A breast consists of glands that produce breast milk (lobules), small ducts and tubes that carry milk from the lobules to the nipple, fatty and connective tissue, lymph vessels, and blood vessels. Each breast consists of tissue overlying the chest wall pectoral muscles. Breasts are composed principally of glandular tissue that produces milk. Fatty tissue fills the spaces between lobules and ducts. Each breast has 15-20 lobes and each lobe has smaller structures called lobules that can produce milk. The breast also contains blood vessels and lymph vessels.
There are no proven prevention measures to prevent breast cancer, but if the cancer is detected early, the odds of living a long healthy life dramatically increase.
According to the American Cancer Society, “Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional preferably every 3 years. Starting at age 40, women should have a CBE by a health professional every year.” It is also advisable to get regular physical activity and eat a healthy diet.
A mammogram is an X-ray of the breast to look for early signs of breast cancer. The breast is pressed between 2 plates to flatten and spread the tissue. An x-ray is taken and then the breast and plates are repositioned and then another picture is taken. The whole process takes about 20 minutes.
A clinical breast exam (CBE) is a breast exam by a health expert such as a doctor, nurse practitioner, nurse, or physician assistant. The area under both arms where lymph nodes are located will also be checked.
It is important for women to be aware of how their breasts normally look and feel and report any changes to a doctor. As a result we recommend that women do a BSE each month. A breast self-exam (BSE) is a step-by-step approach to checking your breasts for changes.
An MRI (magnetic resonance imaging) offers highly detailed images of a breast to examine a region for possible abnormalities or cancer. MRI scans uses magnets and radio waves to produce very detailed, cross-sectional images of the body. Contrast material may be injected into a vein to help the MRI show more details of the breast tissue and the scan can take up to an hour.
The lymph system is one of the primary means of breast cancer metastasis. Lymph nodes are small tissues that contain a certain kind of immune system cell that fight infections. These lymph nodes are connected by lymphatic vessels where breast cancer cells will move and further grow. If cancer cells have spread to lymph nodes, there is a higher chance that the cells have also spread to other places in the body. Metastatic breast cancer (also called stage IV) is when breast cancer spreads to another part of the body, such as the liver or brain.
Most breast lumps are actually benign, but the lump should be medically evaluated by a breast specialist in Alaska on a regular basis. These abnormal growths make the breast feel lumpy and sometimes accompanied with a slightly cloudy nipple discharge. Benign breast tumors are abnormal growths caused by the combination of cysts (fluid-filled sacs) and fibrosis (scar-like tissue).
Breast cancer is a malignant tumor that starts in the cells of the breast.
Most breast cancers begin in the cells that line the milk ducts (ductal carcinoma), while some breast cancers start in the cells lining the lobules that produce the milk (lobular carcinoma). Sarcomas and lymphomas start in cells of the other tissues in the breast.
Breast Cancer Terms and Definitions:
Carcinoma: Carcinoma is a cancer that begins in the lining layer of the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas).
Adenocarcinoma: An adenocarcinoma is a type of cancer that starts in the glandular tissue that makes and secretes a substance.
Sarcoma: Sarcomas of the breast are rare and are cancers that start from connective tissues such as muscle tissue, fat tissue or blood vessels.
How many women get breast cancer?
According to the American Cancer Society:
Breast cancer is the most common cancer among women in the United States, other than skin cancer.
It is the second leading cause of cancer death in women, after lung cancer.
The chance of a woman having invasive breast cancer during her life is about 1 in 8.
The chance of dying from breast cancer is about 1 in 36.
Breast cancer death rates have been decreasing over the past years and there are more than 2.8 million breast cancer survivors in the United States.
Routine ‘once a year’ mammograms are important to find breast cancers before they cause any symptoms.
According to the American Cancer Society, “The most common symptom of breast cancer is a new lump or mass. A lump that is painless, hard, and has uneven edges is more likely to be cancer. But some cancers are tender, soft, and rounded or even painful. So it’s important to have anything new or unusual checked by a doctor.”
Other symptoms of breast cancer include:
Swelling of part of the breast
Skin irritation or dimpling
Redness or scaliness of the nipple or breast skin
Fluid or bloody nipple discharge
Although these symptoms do not necessarily mean breast cancer, it is important to have them checked out by a breast specialist.
Breast Cancer Diagnosis
It is important to find a breast specialist in Alaska if you’ve learned that you may have breast cancer or a lump that needs removal.
Several different types of surgeons may perform breast cancer surgery, but it is very important to only use a surgeon that specializes in breast cancer and breast surgery to save healthy tissue.
Choosing a physician or surgeon who specializes in breast care and surgery in Alaska offers the following benefits:
Expertise: Patients operated on by surgical breast care specialists who perform a large volume of breast cancer surgeries have a higher survival rate than patients who seek non-specialized surgeons.
Breast tissue preservation: Breast care specialists are current on the latest surgical techniques and procedures. A breast surgeon will focus on preserving healthy breast tissue and lessen the cosmetic deformity of the breast.
A surgeon who specializes in breast care and cancer surgery in Alaska helps increase the survivability of the patient while keeping an aesthetic appearance of the breast.
A key part of the diagnosis relates to tests to determine if the breast cancer has spread. This is a key reason why it’s important to contact a breast cancer specialist quickly if you suspect a lump. Early detection of breast cancer is the most important key to easier treatment and a better outcome both in removal or treatment of the cancer, and a better cosmetic result.
Diagnosis can include biopsies of the breast tumor and if necessary, a sentinel node biopsy. This procedure is designed to determine if cancer has spread outside the breast into the lymph nodes.
Lymph nodes are small round organs that are part of the body’s immune system. In some cases, the lymph nodes can carry cancer cells that have broken off from the breast tumor into the body. This can make cancer more difficult to treat.
Sentinel Lymph Node Biopsy (SLNB)
A sentinel lymph node is the designated lymph node where cancer would most likely spread to first. During a sentinel lymph node biopsy (SLNB) the surgeon removes and examines the sentinal lymph node to determine if cancer cells are present. It is typically used in people who have already been diagnosed with cancer. A negative SLNB result means the cancer has not yet spread to nearby lymph nodes or other organs. Conversely, a positive SLNB diagnosis means that cancer is present in the sentinel lymph node and it may have spread to other regional lymph nodes and possibly other internal organs.
A sentinel lymph node biopsy is typically done in the same surgery when the surgeon removes the tumor. The surgeons locates the sentinel lymph node (or nodes) by injecting a radioactive substance or blue dye near the tumor. The surgeon then is able to detect lymph nodes that contain the radioactive substance or looks for lymph nodes that are stained with the blue dye. Once the sentinel lymph node is located, the surgeon makes a small incision and removes the sentinel lymph node. The sentinel node is then examined carefully by a pathologist to detect any cancer cells. If cancer is found, the breast cancer surgeon may remove additional lymph nodes.
Generally speaking, breast cancer cells are most likely to spread first to lymph nodes located in the armpit area near the breast with the tumor. While their can be some downside effects from removing lymph nodes, the overall benefit is to provide some indicator that cancer is confined to the breast tumor and that the patient does not need undergo additional cancer treatment like radiation or chemotherapy.
Breast Cancer Treatment
Breast-conserving surgery (BCS) is also referred to Breast Preservation Surgery. The surgery is sometimes referred to as a lumpectomy in that the breast cancer surgeon only removes only a part of the breast depending on the size and place of the tumor. The removed tumor tissue is then examined for cancer cells close to the edges, and if found, the patient might need more breast tissue removed, or even a mastectomy where the entire breast is removed. There can be great variation among breast cancer surgeons, however, where one surgeon may be overly aggressive and may remove more breast tissue than is necessary. While this may be quicker for the surgeon, it can leave the woman disfigured. At Alaska Breast Center, Dr. Charles Portera is fellowship-trained (the highest level of medical education in the U.S.) in cancer surgery at the world-famous MD Anderson Cancer Institute in Houston, Texas. With nearly 30 years of experience in cancer, he is aware that patients want to be cancer free, and if possible, retain the natural attractive cosmetic appearance of the breast. Consequently, breast preservation surgery at Alaska Breast Center will involve both the breast cancer surgeon working in tandem with a board-certified plastic surgeon who is proficient in breast reconstruction. The team aims to remove the breast cancer while achieving a positive cosmetic result after surgery.
Mastectomy is surgery that removes the entire breast. All of the breast tissue is removed, sometimes along with other nearby tissues. Many women choose to have their breasts reconstructed after a mastectomy as soon as possible. Reconstructive or breast implant surgery is done to restore the way the breast looks. You should talk to a plastic surgeon before your operation if you are having breast surgery and are wanting breast reconstruction after the mastectomy.
Radiation therapy is treatment with high-energy rays or particles that kill cancer cells. Radiation therapy may be used to kill cancer cells remaining in the breast, chest wall, or underarm area after surgery. Radiation to the breast is often needed after breast-conserving surgery. It is usually given after any chemotherapy. Radiation treatment is like getting a regular x-ray but for a longer time. Treatment is usually given 5 days a week, for six weeks. Each radiation treatment lasts only a few minutes and is painless.
Chemotherapy is the use of adding cancer-killing drugs into your bloodstream to help kill any cancer cells that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which leads to side effects. The side effects of chemo depend on the type of drugs used, the amount given, and the length of treatment. You might experience some short-term side effects, including hair loss, nausea and vomiting, and fatigue.
Hormone therapy — Cancers that have hormone receptors in the cells are called hormone receptor-positive. In breast cancer cases, female hormone estrogen promotes the growth of the cancer, so drugs are administered to stop estrogen from telling cells to grow and divide. Hormone therapy for breast cancer works by blocking the effects of estrogen or lowering estrogen levels. It can be used to help reduce the risk of the cancer coming back after surgery. It is also helpful in treating advanced breast cancer.
Targeted therapy — Targeted therapy for breast cancer may involve newer ‘targeted drugs’ that are aimed right at cancer cells, while doing minimal damage to normal cells. These drugs may also have less severe side effects.
Follow-up care — Ongoing follow-up care is helpful to watch for any problems or cancer starting to return or spread. Your doctors will ask about any symptoms you may have and perform a physical examination. Unless both breasts have been removed, you will get regular mammograms. Blood tests and imaging studies might be ordered as needed.
Are there alternatives to mastectomy?
Alaska Breast Center can provide several treatment options for breast cancer.
Similarly, there can sometimes be an alternative treatment to mastectomy (removal of the entire breast), but it requires a surgeon who is trained in “breast preservation surgery.” At Alaska Breast Center, Dr. Portera is proficient in breast preservation surgery, which can involve a second surgeon who specializes in plastic (cosmetic) surgery.
During breast preservation surgery, the cancerous tissue is removed from the breast and an effort is made to preserve the remaining healthy breast tissue. If necessary, a cosmetic breast implant may be used to restore the breast to a normal appearance.
Be sure to ask if your breast surgeon is trained in breast preservation surgery.
Alaska Breast Center specializes in the surgical removal of breast cancer using a highly advanced technique called “Breast Preservation Surgery”, also known as breast conserving surgery. Dr. Charles Portera at Alaska Breast Center sees breast cancer patients at its main office at Providence Alaska Medical Center in Anchorage. For patients in the Wasilla, Palmer and Mat-su Valley, Dr. Portera has a satellite office at Mat-Su Regional Medical Center.
Alaska Breast Center is part of Alaska Surgical Group, which includes Alaska Surgical Oncology and Alaska Hernia Center. Alaska Surgical Group includes Dr. Victoria Lee Murdock, a general surgeon proficient in DaVinci Robotic Surgery, general surgery and minimally invasive hernia repair surgery. Alaska Surgical Oncology includes Dr. Charles Portera who is proficient general surgery, the removal of organ cancers and complex skin cancers, and the treatment of breast cancer with breast preservation surgery. Alaska Breast Center is based in Anchorage at Providence Alaska Medical Center with a satellite office in the Mat-Su Valley on the campus of Mat-Su Regional Medical Center, in Palmer, Alaska. The Mat-Su satellite office is convenient to breast patients living in Palmer and Wasilla.