Breast Cancer

Breast cancer is a disease in which cells inside one or both breasts mutate and grow out of control. It is the second most common cancer among women, the second-leading cause of cancer death in women, and the leading cause of cancer death among women ages 35 to 54. Although breast cancer occurs almost entirely in women, men can get breast cancer as well.

Types of Breast Cancer

The breast has three main parts: (1) lobules, (2) ducts, and (3) connective tissue. Most breast cancers begin in the ducts or lobules. There are different kinds of breast cancer; the type depends on which cells in the breast are affected.

• Invasive Ductal Carcinoma: This is the most common type of breast cancer, making up around 80% of all cases of breast cancer. It begins in the ducts (the small canals that carry milk from the lobules to the nipple) and breaks through the wall of the duct, thereby spreading to surrounding tissue. However, if these cancer cells are caught before they spread, while they are still isolated in the milk duct, it is referred to as “Ductal Carcinoma in Situ (DCIS)” (also referred to as “Stage 0 Breast Cancer”). DCIS is very treatable if treated promptly before it becomes invasive.
• Invasive Lobular Carcinoma: This type of breast cancer accounts for approximately 10% to 15% of all cases of breast cancers. It begins in the lobules of the breast (the glands that produce breast milk) and spreads to the surrounding breast tissue. Sometimes, abnormal cells can form in the lobules as a “precancerous” condition referred to as “Lobular Carcinoma in Situ (LCIS).” LCIS is important to monitor, as it is a marker that indicates a person has a 7 to 12 times higher risk for developing breast cancer in the future.
• Inflammatory Breast Cancer: This type of breast cancer is rare but aggressive. It occurs when the cancer cells spread and block the lymphatic vessels in the skin covering the breast – causing tenderness and a red, swollen appearance (often resembling an infection).
• Paget’s Disease of the Breast: (unrelated to Paget’s disease of the bone) This type of breast cancer is also rare, occurring in less than 4% of breast cancer cases. It starts on the nipple and extends to the circle of skin surrounding the nipple (the areola). However, it is rarely confined to just the nipple. Typically, it is accompanied by underlying ductal breast cancer – either DCIS or, less commonly, invasive ductal carcinoma. This type of breast cancer most often occurs in women over the age of 50.

Other types of cancer can also spread into the breast(s). These cancers, such as angiosarcoma (a cancer that starts in the cells that make up the lining of blood or lymph vessels), are not necessarily considered “breast cancer” since they do not begin in the ducts or lobules but can spread from other areas of the body or different cells of the breast.

Stages of Breast Cancer

After breast cancer is diagnosed, doctors will determine what stage of breast cancer it is. The stage describes how much cancer is in the body and is determined by the grade, size, and location of a tumor and, if it has spread, how far and where it has spread to. The stage of breast cancer diagnosed also helps determine the best treatment options and survival rates.

The earliest stage of breast cancer is stage 0 which was briefly mentioned above as carcinoma in situ and is non-invasive. After stage 0, the stages increase from stage I to stage IV:

• Stage I: The cancer cells have spread to nearby breast tissue and tumors are smaller than 2 centimeters across.
• Stage II: The cancer may or may not have affected the nearby lymph nodes. If it has spread to the underarm lymph nodes, then the tumor is smaller than 2 centimeters across. If it has not spread to the underarm lymph nodes, the tumor may be up to 5 centimeters across.
• Stage III: This stage is also sometimes referred to as “locally advanced breast cancer.” The cancer has spread beyond its point of origin and may have invaded nearby lymph nodes and tissue but has not spread to other organs. Tumors at this stage are larger than 5 centimeters across.
• Stage IV: The cancer has spread and invaded other parts of the body such as the lungs, brain, bones, or liver. When this occurs, it means the breast cancer has “metastasized,” and is referred to as “metastatic breast cancer.” Tumors at this stage can be of any size but are growing into the chest wall or skin. Inflammatory breast cancer is considered to be stage IV breast cancer.

Risk Factors

Although an exact cause of breast cancer has not yet been determined, there are several risk factors that research suggests may increase the chances of developing breast cancer. Being born female is the biggest risk factor; but there are other genetic, hormonal, environmental, and lifestyle factors that researchers have also identified:

• Age: The risk of developing breast cancer increases with age. The majority of breast cancer diagnoses are in women 55 or older.
• Genes: Approximately 5% to 10% of breast cancer cases are determined to be the direct result of an inherited gene mutation passed from parent to child. The most notable gene mutations are in the BRCA1 or BRCA2 A woman with one of these gene mutations has up to a 7 in 10 chance of developing breast cancer by the age of 80. More information on the specific gene mutations and their implications can be found here.
• Family History: Although the majority of people diagnosed with breast cancer do not have a family history if it, people who have close blood relatives (parents, siblings, children) that have been diagnosed with breast cancer have an increased risk of developing breast cancer themselves.
• Personal History: People who have been diagnosed with breast cancer in one breast have an increased risk of developing breast cancer in the other breast. Additionally, women with dense breast tissue or a history of certain benign (non-cancerous) breast conditions such as LCIS, atypical ductal or lobular hyperplasia, or other conditions characterized by excessive growth of normal-looking cells in the ducts or lobules, have an increased risk of breast cancer.
• Radiation Exposure: The risk of breast cancer is increased in women who received radiation treatments to the chest as a child, teen, or young adult when the breasts were still developing.
• Hormones: People who use hormone replacement therapy (HRT) with estrogen (often combined with progesterone) have an increased risk of breast cancer. This risk is often affected by the type of hormone therapy used and the time frame of that use. Additionally, women who started menstruating early in life (before the age of 12), or who go through menopause later in life (after age 55), have a slightly higher risk of breast cancer; possibly due to their longer lifetime exposure to estrogen and progesterone hormones.
• Lifestyle: Drinking alcohol, being overweight or obese, not being physically active, and smoking are all lifestyle-related factors that have been shown to increase the risk of breast cancer. Additionally, women who do not have children before the age of 30 have a slightly increased risk of breast cancer. Studies suggest that becoming pregnant at a young age, having many pregnancies, and even breast feeding may slightly reduce the risk of breast cancer.

It is important to note that having one–or even several–risk factors does not mean that breast cancer is inevitable. Likewise, not having any of these risk factors does not ensure that a person will never develop breast cancer. A risk factor is simply anything that increases the likelihood that a person will develop breast cancer.

Symptoms

The most common symptom of breast cancer is a new lump or mass in the breast. Cancerous masses are more likely to be painless, hard (or “marble-like”) lumps with irregular edges. However, some breast cancer masses can be painful and tender, soft, and round. Most lumps and masses are not cancerous, but it is important to have them checked promptly by an experienced healthcare professional. Other potential symptoms of breast cancer include:

• Changes in the appearance, size, or shape of the breast
• Swelling of one part or the entire breast
• Redness, scaling, crusting, or flaking of the breast or nipple skin
• Skin dimpling or pitting which may resemble the skin of an orange peel
• A newly inverted nipple (“nipple retraction”)
• Breast or nipple pain
• Discharge from the nipple (clear, blood-stained, or other fluid that is not breast milk)
• Swollen lymph nodes near the collar bone or under the arm

It is important to be aware of what your breasts normally look and feel like. Even if your recent mammograms or screenings were normal, it is important to speak to an experienced healthcare professional promptly for an evaluation if you notice any changes. Symptoms of breast cancer vary for each person. Some people don’t even notice any signs of breast cancer; which is why regular screenings and mammograms are also important.

Diagnosing and Detecting Breast Cancer

Prompt detection and treatment of breast cancer is the best was to prevent death from breast cancer. Regular screenings (tests and exams that may detect breast cancer before there are any symptoms) are the most reliable way to detect breast cancer early. The size and spread of the cancer are important factors for the patient’s prognosis; if it is caught early (before it has grown or spread) it is easier to successfully treat.

To properly detect and diagnose breast cancer, healthcare providers will perform a breast examination and recommend tests to check for breast abnormalities. The most common tests include:

• Mammogram: a special x-ray of the breast that can detect changes and abnormal growths–commonly used to screen for breast cancer.
• MRI: breast MRIs do not use radiation unlike other types of imaging tests. Instead, it uses a magnet and radio waves to produce clear, detailed images of the interior structures of the breast. Before a breast MRI, contrast dye is be injected through an IV to help make any abnormalities in the breast easier to see.
• Breast Ultrasound: a test using sound waves to produce images of the tissues inside the breast that can help diagnose breast abnormalities and lumps.

If anything suspicious is seen on the imaging tests, the healthcare provider may remove a sample of breast cells to be biopsied. A biopsy is the only definitive way to diagnose breast cancer. The sample is sent to a pathology lab to be analyzed. If the biopsy sample is breast cancer, the biopsy will help determine the type of cells involved, the grade or aggressiveness, and whether the cells have certain receptors that may influence treatment options.

Screening Guidelines

Healthcare providers should ask about a patient’s family and medical history and any existing symptoms in order to determine if a patient is “high risk” or “average risk” for developing breast cancer. The guidelines for screening recommendations for women vary based on whether they are average or high risk, and how old they are. The guidelines recommended by the American Cancer Society can be found here.

• Average risk: women have no personal or family histories of breast cancer, no genetic mutations known to increase the risk of breast cancer, and have not undergone any radiation therapy to their chest before the age of 30. Average risk women are typically given the option to start yearly screenings with a mammogram at the age of 40. Between the ages of 45 and 54, all average risk women should get yearly mammograms. By the age of 55, average risk women can choose whether they would like to continue yearly mammograms, or switch to getting a mammogram every other year. As long as a woman is in good health and expected to live at least 10 more years, screening should continue beyond the age of 55.
• High risk: women should typically get a breast MRI, in addition to a mammogram, every year beginning at the age of 30 and continue to do so as long as they are in good health. However, this decision and screening plan should be made between a woman and her healthcare providers after taking into account other personal circumstances and preferences.

Treatment

Treatment for breast cancer will depend on many different factors following the results of a biopsy, including the size and location of the tumor, whether it has spread, and other personal circumstances and details. The stage of the breast cancer is an important factor in determining treatment options (a breakdown of common treatments by stage can be found here). Treatment options for breast cancer include surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy, and targeted drug therapy. Many people with breast cancer also receive a combination of treatments. Each person’s treatment plan should be tailored by their healthcare provider to fit that person’s specific and unique needs.

Surgery

Surgery involves removing the cancerous portion of the breast. An area of normal tissue surrounding the tumor will also be removed in surgery. Depending on the circumstances and type of the breast cancer, the following types of surgery may be performed:

• Lumpectomy
• Mastectomy
• Radical mastectomy (rare)
• Modified radical mastectomy
• Sentinel node biopsy
• Axillary node dissection

Chemotherapy

Chemotherapy may be recommended before undergoing a lumpectomy in an effort to reduce the size of the tumor, or after surgery in an effort to kill any remaining cancer cells and reduce the risk of the breast cancer coming back. Chemotherapy may also be recommended as a primary treatment when the breast cancer has spread beyond the breast and invaded other parts of the body.

Radiation

Radiation therapy can be used to treat individual metastatic tumors that have started causing other problems or that are causing pain. Like chemotherapy, it is also common to receive radiation therapy after undergoing a lumpectomy or mastectomy in an effort to kill any remaining cancer cells.

Hormone Therapy

Hormone therapy is most often used after surgery to reduce breast cancer recurrence risks. Some types of breast cancer feed on and use the body’s hormones (i.e., estrogen and progesterone) to grow. Hormone therapy can therefore lower estrogen levels or stop estrogen from attaching to breast cancer cells. Like other therapies, hormone therapy can also be used in an effort to shrink tumors before surgery or treat breast cancers that have spread and invaded other parts of the body.

Immunotherapy

Immunotherapy is a relatively new treatment targeted toward treating recurring, metastatic, and triple-negative breast cancer. It essentially targets and attacks breast cancer cells using the patient’s own immune system and is typically used along with chemotherapy.

Targeted Drug Therapy

Targeted drug therapy uses certain drugs to target specific cell characteristics that can cause cancer. It is often used in cases where breast cancer has invaded other areas of the body. Some of the most common drugs used include:

• Monoclonal antibodies
• Antibody-drug conjugates
• Kinase inhibitors

If treated in its early-stage, breast cancer treatment is often very successful. However, late-stage metastatic breast cancers are more difficult to treat and can be fatal.

Filing a Medical Malpractice Claim or Lawsuit

If you or a family member have suffered complications from breast cancer that was negligently diagnosed or treated, you may be entitled to compensation for your damages. Call Bonner Law at 1-800-4MEDMAL or visit our page for a free consultation.

Medical malpractice cases are complex and can be emotionally challenging for the patients involved. Finding the right attorney can make the process much easier. Michael P. Bonner has over 30 years of experience representing patients in medical malpractice cases all over Florida. Bonner Law has the knowledge and experience to represent you and navigate the legal and medical landscape to ensure that you receive compensation for damages, including medical bills, lost wages, and pain and suffering that you are entitled to. For more information on medical malpractice claims you can also visit our Medical Malpractice page.