There is an interesting and contradictory history between pregnancy and breast cancer.  Most often women hear that pregnancy and breastfeeding help prevent breast cancer.  This is true… to a certain extent.  The younger a woman is when she has her first child the better the preventative effect.  However, a first child born after age 35 nets the mother roughly twice the risk of developing a breast cancer in her lifetime.  That fact alone could account for the increase in breast cancers in our generation.

The National Cancer Institute has a comprehensive list of the factors which will increase or decrease a woman’s risk of breast cancer.  It essentially breaks down to this, to optimize your chances of avoiding the beast you should have at least two kids at a young age and you should breast feed each of them for a year or longer.  And if you want to protect you children from breast cancer, too you should have the foresight to develop pre-eclampsia while you carry them.

That is all pretty much common knowledge.  What is not commonly known, however, is that a woman’s general risk of breast cancer is increased after a she gives birth.  Temporarily.  For a few years.  Contradictory.  So, if a mother can make it through the few years of increased susceptibility she decreases her overall chances of breast cancer.

Feels like it’s all out of our control, doesn’t it?  Except for the breastfeeding part.  That’s not completely true.  We can limit our alcohol intake.  We can maintain a healthy body weight because estrogen is created by fat and fat by estrogen.  It’s an infinite loop.  Gah!  Also, being physically active can reduce risk and eating lots of fruits and vegies.  Don’t you hate it when your parents turn out to be right about everything???

It’s not all bad news, however.  The NCI is doing research on how to mimic the protective effects of pregnancy.  Maybe if they can understand that they may be able to use the knowledge for preventative strategies.

How to examine your breasts

• Lie down and place your right arm behind your head. The exam is done while lying down, not standing up. This is because when lying down the breast tissue spreads evenly over the chest wall and is as thin as possible, making it much easier to feel all the breast tissue.

• Use the finger pads of the 3 middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.

• Use 3 different levels of pressure to feel all the breast tissue. Light pressure is needed to feel the tissue closest to the skin; medium pressure to feel a little deeper; and firm pressure to feel the tissue closest to the chest and ribs. It is normal to feel a firm ridge in the lower curve of each breast, but you should tell your doctor if you feel anything else out of the ordinary. If you’re not sure how hard to press, talk with your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.

• Move around the breast in an up and down pattern starting at an imaginary line drawn straight down your side from the underarm and moving across the breast to the middle of the chest bone (sternum or breastbone). Be sure to check the entire breast area going down until you feel only ribs and up to the neck or collar bone (clavicle).

• There is some evidence to suggest that the up-and-down pattern (sometimes called the vertical pattern) is the most effective pattern for covering the entire breast, without missing any breast tissue.

• Repeat the exam on your left breast, putting your left arm behind your head and using the finger pads of your right hand to do the exam.

• While standing in front of a mirror with your hands pressing firmly down on your hips, look at your breasts for any changes of size, shape, contour, or dimpling, or redness or scaliness of the nipple or breast skin. (The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)

• Examine each underarm while sitting up or standing and with your arm only slightly raised so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it harder to examine.

This procedure for doing breast self exam is different from previous recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that this position (lying down), the area felt, pattern of coverage of the breast, and use of different amounts of pressure increase a woman’s ability to find abnormal areas.

The first symptom, or subjective sign, of breast cancer is typically a lump that feels different from the rest of the breast tissue. According to the ”The Merck Manual”, more than 80% of breast cancer cases are discovered when the woman feels a lump. According to the American Cancer Society, the first medical sign, or objective indication of breast cancer as detected by a physician, is discovered by mammogram.

When breast cancer cells invade the dermal lymphatics—small lymph vessels in the skin of the breast—its presentation can resemble skin inflammation and thus is known as inflammatory breast cancer (IBC). Symptoms of inflammatory breast cancer include pain, swelling, warmth and redness throughout the breast, as well as an orange-peel texture to the skin referred to as ”peau d’orange”.

Occasionally, breast cancer presents as metastatic disease, that is, cancer that has spread beyond the original organ. Metastatic breast cancer will cause symptoms that depend on the location of metastasis. Common sites of metastasis include bone, liver, lung and brain. Unexplained weight loss can occasionally herald an occult breast cancer, as can symptoms of fevers or chills. Bone or joint pains can sometimes be manifestations of metastatic breast cancer, as can jaundice or neurological symptoms. These symptoms are “non-specific”, meaning they can also be manifestations of many other illnesses.

Most symptoms of breast disorder do not turn out to represent underlying breast cancer. Benign breast diseases such as mastitis and fibroadenoma of the breast are more common causes of breast disorder symptoms. The appearance of a new symptom should be taken seriously by both patients and their doctors, because of the possibility of an underlying breast cancer at almost any age.

Breast cancers are described along four different classification schemes, or groups, each based on different criteria and serving a different purpose:

• Pathology – Each tumor is classified by its histological (microscopic anatomy) appearance and other criteria.
• Grade of tumor – The histological grade of a tumor is determined by a pathologist under a microscope. A ”well-differentiated” (low grade) tumor resembles normal tissue. A ”poorly differentiated” (high grade) tumor is composed of disorganized cells and, therefore, does not look like normal tissue. ”Moderately differentiated” (intermediate grade) tumors are somewhere in between.
• Protein & gene expression status – Currently, all breast cancers should be tested for expression, or detectable effect, of the estrogen receptor (ER), progesterone receptor (PR) and HER2/neu proteins. These tests are usually done by immunohistochemistry and are presented in a pathologist’s report. The profile of expression of a given tumor helps predict its prognosis, or outlook, and helps an oncologist choose the most appropriate treatment. More genes and/or proteins may be tested in the future.
• Stage of a tumor – The currently accepted staging scheme for breast cancer is the TNM classification. This considers the Tumor itself, whether it has spread to lymph Nodes, and whether there are any Metastases to locations other than the breast and lymph nodes.

Breast cancer is usually, but not always, primarily classified by its histological appearance. Rare variants are defined on the basis of physical exam findings. For example, inflammatory breast cancer (IBC), a form of ductal carcinoma or malignant cancer in the ducts, is distinguished from other carcinomas by the inflamed appearance of the affected breast. In the future, some pathologic classifications may be changed.

The exact causes of breast cancer remain uncertain. Changes or mutations (inherited or spontaneous) allow breast cancer to develop. BRAC1 and BRAC2, two genes linked to breast cancer, are mutated in 5 to 10% of cases.

Risk factors for developing breast cancer:

Gender and Age:

Women are 100 times more likely to develop breast cancer than men, and the risk increases with age.

Genetics:

A heightened risk for developing breast cancer can be inherited (passed through genes) – having an immediate relative (mother, sister, or daughter) with the disease doubles the chance of getting breast cancer. Chest irradiation, which can cause genetic mutations, increases the risk.

Estrogen:

Elevated estrogen exposure occurring from early onset of menstrual periods (prior to age 12) or late menopause (after age 55) increases the chance of developing breast cancer. First full term pregnancy after the age of 30 as well as never becoming pregnant also increase the risk of developing breast cancer. Alternatively, breast-feeding for longer than one year, first menses after age 15, and premenopausal obesity are all associated with lower estrogen levels and a reduced risk of developing breast cancer.

Breast Abnormalities:

The development of benign breast disease increases the risk for development of breast cancer slightly.

Hormone Replacement Therapy (HRT):

The Women’s Health Initiative clinical trial showed a 26% increase in breast cancer in women who took combined estrogen and progestin (trade name Prempro) [Women's Health Initiative HRT Study]. Another large clinical study conducted in England found an increased risk of developing breast cancer following estrogen only HRT treatment (trade name Premarin) [Million Women Study]. Five years after discontinuation of HRT, the risk for developing breast cancer returns to the background level.

Alcohol:

Drinking one alcoholic beverage a day is associated with a slight risk for breast cancer, while drinking two to five alcoholic beverages per day increases the risk by 1.5-fold.

Breast cancer is cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). It occurs in both men and women, although male breast cancer is rare.

Breast cancer is the most common cause of cancer in women and the second most common cause of cancer death in women in the U.S. While the majority of new breast cancers are diagnosed as a result of an abnormality seen on a mammogram, a lump or change in consistency of the breast tissue can also be a warning sign of the disease. Heightened awareness of breast cancer risk in the past decades has led to an increase in the number of women undergoing mammography for screening, leading to detection of cancers in earlier stages and a resultant improvement in survival rates. Still, breast cancer is the most common cause of death in women between the ages of 45 and 55. Although breast cancer in women is a common form of cancer, male breast cancer does occur and accounts for about 1% of all cancer deaths in men.

Research has yielded much information about the causes of breast cancers, and it is now believed that genetic and/or hormonal factors are the primary risk factors for breast cancer. Staging systems have been developed to allow doctors to characterize the extent to which a particular cancer has spread and to make decisions concerning treatment options. Breast cancer treatment depends upon many factors, including thee type of cancer and the extent to which it has spread. Treatment options for breast cancer may involve surgery (removal of the cancer alone or, in some cases, mastectomy), radiation therapy, hormonal therapy, and/or chemotherapy.

With advances in screening, diagnosis, and treatment, the death rate for breast cancer has declined by about 20% over the past decade, and research is ongoing to develop even more effective screening and treatment programs

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