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The average woman (without an inherited breast cancer gene abnormality) in the United States has about a 12% risk of developing breast cancer over a 90-year life span.

In contrast, women who have an abnormal BRCA1 or BRCA2 gene have about a 60% risk of being diagnosed with breast cancer during their lifetimes, according to the National Cancer Institute.

Women with BRCA1 and BRCA2 abnormalities are also at increased risk of developing ovarian cancer. The lifetime risk is about 55% for women with BRCA1 mutations and about 25% for women with BRCA2 mutations.

By comparison, about 1.8% of women without an inherited BRCA abnormality get ovarian cancer. The risk for certain other cancers may also be higher with BRCA1 or BRCA2 mutations. But these risk increases (for cancers such skin or digestive tract) are much lower than the increases in risk for breast and ovarian cancer.

Yet despite the increased risk, it’s important to remember that not every person with an inherited BRCA1 or BRCA2 abnormality develops cancer. The risks associated with BRCA1 and BRCA2 mutations may be affected by:

• lifestyle and environmental factors
• how well other genes work with BRCA1 and BRCA2 to protect the body against cancer
• the particular abnormality in BRCA1 or BRCA2 and how it affects the proteins that are supposed to suppress cancer

Also, many people mistakenly believe that the cancers caused by inherited genetic abnormalities are more aggressive than other cancers. In fact, recent evidence suggests that a woman with an abnormal gene who develops breast or ovarian cancer may have a LESS aggressive form of the disease than women without an abnormal gene.

Abnormal BRCA genes and men’s cancer risk

Men who inherit abnormal BRCA1 or BRCA2 genes have an increased risk for male breast cancer. This risk is approximately 6% over a man’s lifetime. That’s about 80 times greater than the lifetime risk of men without BRCA1 or BRCA2 abnormalities.

Men with an abnormal BRCA1 or BRCA2 gene may also be three to seven times more likely than men without the abnormality to develop prostate cancer. Other cancer risks, such as cancer of the skin or digestive tract, may also be somewhat higher among men with BRCA1 or BRCA2 mutations. But, as with women, the risk increases for these cancers are much lower than the increase in risk for breast cancer.

Source: http://www.breastcancer.org/risk/genetic/bcrisk_abnrml_genes.jsp

The type of breast cancer you have helps determine the best approach to treating the disease. Get the facts on types of breast cancer and how they differ.

By Mayo Clinic staff

Once you’ve been diagnosed with breast cancer, your doctor works to find out the specifics of your tumor. Using a tissue sample from your breast biopsy or using your tumor if you’ve already undergone surgery, your medical team determines your breast cancer type. This information helps your doctor decide which treatment options are most appropriate for you.

Here’s what’s used to determine your breast cancer type.

Is your cancer invasive or noninvasive?

CLICK TO ENLARGE

Lobular carcinoma in situ

Whether your cancer is invasive or noninvasive helps your doctor determine whether your cancer may have spread beyond your breast, which treatments are more appropriate for you, and your risk of developing cancer in the same breast or your other breast.

• Noninvasive (in situ) breast cancer. In situ breast cancer refers to cancer in which the cells have remained within their place of origin — they haven’t spread to breast tissue around the duct or lobule. The most common type of noninvasive breast cancer is ductal carcinoma in situ (DCIS), which is confined to the lining of the milk ducts. The abnormal cells haven’t spread through the duct walls into surrounding breast tissue. Doctors sometimes refer to this type of cancer as stage 0 cancer.
• Invasive breast cancer. Invasive (infiltrating) breast cancers spread outside the membrane that lines a duct or lobule, invading the surrounding tissues. The cancer cells can then travel to other parts of your body, such as the lymph nodes. If your breast cancer is stage I, II, III or IV, you have invasive breast cancer.

In what part of the breast did your cancer begin?

CLICK TO ENLARGE

Breast anatomy

The type of tissue where your breast cancer arises determines how the cancer behaves and what treatments are most effective. Parts of the breast where cancer begins include:

• Milk ducts. Ductal carcinoma is the most common type of breast cancer. This type of cancer forms in the lining of a milk duct within your breast. The ducts carry breast milk from the lobules, where it’s made, to the nipple.
• Milk-producing lobules. Lobular carcinoma starts in the lobules of the breast, where breast milk is produced. The lobules are connected to the ducts, which carry breast milk to the nipple.
• Connective tissues. Rarely breast cancer can begin in the connective tissue that’s made up of muscles, fat and blood vessels. Cancer that begins in the connective tissue is called sarcoma. Examples of sarcomas that can occur in the breast include phyllodes tumor and angiosarcoma.

How do your cancer cells appear under a microscope?

When a sample of your breast cancer is examined under a microscope, here’s what the pathologist looks for:

• Cancer cells with unique appearances. Invasive ductal carcinoma cells sometimes take on unique appearances that can be seen with a microscope. Subtypes of invasive ductal carcinoma that describe how the cells appear include tubular, mucinous, medullary and papillary.
• The degree of difference between the cancer cells and normal cells. How different your cancer cells look from normal cells is called your cancer’s grade. Breast cancers are graded on a 1 to 3 scale, with grade 3 cancers being the most different looking and considered the most aggressive.

Are your cancer cells fueled by hormones?

Some breast cancers are fueled by your body’s naturally occurring female hormones — estrogen and progesterone. The breast cancer cells have receptors on the outside of their walls that can catch specific hormones that circulate through your body. Knowing your breast cancer is dependent on hormones gives your doctor a better idea of how to cut off the fuel supply for your cancer cells.

Hormone status of breast cancers includes:

• Estrogen receptor (ER) positive. This type of breast cancer relies on estrogen to help it grow.
• Progesterone receptor (PR) positive. This type of breast cancer relies on progesterone to help it grow.
• Hormone receptor (HR) negative. This type of cancer doesn’t have hormone receptors, so it doesn’t need hormones to help it grow.

With ER positive or PR positive breast cancer, hormone-blocking medications, such as tamoxifen, may be an option to slow the cancer’s growth. HR negative cancers don’t respond to hormone-based therapy.

What is the genetic makeup of your breast cancer cells?

Doctors are just beginning to understand how the individual DNA changes within cancer cells might one day be used to determine treatment options. A cell’s DNA is full of instructions (genes) that tell it how to behave. By analyzing the genes, doctors hope to be able to find ways to target specific aspects of the cancer cells to kill them.

Laboratory testing can reveal certain genes in your cancer cells, such as:

• HER-2 gene. Cancer cells that have too many copies of the HER-2 gene produce too much of the growth-promoting protein called HER-2. Medications are available to shut down the HER-2 gene, thus cutting the cancer cells off from their energy supply.
• Other genes. Researchers are studying ways to interpret the genetic makeup of tumor cells. Doctors hope this information can be used to predict which cancers will spread and which may need aggressive treatments. That way, women with relatively low-risk breast cancers may avoid aggressive treatments. Tests that analyze the genetic makeup of breast cancers are available, but aren’t recommended in all situations. Ask your doctor whether this type of test might be helpful in your case.

Source: http://www.mayoclinic.com/health/breast-cancer/HQ00348

HER2+ Breast Cancer

Studies show that approximately 25% of breast cancer patients have tumors that are HER2+. HER2 stands for Human Epidermal growth factor Receptor 2. It is very important to find out your cancer’s HER2 status. This is because HER2+ tumors tend to grow and spread more quickly than tumors that are not HER2+. In addition, the treatment of HER2+ breast cancer is different than the treatment of breast cancer that is not HER2+. Women who are uncertain of their cancer’s HER2 status should talk to their doctor.

HER2+ breast cancer is aggressive, so it is important to find out your cancer’s HER2 status.^1-3 This can help your doctor choose which treatments may be right for you.

How is HER2 positive breast cancer different?

HER2 stands for Human Epidermal growth factor Receptor 2. Each normal breast cell contains copies of the HER2 gene, which helps normal cells grow. The HER2 gene is found in the DNA of a cell, and this gene contains the information for making the HER2 protein. ⁴

The HER2 protein, also called the HER2 receptor, is found on the surface of some normal cells in the body. In normal cells, HER2 proteins help send growth signals from outside the cell to the inside of the cell. These signals tell the cell to grow and divide. ⁴

In HER2+ breast cancer, the cancer cells have an abnormally high number of HER2 genes per cell. When this happens, too much HER2 protein appears on the surface of these cancer cells. This is called HER2 protein overexpression. Too much HER2 protein is thought to cause cancer cells to grow and divide more quickly. This is why HER2+ breast cancer is considered aggressive. ^1-3

HER2+ breast cancer is aggressive, so it is important to find out your cancer’s HER2 status.^1-3 This can help your doctor choose which treatments may be right for you.

Higher risk of breast cancer returning (recurrence)

• Women with HER2+ breast cancer:
• May be less likely to respond to certain breast cancer treatments
• May be more likely to have a recurrence (return) of their cancer

Women who are uncertain of their cancer’s HER2 status should talk to their doctor.

Inheriting the HER2 gene

Your tumor’s HER2 status is not hereditary. This means that HER2 status is not passed down from your parents, and you can’t pass it on to your children. However, there is a relationship between the genes in a person’s DNA and breast cancer in general. Ask your doctor for more information about the relationship between genes and breast cancer. ⁴

HER2/neu-positive, HER2-overexpressing, and HER2+ breast cancer

HER2/neu is another name for HER2, which stands for Human Epidermal growth factor Receptor 2. HER2-overexpressing means there is too much HER2 protein/receptor on the surface of the cancer cells. HER2/neu-positive breast cancer and HER2-overexpressing breast cancer are exactly the same as HER2+ breast cancer. ⁴

Who is Herceptin for?

Herceptin is approved for the adjuvant treatment of HER2-overexpressing, node-positive or node-negative (ER/PR-negative or with one high-risk feature)^† breast cancer. Herceptin can be used several different ways:

• As part of a treatment regimen including doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
• With docetaxel and carboplatin
• As a single agent following multi-modality anthracycline-based therapy

Herceptin in combination with paclitaxel is approved for the first-line treatment of HER2-overexpressing metastatic breast cancer. Herceptin as a single agent is approved for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease.

† High-risk is defined as ER/PR positive with one of the following features: tumor size >2 cm, age <35 years, or tumor grade 2 or 3.

What important safety information should I know about Herceptin?

Herceptin treatment can result in heart problems, including those without symptoms (reduced heart function) and those with symptoms (congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Your doctor will stop or strongly consider stopping Herceptin if you have a significant drop in your heart function.

You should be monitored for decreased heart function before your first dose of Herceptin, and frequently during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

Some patients have had serious infusion reactions and lung problems; fatal infusion reactions have been reported. In most cases, these reactions occurred during or within 24 hours of receiving Herceptin. Your Herceptin infusion should be temporarily stopped if you have shortness of breath or very low blood pressure. Your doctor will monitor you until these symptoms go away. If you have a severe allergic reaction, swelling, lung problems, inflammation of the lung, or severe shortness of breath, your doctor may need to completely stop your Herceptin treatment.

Worsening of low white blood cell counts associated with chemotherapy has also occurred.

Herceptin can cause low amniotic fluid levels and harm to the fetus when taken by a pregnant woman.

The most common side effects associated with Herceptin were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, shortness of breath, rash, low white and red blood cells, and muscle pain.

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, talk to your doctor.

Please see the Herceptin full Prescribing Information including Boxed WARNINGS and additional important safety information.

• References:
• 1. Slamon DJ, Godolphin W, Jones LA, etal. Studies of the HER-2/neu Proto-oncogene in human breast and ovarian cancer. Science. 1989; 244:707-712.
• 2. Slamon DJ, Clark GM, Wong SG, Levin WJ, Ullrich A, McGuire WL. Human breast cancer: correlation of relapse and survival with amplification of the HER-2/neuoncogene. Science. 1987; 235: 177-182.
• 3. Paik S, Hazan R, Fisher ER, etal. Pathologic findings from the national surgical adjuvant breast and bowel project: prognostic significance of erbB-2 protein overexpression in primary breast cancer. J Clin Oncol. 1990; 8:103-112.
• 4. Pegram M, Slamon D. Biological rationale for HER2/neu(c-erbB2) as a target for monoclonal antibody therapy. Semin Oncol. 2000; 27 (suppl9): 13-19.

Source: http://www.herceptin.com/her2-breast-cancer/testing-education/what-is.jsp

Inflammatory Breast Cancer: Questions and Answers

Key Points

1. What is inflammatory breast cancer (IBC)?Inflammatory breast cancer is a rare but very aggressive type of breast cancer in which the cancer cells block the lymph vessels in the skin of the breast. This type of breast cancer is called “inflammatory” because the breast often looks swollen and red, or “inflamed.” IBC accounts for 1 to 5 percent of all breast cancer cases in the United States (1). It tends to be diagnosed in younger women compared to non-IBC breast cancer. It occurs more frequently and at a younger age in African Americans than in Whites. Like other types of breast cancer, IBC can occur in men, but usually at an older age than in women. Some studies have shown an association between family history of breast cancer and IBC, but more studies are needed to draw firm conclusions (2).
2. What are the symptoms of IBC?Symptoms of IBC may include redness, swelling, and warmth in the breast, often without a distinct lump in the breast. The redness and warmth are caused by cancer cells blocking the lymph vessels in the skin. The skin of the breast may also appear pink, reddish purple, or bruised. The skin may also have ridges or appear pitted, like the skin of an orange (called peau d’orange), which is caused by a buildup of fluid and edema (swelling) in the breast. Other symptoms include heaviness, burning, aching, increase in breast size, tenderness, or a nipple that is inverted (facing inward) (3). These symptoms usually develop quickly—over a period of weeks or months. Swollen lymph nodes may also be present under the arm, above the collarbone, or in both places. However, it is important to note that these symptoms may also be signs of other conditions such as infection, injury, or other types of cancer (1).
3. How is IBC diagnosed?Diagnosis of IBC is based primarily on the results of a doctor’s clinical examination (1). Biopsy, mammogram, and breast ultrasound are used to confirm the diagnosis. IBC is classified as either stage IIIB or stage IV breast cancer (2). Stage IIIB breast cancers are locally advanced; stage IV breast cancer is cancer that has spread to other organs. IBC tends to grow rapidly, and the physical appearance of the breast of patients with IBC is different from that of patients with other stage III breast cancers. IBC is an especially aggressive, locally advanced breast cancer.Cancer staging describes the extent or severity of an individual’s cancer. (More information on staging is available in the National Cancer Institute (NCI) fact sheet Staging: Questions and Answers at http://www.cancer.gov/cancertopics/factsheet/Detection/staging on the Internet.) Knowing a cancer’s stage helps the doctor develop a treatment plan and estimate prognosis (the likely outcome or course of the disease; the chance of recovery or recurrence).
4. How is IBC treated?Treatment consisting of chemotherapy, targeted therapy, surgery, radiation therapy, and hormonal therapy is used to treat IBC. Patients may also receive supportive care to help manage the side effects of the cancer and its treatment. Chemotherapy (anticancer drugs) is generally the first treatment for patients with IBC, and is called neoadjuvant therapy. Chemotherapy is systemic treatment, which means that it affects cells throughout the body. The purpose of chemotherapy is to control or kill cancer cells, including those that may have spread to other parts of the body.After chemotherapy, patients with IBC may undergo surgery and radiation therapy to the chest wall. Both radiation and surgery are local treatments that affect only cells in the tumor and the immediately surrounding area. The purpose of surgery is to remove the tumor from the body, while the purpose of radiation therapy is to destroy remaining cancer cells. Surgery to remove the breast (or as much of the breast tissue as possible) is called a mastectomy. Lymph node dissection (removal of the lymph nodes in the underarm area for examination under a microscope) is also done during this surgery.

   After initial systemic and local treatment, patients with IBC may receive additional systemic treatments to reduce the risk of recurrence (cancer coming back). Such treatments may include additional chemotherapy, hormonal therapy (treatment that interferes with the effects of the female hormone estrogen, which can promote the growth of breast cancer cells), targeted therapy (such as trastuzumab, also known as Herceptin®), or all three. Trastuzumab is administered to patients whose tumors overexpress the HER–2 tumor protein. More information about Herceptin and the HER–2 protein is available in the NCI fact sheet Herceptin® (Trastuzumab): Questions and Answers, which can be found at http://www.cancer.gov/cancertopics/factsheet/therapy/herceptin on the Internet.

   Supportive care is treatment given to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer. It prevents or treats as early as possible the symptoms of the disease, side effects caused by treatment of the disease, and psychological, social, and spiritual problems related to the disease or its treatment. For example, compression garments may be used to treat lymphedema (swelling caused by excess fluid buildup) resulting from radiation therapy or the removal of lymph nodes. Additionally, meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. A social worker can often suggest resources for help with recovery, emotional support, financial aid, transportation, or home care.

5. Are clinical trials (research studies with people) available? Where can people get more information about clinical trials?Yes. The NCI is sponsoring clinical trials that are designed to find new treatments and better ways to use current treatments. Before any new treatment can be recommended for general use, doctors conduct clinical trials to find out whether the treatment is safe for patients and effective against the disease. Participation in clinical trials is a treatment option for many patients with IBC, and all patients with IBC are encouraged to consider treatment in a clinical trial.People interested in taking part in a clinical trial should talk with their doctor. Information about clinical trials is available from the NCI’s Cancer Information Service (CIS) (see below) at 1–800–4–CANCER and in the NCI booklet Taking Part in Cancer Treatment Research Studies, which is available at http://www.cancer.gov/publications on the Internet . This booklet describes how research studies are carried out and explains their possible benefits and risks. Further information about clinical trials is available at http://www.cancer.gov/clinicaltrials on the NCI’s Web site. The Web site offers detailed information about specific ongoing studies by linking to PDQ®, the NCI’s comprehensive cancer information database. The CIS also provides information from PDQ.
6. What is the prognosis for patients with IBC?Prognosis describes the likely course and outcome of a disease—that is, the chance that a patient will recover or have a recurrence. IBC is more likely to have metastasized (spread to other areas of the body) at the time of diagnosis than non-IBC cases (3). As a result, the 5-year survival rate for patients with IBC is between 25 and 50 percent, which is significantly lower than the survival rate for patients with non-IBC breast cancer. It is important to keep in mind, however, that these statistics are averages based on large numbers of patients. Statistics cannot be used to predict what will happen to a particular patient because each person’s situation is unique. Patients are encouraged to talk to their doctors about their prognosis given their particular situation.
7. Where can a person find more information about breast cancer and its treatment?To learn more about IBC, other types of breast cancer, and breast health in general, please refer to the following resources:
   • NCI’s Breast Cancer Home Page (http://www.cancer.gov/breast/)
   • Breast Cancer (PDQ®): Treatment (http://www.cancer.gov/cancertopics/pdq/treatment/breast/patient/)
   • Understanding Breast Changes: A Health Guide for All Women (http://www.cancer.gov/cancertopics/understanding-breast-changes)
   • What You Need To Know About™ Breast Cancer (http://www.cancer.gov/cancertopics/wyntk/breast)

Selected References

1. Merajver SD, Sabel MS. Inflammatory breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Diseases of the Breast. 3^rd ed. Philadelphia: Lippincott Williams and Wilkins, 2004.
2. Anderson W, Schairer C, Chen B, Hance K, Levine P. Epidemiology of inflammatory breast cancer (IBC). Breast Disease 2005; 22:9–23.
3. Chittoor SR, Swain SM. Locally advanced breast cancer: Role of medical oncology. In: Bland KI, Copeland EM, editors. The Breast: Comprehensive Management of Benign and Malignant Diseases. Vol. 2. 2^nd ed. Philadelphia: W.B. Saunders Company, 1998.

Source: http://www.cancer.gov/cancertopics/factsheet/Sites-Types/IBC

If you have undergone breast surgery or a mastectomy, you might consider specialized scar massage therapy to help your body heal from the trauma. This type of massage targets scar tissue, which is an ongoing source of pain and discomfort for many women.
Lymph drainage will also be addressed as part of your treatment. Scar tissue can become hard, behaving like a solid wall and preventing the proper flow of lymph. Since your lymphatic system plays such an important role in helping your body eliminate toxins, it is vital to your health that your lymph flows well without obstruction.

Scar therapy massage creates motion around traumatized tissue and enhances the normal flow in lymph capillaries just under the skin. By softening and dissolving scar tissue, it helps release tissue congestion. This improves circulation in surrounding areas, including the arms where many women have continual aching after breast surgeries.

When the circulation and movement is increased – not only in breast tissue, but in your shoulders, chest, back, and neck – it can alleviate swelling, discomfort, and other post-surgery symptoms, such as pain or pulling around the surgery site. For women who have cysts as well, it can decrease the fluid in them.

Breasts are a touchy subject for Americans, despite the apparent fetish with them. Having another person, even a specialist who is well-trained and experienced, touching one’s breasts can be cause for alarm. Many women are self-conscious and uncomfortable with the idea of breast therapy, but scar massage therapists are generally very supportive and are there to help.

I have two colleagues who specialize in techniques to heal scar tissue. They love to help women healing from breast surgery. Both of them have wonderful attitudes toward their work. They are dedicated to helping women live better lives post-surgery. As an added bonus, these therapists know when scar tissue has softened, whether cysts have decreased in size, or even if there are unusual lumps in breast tissue that ought to be checked by your doctor.

Many massage therapists find that working on the breasts is too intimate. Breasts are loaded with emotional, sexual, and societal concerns. Being the therapist who enters this territory can be daunting, but fortunately there are those who know its healing power, who feel very comfortable with it, and are dedicated to helping women in this way.

If you are interested in having scar therapy and breast massage, seek out a female practitioner well educated in breast anatomy and lymphatic massage. The American Massage Therapy Association website at www.amtamassage.org is one place to start. Once you are on this site, click on “Find a Massage Therapist.” Currently breast massage isn’t listed as a modality, but lymphatic drainage is, so once you find a list of therapists in your area you can then narrow your search to one that also specializes in scar therapy.

Dr. Christina Grant is a holistic healer and spiritual counselor who helps people attain well-being, greater insight, and inner peace in their lives. You are welcome to visit her blog and website: www.christinagrant.com.

Source: http://surrogacy101.blogspot.com/2010/09/scar-therapy-for-women-who-have-had.html