Breast Cancer is a very frightening illness for a woman to contemplate.  Our breasts are one of the symbolic parts of our anatomy which define us as women. The diagnosis of cancer is hard enough to hear, but when it is breast cancer, it strikes to the heart and soul of a woman.

There are many types of breast cancer and each of them carries a different prognosis and cure potential. There is much research into causes, treatments and prevention currently ongoing. Now more than ever there are better treatments for breast cancer, and many women who have received this diagnosis live for decades following diagnosis and treatment.

To understand the different types of breast cancer, it is important to know the anatomy and different parts of the breast. The breast is made up of glandular, fatty and fibrous tissue.

The glandular tissue includes lobules which lie deep in the breast and are the milk producing glands; and the ducts which are responsible for carrying milk to the nipple.

The fibrous tissue surrounds the glandular tissue and adds some support to breast tissue.

The fatty tissue surrounds the glandular and fibrous tissue and gives the breast the soft consistency.

Within all of this are the lymph system and the blood vessel system. When a woman goes through menopause, the glandular tissue shrinks, the fibrous tissue looses some of its support and the breast increases the amount of fatty tissue. This decreases the density of the breast and aids in mammogram detection of abnormalities.

What types of cancer can affect the breast?

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DCIS: this stands for Ductal Carcinoma in Situ. This is the most common type of noninvasive breast cancer; it is confined to the ducts of the breast and has not spread into surrounding tissue or distant organs. It is detected on mammogram, 1:5 cases (20%) of breast cancer will be DCIS and it is felt to be almost completely curable. If necrosis is present on biopsy however, this signals the cancer is more aggressive and may be capable of spreading. A sub type of DCIS is Papillary Cancer.

LCIS: this is Lobular Carcinoma in situ. This cancer begins in the lobules which are the milk producing glands of the breast. It does not extend beyond the wall of the lobule, hence the term “in situ”. It is felt to have a low likelihood of becoming a metastatic (spreading) cancer however statistically its’ presence raises the risk of invasive cancer in the same or opposite breast. Researchers are not sure why this is the case.

Both of the above types of breast cancer are felt to have a low malignant potential. This means that they are unlikely to spread or invade surrounding healthy breast tissue, or spread by the lymph system and blood stream to other organs and cause a cancer in those organs.

The types of breast cancer discussed below are all types with a malignant aspect to them, meaning they will grow into surrounding breast tissue and interfere with normal functioning, and can spread to other organs and cause the same diseased activity. Women die from breast cancer when the organs the cancer has invaded can no longer work normally to sustain life. Treatments are aimed at both preventing spread to other organs, as well as trying to  destroy the cancerous breast tissue and any metastatic cancer tissue.

Invasive/Infiltrating Ductal Carcinoma: this is the most common invasive breast cancer. It accounts for 8 out of 10 invasive breast cancers diagnosed. It begins in the ducts and spreads through the walls into the fatty tissue. It is able to metastasize through the lymph system to other organs. A few additional subtypes are Tubular and Paget’s disease.

Invasive Lobular Carcinoma: as the name suggests, this begins in the lobules or milk glands and can spread locally as well as metastasize to other organs. It is more rare and only accounts for 1:10 diagnosis of invasive breast cancer. It is difficult to find on mammogram

Inflammatory Breast Cancer: This type is more uncommon than the above types and the cancer’s DNA behaves differently than other types of cancers. Its’ presentation is different in that there is no specific lump or cluster of calcifications as seen with the above types of breast cancer. Rather, it causes blockage of lymph vessels in the skin which in turn causes a redness and warmth to the skin of an area of the breast. Along with this redness and warmth is a thickening and pitted appearance likened to the peel of an orange. It accounts for 1-3% of breast cancers and usually occurs in younger women and there is a slightly higher incidence in African American women. The breast becomes larger and this is what is seen on mammogram, it is often mistaken for mastitis. MRI is the more sensitive imaging technique for evaluating this cancer. This is a very aggressive cancer and it is difficult to treat successfully as it is usually advanced when discovered. The 5-year survival rate is 40% as compared to 87% for other types of breast cancer.

Triple Negative Breast Cancer: this will be further explained below, but these cancers are usually very invasive ductal cancers with no protein receptors which make them amenable to treatment. They are usually present in younger women and slightly higher incidence in African American women. They are rapidly growing cancers.

When a breast cancer is diagnosed, biopsied and/or removed, several tests are done on the tissue to determine how the specific cancer will respond to therapies. This helps to determine a treatment course and to some extend predict the response and potential survival rate for the patient. These tests are also used to additionally categorize the type of cancer. There are receptors on the walls of the cancer cells which are proteins which can turn on growth when triggered.

The common receptors tested are for estrogen and progesterone. These proteins (receptors) allow these hormones which are naturally occurring in a woman’s body to attach to the cancer cell and fuel its growth. A breast cancer which has these receptors will be called ER + or PR+, or both ER/PR+, and likewise ER-, PR- or ER/PR-. ER or PR positive breast cancers actually have a better prognosis because they can respond to treatment. 2/3’s of breast cancers will contain at least one of these proteins.

HER2: this is a growth promoting protein. There are genes within the breast cell that when “turned on” will instruct the cell to make this protein. HER2 cancers have increased amounts of HER2 genes which leads to increased amounts of this protein. This type of cancer can spread and be more aggressive, however certain chemotherapy agents have been developed which can effectively treat this type of  breast cancer. Any of the above cancers discussed with the exception of the IN-SITU cancers can be determined to be ER or PR + or -; and they may or may not have HER2 protein.

BRCA1  AND BRCA2: many of you have heard about this type of genetic testing. These terms do not relate to a specific cancer but rather a genetic tendency or risk factor for developing breast cancer.

This would be a gene that is passed down within families. BRCA 1 and 2 genes are the most common causes of hereditary breast cancer. Normally, the BRCA1 and BRCA2 genes help prevent cancer by making proteins that prevent abnormal cell growth. When there is an inherited mutation on these genes, they are unable to prevent this abnormal growth. The risk of developing breast cancer with these gene mutations is as high as 80%. These cancers usually occur earlier in life of the women with these genetic mutations. The cancer often occurs bilaterally or in both breasts but not necessarily at the same time.  There is an increased risk of ovarian cancer with these gene mutations. In the US, there is an increased risk of BRCA1 and BRCA2 in women of Ashkenazi Jewish descent.

There are other gene mutations that are not as common.

ATM is a gene which helps repair DNA when functioning normally. It controls cell division. Researchers have yet to discover why a mutation of this gene causes cancer.

P53 is a tumor suppressor gene which plays a role in cell growth when functioning normally. When damaged, it looses the ability to block cell growth. 50% of all cancers of all types will have a p53 mutation. This mutation carries increased risk of brain cancer, leukemia, sarcoma as well as breast cancer when a mutation exists.

PTEN is a gene which regulates cell growth. It is felt by researchers to be the most important tumor suppressor gene yet discovered. When functioning normally, it protects a cell from progressing to a cancer. It may cause cell death if such a precancerous change in the cell occurs. Mutations of this gene are associated with large numbers of cancer types, including breast.

CHEK2 is an inherited genetic marker for breast cancer similar to BRCA1 and BRCA2. The CHEK2 gene normally produces a protein which prevents cells from growing uncontrollably. When mutated, it cannot regulate cell growth and carries a 3 fold increased risk of breast cancer .

The good news about breast cancer is that we know more about it.

Diagnosis and tissue typing have become more sophisticated resulting in improved therapy and improved survival.

Now more than ever women are surviving breast cancer and living long and productive lives.

It is a very frightening diagnosis to consider, and women often delay getting screening tests and exams to aid in early diagnosis because of this fear.

It is vitally important for a woman to identify her risk factors for breast cancer and improve her lifestyle to reduce risk factors which can be controlled.(risk factor is anything, genetic or lifestyle, that increases the risk for a particular disease)

These risk factors have been discussed in a prior posting on our website. I encourage readers to familiarize themselves with those risk factors and begin a program which helps you to reduce them.

I also encourage readers talk with their medical providers about their concerns regarding mammograms and screening tests.

Remember-most breast cancers caught in  early stages carry an excellent prognosis for long survival.

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