Can months make a difference?
HEALTH During each annual breast cancer awareness month, our goal should be to learn more about this insidious disease than formerly known. By a wide margin, more money is spent on breast cancer research per death than any other form of cancer.  Becoming educated regarding prevention, testing and statistical predisposition is quite helpful.
Viewer Discretion: It is undisputed that the best way to combat cancer is through early detection. However, it might take weeks to schedule your first appointment after discovery of a lump. A physician may begin a course of antibiotics for several days to rule out a possible non-bacterial inflammation or monitor whether lump size abates. Months can go by before a diagnosis is provided. Time passes while awaiting results from x-rays, ultrasounds and mammograms. During all this waiting, a patient naturally wonders if more aggressive treatment should have begun sooner.
Off To A Bad Start
It is natural to assume that the moment a lump is detected is when the cancer began — or perhaps just within the interval since the last monthly breast self-examination (BSE). Actually, cell mutations typically take years to manifest themselves as cancer cells. This is why cancer is more common in older people. A genetic predisposition to a type of cancer or exposure to specific carcinogens may factor into development. By the time a lump can be felt or lesions become manifest within radiology images, years of development have taken place. 
Since cancer is abnormal cell growth, advancement is not always linear. Cells can grow slowly over several years, become dormant (remission) and/or rapidly proliferate when malignant. Normal genes multiply during childhood; multiplication primarily becomes a mechanism for wound repair in adulthood. Oncogenes (cancer genes) multiply constantly. A backup system called tumor-suppressor genes, like p53, should keep aberrant cells at bay. However, if these suppressors become damaged, cancer cells gain relative immortality.
Men Can Get Breast Cancer Too
Although gynecomastia — abnormal hormonal male breast enlargement — is the most common male breast disorder, male breast cancer is rare. There are only about 2,000 cases in the United States annually with 400 deaths. Incidence of breast cancers in men is 1 percent of that for women, according to the American Cancer Society (ACS). Regardless of gender, chances increase if parents, grandparents and/or siblings battled breast cancer. Comorbidities can raise the odds of tumor malignancy. For example, Sjögren's makes non-Hodgkin's lymphoma 440 percent more likely.  Men with such heredity or predisposition should perform regular BSE — especially during National Breast Cancer Awareness Month (NBCAM). An ultrasound or mammogram may be required if a lump is discovered.
As is the case with many women, male mammograms may be nondiagnostic due to dense tissue. An estimated 66% of premenopausal women, and 25% of postmenopausal women, have breasts that are dense enough to interfere with mammogram accuracy. Studies show that having dense breasts raises the risk of developing breast cancer fourfold to sixfold, primarily because density can obscure tumors.  Sometimes alternate imaging technologies provide clearer results. A radiologist is trained to look for vascularity within a mass. This indicates that a tumor has a blood supply — an essential charcateristic of cancer malignancy. Poor imaging can hinder this assessment.
Almost 75% of all breast cancers begin in the cells lining the milk ducts and are called ductal carcinomas. Approximately 25% of male breast cancers are lobular carcinoma (cancer that begins in the lobules). Inflammatory breast cancer makes up about 1% to 5% of all breast cancers. Paget's disease of the nipple begins in the ducts, but spreads to the skin of the nipple. Paget's disease is more common in men than in women. Other, less common subtypes of breast cancer include medullary, mucinous, tubular, or papillary. A type of breast cancer that has spread outside of the duct and into the surrounding tissue is called invasive or infiltrating carcinoma. The majority of male breast cancer cases are infiltrating ductal carcinomas (IDC). 
During mammography for men or women, nearby lymph nodes along with breasts are commonly x‑rayed for side-by-side comparison by a physician, preferably an oncologist. An examination should take medical history into account. Discovery of cancer in one location raises suspicion for lesions elsewhere throughout the body so supplemental tests may be required.
Why Cancer Metastasizes
When cancer is confined to one area, removal and prognosis is most favorable. But cancer has atypical properties to encourage spreading or metastases. A growing tumor exerts pressure on adjacent normal body tissue. This can cause a breach over time. Enzymes that normally break down waste cells and tissues can be used destructively by cancer cells to discard healthy tissue, allowing neoplasms to develop. 
Cancer cells also produce a substance that encourages migration. This helps them move though the blood stream or lymphatic system. Some die while traveling. Often, they become trapped within capillaries — the smallest of blood vessels — where growth resumes in a secondary location. Because all blood must be oxygenated, the lungs are a frequent site of secondary cancer. 
About 75% of lymph from the breasts drains into the 20-30 axillary lymph nodes, making them important in the diagnosis of breast cancer. Primary breast cancer can migrate to nearby (secondary) lymph nodes, and nodes are a conduit for further systemic migration. This is why mastectomies generally include removal of one or more nodes. If lymph nodes are the only place cancer is found beyond the main (primary) site, radical mastectomy surgery to remove the main tumor and several nearby lymph nodes may be able to get rid of it all (and cure it). 
Excise as few lymph nodes as possible.
Removing lymph nodes during cancer surgery can leave part of the body without a way to drain off excess fluid in the affected area. Lymph vessels then run into a dead end where the node used to be, and fluid can back up. This is called lymphedema, and it can become a lifelong problem, with skin texture changes, swelling and more limited range of movement in associated extremities. A study of 30 unilateral breast carcinoma patients found a 20% rate of developing lymphedema in the axillary lymph node dissection group compared with none in the sentinel lymph node biopsy group. Rates of lymphedema among women who undergo sentinel lymph node biopsy have been reported to be between 5% and 17%, depending on the diagnostic threshold and length of follow-up. [8,9]
Surgeons are advised to excise as few lymph nodes as necessary. Sentinel biopsy involves injecting dye into the breast lump and seeing which node it first spreads to (the sentinel node). This node is then removed and examined. If there is no cancer present, it is assumed the cancer has not spread. This procedure is often less invasive and less damaging than the axillary lymph node dissection.
Cancer Grows Slowly and Quickly
So in answer to the question of how fast cancer grows, it may take years for cancer to manifest itself or become palpable, but just months to metastasize. Once symptoms become manifest, time should not be allowed to pass unnecessarily. This may allow opportunity for secondary cancers to form. The only certain way to diagnose a suspect lesion is biopsy. Many radiologists prefer excisional over aspiration biopsy for more definitive evaluation. Lab tests can indicate to professionals how quickly cancer may grow, how well certain treatments may work and how likely the cancer is to recur.
Tips for Cancer Prevention
Prolonged psychological stress may affect a person's overall health and ability to cope with cancer. But no studies support the notion that stress causes cancer. Taking birth control pills for an extended time slightly increases breast cancer risk particularly in younger women. However, the risk level goes back to normal 10 years or more after discontinuing oral contraceptives. Interestingly, the risk of endometrial and ovarian cancer appear to be reduced with oral contraceptives. 
Formula for Increased Cancer Risk:
- Sjögren's disease patient
- Family history of cancer/lymphoma
- Overweight and sedentary
- Heavy alcohol drinker
- Tobacco smoker
- Exposure to carcinogens/radiation
- Female hormone replacement therapy
- Teenage oral contraceptive user
- Fellation or cunnilingual activity
- Lack of regular medical checkups
The Mayo Clinic offers the following suggestions to reduce risk of breast cancer: Limit alcohol, don't smoke, control weight, be physically active, breastfeed, limit dose and duration of hormone therapy, avoid exposure to radiation and environmental pollution.  For tips on performing monthly breast self-exam see the anatomy poster entitled The Female Breast to remain A Bit More Healthy. Let me know what you think; is this helpful or a bit more than you want to know about cancer?
- Cancer Funding: Does It Add Up? nytimes.com
- How cancer starts. cancerresearchuk.org
- Complications of Sjogren's syndrome. nhsinform.com
- The Latest Mammogram Controversy: Density. wsj.com
- Breast Cancer - Male. cancer.net
- How a cancer grows. cancerresearchuk.org
- How a cancer spreads. cancerresearchuk.org
- Lymph Nodes and Cancer. cancer.org
- Lymphedema. cancer.gov
- Oral Contraceptives and Cancer Risk. cancer.gov
- Breast cancer prevention: How to reduce your risk. mayoclinic.com
- Cancer By The Numbers. American Cancer Society Facts & Figures annual report for 2012.
- Photos by Uchar and Chris Rogers licensed from iStock Photo, composed by author.