Does Breast Cancer Affect Women Of All Races Equally
All women, especially as they age, are at some risk for developing breast cancer. The risks for breast cancer in general arent evenly spread among ethnic groups, and the risk varies among ethnic groups for different types of breast cancer. Breast cancer mortality rates in the United States have declined by 40% since 1989, but disparities persist and are widening between non-Hispanic Black women and non-Hispanic white women.
Statistics show that, overall, non-Hispanic white women have a slightly higher chance of developing breast cancer than women of any other race/ethnicity. The incidence rate for non-Hispanic Black women is almost as high.
Non-Hispanic Black women in the U.S. have a 39% higher risk of dying from breast cancer at any age. They are twice as likely to get triple-negative breast cancer as white women. This type of cancer is especially aggressive and difficult to treat. However, it’s really among women with hormone positive disease where Black women have worse clinical outcomes despite comparable systemic therapy. Non-Hispanic Black women are less likely to receive standard treatments. Additionally, there is increasing data on discontinuation of adjuvant hormonal therapy by those who are poor and underinsured.
In women under the age of 45, breast cancer is found more often in non-Hispanic Black women than in non-Hispanic white women.
How Quickly Do Breast Cancer Tumors Grow From Stage To Stage
Cancer cells divide and multiply quickly in such a way that as a tumor gets bigger, it divides and grows even faster. The average doubling time for breast cancer tumors is between 50 and 200 days. Breast cancer tumor growth rate is impacted by hormonal factors, such as hormone receptor status and HER2 status.
What Is Advanced Stage Iv Breast Cancer
Stage IV is the most invasive of all stages of breast cancer. At this stage, the cancer has spread;beyond the breast and nearby lymph nodes to other organs of the body such as the lungs, distant lymph nodes, skin, bones, liver or brain.
“Stage IV is often called advanced or metastatic breast cancer, it’s definitely scary for most patients. It’s widespread but varies per person,” Cruz said. “But I’ve had patients come up to me crying, thinking they’re going to die tomorrow but they live dozens of more years.”
Cance and Cruz said stage IV can appear after a different stage of breast cancer was treated. In most stage IV cases, doctors take an aggressive form of treatment involving surgery, chemotherapy and more.
How can you treat breast cancer?
Treatment for breast cancer can vary depending on the stage, Cruz said, though most treatments involve some form of radiation or hormone therapy to shrink the cancer cells.
Cruz said some women opt to take a “drastic” preventative measure via a mastectomy. A mastectomy is;surgery to remove the breast tissue, often where cancer cells are found or could later be found.
“At first, the cancer will be biopsied;and depending on the tumor characteristics, the treatment plan will involve surgery and possible chemotherapy or hormonal therapy and radiation,” Cance said.
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Stage 2 Breast Cancer
The tumor measures between 2 cm and 5 cm, or the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. The cancer cells have spread beyond the original location and into the surrounding breast tissue, and a tumor may be detected during a breast self-exam as a hard lump.
Breast Cancer Staging Guidelines
The TNM system is the most widely used cancer staging system and looks at the following cancer characteristics:
- Tumor The size of the tumor and whether it has grown into nearby tissue.
- Node Whether the cancer has spread to nearby lymph nodes. And if so, how many.
- Metastasis Indicates whether the cancer has spread to distant organs, like the lungs or liver.
But when it comes to breast cancer staging, the TNM system was expanded to include additional cancer characteristics, including:
- Estrogen-receptor status or progesterone-receptor status Whether the cancer has estrogen or progesterone receptors. A positive status means the cancer can use either hormone to grow.
- HER2 status Whether the cancer produces HER2, a protein that promotes the growth of cancer cells.
- Grade Indicates how much the cancer cells look like healthy cells.
- Oncotype DX recurrence score Indicates how likely a group of genes may respond to treatment, depending on ER, PR and HER2 status.
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Life Expectancy By Stage
Even when divided by stage, its hard to determine life expectancy for someone with breast cancer because of the following:
- There are many types of breast cancer, and they vary in their level of aggressiveness. Some have targeted treatment, while others dont.
- Successful treatment may depend on age, other health problems, and treatments you choose.
- Survival rates are estimates based on people diagnosed years ago. Treatment is advancing quickly, so you may have a better life expectancy than people diagnosed even five years ago.
Thats why you shouldnt take general statistics to heart. Your doctor can give you a better idea of what to expect based on your personal health profile.
The Surveillance, Epidemiology, and End Results Program doesnt track breast cancer survival rates by type or in stages 0 to 4. A relative survival rate compares people with breast cancer to people in the general population.
Following are SEER based on women diagnosed between 2009 and 2015:
|Localized: Has not spread beyond the breast||98.8%|
Your doctor will consider all this when recommending treatment. Most people need a combination of therapies.
What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all.;But either way,;the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
- the skin
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What Causes Breast Cancer
Medical professionals generally attribute breast cancer to genetic factors and your lifestyle. In some cases, breast cancer could arise from exposure to harmful radiation. Breast cancer is best diagnosed early.
The symptoms of stage 2 breast cancer are difficult to miss. They include a lump in your breast, having an itch in your breast, and a bloody discharge from your nipple. You will also notice your lymph nodes in the armpit or neck are swollen. A sore nipple or inverted nipple should alert you to the possibility of having stage 2 aggressive breast cancer.A general observable change in the shape and size of your nipple or breast is an indicator of breast cancer in some cases. If it is accompanied by other symptoms or dimpling of your breasts skin with an orange peel texture developing, you should seek immediate medical attention.
What Is Stage I
Stage I is the earliest point of invasive cancer ;when;tumor cells have started to spread to surrounding, normal breast tissue, Cruz said. In this stage the spread is contained to a small area.
Stage I;is divided into categories IA and IB based on the size of a tumor and where cancer cells are detected. In IA, the tumor is about the size of a grape, Cruz said. Stage IB indicates the tumor is smaller or nonexistent, but there are small clusters of cells in the lymph nodes.;
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What Are The Warning Signs Of Breast Cancer
- A lump or thickening in or near the breast or in the underarm that persists through the menstrual cycle.
- A mass or lump, which may feel as small as a pea.
- A change in the size, shape, or contour of the breast.
- A blood-stained or clear fluid discharge from the nipple.
- A change in the look or feel of the skin on the breast or nipple .
- Redness of the skin on the breast or nipple.
- An area that is distinctly different from any other area on either breast.
- A marble-like hardened area under the skin.
These changes may be found when performing monthly breast self-exams. By performing breast self-exams, you can become familiar with the normal monthly changes in your breasts.
Breast self-examination should be performed at the same time each month, three to five days after your menstrual period ends. If you have stopped menstruating, perform the exam on the same day of each month.
Neoadjuvant And Adjuvant Systemic Therapy
For women who have a hormone receptor-positive breast cancer, most doctors will recommend hormone therapy as an adjuvant treatment, no matter how small the tumor is. Women with tumors larger than 0.5 cm across may be more likely to benefit from it. Hormone therapy is typically given for at least 5 years.
If the tumor is larger than 1 cm across, chemo after surgery is sometimes recommended. A woman’s age when she is diagnosed;may help in deciding if chemo should be offered or not. Some doctors may suggest chemo for smaller tumors as well, especially if they have any unfavorable features .
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to 1 year.
Many women with HER2-positive cancers will be treated with trastuzumab followed by surgery and more trastuzumab for up to 1 year. If after neoadjuvant therapy, residual cancer is found during surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. If hormone receptor-positive cancer is found in the lymph nodes, your doctor might recommend one year of trastuzumab followed by additional treatment with an oral drug called neratinib for 1 year.
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What Is A Breast Cancers Grade
Cancer cells are given a grade when they are removed from the breast and checked in the lab. The grade is based on how much the cancer cells look like normal cells. The grade is used to help predict your outcome and to help figure out what treatments might work best.
A lower grade number usually means the cancer is slower-growing and less likely to spread.
A higher number means a faster-growing cancer thats more likely to spread.
How A Breast Cancers Stage Is Determined
Your pathology report will include information that is used to calculate the stage of the breast cancer that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.
The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.
In the past, stage number was calculated based on just three clinical characteristics, T, N, and M:
- the size of the cancer tumor and whether or not it has grown into nearby tissue
- whether cancer is in the lymph nodes
- whether the cancer has spread to other parts of the body beyond the breast
Numbers or letters after T, N, and M give more details about each characteristic. Higher numbers mean the cancer is more advanced. Jump to more detailed information about the TNM system.
Jump to a specific breast cancer stage to learn more:
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Stage 1 Breast Cancer
Stage 1 breast cancer is divided into two groups:
- Stage 1A
- Stage 1B
Stage 1A means the cancer is 2cm or smaller and has not spread outside the breast.
Stage 1B can mean:
No cancer is seen in the breast, but a very tiny area of breast cancer is found in the lymph nodes under the arm
The cancer in the breast is 2cm or smaller and a very tiny area of breast cancer is found in the lymph nodes under the arm .
Determining The True Stage Of Breast Cancer
All the diagnostic tests and scans up to this point have been critical for helping your doctors understand your disease. But the exact stage of cancer cant be determined until surgery happens which is sometimes referred to surgical staging or pathological staging.
Breast surgery is usually the first step in Stages 0-2, and sometimes Stage 3 breast cancer. Surgery allows your surgeon to see whats happening inside your body. It also allows them to remove cancerous tissues which is an important step in preventing the cancer from spreading and determining next steps for your treatment.
If surgery cant be done right away or at all, a clinical stage is given instead based on diagnostic imaging test results, biopsy pathology results, and a physical exam.
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How The Breast Cancer Staging Process Starts
The breast cancer staging process begins with diagnostic testing. Depending on previous screening results, if any breast cancer symptoms are present, and other factors, your doctor may recommend one of the following tests:
- Diagnostic mammogram A mammogram involves using an X-ray to take photos of your breast tissue at different angles. To do this, your breasts are gently compressed between two plates so the X-ray can be taken.
- Ultrasound An ultrasound is a non-invasive imaging test that bounces soundwaves of your breast tissue to create a picture of the inside of your breast.
- MRI An MRI is another non-invasive imaging test that uses radio waves and a magnetic field to create an image of your breast tissue. This can help doctors determine the size and placement of tumors.
- Biopsy A biopsy removes small masses and growths from your breast so they can be examined under a microscope by a pathologist and determine if theyre cancerous.
If cancer is detected, a CT scan may be ordered to look for any distant metastasis or local invasion to other organs. And youll likely be connected with a breast surgeon right away, either through a nurse navigator or your doctor.
What Is Stage 0 Lcis
Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.
If you have been;diagnosed;with LCIS, your doctor may recommend regular;clinical breast exams;and;mammograms. He or she may also prescribe Tamoxifen, a;hormone therapy;medication that helps prevent cancer cells from growing.
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When Is Radiation Usually Used To Treat Stage 2 Breast Cancer
According to the American Cancer Society, radiation therapy may be used after a breast-conserving surgery, or lumpectomy, to mitigate the risk of cancer cells recurring in the same breast or nearby lymph nodes. After a mastectomy, an oncologist may determine that radiation is necessary if the tumor was larger than 5 cm, if there was lymph node involvement, or if cancer was found outside of surgical margins.
Warning Signs And Words To Know
The most common symptom or warning sign of breast cancer is a lump in the breast. But both Cance and Cruz said not all lumps are cancerous.;Women should also watch for nipple discharge and changes in breast shape or size.;
Cance says vocabulary such as local, regional or distant may be used to;describe a patient’s diagnosis. Local refers to the area where;the cancer is confined within the breast. Regional may be used;when the lymph nodes, primarily those in the armpit, are involved. The term distant is used when the cancer is found in other parts of the body as well, according to Cance.
Another term typically introduced after a breast cancer diagnosis is T-N-M.;T represents the tumor size;;N relates to the involvement of nearby lymph nodes;;and M refers to whether the cancer has spread;beyond the breast, according to Memorial Sloan Kettering Cancer Center.
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