Reprinted with permission of Life Extension®.
What Is Breast Cancer? Breast cancer occurs when cells in the breast tissue divide and grow without control. In a healthy body, the cell cycle is the natural mechanism that regulates the creation, growth, and death of cells. It is this mechanism that regulates cell division, allowing the creation of new tissue as older cells die. When the normal cell regulators malfunction and cells do not die at the proper rate, there is a failure of apoptosis (programmed cell death) and cell growth goes unchecked. As a result, cancer begins to develop as cells divide without control, accumulating into a mass of extra tissue called a malignant tumor. As a tumor grows, it elicits new capillary growth (angiogenesis) from the surrounding normal tissues and diverts blood supply and nutrients away from the tissue to feed itself. Unregulated angiogenesis can facilitate the growth of cancer throughout the body. Cancer cells have the ability to leave the original tumor site, travel to distant locations, and recolonize. This process is called metastasis, and it occurs in organs such as the liver, lungs, and bones. Both the bloodstream and lymphatic system (the network connecting lymph nodes throughout the body) serve as ideal vehicles for the traveling cancer. Although, these traveling cancer cells do not always survive beyond the tumor, if they do survive, the cancer cells will again begin to divide abnormally and will create tumors in each new location. A person with untreated or treatment-resistant cancer will eventually die of the disease when vital organs such as the liver or lungs are invaded, overtaken, and destroyed. Cancerous tumors in the breast usually grow slowly. It is thought that by the time a tumor is large enough to be felt as a lump, it may have been growing for as long as 10 years. This has lead to the belief that undetectable micrometastasis may have already occurred by the time of the diagnosis. Therefore, preventative measures such as diet, supplementation, and exercise are the primary defensive tools against the development of cancer. Early diagnosis is the single best way to lower the risk of dying from breast cancer. Early diagnosis can be accomplished with simple monthly self-breast exams, screening mammography, and clinical breast exams. If breast cancer is detected, a polytherapeutic approach is the current treatment of choice. It utilizes multimodalities, including surgery, anticancer drugs, irradiation, hormone therapy, detoxification, supplementation, and diet modification, all of which will be discussed later in the protocol. Breast Anatomy and Physiology The breast is mainly composed of adipose (fat) and breast tissue, along with connective tissue, nerves, veins, and arteries. Breast tissue is a complex network known as the mammary gland. Each breast has a mammary gland. Within that gland, there are 15-20 lobes or compartments separated by adipose tissue. Within each lobe are several smaller compartments called lobules. Lobules are composed of grapelike clusters of milk-secreting glands termed alveoli, which are found embedded in connective tissue. Spindle-shaped cells called myoepithelial cells, whose contractions help propel milk toward the nipple, surround the alveoli. There are about one million lobules contained within each breast (Spratt et al. 1995). The lobules are connected by tiny ducts that are joined together (much like a grape stem) into increasingly larger ducts. Within each breast, there are between five and 10 ductal systems, each with its own opening at the nipple. Surrounding the nipple is a darkly shaded circle of skin called the areola. The areola appears rough because it contains modified sebaceous (oil) glands. These glands secrete small amounts of fluid to lubricate the nipple during breast-feeding. Of all breast cancers, about 80% originate in the mammary (lactiferous) ducts, while about 20% arise in the lobules (IOM 1997). One of the most important distinctions to understand is the difference between invasive breast cancer and carcinoma in situ. Types of Breast Cancer
When abnormal cells from within the lobules or mammary (milk) ducts break out into the surrounding tissue, the condition is referred to as invasive breast cancer. However, this term does not necessarily mean that metastases have been found anywhere beyond the breast. Carcinoma In Situ The term in situ means in place. When abnormal cells grow within the lobules or mammary ducts and there is no sign that the cells have spread into the surrounding tissue or beyond, the condition is called carcinoma in situ. There are two main categories of carcinoma in situ: ductal carcinoma in situ and lobular carcinoma in situ. Although the word carcinoma is used in their titles, the cells involved in the different carcinomas in situ are not fully cancerous. Carcinomas in situ are referred to as precancerous conditions because they can either develop into or raise the risk of invasive cancer. Ductal Carcinoma In Situ Mammary ducts are hollow to allow fluid to pass through them. However, with ductal carcinoma in situ (DCIS), excess cells grow inside the mammary ducts. DCIS is not invasive cancer. It is a precancerous condition that has the potential to develop into breast cancer. DCIS is a risk factor for breast cancer. Lobular Carcinoma In Situ The lobules of the breast tissue have open space inside them much like the mammary ducts. Lobular carcinoma in situ (LCIS) is the growth and accumulation of large numbers of abnormal cells within the lobules. Many health care providers refer to LCIS as lobular neoplasia in situ, believing this title to be a more accurate depiction of the condition. LCIS is not a direct cancer precursor. The abnormal cells found inside the lobules are not likely to mutate into cancer. LCIS is, however, a risk factor for breast cancer. Special Manifestations of Cancer
Paget's disease is a rare, slowly growing cancer of the nipple. Paget's disease is usually associated with in situ or invasive cancer. One of the biggest problems with Paget's disease of the nipple is that its symptoms appear to be harmless. It is frequently thought to be a skin inflammation or infection, leading to unfortunate delays in detection and care. Symptoms of Paget's disease include persistent redness, itching, oozing, crusting, and fluid discharge of nipple or a sore on the nipple that will not heal. Typically only one nipple is affected. Treatment and prognosis for the disease are directly related to the type and extent of the underlying cancer. Inflammatory Breast Cancer (IBC) Inflammatory breast cancer (IBC) is a rare and aggressive form of invasive breast cancer that is usually not detected by mammograms or ultrasounds . IBC usually grows in nests or sheets rather than as a confined, solid tumor and can be diffuse throughout the breast with no palpable mass. The cancer cells clog the lymphatic system just below the skin, resulting in lymph node involvement. Increased breast density compared to prior mammograms should be considered suspicious. However, the main symptoms of IBC are breast swelling; inflammation; pink, red, or a dark colored area (erythema), sometimes with texture similar to the skin of an orange (peau d'orange); ridges and thickened areas of the skin; an area of the breast that is warm to the touch; what appears to be a bruise that does not go away; itching (pruritus) that is unrelenting and unaffected by medicated creams and ointments; increase in breast size over a short period of time; nipple flattening, retraction, or discharge; breast pain that is not cyclic in nature and may be constant or stabbing; and swollen axillary or supraclavicle (area above collar bone) lymph nodes. Since many of these symptoms mimic a breast infection, some doctors frequently first treat inflammatory breast cancer as an infection. Only when symptoms do not improve after antibiotic treatment is the breast cancer diagnosed. IBC has an extremely high risk of recurrence and a very poor prognosis. It is the most lethal form of breast cancer. To improve the chances of survival, it is important that symptoms are recognized early, resulting in an immediate diagnosis and treatment. Chemotherapy is usually begun within days of diagnosis. Without treatment, chances of 5-year survival in inflammatory breast cancer are very poor. With treatment, about 50% of patients will be living 5 years after diagnosis. Breast Diseases
Calcifications Calcifications are randomly scattered bits of calcium that in older women may have left the bones to appear in other parts of the body, such as joints or breasts. Microcalcifications are small, tight clusters of tiny calcifications in the ducts that can be seen on a mammogram and may indicate a precancerous or cancerous condition. Cysts Cysts are sacs filled with fluid; they are almost always benign. Although most are too small to feel, approximately a third of women between the ages of 35-50 have cysts in their breasts. If large enough, cysts may feel like lumps in the breast. Normally, cysts are left alone. However, if a cyst becomes painful, it can be aspirated or drained of its fluid. Some women may want to have a cyst removed if, after being aspirated repeatedly, it continues to recur. Cysts are not associated with an increased risk of cancer; yet, they are more common in women as they approach menopause and occur much less frequently after menopause (Donegan 1995). What causes cysts to develop is unknown; however, certain dietary factors such as the intake of caffeine have been discussed as possible risk factors for developing breast cysts. Fibroadenomas Fibroadenomas are a type of benign lump most commonly found in younger women. They are usually not removed since they pose no risk. If a fibroadenoma is large, uncomfortable, and produces a lump, it may be removed. In older women, fibroadenomas are generally removed to be certain they are not malignant tumors. Fibroadenomas do not pose an increased risk of cancer. Hyperplasia Hyperplasia is not a precancerous condition. It is the excessive accumulation or proliferation of normal cells typically found on the inside of the lobules or the ducts in the breast tissue. Hyperplasia is associated with approximately a double risk for breast cancer. Atypical hyperplasia occurs when excess cells in the lobules or ducts are abnormal. This condition falls between hyperplasia (too many normal cells) and carcinoma in situ (too many abnormal cells). However, atypical hyperplasia is associated with an approximately 3.5-5 times increased risk of developing breast cancer (Page et al. 1985; Colditz 1993; Marshall et al. 1997) Types of Standard Screening Techniques
"Early-stage" invasive cancer is considered very treatable because the tumor is relatively small and the cancer cells have not spread to the lymph nodes. However, when a tumor has become very large or has spread to other organs (such as the liver, lungs, or bones), it is considered "advanced-stage" invasive cancer and is far less treatable. Breast cancer was thought to grow in an orderly progression from a small tumor in the breast tissue to a larger tumor. The cancer was believed to then travel from the breast into the adjacent lymph nodes, spreading throughout the distant nodes and finally metastasizing in other areas of the body. However, a growing body of research now contends that cancer cells are capable of traveling from the breast throughout the blood and lymphatic systems very early in the course of the disease. This strengthens the rationale for early detection and treatment. Breast Self-Exam A breast self-exam provides an opportunity to detect tumors that may develop in the time between an annual mammogram and a clinical breast exam. To increase a woman's chances of detecting a small tumor at a time when it may be more responsive to treatment, a breast self-exam should be performed monthly, usually 2-3 days after menstruation. For women with irregular periods, it is important to remember to perform a monthly exam on the same day each month. Keep in mind that prior to menstruation or during pregnancy breasts may be somewhat lumpy or more tender than usual. By performing self-exams once a month, women can become familiar with the normal appearance and "feel" of their breasts, increasing the likelihood of recognizing changes such as thickening, lumps, or spontaneous nipple discharge. Because breast tissue normally has a bumpy texture, it may feel lumpy. However, there can be a great deal of individual variation. If a breast has lumpiness throughout, then it is probably just the normal contours of the breast tissue and in most cases is no cause to worry. Dominant lumps are firmer than the rest of the breast and are of more concern. When a dominant lump is found, there is an increased risk that it may be cancer, even though cysts and fibroadenomas can cause similar lumps. Any time a woman discovers a lump that feels dominant, it should be checked by a medical professional. How to Do Breast Self-Exam 1. Lie down. Flatten your right breast by placing a pillow or towel under your right shoulder. Place your right arm behind your head. Examine your right breast with your left hand. 2. Use the pads, not the tips, of the middle three fingers on your left hand. With fingers flat, press gently using a circular, rubbing motion and feel for lumps. In small, dime-sized circles without lifting the fingers, start at the outermost top edge of your breast and spiral in toward the nipple. 3. Press firmly enough to feel the different breast tissues, using three different pressures. First, light pressure to just move the skin without jostling the tissue beneath, then medium pressure pressing midway into the tissue, and finally deep pressure to probe more deeply down to the ribs or to the point just short of discomfort. 4. Completely feel all of the breast and chest area up under your armpit, up to the collarbone, and all the way over to your shoulder to cover breast tissue that extends toward the shoulder. 5. Gently squeeze both nipples and look for discharge. After you have completely examined your right breast, examine your left breast using the same method with your right hand. You may want to examine your breasts or do an extra exam while showering. It's easy to slide soapy hands over your skin and to feel anything unusual. You should also check your breasts in a mirror, looking for any change in size or contour, dimpling of the skin, or spontaneous nipple discharge. Clinical Breast Exam Clinical breast exams are physical examinations to check the appearance and "feel" of the breasts for signs of lumps. A physician, nurse practitioner, or other trained medical staff person will examine the breasts, both when the woman is sitting upright and when she is lying down. Clinical breast exams are an important part of breast cancer screening. For younger women, clinical breast exam may have an advantage over mammography; mammographic images can be more difficult to read in some younger women because of their dense breast tissue. For this reason, clinical breast exams are generally started much earlier than mammograms. Mammography Mammography is an x-ray technique used to locate small or indistinctly shaped breast lumps that may not be felt during an exam. A mammogram takes about 15 minutes. An x-ray image is made by compressing each breast individually between two plates. Afterwards, a radiologist will read the film and look for any signs of abnormal tissue. X-ray images appear in gradations of black, gray, and white depending on the density or hardness of the tissue. For example, since bone is especially dense, it appears white on an x-ray, while fat appears dark gray. Cancerous tumors and some other noncancerous abnormalities appear as a lighter shade of gray. Unfortunately, this may pose a problem because normal, dense breast tissue may appear light gray on a mammogram. Breast density changes with age. Younger women have proportionately more breast tissue than fat and therefore denser breasts, making mammograms harder to interpret. In older women's breasts, density dissipates with age, leaving breasts that are composed mostly of fat. A mammogram that shows the light gray patch of a tumor or lesion surrounded by the dark gray image of fat tissue is most easily recognized. Cysts and fibroadenomas appear as circular or oval patches with stark outer edges on x-rays, allowing a radiologist to identify where the border of the benign abnormal tissue ends and the surrounding normal tissue begins. On an x-ray, the core cancerous cells appear as a light patch, while the cancer cells that invade the surrounding tissue create a fuzzy or spiky appearance along the outer edge (called "spiculated"), producing an image with no clear borders. Women between the ages of 50 and 69 should receive an annual mammogram. There is still some debate about the exact benefits of mammograms in younger women. However, if you are genetically predisposed to cancer or have a precancerous condition, you are considered "at risk" and should have an annual mammogram regardless of your age. Overall, x-ray mammography is considered the gold standard of breast cancer screening according to the Institute of Occupational Medicine (Rollins 2001). Mammography can detect tumors at an early stage when they are small and most responsive to treatment. High-Risk Screening Regular screening is especially important for women who are at high risk of breast cancer. A woman can be placed in the high-risk category if she possesses either a single factor that greatly increases her risk or a combination of lesser factors that together increase risk. Single factors that can place a woman in the high-risk category include a personal history of breast cancer, carcinoma in situ, atypical hyperplasia, and exposure to high doses of ionizing radiation in childhood or young adulthood (for instance, for treatment of Hodgkin's disease) (Hancock et al. 1993; USPSTF 1996; Harris et al. 1997). A family history of breast cancer, especially in a mother, sister, or daughter, or a particular genetic mutation can also place a woman at high risk. In addition, research on genetic markers for breast-cancer risk has pinpointed a number of genes, two of which (BRCA1 and BRCA2) are associated with a markedly elevated risk. Research suggests that as many as 60-80% of women with mutations in either of these two genes may develop breast cancer in their lifetimes (Alberg et al. 1997; Struewing et al. 1997; Whittemore 1997). There are also several moderate risk factors for breast cancer. However, in combination, these factors can place a woman at high risk. They include having a first period (menarche) before age 12, not bearing a child, and having a first child after age 30. It is recommended that women at high risk for breast cancer have clinical breast exams and annual mammograms at earlier ages and more frequently than women at average risk. Continued . . . |
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