Here’s Why Some Women Are Forgoing Treatment For This Type of Breast Cancer

When Laura Colletti was told that she had ductal carcinoma in situ (DCIS), or early-stage breast cancer, she dreaded what the diagnosis would mean for her life. Laura’s daughter had some straightforward advice: “Mom, if it was me I’d take it out. You just get rid of it.”

But Laura wasn’t ready for a mastectomy. She and her husband researched DCIS, which is known as stage 0 cancer, and found that at her stage, her lump was made of pre-cancerous cells fully contained inside the ducts of the breast. The cells might never break out of the duct and become an invasive cancer. Laura says she found that, “really we don’t have to have surgery. That it’s not life-threatening, and I’ll probably die from something else.”

Some doctors agree. Surgeon Shelley Hwang, Chief of Breast Surgery at Duke Medical Center, says it makes her sad when patients feel they have to undergo a major mastectomy surgery in order to rid themselves of the anxiety of breast cancer. Dr. Hwang explains that in ductal carcinoma in situ, the in situ phrase means that the abnormal cells are contained, and if they stay contained, they pose much less risk than having a preventative surgery.

Doctors are now finding breast cancer tumors at higher rates because of how detection technology has improved in recent years. But while early detection has improved, breast cancer death rates have stayed about the same from 2002 to 2015. Shouldn’t more detection, especially early detection, mean more lives saved?
Cases of DCIS account for 20- 25 % of breast cancers detected by screening, whereas DCIS made up about 3 percent of detected cancers before screening became more popular in the 1980s. The reaction of many doctors and patients, understandably, is to want to remove any tumors regardless of stage. Even if a woman does have very early stage breast cancer, it may seem far better to undergo surgery than to worry over whether or not the cancer will become invasive.

But not all tumors are the same, and some are so slow-growing that they might not ever cause death, or even symptoms. They key is to know which ones are which. Cancer is the blanket term applied to low-risk DCIS and to stage IV metastatic cancer, but they don’t pose near the same amount of risk, though the terminology can cause an equal amount of fear in both cases.

But even stage 0 DCIS poses some risk of becoming invasive; isn’t it better to operate and be done with it? According to Dr. Hwang, not always: “There have been a couple of very important studies that have been published lately which have shown that for the really low risk DCIS, whether you ever operate on them, whether you do a lumpectomy or whether you do a mastectomy, the patients are equally likely to not die of breast cancer.”

This is a serious consideration, especially because treatment comes with its own set of risks. The side effects of chemotherapy and radiation are both short-and long-term, and even a double mastectomy is not a magic bullet. Aside from the emotional side effects, a mastectomy may involve  revisions, prolonged pain, loss of sensation, or hernias. 

Some doctors are beginning to think there are times when treatment risks outweigh the benefits, and they’re putting a new option on the table: active surveillance. Active surveillance involves screenings every six months and may include estrogen-blocking drugs. This is the route that Laura Colletti chose. Her daughter was, understandably, against the decision at first. But after talking to her mom about the research the the pros and cons of more aggressive treatment, she become supportive.

Laura was relieved that she wouldn’t have to, at least at this stage, undergo surgery. “I feel great about my decision. If options were given to women, more women would choose active surveillance. But because there’s no options out there, people don’t know to even ask.”

Dr. Hwang is not suggesting that people stop getting mammograms; she’s simply questioning the rapid-fire reaction to all types of cancer. If active surveillance can help women avoid surgery without sacrificing peace of mind, it may be a good option for those with very low-risk DCIS—at least it should be one of the options presented. 

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The Five Deadliest Types of Cancer

According to data gathered from the doctors, in 2015, around 1,658,370 million new cases of cancer were diagnosed in the USA alone, and around 589,430 people died from this terrible affliction. Below, you'll find a breakdown of 5 of the deadliest types of cancer that are still prevalent in the world today:

5. Prostate Cancer

Prostate cancer cases in 2015: 220,800
Prostate cancer deaths in 2015: 27,540
Prostate cancer arises from glandular cells and typically affects older men. It is the most prevalent among people with a family history of the disease, as well as  African Americans. Most cases grow slowly, and many patients with asymptomatic prostate cancer are generally only observed without any further treatment being required. Treatment options include external beam radiation therapy (radiotherapy), surgical removal (prostatectomy), or even brachytherapy, which is the implantation of radioactive iodine into the prostate.

4. Pancreatic Cancer

Pancreatic cancer cases in 2015: 48,960
Pancreatic cancer deaths in 2015: 40,560
Pancreatic cancer is, unfortunately, one of the most terribly aggressive cancers. It often besets the sufferer with many dangerous symptoms including stomach pain, bleeding, biliary obstruction, ascites and more, and it can become deadly very quickly. In spite of continuous research, there are no adequate screening options or treatments available yet.

3. Breast Cancer

Breast cancer cases in 2015: 234,190
Breast cancer deaths in 2015: 40,730
Breast cancer is caused by the appearance and growth of malign cells lining the ducts or lobules of the breast. Breast cancer treatment is far from a simple matter, as it is based on quite a number of factors. The main options available include hormone therapy, chemotherapy, lumpectomy, or mastectomy. Thanks to advances in research and technology, more people are beating this type of cancer each year.

2. Colorectal Cancer

Colorectal cancer cases in 2015: 132,700
Colorectal cancer deaths in 2015: 49,700
If caught early, colorectal cancer is highly treatable with fairly positive survival rates. In fact, around 90% of patients diagnosed with early-stage colorectal cancer end up surviving. However, when it enters its advanced stages, the chances of survival are a lot slimmer. There are quite a few treatment options available, including embolization, chemotherapy, surgery or radiotherapy.

1. Lung Cancer
 

Lung and bronchus cancer cases in 2015: 221,200
Lung and bronchus cancer deaths in 2015: 158,040
Unfortunately, most sufferers of lung cancer who are diagnosed with an advanced form of the disease will eventually lose their lives to it. Smoking, which is a modifiable risk factor, is the most common cause of lung cancer by a long shot, which is why quitting smoking (or never starting in the first place) is the best preventative measure possible. Depending on certain factors, treatment may include chemotherapy, surgery or radiotherapy.

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BREAST CANCER- SYMPTOMS, TESTS, TYPES, THERAPIES, LIFE AFTER IT, OPTIONS ETC.

There are often no symptoms of breast cancer, but sometimes women may discover a breast problem on their own. Signs and symptoms to be aware of may include:
A painless lump in the breast
Changes in breast size or shape
Swelling in the armpit
Nipple changes or discharge
Breast pain can also be a symptom of cancer, but this is not common.

Signs of Inflammatory Breast Cancer

Inflammatory breast cancer is a rare, fast-growing type of cancer that often causes no distinct lump. Instead, breast skin may become thick, red, and may look pitted -- like an orange peel. The area may also feel warm or tender and have small bumps that look like a rash.

Breast Cancer and Mammograms

The earlier breast cancer is found, the easier it is to treat. And mammograms, X-rays of the breast, can detect tumors before they are large enough to feel. The American Cancer Society recommends yearly mammograms beginning at age 40 for women at average risk. While the U.S. Preventive Services Task Force recommends a screening mammogram every two years from age 50 to 74. It also notes that before age 50, each woman should check with a doctor to find out what screening schedule is right for her, considering the potential benefits and harms from screening.

Breast Ultrasound and MRI

Besides a mammogram,  your doctor may order additional imaging with breast ultrasound. An ultrasound can help determine the presence of cysts, fluid-filled sacs that are not cancer. An MRI may be recommended along with a mammogram for routine screening in certain women who have a higher risk of breast cancer.

Breast Self-Exams

It was once widely recommended that women check their own breasts once a month. But studies suggest these breast self-exams play a very small role in finding cancer. The current thinking is that it’s more important to know your breasts and be aware of any changes, rather than checking them on a regular schedule. If you want to do breast self-exams, be sure to go over the technique with your doctor.

What If You Find a Lump?

Don't panic. 80% of breast lumps are not cancerous. Lumps often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But you should let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it's found the better. And if it's not, testing can give you peace of mind. 

Breast Biopsy

The only sure way to determine whether a lump is cancer is to do a biopsy. This involves taking a tissue sample for further examination in the lab, sometimes through a small needle. Sometimes surgery is done to take part of or the entire lump for testing. The results will show whether the lump is cancer, and if so, what type. There are several forms of breast cancer, and treatments are carefully matched to the type of cancer.

Hormone-Sensitive Breast Cancer

Some types of breast cancer are fueled by the hormones estrogen or progesterone. A biopsy can reveal whether a tumor has receptors for estrogen (ER-positive) and/or progesterone (PR-positive). About two out of three breast cancers are hormone sensitive. There are several medications that keep the hormones from promoting further cancer growth. 

HER2-Positive Breast Cancer

In about 20% of patients, breast cancer cells have too many receptors for a protein called HER2. This type of cancer is known as HER2-positive, and it tends to spread faster than other forms of breast cancer. It's important to determine whether a tumor is HER2-positive, because there are special treatments for this form of cancer.

A HER2-positive breast cancer cell is illustrated here, with abnormal growth signals shown in green.

Breast Cancer Stages

Once breast cancer has been diagnosed, the next step is to determine how big the tumor is and how far the cancer has spread. This process is called staging. Doctors use Stages 0-4 to describe whether cancer is localized to the breast, has invaded nearby lymph nodes, or has spread to other organs, such as the lungs. Knowing the stage and type of breast cancer will help your health care team formulate a treatment strategy.

Breast Cancer Surgery

There are many types of breast cancer surgery, from taking out the area around the lump (lumpectomy or breast-conservation surgery) to removing the entire breast (mastectomy.) It's best to discuss the pros and cons of each of these procedures with your doctor before deciding what's right for you.

Radiation Therapy for Breast Cancer

Radiation therapy uses high-energy rays to kill cancer cells. It may be used after breast cancer surgery to wipe out any cancer cells that remain. It can also be used along with chemotherapy for treatment of cancer that has spread to other parts of the body. Side effects can include fatigue and swelling or a sunburn-like feeling in the treated area

Chemotherapy for Breast Cancer

Chemotherapy uses drugs to kill cancer cells anywhere in the body. The drugs are often given by IV, but are sometimes taken by mouth or shot. Chemotherapy may be done after surgery to lower the odds of the cancer coming back. In women with advanced breast cancer, chemotherapy can help control the cancer's growth. Side effects may include hair loss, nausea, fatigue, and a higher risk of infection..

Hormone Therapy for Breast Cancer

Hormone therapy is an effective treatment for women with ER-positive or PR-positive breast cancer. These are cancers that grow more rapidly in response to the hormones estrogen or progesterone. Hormone therapy can block this effect. It is most often used after breast cancer surgery to help keep the cancer from coming back. It may also be used to reduce the chance of breast cancer developing in women who are at high risk.

Targeted Drugs for Breast Cancer

Targeted therapies are newer drugs that target specific properties within cancer cells. For example, women with HER2-positive breast cancer have too much of a protein called HER2. Targeted therapies can stop this protein from promoting the growth of cancer cells. These drugs are often used in combination with chemotherapy. They tend to have milder side effects compared to chemotherapy.

Life After Diagnosis

There's no doubt that cancer is a life-changing experience. The treatments can wear you out. You may have trouble managing daily chores, work, or social outings. This can lead to feelings of isolation. It's crucial to reach out to friends and family for support. They may be able to go with you to treatments, help out with chores, or just remind you that you are not alone. Many people choose to join a support group.

Breast Reconstruction

Many women who have a breast removed choose to undergo reconstructive surgery. This replaces the skin, nipple, and breast tissue that are lost during a mastectomy. Reconstruction can be done with a breast implant or with tissue from somewhere else in your body, such as the tummy. Some women opt to begin reconstruction at the same time as their mastectomy. But it's also possible to have reconstructive surgery months or years later.

Breast Forms

An alternative to breast reconstruction is to be fitted for a breast form. This is a breast-shaped prosthesis that fits inside your bra. Wearing a breast form allows you to have a balanced look when you are dressed -- without undergoing additional surgery. Like reconstructive surgery, breast forms are often covered by insurance.

Breast Cancer: reasons/ risk factor

The most obvious risk factor for breast cancer is being a woman. Men get the disease, too, but it is about 100 times more common in women. Other top risk factors include being over age 55 or having a close relative who has had the disease. But keep in mind that up to 80% of women with breast cancer have no family history of the illness.

Breast Cancer Genes

Some women have a very high risk of breast cancer because they inherited changes in certain genes. The genes most commonly involved in breast cancer are known as BRCA1 and BRCA2. Women with mutations in these genes have up to an 80% chance of getting breast cancer at some point in life. Other genes may be linked to breast cancer risk as well.

Risk Factors UNDER YOUR Control

Being overweight, drinking more than one alcoholic beverage per day can raise the risk of developing breast cancer. Birth control pills and some forms of postmenopausal hormone therapy can also boost your risk. But the risk goes back to normal after these medications are stopped. Recent studies suggest that physical activity may help lower the risk of a recurrence and it's a proven mood-booster.

Breast cancer- pain/ lump, can it be cancer?

A breast lump can occur in men as well as in women. Any tenderness can be scary & make you run to the doctor. Most early stage breast cancers show no symptoms, but if they're detected early, then one can survive.

Causes of Pain & Tenderness

Normally any breast pain is associated with cancer. But breast pain is rarely the 1st noticeable symptom of breast cancer. There can be other reasons for the pain- 

fluctuation of hormones caused by menstruation

• a side effect of some birth control pills
• a bra that doesn't fit
• stress

Breast Lumps

A lump in the breast isn't always cancerous & can happen due to  hormonal changes in teens to damaged fat tissue, most  breast lumps are noncancerous for women under the age of 40.

Common causes of benign breast lumps include:

• breast infection
• fibrocystic breast disease
• fibroadenoma (noncancerous tumor)
• fat necrosis (damaged tissue)

With fat necrosis, the mass cannot be distinguished from a cancerous lump without a biopsy. 

Signs of Breast Cancer

Other symptoms of breast cancer include:

• nipple discharge or retraction of the nipple
• enlargement of one breast
• dimpling of the breast surface
• an "orange peel" texture to the skin
• vaginal pain
• unintentional weight loss
• enlarged lymph nodes in the armpit
• visible veins on the breast

If you experience any of those symptoms, you should see your doctor. Breast exams are covered on the next page.

Breast Exams

When you visit your doctor with concerns about breast pain, tenderness or a lump, there are common tests he or she will perform:

• Mammogram: an x-ray of the breast to help tell between a benign and malignant mass
• Biopsy: removal of a small amount of breast tissue for testing
• Ultrasound: use of ultrasonic sound waves to produce an image of the tissue
• MRI: Normally used in conjunction with other tests, magnetic resonance imaging is another noninvasive way to examine breast tissue

Types of Breast Cancer

Two categories reflect the nature of the cancer:

• Noninvasive (in situ): cancer has not spread from the original tissue (Stage 0)
• Invasive (infiltrating): cancer cells have spread to surrounding tissues (Stages I-IV)

The tissue affected determines the type of cancer:

• Ductal carcinoma: cancer forms in the lining of the milk ducts (most common)
• Lobular carcinoma: cancer in the lobules of the breast where milk is produced
• Sarcoma: cancer in the breast's connective tissue (rare)

Genes and Hormones Affect Cancer Growth

Geneticists are starting to learn how genes affect the growth of cancer and have even identified one:

• HER-2 in cancer cells helps their growth. Medications can help shut the HER-2 gene down.

Like genes, hormones can also speed up the growth of some types of breast cancers that have hormone receptors.

• Estrogen receptor positive: this cancer uses estrogen to grow
• Progesterone receptor positive: this cancer is fueled by progesterone
• Hormone receptor negative: doesn't use hormones as fuel (no hormone receptors)

Treatments

Depending on the type and stage of cancer, treatments can vary. 

• Mastectomy: surgical removal of part or the whole breast to remove a tumor and connecting tissue
• Lumpectomy: removes the tumor while leaving the breast intact
• Chemotherapy: the most common cancer treatment, chemotherapy uses anticancer drugs to interfere with cells' ability to reproduce
• Radiation: another standard in the fight against cancer, radiation uses X-rays to directly treat cancer
• Hormone & Targeted Therapy: used when either genes or hormones play a part in the cancer's growth

Prognosis

Like any other cancer, early detection and treatment is a major factor in determining the outcome. Breast cancer is easily treated and usually curable when detected in the earliest of stages.

According  to a study, the five-year survival rate for Stage 0 to Stage II breast cancer is more than 80 percent. Stage III breast cancer five-year survival rate is still more than 50 percent.

Staying Ahead of Breast Cancer

Breast cancer is the most common cancer in women, it's important to stay informed on risk factors and warning signs of breast cancer.

The best way to fight breast cancer is early detection, whether that be self-examinations or regular mammograms. If you're worried that your breast pain or tenderness could be something serious, make an appointment with your doctor immediately