Understanding breast cancer

Jonathan Leger
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No area of oncology is more complex and controversial than the relationship of cancer and diet. Everyone would like to believe that there is some diet which can substantially affect the likelihood of cancer, or better still to cure it once contracted. But to date, the evidence of the effect of diet is unclear and often inconsistent.

All reputable sources agree that no diet outright cures cancer. Nor is there strong evidence to support the view that any particular diet prevents contracting it. But there are many studies that suggest that occurrence, recurrence and survivability may be affected by the foods we choose.

Though far from certain, many studies examined by researchers at Cornell University were able to correlate lower death rates - an increased five or ten year survivability, with certain dietary choices.

In one study examined (the Nurses Health Study), 1,982 women who had already developed breast cancer were followed for an average of 13 years. Over 1,200 had cancers that had not metastasized (spreading of a primary tumor to other areas producing secondary tumors of the same type). Survival rates of cancer patients whose disease has spread are known to be much lower (21% five-year survival, as contrasted to 86% for those whose cancer has not metastasized).

Some in the first group ate larger amounts of poultry and fish, containing protein and omega-3 fatty acids. They had significantly lower risk of death than women in the group who did not consume as much. Further, women who ate large amounts of hydrogenated oils had a significantly higher death rate.

Another study was carried out by the National Cancer Institute of more than 2,400 individuals. A subset, 975 women, who had contracted breast cancer consumed a low fat diet (33.3g per day) for five years. Another 1,462 consumed 51.3 g per day. The low fat group experienced a 42% reduction in recurrence.

The difficulty with all these studies is they are looking only at associations, not causation. It’s unclear from the data what is relevant. Do these dietary choices reflect only the fact that women who focus on maintaining a healthy diet are making healthier lifestyle choices overall? Or, are the foods themselves actually helpful or harmful, and to what degree?

As with many studies involving fruits and vegetables, the answer is unclear. Apart from those which contain antioxidants, any beneficial effect is simply not known with confidence. In this case, however, the evidence is strong that foods high in antioxidants do help reduce the chances of contracting breast cancer.

Free radicals in the blood stream are ionized atoms that are known to be able to harm cells. Antioxidants ‘gobble them up’ - reduce the amount by combining with the free radicals, rendering them harmless.

But fat studies are less clear. The leading theory says, since high estrogen levels are known to highly correlate with higher breast cancer risk, and fat efficiently stores estrogen, then lowering fat lowers the risk.

The flawed conclusion that is sometimes drawn however is the belief that eating fat makes you fat. But it isn’t the consumption of fat that causes higher body fat, per se. Eating more calories than are used causes the body to store the excess in fat, leading to a higher body fat percentage. And, fat contains more calories per unit weight than other foods. The route is indirect.

Despite difficult to interpret or incomplete evidence, there is one thing all experts can readily agree on: maintaining a healthy diet and lifestyle are wise choices. Whether they lower the risk of contracting breast cancer or not, for the 1 in 12 women who will get it sometime in their life, being in optimal health helps combat it before, during and after.

About one in twelve women will develop breast cancer sometime in her life. There are numerous risk factors for contracting breast cancer, some within your control and some that are not. Fortunately, for those factors that are in your control, no great sacrifice is required to minimize them.

Diet

Eating a healthy diet is the first, and in many ways the easiest, step. There’s considerable evidence to suggest that diet does alter the odds. While there’s nothing you eat that will produce breast cancer, nor anything you can eat to prevent it, some foods are helpful, others less so.

Since one leading theory indicates that breast cancer is, if not caused by at least encouraged by, free radicals in the blood, eating foods rich in antioxidants is a good idea. Free radicals are charged ions, usually oxygen, that can do damage to cells. Antioxidants chemically combine with these active molecules to render them harmless. There’s ample evidence to suggest that eating foods rich in antioxidants lowers the risk of breast cancer.

Green vegetables are great for this purpose, but any others will also help. Apples, strawberries and other fruits are also beneficial. Red wines in moderation, as well as green teas, are rich in antioxidants.

Exericse

Exercise is another risk factor within your personal control. Along with diet, not only does it help raise the general level of health but it can help  smooth hormone levels and provide other health values. Even if you do contract breast cancer, being in good shape helps you deal with treatments in an optimal way.

Hormones

Estrogen and progesterone are strongly believed by researchers to contribute to the risk of contracting breast cancer (the first in particular). These natural hormones are vital for health, but excessive amounts can occur. They are readily stored in fat tissues and regular exercise helps keep your body fat percentage at the appropriate level. Proper diet helps here, too.

Alcohol

High alcohol consumption has been correlated with increased cancer risk. It has a generally bad effect on health and tends to raise estrogen levels and interfere with the body’s ability to combat antioxidants.

A glass of wine per day is generally beneficial. Even a small drink of hard alcohol can be beneficial. But for every 10g of alcohol consumed per day over long periods, the risk of contracting breast cancer increases by about 10%.

Menstruation

Reducing the number of menstrual cycles correlates with a reduced risk of experiencing breast cancer, since hormone levels are altered. The jury is still out on the contribution to cancer risk, if any, of taking oral contraceptives. So far, no clear cut evidence suggests that long term use is harmful. And new pills that may soon come on the market promise to eliminate menstrual cycles entirely.

Pregnancy, of course, is another way of reducing the risk of breast cancer but it has its own set of risks for other problems, of course. For those who wish to bear children, however, having them before age 30 has been correlated with a lower risk of breast cancer.
While there is no magic bullet, a healthy lifestyle is your best preventative. Even if you do contract the disease, better health gives you a much better chance of detecting and eliminating it early. Those in good health have much better chances of full recovery and long term survival.

The overall average of five-year survival rate for women who contract breast cancer is around 86% for those whose disease has not metastasized. That means, 86% of the women who contract it survive for at least five years. But even that fairly high number is just an overall average. The numbers are even better for some categories. Those numbers depend on the stage at which the cancer is detected and treated.

Breast cancer, like others, develops in stages. Those stages are lettered and numbered according a now-standard classification of T, N and M and a scale from 0-IV. T indicates tumor size, N spread to lymph nodes and M distant metastasis. Metastasis is spreading of a primary tumor to secondary areas forming tumors of the same type.

TX tumors are those that can not yet be assessed at all. T0 designates a situation in which there’s no evidence of the cancer at all. Tis indicates one that may be of type DCIS (ductal carcinoma in situ), LCIS (lobular carcinoma in situ) or Paget’s disease (a rare form in which the nipple and/or areola is cancerous).

Stage 0 cancers are the earliest of all. In Stage I, tumors are less than 2cm in size and have not spread. Stage II indicates a tumor that is 2-5cm in diameter, and Stage III one larger than 5cm. A Stage IV tumor has become attached to the chest wall and spread to the lymph nodes.

Fortunately, thanks to improved diagnosis and treatment methods, many more breast cancers are caught and eliminated in the very early stages.

For those women and men treated in Stage 0 or I the average five year survival rates are roughly 100%. Yes, men get breast cancer too, albeit at about 1/133 the rate of women. Even Stage II sufferers have a survival rate between 81%-92%. It isn’t until Stage III that the rate dips to 67%. For Stage IV it is approximately 20%.

Of course, many women and men do beat the odds. Even many of those in later stages survive significantly longer than seven years. As diagnostic techniques and treatment methods continue to improve the numbers do as well. As medical knowledge advances, more and more on the lower end of the category move into the upper reaches.

One new diagnostic technique, for example, is QM-MSP (quantitative multiplex methylation-specific PCR). Discovered in 2001, it is a chemical test that uses fluid from the breast. By analyzing chemical tags on certain genes, it’s possible to detect cancer clumps as small as 50 cells with 86% reliability. As it and other innovative methods move into the mainstream, ‘early’ detection becomes ‘earliest possible’ detection. That greatly improves the odds of successful treatment.

Treatments are improving, too. Hormone therapy, targeted radiation, molecule specific drugs and other contemporary techniques constitute the cutting edge, where once there was only cutting.

Though never pleasant, and still a serious condition, breast cancer no longer has to be life threatening or even permanently scarring.

Medical professionals now have an extensive array of tools at their disposal to make diagnosis of breast cancer more reliable, especially in the early stages. That’s great news, since it considerably increases the odds of keeping breast cancer down to the level of ’serious but not permanently scarring or life-threatening’.

Diagnosis will usually start with a clinical exam. The physician will perform a hands-on breast examination similar to the self-exam that is recommended for all women over age 19. Cancerous lumps generally feel harder and less mobile than benign cysts. Cancer tumors are frequently irregular while non-cancerous lumps tend to be round. A trained professional can often tell the difference.

A mammogram will help confirm the diagnosis. Modern digital mammograms are often computer assisted. Detection of tumors is aided by complex algorithms that do a good job of differentiating suspect image sections. This new tool greatly enhances the ability to eliminate false positives and to detect smaller, less obvious problems in the early stage of development.

Ultrasound is another modern tool that has been improved since its introduction. They’re excellent at helping to distinguish between a benign cyst and a cancer tumor. Since cysts are harmless, fluid-filled sacs they react to sound waves differently than do the harder, denser cancer cells.

MRI (Magnetic Resonance Imaging) is another diagnostic tool coming to be used more and more often. Years ago, insurance companies would never pay for this highly expensive test. But as costs have come down and coverage has expanded, it’s more common. As a powerful magnetic field is swept over the breast, it excites molecules in a way that is harmless but produces distinctive effects. That allows professionals to use images generated by MRI to detect very small anomalies.

When other tests suggest that a closer look is warranted, a biopsy is often performed. Some may be as simple as a fine-needle aspiration. A small amount of fluid is removed via a needle from the detected breast lump. That fluid can be examined for cells that are associated with or constitute cancer.

A deeper or core biopsy may be called for in certain cases. That too uses a needle, but one that’s thicker and removes tissue. Still more tissue is removed in a surgical biopsy. The sample is then examined by an oncologist for the presence of cancer cells.

A new test developed at John Hopkins offers promise for even more accurate early diagnosis. Called a QM-MSP (quantitative multiplex methylation-specific PCR), it relies on fluid drawn from the breast. That fluid is then chemically analyzed. When abnormally high levels of certain molecules are detected it indicates the presence of cancer cells. Some studies suggest that clusters with as few as 50 cancer cells can be detected in this way. It was able to detect cancer in 84% of breast tumor samples used.

With modern tests and techniques, diagnosis can be done early and with far greater reliability than in the past. That’s key to treating breast cancer at the earliest possible stage. That greatly improves the odds of keeping it from becoming a more serious matter than it has to be.

Though still an area of active research, many lifestyle and environmental risk factors for breast cancer have been identified. Fortunately, almost all of them are controllable by an individual seeking to optimize his or her health. Yes, men get breast cancer, too, at about 1/133 the rate of women.

Women who have had no children prior to age 30 are at a slightly higher risk. The cause of the increase is likely to be twofold: the number of menstrual periods experienced and the related factor of the amount of estrogen in the body. Hormones, particularly estrogen and progesterone, play a role in cell growth and cancer is a condition in which cells grow in abnormal shapes and numbers.

Multiple pregnancies before age 30 lowers the risk of breast cancer. But pregnancy itself carries some risk too, even in a modern medical setting. Offsetting the risk of breast cancer by this method should therefore be low on anyone’s list. But for those who intend to bear children anyway, it’s comforting to know about this not inconsequential side benefit.

Incidentally, the jury is still out on the relative cancer risk of taking oral contraceptives. Women who have ceased using birth control for more than ten years show no increased risk. Since most women who contract the condition don’t get breast cancer until their 50s or later, it’s difficult to isolate the contribution.

Diet is a more direct contributor, but here again research is ongoing and the final answer is far from clear. What is known, however, is that a healthy diet in general is a factor. Obesity almost certainly raises the risk of breast cancer since fat cells store estrogen. They also produce a small amount on their own, though most is generated by the ovaries.

But the exact contribution of diet isn’t known. It was popular for a while to assert that a high fiber diet was almost a preventative. The research doesn’t support that notion, but a high fiber diet is undoubtedly healthy for a number of reasons. Even if diet doesn’t prevent the onset of breast cancer, general good health is extremely helpful when it comes to any kind of treatment and diet is a major part of that effort.

Along with diet, age and body type-appropriate exercise is a major contributor to good overall health. An hour a day of moderate activity is a major factor in keeping muscles toned and the body in overall good shape. Exactly how much this helps reduce the risk of breast cancer is unknown, but one study correlated a 1-2 hour brisk walk per week with an 18% lower risk.

Surprisingly, there are several factors commonly suspected to increase breast cancer risk that are not supported by contemporary research findings, according to the American Cancer society. Smoking is one of them. No link has been found between cigarette smoking and breast cancer. Lung cancer, of course, is another story. Environmental pollutants in general have not been correlated with breast cancer.

But since these are clearly not healthy lifestyle choices, the goal of optimizing overall well-being would weigh against them.

Alcohol in moderation is healthy. But heavy use of alcohol is definitely correlated with increased risk of breast cancer. The risk increases by about 10% for every daily drink of hard alcohol consumed. And since it also damages the liver and contributes to overall poor health, heavy drinking is an unwise choice.

Maintain a good attitude and a good health program and your odds of breast cancer will be as low as you can make them.

According to most sources, breast cancer is ‘cancer of the breast tissue’. Not very helpful. But digging a little deeper makes the answer clear. Cancer is a malignant growth or tumor caused by abnormal or uncontrolled cell division. Normal cells become misshapen and grow too rapidly. The result is a mass or lump that continues to grow and may spread.

Not all lumps are cancerous. Most are benign. They reach a certain size and level off. They may be soft and fluid filled, like cysts. Or they may be firm like fibroadenomas, which also are benign since they don’t grow and spread. Or, they may simply be scar tissue or hardened fat.

But a true cancer in breast tissues is malignant and serious. Nearly 90% are a type known as ductal carcinoma (sometimes called DCIS, ductal carcinoma in situ). Somewhat less than 10% of the rest are lobular carcinomas (LCIS). In both cases lumps may appear as a thickening in some part of the breast, or even in the armpit. Lymph nodes are located there and sometimes play a role in the development of the disease.

The American College of Physicians recommends self-examination beginning around age 20 and regular mammograms after age 40. 

Though one shouldn’t become alarmed at every possible change, an alteration of the size or shape of the breast after maturity is one sign to look for. Fluid may leak from the nipple that doesn’t resemble milk. In cases of cancer, it’s typically a type of pus, indicating infection.

The nipple or areola (the darkened skin around the nipple) can also change size or shape.

Breast cancer develops through identifiable stages which mark out the progression of the disease.

Stage 0 is when the condition first occurs, Stage I exists when the tumor is less than 2cm thick and hasn’t spread. By Stage II the tumor is between 2-5cm thick and there may be other areas affected. Once the disease reaches Stage III it has penetrated the chest wall. By that level, treatment becomes very difficult and the survival rate is correspondingly low.

Stage IV is the most serious. At this point the cancer has, as it’s called, metastasized. That means the cancer has spread and that it has formed secondary tumors which resemble the initial growth. Such cancers are very often fatal.

Because of these stages, and the increasing health consequences at each level, seeking diagnosis and treatment early is imperative. A simple lumpectomy may well cure the condition completely. If it progresses to the point that chemotherapy or radiation treatments are called for, the odds of recover are much lower and the cure is often as bad as the disease.

Fortunately, enormous progress has been made over the past 40 years. The latest equipment allows for much better diagnosis. Treatments have evolved to make the cure less painful and more certain.

Though any stage is a concern, there is an over 95% five-year survival rate for those that are identified and treated by Stage I. Improve your odds by careful monitoring and seeking early diagnosis.

This web site is designed to provide you with information to help you understand breast cancer.  While we strive to provide accurate information, this is not intended to replace the expertise of a medical doctor.  Please consult your Physician if you’re concerned about any symptoms you may be having.