One in Eight - A Teens Guide to Understanding Breast Cancer

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The impact of the BRCA1 and BRCA 2 mutation expands beyond just breast cancer as having mutations in either of these genes is associated with an increased ovarian cancer risk as well. Conversely, BRCA1 mutations are found less frequently in breast cancers occurring in men while BRCA2 mutations are associated with a lifetime breast cancer risk of only about 6.

Although less common and less drastic in their increase of breast cancer risk than the BRCA mutations, inherited mutations in many other genes can also lead to breast cancer development. In terms of practically making use of genetic testing for detection and prevention of breast cancer, it's also necessary to keep in mind that the testing is quite expensive and may not be covered by all health insurance plans.

Breast cancer

While genetic testing can be helpful in some cases, not every woman needs to be tested. Interestingly, women with a father or brother who have breast cancer also have a higher risk of breast cancer. Within the context on an individual, a woman with cancer in one breast has a higher risk of developing a new cancer in the other breast or in another part of the same breast.

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Race and ethnicity: In general, Caucasian women are slightly more likely to develop breast cancer than African-American women although breast cancer is more common in African-American women under age Furthermore, African-American women are more likely to die from breast cancer at any age. Other races such as Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer.

Certain benign breast conditions: Women with dense breasts on mammogram have a risk of breast cancer that is about 1.

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Certain non-proliferative lesions may marginally affect breast cancer risk. Certain proliferative breast lesions: Some proliferative lesions without atypia seem to raise a woman's risk of breast cancer slightly. However, certain proliferative lesions with atypia in the ducts or lobules of the breast tissue will increase breast cancer risk 4—5-fold; and these include atypical ductal hyperplasia ADH and atypical lobular hyperplasia ALH.

Lobular carcinoma in situ LCIS or lobular neoplasia: LCIS cells are cancer-like and grow in the lobules of the milk-producing glands of the breast, but are limited within the walls of the lobules. Women with LCIS also have a much higher risk of developing cancer in either breast. Chest radiation therapy: Women, who were treated with radiation therapy to the chest for another cancer when they were younger, have higher risk for developing breast cancer.

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  4. Conversely, radiation treatment after age 40 does not seem to increase breast cancer risk. Exposure to diethylstilbestrol DES : From s through early s some pregnant women were given an estrogen-like drug DES because it was thought to lower the incidence of miscarriage. These cancers may be caused by genetic mutations that occur as a result of the aging process and lifestyle-related risk factors, rather than inherited mutations.

    Birth control and contraceptives: Many birth control methods use hormones, which may increase breast cancer risk. As an injectable form of progesterone, Depo-Provera has been shown to have an increase in breast cancer risk, but there is seemingly no increased risk in women five years after they have stopped receiving the shots.

    Talking with children about breast cancer

    Birth control implants, intrauterine devices IUDs , skin patches, and vaginal rings usually also use hormones and thus in theory may increase breast cancer risk. Consequently, whenever considering the use of hormonal birth control, women should discuss the coupling of this impact with any other risk factors for breast cancer with their health care providers.

    Hormone replacement therapy HRT after menopause: The hormone estrogen often combined with progesterone has been used to relieve symptoms of menopause and to prevent osteoporosis. However, for women who have had a hysterectomy, estrogen by itself can be used. Postmenopausal combined hormone therapy increases the risk of breast cancer, the chances of dying from breast cancer, and the likelihood that the cancer may be found only at a more advanced stage. This increase in risk is usually seen with as little as two years of use.

    However, the increased risk from combined HRT is reversible and its risk applies only to current and recent users, as a woman's breast cancer risk seemingly returns to that of the general population within five years of stopping HRT.

    Breast cancer in women - NHS

    Short term use of estrogen alone after menopause does not seem to increase the risk of breast cancer much. However, long-term use of estrogen therapy e. Thus, the decision to use any forms of HRT should be made by a woman and her physician after weighing the possible risks and benefits, and considering her other risk factors for heart disease, breast cancer, and osteoporosis. Excessive alcohol consumption: Drinking alcohol is clearly linked to an increased risk of breast cancer, and the increase in risk caused by this factor correlates with the amount of alcohol consumed.

    Women who have only one alcoholic drink per day have a very small increase in risk. Significant overweight or obese: Before menopause women's ovaries make most of the body's estrogen, while fat tissue makes only a small amount. Thus, having more fat tissue after menopause will raise estrogen levels and increase breast cancer risk.

    Furthermore, being overweight tends to lead to higher blood insulin levels, and higher insulin levels are linked to certain cancers, including breast cancer. Nonetheless, the link between body weight and breast cancer risk is complex and remains to be fully understood. Not having children or not breastfeeding: Women who have not had children or who have their first child after age 30 have a slightly higher overall risk for breast cancer.

    It has been suggested that breastfeeding may slightly lower breast cancer risk, especially if it is continued for 1. A possible explanation for this effect is that breastfeeding reduces woman's total number of lifetime menstrual cycles. Starting menstruation early or stopping menopause after age Women will have more menstrual cycles if they start menstruating early, especially before age 12, and thus they will have a longer lifetime exposure to the hormones estrogen and progesterone, leading to a slightly higher risk of breast cancer. Lack of physical activity: Growing evidence indicates that regular physical activity, especially in women past menopause, may reduce breast cancer risk.

    There are many types of breast cancers as it can present in distinct areas of the breast, such as the ducts, the lobules, or the tissue in between. The type of breast cancer is determined by the specific cells that are affected. Based on which cell origin is involved, breast cancers can be divided into two broad classifications, carcinomas and sarcomas. Carcinomas are breast cancers arising from the epithelial component of the breast, which consists of the cells that line the lobules and terminal ducts responsible for making milk. These groups are not always sufficient categories as, in some cases, a single breast tumor can be a combination of different cell types.

    Most breast cancers are carcinomas. Within the large group of carcinomas, there are many different types of breast cancer identified based on their invasiveness relative to the primary tumor sites. Accurately being able to distinguishing between the various subtypes is vital as they each have different prognoses and treatment implications.

    Based on criteria of pathological features and invasiveness, common breast cancers can be divided into three major groups: non-invasive or in situ , invasive, and metastatic breast cancers. Ductal carcinoma in situ DCIS; also called intraductal carcinoma : As one of the most common types of breast cancer, DCIS is a non-invasive or pre-invasive breast cancer, which develops inside of pre-existing normal ducts. Invasive or infiltrating breast cancer Invasive breast cancers have cancer cells that invade and spread outside of the normal breast lobules and ducts, growing into the surrounding breast stromal tissue.

    Invasive carcinomas have the potential to spread to other sites of the body, such as the lymph nodes or other organs and to form metastases thus entering the classification of metastatic breast cancers.

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    Lobular carcinomas grow as single cells arranged individually, in single file, or in sheets, and they have distinct molecular and genetic aberrations that distinguish them from ductal carcinomas. Ductal and lobular carcinomas may have different prognoses and treatment options and are thus important to clearly differentiate from one another. Metastatic breast cancers, also known as stage IV or advanced breast cancers, are late stage breast cancers, which have spread to other organs in the body.

    Even after the primary tumor is removed, microscopic tumor cells or micro-metastases may remain in the body, which allows the cancer to return and disseminate. Clinically, patients may initially be diagnosed with metastatic disease or de novo metastatic breast cancers , or they may develop metastases months or years after receiving initial treatment.

    The risk of breast cancer returning and metastasizing is not clearly understood or predictable as it varies from person to person, largely depending on the unique molecular biology of the tumor and the stage at the time of the original diagnosis. Typical IBC symptoms include inflammation-like breast swelling, purple or red color of the skin, and pitting or thickening of the skin of the breast, all of which are likely caused by cancer cells blocking lymph vessels in the skin.

    Through the eyes of teens with cancer

    IBC often does not present with a breast lump and may not be identifiable on mammograms. IBC tends to occur in younger women, and is more common in African-American women as well as in women who are overweight or obese. Furthermore, IBC tends to be more aggressive, growing and spreading much more quickly than the common types of breast cancers. IBC is always first diagnosed at a locally advanced stage where the breast cancer cells have grown into the skin.

    The most common breast lesion in males is gynecomastia or breast enlargement , which may involve either the unilateral breast or bilateral breasts. Breast lesions are also uncommon in children and adolescents, but do occur. These rare cases can include both benign lesions, such as juvenile fibroadenoma, and malignant lesions, such as secretory carcinoma. Pediatric patients are more likely to suffer from metastatic tumors to the breast from lymphoma or alveolar rhabdomyosarcoma. Paget disease of the breast: This rare form of breast cancer starts in the breast ducts, spreads to the skin of the nipple and then expands to the areola the dark circle around the nipple.

    Paget's cells look significantly different from normal cells and divide rapidly. About half of the cells are positive for estrogen and progesterone receptors, and most cells are positive for the HER2 protein. The cancer is typically diagnosed with a biopsy of the tissue, sometimes followed by a mammogram, sonogram or MRI to confirm the diagnosis. It should also be pointed out that Paget's disease of the breast is not related in any medical way to other conditions named after Sir James Paget, such as Paget's disease of the bone. In some cases, the cancer cells are quite small in size and form micropapillary.

    Most papillary carcinomas are invasive, and are treated in the same manner as IDCs. However, invasive papillary carcinoma usually has a better prognosis than other invasive breast cancer. It is noteworthy that papillary carcinomas may also be detected when they are still noninvasive.

    A noninvasive papillary carcinoma is usually considered a variety of DCIS. Phyllodes tumor: Phyllodes tumors are rare breast tumors that develop in the stromal cells of the breast. Phyllodes tumors are most commonly found in women in their 40s, and in women with Li-Fraumeni syndrome who have an increased risk for this type of tumor. Angiosarcoma of the breast: As a form of sarcoma, angiosarcoma is a rare cancer that originates the epithelial cells that line blood or lymph vessels. Some arise from prior radiation therapy in that area. Although rare, angiosarcomas tend to grow and spread quickly and need to be treated accordingly.

    Breast cancer encompasses a heterogeneous and phenotypically diverse group of diseases. It is composed of several biological subtypes that have distinct behaviors and responses to therapy. With the advance of gene expression profiling techniques, the list of intrinsic genes that differentiate these subtypes is now made up of several clusters of genes relating to estrogen receptor ER expression the luminal cluster , human epidermal growth factor 2 HER2 expression, proliferation, and a unique cluster of genes called the basal cluster.

    They are low-grade, slow growing, and tend to have the best prognosis. Treatment typically involves hormonal therapy. Luminal B cancers grow slightly faster than luminal A cancers, and their prognosis is slightly worse. However, they can be successfully treated with targeted therapies aimed at the HER2 protein, such as Herceptin or trastuzumab , Perjeta or pertuzumab , Tykerb or lapatinib , and Kadcyla or T-DM1 or ado-trastuzumab emtansine.

    TNBC usually behaves more aggressively than other types of breast cancer making it a high grade breast cancer. The most common histology seen in TNBC is infiltrating ductal carcinoma, although a rare histologic subtype, medullary carcinoma, is generally also triple negative.

    Normal-like breast cancer: This subtype is similar to luminal A disease. The cellular and molecular heterogeneity of breast cancers mandates the analyses of multiple genetic alterations in concert, which has been made possible by the emergence of next-generation genomics and transcriptomics techniques. This segregation is consistent with both literature and clinical experience which show ER-positive and ER-negative cancers to define biologically distinct phenotypes that may derive from different progenitor cells.