Breast 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 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 come from the mammary lobules (see figure).

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 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.

Padget's Disease

Padget’s Disease refers to two distinct disease conditions ( of breast and of bone) which have nothing in common except being named for the physician who first described them, Sir James Padget (1814 - 1899).

Padget’s Disease of the breast is a rare condition almost always associated with underlying breast cancer, usually invasive or intraductal carcinoma. It is associated with a red, scaly lesion on the nipple and surrounding tissue, and there may or may not be a discharge from the nipple. Sometimes in early stages of the condition it may be misdiagnosed as eczyma, dermatitis or psoriasis, if signs of the underlying cancer are not readily apparent.

Padget’s Disease is characterized by inflammatory cells that are large and irregular, as first described by Padget. These Padget’s cells are not themselves cancerous and when found on other parts of the body are not associated with cancer.

The presence of Padget’s Disease with breast cancer does not materially affect the treatment or prognosis of the cancer. Indeed, its primary importance may be in those early stages of cancer to cause the physician to look for cancer when there are no readily observed symptoms (lump) to suggest breast cancer.

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. 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 treatment regimens, prognosis, etc. are the same for both sexes.