Breast cancer is characterized by the malignant growth of epithelial cells of the ducts or lobules of the breast. Approximately 185,000 cases of breast cancer are diagnosed each year; there are 43,500 deaths, making breast cancer second to lung cancer as a leading cause of death by cancer among women. Incidence rates of breast cancer are rising (8.2% for white and 7% for black women in U.S.) in developed countries; mortality rates are stable. Breast cancer in men is uncommon (<1%). The different types of breast cancer include: lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), invasive ductal carcinoma (70% to 80% of all breast cancers), Paget's disease of the nipple, inflammatory carcinoma, and other uncommon types. Women detect 90% of their breast cancers with breast self-examination (BSE). This early detection is associated with a more favorable clinical stage; it does not reduce mortality.

There is no evident cause of breast cancer, though there are many proposed risk factors.

• Increasing age
• History of cancer in one breast
• History of benign breast disease
• Nulliparity or first pregnancy after 30
• Family history (first-degree relative) of breast cancer (especially significant for premenopausal women)
• Early menarche and late menopause
• Long-term oral contraceptive use; this is controversial
• High doses of ionizing radiation before age 35
• History of cancer of the colon, thyroid, endometrium, or ovary
• Diet high in animal fat, excessive alcohol consumption, and in some studies, obesity
• Inherited germline mutations (10% of cases) of the following genes: p53 (Li-Fraumeni syndrome), BRCA-1, and BRCA-2, and the ataxia-telangiectasia gene.
• History of breast implants

Between 70% and 80% of breast cancer cases present with no evident risk factors.

• Palpable lump
• Dimpled skin
• Striae and erythema
• Increased vascularity
• Enlarged axillary lymph nodes
• Yellow, clear, or bloody discharge from the nipple
• Breast pain and soreness (rare except in very advanced cases)

Benign breast disease

Gynecologic examinations should routinely include examination of the breasts. The examining physician looks for skin lesions, secondary inversion of the nipples, dimpling of the skin, striae, erythema, or increased vascularity. The breasts should be examined with the patient sitting and palpated while lying down. Women should also be encouraged to do monthly BSEs the week after the menstrual period.

• Histologic examination of breast tissue, to give a definitive diagnosis
• Genetic studies for DNA mutations, to determine inherited predispositions to develop cancer

Benign breast masses that demonstrate epithelial hyperplasia are associated with an increased risk of future cancer. Alteration in the basement membrane detected by light microscopy is the standard determinant of invasive breast carcinoma.

• X-ray mammography
• Optical and doppler ultrasound, to distinguish a cyst from a solid mass
• Diaphanography (transillumination of the breast), to characterize differences in breast tissue
• Thermography, to measure the temperature of the breast (elevated in the area of the breast cancer)
• Magnetic resonance imaging (MRI), to distinguish benign from malignant disease
• Digital radiography
• Radionuclide imaging

• Fine-needle aspiration biopsy (FNAB)
• Percutaneous needle aspiration

Treatment strategies are based on the TNM staging of the primary tumor. Breast-conserving surgery is now considered as effective as radical surgery because survival statistics with lumpectomy and radiation appear to be equal to that of mastectomy. Mastectomy is recommended if the tumor is large (>7 cm) or encompasses the nipple-areolar area, if there is extensive intraductal disease, or in women with collagen-vascular disease. Systemic treatment is as important as surgical excision of the primary lesion because axillary and distant metastases appear to occur simultaneously, not sequentially.

• Adjuvant therapy delays recurrences and prolongs survival in patients with lymph node involvement.
• Antitumor antibiotics (e.g., doxorubicin, mitomycin C)
• Alkylating agents (e.g., cyclophosphamide, melphalan, thiotepa)
• Antimetabolites (e.g., methotrexate, 5-fluorouracil)
• Vinca (plant) alkaloids (e.g., vinblastine, vincristine)
• Antiestrogens (e.g., tamoxifen, LHRH agonists) block the action of estrogen on breast tissue; tamoxifen reduces the risk of invasive breast cancer by 49% and estrogen receptor-positive breast cancer by 69%.
• Estrogen receptor modulator, raloxifene, blocks estrogen-induced DNA transcription; the risk of invasive estrogen receptor-positive breast cancer is reduced by 90%.
• Monoclonal antibody, herceptin, blocks the protein receptor (HER2) that is produced in large numbers in women with breast cancer.
• High-dose progestogens

• Lumpectomy with or without radiation (for tumors <5 cm); wide excision alone is associated with a high rate of local recurrence
• Mastectomies (e.g., subcutaneous, partial [quadrantectomy], simple, modified radical [total], radical [Halstead procedure], super radical [Urban procedure])
• Axillary lymph node dissection (a minimum of 15 to 20 level I and II nodes) for pathologic staging to determine prognosis and treatment options
• Prophylactic castration for estrogen receptor-positive patients
• Irradiation as a supplement to surgical excision

Herbs and nutrients support cancer treatment and aid in preventing recurrence, as well as minimizing side effects and reducing anxiety. Homeopathy can be useful for treating nausea secondary to chemotherapy. Psychotherapy and support groups may have a significant impact on both survival and quality of life.

• Eliminate foods that increase estrogen levels in the body and the liver's ability to metabolize it. These include non-organic poultry, dairy, red meat, sugar, white flour and refined foods, and methylxanthines (coffee, tea, chocolate, colas).
• Cruciferous vegetables (broccoli, cabbage, cauliflower, etc.) enhance glutathione activity.
• Eat only organically raised foods to avoid hormone-potentiating pesticide residues.
• Include liver foods such as beets, carrots, yams, garlic, dark leafy greens, lemons, and apples.
• Fiber facilitates the excretion of metabolized estrogen and toxins.
• Soy may be protective due to its estrogenic compounds.
• Coenzyme Q10 (120 mg tid) has anti-tumor effects.
• Calcium d-glucarate (500 to 1,000 mg tid) enhances excretion of metabolized estrogens.
• Vitamin A (25,000 IU/day), vitamin E (800 IU/day), and vitamin C (3 to 6 g/day) may decrease side effects of chemotherapy and radiation.
• Selenium (200 to 400 mcg/day) potentiates glutathione, a powerful detoxifier.
• Bromelain (500 mg bid between meals) has anti-tumor activity.
• Melatonin (10 to 50 mg/day) inhibits cancer growth (is used extensively in Europe).

Herbs may be used as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose for teas is 1 heaping tsp. herb/cup water steeped for 10 minutes (roots need 20 minutes).

Herbs that block estrogen receptor sites may be protective: black cohosh (Cimicifuga racemosa), red clover (Trifolium pratense), and alfalfa (Medicago sativa). Use these herbs as a base (1 to 3 g) and add two to three of the following in equal parts, 30 to 60 drops bid to tid.

• With anxiety: passionflower (Passiflora incarnata), kava kava (Piper methysticum)
• With lymphadenopathy: poke root (Phytolacca americana), red root (Ceonothus americanus); maximum dose of poke root is 0.4 ml/day.
• With nausea: ginger root (Zingiber officinale), fennel seed (Foeniculum vulgare)
• With exhaustion: oatstraw (Avena sativa), skullcap (Scutellaria lateriflora)

An experienced homeopath evaluates an individual's symptoms and constitutional type before prescribing a specific treatment regimen. Some of the most common acute remedies used in treating symptoms that may be associated with breast cancer are listed below. Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms resolve.

• Arsenicum for anxiety, deathly nausea, with restlessness and burning pains
• Ipecac for incapacitating nausea unrelieved by vomiting
• Nux vomica for cramping, sharp abdominal pains with anger and collapse

Women should be followed every 3 months for recurrent disease for 18 months to 4 years, then every 6 months thereafter. Follow-up care is individualized according to risk factors.

Studies suggesting an association between breast cancer and a high-fat diet are inconclusive. Nutritional substances such as hydroxyanisole (BHA) and butylated hydroxytoluene (BHT), which are food preservatives, vitamin A, and vitamin E appear to have inhibitory effects in breast carcinogenesis (in animal studies).

Most of the complications result from surgery, radiation, or chemotherapy. Tamoxifen, which is given to women with advanced breast disease, increases a woman's risk of endometrial cancer and thrombo-embolic disease.

Modified radical mastectomy:

• Lymphedema of the arm
• Restricted shoulder movement
• Hypertrophy of the operative scar
• Cellulitis of the affected arm
• Lymphangiosarcoma in the affected arm

Lumpectomy plus irradiation:

• Edema of the breast; lymphedema of the arm
• Discoloration and telangiectasia of the irradiated skin
• Irradiation pneumonitis
• Fat necrosis of underlying breast tissue
• Recurrence of the carcinoma

Prognosis for breast cancer depends on the TNM staging of disease at the time of the initial diagnosis. Microscopic invasion into the surrounding tissues beyond the basement membrane and positive lymph node status negatively alter prognosis. The more nodes that are involved, the worse the prognosis.

The peak ages for breast cancer are 45 to 50 and 55 to 60 years age; however, there are cases diagnosed when pregnancy is still probable. Approximately 0.03% of pregnant women are diagnosed with breast cancer, and 7% to 10% of breast cancer patients become pregnant after treatment. Pregnant women with cancer should be treated similarly to women who are not pregnant. Abortion is contraindicated except with distant metastases; women who deliver a full-term pregnancy have a much better prognosis than those who abort. Lactation must be discontinued because hormonally induced changes in the breast may obscure breast tumors. The incidence of the teratogenic effects of radiation and chemotherapy are very low and are more common in early pregnancy.

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