Understanding breast cancer

If you're among the 21,000-plus Canadian women diagnosed with breast cancer this year, you have a good chance of beating this disease — much better than just a decade ago. The tough part may be sorting through all the options now available.

Surveys consistently show that breast cancer is the disease that women fear most. It’s important to keep in mind that the outlook for women with breast cancer is steadily improving, with the development of more sophisticated screening tools, earlier diagnosis and more effective treatments.

A few basic facts

Breast cancer begins when abnormal cells start to grow, eventually forming a tiny mass (a tumour) in the breast. About 90 percent of the time, this malignancy occurs in the milk ducts (called ductal carcinoma) or in the milk glands (called lobular carcinoma). Sometimes, an overgrowth of abnormal cells along the lining of a milk duct stays confined to one spot, or in situ, a condition known as ductal carcinoma in situ, or DCIS. Only rarely, however, does a tumour develop in the connective tissue that makes up the rest of the breast.

At diagnosis, a breast cancer tumour is classified by stage — from 0 for the smallest to IV for the most serious — to indicate a tumour’s size and whether malignant cells have spread elsewhere in the body. You may already know the stage of your disease; this is important because it helps to clarify the best treatment options for your particular case.

Another important factor determined at diagnosis is whether the tumour is hormone receptor-positive (hormone sensitive). If it is, anti-estrogen therapy and removal of your estrogen-producing ovaries are much more likely to work.

For most breast cancers, it’s good news if the lymph nodes (called axillary nodes) in the armpit closest to the affected breast are cancer-free, or "node-negative." This means it’s unlikely the cancer has spread, or metastasized, through your lymphatic system to other sites in the body. And even if you're "node-positive," an excellent array of effective treatments are now widely used.

• Seek a second (or third) opinion.
• Surgery to remove the cancerous growth, sometimes followed by chemotherapy or hormonal therapy.
• Radiation to shrink the tumour and kill remaining cancer cells.

• Bring a friend along. When discussing treatment options with your doctor, have an advocate in the room to take notes and pose questions you can't muster. Even better: audio record the appointment, with your doctor’s permission.
• Pose key questions to yourself. Feeling comfortable with a treatment choice is critical, because often there’s no "right" choice.
• Sign up for a clinical trial. Doing so can put you in the hands of highly experienced doctors.
• Plan for a wig. Before you lose your hair from chemo, visit a wigmaker to choose a style and colour that matches your own. With a doctor’s prescription, insurance companies should cover the cost.

• The Canadian Cancer Society (1-888-939-3333 or www.cancer.ca) has in-depth research, statistics and tips on reducing your risk of breast cancer as well as other forms of cancer.