278 ‒ Breast cancer: how to catch, treat, and survive breast cancer | Harold Burstein, M.D., Ph.D.

In American women, the lifetime risk of breast cancer is about 1 in 8, or 12%. Approximately 275,000 cases are diagnosed annually in the US, with around 38,000 deaths. This suggests that 80-85% of women are cured, while 15-18% are at risk of recurrence and death. (160 seconds)

The breast, fundamentally a sweat gland, matures during puberty due to hormonal changes, enabling milk secretion. It's mainly composed of fat and glandular tissue, with cancer mostly arising from ductal or glandular tissue. Early puberty and longer menstruation, coupled with fewer pregnancies and shorter nursing durations on a population level, are linked to an increased breast cancer incidence. (270 seconds)

Breast density, often visible on a mammogram, correlates with a slightly greater risk of developing breast cancer in postmenopausal women. This likely relates to lifetime estrogen exposure. While density can make detection harder, it is an independent risk factor. (1234 seconds)

While regular monthly breast self-exams haven't been definitively shown to reduce mortality, women should be aware of their body's normal texture. If you feel anything different, suspicious, or concerning, you should seek medical evaluation for imaging and potentially a needle biopsy. Most lumps found are benign. (1584 seconds)

DCIS is a precancerous lesion where abnormal cells remain within the breast ducts without invading surrounding tissue. It's often found via mammography calcifications. Treatment typically involves surgical removal (lumpectomy), followed by radiation therapy to reduce recurrence, and sometimes anti-estrogen medications. (2289 seconds)

ER-positive (estrogen receptor positive) is the most common, often with favorable prognosis, peaking around age 65, and typically found on mammograms. Triple-negative (lacking ER, PR, and HER2) presents earlier, is more aggressive, and more common in younger and African-American women. HER2-positive involves an overexpressed oncogene, historically aggressive but now highly treatable with targeted therapies. (904 seconds)

A sentinel lymph node biopsy is routinely performed in invasive breast cancer to check if cancer cells have spread to the armpit lymph nodes. A radioactive tracer and blue dye are injected into the tumor to identify the first nodes in the lymphatic drainage, which are then removed and checked for cancer. This is crucial for staging and guiding further treatment. (2421 seconds)

Side effects of anti-estrogen therapies, due to estrogen deprivation, include hot flashes, night sweats, bone and joint stiffness, hair thinning, vaginal dryness, and increased risk of osteoporosis. While significant, the benefits in cancer prevention and treatment often outweigh these for many patients. (6591 seconds)

BRCA1 and BRCA2 mutations are the most well-known, accounting for about half of all hereditary breast cancers and significantly increasing lifetime risk of breast and ovarian cancers. Other important genes include PALB2, CHEK2, and ATM mutations, all of which are involved in DNA repair pathways. (6817 seconds)

Neo-adjuvant therapy involves giving drug therapy (like chemotherapy or targeted therapy) before surgery. Its primary goals are to shrink the tumor (in breast and lymph nodes) to allow for less extensive surgery, and to assess the tumor's response to therapy, which helps tailor subsequent treatments and predict prognosis. (6345 seconds)

Multidisciplinary care, involving surgeons, radiation oncologists, medical oncologists, pathologists, and genetic counselors, is critical. It ensures a coordinated, comprehensive treatment plan tailored to the patient, with specialists collaborating and communicating closely. (7334 seconds)

Yes, men can get breast cancer, though it's rare (1 in 200 cases compared to women). Risk factors are less known but include genetic predisposition and hormonal conditions. Men are often diagnosed at later stages due to lack of awareness. Male breast cancers are almost universally estrogen receptor positive, making triple-negative rare. Treatment principles are similar to women's. (7999 seconds)