Diagnosis of Breast Cancer

  It is likely that your doctor has suspected the presence of breast cancer:

    *      Due to an abnormality revealed by mammography screening;
    *      Because you would have reported a change in your breast or nipple;
    *      After examining your breasts and you have asked about your health and your personal and family medical history.

If you have a lump in one breast, your doctor palpated to determine the size, shape and texture, and check if it is easily mobile. Often, the masses are different from non-cancerous tumor masses to the touch. To confirm the diagnosis, your doctor will use some analysis, which will also establish the "stage" and "grade" (degree of malignancy) of cancer. It may be that you have to spend any of the following tests.

Imaging Techniques

These techniques allow to carry out a thorough examination of tissues, organs and bones. Radiography, ultrasonography, computed tomography [CT] and bone scan are all means for your health care team to obtain an image of the tumor and whether it has spread. These tests are usually painless and do not require anesthesia.

Even if you had a mammogram screening, diagnostic mammography will be performed. During this procedure, we take more photographs of the breast that appeared abnormal on the mammogram. A mammogram can lead to discomfort and can even be painful because the breast is compressed between two plates of glass. You must remain still for less than a minute while taking mammograms.

Biopsy

A biopsy is usually required to establish with certainty a diagnosis of cancer. This procedure involves removing cells for examination under a microscope. If the cells are cancerous, it will then determine how quickly they multiply. There are several types of breast biopsies.

    *      The fine needle aspiration biopsy uses a thin needle to remove fluid or cells from the mass. The procedure is quick but can be uncomfortable because of breast tenderness.

    *      During a core needle biopsy, the doctor inserts a needle into a small incision in the breast to remove one or more samples of breast tissue. If necessary, we will use the ultrasound or X-ray to guide the needle into the ground and a local anesthetic will be used to numb the area under consideration. After the biopsy, it is possible that the breast is sensitive and bruises appear for a short period.

    *      A biopsy is a surgical procedure that involves removing part or all of a lump in one breast or breast tissue suspected. It may be of two types. During a biopsy incision, a sample is a mass or abnormal area. In an excisional biopsy, we remove the entire mass or suspicious tissue. The biopsy may take place either in the doctor's office or at the hospital, outpatient clinic (you will not spend the night in the hospital). A local anesthetic will be used to numb the area under consideration.

Laboratory Tests

If the sample used for the biopsy contains cancer cells, your doctor may request further analysis of breast tissue removed. These tests will have a better idea of the state of cancer and offer the best treatment options.

    *      The analysis of hormone receptor status is used to detect the presence of certain hormone receptors. The breast cancer cells bearing these receptors need estrogen and progesterone to grow. If there are hormone receptors in the biopsy sample, we say that the tumor is hormone dependent (hormone receptor positive). Knowing hormone receptor status of the tumor helps predict how it will evolve and whether it is likely to respond to hormonal therapy. The tumors are more common in a hormone-menopausal women.

    *      The test for detection of Her2 gene to verify the presence of an oncogene that regulates the protein called Her2 (human epidermal growth factor receptor 2, or receptor 2 human epidermal growth factor). This protein is found on the surface of breast cells and stimulates their growth, some breast cancer cells contain much more than others. If there is an excessive amount of Her2 protein or copies of the gene that governs, we say that the tumor is Her2-positive. Breast Her2-positive do not evolve like other breast cancers and require special treatment.

    *      It could happen that blood tests are required. Using samples of your blood, it verifies the amount and appearance of different types of blood cells. The doctor can see whether your organs are functioning normally. Test results may also provide evidence suggesting the presence or absence of cancer and, where applicable, the spread of the disease.

Benefits and risks of screening for breast cancer

Virtually any test or procedure has both advantages and risks. What counts is to be informed to make fully informed choices appropriate decision for you.

No screening test is absolutely foolproof, but a good screening test reduces mortality in people with cancer.

Researchers are also trying to develop other positive aspects of screening, including improved quality of life and the use of less toxic treatment because of early detection of disease.
 

Benefits of regular screening

Early detection of cancer: In most cases, more cancer is detected, the better the chances of survival. Research indicates that women who have regular mammograms are more likely to survive cancer. Early detection may also help reduce the duration of treatment and convalescence. Studies have shown that breast tumors from women screened regularly by mammography are smaller and medium easier to treat.

Reduced anxiety due to the fact of "not knowing": Many people prefer to have regular tests for "verification", like a yearly review with the family doctor.
 

Risks of routine screening

False positive: When test results suggest the presence of cancer when it is not. False positive results can cause anxiety, stress and possibly other painful and unnecessary tests to disprove the initial results (that is to say for sure that you do not have cancer despite what could suggest the testing). For example, research has shown that screening for breast cancer in younger women can lead to many more false positive results. There are still doubts about whether regular mammograms for women under 50 years can save lives.

More information on screening for breast cancer during quarantine

False negative results: When cancer is actually present is not detected by the test. False negative results can take you, you or your doctor, to ignore other symptoms suggestive of cancer, thereby delaying diagnosis and treatment.

Overdiagnosis: Some cancers may never cause symptoms or decrease expectancy or quality of life. According to research, however, we know that most breast cancers are harmful and that the disease should be detected and treated as quickly as possible.

Increased exposure to toxic processes, such as very low doses of radiation during radiography.

Breast Cancer Screening

A clinical breast exam is a physical breast examination by a qualified health professional. Periodic clinical examinations may help in early detection of breast cancer.

If you are over 40 years, you should have a clinical breast exam every two years.

If your risk of breast cancer is higher than the average, you will probably undergo screening tests more often or at a younger age (before age 40). Check with your doctor about the best screening program for you.

More information on clinical breast examination
 

Mammography screening. Screening mammograms are performed in clinics and testing centers.

Mammography is a very low dose radiography of breast tissue. The mammograms provide detailed images of the breast from different angles. The breast is first placed between two plastic plates that are then pressed toward each other to flatten the breast. The procedure may cause some discomfort but it only takes a few seconds. Compression of breast tissue allows for clearer images while minimizing as much as possible the amount of radiation used. Discuss the risks and benefits of mammography with your doctor.

Screening programs for breast cancer vary from one province to another. All provinces have screening programs for women 50 to 69 years. You can make an appointment at one of these testing centers without prior recommendation of a physician.

For women 40 to 49 years, the situation is not as clearly defined. Depending on your province of residence, you may be able to have a mammogram if your doctor or nurse practitioner directs you to the program (after discussing with you the pros and cons of early detection). However, it is also possible that the testing program in your province just can not accept women aged 40 to 49 years in this case, you may need to see your doctor what is the best way to mammography.

Find a center for breast cancer screening near you.

Causes of Breast Cancer

Most women who develop breast cancer do not present a particular risk factor, except that of being a woman and getting older (especially after 50 years). Discuss your risk with your doctor.

Other possible risk factors:

    *  Having had breast cancer;

    * Family history of breast cancer (especially if the mother, sister or daughter has been diagnosed before menopause or if the presence of inherited mutations in certain genes such as BRCA1 or BRCA2);
  
    * Family history of ovarian cancer;
  
    * Exposure higher than average estrogen, hormones produced naturally by the body, among other things because you:
    

    * Have never had children or have given birth to your first child after age 30;
          

    * Had your first menstrual period at an early age;
         
    * Have reached menopause at an older age than average;
      

    * Have taken hormone replacement therapy (estrogen and progestin combined);
   
    * Dense breast tissue (proved in mammography);
    

    *  Previous biopsies showing certain breast changes, including a growing number of non-cancerous abnormal cells (atypical hyperplasia);
   
    *  radiation therapy to the breast (eg to treat Hodgkin's lymphoma), especially before the age of 30.

    * Some factors are slightly worsen the risk of breast cancer. Your personal risk could well be a bit higher if you:

    * Obese (especially after menopause);
 
    * Drink alcohol;
    

    * Taking oral contraceptives (the pill).
    
Breast cancer can sometimes grow in the absence of these risk factors. Most women affected have no family history of disease.

Breast cancer in men

Like women, men have breast tissue and may develop breast cancer. In Canada, less than 1% of all cases of breast cancer affecting men. The male breast cancer is most often diagnosed in men over 60 years, but the disease can occur at any age.

Breast cancer will develop equally in men and women, our information on risk factors, diagnosis, staging and treatment is the same for both sexes.

Breast Health starts with good knowledge of his own body to be more able to notice any changes that may cause a problem. The most common type of male breast cancer occurs in the breast ducts (ductal carcinoma); 

Symptoms usually include:

    * Small painless lump in the breast;
    * Slight nipple discharge.

Do not forget that most of the problems affecting the breasts are not cancerous; consulting a physician will determine the nature of the problem and the need for treatment.

If you are diagnosed with breast cancer and receive treatment, this may change the perception you have of your body and affect your sexuality. Whether you have a partner or not, it is not necessarily easy to talk about these issues and find information to help you live better situation. Feel free to share your thoughts with members of your team. They can direct you to resources where you can find information and support you need.

Inflammatory breast cancer

The inflammatory breast cancer is a rare form of cancer that can develop and spread quickly, even in the early stages of the disease. This type of cancer can occur when breast cancer cells block the lymph vessels to help remove fluids, bacteria and other waste from the breast tissue. It may then result in inflammation of the breasts. Unlike most breast cancers, which cause the appearance of one or several different solid tumors, the inflammatory breast cancer tends to grow in layers or nests.
 

Symptoms

Symptoms of inflammatory breast cancer vary from person to person and can occur suddenly. Consult your doctor if you notice one or more of the following symptoms:

    * Changing the size or shape of the breast, the breast can take in a short amount of time (for some women, the equivalent of a cup size bra in a few more weeks);

    * Boobs hot or warm to the touch;
 

    * Change in color or normal breast texture of the skin of the breast can become red, pink or bruised for no apparent reason (in whole or in patches);
 

    * Itching breasts as ointments or creams can not relieve;
 

    * Sudden onset of a lump in the breast, but as inflammatory breast cancer tends to grow in layers instead of forming a solid tumor, a person with this type of cancer may not necessarily see the presence of a breast lump;

    * Swollen lymph nodes under the arm or above the clavicle;
 

    * Nipple discharge.

Symptoms of inflammatory breast cancer can be similar to a breast infection (mastitis), which can be treated successfully with antibiotics. If antibiotic treatment fails to eliminate the symptoms, it is important to consult the doctor again. Other tests may be needed to confirm or exclude a diagnosis of inflammatory breast cancer.
 

Diagnosis

The inflammatory breast cancer is rarely detected through mammography or ultrasound, unless a solid tumor has developed. The biopsy is the surest way to detect an inflammatory breast cancer.
 

Treatment

Treatment is often undertaken on the spot because inflammatory breast cancer can spread quickly. We usually use a combination of treatments: chemotherapy, surgery, radiotherapy and hormone therapy. As cancer cells proliferate inflammatory breast in all breast tissue rather than concentrating in a single tumor, often administered chemotherapy prior to surgery or radiotherapy.

Breast Cancer: acupuncture against hot flashes

The hot flashes caused by some treatments for breast cancer could be permanently reduced by acupuncture.

Acupuncture against hot flashes

According to the results of a U.S. clinical trial, acupuncture would help curb hot flashes and night sweats often caused by hormonal therapy for breast cancer. The benefits of this approach are also important and more durable than those made by drugs classically used to counteract these unpleasant side effects. Hot flashes caused by some cancer treatments can be alleviated by the administration of venlafaxine. However, this molecule has its own specific side effects: it causes a dry mouth, loss of appetite, nausea and constipation.

Acupuncture can relieve hot flashes associated with menopause, a team of American doctors had imagined it could also benefit patients in antitumor hormone. The hypothesis was tested in a small clinical trial. Fifty patients were divided randomly into two groups: the first group of women received the drug typically used to reduce hot flashes for twelve weeks. Those of the second group were treated by acupuncture, with two sessions per week for four weeks, then a weekly meeting the remaining eight weeks. Patients were then followed for one year.

Initially, it appeared that both treatment modalities were equally effective, leading one to the other as a reduction of 50% of episodes of hot flashes and mood changes associated. However, while the effect of drug treatment fades after only two weeks, one of acupuncture lasts up to three months. In addition, acupuncture is well tolerated by patients and not accompanied by side effects.

Before it can be definitively established that the benefit of acupuncture is superior to that of the administration of venlafaxine to relieve patients under hormone tumor, these results should be replicated on a larger group of patients.