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Diagnosis

 
Diagnosis

Chapter: 4 - Diagnosis

Subchapter: 1 - Causes of Breast Cancer

Causes of Breast Cancer

- What if it’s cancer?
- What caused it?
- What should I do now?
- How is breast cancer treated?
- How long will treatment take?
- What will it be like?
- Will I be okay?
- What about my family?

When a lump or suspicious site in your breast is detected, it raises some serious questions. In this chapter, we are going to do our best to answer them. We will discuss what doctors know and do not know, how to react to your diagnosis as well as how to understand it, and how to move beyond the shock.

Risk Factors
So what do scientists actually know about the causes of cancer? It’s a difficult question. Cancer grows when a cell’s DNA is damaged, which we discussed in Chapter 3, but why or how that DNA becomes damaged is still unknown. It could be genetic or environmental, or in most cases a combination of the two. But most patients will never know exactly what caused their cancer.

However, there are certain established risk factors that are associated with breast cancer:

- A family history with breast cancer
- Early menstruation (before age 12)
- Late menopause (after 55)
- Breast tissue that is more dense with lobular and ductal tissue relative to fatty tissue
- Noncancerous cell abnormalities

These factors are genetic, they are not something you can control.

60-70% of people with breast cancer have no connection to them at all, and other people with risk factors will never develop cancer.

Related Questions

  • Thumb avatar default

    My cancer is stage 1, but my grade is a 3, will that change the type of treatment I will have?

    Asked by anonymous

    Learning About Breast Cancer
    almost 7 years 1 answer
    • Sharon Danielson Profile
      anonymous
      Survivor since 2007

      Oh SO many things are looked at for determining treatment. Many more aspects than just stage and grade.... what type of breast cancer, your age, hormone receptors, types of cells etc. those all go into your treatment plan. Cancer treatment is tailored made for each woman's diagnosis. Your...

      more

      Oh SO many things are looked at for determining treatment. Many more aspects than just stage and grade.... what type of breast cancer, your age, hormone receptors, types of cells etc. those all go into your treatment plan. Cancer treatment is tailored made for each woman's diagnosis. Your individual cells change your treatment from all the other women with breast cancer. Hang in there....This is a great group of women on this site and we'd love to help and support you as you are going through your treatment. Take care, Sharon

      Comment
  • Tiffani Warila Profile

    To those of you diagnosed young, were you taking any forms of birth control and if so, for how long?

    Asked by anonymous

    Learning About Breast Cancer
    over 7 years 5 answers
    • View all 5 answers
    • Tiffani Warila Profile
      anonymous
      Learning About Breast Cancer

      Thanks for the info. I was on the ortho evra patch for about 5 years following the birth of my daughter. I started using it sometime in 2006. My doctor said that the cancer probably started about 5 years ago so my first thought was that the patch had something to do with all of this. My doctor...

      more

      Thanks for the info. I was on the ortho evra patch for about 5 years following the birth of my daughter. I started using it sometime in 2006. My doctor said that the cancer probably started about 5 years ago so my first thought was that the patch had something to do with all of this. My doctor has told me to stop using the patch now - which i was going to do anyways. I wasnt sure if he wanted me to stop because of the upcoming treatments or what? I'm glad that there are other ladies to talk to that are going through the same thing as me.

      Comment
    • Amanda Metivier Profile
      anonymous
      Learning About Breast Cancer

      I am 27 and was diagnosed in December with stage 2a invasive ductal carcinoma. I used the pill from age 16-17, then depo-provera until age 24. I had my son in January of 2008 and had a mirena inserted six weeks later. My doctors believe my cancer starting developing around the time my son was...

      more

      I am 27 and was diagnosed in December with stage 2a invasive ductal carcinoma. I used the pill from age 16-17, then depo-provera until age 24. I had my son in January of 2008 and had a mirena inserted six weeks later. My doctors believe my cancer starting developing around the time my son was born, however it may have been in-situ and drawn out by nursing. I still have the mirena.

      Comment
  • Jessica  Addom  Profile

    I've been having dark green almost black discharge out of my left breast for 6 months! An ultrasound, mammogram & a sample of the fluid, which nothing came back abnormal the sample came back only skin cells.

    Asked by anonymous

    Learning About Breast Cancer
    over 4 years 2 answers
    • Michele Schultz Profile
      anonymous
      Learning About Breast Cancer

      Has the fluid been biopsies? Consult a beast surgeon. Good luck. Maybe consult an oncologist too. That discharge does not seem normal and more opinions would ease your mind!

      Comment
    • Michele Schultz Profile
      anonymous
      Learning About Breast Cancer

      Breast surgeon not beast surgeon. :)

      Comment
  • marcella turgeon Profile

    is an Mri a good tool for detecting DCIS

    Asked by anonymous

    Learning About Breast Cancer
    over 6 years 3 answers
    • Coco Smith Profile
      anonymous
      Learning About Breast Cancer

      This is an interesting question and there are many ways of approaching it.

      This is my view.

      It is universally acknowledged that the earlier a cancer is detected and treated, the greater are our survival statistics. Globally with DCIS alone with no spread you are already in the category of...

      more

      This is an interesting question and there are many ways of approaching it.

      This is my view.

      It is universally acknowledged that the earlier a cancer is detected and treated, the greater are our survival statistics. Globally with DCIS alone with no spread you are already in the category of higher disease free survival - well over 85% and closer to 90%.

      I am more supportive of medical technologies that detect any cancer earlier rather than later. Later normally means the cancer may be older, bigger and therefore has had more time to be in the breast and spread by tossing off cancerous cells into the body. It's that - cancer metastases - that poses the greatest risk to our survival.

      There are also some groups of women who studies already show benefit even more from MRI's. The medical profession tend to agree that if you have the BRACA genes you are better off with MRI's.

      The problem here of course is that you and your doctors will not know if you have the more dangerous genes without a very expensive genetic test. If you do not have that expensive tests that shows you have the genes posing most risk for breast cancer, then the system treats you as if you do not have that gene. You see the logical problem here - it is quite possible to have the genes - but not be able to afford the test to prove it.

      These are women with dense breast tissue [who tend to be younger but not always - I am over 50 with dense breast tissue], women with higher family risk of breast cancer, and I would add three others - women who have a personal, proven history of breast cancer already, women who avoid mammograms because they find them too painful and women who do want to subject their bodies to avoidable radiation.

      MRIs use magnets with low dose contrast agent via injection - mammograms use radiation. About 1% of MRI patients can have an adverse reaction to the contrast agent. If you have a history of allergies, anaphylaxsis etc you need to inform the MRI service - they can in fact use a low allergy contrast dye that is a bit more expensive to further reduce this risk.

      There is also serious under acknowledgement amongst medicos of women with long histories of exquisitely tender breasts who find the degree of hard compression associated with effective mammograms too painful and unfortunately we have a mammogram culture where almost no effort is put into identifying women with such tender breasts and offering them effective and cheap pain relief prior to mammographic screening. If it was men's testicles involved, I am sure they would have been offered those inhaler tubes of pain relief!

      The two main criticisms of MRI are - that they are too sensitive and cost more than mammograms. The cost issue in my country [Australia] is this - a mammogram costs @ -$100 whereas breast MRI is closer to $600-1000. So @ a factor of 6-10. In Australia most mammograms are free as part of our subsidised health cover for all citizens but MRI's even for breast cancer survivors, women over 50 etc are not. This cost aspect varies from country to country.

      The greater sensitivity of the MRI seems to be the major reason its critics disfavour it. MRI's detect cancer up to 3 years before other screening modalities and at tiny, tiny fractions. It can also detect changes in breast tissue therefore that are not yet defined as cancer. This is where the term false/positive comes up regularly. Those not favouring MRI's often refer to the trauma women with false positives needlessly go through by having the site ultrasounded and/or biopsied. My view? I would happily go through an MRI caused false positive that meant I had to have ultrasound and/or a biopsy any day as opposed to running the risk of a false negative from a mammogram with less than 50% detection rate! No contest. However there is a lot of literature devoted to the upset to women arising from false positives. A false positive means this - you don't have cancer and no further surgery, chemo etc is required I would do cartwheels over that. However a false negative means you do have breast cancer, but you and your medicos don't know you do, you are not getting any treatment and meanwhile the cancer that is there can grow and spread. You see what I mean about a false positive and some additional testing not being a major problem for me when I consider the alternative?

      DCIS occupies a strange space in breast cancer. Some medicos refer to it as a non-cancer or a pre-cancer or cancer stage 0. Some even dispute that DCIS is even cancer. Others say DCIS is a form of cancer or cancer precursor and want to throw the full treatment modality at it. There is a lot of literature about this debate in nomenclature that you can find online - I do suggest you access credible medical sources if you do so.

      In my case, with dense breasts even over age of 50 [the age some medical authorities deem I am not supposed to have dense breasts anymore!], tender breasts, mammograms leading to severe pain, high blood pressure, bruising and pain for months afterwards, a personal history of breast cancer, desire to avoid unnecessary radiation, no issue paying for MRI and no problems with claustophobia [some MRI's are conducted in a tube that can upset claustrophics] I prefer MRI's.

      Mammogram technology also has trouble picking up cancer in certain breast locations - the best known is under the nipple. Localising unusual breast lesions to get reliable images can also be a problem for the technologist. MRI's do not have this problem.

      I find MRI's far less painful as there is no compression or repeat dragging my breasts into position. have had the skin between my breast and rib torn and bleeding because the mammographer was irritated at her inability to get a workable scan of my dense breasts and commenced shoving and dragging one breast harshly across the glass plate to which the breast had stuck due to sweat/fear/pain. I ended that session with blood dripping on to my shoes! I realise not all mammographers are as rough as that but unfortunately the necessary amount of compression required to get decent images is something I have found traumatic.

      Most women also fail to realise that mammograms may only be 60% or thereabout accurate. In cases like mine the accuracy rate of mammograms is even lower than that.

      In Australia most women have no idea about the true rates of mammogram accuracy. In the US some states now have laws forcing mammographers to inform women if they have dense breasts and to tell you what that means in terms of the accuracy or lack thereof of the mammogram. MRI's accuracy is over 90%+.

      I did read a study in the past 18 months that made reference to detection rates for DCIS versus cancer than had become invasive. I do not have the citation for that study at my fingertips to quote to you so I apologise for that. My recollection was that mammograms within their 60% overall accuracy rates were more reliable detecting invasive cancers than non-invasive and MRI's with their 90%+ accuracy were even more reliable detecting non-invasive cancers than invasive. I cannot recall though how those stats stacked up on an over arching comparison between MRI vs mammograms. I just recall there was a difference.

      One thing I also like about MRI's is that their higher sensitivity means occult breast cancer away from the main lesion are more likely to be sighted so if we have surgery, I prefer one dose of general anaesthetic and one surgical intervention to remove all cancer cells including the occult, rather than just the removal of the detected lesion. Not all breast cancer conveniently presents itself as a single lesion - there can be sprinkles of cancer cells elsewhere in either breast.

      Finally, remember in addition to MRI's and/or mammogram there are ultrasounds, biopsies and even MRI guided biopsies.

      I realise this is a long response but because of my situation I was forced to research this whole MRI vs mammogram issue till I had enough information to make a decision that was right for me. Our decisions here can never be perfect because the technology and those that operate and interpret it are not perfect. I aim for the most accurate and safest methods with cost being a lesser factor. I also look for imaging methods that fit more with my personal needs. Another commentator could have a totally different decision matrix and come up with a different response.

      I also want to ensure you understand that my embracing of MRI far and above mammograms - for the reasons I have given - may not be an approach favoured by some breast cancer specialists. The Protocols for treating breast cancer - which tend to be some years out of date as they need a consensus arising from finalised clinical trials to underpin amendments - tend to want MRI's in more tightly defined circumstances than my situation. Many of the medical decisions we need to make are a trade off between various competing debates, which frustratingly all may have advantages and disadvantages.
      Good luck Marella!

      6 comments
    • Sharon Danielson Profile
      anonymous
      Survivor since 2007

      An overall answer would be yes because MRI's are highly sensitive and can detect "things" down to 4 to 5 mm. I have a particular soft spot for MRI's because if I would have been able to have one when my referring doctor wanted it, I would have been found to have cancer 7 months earlier. I...

      more

      An overall answer would be yes because MRI's are highly sensitive and can detect "things" down to 4 to 5 mm. I have a particular soft spot for MRI's because if I would have been able to have one when my referring doctor wanted it, I would have been found to have cancer 7 months earlier. I didn't meet the criteria so said the breast clinic.!!! If there is any doubt you have something hiding out in your breast, I would pretty much be standing on the chest of a radiologist wearing cleats to get a referral.
      But... that's just me. Take care, Sharon

      2 comments

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