THINKING PINK
Types, treatments of breast cancer vary
Area of origin, degree of spread dictate therapy decisions and prognosis
Published: Friday, October 23, 2009 at 5:00 p.m.
Last Modified: Friday, October 23, 2009 at 5:00 p.m.
We should really have breast cancer awareness ribbons in many different shades of pink, because breast cancer is not one simple disease. It has many forms, some of which have fairly new specific treatments that improve prognosis and the likelihood of a cure.
When my dear friend and fellow physician was told she had breast cancer, the first question she asked was, “What kind?” She knew that the answer to that question would shape her life for years to come.
The two most common breast cancers are named for the parts of the breast in which they start. So to understand the different diseases that cause breast cancer, it helps to understand the basic structure of the breast.
The breast is made of glands called lobules. These glands produce milk when stimulated by hormones. The milk-producing glands are connected to the nipple by passages called ducts. Filling in the space around the lobules and ducts is connective tissue consisting of lymph tissue, fat, blood vessels, and supportive ligaments.
About 5% of breast cancers are Infiltrating Lobular Carcinomas, beginning in the glands that produce milk.
The majority of breast cancers start in the cells that line the ducts inside the breast. If the cancer is confined to the duct it is called ‘Ductal Carcinoma in Situ’ (DCIS), but if it has invaded the surrounding tissue it is called ‘Infiltrating Ductal Carcinoma.’
Cancer cells can be confined to the area of origin, as in DCIS, or they can spread to the rest of the breast and further, to other parts of the body. Breast cancer usually spreads through the lymph system, so the lymph nodes under the arm on the affected side are examined for diseased cells. If the cancer has spread outside the breast, it’s a different disease.
In men, the breast has the same structure as a woman’s, except there are relatively small amounts of nonfunctioning glandular tissue. About 1% of breast cancers affect men, and most of these cases involve the ducts.
A rare and aggressive type of breast cancer that affects both men and women is called ‘inflammatory breast cancer’. The breast will appear red and swollen due to blocked lymph vessels.
The least common type of breast cancer is ‘Paget’s Disease of the Nipple’. It often looks like a skin rash or rough skin, and can be itchy. By the time the signs are seen on the surface, the cancer has usually invaded the ducts, so surgical treatment is necessary.
Once my physician friend knew the type of cancer she had and how far it had spread, her next question was, “Is it receptor positive or negative?” If her disease had receptors that responded to estrogen or progesterone, then hormone-specific chemotherapy could be effective in treating it. If not, then her options would be more limited.
The other cell receptor of interest is the “HER2” receptor. HER2 is a gene that sends control signals to breast cells. A healthy breast cell has two copies of this gene, but in some women there are more than two and the extra copies start over-producing proteins. These over-producing cells grow rapidly and create a cancer. HER2-positive breast cancer is a specific disease with unique treatment options.
Most breast cancers are not due to heredity. However, men and women who carry the BRCA1 or BRCA2 gene mutation do account for 5 — 10% of breast cancers. It was important for my friend to know her BRCA status; she has a daughter who may be affected.
My colleague and friend is getting treatment for her specific type of breast cancer, and as I sit in the chemotherapy infusion center with her I think how wonderful it would be to find a definitive cure for all breast cancers. Hope for a cure gives her the courage to continue. But we both know that with all these different shades of pink, we must hope for many different kinds of cure.
Dr. Stacey Kerr, a longtime Sonoma County family physician, graduated from UC Davis Medical School and is certified in her specialty by the American Board of Family Medicine. Her columns are not intended as a substitute for hand-on medical advice or treatment. Consult your health care provider before adhering to any recommendations in this column. Email comments to drkerr@the-doctors-inn.com.
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