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Breast Cancer
Breast cancer is the most common cancer among Canadian women. One in nine Canadian
women is expected to develop breast cancer during her lifetime. One in 28 will die of it.
However, breast cancer death rates have declined in every age group since the mid 1990s.
Are all lumps cancerous?
The breast tissue covers an area larger than just the breast. It extends up to the collarbone and
from the armpit across to the breastbone in the centre of the chest. The breasts sit on the chest
muscles that cover the ribs.
Breast cancer occurs when breast tissue cells divide without control. If cells keep dividing
uncontrollably, a mass of tissue forms. This is called a growth or tumour. The term cancer
refers to malignant tumours. They can invade nearby tissue and spread to other parts of the
body.
However, 80% of lumps found in the breast are benign (non-cancerous). Most of these are due
to fibrocystic changes that affect 50% to 60% of all women and occur when fibrous breast
tissue, mammary glands, and ducts overreact to the normal hormones produced during
ovulation, resulting in the development of fibrous lumps and/or numerous, small multiple cysts,
(lumpy, fluid-filled sacs or "pockets"). They are unusual after menopause unless a woman is
taking hormones.
Although most people think of breast cancer as a woman’s disease, men can develop breast
cancer as well. Breast cancer in men can be more aggressive.
Symptoms
When breast cancer first develops, there may be no symptoms at all. But as the cancer grows,
it can cause the following changes:

A lump or thickening in or near the breast or in the underarm area or in the neck

A change in the size or shape of the breast

Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast

Ridges or pitting of the breast skin (like the skin of an orange)

A change in the way the skin of the breast, areola, or nipple looks or feels (for example,
warm, swollen, red, or scaly)
Note: These symptoms may also be caused by other, less serious health conditions. Anyone
experiencing these should see a doctor.
Diagnosis
Your doctor will ask about your symptoms and medical history and then conduct tests that may
include:

Clinical breast exam—the size and texture of the lump is manually examined to determine
whether the lump moves easily

Mammography—x-rays of the breast used to see lumps or other changes in breast tissue

Ultrasonography—the use of high-frequency sound waves to see whether a lump is a
fluid-filled cyst or a solid mass

Biopsy—removal of tumour tissue to be tested for cancer cells.

Genetic testing—blood is evaluated for the presence of specific gene mutations
Treatment
Once breast cancer is found, staging tests are done. This will help to find out if the cancer has
spread and, if so, to what extent. Treatments include:
Surgery

Lumpectomy—removal of the breast cancer and some normal tissue around it. Often,
some of the lymph nodes under the arm are also removed.

Segmentectomy—removal of the cancer and a larger area of normal breast tissue
around it.

Simple mastectomy—removal of the breast, or as much of the breast as possible. The
surgeon will try not to remove lymph nodes.

Radical mastectomy—removal of the breast, both chest muscles, the lymph nodes
under the arm, and some additional fat and skin. This procedure is only considered in
rare cases. It is done if the cancer has spread to the chest muscles.

Modified radical mastectomy—removal of the whole breast, the lymph nodes under the
arm and, often, the lining over the chest muscles.

Axillary lymph node dissection—removal of the lymph nodes under the arm. This is
done to help determine whether cancer cells have entered the lymphatic system.

Sentinel lymph node biopsy—a small amount of blue dye and/or a radioactive tracer is
placed in the area where the tumour was located. The dye or tracer is then followed into
the armpit. The lymph nodes that pick up the substance may contain cancer cells and
are removed. The accuracy rate for this procedure exceeds 95%. .
Radiation Therapy
This is the use of radiation to kill cancer cells and shrink tumours. Two main types of radiation
may be used:

External radiation therapy—radiation directed at the breast from a source outside the
body

Internal radiation therapy—radioactive materials placed into the breast in or near the
cancer cells
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. It may be given in many forms including
pill, injection, and via a catheter. The drugs enter the bloodstream and travel through the body
killing mostly cancer cells. Some healthy cells are killed as well.
Biologic Therapy
The use of medications or substances made by the body can increase or restore the body's
natural defenses against cancer. It is also called biologic response modifier (BRM) therapy.
Prevention
Finding and treating breast cancer early is the most effective treatment. Since breast cancer
does not cause symptoms in the early stages, it is important to have screening exams and
tests regularly.

Women age 20 or older should perform a breast self-exam (BSE) every month

Women between the ages of 20-39 should have a clinical breast exam by a health
professional every three years (A breast exam should be performed more regularly if
there is a family history or there have been previous breast biopsies)

Women age 40 and older should have a screening mammogram every year Some
advocate that a mammogram should be performed sooner for patients with a strong
family history or whom have had previous breast biopsies performed

After age 40, women should have a breast exam by a healthcare professional every
year
Researchers are still studying the effectiveness of these measures. According to a study,
getting regular mammograms starting at age 50 does appear to decrease deaths related to
breast cancer.
Resources
Canadian Breast Cancer Foundation
http://www.cbcf.org/
Canadian Cancer Society
http://www.cancer.ca/
Canadian Breast Cancer Society
http://www.bcsc.ca/
Health Canada
http://www.hc-sc.gc.ca/
Breast Cancer Action
http://www.bcaott.ca/
Breast Cancer Support Services
http://www.breastcancersupport.org/