Category Archives: Found a Breast Lump?

Please Don’t Needlessly Lose Your Breasts to Mastectomy

Photo courtesy of freedigitalphotos.net and marin
Photo courtesy of freedigitalphotos.net and marin

While I was doing my research for yesterday’s article, I came across an article concerning needless mastectomy, a matter of which I was blissfully unaware.  Today I’m sharing that with you because you need to know.

Women are often enduring mastectomies for no good reason.

I’m not saying it’s always the case, but by the time you’ve finished this article, hopefully you’ll know the best reasons for having a mastectomy and when you should go after a second opinion.

Back on October 27th, Nicholas Regush of ABC News wrote “While we hear news almost daily of the need for women to have mammograms and to inspect their breasts for changes that could suggest breast cancer, the actual treatment for breast cancer that many women receive, especially poor ones, is often outrageously out-of-date, if not bordering on the criminal.”  Here’s a link to the full article.

The article goes on to state, “In Texas, for example, a study of breast cancer treatment at one large urban hospital revealed that 84 percent of the women with early stage breast cancer had mastectomies and only 16 percent had lumpectomies. The women who lost their breasts were mostly poor.”

Mr Regush referenced an article written by Diana Zuckerman, President of the Washington, DC-based National Research Center for Women and Families.  The article was published in the Journal of the American Medical Women’s Association.  Despite much digging, I wasn’t able to get hold of a copy of that article, but I did discover that Ms Zuckerman has been extremely proactive with the Breast Cancer Public Education Campaign.

Because many women diagnosed with breast cancer do not have all the facts they need to get the treatment that is best for them, the National Research Center has been working to raise awareness of this issue.

Unnecessary Mastectomies

What I discovered from some of the online articles I read was that if a doctor was trained before 1981, his patient is much more likely to have a mastectomy. Apparently, old medical habits are hard to break.

Research is clear that lumpectomies are as safe as a mastectomy for most women with early stage disease.

Back in my grandmother’s day, nearly every woman who was diagnosed with breast cancer underwent mastectomy, often while under anesthesia for the biopsy itself with no participation in a discussion about treatment options.  How fortunate we are that this is no longer the case.

However, tens of thousands of women with breast cancer are losing a breast (sometimes both) unnecessarily each year.  Many women are getting their breasts removed for no good reason — meaning that such decisions are often not based on sound medical judgment but more on the basis of other factors such as her income (it’s cheaper to perform a mastectomy than lumpectomy followed by expensive radiation treatments), the training of her doctor, the age of her doctor, and where she lives.  Sometimes it’s based purely on fear of the return of the disease.

There is absolutely no data that mastectomy (either single or bilateral) in a breast cancer patient improved survival rates or helped them live longer.  It appears that many women are doing this in panic mode.

Mastectomy vs Lumpectomy

Presuming you have already found a breast lump and your doctor has told you it’s malignant, you will need to make the decision between a mastectomy and lumpectomy.

There’s a helpful article in www.breastcancer.org titled Mastectomy vs Lumpectomy.  Please read the article, it references the deciding factors, advantages and disadvantages, and there’s no need for me to reiterate it here.

When Mastectomy Makes Sense

  • If the tumor is big and, after the lumpectomy, very little breast tissue would remain
  • If there are multiple tumors in more than one quadrant of the breast
  • If you do not want to undergo radiation therapy after the surgery (and you don’t have to – I chose against radiation after my lumpectomy but I was very proactive in my health care and chose something else)
  • If you believe you will have less anxiety about a recurrence of breast cancer with a mastectomy

There is an alarming trend of more and more women removing healthy breasts because they are panicked or in fear of breast cancer returning or migrating to the other breast.  In some cases, doctors recommend prophylactic mastectomy, which is surgery that is performed to reduce your breast cancer risk.  That is a whole, huge topic unto itself and the subject of my next article.

While I can’t tell you what to do, I do want you to be aware that YOU HAVE CHOICES.  Please don’t choose mastectomy purely out of fear.  Sign up for my newsletters (the bright colored box on the right) and let me help you through this process.  I will share with you what I did, help you with your anxiety and walk with you through this journey.

Remember, the greatest enemy cancer has is a great functioning immune system.

The Difference Between DCIS, LCIS, ILC, IBC, Paget’s Disease & Phyllodes Tumors

types of breast cancer

The Difference Between DCIS, LCIS, ILC, IBC, Paget’s Disease & Phyllodes Tumors

Some of my subscribers have voiced a little confusion in past weeks over the various types of breast cancer and exactly how they differ, prompting me to write this article and hopefully untangle that confusion.

The 8 Faces of Breast Cancer

Ductal Carcinoma In Situ (DCIS) is the most common type of non-invasive breast cancer.  Ductal means that the cancer starts inside the milk ducts, carcinoma means any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and “in situ” means “in its original place.” DCIS is considered “non-invasive” because it hasn’t spread beyond the milk duct into any of the surrounding breast tissue.  DCIS is not considered to be life-threatening, however, having DCIS can increase the risk of developing an invasive breast cancer later on.  Experts feel that when you have had DCIS, you can be at an increased risk for the cancer returning or for developing a new breast cancer than a person who has never had breast cancer.  Studies indicate that most recurrences happen within 5-10 years after initial diagnosis (but this is certainly not always the case).

Invasive Ductal Carcinoma (IDC), sometimes referred to as infiltrating ductal carcinoma, is the most common type of breast cancer, comprising about 80% of all breast cancers.  Invasive means that the cancer has “invaded” or spread to the surrounding breast tissues. Ductal is defined in the paragraph above, and carcinoma refers to any cancer that begins in the skin or other tissues that cover internal organs — such as breast tissue.  All together, “invasive ductal carcinoma” refers to cancer that has broken through the wall of the milk duct and begun to invade the tissues of the breast.  Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body.  According to the American Cancer Society, about 2/3 of women are 55 or older when they are diagnosed with an invasive breast cancer, however, it can strike at any age.  IDC also affects men.

There are 5 sub-types of IDC – tubular carcinoma, medullary carcinoma, mucinous carcinoma, papillary carcinoma and cribriform carcinoma.  These all refer to a specific type of tumor and these further classifications help your oncologist decide on treatment.  You can find out a lot more about these subtypes on www.breastcancer.org.

Invasive Lobular Carcinoma (ILC) is the second most common type of breast cancer after IDC.  Invasive is defined above, lobular refers to cancer that has grown in the milk-producing lobules which empty out into the ducts that carry milk to the nipple. Carcinoma is defined above.  All together, “invasive lobular carcinoma” refers to cancer that has broken through the wall of the lobule and begun to invade the tissues of the breast.  Again – over time, ILC can spread to the lymph nodes and possibly to other areas of the body.  According to the American Cancer Society, this type of breast cancer is more common as women age.

Lobular Carcinoma In Situ (LCIS) is when abnormal cells grow inside the lobules of the breast, but have not spread to any nearby tissue or beyond.  With LCIS, the abnormal cells are still in place inside the lobules and have not invaded any other tissues.  Experts feel that it is rare for LCIS to become invasive breast cancer, however, having LCIS increases the risk of invasive breast cancer, statistically speaking.  Compared to women without LCIS, those with LCIS are 7-12 times more likely to develop invasive cancer in either breast.  Studies show that women with LCIS “may” go on to develop ILC or IDC.

Inflammatory Breast Cancer (IBC) is a rare and more aggressive form of breast cancer.  According to the National Cancer Institute, about 1-5% of all breast cancer cases in the USA are IBC.  Inflammatory breast cancer generally starts with the reddening and swelling of the breast rather than a distinct lump.  The alarming thing about IBC is that it tends to spread and grow quickly, with symptoms worsening within days or even hours.  It is very important to recognize symptoms and seek treatment PROMPTLY.  Although IBC is considered a serious diagnosis, keep in mind that treatments today are better at controlling the disease than they used to be.  The average age at diagnosis for IBC in the USA is 57 for white women and 52 for African American women, and that’s about 5 years younger than the average ages at diagnosis for other forms of breast cancer.  I’ve found an excellent resource for women with IBC.  Go to http://eraceibc.com – they are wonderful over there and will provide you with extra support for your specific diagnosis.

Paget’s Disease is a rare form of breast cancer in which cancer cells collect in or around the nipple. The cancer usually affects the ducts of the nipple first (small milk-carrying tubes), then spreads to the nipple surface and the areola (the dark circle of skin around the nipple). The nipple and areola often become scaly, red, itchy, and irritated.  According to the National Cancer Institute, Paget’s disease accounts for less than 5% of all breast cancer cases in the USA. It’s important to be aware of the symptoms because more than 97% of people with Paget’s disease also have cancer, either DCIS or invasive cancer, somewhere else in the breast. The unusual changes in the nipple and areola are often the first indication that breast cancer is present. Doctors aren’t quite sure how Paget’s develops.  It is more common in women, but is sometimes found in men as well and usually develops after the age of 50.

Phyllodes Tumors – Prior to my doing research for this article, I have to admit I’d never even heard of this type of tumor.  It’s a rare one and accounts for less than 1% of all breast cancers.  A phyllodes tumor can be benign (harmless) or malignant (cancerous).  This type of tumor is called a “sarcoma,” because it occurs in the connective tissue (stroma) of your breast, rather than in the tissue lining of ducts and lobes.  Phyllodes tumors take their name from the Greek word phullon (leaf) because of their leaf-shaped growth pattern.  This type of tumor will feel like a firm, smooth-sided, bumpy (not spiky) lump in your breast tissue and the skin over the tumor may become reddish and warm to the touch.  This type of tumor seems to grow very fast – so much so that the lump can become bigger in a couple of weeks.

Male Breast Cancer – Breast cancer in men is rather rare, less than 1% of all breast cancers occur in men but no discussion of the types of breast cancer would be complete without mentioning this.  In 1998 I lost a family friend to male breast cancer that was diagnosed too late (RIP, Bud).  In 2011, about 2,140 men were diagnosed with male breast cancer.  For men, the lifetime risk of being diagnosed with breast cancer is only about 1 in 1,000.  For risk factors, symptoms, diagnosis of male breast cancer and treatment for male breast cancer go to www.breastcancer.org, an excellent resource.

A Good Visual For You

Someone clever has photographed a bunch of lemons and used them to illustrate things like lumps, a growing vein, nipple retraction – all things to be aware of in reference to breast changes.  The photo is on Stumble Upon (click this link).  I hope this information helps someone!

Sources:

http://www.breastcancer.org/symptoms/types/

http://breastcancer.about.com/od/types/p/phyllodes_sa.htm

http://www.eraseibc.com/ibc.html

http://ww5.komen.org/understandingbreastcancerguide.html

If you’d like to stay connected, sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com) and I’ll do my utmost to keep you informed and empowered on your healing journey… and beyond.

Okay, So You’ve Found a Breast Lump – Here’s What to Do

hand on chest2It’s every woman’s secret fear – finding a breast lump.

The first important thing to do is DON’T PANIC.  Studies have shown that 80% of all breast lumps are harmless.

There are many things that can cause a breast lump

Cysts – fluid-filled sacs that can feel like over-ripe grapes. A cyst can sometimes be tender, especially just before your menstrual period.

Fibrocystic changes – lumps that are often painful.  Contrary to popular belief, fibrocystic breast changes do not increase your risk of breast cancer.  You might find that symptoms are usually worse right before your menstrual period, and then improve after your period starts.

Fibroadenomas – noncancerous lumps that feel rubbery and move easily inside the breast tissue. Like fibrocystic changes, they occur most often during your reproductive years. They are usually not tender and except in rare cases, they do not become cancerous.  A doctor can tell during an exam whether a lump is a fibroadenoma. Some doctors will still recommend a lump biopsy just to be sure.

Lipoma – a collection of fatty tissue, a lipoma moves easily with very little finger pressure. Sometimes they are tender to the touch but are usually not associated with any other symptoms. Lipomas rarely become malignant.

Milk cysts – sacs filled with milk and infections (known as mastitis), which may turn into an abscess.  These typically only occur if you are breastfeeding or have recently given birth.  They are painful!

Other causes of breast lumps

There are other conditions which can cause breast lumps:

  • Injury — sometimes if your breast is badly bruised, there will be a collection of blood that feels like a lump. These lumps tend to heal themselves in a few days or weeks but if they do not improve, see your doctor.
  • Breast cancer — if you suspect this, see your doctor

Other breast changes to look for

  • Bruising on your breast, but you did not experience any injury;
  • Any discharge from your nipple, especially if it is bloody or pinkish
  • The skin on your breast appears dimpled or wrinkled, like the peel of an orange
  • A new breast lump during your monthly self-exam
  • Your nipple is inverted (turned inward) but normally is not inverted

Do this first!

Make a call to your primary care doctor and go get it checked out.  Don’t delay, because if it is breast cancer, the earlier you find it and get treatment, the better your chances for survival.

Your doctor will most likely order an ultrasound exam; it’s a painless, radiation-free way of determining if the lump is a mass or a harmless, fluid-filled cyst.  You might also have a core needle biopsy where, with the assistance of the ultrasound equipment, they insert a very slender needle into the breast (it’s not as bad as it sounds) and suck out a small sampling of cells which they test for cancer.

In the event that the lump can’t be seen during your ultrasound exam (which apparently does happen about a third of the time)  a similar procedure known as a “stereotactic needle biopsy” uses a mammogram to guide the procedure.  They use the mammography equipment when they insert the needle and then scan the breast to ensure accuracy.

I know all this sounds very scary, but go and get yourself checked anyway.  If it turns out to be nothing, at least you’ll know and NO ONE will think you are over-reacting.

References:

http://www.webmd.com/breast-cancer/features/advances-in-diagnosing-breast-cancer

http://www.nlm.nih.gov/medlineplus/ency/article/003155.htm

If you’d like to stay connected, sign up for my free e-newsletters on the right, or “like” me on Facebook (MarnieClark.com) and I’ll do my utmost to keep you informed and empowered on your healing journey… and beyond.