By now, it’s common knowledge that October is Breast Cancer Awareness Month, an observance commemorated worldwide. Simply put, breast cancer is the uncontrolled growth of abnormal cells in the tissues of the breast. The abnormal cells ultimately form a lump, or tumor, in the breast.

Breast cancer is the second most common cancer in women in the United States, behind skin cancer. It accounts for about 30 percent of all new cancers in females each year. While breast cancer is much more common in women, men can be affected as well.

According to the American Cancer Society, about 287,850 new cases of invasive breast cancer and about 51,400 new cases of noninvasive breast cancers are expected to be diagnosed in women in 2022. About 43,250 women are expected to die from breast cancer in 2022. In addition, about 2,710 new cases of invasive breast cancer are expected to be diagnosed in men in 2022, and about 530 men are expected to die from it.

Each breast is composed of three main parts: lobules, ducts and connective tissue. The lobules are glands that produce breast milk. The ducts are tiny tubes that carry the milk to the nipple, and the connective tissue holds all the breast tissues in place. Most breast cancers begin in the ducts and lobules and are called invasive ductal carcinoma and invasive lobular carcinoma. Invasive ductal carcinoma makes up 70 to 80 percent of all breast cancers.

Ductal carcinoma in situ (DCIS) is a breast disease that may lead to invasive breast cancer. It is also referred to as stage 0 breast cancer because the abnormal cells are only found in the lining of the ducts. They haven’t spread to other tissues in the breast or other parts of the body.

Symptoms of breast cancer can vary from person to person. Some people experience no signs or symptoms. Possible warning signs include a change in the size, shape or contour of the breast; a mass or lump in the breast or underarm; a rash around or on a nipple; discharge from a nipple that may contain blood; armpit or breast pain that doesn’t change with the menstrual cycle; and irritation or dimpling of the skin of the breast.

Doctors don’t know what causes abnormal cells in the breast to divide and multiply, but genetics seems to play a role in the development of some breast cancers.

Researchers have also identified several factors that increase the risk for developing breast cancer. These include age (risk is higher in those 55 and older); family history of breast cancer; smoking; alcohol use; obesity; previous radiation exposure, especially to the head, neck or chest; and hormone therapy. Women who use hormone replacement therapy (HRT) after menopause or the pill for contraception are at an increased risk.

Breast cancer screening can detect signs or symptoms. It cannot prevent breast cancer, but it can catch it in its early stages when it’s easier to treat. Screening begins with you. Examine your breasts regularly to look for changes in size and shape. Also feel your breasts for lumps.

The most common screening test for breast cancer is the mammogram, which is an x-ray of the breast to look for abnormalities, including tumors. Another screening test is ultrasound, which uses sound waves to create pictures of the insides of the breasts. Ultrasound can differentiate between a solid mass and a fluid-filled cyst.

The doctor may follow up with a breast MRI, which provides detailed images of the inside of the breast. An MRI can help a doctor identify cancer and other abnormalities within the breasts. If a tumor is detected, the doctor may take a sample of its tissue to analyze under a microscope, a process called biopsy.

Treatment options for breast cancer include surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy and targeted drug therapy. The treatment or combination of treatments chosen depends on the type of breast cancer and how far it has spread from its original site.

There are different types of surgery for breast cancer. A lumpectomy removes the tumor and an area of healthy tissue surrounding it. A mastectomy is the removal of the entire breast, which is often followed by a breast reconstruction. Other procedures remove lymph nodes affected by the cancer.

Chemotherapy may be recommended before surgery to help shrink tumors or after surgery to kill remaining cancer cells. Radiation therapy is typically used after surgery to destroy remaining cancer cells.

Some types of breast cancer feed on hormones, such as estrogen and progesterone. Hormone therapy is used to either lower these hormone levels or stop the hormones from attaching to cancer cells. This is often used after surgery to prevent hormone-sensitive cancers from recurring.

Immunotherapy energizes the body’s infection-fighting immune system to fight cancer cells. Targeted drug therapy uses certain drugs that target specific cell characteristics that lead to cancer.

Unfortunately, there is no way to prevent breast cancer. However, there are steps that can significantly lower the risk for developing the disease. These include limiting alcohol consumption, eating a healthy diet with plenty of fruits and vegetables, exercising regularly, maintaining a healthy weight and following doctor recommendation for screening exams, including mammograms.

With more emphasis on screening and improved treatments, the survival rates for people with breast cancer are increasing. That’s the best news to celebrate this Breast Cancer Awareness Month.

Patti DiPanfilo

It’s October, and we all know that October is National Breast Cancer Awareness Month. Look around. See all the pink ribbons? The color pink is a reminder to learn the basics of breast cancer and then get screened. And men, don’t think this doesn’t apply to you. Though it’s much more common in women, breast cancer affects men, too.

Consider these facts. About one in eight American women will develop breast cancer over the course of her lifetime. Breast cancer is the second most common cancer in women after skin cancer and the second leading cause of cancer death in women. Only lung cancer kills more women each year.

The American Cancer Society estimates that 281,550 new cases of invasive breast cancer will be diagnosed in American women in 2021. In addition, 49,290 new cases of non-invasive breast cancer (ductal carcinoma in situ) will be diagnosed. Sadly, about 43,600 women are expected to die from breast cancer this year.

Further, the American Cancer Society estimates that about 2,650 new cases of invasive breast cancer will be diagnosed in American men in 2021, and about 530 men will die as a result. A man’s lifetime risk for developing breast cancer is about one in 833.

Breast cancer occurs when cells in the breast start growing uncontrollably. Most of the time, but not always, these extra cells collect and form tumors. These are the lumps that can often be detected in the breast on your self-exams or mammograms.

A new lump in your breast or armpit is one symptom of breast cancer, but there are others as well. You might notice thickening or swelling of an area of your breast, or irritation or dimpling of your breast skin. Look for red or flaky skin near the nipple, as well as secretions from the nipple other than breast milk. Changes in the size and shape of your breast, and pain in any area of the breast are other breast cancer symptoms.

If you have any of these symptoms, visit your doctor for a proper diagnosis.

Breast cancer is the result of a mutation, or abnormal change, in the genes that regulate the growth and reproduction of breast cells. About 5 percent to 10 percent of breast cancers are inherited, or caused by mutations passed on from your parents. The rest are caused by abnormal changes that occur as the result of aging and life in general.

That makes getting older a risk factor for breast cancer, one you can’t do anything about. Other risk factors for breast cancer you cannot control include getting your period before age 12 and menopause after 55, having dense breasts, having a personal or family history of breast cancer and having been treated with radiation therapy.

There are also risk factors for breast cancer you can control, things like being physically inactive, being overweight, drinking a lot of alcohol and taking hormones. In addition, having your first baby after age 30, not breastfeeding and never having a full-term pregnancy can also increase your risk for breast cancer.

You can’t change your age or your genes, but there are steps you can take to reduce your risk for breast cancer. A few of these suggestions are no-brainers. We already know that we should maintain a healthy weight, exercise regularly and limit our alcohol consumption to one drink a day.

These suggestions you may not have heard. For one, think hard and have a heart-to-heart discussion with your doctor about the risks of taking the Pill or hormone replacement therapy (HRT). They may not be right for you. If you have a baby, consider breastfeeding, if you’re able. If you have a family history or a genetic mutation, talk to your doctor about ways you can lessen your breast cancer risk.

With breast cancer, as with most cancers, early detection is critical to treatment success. It’s best to find it before the cancer cells have had a chance to invade the nearby lymph nodes and spread to other areas of the body. Maintaining a routine screening schedule can assist with early detection.

The first part of the screening process is regular breast self-exams. You know the look and feel of your breasts, so you’re likely to notice changes such as lumps, pain, or differences in size or shape. You should also get routine clinical breast exams by a doctor or nurse, who use their hands to feel for lumps in your breasts.

The next step is to get a mammogram. The American Cancer Society’s Breast Cancer Screening Guidelines recommend that women begin yearly mammograms by age 45. They can switch to having mammograms every other year at age 55. If lumps are detected, your doctor may perform a biopsy to determine if their cells are cancerous.

If cancer is detected, there are many approaches to treating it. Doctors often use more than one approach on each patient.

Chemotherapy is a common approach. It uses drugs to kill cancer cells and shrink tumors. Surgery, called mastectomy, is often used to remove the breasts and the tumors. Radiation therapy uses high-energy rays directed at the spot of the cancer to kill cancer cells. Unfortunately, chemotherapy and radiation therapy have uncomfortable side effects.

Doctors use additional treatment approaches including hormonal therapy, which doesn’t allow the cancer cells to get the hormones they need to survive. Another approach is biological therapy, which works with the immune system, your body’s natural defense against disease. Biological therapy helps the immune system fight the cancer. It also helps control the side effects of other cancer treatments.

Breast cancer is the subject of much research, and if you’re interested, you can participate in a clinical trial to test the safety and effectiveness of new drugs and treatments. To find a clinical trial near you, ask your doctor or go to clinicaltrials.gov.

Now, you know the basics of breast cancer. Put on something pink and share what you’ve learned!

Bad news: More Florida women getting breast cancer.

Good news: Death rate now among nation’s lowest.

When I scanned the first sentence of her Facebook post, I thought at first that it was just another attempt to raise awareness for a worthy cause that would eventually ask me to do my part in the fight by sharing the post with others.

If only it had been.

“I have breast cancer,” it said.

In the paragraphs that followed, my friend explained how she had known for a week that the two-centimeter lump she found last month was malignant. She then talked about the uncertainty, the fear and the battle ahead, and how she planned to kick cancer’s, um, rear end.

It’s an all too familiar post. In the past few months, my pastor’s wife made a similar announcement on Facebook.  Last week, a former colleague who survived breast cancer 12 years ago told me she is having another biopsy.

It’s no wonder we are seeing more of these posts. According to statewide figures from the Florida Department of Health, the breast cancer incident rate increased from 137.6 to 161.7 per 100,000 women between 2006 and 2016.

In 2016 alone, doctors diagnosed 16,721 new cases of breast cancer among women.  Last year, 2,955 women died from breast cancer. That translates to a death rate of 18.5 per 100,000 women.

In 2018, Glades County topped the list with a death rate of 41.9 per 100,000 people, though deaths totaled five. Other counties with high rates included Holmes, Walton, Franklin, Wakulla, Dixie, Gilchrist, Lafayette, Marion, Citrus, Pasco, Nassau, Brevard, Okeechobee and Hendry. Counties reporting the lowest rates were Calhoun, Liberty and Washington, all of which reported no deaths.

Nationally, the good news is that Florida is among the states with the lowest death rates. After peaking in 1999 and 2000 at 24.4 deaths per 100,000, the rate has decreased, with 19.7 in 2016, according to the latest figures from the Centers for Disease Control and Prevention.

Though researchers at the Mayo Clinic in Jacksonville say a vaccine could be available in eight years, the best ways to prevent breast cancer right now is to adopt a healthy lifestyle and get regular screenings to ensure early detection.

So, we’ll continue to wear our pink, participate in three-day walks, and support our friends who make those heartbreaking social media announcements as much as we possibly can.

We’ll also perform regular self exams and screening mammograms as soon as they’re due. No procrastination. Taking care of ourselves is critical, especially if we are taking care of others. Thankfully, we have help in that endeavor.

To make sure every woman is able to get a screening, the Florida Breast and Cervical Cancer Early Detection Program provides free or low-cost mammograms to women who are residents of Florida, 50-64 with no insurance and low income. To see if you qualify, call your county Health Department.

 

A couple of months ago, we looked at some of the research being done on breast cancer and learned about some of the breast cancer breakthroughs that’ve been made. Since then, a study’s results were released regarding another potential treatment for an aggressive form of breast cancer. I thought I’d end the year with some good news about a deadly disease.

The study’s findings were reported in The New England Journal of Medicine and presented at a meeting of the European Society for Medical Oncology in Munich, Germany in October. The study looked at the effect of adding an immunotherapy drug to chemotherapy for women with advanced cases of triple-negative breast cancer.

This cancer is called “triple-negative” because it doesn’t have docking points for the hormones estrogen and progesterone, and it’s lacking human epidermal growth factor receptor 2 (HER 2). These are proteins that anti-cancer medications can latch onto to kill tumor cells.1 Without these proteins, the medications have little effect on the tumors.

About ten to twenty percent of breast cancers are triple negative. Triple-negative breast cancer is diagnosed in nearly 40,000 American women each year. It is twice as common in African-American women than in white women, and more likely to occur in younger women.

Triple-negative cancer often resists standard cancer therapies, so survival rates are poor. It’s a deadly form of breast cancer. It accounts for 30 percent to 40 percent of all invasive breast cancer deaths. The October study looked at the effectiveness of Tecentriq (atezolizumab) when taken along with the chemotherapy drug Abraxane (nab-paclitaxel).

In the past, immunotherapy alone had little effect on any form of breast cancer. It’s believed to be because breast cancer cells don’t have as many genetic abnormalities than other cancers that the immune system can recognize as foreign and attack.

Combining immunotherapy with chemotherapy, however, was found to overcome this problem. The right chemotherapy, given at the right dose, the study discovered, ignites the immune system by killing cancer cells that then leave substances behind that the immune system’s cells can detect and attack.

The results of the recent study were that the combination of Tecentriq and Abraxane made both drugs more effective in battling triple-negative breast cancer. The study showed that adding the immunotherapy drug to the chemotherapy helped lower the risk of disease progression, and of death, by 20 percent compared to treatment with chemotherapy alone, which is the standard treatment.

Researchers agree that more work is needed to study potential side effects of Tecentriq. The drug also has to be approved by the US Food and Drug Administration before it becomes widely available in this country.

If you’d like to be part of the process to study an investigational drug like Tecentriq or any new procedure or device to treat breast cancer, consider participating in a clinical trial. Clinical trials are research studies to test the safety and effectiveness of these treatments before they can become standard treatments.

There are four phases of clinical trials. After a treatments has been carefully studied in a lab, clinical trial can start. Phase 1clinical trials help determine if a treatment is safe for human use. During this phase, a small group of volunteers are monitored for side effects. Different doses of the medication are usually also tested.

Phase 2 trials concentrate on whether the treatment is effective against the cancer using the dose or method determined during phase 1. Phase 3 trials focus on whether the treatment being studied is better than the current standard treatment. If the new treatment is determined to be safer or more effective, it is sent to the FDA for approval.

Phase 4 clinical trials include long-term follow-up and monitoring to study the effects of the treatment once it’s been FDA approved. If you’d like to find out more about clinical trials on breast cancer treatments, check out these websites:

• cancer.gov/about-cancer/treatment/clinical-trials/search
• clinicaltrials.gov
• breastcancertrials.org

With today’s screening tools and advanced treatments, a breast cancer diagnosis isn’t a certain death sentence. But you have to be an active partner with your doctor in helping to detect the cancer early so treatment can be started when it’s most effective.

It’s your job to perform routine breast exams to feel for lumps and look for any changes in your breasts. Get regular physical breast checks from your doctor as well. Follow your doctor’s recommendations about how often to get mammograms for a closer look inside your breasts. Breast cancer is most survivable when found and treated early.

It’s pretty common knowledge that when someone is diagnosed with cancer, the cancer is typically assigned a “stage,” which is based on where the cancer cells have been detected. Generally, it goes from stage 0, meaning the cells are found only within the organ’s tissues, to stage IV, meaning the cancer cells have spread beyond the original organ.

The same is true with breast cancer. Stage IV breast cancer, which is also known as metastatic breast cancer, or MBC, is when breast cancer cells have traveled through the bloodstream or lymphatic system to other areas of the body. The most common places for MBC are the bones, lungs, liver and brain.

According to the Susan G. Komen Breast Cancer Foundation, there are an estimated 154,000 people in the United States with MBC.1 In some cases, women have MBC when they’re initially diagnosed with breast cancer. This is called de novo MBC, and it’s uncommon. It only occurs in about 6 percent of cases.

The rest of the time, MBC is diagnosed months or years after the initial breast cancer treatment has been completed. This is generally referred to as a distant recurrence. In either case, the disease starts in the cells of the breast, and they’re breast cancer cells that cause the problems elsewhere, not bone, lung, liver or brain cells.

Symptoms of MBC vary tremendously and depend on which area of the body is involved. When the bones are affected, the most common symptoms are pain and bone fractures. Lung symptoms include shortness of breath, difficulty breathing, prolonged coughing and fatigue.

Liver MBC symptoms tend to be subtle and are not obvious until much of the liver is compromised. They include nausea, extreme fatigue, increased abdominal size, swelling of the feet and hands, and yellowing of the skin. Brain symptoms may include headaches, confusion, memory loss, blurred or double vision, and speech or movement difficulties.

The reality is that, unlike breast cancer confined to the breast, MBC cannot be cured. It can, however, be treated, and treatment is guided by several factors. These include the characteristics or biology of the cancer cells themselves, the location of the metastasis, the current symptoms and past treatments used on the breast cancer.

The major goals of MBC treatment are to shrink tumors and weaken the cancer, manage your symptoms and side effects, and prevent the cancer from spreading further. The guiding hope is to control the cancer for as long as possible, while providing the highest possible quality of life. There are many approaches to treatment for MBC to help achieve this.

Chemotherapy, which is a systemic treatment, is often used to treat MBC; but in many cases, it is supplemented by another approach such as hormonal, or biologic or targeted therapies. Hormonal therapies target cancers that grow in the presence of certain hormones like estrogen or progesterone. Biologics target specific genes that make proteins that stimulate cell growth. They work if the MBC tumor overexpresses these proteins.

Other medications are sometimes used in the treatment of women with MBC. These include CDK4/6 inhibitors, which are a class of drugs designed to inhibit the CDK4 and CDK6 enzymes that are important in cell division. The CDK4/6 inhibitors interrupt the growth of cancer cells.

Research into new and improved treatment options for MBC is ongoing. One way to access these advanced approaches is by participating in a clinical trial. Clinical trials are research studies on the safety and effectiveness of new medications and treatment protocols. To find a clinical trial on MBC near you, ask your oncologist or visit www.clinicaltrials.gov.

Receiving treatment as soon as possible and updating it when appropriate are good strategies for helping to increase your longevity and your quality of life with MBC. Building good lifestyle habits can also help improve your quality of life as you cope with the strain of treating and living with MBC.

Eating a balanced diet low in saturated fat but high in plant-based foods is your best nutritional bet for fighting cancer. Exercise is important for your overall physical and mental health. It can help you increase your strength, reduce your stress, improve your mood and reduce side effects from cancer treatment.

The Susan G. Komen Foundation reports that of American women with MBC today, an estimated 34 percent have lived at least five years after diagnosis. And as treatments continue to improve, some may live ten years or more after diagnosis.

Life expectancy after an MBC diagnosis can be influenced by many factors. These include your age, your overall health, the types of tissues affected by the MBC and your general attitude and outlook. The fact is many women with breast cancer now live longer than they used to.

This is good news for women with MBC as well. Ongoing research is finding ever new and improved ways to treat this disease. Improved screening, and early diagnosis and treatment are prolonging the lives of women with MBC, as well as improving the quality of those lives.

October is Breast Cancer Awareness Month, an annual campaign to increase awareness of the importance of early detection of the disease. The pink ribbon is an international symbol of breast cancer awareness. Pink ribbons, and the color pink in general, identify the wearer or promoter with the breast cancer brand and express moral support for women with breast cancer. 

Breast cancer is the most common cancer in American women, except for skin cancers. Currently, the average risk of a woman in the United States developing breast cancer sometime in her life is about 12%. This means there is a 1 in 8 chance she will develop breast cancer. This also means there is a 7 in 8 chance she will never have the disease.

Breast cancer is the second leading cause of cancer death in women (only lung cancer kills more women each year). Breast cancer incidence rates are highest in non-Hispanic white women, followed by African American women and are lowest among Asian/Pacific Islander women.

Certain breast cancer risk factors are related to personal behaviors, such as diet and exercise. Lifestyle-related risk factors include alcohol consumption, leading a sedentary lifestyle, certain birth control methods, decisions about having children, hormone therapy after menopause.

Early detection is the key to survival. Breast cancer that’s found early, when it’s small and has not spread, is easier to treat successfully. Getting regular screening tests is the most reliable way to find breast cancer early. Recommendations for early detection include annual mammograms, ultrasounds, MRIs, and breast biopsies. Annual mammograms are recommended for women aged 45 and older.

Breast cancers found during screening exams are more likely to be smaller and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the prognosis.

It’s also important for women to know what signs or symptoms to recognize that may be related to breast cancer. Those can include:

• Swelling of all or part of a breast
• Skin irritation
• Breast or nipple pain
• Nipple retraction (turning inward)
• Redness, scaling, or thickening of the nipple or breast skin
• Nipple discharge (other than breast milk)

At times, breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump or swelling there, even before the original tumor in the breast is large enough to be felt. Swollen lymph nodes should also be checked by a health care provider.

Although any of these symptoms can be caused by things other than breast cancer, if you have them, they should be reported to a health care professional so that the cause can be determined.

In support of those battling breast cancer, as well all survivors, please wear pink during the month of October and make sure you get that mammogram!