Remember how I said there is a lot to be ‘aware’ of this month? Well another huge topic of focus is breast cancer. October is Breast Cancer Awareness Month, so I thought it might be a good idea to share some quick breast cancer facts and information (there is so much information on breast cancer that I can only pick a few points to cover in this blog post!). I’ll also share some resources I like at the end.

*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*

What is breast cancer?

Most people are familiar with cancer, some people intimately so. Cancer is – to put it in the simplest way (and there are obviously so many things involved in cancer development) – cells growing rapidly and beyond control. The American Cancer Society provides a good explanation of what cancer is and how the different types can vary here.

Breast cancer is of course, cancer that arises in the breast tissue (though it can impact surrounding tissue as well). Cancer can develop in the breast ducts or lobes (ductal or lobular breast cancer) for example. It can also occur in tissues involving the breast, but it may not be specifically classified as breast cancer (such as in lymphomas). I’ll talk more about the classifications or types of breast cancer in a moment.

Breast cancer is the cancer that is the most common in women of reproductive age. It is actually also the second most common cancer in all women (it is preceded by skin cancer). There is a 1 in 8 chance of a woman developing breast cancer in her lifetime, however that also means there is a 7 in 8 chance of not developing it.

The survival rate at 5-years post-diagnosis is 91% in those who are diagnosed with non-metastatic (meaning the cancer doesn’t spread from the breast tissue to a secondary location) forms of breast cancer. For more detailed statistics, look here.

How does breast cancer get diagnosed?

There are two common pathways to diagnosis (meaning, there may be other ways people get diagnosed):
1) through regular screening (mammograms);
2) through discovery by the patient.

A full diagnosis usually doesn’t come till later, but these pathways will often start an investigation. Notably, a lump does not automatically indicate breast cancer – there are benign breast tissue lumps, which I will talk about briefly below (but hopefully more in a future post).

Mammograms are recommended for cancer screening between ages 50-74 in Ontario (exact age recommendations/coverage may vary depending on location). They are usually done every two years (again – this varies depending on location and your risk level). It can be done outside of regular screening recommendations if there is a suspicious lump, nipple changes, or breast pain; or if you fall into a high risk category.

Wait, what is a mammogram? It’s a form of x-ray imaging done on the breasts. Your breasts will be compressed for a few moments between two plates (not dish plates, but those used for x-rays) – pleasant, I know. However, this is how they get a more detailed image of the tissue. It can be uncomfortable (I honestly have heard mixed reviews of how it feels – some say it’s painful, others just that it is uncomfortable, and some still who say it’s not bad at all, similar to reviews of pap smears) but it is quick and for a good cause. If it does hurt significantly, speak up!

Who would be considered high risk? Again, this criteria will vary depending on your location, however I can tell you that in Ontario, the High Risk program accounts for women ages 30-69 who a known gene mutation putting them at higher risk for cancer (BRCA 1/2 and others – this topic honestly needs a post all of its own, or an excellent podcast episode with an expert) or have a first-degree relation (parent, sibling, or child) that has this mutation; have had a genetics assessment and have been determined to have a 25%+ risk of getting breast cancer in their lifetime; or have had previous chest radiation to treat another condition when they were <30 years old or within 8 years or longer ago. High risk patients receive yearly mammograms as well as a breast MRIs (or ultrasound).

What about breast self-exams? This is a debated area – some studies show that regular self-exams may actually cause more harm than good, because people find what they expect to be a lump, and sometimes receive a biopsy when it is not necessary. They also don’t appear to impact early diagnosis rate. As a result, regular breast self-exams are not recommended by the American Cancer Society (nor by Canadian health officials). They do include two caveats:

1) A woman should still be aware and familiar with her own body (especially her breasts!)
2) If you are high risk and/or just want to self-examine (in order to achieve #1), that’s okay!

In addition to screening by mammogram, a health history would be taken by your provider and often a physical exam (although a breast exam would only usually be done if you present with symptoms, as routine breast exams by your provider are also not supported by the current evidence).

If a mammogram is unclear or suspicious (there is a lump, for example), you may need a breast ultrasound (it helps to determine the difference between the tissue being examined). If needed, a biopsy can be done simultaneously and this provides a definite diagnosis. A biopsy involves the retrieval of a sample of breast cells or tissue, which would then be sent off for further investigation. There are many different types of biopsies including: fine needle aspiration (FNA; use of a small needle to determine if cyst or tumor); core biopsies (using a hollowed out needle, and may be vacuum-assisted or done using 3D imaging on lumps that are deeper in the tissue); or surgical biopsies (removes the lump or a large part of it), among others. It is usually an outpatient procedure.

Sometimes, breast cancer spreads locally (meaning around where the breasts are) to the lymph nodes in your armpits. If this is suspected, lymph nodes can also be biopsied to check for cancer.

Bloodwork may also be done if mammograms or any imaging are suspicious (or, they may be done at a physical at the same time as your screening mammogram is booked), as well as additional and more detailed types of imaging. You can read more about additional testing here.

What are the types of breast cancer?

This is a very complex question, because there are actually several classifications of breast cancer, and cancer itself (no matter where it is) can be very complex. As a result of this, I’ll just give an overview of overarching and common types and common terminology you may see or hear.

So firstly, there is carcinoma in situ. “In situ” means something is in its existing place, so in regards to breast cancer (because this is a term used for other types of cancers as well), it is non-invasive (because it is still where it arose and has not invaded local tissue or spread further away, a.k.a. metastasized). Both ductal and lobular breast cancers can present this way.

Invasive breast cancer then of course indicates that the cancer, which began usually either in the breast ducts or lobes, has spread within the breast.

Invasive Ductal Carcinoma (which starts in the ducts) is the most common breast cancer type (~70-80% of cases). I can’t believe I didn’t mention this before, but if you didn’t know, breast cancer also affects men. This type is also the one most commonly seen in the male population. Ductal Carcinoma In Situ starts in the ducts too, but does not spread to other breast tissue.

Similarly, there is Invasive Lobular Carcinoma (starts in the lobes) and Lobular Carcinoma In Situ (stays in the lobes). Make sense? Invasive Lobular Carcinoma is the type of breast cancer that is the second most common (accounting for ~10%+ of cases). Notably, Invasive Lobular Carcinoma is harder to catch on a mammogram – a breast MRI is often needed.

The “In Situ” types of breast cancer I mentioned above are very treatable if diagnosed early (by screening) – and that is because they haven’t invaded surrounding tissue or spread to far off tissue.

As you can imagine, when breast cancer spreads beyond local tissue (it metastasizes) it can become more challenging to treat. Metastatic breast cancer is also called Stage 4 breast cancer (click here to learn about staging and further classification of breast cancer – unfortunately it is just too much info to cover in this post). Breast cancer commonly spreads to the liver, lungs, brain, or bone. Symptoms of metastatic breast cancer are much more varied than other types, because it involves more organs or systems.

There are other types of breast cancer too, but they are less common. One that stands out is Inflammatory Breast Cancer, which is aggressive (meaning it grows + spreads fast), infiltrative (of the surrounding tissue + lymph nodes), and unlike other forms, often produces no tumor or palpable lump. Early symptoms are very similar to mastitis and include swelling, rash, itching of the breast, nipple changes, and sometimes an “orange peel” like appearance of the skin. Some other rare types of breast cancer are covered here.

How is breast cancer treated?

There are a whole slew of breast cancer treatment options, including: chemotherapy, radiation, hormone therapy, surgery, or a combination of some of these options. Which treatment option is used will depend on the type of breast cancer; the spread, stage, or presence of metastasis; patients age and if they have reached menopause; overall health; and more. It also depends on what you want as the patient.

There is also monoclonal antibody therapy now – which is more targeted towards certain types of cancer cells. You can read more about this interesting treatment here.

Surgery is the treatment type that is used most often. A mastectomy (removal of the breast, but sometimes also additional tissues) can actually be further classified, depending on the amount of additional tissue(s) that is/are removed. A lumpectomy is removal of breast tissue, but not the entire breast – usually just the tumour and surrounding tissue. Lymph nodes may also be removed, if deemed necessary by the surgeon. Afterwards, breast reconstruction is often an option, depending on a few factors and if it is desired.

What are the risk factors for breast cancer?

I mentioned some risk factors above when I discussed higher risk patients, such as family history (of any cancer) and BRCA 1/2 gene mutations. Other non-modifiable risk factors can include other hereditary disorders or gene mutations; breast density (if increased density is noted on mammogram this is usually monitored); reproductive history (like starting your period at a very young age or reaching menopause later than expected – both involve you being exposed to estrogen for longer); socioeconomic status (but I’ll shock you all and tell you there is a slightly higher risk for higher status women); and being tall (slight increase, but more research is warranted).

Modifiable risk factors for breast cancer include:

• Body Mass Index (BMI) and being overweight increase risk for breast cancer (I sometimes don’t like putting weight in here because by classifying it as modifiable we make it seem like it’s just that – so easy to fix, when often being overweight is a result of many factors coming together and sometimes not so simple to modify)
• Oral contraceptive use (again – the idea of prolonged estrogen exposure) – this is a complex relationship though, and if you’re concerned you should discuss the risks with your healthcare provider (because it’s not all contraceptives; depends on dose, length of use and more) – the risk is described as a slight increase by some sources

One other that is often classified as “modifiable” which I definitely don’t agree with is number of pregnancies. First of all, not everyone can get pregnant or wants to get pregnant. Sure, those who don’t want to have children could probably get pregnant but there is just so many ethical issues with that, I don’t even want to get into it. It is known though, that nulliparous women (those with 0 pregnancies) have an increased risk for breast cancer – but I’d say in many situations this can be considered non-modifiable, or just a choice.

Your lifestyle seems to always impact your risk for cancers as well – so exercising (inactivity is related to an increased risk for breast cancer, more research is being done), eating well, and being mindful of alcohol intake are important (alcohol is related to an increased risk of breast cancer in women, even low consumption rates).

I want more information, where can I look?

Any of the sites I’ve linked all provide information without an overuse of medical jargon (or if they do use it, they explain it well). The National Breast Cancer Foundation website has a great list of resources here as well (I really like their site, very user friendly).

One of my favourite people on Instagram right now is Sabrina Skiles, who talks a lot about her experiences with breast cancer. She does IGTV interviews frequently with other cancer survivors too. She has a website and has lots of good blog posts about treatment, diagnosis, and just survivorship and her life.

If you’re concerned about your risk for breast cancer (or some other cancers), My CancerIQ is a really cool site to assess risk factors.

But as always – your healthcare provider is a great resource if you have questions or concerns about risks, screening, and more.

As always, if anything I’ve posted needs correction – please feel free to contact me via social media or e-mail me at info@elephantinthewomb.ca!