[TiT] That’s It Tuesday €? Issue 35

Paying out-of-pocket expenses related to your treatment can be a burden. This can lead to struggles paying other expenses such as rent, groceries and car payments. There are some financial assistance programs that may help.

[TiT] That’s It Tuesday – Issue 35

DCIS is very early breast cancer. In DCIS, the cancer cells are only inside the milk ducts. (Ducts are the tiny tubes that carry milk to the nipple). The cancer cells have not spread through the walls of the ducts into the nearby breast tissue. Nearly all women with DCIS can be cured.

Invasive breast cancer means the cancer has grown outside the place it started (for example, a milk duct or milk gland) and is invading (growing into) nearby breast tissue. These cancers might also spread to other places in the body. Most invasive breast cancers are one of these types:

TNBC is invasive breast cancer that certain types of treatment won't work on. It's called triple-negative because the cancer cells are missing three kinds of proteins that breast cancers are tested for: estrogen and progesterone receptors (proteins that help cells respond to hormones), and another protein called HER2 (a protein that other types of breast cancer make too much of). When a breast cancer tests negative for all three of these proteins, it means the cancer might be harder to treat because there are fewer treatment options.

Breast ultrasound: For this test, a small wand-like instrument is moved around on your breast. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture on a computer screen. Ultrasound can help the doctor see if a lump is a fluid-filled cyst (which is not likely to be cancer), or if it's a solid mass that could be cancer.

The cancer cells might also be tested for certain genes, which can help decide if chemo might be helpful and how likely it is that the cancer will come back. Other gene tests can help show if certain drugs might be helpful.

Your cancer can be stage 0, 1, 2, 3, or 4. The lower the number, the less the cancer has spread. A higher number, like stage 4, means a more serious cancer that has spread farther than the breast. Be sure to ask the doctor about the cancer stage and what it means for you.

Any type of surgery can have risks and side effects. Be sure to ask the doctor what you can expect. If you have problems after surgery, let your cancer care team know. They should be able to help you with any problems that come up.

Radiation uses high-energy rays (like x-rays) to kill cancer cells. This treatment may be used to kill any cancer cells that may be left in the breast, chest, or armpit after surgery. It can also be used in some areas outside the breast where cancer has spread.

Your body makes estrogen, a female hormone, until you go through menopause. After that, your body still makes it but in much smaller amounts. Even these small amounts are enough to cause some breast cancers to grow. Drugs that block the effect of estrogen or cut down estrogen levels can be used to treat these breast cancers. Drugs like this are a type of hormone therapy.

Targeted drug therapy for breast cancer can cause many different side effects, depending on which drug is used. A serious side effect that can happen with drugs that target the HER2 protein is damage to the heart. You doctor will watch you closely for this and check your heart regularly.

Anyone with cancer, their caregivers, families, and friends, can benefit from help and support. The American Cancer Society offers the Cancer Survivors Network (CSN), a safe place to connect with others who share similar interests and experiences. We also partner with CaringBridge, a free online tool that helps people dealing with illnesses like cancer stay in touch with their friends, family members, and support network by creating their own personal page where they share their journey and health updates.

IDC or invasive ductal carcinoma (in-VAY-siv DUCK-tul CAR-sin-O-muh): breast cancer that starts in a duct and grows through the wall of the duct. It can spread to other parts of the body.

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Histologic section of a fibroadenoma (hematoxylin-eosin staining, 40). The cellular fibroblastic stroma, which resembles intralobular stroma, encloses glandular and cystic spaces lined by epithelium. Round and oval gland spaces, lined by either single or multiple cell layers, are present in other areas. The stroma in the connective tissue appears to have undergone a more active proliferation with compression on the gland spaces.

Macroscopic appearance of a fibroadenoma. The spherical mass is sharply circumscribed, and could be easily separated from the surrounding breast tissue. The section margins have a green-white color, and contain slit-like spaces.

The risk of missing breast cancer in women under 25 years of age who have fibroadenomas as diagnosed by physical examination, sonography, and FNA is 1 in 229 to 1 in 700.21, 24 This risk remains very low in women under the age of 35 years. Therefore, it has been recommended that young patients should be observed with frequent clinical evaluations, and the lesions excised in women over the age of 35 years.22, 23, 30 Other investigators suggested that the cutoff age should be 25 years.33

For women in which a fibroadenoma is diagnosed before the age of 35, we recommend conservative management with a protocol of follow-up every 6 months in order to detect any changes of the lesion (Fig. 4). In cases of regression, the follow-up should continue until complete regression. Fibroadenomas that either do not completely regress, or remain unchanged by the age of 35, should be excised surgically. Fibroadenomas that become larger should be excised without delay. In patients with a family history of breast cancer, or known changes of complex fibroadenoma, we recommend excisional biopsy shortly after diagnosis has been established.

A complete clinical breast examination (CBE) includes an assessment of both breasts and the chest, axillae, and regional lymphatics. In premenopausal women, the CBE is best done the week following menses, when breast tissue is least engorged. With the patient in an upright position, the physician visually inspects the breasts, noting asymmetry, nipple discharge, obvious masses, and skin changes, such as dimpling, inflammation, rashes, and unilateral nipple retraction or inversion.15

Benign masses generally cause no skin change and are smooth, soft to firm, and mobile, with well-defined margins. Diffuse, symmetric thickening, which is common in the upper outer quadrants, may indicate fibro-cystic changes. Malignant masses generally are hard, immobile, and fixed to surrounding skin and soft tissue, with poorly defined or irregular margins.15 However, mobile or nonfixed masses can be cancerous. Infections such as mastitis and cellulitis tend to be erythematous, tender, and warm to the touch; they may be more circumscribed if an abscess has formed. Similar symptoms may occur in patients with inflammatory breast cancer. Therefore, caution should be used in assessing patients with suspected breast infections.

Digital palpation of the breast is effective in detecting masses and can help determine whether a mass is benign or malignant.15,17 CBE can detect up to 44 percent of cancers, up to 29 percent of which would not have been detected by mammography.15,17 Despite its accuracy, CBE alone is not adequate for definitive diagnosis of breast cancer. Further evaluation, including follow-up examinations, imaging, and tissue sampling, is required in all patients with breast masses.

Although ultrasonography is not considered a screening test, it is more sensitive than mammography in detecting lesions in women with dense breast tissue.18,20 It is useful in discriminating between benign and malignant solid masses,18,21 and it is superior to mammography in diagnosing clinically benign palpable masses (i.e., up to 97 percent accuracy versus 87 percent for mammography).21

Diagnostic mammography can help physicians determine whether a lesion is potentially malignant, and it also screens for occult disease in surrounding tissue. A radio-opaque ball bearing marks the location of the mass, and spot compression and magnification views can clarify the breast mass and determine its density. If old films are available, they are compared with the new images. Diagnostic mammography is up to 87 percent sensitive in detecting cancer.22 Its specificity is 88 percent, and its positive predictive value may be as high as 22 percent.22

Core-needle biopsy (CNB) produces a larger tissue sample than FNA and may be used in conjunction with ultrasonography or stereotactic imaging for small or difficult-to-palpate lesions. Local anesthesia is required. A 14- to 18-gauge cutting needle is used to obtain two to six slender cores of tissue for histology.37,38 The sensitivity of ultrasonography-guided CNB may be as high as 99 percent in diagnosing malignancy in palpable lesions and 93 percent in nonpalpable lesions.1 Specimens can be used to differentiate between in situ and invasive carcinoma, and to identify hormone-receptor levels.39 Results vary depending on radiographic guidance, the size of the needle, and the number of cores sampled. A minimum of four cores is suggested to achieve greater accuracy.37,38 Insufficient specimens are rare.1,38 Compared with FNA, CNB takes more time and requires specific training and patient anesthesia, but it has a higher positive predictive value for suspicious and atypical results and may provide an overall cost benefit.38

The Triple Test Score (TTS) was developed to help physicians interpret discordant triple test results.41,42 A three-point scale is used to score each component of the triple test (1 = benign, 2 = suspicious, 3 = malignant). A TTS of 3 or 4 is consistent with a benign lesion; a TTS of 6 or more indicates possible malignancy that may require surgical intervention. Excisional biopsy is recommended in patients with a TTS of 5 to obtain a definitive diagnosis.