Breast cancers are malignancies — life-threatening masses — that develop in one or both breasts. About 175,000 invasive breast cancer cases will be diagnosed this year. Age is the major risk factor, since about 80% of breast cancer cases occur in women over 50. The general risk for women developing breast cancer, according to Betsy Kopp is a "one in nine" if they live to 85. Kopp is PinnacleHealth’s Oncology Program Administrator.

By 40, Kopp says, a woman’s odds are one in 217. By age 50, they are one in 50. "Cancers are genetic which means they affect cells’ genetic make up," she says, The genetic change to cells may be "inherited or environmental or both." "Family history is important since 10% of breast cancers are inherited genetic alterations," she says. Environmental factors include the age women begin the menstrual cycle and experience menopause. "The younger a woman’s menstrual cycle begins or the older she is when her menopausal cycle begins are risk factors." A woman’s child-bearing history is considered. "Women over 30 who have not had children are at higher risk than women who have given birth," Kopp says. She also looks at diet and tobacco use.

Cancer in women younger than 30 is rare, accounting for only 1.5% of all breast cancer cases. Native Americans and Asians have lower rates of breast cancer than Caucasians, Hispanics, and African Americans. About 1% of breast cancers will occur in men.

Breast cancer affects the interior of the female breast, which is divided into about 20 sections called lobes. Breast cancer is either invasive (spreading), which accounts for 70%, or noninvasive (confined to a specific site or called in situ). "Basically, breast cancer develops in a lobe or lobes or in a duct," Kopp explains. Stage I breast cancer is often curable by using surgical procedures. However, a 10 to 20 year follow-up of patients managed with only surgery indicates that as many as 21% may experience a relapse, according to the National Cancer institute.

There are procedures that conserve major portions of the involved breast. These procedures are followed by radiation therapy. Cancerous breast tumors can sometimes be controlled without extensive surgical procedures. Patients should know that the biopsy, a diagnostic test used to identify cancerous cells, and surgical procedures that may be used as an initial treatment are usually performed as separate procedures. In many cases, a simple biopsy test confirms a breast cancer diagnosis. If a biopsy confirms cancer, then lymph nodes are biopsied to determine the extent of the cancer. "PinnacleHealth uses a Sentinel Method, a state-of-the-art lymph node biopsy approach which removes only two lymph nodes and, in the process, can eliminate problems down the road for patients," Kopp explains.

If cancer is confirmed, patients then discuss treatment options with a physician before therapy is started. Treatments include surgical options like mastectomy (removal of a breast), mastectomy with reconstruction of the breast, or breast-conserving surgery referred to as lumpectomy (the cancerous lump is removed) or quadrantectomy, a more invasive surgical procedure. Radiation usually follows surgery to eliminate remaining cancerous cells. A patient’s treatment depends on the location and size of the lesion, breast size, patient’s age, and the mammogram. "Patients’ feelings about breast preservation is considered, too," stresses Kopp.

Stage II breast cancer involves more extended treatments involving chemotherapy which oftens prolongs the cancer-free interval of time and survival rate for pre- and post-menopausal patients. Depending on the patient, chemotherapy lasts 3 – 6 months. Depending on a woman’s clinical traits, hormonal therapy with tamoxifen prolongs the disease-free interval and overall survival rate. The tamoxifen is taken for five years.

Chemotherapy uses cyclophosphamide, doxorubicin, methotrexate, and fluorouracil (abbreviated as CMF). This combination can extend the disease-free interval of time for premenopausal and postmenopausal patients, although toxic effects may influence a patient’s course of treatment. A long-term follow-up of women who received cyclophosphamide as part of their chemotherapy regimen indicates that the incidence of other solid tumors and secondary leukemia is not much higher than that in the general population, according to the National Surgical Adjuvant Breast and Bowel Project. Another small study indicates that disease-free survival may be increased with prolonged tamoxifen therapy and one year of a combination of chemotherapy drugs. PinnacleHealth is also involved in evaluating the use of tamoxifen versus the osteoporosis drug Evista in the prevention of breast cancer in high risk patients. "We’re on the cutting edge," says Kopp.

"Women need to know that early detection is important and that we have better treatment. Prevention is important also. Eat less fat, drink less alcohol," Kopp concludes.