National Women of Color Cancer Foundation 

Breast cancer is an uncontrolled growth of breast cells. To better understand breast cancer, it helps to understand how any cancer can develop.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.

The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Breast Anatomy

• Larger Version

Over time, cancer cells can invade nearby healthy breast tissue and make their way into the underarm lymph nodes, small organs that filter out foreign substances in the body. If cancer cells get into the lymph nodes, they then have a pathway into other parts of the body. The breast cancer’s stage refers to how far the cancer cells have spread beyond the original tumor (see Stages of Breast Cancer table for more information).

Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. About 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.

While there are steps every person can take to help the body stay as healthy as possible (such as eating a balanced diet, not smoking, limiting alcohol, and exercising regularly), breast cancer is never anyone's fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.

Stages of Breast Cancer

 A partially circumscribed retroareolar mass in a male with suspicious microcalcifications; this is known breast cancer.

On mammography, male breast cancer is subareolar or somewhat eccentric to the nipple, with well-defined, ill-defined, or spiculated margins. Calcifications are observed less commonly than in female breast cancer and, when found, are coarser in appearance. Calcifications can also be seen in fat necrosis. Axillary adenopathy may be observed as well.^1,22

Degree of Confidence

Mammography is highly sensitive and specific for breast cancer in men, but it should be used to complement the clinical examination. At present, not enough clinical data are available to determine whether the combination of imaging and clinical findings can replace biopsy for the diagnosis of palpable breast abnormalities in men. Ultimately, biopsy should be considered to diagnose male breast cancer because the findings of inflammation, gynecomastia, and fat necrosis can be similar.²⁴

False Positives/Negatives

Inflammation, gynecomastia, and fat necrosis may appear similar on mammograms; therefore, these condition can cause false-positive findings. Cases of carcinoma have been found by ultrasonography after they were obscured on previous mammograms by gynecomastia.

Male breast cancer is similar to breast cancer in females in its etiology, family history, prognosis, and treatment. In approximately 30% of cases of breast cancer in men, the family history is positive for the disease. A familial form of breast cancer is seen in which both genders are at increased risk for breast cancer. Male breast neoplasms are relatively rare, in contrast to gynecomastia, which is a relatively common condition.^{1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17}

For excellent patient education resources, visit eMedicine's Cancer and Tumors Center. Also, see eMedicine's patient education articles Breast Cancer, Breast Lumps and Pain, and Breast Self-Exam.

Pros And Cons Of Stem Cell Research

Pros and Cons of Stem Cell Research - What are Stem Cells?
There has been much controversy in the press recently about the pros and cons of stem cell research. What is the controversy all about? "Stem" cells can be contrasted with "differentiated" cells. They offer much hope for medical advancement because of their ability to grow into almost any kind of cell. For instance, neural cells in the brain and spinal cord that have been damaged can be replaced by stem cells. In the treatment of cancer, cells destroyed by radiation or chemotherapy can be replaced with new healthy stem cells that adapt to the affected area, whether it be part of the brain, heart, liver, lungs, or wherever. Dead cells of almost any kind, no matter the type of injury or disease, can be replaced with new healthy cells thanks to the amazing flexibility of stem cells. As a result, billions of dollars are being poured into this new field.

Pros and Cons of Stem Cell Research - Where Do They Come From?
To understand the pros and cons of stem cell research, one must first understand where stem cells come from. There are three main sources for obtaining stem cells - adult cells, cord cells, and embryonic cells. Adult stem cells can be extracted either from bone marrow or from the peripheral system. Bone marrow is a rich source of stem cells. However, some painful destruction of the bone marrow results from this procedure. Peripheral stem cells can be extracted without damage to bones, but the process takes more time. And with health issues, time is often of the essence. Although difficult to extract, since they are taken from the patient's own body, adult stem cells are superior to both umbilical cord and embryonic stem cells. They are plentiful. There is always an exact DNA match so the body's immune system never rejects them. And as we might expect, results have been both profound and promising.

Stem cells taken from the umbilical cord are a second very rich source of stem cells. Umbilical cells can also offer a perfect match where a family has planned ahead. Cord cells are extracted during pregnancy and stored in cryogenic cell banks as a type of insurance policy for future use on behalf of the newborn. Cord cells can also be used by the mother, the father or others. The more distant the relationship, the more likely it is that the cells will be rejected by the immune system's antibodies. However, there are a number of common cell types just as there are common blood types so matching is always possible especially where there are numerous donors. The donation and storage process is similar to blood banking. Donation of umbilical cells is highly encouraged. Compared to adult cells and embryonic cells, the umbilical cord is by far the richest source of stem cells, and cells can be stored up in advance so they are available when needed. Further, even where there is not an exact DNA match between donor and recipient, scientists have developed methods to increase transferability and reduce risk.

Pros and Cons of Stem Cell Research - Embryonic Cells
The pros and cons of stem cell research come to the surface when we examine the third source of stem cells - embryonic cells. Embryonic stem cells are extracted directly from an embryo before the embryo's cells begin to differentiate. At this stage the embryo is referred to as a "blastocyst." There are about 100 cells in a blastocyst, a very large percentage of which are stem cells, which can be kept alive indefinitely, grown in cultures, where the stem cells continue to double in number every 2-3 days. A replicating set of stem cells from a single blastocyst is called a "stem cell line" because the genetic material all comes from the same fertilized human egg that started it. President Bush authorized federal funding for research on the 15 stem cell lines available in August 2001. Other stem cell lines are also available for research but without the coveted assistance of federal funding.

So what is the controversy all about? Those who value human life from the point of conception, oppose embryonic stem cell research because the extraction of stem cells from this type of an embryo requires its destruction. In other words, it requires that a human life be killed. Some believe this to be the same as murder. Against this, embryonic research advocates argue that the tiny blastocyst has no human features. Further, new stem cell lines already exist due to the common practice of in vitro fertilization. Research advocates conclude that many fertilized human cells have already been banked, but are not being made available for research. Advocates of embryonic stem cell research claim new human lives will not be created for the sole purpose of experimentation.

Others argue against such research on medical grounds. Mice treated for Parkinson's with embryonic stem cells have died from brain tumors in as much as 20% of cases.¹ Embryonic stem cells stored over time have been shown to create the type of chromosomal anomalies that create cancer cells.² Looking at it from a more pragmatic standpoint, funds devoted to embryonic stem cell research are funds being taken away from the other two more promising and less controversial types of stem cell research mentioned above.

 

Depression and Cancer Patients

Depression is a disabling illness that affects about 15% to 25% of cancer patients. It affects men and women with cancer equally. People who face a diagnosis of cancer will experience different levels of stress and emotional upset. Important issues in the life of any person with cancer may include the following:

·         Fear of death.

·         Interruption of life plans.

·         Changes in body image and self-esteem.

·         Changes in social role and lifestyle.

·         Money and legal concerns.

Everyone who is diagnosed with cancer will react to these issues in different ways and may not experience serious depression or anxiety.

Patients who are receiving palliative care for cancer may have frequent feelings of depression and anxiety, leading to a much lower quality of life. Patients in palliative care who suffer from depression report being more troubled about their physical symptoms, relationships, and beliefs about life. Depressed terminally ill patients have reported feelings of "being a burden" even when the actual amount of dependence on others is small.

Just as patients need to be evaluated for depression throughout their treatment, so do family caregivers. Caregivers have been found to experience a good deal more anxiety and depression than people who are not caring for patients with cancer. Children are also affected when a parent with cancer develops depression. A study of women with breast cancer showed that children of depressed patients were the most likely to have emotional and behavioral problems themselves.

There are many misconceptions about cancer and how people cope with it, such as the following:

·         All people with cancer are depressed.

·         Depression in a person with cancer is normal.

·         Treatment does not help the depression.

·         Everyone with cancer faces suffering and a painful death.

Sadness and grief are normal reactions to the crises faced during cancer, and will be experienced at times by all people. Because sadness is common, it is important to distinguish between normal levels of sadness and depression. An important part of cancer care is the recognition of depression that needs to be treated. Some people may have more trouble adjusting to the diagnosis of cancer than others may. Major depression is not simply sadness or a blue mood. Major depression affects about 25% of patients and has common symptoms that can be diagnosed and treated. Symptoms of depression that are noticed when a patient is diagnosed with cancer may be a sign that the patient had a depression problem before the diagnosis of cancer.

All people will experience reactions of sadness and grief periodically throughout diagnosis, treatment, and survival of cancer. When people find out they have cancer, they often have feelings of disbelief, denial, or despair. They may also experience difficulty sleeping, loss of appetite, anxiety, and a preoccupation with worries about the future. These symptoms and fears usually lessen as a person adjusts to the diagnosis. Signs that a person has adjusted to the diagnosis include an ability to maintain active involvement in daily life activities, and an ability to continue functioning as spouse, parent, employee, or other roles by incorporating treatment into his or her schedule. If the family of a patient diagnosed with cancer is able to express feelings openly and solve problems effectively, both the patient and family members have less depression. Good communication within the family reduces anxiety. A person who cannot adjust to the diagnosis after a long period of time, and who loses interest in usual activities, may be depressed. Mild symptoms of depression can be distressing and may be helped with counseling. Even patients without obvious symptoms of depression may benefit from counseling; however, when symptoms are intense and long-lasting, or when they keep coming back, more intensive treatment is important. Stated by the National Cancer Institute (NCI).

What Women -- and Men -- Should Know about Breast Cancer

Breast Cancer

By Fred Cicetti

May 24, 2008
Breast cancer is second — behind lung cancer — as the leading cause of cancer death in women. The chance of developing invasive breast cancer at some time in a woman's life is about 1 in 8.

The female breast is composed primarily of milk-producing glands (lobules), ducts that connect the glands to the nipple, and soft tissue.

Breast cancer is a malignant tumor that has grown from breast cells. Nearly all breast cancers start in the ducts or lobules of the breast. The cancer can spread (metastasize) to other parts of the body, but it will continue to be defined as breast cancer.

Types of breast cancer

There are many forms of breast cancer.

Infiltrating ductal carcinoma (IDC) is the most common form. It starts in a duct, then breaks through the duct wall and invades the tissue of the breast. At this point, it can metastasize through the lymphatic vessels and the bloodstream. About 80% of invasive breast cancers are infiltrating ductal carcinomas.

Lymph plays a major role in breast cancer. It is a fluid that carries immune-system cells through lymphatic vessels. Lymph nodes are small collections of these cells in the vessels. Almost all lymphatic vessels in the breast connect to lymph nodes under the arm. Cancer cells that enter lymphatic vessels can spread and begin to grow in lymph nodes. This is why doctors check the lymph nodes to see if breast cancer has spread.

Ductal carcinoma in situ (DCIS) is the most common type of noninvasive breast cancer.

The term “in situ” means the cancer is confined to its original site. DCIS denotes that the cancer cells are inside the ducts but have not spread through the walls of the ducts into the surrounding breast tissue. About 20% of new breast cancer cases will be DCIS. Nearly all women diagnosed at this early stage of breast cancer can be cured.

Risk factors

There are many risk factors for breast cancer.

• The risk rises with age. About 77% of women with breast cancer are older than 50 when they are diagnosed.

• Breast cancer risk is higher among women whose close relatives have the disease.

• A woman with cancer in one breast is at high risk of developing a new cancer in either of her breasts.

• Women who started menstruating before age 12 or who went through menopause after age 55 have a slightly higher risk of breast cancer.

• Having multiple pregnancies and becoming pregnant at an early age reduces breast cancer risk.

• Long-term use of hormone replacement therapy (HRT) after menopause increases your risk of breast cancer.

• Drinking alcohol is linked to an increased risk of developing breast cancer.

• Obesity is a breast cancer risk, especially for women after menopause.

Evidence is growing that exercise reduces breast cancer risk.

Diagnosis

The most common breast cancer symptom is a lump. Other symptoms include swelling, skin irritation, nipple pain or retraction, and an unusual discharge.

Early diagnosis saves lives. The combination of a mammogram, a clinical breast exam and self-exams is recommended by healthcare experts to reduce breast-cancer deaths.

A mammogram is a breast x-ray. If mammography finds an abnormality, confirmation by biopsy is required. In a biopsy, a tissue sample is taken for analysis.

About 2/10 percent of mammograms lead to a cancer diagnosis. About 10 percent of women examined will need another mammogram. Only about 10 percent of those women will need a biopsy. Out of those biopsies, 80 percent will come back negative for cancer.

Women 40 and older should have an annual mammogram and breast exam by a healthcare professional. As long as a woman is in good health and would be a candidate for treatment, she should continue to get mammograms and exams.

Research has shown that self exams help find breast cancer. Self examination teaches women how their breasts feel normally and to notice changes.

Ultrasound and MRI are other diagnostic tools.

Ultrasound uses high-frequency sound waves to outline a part of the body. Breast ultrasound can focus upon something picked up by a mammogram.

Magnetic resonance imaging (MRI) use radio waves and strong magnets instead of x-rays. They can be used to examine cancers found by mammogram.

Treatment

Most women with breast cancer have some type of surgery. Surgeries include lumpectomy to remove only the breast lump and surrounding tissue, a mastectomy that removes part or all of the breast or can be more extensive to include lymph nodes and muscle tissue.

Radiation therapy is another form of treatment. It uses high-energy rays or particles that destroy cancer cells. This treatment may be used to destroy cancer cells that remain in the breast, chest wall, or underarm area after surgery.

Medicines are also used to treat breast cancer. Chemotherapy employs intravenous and oral drugs that can kill cancer cells in most parts of the body. The anti-estrogen drug tamoxifen has been used for more than 20 years to treat breast cancer.

Hormone replacement therapy (HRT) to treat menopause symptoms and its relationship to breast cancer has become a controversial issue. Unfortunately, many women experience menopausal symptoms after treatment for breast cancer.

In the past, doctors had offered HRT after breast-cancer treatment to women suffering from severe symptoms. However, recently, a study found that breast cancer survivors taking HRT were much more likely to develop a new or recurrent breast cancer than women who were not taking the drugs. This study discouraged doctors from recommending HRT to breast-cancer patients.

Phytoestrogens, estrogen-like substances, may be safer than the estrogens used in HRT. However, there is insufficient data on phytoestrogens to evaluate their safety for breast cancer survivors.

Male breast cancer

Breast cancer strikes most often when men are in their sixties.

Male breast cancer? Men do have breast cells that can become cancerous. The disease is uncommon in men. It represents only 1% of all breast cancers. Because of its rarity, many men aren’t aware it exists. And that’s a problem.

For unknown reasons, the incidence of male breast cancer has been increasing. About 2,000 men in the U.S. are diagnosed with breast cancer annually.

Young boys and girls have a small amount of breast tissue made up of a few ducts. At puberty, female hormones in girls make breast ducts grow, milk glands form and fat increase. The male hormones in boys prevent further growth of breast tissue. Men's breast tissue contains ducts, but only a few if any lobules.

The most common symptom of male breast cancer is the same as it is for women — a lump. Other signs include: skin dimpling, a new indentation of the nipple, redness or scaling of breast skin, a clear or bloody discharge from the nipple.

Risk factors

Some risk factors for male breast cancer are:

• Age. The average age for a man diagnosed with breast cancer is 67.

• Family. About 20 percent of men with breast cancer are related to someone with the disease.

• Genes. About 7 percent of breast cancers in men are inherited.

• Radiation. There’s a higher risk to men who underwent chest radiation treatments when they were younger.

• Klinefelter Syndrome. Men with this syndrome make lower levels of male hormones — androgens — and more female hormones. This can cause gynecomastia, benign breast enlargement. Men with this condition may be at greater risk of breast cancer. Many medicines used to treat ulcers, high blood pressure, and heart failure can cause gynecomastia, too.

• Estrogen. The risk is small for men who take estrogen — the main female hormone. Estrogen drugs may be used to treat prostate cancer.

• Liver disease. This can increase your risk of gynecomastia and breast cancer.

• Obesity. Fat cells convert androgens into estrogen.

• Alcohol. Drinking alcohol raises the odds that a man will develop breast cancer. The risk increases with the amount of alcohol consumed.

If a man has a family history of the disease, he should consult a doctor about regular testing. Diagnostic tests for men include a clinical breast exam, mammograms, ultrasound, biopsy and, if indicated, a nipple discharge exam.

Breast cancer treatment for men is similar to that given to women. Some men may need only surgery. Others will need surgery and radiation, chemotherapy or hormone therapy.

There isn’t much tissue to a man's breast, so removing the cancer usually means excising most of the tissue. The procedures that are used on women to save breast tissue aren’t practicable for men.

Most men with breast cancer require a modified radical mastectomy. In this procedure, a surgeon removes the entire breast and some underarm lymph nodes, but leaves chest muscles intact.