Thursday, January 8, 2015


With the recent release of the American Cancer Society estimates of 2015 incidences and deaths of many cancer types in the USA, broken down by state, this is a post that bears recycling.  This is the link to the page that estimates there will be 40,290 deaths from female breast cancers.  Let's remember that number is actually higher.  Men count. And men do get breast cancer and men die from breast cancer.  Maybe that belongs in the fact section?

The ACS 2015 Facts and Figures page has charts for everything.  You can find that page here.  Remember the thing about statistics..... understand what you are reading.

And now, my updated list of breast cancer facts.

Fact:  Breast cancer is not one disease.

Fact:  There are many different types of breast cancer.  Ductal, the most common, accounts for approximately 80% of all breast cancers.

Fact:  The most common in the other 20% would be inflammatory, for which mammography is useless as there is no lump and is mostly "rash-like" and lobular which is also a bit tricky with imaging.  Lobular is the sneaky cancer.

Fact:  Now that research is on the molecular level, further subtypes can be defined based upon hormone receptors and specific proteins. ER/PR/HER neu status aren't really types of breast cancer but rather, a means of better understanding the characteristics of a cancer type.  Having the ability to identify these receptors allows for more targeted treatments.  Ductal cancer can be triple negative or HER positive.  Lobular cancer is tested for the same receptors. 

Fact:  Metastatic breast cancer is NOT a type of cancer.  It's a stage.  The last stage to be precise.

Fact:  DCIS is NOT a type of cancer either.  It's also a stage.  Technically, it's stage zero because it's still confined to the duct. A more accurate stage would be "Stage ?" since there is no way of knowing which DCIS lesions will become invasive and which ones will go away without any intervention.

Fact:  Five years is not some sort of magic mark on the pink brick road.  Plenty of cancers can, will and DO recur long after the five year mark.  Tumor cells are dormant and then, they aren't and they are killers wreaking havoc in bones or lungs or in the case of my particular variety, lobular, in the stomach area, too.  It appears ER+ cancer types, those fueled by estrogen, are the ones that tend to recur later.  ER+ cancers account for approximately 80% of breast cancer diagnoses.  In other words, the majority.

Fact:  Early detection is just that.  Early detection.  Early detection is the big message that is pushed by the big pink machine.  Timely mammograms to detect cancers earlier is an equally huge message being pushed.  Don't want to rain on anyone's pink parade but early detection guarantees nothing.  The biology of the tumor that is detected trumps any detection, at any stage.  

Fact:  Metastatic means the cancer has spread beyond the cancer site to another part of the body.  Thus, most or all cancers (lung, colon, prostate, melanoma etc etc etc) have the potential to become metastatic. If breast cancer spreads to the lung, it's NOT lung cancer.  It's still breast cancer that has now taken up residence in the lung.  If lung cancer spreads to the brain, it's NOT brain cancer.  It's still lung cancer that has now found a spot in the brain.

Fact That Bears Repeating:

Metastatic Breast Cancer is not a TYPE of cancer.

Any type of breast cancer with any molecular signature can metastasize.  Some breast cancers are more likely to metastasize because they are more aggressive.  In plenty of cases, a metastasis is a crapshoot.  Off the top of my head and in less than a millisecond, I can think of five people who developed what might be considered an unexpected metastasis.  If I allow myself a full minute, I'm sure I could come up with a list that is far too long.

And the reason for this chat?  We are taught, as advocates, that it's not about our type of breast cancer.  It's about the community at large.

Since any type or subtype of breast cancer can and does metastasize, those of us who are staunch advocates for those who have metastatic disease are not advocating for a particular group.  We are advocating for all.  Any one of us has the potential to develop a distant metastasis.

To be chastised or to be accused of selecting a particular group of patients over another is off the mark. Metastatic patients are patients whose disease fits into any type or category.  They can be ductal or lobular, inflammatory or triple negative. They can be HER2 positive.  Or not.

In other words, it's not a type of disease, nor is it a population of patients with uniform diagnoses.  Their disease fits into every nook and cranny.  It's just that their needs are far more urgent than the needs of the rest of us.

Oh... and for whatever it's worth.  Dr. Oz is on my About Me page as being someone who was close to "the selling snake oil guy."  He's crossed over to the dark side.  

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  1. Technically inflammatory breast cancer is a clinical diagnosis made by combining a diagnosis of invasive breast cancer with the visual symptoms (swelling, redness, etc) that arise over a 6-month or less period of time. Histologically it can be ductal (~85% of the time), lobular, mixed or any of the other rarer histologies like mucinous, small cell, medullary or papillary. So calling it the most common after ductal is a difficult statement to agree with since the total IDC population includes IBC patients too. Your point however that IBC is different from a detection point of view is really important and absolutely correct!

  2. Fabulous post, AM! Agree with Angela - most cases of IBC are invasive ductal; the difference between IBC and "usual" invasive ductal is that there is invasion of the lymphatic vessels of the skin of the breast by cancer cells. This essentially leads to a "lymphedema" appearance of the breast - the medical term is peau d'orange (orange peel skin). When talking about ductal vs. lobular, IDC is usually part of the ductal group, which as you correctly stated, accounts for about 80% of all breast cancers.

  3. You guys rock! Thanks for clarifying.... I will say, there are some very reputable sites listing IBC as a type of cancer and now that you've both explained it, I think I understand why... but accuracy counts. As far as medullary and papillary, this always confused me since these are both forms of thyroid cancer, too... I have a very dear friend w/medullary thyroid cancer with a RET mutation so I follow everything that mentions medullary cancer. Thank you both, again....

  4. Medullary and papillary are also rare kidney cancer histologies.

  5. Thanks, Angela. And the plot continues to thicken. My mom had renal cancer in 1987. An incidental finding when they were scanning her liver after her initial breast cancer dx. I have to go see if there is a pathology report in my dad's records.... I have a very large folder of everything that went on with her when she was dx'd the first time.....


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