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Breast Cancer

 

In 2007, 180,510 women were diagnosed with breast cancer. In women, breast cancer is the most common form of cancer and the second leading cause of death. Due to early detection, the number of deaths due to breast cancer is on the decline. When self-exams are done regularly and mammograms once a year, breast cancer can be caught early leading to an increased chance of being curable. Today women genetically prone to developing breast cancer and those in advanced stages have improved prognosis because of technological advances. These advances can be seen in chemo and hormonal therapy, surgery, genetic screening, and X-ray technologies such as mammograms.

Genetics

Studies have shown that having an inherited abnormality in the p53, BRCA-1, BRCA-2 tumor suppressor genes or PTEN genes increases a woman’s risk of developing breast and ovarian cancer. In men having one or more of these abnormalities increases their risk of developing prostate and breast cancer. Genetic screening programs help to counsel patients on their risk of developing cancer by discussing their family history and offering testing for genetic mutations.

Tumor Types

The most common type of breast cancer is called ductal carcinoma. It begins by forming in the lining of ducts in the breast. A less common type of breast cancer is called lobular carcinoma. Lobular carcinoma forms in the lobules of the breast and usually occurs in both breasts or in separate locations within a single breast. Because breast cancer can be found in all areas of the breast, it is important to be thorough when completing self examinations.

DCIS stands for ductal carcinoma in situ (aka intraductal carcinoma). This type of tumor is composed of abnormal cells, confined to the inside of the milk ducts in the breast and have not spread beyond the breast, to the lymph nodes under the arm, or to other parts of the body. DCIS has the ability to be found in small or large portions of a duct system in the breast. DCIS has a high cure rate, but if not removed it has the ability to change over time and become invasive.

LCIS stands for lobular carcinoma in situ. This type of tumor is composed of abnormal cells, found in the lining of the milk lobules. LCIS is not classified as breast cancer but it is considered a warning sign of an increased invasive cancer risk in either breast. During the exploration of a lump, LCIS can sometimes be found.
Invasive Vs. Noninvasive Breast Cancer

An important factor in assessing any breast tumor is determining whether it is noninvasive or invasive. Noninvasive or in situ cancer confines themselves to the ducts or lobules and do not spread to the surrounding areas. They can develop into or raise your risk for a more serious, invasive cancer. Invasive or infiltrating cancers have started to break through normal breast tissue barriers and invade surrounding areas. The spread of breast cancer to other tissues and organs of the body is called metastatic breast cancer. The first sign of metastasis occurs in the lymph nodes and spreads deep into the breast and surrounding tissue. Much more serious than noninvasive cancers, invasive cancers can spread cancer to other parts of the body through the blood stream and lymphatic system, often invading nearby lymph nodes. This process is called metastasis.

Invasive breast cancers are typically classified as being invasive ductal cancer, invasive lobular cancer or one of several other types. Most women diagnosed with breast cancer have invasive ductal cancer accounting for nearly 75% of all breast cancer cases. Lobular cancers are harder to detect on screening mammography or clinical exam and have a slightly greater likelihood of being bilateral or in both breasts. The incidence of lobular carcinoma has been increasing in recent years.

Inflammatory breast cancer

Inflammatory breast cancer has different signs and symptoms than DCIS or LCIS. This type of breast cancer is a rare and aggressive cancer that can go unnoticed until late stages, because easily detected tumors or lumps in the breast do not have to be present. Symptoms of the breast can look like an allergic reaction but will persist for more than a few days. Examples are hives, welts, increased temperature of the skin, and a reddish color.

Male Breast Cancer

Breast cancer in men occurs mostly commonly in the 60s and is found in less than 1% of men in the United States. In 2004, 1450 diagnosed cases of male breast cancer were predicted. Though breast cancer is more common in women, men may develop it. Some risk factors for men include aging, a family history of breast cancer, radiation exposure, alcohol/liver disease, obesity, diagnose of Klinefelter syndrome, and infertility. Though men may have any of these risks it does not define whether or not they will have breast cancer. Since male breast cancer is rare, delays in diagnosis occur allowing for breast cancer to develop into late stages. It is important that a man showing any signs or symptoms should contact a doctor.

Staging

Staging includes all information found by clinical findings, surgery, and pathological review of the breast tumor. Letters usually seen are T, N, M, and G. The T stage is determined by the size of the primary breast tumor. The N stage is determined by the number of positive nodes. The M stage is determined by the presence or absence of metastatic disease to other organs. The G stands for the grade which is determined by comparing the breast cancer tissue to normal breast cancer.

Risk Factors

Lifestyle aspects, family history of cancer, personal history of diseases, and physical history play a key role in assessing the risk of breast cancer. Factors that increase the risk of breast cancer include:

• Current age of the patient is important since the average of diagnosis is in a women’s 60s. At this age 1 in 8 women will be diagnosed with breast cancer. As a women’s age increases, so does her risk for breast cancer.
• Diet, including the use of alcohol
• Amount of exercise and weight (especially overweight/obese)
• The age of the patient’s first period (menarche) and menopause are important factors. Menarche before the age of 12 and/or menopause after 52 increases the risk of breast cancer. If the patient has or has not had children, if those children were breast feed, and the age of the patient at the time of her children’s births are also important when determining the risk of breast cancer.
• Past medical history such as breast, ovarian, uterine, or colon cancer.
• Abnormally high hormone produce of estrogen and progesterone.
• Exposure to radiation.
• Blood relatives with breast cancer.
• Race (In the United States, Caucasians have a higher rate of breast cancer than Non-Caucasians, African Americans and Hispanics)

Preventive measures

Affecting nearly 1 in 3 American women, breast cancer is a serious cause of concern. Fortunately, significant research is in progress at Feist-Weiller Cancer Center and clinical trials permit groundbreaking treatments. Scientists recommend women eat low fat diets; exercise frequently and breast feed their infants to help reduce breast cancer risk. Early detection of possible tumors with monthly self breast exams and annual mammograms after the age of 40 can lead to effective treatment. Any unexpected change in the breast that persists for more than a few days should be seen by a doctor and monitored. Efforts to decrease the risk of breast cancer have been focused on early detection, and modifying known risk factors such as diet and exercise.

Screening

Women who suspect a lump during their monthly self breast exam first should visit their Ob/Gyn or primary care physician. These physicians may order a mammogram and refer the patient to a Surgical Oncologist, depending on the results. Surgical Oncologists are specialists who can handle referrals and diagnose true breast cancer with a biopsy.

Breast Cancer Screening at Feist-Weiller

Diagnostic Process & Tests

• Mamography 
• Advanced Molecular Testing  
• Staging and Grade 
• Getting a second opinion 

Treatments

Patients receive high quality care that is determined on an individual basis. A Surgical Breast Conference, which consists of Medical Oncologists, Surgical Oncologists, Radiation Oncologists and Pathologists, meets weekly to discuss patients’ cases to determine the best plan of care.

The Workup

Surgical options

• Lumpectomy
• Mastectomy
• Checking the Lymphnodes

Breast Reconstruction

Radiation

Body-wide therapy

• Hormone Therapy
• Biological Therapy
• Chemotherapy

Physicians may refer patients receiving treatment to rehab or physical therapy at a state-of-the-art Physical Therapy Clinic at LSU Health Sciences Center if necessary.

 

Advanced Science & Research

Basic Science:  Breast Cancer Focus Group

Clinical Trials

We are actively participating in clinical trials and research for our cancer patients. Newly developed treatments or investigational drugs may reduce tumor size and eliminate symptoms better than treatments currently available.

Patients are asked if they would like to participate in our clinical trials to evaluate new cancer prevention and treatment choices. Participation is completely voluntary. Ask the doctor about clinical trials at your visit.

See the patient information on Clinical Trials at the Feist-Weiller Cancer Center. Additional information is available for medical professionals.  For more information about ongoing clinical trials at the Feist-Weiller Cancer Center, please call us toll-free at 1-866-LSU-FWCC (578-3922) or (318) 813-1410.

Cancer Support Group

The Feist Weiller Cancer Center offers two patient support groups, meeting once a week, for all types of cancer. For more information about these two support groups, please call:

Jo Ann Stewart, RN at (318) 813-1409
Susie Wiggins, RN at (318) 813-1417
Ron Nierman at (318) 470-6180

Genetic Testing and Counseling 

Almost all of us have known someone with cancer, be it a colleague, friend, or family member. For many, these acquaintances are few, and family occurrences sporadic, but for some families, cancer appears to have a much higher prevalence and may be passed throughout many generations. Our expanding knowledge regarding the hereditary aspect of cancer has enabled genetic counselors, nurses, and physicians to provide risk counseling to patients; and advances in genetics have allowed us to develop tests that help to pinpoint this hereditary risk. 

At the Feist-Weiller Cancer Center, the Hereditary Cancer Risk Assesment Program performs an initial cancer risk assessment for all patients by recording a complete family history and creating a pedigree in which all affected relatives are shown. If the patient has a positive family history of cancer, he or she is referred for genetic counseling in order to determine if genetic testing is the next appropriate step. Once genetic testing is completed, patients receive an additional counseling session in which results are disclosed and discussed. If a patient tests positively for a given mutation, specific surveillance and preventive options, as well as additional genetic testing for other family members, are discussed.

If a genetic mutation is detected in at-risk individual, which predisposes him to development of a hereditary cancer syndrome, this information is crucial in guiding the future medical and surgical management of this individual. In addition, certain hereditary cancers have unique behaviors at both a clinical and molecular level, and detection of specific mutations may help to guide therapy for these types of cancer. Discovery of a mutation specific for a hereditary cancer syndrome is not only helpful in guiding future management of that individual, but it also provides useful information about disease risk in other family members, and also the risk of the affected individual passing the mutation to his or her unborn offspring.

See the Breast Cancer Trials at Feist-Weiller