Calculating Risk Based On Tumor Size
Memorial Sloan Kettering Cancer Center provides a Breast Cancer Nomogram through which you can predict the likelihood that a breast cancer has spread to axillary lymph nodes based on tumor size .
To complete this estimate, you are asked to agree to the conditions, and understand that it is only an estimate.
‘my Breast Looked A Little Pink’
In the shower one day, I noticed a pale pinkness on my breast just below my nipple area, which looked more like a mild sunburn than a rash. I knew something was off. I had my ob-gyn take a look, and he said he wasnt concerned at all because it was barely noticeable. He suggested my bra fit too snugly, and I needed to go shopping for new bras. So I did just that.
“Over time, that pink area hardened slightly and was sore to the touch. My ob-gyn again said he wasnt concerned. Eventually the pain increased behind my breast in my back. My ob-gyn said that breast cancer does not hurt, so I didnt need to worry about it. He ordered a mammogram to put my mind at ease. The mammogram and all other tests came back normal.
“Weeks went by and my lower back began to hurt. Eventually, after my GP suggested I had arthritis and I went to physical therapy.;I went to see a breast specialist. He told me I had mastitis and gave me antibiotics. That didnt help. Back at the breast surgeon, he sent a picture of my breast to the top surgeon who ordered a diagnostic mammogram, which includes a sonogram and a biopsy. I was diagnosed with Stage IV inflammatory breast cancer in my breast, bones, and liver.
Jennifer Cordts, stay-at-home;mom, Dallas
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How Is Inflammatory Breast Cancer Diagnosed
Inflammatory breast cancer can be difficult to diagnose. Often, there is no lump that can be felt during a physical exam or seen in a screening mammogram. In addition, most women diagnosed with inflammatory breast cancer have dense breast tissue, which makes cancer detection in a screening mammogram more difficult. Also, because inflammatory breast cancer is so aggressive, it can arise between scheduled screening mammograms and progress quickly. The symptoms of inflammatory breast cancer may be mistaken for those of mastitis, which is an infection of the breast, or another form of locally advanced breast cancer.
To help prevent delays in diagnosis and in choosing the best course of treatment, an international panel of experts published guidelines on how doctors can diagnose and stage inflammatory breast cancer correctly. Their recommendations are summarized below.
Minimum criteria for a diagnosis of inflammatory breast cancer include the following:
- A rapid onset of erythema , edema , and a peau d’orange appearance and/or abnormal breast warmth, with or without a lump that can be felt.
- The above-mentioned symptoms have been present for less than 6 months.
- The erythema covers at least a third of the breast.
- Initial biopsy samples from the affected breast show invasive carcinoma.
Imaging and staging tests include the following:
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Ovarian Ablation Or Suppression
In women who haven’t;experienced the menopause, oestrogen is produced by the ovaries. Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be carried out using surgery or radiotherapy. It;stops the ovaries working permanently and means you’ll experience the menopause early.
Ovarian suppression involves using a medication called goserelin, which is a luteinising hormone-releasing hormone agonist . Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re;approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin is taken as an injection once a month and can cause menopausal side effects, including:
- hot flushes and sweats
- Breast Cancer Now: Hormone therapy
Some Risk Factors For Breast Cancer
The following are some of the known risk factors for breast cancer. However, most cases of breast cancer cannot be linked to a specific cause. Talk to your doctor about your specific risk.
Age. The chance of getting breast cancer increases with age. Nearly 80 percent of breast cancers are found in those over the age of 50.
Personal history of breast cancer. An individual who has had breast cancer in one breast is at an increased risk of developing cancer in the other breast.
Family history of breast cancer. A higher risk of breast cancer is associated with having an immediate relative with breast cancer, especially at a young age . Having other relatives with breast cancer may also raise the risk.
Genetic factors. Certain genetic mutations, including changes to the BRCA1 and BRCA2 genes, are associated with a higher risk of developing breast cancer at some point. Other gene changes may raise breast cancer risk as well. For more information, ask your doctor about comprehensive biomarker testing, which may include genetic testing for inherited cancer risk.
Childbearing and menstrual history. Research suggests a link between reproductive and menstrual history and the risk of breast cancer. Higher risk factors include:
- Early onset menstruation
- Late onset menopause
- Never having children, childbirth later in life or not breastfeeding
Hormone use. Menopausal hormone therapy and certain types of birth control may have hormones that are risk factors for breast cancer.
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Maintain A Healthy Weight
Being overweight increases the risk of breast cancer among women. In fact, being obese after menopause can lead to the development of fat tissue in our bodies, which can increase the amount of estrogen in our bodies and trigger cancer. To avoid this, it’s important to maintain a healthy weight and exercise regularly.
Previous Breast Cancer Or Lump
You have a higher risk of developing breast cancer again if you’ve previously had breast cancer. The risk is also higher if you’ve had early non-invasive cancer cell changes in breast ducts. This could have been either in your other breast or in the same breast.
A benign breast lump doesn’t mean you have breast cancer.
Certain changes in your breast tissue, such as cells growing abnormally in ducts , or abnormal cells inside your breast lobules , can make getting breast cancer more likely.
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Breast Cancer Doubling Time
An easier way to envision how fast a breast cancer grows is by looking at the growth rate or volume doubling time. Tumor doubling time is the period of time that it takes for the tumor to double in size.
Since it would be unethical to leave a cancer untreated to see how rapidly it grew, doubling time is estimated in a number of ways. Looking at these estimates, however, doubling times have varied widely from study to study.
A 2019 study estimated doubling time by looking at serial ultrasounds between diagnosis and surgery. It was found that growth varied significantly based on the estrogen receptor status of the breast tumors.
During an average interval of 57 days, 36 percent of tumors did not change in size, while 64 percent grew. Of those tumors that increased in size, the average gain in volume was 34.5 percent.
Tumors that were triple negative had greater increases in volume and shorter doubling times than those that were estrogen receptor positive and HER2 negative tumors.
In a 2016 study that similarly looked at growth based on ultrasound between diagnosis and surgery over a 31 day period, tumors increased from 1.47 centimeters to 1.56 centimeters in diameter. Daily growth rate based on type was:
- 1.003 percent per day increase for triple negative tumors
- 0.859 percent per day increase for HER2 positive/estrogen receptor negative tumors
- 0.208 percent per day increase for estrogen receptor-positive tumors
What Is The Average American Womans Risk Of Developing Breast Cancer During Her Lifetime
Based on current incidence rates, 12.9% of women born in the United States today will develop breast cancer at some time during their lives . This estimate, from the most recent SEER Cancer Statistics Review , is based on breast cancer statistics for the years 2015 through 2017.;
This estimate means that, if the current incidence rate stays the same, a woman born today has about a 1 in 8 chance of being diagnosed with breast cancer at some time during her life. On the other hand, the chance that she will never have breast cancer is 87.1%, or about 7 in 8.;
For men born in the United States today, the lifetime risk of breast cancer is 0.13%, based on breast cancer statistics for the years 2015 through 2017. This means that a man born today has about a 1 in 800 chance of being diagnosed with breast cancer at some time during his life.
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How Quickly Breast Cancer Develops
You may have heard remarks that cancer has been present for five years before it is diagnosed, and this may sometimes be true.
The actual time it takes for breast cancer to grow from a single cancer cell to a cancerous tumor is unknown, as estimates based on doubling time assume that this is constant throughout the duration of tumor growth.
If doubling time were constant, cancer with a doubling time of 200 days would take 20 years to develop into a detectable tumor, and a doubling time of 100 days would take 10 years to be evident on exam.
In contrast, a breast tumor with a doubling time of 20 days would take only 2 years to develop.
Since the majority of studies have found the average doubling time to be between 50 days and 200 days, it’s likely that most breast cancers that are diagnosed began at least 5 years earlier .
Breast Exam By Your Doctor
The same guidelines for self-exams provided above are true for breast exams done by your doctor or other healthcare professional. They wont hurt you, and your doctor may do a breast exam during your annual visit.
If youre having symptoms that concern you, its a good idea to have your doctor do a breast exam. During the exam, your doctor will check both of your breasts for abnormal spots or signs of breast cancer.
Your doctor may also check other parts of your body to see if the symptoms youre having could be related to another condition.
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What Is Inflammatory Breast Cancer
Inflammatory breast cancer is a rare and very aggressive disease in which cancer cells block lymph vessels in the skin of the breast. This type of breast cancer is called inflammatory because the breast often looks swollen and red, or inflamed.
Inflammatory breast cancer is rare, accounting for 1 to 5 percent of all breast cancers diagnosed in the United States. Most inflammatory breast cancers are invasive ductal carcinomas, which means they developed from cells that line the milk ducts of the breast and then spread beyond the ducts.;
Inflammatory breast cancer progresses rapidly, often in a matter of weeks or months. At diagnosis, inflammatory breast cancer is either stage III or IV disease, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well.;
Additional features of inflammatory breast cancer include the following:
- Compared with other types of breast cancer, inflammatory breast cancer tends to be diagnosed at younger ages.
- Inflammatory breast cancer is more common and diagnosed at younger ages in African American women than in white women.
- Inflammatory breast tumors are frequently hormone receptor negative, which means they cannot be treated with hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fueled by estrogen.
- Inflammatory breast cancer is more common in obese women than in women of normal weight.;
Youve Been Diagnosed With Breast Cancer How Soon Do You Need Treatment
Timely surgery for breast cancer is obviously better than delaying surgery, but how long can a patient safely wait for surgery once diagnosed. Because a randomized controlled clinical trial to answer this question would be unethical, this has been a difficult question to answer. Fortunately, a new study provides an estimate of how much of a delay it takes before outcomes start to suffer.
A new year is upon us yet again, and Science-Based Medicine has been in existence for eight years now. It seems only yesterday that Steve Novella approached me to ask me to be a contributor. Our part-serious, part-facetious predictions for 2016 notwithstanding, one thing about 2016 is certain: I will almost certainly encounter some form of cancer quackery or other and deconstruct it, probably multiple forms. In any case, a topic Ive been meaning to write about is based on a couple of studies that came out three weeks ago that illustrate why, even if a patient ultimately comes around to science-based treatment of his cancer, the delay due to seeking out unscientific treatments can have real consequences.
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‘it Felt Like There Was A Marble In My Breast’
I had fibrous breasts, so even on a good day, my breasts felt like a bag of frozen peas. I had been receiving Bright Pinks Breast Health reminder texts;to check my breasts, so I was pretty familiar with how my breasts felt. However one day I felt a lump in my left breast near my nipple, which seemed to be the size of a marble or gumball. This lump felt different. It was hard, but had a bit of a give to it.
“From the moment I felt the lump, I knew I had breast cancer. I went in that day for an appointment with my gynecologist,;who ordered a mammogram for later that afternoon. After that, I had a core needle biopsy, but the tests all came back negative. I never felt relieved or satisfied with that result.
“At a later breast check, I felt the lump had grown, so I insisted my gynecologist help me find a surgeon to remove the lump. It was removed and I was told it was stage 2, aggressive triple negative breast cancer. I also discovered I was BRCA-1 positive, meaning I had the breast cancer gene. I cant stress it enough, listen to your body!
Erin Scheithe, DC Education Ambassador for;Bright Pink, Washington, D.C.
What Can Be Learned From The Biopsy Results
Once the biopsy is complete, a specially trained doctor called a pathologist examines the tissue or fluid samples under a microscope, looking for abnormal or cancerous cells. The pathology report, which can take one or two weeks to complete, is sent to the patients doctor. It indicates whether the suspicious area is cancerous and provides a full picture of your situation. For the patient, waiting for results can be a real challenge, but being able to make an informed decision regarding your treatment is well worth it. Your doctor will go over the report with you and, if necessary, discuss the treatment options.
If no cancer cells are found, the report will indicate that the cells in the lump are benign, meaning non-cancerous. However, some type of follow-up or;treatment;may still be needed, as recommended by the healthcare professional.
If cancer cells are found, the report will provide more information to help determine the next steps.
The report for a core-needle biopsy sample will include tumor type and the;tumors;growth rate or grade.;If cancer is found, the pathologist will also perform;lab tests;to look at cells for estrogen or progesterone receptors.
In the case of a surgical biopsy, the results reveal data about the type, grade, and receptor status of the tumor, as well as the distance between the surrounding normal tissue and the excised tumor. The margin, as we mentioned earlier, shows whether the site is clear of cancer cells.
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What Is Stage Iii
“In this stage, I tell my patients the real war against the cancer begins,” Cruz said. “Spreading is much more advanced.”
According to Cruz, stage III is unique in that it has three subcategories: IIIA, IIIB and IIIC.
IIIA has tumors all larger than five millimeters and has spread to lymph nodes. Cruz said the higher number of lymph nodes with cancer cells, the more advanced it is.
In stage IIIB, the tumor has spread to the chest wall and skin of the breast. In many cases, this spreading can result in swelling or ulcers. The cancer cells have also spread to nine lymph nodes.
There is advanced spreading in stage IIIC: the cancer has spread to the chest wall, skin of the breast, 10 or more lymph nodes and the collarbone.
“In stage III, yes there is advanced spreading. Yes it is harder to treat, but not untreatable,” Cruz said. “That’s what we tell our patients, although the spreading is scary, we can still fight it.”
Cancer Blood Test Before Symptoms Arise
The problem with cancer lies in its early detection. Often, by the time symptoms like extreme weight loss, blood in urine, swollen lymph nodes, lumps in the breast, and other possible signs are detected, the cancer has already advanced. This is why a comprehensive cancer blood test is vital even before the symptoms are noticed.
Blood testing for cancer is especially important for people who have a history of the disease in the family. Patients who are in remission are given a schedule by their doctor of how often they need to get screened to check for a recurrence of the disease. But people who have never had cancer usually dont think of getting a check-up. And with so many types of cancer, it can be difficult to know what to look for and how many tests to get done.
Luckily, eight types of cancer can be detected using a single sample of blood, as they have markers that show up relatively early and are present in the bloodstream. One sample of blood can be used to test for all eight of these cancers and either rule out their presence or detect those that have developed. A cancer blood test is a good place to start for people who want to undergo annual cancer screening.
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