The Importance of Breast Cancer Screenings
- Australian mom of two, 41-year-old Em Davies was diagnosed with early-stage invasive HER2+ breast cancer after being diagnosed with Paget disease of the breast, rare type of cancer that involves the nipple and areola, three years after irritation and scabbing around her nipple was wrongly thought to be from a chronic skin condition called eczema.
- Davey’s story highlights the importance of early detection and advocating for your health, as she first noticed symptoms while taking a shower.
- SurvivorNet experts recommend performing a monthly breast self-exam to look for anything unusual because it can help catch breast cancer.
- Talk to your doctor if you notice one or more of the following symptoms: a new lump in the breast, unusual sagging, new swelling in the breast, changes to the nipple (such as puckering), flaking or redness in the breast or nipple, discharge (including blood) coming from the nipple and pain in the breast.
- The U.S. Preventive Services Task Force recommends women at average breast cancer risk begin screening at age 40. Women with the BRCA gene mutation, who have a family history of cancer, or have dense breasts are at higher risk and should talk with doctors about screening earlier.
Davey, who was ultimately diagnosed with early-stage invasive HER2+ breast cancer, recently spoke about her diagnosis, revealing the first symptom she experienced was that her right nipple appeared “quite dry right in the center” and a small piece of skin peeled off back in 2021, while she was taking a shower, according to the Daily Mail.
Read MoreRELATED: Getting to Know Your Breasts with Self-Exams
However, months later her nipple became inverted, prompting her to worry as nipple changes could be a sign of breast cancer. She didn’t receive a diagnosis until 2024.
As per the Daily Mail, Davey said in an Instagram page, titled “Our Wellness Baseline,” the resilient mom warned, “Unfortunately, as Paget’s Disease of the breast is quite rare, it is often misdiagnosed as nipple eczema for months if not years, which sadly is what happened to me. I do not want this for anyone else.”
After having testing done, Davey learned there was a small cancerous mass behind her nipple and pre-cancerous cells located in her milk ducts. She’s now patiently waiting to hear whether the cancer had spread to her lymph nodes.
Before beginning her year-long chemotherapy treatments, Davey underwent surgery to remove her right nipple and nearby tissue,
Now she’s urging others, “Do not let others tell you you’re fine or you’re overacting. The past few months has taught me a lot about my health and self advocacy.
“Knowing deep down things were off, but finding someone who would listen was a struggle. Never give up fighting for your health.”
Understanding Paget Disease of the Breast
According to the American Cancer Society (ACS), Paget disease often only affects one breast, and in approximately 80 to 90 percent of cases, “it’s usually found along with either ductal carcinoma in situ (DCIS) or infiltrating ductal carcinoma (invasive breast cancer).”
RELATED: Why Active Surveillance is Being Studied for Stage Zero Breast Cancer
Symptoms of Paget disease are explained by the ACS as a “crusted, scaly, and red” nipple. Blood or yellow fluid may as be seen coming out of the nipple. The nipple may also burn, itch, or look flat and inverted.
“Your doctor might try to treat this as eczema first, and if it does not improve, recommend a biopsy,” the ACS warns.
Additionally, most people with Paget disease have tumors in the same breast where the disease is found, and imaging tests, like a mammogram, breast ultrasound, or MRI, to look for further issues. Paget disease is diagnosed following a biopsy.
“Paget disease can be treated by removing the entire breast (mastectomy) or breast-conserving surgery (BCS) followed by whole-breast radiation therapy. If BCS is done, the entire nipple and areola area also needs to be removed. If invasive cancer is found, the lymph nodes under the arm will be checked for cancer,” the ACS explains further.
“If no lump is felt in the breast tissue, and your biopsy results show the cancer has not spread within the breast tissue, the outlook (prognosis) is excellent. If the cancer has spread within the breast tissue (is invasive), the outlook is not as good, and the cancer will be staged and treated like any other invasive ductal carcinoma.”
Expert Resources On HER2 Breast Cancer
- A ‘New’ Type Of Breast Cancer? Practice-Changing Results? New Study Says Yes, And Provides Hope For Patients With HER2 ‘Low’ Breast Cancer
- Do You Have HER2-Positive Metastatic Breast Cancer? Here’s A Breakdown Of Some Of Your Treatment Options
- Exciting New Option For HR+, HER2- Breast Cancer Recurrence: With the Approval of Truqap, More Women Can Be Treated With Targeted Therapy
- Treatment for HER2-Positive Breast Cancer
- When to Order Immunohistochemistry Testing: With Tailored Therapies for HER2-Positive Cancers, IHC is More Relevant for More Patients
Meanwhile, Ductal Carcinoma In Situ (DCIS), which can be found with Paget disease, is known as stage zero breast cancer. DCIS are abnormal cells that line the duct in a breast. A normal breast is made up of lots of ducts (these ducts carry milk to the nipple in a woman who is lactating).
DCIS is not an invasive cancer, meaning it hasn’t spread outside the milk duct and it cannot invade other parts of the breast. In some instances, if left untreated, doctors believe that DCIS can evolve into a more invasive breast cancer. This is why historically, the standard treatment for DCIS is to remove it surgically and in some instances offer radiation as well.
Deciding the Right Course of Breast Cancer Treatment
Doctors treating breast cancer seek out markers on your particular cancer to help decide what course of treatment is best for you. This is due to the cancer cells possibly having what are known as receptors that help identify the unique features of the cancer.
The three main receptors are the estrogen receptor, the progesterone receptor, and the HER2 receptor. The estrogen and progesterone receptors go together because they are fueled by hormones. Think of the cancer cell as having little hands on the outside of the cell which grabs hold of proteins that help it grow. These proteins are sometimes called “ligands.”
An example of a type of ligand that can stimulate a cancer cell is the hormone estrogen. An estrogen receptor-positive breast cancer will be stimulated by estrogen to grow. In this instance, your doctor may offer you treatment to specifically target the estrogen receptor.
The Unique Features of Breast Cancer
Another important receptor to test for is the HER2 receptor. For HER2 positive breast cancers, therapies that uniquely target the HER2 receptor are essential to treating the disease.
What is ‘HER2-positive’ breast cancer?
The human epidermal growth factor receptor 2 (HER2) is a receptor on the surface of almost all the cells in our body, and it is one of the many receptors responsible for the communication between the cells to promote their growth, division, repair, and survival.
In other words, HER2 is one of the many receptors that help cells grow and divide when the timing is right.
Advocating For Yourself While Navigating the Medical World
Living With HER2-Positive Breast Cancer
All breast cells are examined for an abundance of this protein (HER2). HER2 proteins act as receptors that regulate the growth and division of cells. If there is an excess of HER2 receptors in breast tissue (known as overexpression), it can lead to rapid multiplication of breast cells. This uncontrolled growth may result in the formation of a tumor.
Breast cancer classified as HER2-positive tends to exhibit faster growth, increased likelihood of spreading (metastasis), and a higher chance of recurrence. Despite its aggressive nature, HER2-positive cancer responds well to treatments that specifically target HER2 proteins.
There are no distinct symptoms or specific risk factors associated with HER2-positive breast cancer, although research indicates that this type of cancer may be more prevalent among younger women.
As for metastatic breast cancer, which is also called “stage four” breast cancer and the stage of cancer Willits was diagnosed with, this means that the cancer has spread, or metastasized, beyond the breasts to other parts of the body. It most commonly spreads to the bones, liver and lungs, but it may also spread to the brain or other organs.
Treating advanced HER2-positive breast cancer
Metastatic breast cancer is generally considered to be “incurable” at the moment, but there are a wide variety of treatment options used to battle the disease including hormone therapy, chemotherapy, targeted drugs, immunotherapy and a combination of various treatments.
Breast Cancer Symptoms & Self-Exams
Women are encouraged to do regular self-exams to become familiar with how their breasts feel normally so something like a lump can be easily detected. A self-exam includes pressing your fingertips along your breast in a circular motion.
If you feel something abnormal, such as a lump or discharge from the nipple, you should contact your doctor for further examination.
WATCH: How often should you get mammograms?
Below are common symptoms to look out for:
- New lump in the breast or underarm (armpit)
- Any change in the size or the shape of the breast
- Swelling on all or part of the breast
- Skin dimpling or peeling
- Breast or nipple pain
- Nipple turning inward
- Redness or scaliness of breast or nipple skin
- Nipple discharge (not associated with breastfeeding)
What to Know About Screening For Breast Cancer
The medical community has a consensus that women between 45 and 54 have annual mammograms. However, an independent panel of experts called the U.S. Preventive Services Task Force (USPSTF) is saying that women should start getting mammograms every other year at the age of 40, suggesting that this lowered the age for breast cancer screening could save 19% more lives.
WATCH: Screening for Breast Cancer
For women aged 55 and older, the American Cancer Society recommends getting a mammogram every other year. However, women in this age group who want added reassurance can still get annual mammograms.
Women who have a strong family history of breast cancer, have dense breasts, have a genetic mutation known to increase the risk of breast cancer, such as a BRCA gene mutation, or a medical history, including chest radiation therapy before age 30, are considered at higher risk for breast cancer.
Experiencing menstruation at an early age (before 12) or having dense breasts can also put you into a high-risk category. If you are at a higher risk for developing breast cancer, you should begin screening earlier.
Breast density is determined through mammograms. However, women with dense breasts are at a higher risk for developing breast cancer because dense breast tissue can mask potential cancer during screening. 3D mammograms, breast ultrasound, breast MRI, and molecular breast imaging are options for women with dense breasts for a more precise screening. It is important to ask your doctor about your breast density and cancer risk.
Although breast cancer can happen to anyone, certain factors can increase a person’s risk of getting the disease. The known risk factors for breast cancer include:
- Older age
- Having a gene mutation such as the BRCA1 or BRCA2
- Added exposure to estrogen
- Having children after the age of 30
- Exposure to radiation early in life
- Family history of the disease
RELATED: Is Genetic Testing Right for You?
About ten percent of breast cancers are hereditary, says Dr. Ophira Ginsburg, Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center.
“We encourage only those who have a family history to really get [genetic testing],” Dr. Ginsburg previously told SurvivorNet.
“I would say that if you have anyone in your family who was diagnosed with a very rare cancer. Or if you have a strong family history of one or two kinds of cancer, particularly breast and ovarian, but also colon, rectal, uterine, and ovarian cancer, that goes together in another cancer syndrome called the Lynch Syndrome,” Dr. Ginsburg adds.
Contributing: SurvivorNet Staff
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