Breast Cancer By Dr. Peter W. Kujtan, B.Sc., M.D., Ph.D.

Breast cancer has most likely touched your life in some way. Whether it is a suspicious lump, biopsy, mastectomy, radiation or chemotherapy, I deal with it on a daily basis. In Canada, about 70 women and 1 man start their battle with some form of breast cancer every single day. One in nine Canadian women alive today will face this entity in their life-time. It often starts with a great deal of anxiety, uncertainty, fear and worry, but for many patients it also has a way of bringing out wondrous bouts of courage and perseverance fuelled by spiritual convictions from connections with those around them.

It is important to remember that not all breast cancers are the same. Many suspicious lumps turn out to be non-life threatening cysts, collections of calcium or cells. The gold standard for diagnosis is to put a small sample under a microscope and look at it first hand. To accomplish this we often use fine needle biopsies, or stereotaxic biopsies. Lumpectomies and partial mastectomies are minor surgical procedures that remove larger areas of tissue for examination. This can often cure the problem. The other advantage to surgery is the ability to gather some lymph nodes. These structures that are part of our immune system tend to gather up abnormal things in their vicinity, and this includes cancer cells. It helps us in deciding whether tumour cells have mutated to the point of being able to migrate to other areas, a process known as metastasis.

The most common type of breast cancers are ductal and lobular carcinoma. Ductal cancers begin in the milk ducts, while lobular cancers begin in the mild-producing glands. Cancer is simply an abnormal growth of cells that has evaded our normal system of checks and balances. If the cells are in a group at their point of origin, we refer to this as “in-situ”. When they continue to grow and spontaneously mutate, they can gain the ability to infiltrate surrounding tissue and we refer to this as “invasive” cancer. When they spread to other parts of the body we call this “metastatic”. Invasive ductal carcinomas are by far the most common type that we see. A rarer form of breast cancer is called Pagets Disease which looks like an inflammation of the nipple. In the still rarer cases, breast cancer can arise from other structures within the breast such as blood vessels, lymphatics and fibrous connective tissue. There are also other types of cancer that can spread to the breast. These include colon and lung cancer, lymphomas and skin cancer.

Cancer cells from any given cancer often have different appearances. In invasive cancers, a pathologist will assign a “tumour grade” from 1 to 3. It is based on how close the cells resemble “normal” cells. A higher grade suggests a poorly developed cell which has a greater chance of spreading. Breast cancers are also tested for hormone receptors called HR-status. Positive tumours can have either estrogen or progesterone receptors on their surfaces. We take advantage of this feature by attempting to stunt growth using Tamoxifen to block the receptor.

With genetic testing ability, we now look at specific genes in the tumour. Having too many copies of the HER-2 gene will cause the cell to over produce a certain protein, giving the cancer an aggressive character. With continuing advances classifications are being revised to better influence treatment and prognosis.

Breast cancer can be beaten. It involves a collaboration of Family Physicians, Oncologists, Geneticists, and Radiologists, Pathologists and specialized nurses, counsellors, skilled technologists and others on the medical side. But it also requires the help of family members, friends, clergy and society as a whole. A group of local doctors have decided to put their sticks where their stethoscopes are. Hockey simply got more votes than the Full-Monty Doctor Calendar. So, this Wednesday February 13th, 2008, Hershey Centre, 5 pm. The Mississauga News and the St.Mikes Majors presents “Docs on Ice”. My own Bandage Clad Blades coached by NHL great, Johnny Bower have challenged Dr.Dennis Izukawa’s Tyranical Titans coached by the legendary Dick Duff to a duel on ice. The ice is sure to turn pink as we duel for the coveted Golden Bedpan and proceeds go to the Breast Cancer Foundation. For a mere $8 you can cheer on your favourite doc, raise funds for breast cancer, meet a famous Maple Leaf Stanley Cup Champion, and even stay to watch the St.Mikes Junior Game at no extra cost. And it’s all thanks to Mr. Ron Lenyk and the News, one of the most valuable, community spirited individuals in our city. Mr. Eugene Melnyk has also pledged to match ever dollar raised for this noble cause. Together, we can make a difference. Donations can be made out to the Canadian Breast Cancer Foundation, are tax deductible, and can also be dropped off at the Mississauga News office. We hope to see you there!