Understanding Breast Changes, Part III

Prevention Research

Many of the factors that influence your chances of developing breast cancer--your age or inheritance of a breast cancer susceptibility gene--are beyond your control. Others present opportunities for change, and several large research studies are looking at possibilities for intervention--changing medication, diet, or behavior to prevent or delay onset of disease.

The Breast Cancer Prevention Trial is a randomized study of tamoxifen, a drug that has been widely used in the treatment of women with breast cancer. Because tamoxifen, when taken for 5 years, has been found to markedly reduce the occurrence of new cancers in the opposite breast of a woman who has already had breast cancer, it is now being tried as a prevention treatment in healthy women at increased risk for breast cancer either because they are age 60 or older, or because they are between the ages of 30 and 59 and have combinations of high-risk factors.

Nutrient chemoprevention is being tested in research studies in Italy, where women who have already been treated for breast cancer are taking 4-HPR, a synthetic form of vitamin A, in hopes of preventing cancer in the opposite breast. Other researchers are investigating the protective potential of several other vitamins, including C and E. Yet other scientists are checking out naturally occurring chemicals, called phytochemicals, found in common fruits, vegetables, and other edible plants, in hopes of finding cancer-fighting substances that can be extracted, purified, and added to our diets.

Diet itself is another target of prevention research. In the Women's Health Initiative, a project of the National Institutes of Health, 70,000 women over age 50 are enrolled in a series of clinical studies to measure the effectiveness of prevention strategies for coronary heart disease, cancer, and osteoporosis. Strategies under study include a low-fat diet (less than 20 percent of calories from fat) and calcium plus vitamin D supplements, along with hormone replacement therapy. Another large study evaluating a low-fat diet in high-risk women is under way in Canada.

A much more drastic approach to breast cancer prevention is surgery to remove both breasts. Such a procedure, known as prophylactic mastectomy, is sometimes chosen by women with a very high risk for breast cancer--for instance, carrying a genetic mutation in BRCA1 or BRCA2, having a mother and one or more sisters with premenopausal breast cancer, plus a diagnosis of atypical hyperplasia and a history of several breast biopsies.

Unless a woman finds that anxiety is undermining the quality of her life, she is usually counseled not to choose this physically and psychologically draining surgery. The vast majority of breasts removed prophylactically show no signs of cancer. Moreover, since even a total mastectomy can leave a small amount of breast tissue behind, it cannot guarantee the woman will remain cancer-free. The preferred approach for most high-risk women is careful watching with clinical breast exams and mammography once or twice a year.

If you are considering a prophylactic mastectomy, with or without subsequent breast reconstruction, you will want to get a second opinion, preferably from a breast specialist. There is seldom reason to rush your decision. Many doctors advise a woman to give herself several months to weigh the options.

If your risk for breast cancer is high, you might also consider talking with a genetic counselor about gene testing for breast cancer susceptibility.

Steps to Take

Whether your risk of breast cancer is average or higher, there are some steps you can take:

• Follow early detection practices. Ask your doctor when you should begin mammograms at regular intervals. Get regular breast exams by a doctor or nurse.
• Consult your doctor about your personal situation and carefully weigh any potential risks against the benefits in making decisions about hormone-containing drugs. Stay informed as new research findings become available.
• Exercise and eat a balanced diet that provides a good variety of nutrients and plenty of fiber. Limit dietary fat and alcohol. These are good health measures that make sense for everyone.

Questions to Ask Your Doctor

We hope this information has answered many of your questions about breast changes and the early detection of breast cancer. However, no information on the world wide web can take the place of talking with your doctor. Take any questions you have to your doctor. If you don't understand the answer, ask her or him to explain further.

Many women find it helpful to write down their questions ahead of time. Here is a list of some of the most common questions that women have. You may have others. Jot them down as you think of them, and take the list with you when you see your doctor.

• How often should I schedule appointments with you?
• How can I tell which lumps are not normal?
• What kind of lumps do I have?
• Do I need to have a mammogram? When? How often? Or if not, why not?
• Is there anything in my background that indicates I should have mammograms more often than your usual recommendations?
• Where should I have my mammogram?
• Did you receive the results of my mammogram? What does the report mean?

Glossary

Abscess: A pocket of pus that forms as the body's defenses attempt to wall off infection-causing germs.

Areola: The colored tissue that encircles the nipple.

Aspiration: Removal of fluid from a cyst or cells from a lump, using a needle and syringe.

Atypical hyperplasia: Cells that are both abnormal (atypical) and increased in number. Benign microscopic breast changes known as atypical hyperplasia moderately increase a woman's risk of developing breast cancer.

Average risk (for breast cancer): A measure of the chances of getting breast cancer without the presence of any specific factors known to be associated with the disease.

Benign: Not cancerous; cannot invade neighboring tissues or spread to other parts of the body.

Benign breast changes: Noncancerous changes in the breast. Benign breast conditions can cause pain, lumpiness, nipple discharge, and other problems.

Biopsy: The removal of a sample of tissue or cells for examination under a microscope for purposes of diagnosis.

BRCA1 and BRCA2 genes: The principal genes that, when altered, indicate an inherited susceptibility to breast cancer. These gene alterations are present in 80 to 90 percent of hereditary cases of breast cancer.

Breast density: Glandular tissue in the breast common in younger women, making it difficult for mammography to detect breast cancer.

Breast implants: Silicone rubber sacs, which are filled with silicone gel or sterile saline, used for breast reconstruction after mastectomy.

Calcifications: Small deposits of calcium in tissue, which can be seen on mammograms.

Cancer: A general name for more than 100 diseases in which abnormal cells grow out of control. Cancer cells can invade and destroy healthy tissues, and they can spread through the bloodstream and the lymphatic system to other parts of the body.

Carcinoma: Cancer that begins in tissues lining or covering the surfaces (epithelial tissues) of organs, glands, or other body structures. Most cancers are carcinomas.

Carcinoma in situ: Cancer that is confined to the cells where it began, and has not spread into surrounding tissues.

Chemoprevention: The use of drugs or vitamins to prevent cancer in people who have precancerous conditions or a high risk of cancer, or to prevent the recurrence of cancer in people who have already been treated for it.

Chromosomes: Structures located in the nucleus of a cell, containing genes.

Clinical breast exam: A physical examination by a doctor or nurse of the breast, underarm, and collarbone area, first on one side, then on the other.

Computed tomography (CT) scanning: An imaging technique that uses a computer to organize the information from multiple x-ray views and construct a cross-sectional image of areas inside the body.

Computer-aided diagnosis (CAD): the use of special computer programs to scan mammographic images and flag areas that look suspicious.

Core needle biopsy: The use of a small cutting needle to remove a core of tissue for microscopic examination.

Cyclic breast changes: Normal tissue changes that occur in response to the changing levels of female hormones during the menstrual cycle. Cyclic breast changes can produce swelling, tenderness, and pain.

Cyst: Fluid-filled sac. Breast cysts are benign.

Diagnostic mammogram: The use of a breast x-ray to evaluate the breasts of a woman who has symptoms of disease such as a lump, or whose screening mammogram shows an abnormality.

Digital mammography: A technique for recording x-ray images in computer code, which allows the information to enhance subtle, but potentially significant, changes.

Ducts: Channels that carry body fluids. Breast ducts transport milk from the breast's lobules out to the nipple.

Ductal carcinoma in situ (DCIS): Cancer that is confined to the ducts of the breast tissue.

Excisional biopsy: The surgical removal (excision) of an abnormal area of tissue, usually along with a margin of healthy tissue, for microscopic examination. Excisional biopsies remove the entire lump from the breast.

False negative (mammograms): Breast x-rays that miss cancer when it is present.

False positive (mammograms): Breast x-rays that indicate breast cancer is present when the disease is truly absent.

Fat necrosis: Lumps of fatty material that form in response to a bruise or blow to the breast.

Fibroadenoma: Benign breast tumor made up of both structural (fibro) and glandular (adenoma) tissues.

Fibrocystic disease: See Generalized breast lumpiness.

Fine needle aspiration: The use of a slender needle to remove fluid from a cyst or clusters of cells from a solid lump.

Frozen section: A sliver of frozen biopsy tissue. A frozen section provides a quick preliminary diagnosis but is not 100 percent reliable.

Generalized breast lumpiness: Breast irregularities and lumpiness, commonplace and noncancerous. Sometimes called "fibrocystic disease" or "benign breast disease."

Gene: Segment of a DNA molecule and the fundamental biological unit of heredity.

Genetic change: An alteration in a segment of DNA, which can disturb a gene's behavior and sometimes leads to disease.

Higher risk (for breast cancer): A measure of the chances of getting breast cancer when factor(s) known to be associated with the disease are present.

Hormone replacement therapy: Hormone-containing medications taken to offset the symptoms and other effects of the hormone loss that accompanies menopause.

Hormones: Chemicals produced by various glands in the body, which produce specific effects on specific target organs and tissues.

Hyperplasia: Excessive growth of cells. Several types of benign breast conditions involve hyperplasia.

Incisional biopsy: The surgical removal of a portion of an abnormal area of tissue, by cutting into (incising) it, for microscopic examination.

Infection: Invasion of body tissues by microorganisms such as bacteria and viruses.

Infiltrating cancer: Cancer that has spread to nearby tissue, lymph nodes under the arm, or other parts of the body. (Same as Invasive cancer.)

Inflammation: The body's protective response to injury (including infection). Inflammation is marked by heat, redness, swelling, pain, and loss of function.

Intraductal papilloma: A small wartlike growth that projects into a breast duct.

Invasive cancer: Cancer that has spread to nearby tissue, lymph nodes under the arm, or other parts of the body. (Same as Infiltrating cancer.)

Laser beam scanning: a technology being studied in research for breast cancer detection that shines a laser beam through the breast and records the image produced, using a special camera.

Lobes, lobules, bulbs: Milk-producing tissues of the breast. Each of the breast's 15 to 20 lobes branches into smaller lobules, and each lobule ends in scores of tiny bulbs. Milk originates in the bulbs and is carried by ducts to the nipple.

Localization biopsy: The use of mammography to locate tissue containing an abnormality that can be detected only on mammograms, so it can be removed for microscopic examination.

Lumpectomy: Surgery to remove only the cancerous breast lump; usually followed by radiation therapy.

Lymphatic system: The tissues and organs that produce, store, and transport cells that fight infection and disease.

Macrocalcifications: Coarse calcium deposits. They are most likely due to aging, old injuries, or inflammations and usually are associated with benign conditions.

Magnetic resonance imaging (MRI): A technique that uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body.

Malignancy: State of being cancerous. Malignant tumors can invade surrounding tissues and spread to other parts of the body.

Mammary duct ectasia: A benign breast condition in which ducts beneath the nipple become dilated and sometimes inflamed, and which can cause pain and nipple discharge.

Mammogram: An x-ray of the breast.

Mammography: The examination of breast tissue using x-rays.

Mastectomy: Surgery to remove the breast (or as much of the breast as possible).

Mastitis: Infection of the breast. Mastitis is most often seen in nursing mothers.

Menopause: The time when a woman's monthly menstrual periods cease. Menopause is sometimes called the "change of life."

Menstrual cycle: The monthly cycle of discharge, during a woman's reproductive years, of blood and tissues from the uterus.

Microcalcifications: Tiny deposits of calcium in the breast, which can show up on a mammogram. Certain patterns of microcalcifications are sometimes a sign of breast cancer.

Mutation: A change in the number, arrangement, or molecular sequence of a gene.

Needle biopsy: Use of a needle to extract cells or bits of tissue for microscopic examination.

Nipple discharge: Fluid coming from the nipple.

Nonpalpable cancer: Cancer in breast tissue that can be seen on mammograms but that cannot be felt.

One-step procedure: Biopsy and surgical treatment combined into a single operation.

Osteoporosis: A condition of mineral loss that causes a decrease in bone density and an enlargement of bone spaces, producing bone fragility.

Palpation: Use of the fingers to press body surfaces, so as to feel tissues and organs underneath. Palpating the breast for lumps is a crucial part of a physical breast examination.

Pathologist: A doctor who diagnoses disease by studying cells and tissues under a microscope.

Permanent section: Biopsy tissue specially prepared and mounted on slides so that it can be examined under a microscope by a pathologist.

Phytochemicals: Naturally occurring chemicals found in plants that may be important nutrients for reducing a person's cancer risk.

Positron emission tomography (PET scanning): A technique that uses signals emitted by radioactive tracers to construct images of the distribution of the tracers in the human body.

Prophylactic mastectomy: Surgery to remove a breast that is not known to contain breast cancer, for the purpose of reducing an individual's cancer risk.

Rad: A unit of measure for radiation. It stands for radiation absorbed dose.

Radiation: Energy carried by waves or by streams of particles. Various forms of radiation can be used in low doses to diagnose disease and in high doses to treat disease. See X-rays.

Radiologist: A doctor with special training in the use of x-rays (and related technologies such as ultrasound) to image body tissues and to treat disease.

Risk: A measure of the likelihood of some uncertain or random event with negative consequences for human life or health.

Risk factors (for cancer): Conditions or agents that increase a person's chances of getting cancer. Risk factors do not necessarily cause cancer; rather, they are indicators, statistically associated with an increase in likelihood.

Sclerosing adenosis: A benign breast disease that involves the excessive growth of tissues in the breast's lobules.

Screening mammogram: Breast x-ray used to look for signs of disease such as cancer in people who are symptom-free.

Sonogram: The image produced by ultrasound.

Specimen x-ray: An x-ray of tissue that has been surgically removed (surgical specimen).

Stereotactic localization biopsy: A technique that employs three-dimensional x-ray to pinpoint a specific target area. It is used in conjunction with needle biopsy of nonpalpable breast abnormalities.

Surgical biopsy: The surgical removal of tissue for microscopic examination and diagnosis. Surgical biopsies can be either excisional or incisional. (See Excisional biopsy and Incisional biopsy.)

Tamoxifen: A hormonally related drug that has been used to treat breast cancer and is being tested as a possible preventive strategy.

Tumor: An abnormal growth of tissue. Tumors may be either benign or cancerous.

Tumor markers: Proteins (either amounts or unique variants) made by altered genes in cancer cells that are involved in the progression of the disease.

Two-step procedure: Biopsy and treatment done in two stages, usually a week or two apart.

Ultrasound: The use of sound waves to produce images of body tissues.

X-ray: A high-energy form of radiation. X-rays form an image of body structures by traveling through the body and striking a sheet of film. Breast x-rays are called mammograms.

Source: National Cancer Institute, National Institutes of Health