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- Facts and Statistics
- Risk Factors
- Screening and Early Detection
- Diagnosis and Staging
- Breast Cancer Treatment Options
Facts and Statistics
According to the American Cancer Society:
- Next to skin cancer, breast cancer is the most common cancer among American women.
- In 2009, approximately 192,370 new invasive breast cancer cases are expected to be diagnosed among American women, with an additional 62,280 cases of noninvasive carcinoma in situ.
- A woman has a 1 in 8 (12%) lifetime risk of developing breast cancer. There is a 1 in 35 (3%) risk that a woman's death will be due to breast cancer.
Risk Factors
While all women are at risk of developing breast cancer, there are specific factors that can increase a person's risk. Some of the risk factors below are proven, while others are associated with breast cancer risk but unconfirmed.
- Hormone Therapy: Combination hormone therapy (estrogen-progestin) is associated with a 24% increase in the incidence of invasive breast cancer.
- Ionizing Radiation: Exposure of the breast to ionizing radiation is associated with a 6-fold increase in breast cancer incidence. Risk depends on dose and age at exposure.
- Obesity: An observational study by the Women's Health Initiative of 85,917 postmenopausal women reported that women weighing more than 82.2 kg had a relative risk of developing breast cancer of 2.85 compared to women weighting less than 58.7 kg.
- Alcohol Consumption: The relative risk of developing breast cancer in women consuming approximately 4 alcoholic drinks per day is 1.32 compared to nondrinkers.
- Previous Breast Cancer: Women who have had breast cancer have a 3- to 4-fold increased risk of developing a new cancer in the other breast or in another part of the same breast. It should be noted that this is different from recurrence of the first cancer.
- Family History of Breast Cancer: Having a first-degree relative (eg, mother, sister, or daughter) who has had breast cancer approximately doubles a woman's risk for developing breast cancer.
- Genetic Factors: BRCA1 and BRCA2 genes. Mutations in these tumor suppressor genes may put patients at an increased risk of breast cancer. An estimated 5% to 10% of breast cancer cases are caused by BRCA1 and BRCA2 mutations.
- Age: The risk of breast cancer increases with age. Approximately 1 in 8 invasive breast cancers are found in women younger than 45, while about 2 in 3 are found in women 55 years or older.
- Reproductive History: Women who have never been pregnant or never had a baby may have an increased risk of breast cancer. Women who had their first baby after the age of 30 may be at an increased risk of breast cancer. In addition, women who had their first menstrual period before the age of 12 or developed menopause late may have an increased risk of breast cancer.
- Benign Breast Conditions: Certain benign breast conditions may increase the risk of breast cancer, including the presence of hyperplasia. The risk increases if there is a family history of breast cancer.
Screening and Early Detection
Early breast cancer rarely produces symptoms, so it is possible to have breast cancer for some time and not know it. This is why screening for breast cancer is so important. The earlier breast cancer is detected, the better the chances are for successful treatment.
Oncology Nursing Society Position Statement on Breast Cancer Screening
Breast cancer is a significant public health problem. Breast cancer treatment usually is better tolerated when the disease is detected early. Currently, the 3 primary tools used for the early detection of breast cancer are breast self-examination (BSE), clinical breast examination (CBE) by a healthcare provider, and mammography. It is the position of the Oncology Nursing Society that women have access to comprehensive breast cancer screening. This includes:
- Discussion of benefits, risks, and potential limitations of BSE, CBE, and mammography with each woman according to her individual breast cancer risk assessment
- Performance of CBE by a healthcare provider for all female patients starting at age 20 and mammography starting at age 40
- Continued education for oncology nurses to enhance their knowledge of early breast cancer detection tools
Diagnosis and Staging
Several options are available for the diagnosis of breast cancer:
- Diagnostic Mammogram: A type of X-ray used to check for breast problems. While a mammogram is not diagnostic of breast cancer, problem areas can by identified and explored further via biopsy.
- Ultrasound: The use of sound waves to create a computerized image of the entire breast. Typically ultrasounds are used after mammograms to check for problem areas the mammogram might not have identified.
- Magnetic Resonance Imaging (MRI): The use of radio waves and strong magnets to visualize the entire breast. MRIs may be used to characterize a cancer found through mammogram or to take a closer look at the breasts of women who are at high risk of breast cancer.
- Ductogram: A type of X-ray that helps determine the cause of nipple discharge. A ductogram can show if there is a mass inside the duct at the nipple. A ductogram also is known as a galactogram.
- Biopsy: Breast biopsies are performed when other diagnostic tests have indicated possible cancer. Biopsies are the only way to confirm a breast cancer diagnosis. Biopsy results indicate whether the sampled breast tissue is benign or cancerous.
Once breast cancer is diagnosed, the disease is staged:
| Breast Cancer TNM Staging Guide | |
|---|---|
| Primary Tumor (T) | |
| TX | Primary tumor cannot be assessed |
| T0 | No evidence of primary tumor |
| Tis | Carcinoma in situ |
| Tis (DCIS) | Ductal carcinoma |
| Tis (LCIS) | Lobular carcinoma |
| T1 mic | Microinvasion ≤1.0 cm |
| T1 Tumor ≤2 cm |
Tumor >0.1 cm but ≤0.5 cm Tumor >0.5 cm but ≤1 cm Tumor >1 cm but ≤2 cm |
| T2 | Tumor >2 cm but ≤5 cm |
| T3 | Tumor >5 cm |
| T4 | Tumor of any size with direct extension to a) chest wall or b) skin |
| Breast Cancer TNM Staging Guide | |
|---|---|
| Regional Lymph Nodes (N) | |
| NX | Regional lymph node metastases cannot be assessed |
| N0 | No regional lymph node metastasis |
| N1 | Metastasis in movable ipsilateral axillary lymph node(s) |
| N2 | Metastases in ipsilateral axillary lymph nodes fixed or matted:
|
| N3 | Metastasis in:
|
| *Clinically apparent is defined as detected by imaging studies or by clinical examination. | |
| Breast Cancer TNM Staging Guide | |
|---|---|
| Distant Metastases (M) | |
| MX | Distant metastasis cannot be assessed |
| M0 | No distant metastasis |
| M1 | Distant metastasis present |
Breast Cancer Treatment Options
As a healthcare provider managing oncology patients, you may find yourself educating patients about their treatment options. The following is a brief summary of common therapies used to treat breast cancer that may be helpful to you and your patients.
- Surgery: The majority of breast cancer treatment plans include some form of surgery. The purpose of breast surgery is to remove as much of the tumor as possible and to determine if the cancer has spread to the lymph nodes. Breast surgery may comprise lumpectomies or mastectomies.
- Radiation Therapy: Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. The radiation may be delivered from outside of the body (external radiation) or internally via the placement of radioactive material inside the body.
- Chemotherapy: Oral or intravenous chemotherapy may be used to help kill cancer cells and prevent disease recurrence. Several chemotherapy options are available to treat breast cancer and typically are administered after the tumor has been removed via surgery or alone for early-stage disease. Each chemotherapeutic agent is associated with specific side effects.
- Hormone Therapy: Hormone therapy is the use of drugs to help block the effects of estrogen, a hormone that may encourage the growth of breast cancer cells. Hormone therapy may be used to help treat hormone-positive breast cancer and prevent it from reoccurring, and to prevent breast cancer in high-risk women. Hormone therapy has been demonstrated to drastically reduce the risk of recurrent disease in women with hormone-positive breast cancer.
- Biologic Therapy: Some breast cancers (eg, HER2/neu-positive) may respond to treatment with a biologic.
- Clinical Trials: Clinical trials give patients access to investigational approaches and treatments that often are not otherwise available. There are both benefits and drawbacks to participation in clinical trials that patients and healthcare providers should discuss.
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