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Breast Cancer

Breast cancer is the most common type of cancer in women in the U.S. This type of cancer starts in the breast and occurs when cells change and grow. The ducts and lobules are the two parts of the breast where cancer is most likely to start.

Our Capabilities

The UC Comprehensive Breast Cancer Center maintains accreditations through the National Quality Measures for Breast Centers as a Certified Quality Breast Center of Excellence; the American College of Radiology as a Breast Imaging Center of Excellence; and the American College of Surgeons’ National Accreditation Program for Breast Centers. We are one of just 21 centers nationally and the only one regionally to earn and maintain this “Triple Crown” of accreditations.

Compassionate Healing Starts Here

Click below to learn more about where you can find compassionate care.

As the region's only triple-accredited breast cancer center, our promise to you is world-class care delivered with deep compassion. Our experts are physicians and researchers who relentlessly pursue the best and latest treatments for your breast cancer, offering you hope for your diagnosis.

To schedule an appointment, please call the UC Breast Cancer team at 513-584-5023.

About This Condition

Understanding Breast Cancer

What is breast cancer?

Cancer is a disease caused by uncontrolled growth of abnormal cells. Just like in other organs, cancer can grow in breast tissue. The breast is composed of two types of tissue: epithelium and stroma.

  • Epithelium is a type of tissue that is composed of glands that make milk and transport it to the nipple. Epithelial tissue is made of small units called duct-lobular units, which connect to form 20–30 large channels called lactiferous ducts. These ducts open into the nipple.

  • Stroma is breast tissue that is made of fat, blood vessels and fibrous tissue and acts as the connective, supportive framework for the epithelial tissue.

Cancer can grow in both of these types of breast tissues. The most common types of breast cancers grow from epithelial tissue.

Types of breast cancer

  • Ductal carcinoma in situ (DCIS). This type of cancer grows in the cells of your breast ducts and is confined to that area. DCIS is the most common type of breast cancer in the epithelial tissue. DCIS can be classified as low-grade, or less aggressive, or high-grade/comedo type, or more aggressive. Low-grade DCIS is usually discovered during a mammogram, but high-grade DCIS may produce a lump that can be felt during a self-breast exam; this is a noninvasive cancer.

  • Invasive ductal carcinoma. This type of cancer begins in the breast duct like DCIS, but breaks the “basement membrane,” or the barrier around the ducts. When the cancer cells break the basement membrane, they travel into the stroma tissue, which is called invasion. This means the cancer can grow in both types of breast tissue and spread, or metastasize, to other parts of the body. 

  • Invasive (infiltrating) lobular carcinoma. This type of cancer begins growing in the milk-producing glands of the breast called lobules. Much like invasive ductal carcinoma, the cancer cells break the barrier that separates the tissues, giving the cells the opportunity to metastasize to other areas of the body. This type of cancer not only looks different than invasive ductal carcinoma but is also different in the way it spreads and responds to treatment. 

  • Paget’s disease. This condition can be malignant or benign and begins growing in the breast ducts and spreads to the skin of the nipple and areola. Characterized by a rough, red, irregular appearance, similar to a scaly rash, this type of cancer is usually associated with aggressive types of DCIS or invasive ductal carcinoma. Cancer underlying the Paget’s disease may or may not form a lump.

  • Inflammatory breast cancer. Occasionally, high-grade invasive ductal carcinoma transfers small clusters of tumor cells into the lymphatic channels of breast skin. These cancer cell clusters block the lymphatic spaces, causing swelling and redness of the breast skin, giving it the appearance of an orange peel. Inflammatory breast cancer tends to be more aggressive than other types of cancers and usually occurs at a younger age than the more common types of cancer.

  • Triple-negative breast cancer. This is a type of breast cancer that doesn’t have estrogen receptors and progesterone receptors. It also doesn’t have an excess of the HER-2 protein on the cancer cell surfaces. This type of breast cancer tends to occur more often in younger women and in African American women. It tends to grow and spread faster than most other types of breast cancer. Because these cancer cells don't have hormone receptors or excess HER-2, medicines that target these changes don't work. The most common kind is triple-negative invasive ductal carcinoma.

  • Special types. Some uncommon subtypes of breast cancer are called special types. Depending on the subtype, these cancers can have a better or worse outcome compared to invasive ductal carcinoma. For example, patients with mucinous carcinoma tend to have a better prognosis. On the other hand, metaplastic carcinoma is often associated with a worse outcome.

Understanding your tumor grade and stage

Breast cancer grade

The grade of cancer describes how abnormal the cancer cells look under the microscope. Understanding the grade helps your doctors predict how fast the cancer may grow and spread. To grade your cancer, the pathologist gives a number from 1 to 3. Slower-growing tumors score a 1, while faster-growing tumors score a 3. A grade 3 cancer detected at a very early stage may have a better prognosis than a grade 1 cancer that is undiscovered until after it has spread to other organs. Ask your doctor to explain the grade of your cancer.

Breast cancer stage

The stage of your cancer is how doctors communicate the size of a tumor and how far it has spread. The stage and grade of a cancer are unrelated. However, the two categories combined describe the status of the cancer in such a way that your doctor can figure out appropriate treatment. The stage is based on the size and extent of your tumor, the number of nodes involved and whether the cancer has spread. Your oncologist will determine your stage from tests, including a breast biopsy and lymph node evaluation. Usually, the stage of a cancer is more important in determining a treatment strategy than its grade.

Pathologist

A pathologist is a doctor with special training in identifying cells by looking at them under a microscope. After a biopsy is obtained, the pathologist will examine the cells and issue a report that includes the type of cancer as well as information about the cancer’s biology, such as rate of growth and sensitivity to hormones. After additional surgery, the pathologist provides a report that discusses the stage of the cancer.

Breast cancer stages

Doctors need to know what stage your breast cancer is in to decide what treatment to recommend. The stage is based on the size and extent of your tumor, the number of nodes involved and whether the cancer has spread. Your oncologist will determine your stage from tests like a biopsy or a lymph node biopsy. Usually, the stage of a cancer is more important in determining a treatment strategy than its grade.

After a woman is diagnosed with breast cancer, tests will be done to determine if the cancer has spread from the breast to other parts of the body. This is called staging and is an important step in planning a treatment plan.

What are the different stages of breast cancer?

Stage 0

Stage 0 means there is no presence of a tumor. Paget’s disease of the nipple is also considered stage 0.

Carcinoma in situ or stage 0

Carcinoma in situ is an early form of cancer, and it has two types:

  • Ductal carcinoma in situ (DCIS)
  • Lobular carcinoma in situ (LCIS)

This stage may also be called breast cancer in situ.

Stage I

Stage I is subdivided into two stages:

  • Stage IA: The tumor is 2 centimeters or smaller, and cancer is not found in any lymph nodes or distant sites.

  • Stage IB:The cancer is 2 centimeters or smaller, or no tumor is found at all, but very small amounts of cancer cells have spread to the lymph nodes under the arm. No cancer cells have spread to any other distant areas of the body.

Stage II

Stage II is subdivided into two stages. There is no spread to distant body parts in either stage:

  • Stage IIA is defined by any of the following:

    • The tumor is 2 centimeters or smaller, or no tumor is found at all, but cancer is found in 1–3 lymph nodes under the arm.

    • The tumor is no larger than 2 centimeters, or no tumor is found at all, but has spread in very small amounts to the internal mammary lymph nodes.

    • The tumor is 2 centimeters or smaller, or no tumor is found at all, but has spread to 1–3 lymph nodes under the arm and has spread to the internal mammary lymph nodes.

    • The tumor is between 2 and 5 centimeters but has not spread to any lymph nodes.

  • Stage IIB is defined by either of the following:

    • The tumor is between 2 and 5 centimeters and has spread to the lymph nodes under the arm and/or very small amounts of cancer are found in the internal mammary lymph nodes.

    • The tumor is less than 5 centimeters but has not spread to any lymph nodes, the chest wall or the skin.

Stage III

Stage III is subdivided into three stages, but the cancer has not spread to distant parts of the body in any of these stages: 

  • Stage IIIA is defined by either of the following: 

    • The tumor is less than 5 centimeters, or no tumor is found at all, but cancer is found in 4–9 lymph nodes under the arm, or has enlarged the internal mammary lymph nodes.

    • The cancer is larger than 5 centimeters and has spread to the lymph nodes under the arm or the internal mammary lymph nodes but not to the chest wall or skin. 

  • Stage IIIB is defined by any of the following: 

    • The cancer has spread to tissues near the breast (skin or chest wall, including the ribs and the muscles in the chest) but not into any lymph nodes. 

    • The cancer has spread to tissues near the breast and to 1–3 lymph nodes under the arm and/or very small amounts of cancer are found in the internal mammary lymph nodes. 

    • The cancer has spread to 4–9 lymph nodes under the arm, or it has enlarged the internal mammary lymph nodes. 

  • Stage IIIC can have a tumor of any size and is defined by any of the following: 

    • Cancer has spread to lymph nodes under or above the collarbone and near the neck. 

    • The cancer has spread to 10 or more lymph nodes under the arm. 

    • The cancer has spread to lymph nodes under the arm and has enlarged the internal mammary lymph nodes. 

    • The cancer has spread to four or more lymph nodes under the arm and very small amounts of cancer are found in the internal mammary lymph nodes.

Stage IV 

  • Stage IV is defined by either of the following: 

    • The cancer has spread to other organs in the body, most often the bones, lungs, liver or brain. 

    • The tumor has spread to lymph nodes far from the breast.

Inflammatory breast cancer 

This is a rare type of cancer in which the breast looks inflamed because of its red appearance and warmth. Skin may show signs of ridges and wheals or it may have a pitted appearance. It is considered stage IIIB unless it has spread to distant lymph nodes or organs, in which case it is considered stage IV.

Local/regional recurrent breast cancer 

Local and regional recurrence is cancer that returns in the same general area of previous breast surgery, skin, breast tissue, or chest wall and/or nearby lymph nodes.

Systemic recurrent breast cancer 

This is cancer that returns in other parts of the body.

How breast cancer spreads

The place in the body that cancer begins is called the primary site or primary tumor. When cancer spreads to other parts of the body, it is called metastatic cancer or metastasis. Usually breast tumors use the lymph nodes or blood stream to travel from the breast to other organs.

The lymph nodes under your arms are usually the first area where breast cancer spreads. In some cases, breast cancer spreads to distant parts of your body including the bones, lungs, liver, brain or other organs. It may also spread to your skin. Although the cancer has spread, it is not a new cancer. For instance, if breast cancer spreads to your liver, it is not considered liver cancer. It is called metastatic breast cancer, and its treatment will be for advanced breast cancer.

Risk factors

Breast cancer: An equal opportunity disease

There are approximately 240,000 new cases of invasive breast cancer as well as 50,000 new cases of noninvasive breast cancer diagnosed every year in the United States. Ideally, we would like to identify risk factors that can predict which women will be diagnosed. The major identified risk factor categories relate to hormone history and family history. Other past medical problems including prior history of premalignant breast biopsies, dense breast tissue and history of chest wall radiation can also increase a woman's risk for breast cancer. Although these risk factors are important, 70% of newly diagnosed women have no special risk factors except female sex and advancing age.

Hormone risk factors

Because 99% of breast cancer occurs in women, it is important to consider endogenous (natural body produced) and exogeneous (supplemental) hormones as risk factors for breast disease and breast cancer. Having your first menstrual period (menarche) before age 11, or your last menstrual period (menopause) after age 55 increases a woman’s risk for breast cancer. Likewise, women who have never had a full-term pregnancy, or delay their first full-term pregnancy until after age 30, are also at a slight increased risk for breast cancer.

Women who receive supplemental hormones may also be at increased risk for the development of breast cancer. Hormone replacement therapy (HRT) is frequently prescribed to control symptoms of menopause. Combined hormone therapy uses two types of hormones called estrogen and progesterone. This type of hormone therapy is generally prescribed for women who have not had their uterus removed (hysterectomy). Estrogen therapy alone can also treat menopausal symptoms, and it is the preferred option for women who have previously had a hysterectomy. Studies suggest that women who use combined hormone replacement therapy are at increased risk for the development of breast cancer. This increased risk occurs after more than four years of usage and in older women. Usually the risk returns to normal within five years of discontinuing use. Current guidelines recommend using the lowest doses of HRT and for as short a time as possible.

Currently there are no studies confirming a definite link between birth control (oral contraception) pills or fertility drugs and the development of breast cancer.

After the diagnosis of breast cancer, it is recommended that all forms of exogenous (supplemental) hormones be discontinued.

Lifestyle

What are lifestyle factors that increase my risk for breast cancer?

Research has indicated that women with the following risk factors have an increased chance of developing breast cancer.  

Alcohol use: Studies have indicated that the use of alcohol is linked to an increased risk of developing breast cancer. This risk appears to increase in proportion to the amount of alcohol consumed daily. Women who consume 2–5 drinks daily have about one and a half times greater risk than women who don’t drink alcohol at all.

Smoking: Evidence suggests a link between smoking and breast cancer risk, particularly in premenopausal women. In addition, not smoking is one of the best things you can do for your overall health.

High weight or obesity: Many studies suggest that postmenopausal women who are overweight are at increased risk for breast cancer development. Being overweight is not an identified risk factor for premenopausal women. Maintaining a normal body mass index after the diagnosis of breast cancer is associated with better outcome as well.

Limited exercise: Women who are physically inactive throughout their life may have an increased risk of breast cancer.

Poor diet: Eating a low-fat diet appears to offer only a slight reduction in the risk of breast cancer. However, a healthy diet can also help maintain a healthy weight, which is a key factor in breast cancer prevention.

UC Breast Cancer High Risk Program

The Breast and Ovarian Cancer High Risk Program exists to promote awareness about breast and ovarian cancer risk to patients, families and healthcare providers. The

program provides an expert evaluation for patients who are identified as high risk for either breast or ovarian cancer.  

After a patient is evaluated, he or she is offered appropriate counseling, testing and primary prevention measures to reduce the likelihood of cancer development. This multidisciplinary approach to women’s cancer risk assessment and management (RAMP) will utilize the services of breast imaging and genetics along with surgical oncology, medical oncology, and gynecologic oncology.

Who would be considered at high risk?

  • A person who has one or more first-generation relatives with breast or ovarian cancer before the age of 50.

  • An individual who has one first-generation relative with bilateral breast cancer.

  • Individuals with a known personal or family genetic abnormality in a breast cancer-causing gene, such BRCA or CHEK-2.

  • A person with prior breast biopsy showing atypical ductal hyperplasia or lobular neoplasia.

  • Individuals with a Gail Model breast cancer risk of greater than or equal to 1.67% over the next five years or greater than 20% lifetime risk.

  • An individual with a history of chemoradiotherapy to treat Hodgkin’s disease.

What are aggressive surveillance strategies?

Aggressive breast screening methods are comprehensive exams that may offer additional procedures, such as MRIs, or more frequent examinations compared to regular annual screening evaluations. The appropriate surveillance procedures and frequency will be determined by your breast team of physicians.

Clinical breast exam

A clinical breast exam is much like the self-breast exams you perform regularly at home, but a doctor or nurse practitioner conducts this physical exam. The examination will include visual inspection and palpation of the breast and underarm areas to detect changes or abnormalities.

Mammogram

Mammography can detect abnormalities in breast tissue before more obvious symptoms are present. Mammography remains the most reliable screening method for early signs of breast cancer. Annual mammograms are recommended for average-risk women beginning at age 40. Some women who have an increased risk for breast cancer may begin at an earlier age. In some cases, there are limitations to the effectiveness of mammograms. For example, in women younger than 40 and those with dense breast tissue, mammography may not be as effective in detecting abnormalities.

Breast ultrasound

Ultrasound may be used in addition to mammography for women with dense breast tissue seen on their mammogram. Mammograms are the first choice for breast cancer screening in all women. Adding an annual breast ultrasound may assist in better identifying lumps in dense breast tissue. However, ultrasonography tends to find noncancerous lesions more often than mammography. This may lead to additional testing and biopsy to exclude cancer.

MRI

A breast MRI is the most sensitive test for detecting early breast cancer. Although an MRI can detect small cancers not visible by mammography or ultrasound, it may also find more noncancerous lesions. MRI should be used as a screening tool in addition to mammography for women who have a significantly increased risk for breast cancer. These high-risk patients can include those with BRCA gene mutations, prior history of therapeutic chest radiation between ages 10 and 30, strong family history of breast cancer, personal history of breast cancer or LCIS or a combination of risk factors resulting in a greater than 20% lifetime risk of breast cancer based on breast cancer risk models.

Prophylactic (preventive) surgery

Prophylactic surgery involves removing a noncancerous body part to prevent cancer from developing. Women at high risk for breast cancer or BRCA mutation carriers will sometimes opt to undergo a prophylactic mastectomy. Because BRCA mutation carriers are also at high risk for the development of ovarian cancer, prophylactic oophorectomy (removal of both ovaries) are often considered. Prophylactic surgeries are very effective at preventing the development of new cancers. However, they are not 100% foolproof, and the decision needs to be made after careful discussion with family members and the healthcare team.

Chemotherapy prevention or pharmacologic prevention

Chemotherapy prevention involves prescribing medications known to reduce disease to healthy people who are at risk of developing a disease. This practice is used in many other disease states such as the prescribing of statin drugs to reduce cholesterol and eventually heart disease. Currently there are three oral medications — tamoxifen, raloxifene, and aromatase inhibitors — that have been extensively tested and approved to reduce breast cancer risk. For some high-risk women, taking one of these medications can reduce the chances of developing hormone-responsive breast cancer by as much as 50–60%. Although generally these medications are very well tolerated, side effects can occur.

It is important for all high-risk women to discuss chemoprevention. Ongoing clinical research is being conducted to explore other possible drug interventions.

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