Dr. Rachel Wellner is an oncologist practicing in New York, New York. Dr. Wellner specializes in the care and treatment of patients with cancer. As an oncologist, Dr. Wellner manages and oversees the treatment of a cancer patient after he or she has been diagnosed with the disease. Oncologists will care for their patients... more
Breast cancer is the world's leading cancer in women behind all skin malignancies. Behind lung cancer, breast cancer is the second most form of cancer in women. It affects one in eight women over a lifetime, and there are roughly over 230,000 new cases of invasive breast cancer and over 50,000 cases of non-invasive breast cancer per year in the country alone. About 40,000 people die of breast cancer annually in the U.S. It continues to be a major cause of mortality world-wide, particularly in developing countries, where access to prevention, screening, and even appropriate management might be scarce. One percent of all breast cancers actually occur in men.
Breast cancer refers to the malignant growth of cells within the breast gland. The gland consists of structures known as lobes, lobules and ducts and is surrounded by fat and connective tissue. Each breast contains around 15-20 lobes, which are, in turn, composed of smaller lobules, the milk-making factory of the breast, all clustered together. Connecting lobes and lobules are lactiferous ducts, which carry the milk out the nipple. Breast development, function, and even tumor genesis are primarily under hormonal control but are also affected by genetic and environmental factors.
- Breast cancer incidence is strongly related to age, peaking in the later decades.
- Other risk factors implicated in the development of breast cancer include genetics (strong family history of breast or other related malignancies),
- Hormonal and reproductive risk factors such as early menarche, late menopause, late onset of first pregnancy, hormone replacement therapy,
- Environmental risk factors including obesity, excess alcohol, high-dose radiation, and possibly nutritional factors.
- People at high risk for breast cancer include those previously diagnosed with breast cancer, those with atypical cells on a breast biopsy, and patients with mammographically dense breasts.
Paralleling our improved understanding of breast carcinogenesis, risk factors, and improved surveillance are a multitude of advances in treatments. Whereas in the past, a classic radical mastectomy represented a patient’s only option for resection, developments in surgical management has allowed us to offer patients less radical surgery, ranging from breast conservation (lumpectomy) to skin- and nipple-sparing mastectomies, and less radical lymph node resections. Furthermore, advances in breast reconstruction, including “oncoplastic” surgery (the restoration of tissue contours while removing all cancer), afford women the opportunity to restore their bodies.
Advances in modern chemotherapy have also influenced the landscape of breast cancer treatment. The survival rate for early-stage breast cancer is greater than 90 percent, and even many patients with Stage IV breast cancer, the most advanced stage indicating wide-spread disease, can expect a longer survival on systemic therapies. Newer techniques in radiation therapy have also made lumpectomy exceptionally safe while lowering recurrence rates significantly.
As our understanding of carcinogenesis is evolving, more and more targeted treatments are being developed. In lieu of a definitive cure, our efforts must be focused on prevention, early detection, and prompt management, all proven strategies in the prevention of cancer death.
Preventive strategies include:
- Adopting a healthy lifestyle involving a diet rich in vitamins (esp. vitamin D) and anti-oxidants, low in saturated fats, moderate exercise, and low alcohol consumption.
- Additional risk reduction involves judicious use of combination hormone replacement regimens.
- Early detection, or secondary screening, emphasizes the importance of going for yearly mammograms and other appropriate screening tests (sonograms, MRIs appropriate in select groups).
- Furthermore, capturing patients who are at high risk for developing breast cancer, such as those with a heavy family history and/or those with a known genetic mutation, can also lead to earlier diagnosis and allow for the employment of specific prevention techniques as guided by a specialist physician.
- Finally, with early diagnosis and prompt treatment, patients are candidates for minimally invasive medical and surgical options with a largely improved prognosis.