Articles on Breast Cancer
What is breast cancer staging?
Breast cancer staging is the determination of the extent and spread of the cancer. An individual's health care team uses stages to summarize the extent of the cancer in a standardized way that is recognized by all health care providers. They use this staging to determine the treatment most appropriate for the type of cancer. Cancer staging helps to determine the prognosis, or outlook, of a cancer, including rates of recurrence and survival rates.
What are the stages of breast cancer?
The most widely used system in the U.S. is the American Joint Committee on Cancer (AJCC) TNM system. Medical professionals developed a new eighth edition of this staging system for 2018 that includes results of testing for certain biomarkers, including the HER2 protein, estrogen receptor (ER) and progesterone (PR), and the results of gene expression assays, in addition to the factors (TNM) described below.
Besides the information gained from the imaging tests, this system also uses the results from surgical procedures. After surgery, a pathologist looks at the cells from the breast cancer as well as from the lymph nodes. They incorporate this information into the staging, as it tends to be more accurate than the physical exam and X-ray findings alone.
The TNM system uses letters and numbers to describe certain tumor characteristics in a uniform manner. This allows health care providers to stage the cancer (which helps determine the most appropriate therapy) and aids communication among health care providers. The following is an abbreviated example of the TNM staging system.
T: This describes the size of the tumor. A number from 0 to 4 follows. Higher numbers indicate a larger tumor or greater spread:
- TX: Primary tumor cannot be assessed
- T0: No evidence of primary tumor
- Tis: Carcinoma in situ
- T1: Tumor is 2 cm or less across
- T2: Tumor is 2 cm-5 cm
- T3: Tumor is more than 5 cm
- T4: Tumor of any size growing into the chest wall or skin
N: This describes the spread to lymph node near the breast. A number from 0 to 3 follows.
- NX: Nearby lymph nodes cannot be assessed (for example, if they have previously been removed)
- N0: There has been no spread to nearby lymph nodes. In addition to the numbers, this part of the staging is modified by the designation "i+" if the cancer cells are only seen by immunohistochemistry (a special stain) and "mol+" if the cancer could only be found using PCR (special detection technique to detect cancer at the molecular level).
- N1: Cancer spreads to one to three axillary lymph nodes (underarm lymph nodes) or medical professionals find tiny amounts of cancer in internal mammary lymph nodes (lymph nodes near breastbone).
- N2: Cancer has spread to four to nine axillary lymph nodes or the cancer has enlarged the internal mammary lymph nodes.
- N3: Any of the conditions below:
- Cancer has spread to 10 or more axillary lymph nodes with at least one cancer spread larger than 2 mm.
- Cancer has spread to lymph nodes under the clavicle with at least area of cancer spread greater than 2 mm.
M: This letter is followed by a 0 or 1, indicating whether the cancer has spread to other organs.
- MX: Medical professionals cannot assess metastasis.
- M0: Health care providers find no distant spread on imaging procedures or by physical exam.
- M1: Spread to other organs is present.
Once physicians determine the T, N, and M categories, they combine them into staging groups. There are five major staging groups, stage 0 to stage IV, which are subdivided into A and B, or A and B and C, depending on the underlying cancer and the T, N, and M scale.
Cancers with similar stages often require similar treatments.
What are breast cancer survival rates by stage?
Survival rates are a way for health care professionals to discuss the prognosis and outlook of a cancer diagnosis with their patients. The number most frequently discussed is 5-year survival. It is the percentage of patients who live at least 5 years after a cancer diagnosis. Many of these patients live much longer, and some patients die earlier from causes other than breast cancer. With a constant change in therapies, these numbers also change. The current 5-year survival statistic is based on patients diagnosed at least 5 years ago and may have received different therapies than are available today. As with all statistics, although the numbers define outcomes for the group, any individual's outcome has the potential for a wide range of variation.
All of this needs to be taken into consideration when interpreting these numbers for oneself.
Below is the statistics chart from the National Cancer Institute's SEER database.
|Stage||5-year survival rate|
These statistics are for all patients diagnosed and reported. Several recent studies have looked at different racial survival statistics and have found a higher mortality (death rate) in African-American women compared to white women in the same geographic area.
How to prevent breast cancer
There is no guaranteed way to prevent breast cancer. Reviewing the risk factors and modifying the ones that can be altered (increase exercise, keep a good body weight, etc.) can help in decreasing the risk.
Following the American Cancer Society's guidelines for early detection can help early detection and treatment.
There are some subgroups of women that should consider additional preventive measures.
- Women with a strong family history of breast cancer need genetic testing such as HER2-Positive and BRCA Gene tests. Discuss this with a health care provider and meet with a genetic counselor who can explain what the testing can and cannot tell and then help interpret the results after testing.
- Chemoprevention is the use of medications to reduce the risk of cancer. The two currently approved drugs for chemoprevention of breast cancer are tamoxifen (a medication that blocks estrogen effects on the breast tissue) and raloxifene (Evista), which also blocks the effect of estrogen on breast tissues. Their side effects and whether these medications are right for an individual need to be discussed with a health care provider.
- Aromatase inhibitors are medications that block the production of small amounts of estrogen usually produced in postmenopausal women. They prevent reoccurrence of breast cancer but are not approved at this time for breast cancer chemoprevention.
- For a small group of patients who have a very high risk of breast cancer, surgery to remove the breasts may be an option. Although this reduces the risk significantly, a small chance of developing cancer remains.
What research is the latest research on breast cancer? Is it worthwhile to participate in a breast cancer clinical trial?
Research can take many forms, including research in the laboratory directly on cancer cells or using animals. Research can also be performed using patient volunteers.
Research that a patient can be involved in is referred to as a clinical trial. In clinical trials, different treatment regimens are compared for side effects and outcomes, including long-term survival. Clinical trials aim to find out whether new approaches are safe and effective.
Whether one should participate in a clinical trial is a personal decision and should be based upon a full understanding of the advantages and disadvantages of the trial. One should discuss the trial with a health care team and ask how this trial might be different from the treatment one would usually receive.
Someone should never be forced to participate in a clinical trial or be involved in a trial without full understanding of the trial and a written and signed consent.
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Salerno, K.E. "NCCN Guidelines Update: Evolving Radiation Therapy Recommendations for Breast Cancer." J Natl Compr Canc Netw 15(5S) May 2017: 682-684.
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Top Breast Cancer/Stages Related Articles
Breast cancer is an invasive tumor that develops in the mammary gland. Breast cancer is detected via mammograms, breast self-examination (BSE), biopsy, and specialized testing on breast cancer tissue. Treatment of breast cancer may involve surgery, radiation, hormone therapy, chemotherapy, and targeted therapy. Breast cancer risk may be lowered by managing controllable risk factors.
Breast Cancer RecurrenceBreast cancer most often recurs within the first three to five years after the initial treatment. Changes in the look, feel, or appearance of the breast may indicate breast cancer recurrence. Factors related to recurrence include tumor size, tumor grade, hormone receptor status, lymph node involvement, and oncogene expression. Treatment for recurrent breast cancer depends on the initial treatment.
Breast Cancer Symptoms and SignsIn most cases, there are no early warning signs of breast cancer. Breast cancer may not produce any early symptoms, and in many cases, it is first discovered on screening mammography. The most common sign of breast cancer is a new lump or mass in the breast.
Breast Cancer Facts
Breast cancer is the most common non-skin cancer of American women, but it can also occur in men. Every year in the U.S., there are over 266,000 new diagnoses of breast cancer. A woman has a risk of one in eight for developing breast cancer at some point during her lifetime.
Can Fibroadenomas Turn Into Breast Cancer?A fibroadenoma is the most common type of benign, non-cancerous lump of the breast. Although it is rare, complex fibroadenomas and phyllodes tumors have a chance to develop into malignant breast cancer.
Inflammatory Breast CancerInflammatory breast cancer is an accelerated form of breast cancer that is not usually detected by mammogram or ultrasound. Symptoms of inflammatory breast cancer include pain in the breast, skin change in the breast area, bruise on the breast,sudden swelling of the breast, nipple retraction or discharge, and swelling of the lymph nodes.
Male Breast CancerMale breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
What Is the Difference Between a Radical Mastectomy and Modified Radical Mastectomy?In a radical mastectomy, the entire breast tissue along with the nipple, covering skin, lymph nodes (filter organs for harmful substances) in the armpit and chest wall muscle under the breast is removed. It is known as a standard treatment for breast cancer. In a modified radical mastectomy (MRM), the entire breast is removed, including the skin, areola (surrounding the nipple), nipple and most armpit lymph nodes. The underlying chest wall muscles (the pecs) will be left intact. Additionally, the skin covering the chest wall may or may not be removed.
Triple-Negative Breast CancerTriple-negative breast cancer is more common in Hispanic and African-American women. Signs and symptoms include a lump in the armpit or breast, nipple discharge and inversion, and changes in the breast's skin. Treatment may incorporate surgery, chemotherapy, and radiation therapy.
What Is Usually the First Sign of Breast Cancer?A lump in the breast or in the armpits is often the first sign of breast cancer. This may be felt while in the shower. There may or may not be changes in the structure of the breast. Other early signs include changes in breast skin, breast pain and others.