Pink is the color of October, as the country marks Breast Cancer Awareness Month.

Breast cancer is the most common cancer in women after skin cancer, accounting for 30 percent of all new female cancers each year, according to the American Cancer Society. In 2022, an estimated 287,850 new cases of invasive breast cancer will be diagnosed in women; about 51,400 new cases of ductal carcinoma in situ will be diagnosed; and about 43,250 women will die from breast cancer.

These are sobering statistics that PEF members in the breast cancer clinic at Roswell Park fight every day as they diagnose and treat patients.

For the past 16 years, nurse practitioner and PEF member Julie Mussell has spent her days surrounded by patients facing what may be the most difficult and frightening days of their lives. She and her colleagues’ knowledge and expertise at Roswell Park can make all the difference for these patients.

“The lifetime risk for breast cancer in women is 1 in 8,” Mussell said. “All women aged 40 and above should undergo breast cancer screening with annual mammogram and physical exams. Men and women who have higher-than-average risk due to family history of breast cancer or genetic mutation predisposing them for increased risk should have an MRI screening in addition to an annual mammography.”

Julie Mussell
PEF member Julie Mussell. Photo courtesy of Roswell Park

Roswell Park’s High Risk Breast Cancer Program is the region’s longest-running breast cancer risk assessment and prevention program, according to the website. The program offers the most advanced screening, surveillance, diagnostic and preventive methods to help patients take charge of their health. Men make up less than 1 percent of breast cancers and they often have a family history or carry a genetic mutation such as BRCA 1 and 2, making the high-risk program a vital tool in their arsenal.

Patients facing suspected breast cancer should first and foremost obtain an accurate diagnosis and undergo the appropriate workup prior to treatment, Mussell said.

“Some cancers are straightforward at diagnosis, but others require additional testing,” she said. “For example, they may need scans such as a CT, PET or bone scan. There may be additional biopsies.”

Along the way, patients benefit from a strong support system, whether it be friends, family, or Roswell Park staff.

“We have patient navigators, counselors and child life specialists who can help the patient navigate through this difficult and uncertain time,” Mussell said.

Who can get breast cancer?

Anyone can get breast cancer, and most women who develop breast cancer have no known risk factors.

Some risk factors include:

    • A family history of breast cancer among your parents, siblings or at least two other close relatives.
    • A personal or family history of ovarian cancer.
    • Multiple cancers within your family.
    • A relative diagnosed with breast cancer before menopause.
    • A known gene mutation, such as BRCA1, BRCA2, TP53, or PTEN in your family.
    • An abnormal breast biopsy.
    • Prior radiation to the chest.

Types of breast cancer

Breast cancers are classified by the cell type in which the disease begins. Most begin in cells that line ducts that carry breast milk to the nipple, or glands that produce milk.

Non-invasive breast cancers have not spread from their original site into surrounding tissues. For example, when abnormal cells are found in breast lobules, but have not spread, the condition is called lobular neoplasia. It does not usually require treatment, but can be an indication a woman faces a higher risk of developing cancer later in life.

Ductal carcinoma in situ, also known as Stage 0 breast cancer, means cancer cells have been found only in cells that line breast milk ducts. Many of these will never spread or become invasive, but since there is no reliable way to determine that, almost all cases are treated.

Invasive breast cancers have already spread.

Eight out of 10 invasive breast cancers are classified as ductal carcinoma, which begins in cells that line milk ducts and spreads through the duct wall into neighboring tissue. Far less common is invasive lobular carcinoma, beginning in the lobules or glands that produce milk.

Subtypes of invasive breast cancer are even more rare, accounting for less than 5 percent of all breast cancers.

Inflammatory breast cancer is characterized by swelling and redness, inverted or retracted nipples, and thickening or pitting of the breast skin that resembles orange peel and may be itchy. It is rare but tends to be more aggressive and diagnosed at later stages, making treatment more challenging.

Learn more about all these types of cancers, here.

Be on the lookout for these signs and symptoms

The most common symptom of breast cancer is a new lump or mass, according to the American Cancer Society. Although most breast lumps are not cancer, a painless, hard mass that has irregular edges is more likely to be cancer. Breast cancers can be also soft, round, tender, or even painful.

Other possible symptoms include:

    • Swelling of all or part of a breast (even if no lump is felt)
    • Skin dimpling (sometimes looking like an orange peel)
    • Breast or nipple pain
    • Nipple retraction (turning inward)
    • Nipple or breast skin that is red, dry, flaking, or thickened
    • Nipple discharge (other than breast milk)
    • Swollen lymph nodes under the arm or near the collar bone (Sometimes this can be a sign of breast cancer spread even before the original tumor in the breast is large enough to be felt.)

Many of these symptoms can also be caused by benign (non-cancerous) breast conditions.

Making treatment her mission

For Mussell, the job is both inspiring and difficult.

“I truly enjoy taking care of patients with breast cancer,” she said. “They have taught me so much over these years and I am a better person because of them. When I tell people I work at Roswell, I often hear, ‘That must be hard.’ But what is actually hard, is what these women go through.

“The impact a breast cancer diagnosis has on mental and physical health is tough, and patients are often also juggling careers and families,” she said. “They are inspiring, and I am honored to be part of their journey.”