Breast cancer

Breast CancerBreast cancer - the two words women fear the most. It threatens a woman’s self image, even if she survives the cancer. Statistically, one in eight women will be diagnosed with breast cancer so every woman knows someone who has or has had this disease. Over 170,000 will be diagnosed per year and over 40,000 will die in the same year. She knows the impact of the disfiguring surgery to those who have survived and the severe side effects of chemotherapy and radiation. While not discounting the above, there are much better breast cancer treatment outcomes possible, especially if the disease has been diagnosed early.

Breast cancer has usually metastasized (spread) by the time it is detected. The cancer has typically been growing for 10+ years before it can be detected by exam or scan. The typical barely detectable lump usually contains nearly 50 billion cancer cells. Mammograms are controversial, some believe that the pressure employed is likely to rupture the tumor, particularly ductal cancer, and promote metastasis. Others fear the ionizing radiation (x-rays) will themselves induce cancer. Thermography does not carry this danger but thermograms are not yet as sensitive to small tumors. Translimanated infrared (diaphanography) is claimed to be as sensitive as mammograms, does not require pressure, and can be used even daily to follow tumor status since it does not use ionizing radiation. Although first developed in the US, it is only available in China, one hopes that this will soon change.

Breast cancers are classified by site of origin and cell type. Padget's Disease is a rare condition associated with ductal carcinoma and is discussed below. Most often breast cancer has only one location in a single breast, almost half of which originate in the upper and outer quadrant of the breast. Ductal carcinomas comprise over 90% of breast tumors and originate from the epithelium of the mammary ducts. The remaining are lobular carcinomas since they arise from the mammary lobules (see figure).

Ductal carcinoma

Ductal carcinoma

Ductal carcinoma rarely remains in the ducts, but infiltrates into other breast tissues and lymph nodes, and is termed infiltrating ductal carcinoma. They are usually hard on palpation. Medullary carcinomas are a special class of ductal carcinoma, the cells are better differentiated and the tumor is often large and soft to palpation. Ironically, with this larger tumor, the prognosis is better after breast cancer treatments than with invasive ductal carcinoma. Medullary carcinoma is less invasive. Colloidal intraductal tumors  (mucinous tumor) are large, gelatin like masses and usually develop in older women, they are slow growing and have a more favorable prognosis. Other intraductal carcinomas are papillary and comedo carcinoma.

Lobular carcinoma

These carcinomas can be restricted to an initial site (in situ) or invasive. In situ lobular carcinoma has the danger of being initially diagnosed as hyperplasia associated with fibrocystic breast disease in which these patients tend to seek alternative cancer treatments.  The invasive form usually shows multiple sites in the breast. In most cases where both breasts are involved, it is usually lobular carcinoma.

Male Breast Cancer 

While considered rare, male breast cancer represents about 1% of breast cancers. The male breast has less tissue mass than the female, thus the tumor spreads rapidly and infiltrates the underlying muscle and overlying skin. Ulceration through the skin is common. Tumor spread through the surrounding tissue and lymph nodes is similar to that of the female. The conventional treatments for breast cancer, alternative medicine, IPT and the prognoses are the same for both sexes.

Other Considerations

Breast cancer arises in an organ that is sensitive to hormones, so often the cancers which arise may be estrogen sensitive. Those that are sensitive to estrogen will often respond to estrogen manipulation, this is the basis of tamoxifen activity, although it does have limited activity against estrogen negative cancer cells. Tamoxifen should only be .considered as an adjuvant to other therapy rather than used alone. There are several reasons for this caution: One is that after prolonged tamoxifen use the estrogen levels in the body actually increase, possibly explaining cancer cells becoming resistant. Tamoxifen should not be used past 2 years giving credence to the initiation of alternative cancer treatments. Another reason is that estrogen positive cells often mutate to become estrogen independent. In some cases the tumor may be a mixture of  sensitive and insensitive cells. In all of these cases, the cells not sensitive to estrogen will continue to grow in the presence of tamoxifen. An interesting natural product indole-3-carbinol (IC3) has activity similar to tamoxifen without the side effects. There is evidence that it is active alone and should enhance the activity of tamoxifen.

We believe that Tamoxifen and IC3 therapy as breast cancer treatments should be used in conjunction with immune therapy and antiangiogenesis, rather than with other chemotherapy agents. They help the patient to avoid the added toxic reactions and secondly, to avoid immune suppression. We feel that this combination would be more active within the tamoxifen 2 year range.