-293-5066.

Following are some of the most frequently asked questions by patients about breast cancer.

Q. What are the warning signs?

A. The most common sign of breast cancer is a lump or thickening in the breast. Other signs include:

    * change in the size or shape of the breast,
    * discharge from the nipple, or
    * change in the color or feel of the skin of the breast or nipple (dimpled, puckered or scaly; warm, red or swollen).

It's important to note that there may be no warning signs or symptoms. Breast self-exams, clinical breast exams and regularly scheduled mammograms are vital in the screening and early detection of the disease.

Q. What causes breast cancer?

A. No one yet knows what causes breast cancer, but medical research has generated a lot of knowledge about the disease. Researchers at the Comprehensive Cancer Center have made some important discoveries in the treatment and prevention of breast cancer, ranging from understanding more about the genetic aspects of cancer to developing a vaccine that may treat and prevent breast cancer. Read more about breakthroughs at The James.

Q. How likely am I to get breast cancer?

A. Statistics show that a woman has a 1 in 8 lifetime chance of developing breast cancer. Breast cancer is the most frequently diagnosed cancer in women in the United States, other than non-melanoma skin cancers. Three-fourths of breast cancer cases are diagnosed in women age 50 and older. And although breast cancer is more common in older women, it does occur in younger women and in men. There are additional factors that may increase a woman's cancer risk.

Q. What should I do if I find a lump while performing a monthly breast self-exam?

A. Check the other breast. Some lumpiness is normal. However, if the lump is new or unusual, it warrants examination by a physician. A lump found during a breast self-exam, a clinical breast exam or a mammogram does not necessarily mean that a woman has breast cancer. Nearly 80 percent of all breast lumps are noncancerous (benign). However, cancer is a possibility. Early detection and treatment provides the best outcome, so a woman shouldn't let fear stop her from seeing a physician.

Q. What are my risks for getting breast cancer?

A. Being a woman and getting older are the biggest risk factors for developing breast cancer. Other risk factors include:

    * age;
    * family history of breast cancer in a close family member on either mother's or father's side;
    * onset of menstruation before age 12;
    * onset of menopause after age 50; or
    * not having children or having a first child after age 30.

Q. Is a mammogram painful?

A. The pressure caused by spreading the breast tissue may be uncomfortable, but it should not be painful. Women who experience pain should tell the technologist.

Q. Is the radiation exposure from getting a mammogram harmful?

A. The radiation exposure from modern, low-dose mammography equipment is minimal. Radiation doses usually are so low they're negligible. Plus, the medical benefits of early detection outweigh any potential risk.

Q. How do I decide which treatment option is best for me?

A. Speak with your physician about treatment options. Although there are four standard ways to treat breast cancer (surgery, radiation therapy, hormonal therapy and chemotherapy), several treatments may be combined. Your physician can recommend specific treatments depending on the type and location of the cancer, the stage at which it was detected, and your age and general health.

Q. What exactly is a clinical trial? Should I participate in one?

A. Clinical trials are studies that help evaluate a new treatment. Clinical trials attempt to answer scientific questions and to find new and better ways to help cancer patients. An institutional review board (IRB) carefully reviews the study before patients begin participation in the clinical trial. Also, some studies are reviewed by government agencies, such as the National Cancer Institute (NCI) and the National Institutes of Health (NIH).

Anyone wishing to participate in a clinical trial should speak with their physician about treatment options and eligibility.

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Treatment & Side Effects

In recent years, there's been an explosion of life-saving treatment advances against breast cancer, bringing new hope and excitement. Instead of only one or two options, today there's an overwhelming menu of treatment choices that fight the complex mix of cells in each individual cancer. The decisions—surgery, then perhaps radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy—can feel overwhelming.

breastcancer.org can help you understand your cancer stage and appropriate options, so you and your doctors can arrive at the best treatment plan for YOU.

In the following pages of the Treatment section, you can learn about:

    * Overview of Options
      What types of treatment are available and which might be appropriate for you.

    * Surgery
      Breast-conserving surgery (lumpectomy), mastectomy, and lymph node dissection, and what to expect from each.

    * Radiation Therapy
      What it is, who it's for, advantages, side effects, and what to expect when you get it.

    * Targeted Therapies
      Including Herceptin: How they work, who should get them, how they're given, side effects, and major studies.

    * Hormonal Therapy
      The link between hormones and breast cancer and how different groups of drugs—including ERDs, SERMs, and aromatase inhibitors—can affect that link.

    * Chemotherapy
      Who should get it, how it works, different types, side effects, and how to manage them.

    * Complementary Medicine
      How complementary medicine techniques such as acupuncture, meditation, and yoga could be a helpful addition to your regular medical treatment. Includes research on complementary techniques and ways to find qualified practitioners.

    * Building Long-Term Health
      Why it's so important to stick to your treatment plan, take the full course of medications, and continue with regular tests and doctors' visits to keep yourself healthy into the future.

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Symptoms

Generally, early breast cancer does not cause pain. Even so, a woman should see her health care provider about breast pain or any other symptom that does not go away.

Common symptoms of breast cancer include:

    * A change in how the breast or nipple feels
      You may experience nipple tenderness or notice a lump or thickening in or near the breast or in the underarm area.
    * A change in how the breast or nipple looks
      This could mean a change in the size or shape of the breast or a nipple that is turned slightly inward. In addition, the skin of the breast, areola or nipple may appear scaly, red or swollen or may have ridges or pitting that resembles the skin of an orange.
    * Nipple discharge

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McGill researchers draw up unique profile of breast cancer
Hope to tailor better therapies; Scientists focused on genes in normal tissue surrounding tumours

AARON DERFEL
The Gazette

Tuesday, April 29, 2008

McGill University researchers have drawn up one of the most detailed genetic profiles yet of breast cancer - a discovery that raises hopes of tailoring better therapies for each patient.

Led by Morag Park, director of the molecular oncology group, the researchers analyzed tissue from 53 breast cancer patients. But rather than examine the cancer cells, they instead focused on the genes in the normal stromal tissue surrounding the tumours. (Stromal tissue refers to the supportive framework of an organ or other structure.)

Out of thousands of genes, they pinpointed 26 that could be used to predict how patients will respond to different treatments.

"This revolutionizes how we think about the tumour, and it will give us the opportunity to build clinical tests using these 26 genes," Park said.

At present, pathologists divide breast-cancer patients into three main groups: those who are estrogen-receptor-positive, those who test positive for the Her-2/neu gene, and those who aren't in either of those categories.

Those whose cancer is fuelled by estrogen are usually treated with the drug Tamoxifen, while the Her-2/neu-positive patients are given Herceptin.

But the McGill group's research suggests there might be as many as nine subtypes of breast cancer. That raises the possibility that some patients in a Her-2 subtype might not respond to Herceptin, and thus a different therapy would have to be chosen, Park explained.

"Essentially, our 26-gene predictor profile will identify those patients who will respond well to certain therapies and those who won't," Park said.

The findings, published this week in Nature Medicine, also open the door to new drug targets. For example, the researchers found that women who respond well to treatment possess stromal cells with a strong immune response - a sign the body is fighting the cancer.

Conceivably, a drug company could develop a treatment that stimulates the immune response in the healthy stromal cells around the tumour. Traditionally, drug treatments have hit on the tumour itself.

"This may be one of the biggest implications of this study," Park said.

Carole Secter, president of Breast Cancer Action Montreal, praised the McGill Research Institute for seeking "refinements in treatment."

"But why is there not more money being spent on prevention?" Secter asked.

Breast cancer is the most common cancer among Canadian women.

This year, at least 22,000 women will learn they have breast cancer and 5,300 will die of it, the Canadian Cancer Society predicts. About 170 men are expected to find out they have breast cancer and 50 will die of the disease.