If you have been diagnosed with cancer or know someone who has, there is hope.
With improved screening methods, more sophisticated treatment methods and greater public awareness, breast cancer is being put in its place.
Over the course of a lifetime, one in nine Canadian women will develop breast cancer. One in 27 will die of the disease.
Many of us can think of a person who developed cancer at a young age but when we look at the population as a whole the biggest risk factor for cancer is aging. For younger women, the risk is far less: for women aged 30 to 34, just one in 625 will develop breast cancer compared with one in 13 women aged 75.
Men can also develop breast cancer – but it is a rarity, accounting for less than 1 percent of all cases.
Regular screening and early detection have paid off. Since the mid-1980s, the number of women who die from breast cancer has fallen steadily, particularly in the 50-69 age range. Happily, fully two-thirds of Canadian women diagnosed with breast cancer will survive long-term. And, since the late 1990s, the incidence of breast cancer in Canada has stabilized.
WHAT IS CANCER?
Cancer is a result of uncontrolled cell growth which can cause a swelling or tumour to develop. This is a characteristic of many cancers, including breast cancer.
There are two types of tumours – benign and malignant. A tumour is considered benign if it stays contained within a limited area. A benign tumour is not life-threatening.
But if the tumour continues to grow and spread, the tumour is called malignant. Nearby normal cells are pushed aside; healthy surrounding tissue is invaded.
If the cancerous cells spread to other parts of the body, the process is called a metastasis, or secondary cancer. It is the same kind of cancer as the original – just located in a new part of the body.
WHAT IS BREAST CANCER?
Breast cancer starts in the breasts. Breast tissue covers an area larger than just the breasts: it extends up to the collarbone and from the armpit to the breastbone.
Different kinds of breast cancers occur in different tissues in this more extensive area. If cancer cells start to develop in the ducts of the breast, it is called ductal carcinoma. This is the most common type of breast cancer.
If the cancer cells start to grow in the lobules (groups of glands that produce breast milk), it is called lobular carcinoma.
Breast cancer can spread to other parts of the body through the blood stream or through the lymphatic system. Breasts contain lymph vessels and lymph nodes, which are part of the larger lymphatic system. That’s why there is always concern about whether or not the cancer has moved into a woman’s lymph nodes.
Once the cancer has begun to travel to other parts of the body, metastasis is under way and a more aggressive fight must ensue to stem its progress. Early detection can help stop breast cancer before it metastasizes and greatly increase the odds of survival.
There are other types of breast cancer, such as inflammatory breast cancer and Paget’s disease. These behave differently and require different treatment.
BECOMING BREAST AWARE
A woman’s breasts change constantly throughout life – at different times of the month when a woman is menstruating, during pregnancy and throughout the process of menopause.
The best strategy is to become “breast aware”. Know what looks and feels normal for you and increase your chances of noticing any changes that occur. That, in turn, increases the chance of early detection of any cancer that might occur – one of the key elements of surviving breast cancer.
Many women find tumours themselves through regular breast self-exam, but that may not be enough. Regular medical screening, such as mammograms and examination by a physician should also be added.
For detailed information, see “The Five Steps To Becoming Breast Aware” and “What to Look For” on the website of the Canadian Breast Cancer Foundation.
A change in the breasts is not necessarily a sign of breast cancer. Still, it is important to have changes checked by your doctor, especially if you’ve been treated previously for breast cancer. For more information, see “Signs and Symptoms” and “When to Seek Medical Attention” on the Mayo Clinic website.
RISKS, RISK FACTORS AND PREVENTION
The exact causes of breast cancer are not known. It is believed to be the result of a number of inherited and environmental factors.
There are two categories of risk factors for breast cancer: “internal” risk factors and “external” risk factors.
Internal risk factors cannot be changed or controlled. Nor do they automatically set you up for developing breast cancer. On the other hand, external risk factors are things we can all modify.
Internal risk factors for breast cancer are: gender, age, personal history of breast cancer, family history of breast cancer, breast conditions, breast density, early menstruation/late menopause.
External, modifiable risk factors are: radiation exposure, hormone replacement therapy, oral contraceptives, excess body weight, lack of physical activity, use of alcohol and tobacco.
A woman’s reproductive history – whether or not she has had children and at what age she has her first child – and whether she chooses to breastfeed – also affect her risk for developing breast cancer.
Research is underway to pinpoint risk factors for breast cancer and the extent of their influence. To find out more about risk factors, visit breastcancer.org.
You can also reduce your risk of developing breast cancer by following a healthy lifestyle. Research supports this. Maintaining a healthy body weight, getting regular physical activity, eating well and limiting tobacco and alcohol use are just some of the ways you can help your body.
Women at very high risk of developing breast cancer – such as a strong family history or a previous bout of breast cancer - might also want to explore other preventative steps with their doctor, such as preventative surgery.
EARLY DETECTION AND SCREENING
Early detection of breast cancer usually offers a better chance of successful treatment. That’s why regular breast screening is very important.
The evidence for mammography for women aged 40-49 is not as clear as for women aged 50-69. Therefore, in Ontario it is recommended that women aged 40-49 talk to their doctor to make a personal decision about mammography.
Mammography, according to Health Canada, is the only technique proven to be safe and effective in screening for breast cancer. For more information about mammography, visit the Health Canada website.
Studies show that regular mammograms – at least once every two years - can reduce breast cancer deaths for women aged 50 to 69 by as much as one-third. To find out about the Ontario Breast Screening Program for women over the age of 50, call 1-800-668-9304.
It is also important to know that mammography can result in a “false positive”, which is when you get called back for further testing such as another mammogram, an ultrasound, or a biopsy to check out any suspicious signs on the first mammogram. The majority of the time nothing is found and the patients are reassured, but it can be very anxiety provoking so it is helpful to know this possibility going in. Studies indicate that this could happen for one in 4 women over 10 years of screening every second year.
Your doctor may also recommend a mammogram if you have a higher risk factor for breast cancer or if there is reason to suspect you have breast cancer.
DIAGNOSIS
If your doctor detects any potential sign of breast cancer during a clinical examination or after a mammogram, you will probably be sent for diagnostic imaging or for a biopsy.
There are two main methods of diagnostic imaging: a diagnostic mammogram or breast ultrasound. Both are intended to give your doctor a clearer picture of what is happening inside your breast and can help pinpoint the cause of any symptoms you are experiencing.
A biopsy entails taking a sample of breast tissue. The sample is then sent to a lab for testing. This is the only method of determining for sure if a breast problem is cancer or not.
There are several different kinds of biopsies, including a fine-needle aspiration biopsy, core biopsy and surgical biopsy. Each follows a different procedure – so find out from your doctor what to expect.
A biopsy can also determine what kind of breast cancer you have – critical to determining what kind of treatment plan you should have, should you need treatment.
Breast cancers are also staged and graded. Stages range from 0 to 4, depending on the size of the tumour, the potential for metastasis and whether (and to what extent) it has metastasized. Grading indicates how aggressive the cancer is likely to be, and help guide decisions about treatment.
TREATMENT
A diagnosis of breast cancer can be a shock, followed by an onslaught of emotion – fear, despair, anger, grief. There are many questions to be answered and many important decisions regarding treatment to be made. Many women are surprised to learn that breast cancer is not simply one type of cancer and that treatment is not a one-size-fits-all affair.
Coping with a diagnosis of breast cancer is often very difficult. But there are many resources available to help guide and support patients and their families.
Three good sources are Willow Breast Cancer Support Canada, the Canadian Breast Cancer Network and Women’s Health Matters. All three have information on programs, services, support groups, online forums, general information and more.
You can also visit the Community Resources Database of HealthyOntario.com.
Your health care team will help you decide among various treatment options. There are several ways to treat breast cancer, depending on the type and stage of the cancer. You may have some preferences of your own, which will affect which treatment you choose. Learn as much as you can about each type of treatment in the available time.
There are two kinds of treatment: local, such as surgery and radiation therapy; and system treatment, such as chemotherapy, hormone therapy and HER-2 therapy. Systemic treatments come into play when the there is a possibility that the cancer has spread to other parts of the body.
For more information about types of treatment, visit the Canadian Breast Cancer Foundation.
AFTER TREATMENT
If you have had breast cancer, you have a higher-than-average risk of getting it again. That is why follow-up care – including regular mammograms and clinical exams – is so important.
Post-treatment care is important to help you adjust to life as a “breast cancer survivor” and to help prevent a recurrence of the disease. You will be dealing with the effects of the disease, the potential long-term side effects of any treatment, the emotional impact and the possible need for breast reconstruction or prostheses.
For more information on follow-up care visit the Canadian Breast Cancer Foundation website or one of the support groups listed below. You can also order a booklet from the Canadian Cancer Society entitled Living with Cancer.
Part of good after-treatment care entails a healthy diet and lifestyle. There is a growing body of evidence which indicates regular exercise and healthy eating increases survival rates after breast cancer. Eat at least five servings each of fruit and vegetables per day and exercise at least 30 minutes, six days a week. It is also important to limit your fat intake and maintain a healthy body weight.
For more information on how to follow a healthy diet, visit Canada’s Food Guide or call toll-free 1-877-510-5102 to speak to a Registered Dietitian. For information on healthy eating, visit EatRight Ontario.
Resources
Article - Cutting Your Cancer Risk - Part 1
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Article - Cancer: Coping Tips - Part 1
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Article - Cancer: Coping Tips - Part 2
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Canadian Cancer Society - Ontario
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Article - Teen exercise protects against breast cancer later in life
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