The female breast is a very complicated, glandular organ and is the site of the most common cancer in women - breast cancer. No one knows exactly what causes breast cancer. Having a family history of breast cancer increases the risk. Other possible causes include environmental carcinogens, viruses, radiation therapy and life-style factors, including diet and hormonal function.

Cancer begins when the cells of the breast undergo changes. A normal cell converts into a cell that has an uncontrolled growth pattern. These cancer cells continue to divide and grow and may spread to other parts of the breast and then to other parts of the body if not removed. The process of cancer cells spreading throughout the body is called metastasis.

Types of Breast Cancer:
Approximately 15 different types of breast cancer have been identified. The term carcinoma is used to describe a malignant or cancerous growth. Tumors which develop from different types of breast tissue, in different parts of the breast, may have varying characteristics.

Breast cancers are named according to the part of the breast in which they develop. Cancers beginning in the ducts are called ductal carcinomas and comprise the largest number of cancers occurring in women. Cancers beginning in the lobules are called lobular carcinomas and account for a small percentage of cases. Your physician will tell you which type of cancer your have - ductal or lobular.

Ducts and lobules are lined with one or two layers of orderly, normal cells. When the cells become cancerous they grow and fill the duct or lobule. In situ carcinomas are cancers which are still contained within the walls of the breast area in which they developed. They have not invaded surrounding tissue. If the cancer grows through the cell walls, it is called an infiltrating or invasive carcinoma . Your pathology report will explain if your cancer is in situ or invasive (infiltrating).

How Fast Do Breast Cancers Grow?
Some breast cancers grow rapidly, while others grow slowly. Breast cancers have been shown to double in size every 23 to 209 days. A tumor that doubles every 100 days (the averaging doubling time) would have been in your body approximately eight to ten years when it reaches one centimeter in size (3/8 inch) - the size of the tip of your smallest finger. The cancer begins with one damaged cell and doubles until it is detected. The cancer must be surgically removed from the body, killed with chemotherapy or radiation therapy, or controlled with hormonal therapy. Some people believe a cancer grows in spurts, and the doubling time varies at different times. However, by the time a one centimeter tumor is found, the tumor has already grown from one cell to approximately 100 billion cells. The pathology report will tell how fast a tumor is estimated to grow.

Some tumors spread more rapidly to other parts of the body, while others do not spread as readily. Breast cancer spreads to other parts of the body through the lymphatic system or the blood system. The spread of the cancer can be local (in the area of the breast), regional (in the nodes or area near the breast) or distant (to other organs of the body).

The Role of the Lymphatic System
Lymph nodes play an important role in the discussion of your treatment decisions. The lymphatic system serves as the sewage system for cellular waste in the body. The lymph vessels follow closely beside the blood vessels and receive the cell's waste products. This waste is carried by the vessels and filtered through rounded areas of the lymph systems, called lymph nodes. Nodes appear as small round capsules and vary from pinhead to olive-size. Lymphocytes and monocytes (components of fluid that fight infection) are produced in the nodes. Nodes act as filters to stop bacteria, cellular waste and cancer cells from entering the blood stream. Lymph nodes may also serve as metastasis sites - places where cancer has spread from the original site to nodes, referred to as secondary sites.

Three percent of the lymphatic fluid leaving the breast is drained in the lymph nodes located near the breast bone, called internal mammary nodes . Ninety-seven percent of the fluid is drained through the nodes of the arm pit, referred to as the axillary nodes. There are three levels of nodes in the axillary area. Your surgeon may remove nodes from one or several levels, a procedure called axillary sampling. Axillary dissection is the term used when all the nodes under the arm are removed. The number of nodes in the each level varies from person to person.

Nodes are removed to determine whether your cancer has moved from the breast into the node area. The term negative nodes means that your lymph nodes did not have any evidence of cancer. Positive nodes indicate that the cancer was found in the lymph nodes. Your surgeon will tell you how many nodes were removed during your surgery and whether any were found to have cancer cells present. Treatment decisions are often based on the number of nodes in which cancer cells are found. Two important factors that determine your oncologist's treatment plan are the number of positive nodes and the size of your tumor. Before surgery, the surgeon can tell you the nodes that are planned to be sampled or removed. After surgery, the surgeon can tell you how many lymph nodes were removed and if they contained evidence of cancer cells.

Surgery and treatment with chemotherapy, radiation therapy or hormonal therapy can vary because of differences in types of cancer, sizes of tumors, potential lymph node involvement or documented metastasis, aggressiveness of tumors and hormonal sensitivity. Therefore, it is necessary for you to communicate with your physicians, who know your particular disease type, when seeking any specific information or advice on your breast cancer treatment.

Breast cancer occurs 85 to 90 percent of the time as a hard, stony, singular, non-mobile lump that is anchored in surrounding tissues of the breast. It is usually a painless lump that can be felt, is found in only one breast, and occurs in women over 35 years of age.

However, dangerous breast cancer signs are often ignored because they have different characteristics than the lump that is usually identified as cancer. Learning these common misconceptions about breast cancer could save a woman's life.

Misconception #1: Young women (under 35) do not have breast cancer.
Breast cancer is more likely to occur in a woman over 35, but it can occur in very young women. Any lump, at any age, needs professional evaluation by a physician.

Misconception #2: Women with high risk factors (family history, no children, etc.) are usually the ones who will have breast cancer.
76 percent of women who have breast cancer had none of the risk factors. Being female is the highest risk factor. All women are at risk.

Misconception #3: Breast cancer is not painful; fibrocystic breast condition is what causes the pain.
Breast cancer is usually not associated with pain. However, 11 percent of women diagnosed with breast cancer experienced pain as a symptom. Any pain in the breast needs thorough evaluation by a physician.

Misconception #4: A mammogram that is without signs of cancer ensures that no cancer is present
Mammography is a good diagnostic tool, but it has limitations. There are some lumps that you can feel but are not seen on mammography even though mammography is able to detect lumps that are too small to be felt. 10 percent of breast cancers never form a lump that can be felt or seen on mammography. It is important to recognize the clinical signs of breast cancer that produce changes in the breast. Because mammography does not detect 10 to 15 percent of cancers, breast self-exams and clinical exams by a physician must be performed in conjunction with mammography to insure that a woman receives every method of detection available.

Misconception #5: Breast cancer occurs as a single lump and in one breast at a time
A very small percentage of breast cancers occur with multiple lumps (multicentric) and occurs in both breasts. As always, any lump, multiple lumps in one breast or lumps in both breasts should be fully explored by a physician.

Misconception #6: Redness, pain, or bloody discharge are signs only of mastitis (inflammation/infection) in new mothers.
Mastitis is a common occurrence in the young mother, but if, after treatment with antibiotics, the symptoms do not improve or disappear, the patient should be evaluated further. Breast cancer in the young woman can cause the same symptoms as mastitis.

ALL LUMPS NEED EVALUATION BY A PHYSICIAN

• Perform a monthly breast examination
• Have an annual breast examination by your physician
• Have annual mammography starting at age 40
• Exercise 3-4 hours a week
• Watch your weight
• Limit alcohol intake (2-3 drinks/week) and fat intake (less than 20% of your calories should be fat)
• Incorporate specific food groups into your diet such as leafy green (cruciferous) vegetables, bran (30 grams/day), soy (isoflavones), and flaxseeds
• Discuss genetic counseling with your physician if you have a strong family history of breast/ovarian cancer
• Discuss hormone replacement therapy with your physician if you have been on estrogen for a prolonged period of time (more than 10 years)

Dominant Mass on Palpitation
A dominant mass is defined as a mass, lump, or nodule that stands out from the surrounding breast tissue. It is not present in the opposite breast. A dominant mass can be movable or fixed, soft or hard, tender or non-tender, smooth or irregularly shaped, and may be associated with skin changes. It is difficult to determine just from a clinical examination whether or not the mass is benign or malignant.

Breast Dimpling
This resembles the peel of an orange and can occur when cancer cells are present in the skin lymphatic channels of the breast and the breast skin accumulates with fluid. Dimpling may be associated with inflammatory cancer. It may also be seen after surgery.

Nipple Discharge
This can be clear, milky, yellow, multicolored, or bloody. A spontaneous, persistent discharge that is not milky and related to breast-feeding needs to be evaluated by a physician.

Breast or Nipple Ulceration
A crusting, scaly, red, inflamed tissue of the breast or nipple.

Breast Redness
An inflamed redness of the breast.

Breast Asymmetry
Disproportionate breast size which may occur as a result of surgery and/or radiation, breast-feeding on one side only or rapidly growing tumors.

Breast Puckering
A puckering in the breast skin.