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Breast Cancer

Introduction

In this free educational guide on breast cancer, we provide you with a general discussion about this severe medical condition, and review what evidence or tests are needed to help prove that you are eligible for Social Security Disability Insurance (SSDI) and/or Supplemental Security Income (SSI).

For your general knowledge about this medical condition, we have included in this guide helpful information about what the disease is, symptoms, diagnosis, common treatment, and where you can find more help and information for this medical condition. This guide may also provide information about current legal issues that may be of value to you. This guide is not intended as legal advice or as a legal opinion.

After reading this guide, if you still have questions or would like to discuss your case with us, please call Chad Brown Law at (800) 556-9115. We are here to help you get the benefits you deserve.

 

1. What is breast cancer?

Generally, cancer, also called a carcinoma, is a disease in which the cells in the body begin to uncontrollably grow and multiply. Unlike normal cells, cancer cells do not die but rather they continue to rapidly divide, grow, and form more abnormal cells. Once cancer cells develop, they can grow into other tissues surrounding the origin point, whereas normal cells cannot. That is what makes cancer unique from normal cells: uncontrollably growing cells that grow into other tissues and do not have a normal cell death.

Every cell contains DNA, the blueprints of how that cell acts and operates. A cancer cell develops when a normal cell’s DNA is damaged, therefore changing its operational plan. In normal cells, if the DNA is damaged the cell will either repair the damage or it will result in the death of the cell. Cancer cells respond to DNA damage differently. In cancer cells there is no ability to repair the damage, but also the cell cannot die. Rather, the cancer cell begins to act abnormally and starts to replicate, producing new cells that do not provide any benefit to the body. The new cells will contain the same damaged DNA as the original cancer cell, along with its inability to die.

1a. Understanding Breast Cancer

The human breast is made up of three main parts: the lobules and glands, the ducts, and the connective tissue. A breast is made up of three main parts: lobes (glands), ducts, and connective tissue. The lobules contain the glands that produce milk shortly after a woman gives birth. The ducts make up the passageways that carry the milk from the glands to the nipples. Holding the lobules, glands, and ducts together is the connective tissue, which is made up of both fatty and fibrous tissues.

Breast cancer most often occurs in the milk ducts of the breast (ductal carcinoma), but can be found in the glands (lobular carcinoma). Invasive ductal cancer is cancer that has spread to surrounding tissue in the breast or other parts of the body. Invasive lobular cancer is cancer that has spread to the breast tissues close by or to others parts of the body. If either breast cancer has not spread beyond the lining of the duct or glands, this cancer is called in-situ rather than invasive.

When cancer begins in the breast, the normal breast cells grow out of control. These cells can travel to other parts of the body where they are not normally found. When this spread of breast cancer occurs, it is called metastatic breast cancer:

Even when breast cancer travels to an organ or another part of the body, if it originated in the breast, it is still called breast cancer and treated as breast cancer. The rate at which breast cancer spreads and grows depends on the type of cancer – some can take years to spread outside the breast while others can grow and spread within a matter of months.

In most cases the cancer cells form a tumor. Your body can form non-cancerous tumors (benign) or cancerous tumors. Benign tumors are typically harmless, but in some cases can cause complications when they grow too large and press on healthy organs and tissues. The important difference between a benign and a cancerous tumor is that a benign tumor cannot grow out of (invade) the tissue it originates from. The inability of benign tumors to spread (metastasize) to other tissues means that these tumors are rarely life threatening.

1b. Causes of Breast Cancer and Preventions

The Center for Disease Control (CDC) and the American Cancer Society (ACS) list some known risk factors for getting breast cancer (having a risk factor does not mean you will absolutely get the disease):

  • Family History – Breast cancer can run in the family. If your mother, sister, or daughter was diagnosed with breast cancer, you are at a two to three times higher risk of developing the disease yourself. The risk is higher the more prevalent breast cancer is in your immediate female relatives.
  • Age – The risk of developing breast cancer generally increases with age. At age 50, women are urged to perform more screenings and self-breast exams, as the risk of breast cancer is higher as you age.
  • Ethnicity – African-American women are more likely to develop breast cancer before menopause than Caucasian women.
  • Hormones – Doctors are researching the link between an abundance or lack of certain hormones and the role it plays in the development of breast cancer.
  • Genes – Researchers have identified two genes responsible for some instances of breast cancer in the same family — BRCA1 and BRCA2. About 1 woman in 200 carries one of these genes. Having a BRCA 1 or BRCA 2 gene is a risk factor to breast cancer and — while it does not ensure that she will get breast cancer — her risk of contracting breast cancer is high at 56%-85%.
  • Unhealthy lifestyle – being overweight, alcohol use, sedentary lifestyle – these are all potentially contributing factors to overall poor health and risk of breast cancer development.

2. Common Medical Terms Associated with Breast Cancer

Carcinoma – Cancer created from healthy epithelial cells. Epithelial cells are the type of cells that form the linings of the internal organs such as the stomach and esophagus, as well as the body cavities, glands, and the outer layer of your skin.

In-situ – A term meaning “in its original place”, when used to describe cancer it means the cancer has not yet invaded or spread to the surrounding tissue. Carcinoma in situ is a common term used to designate a cancer that is in its early stages.

Ductal carcinoma – The most common type of breast cancer being diagnosed today. In this type of breast cancer, the cells in a milk duct of the breast become cancerous and begin to grow abnormally, often spreading to the lobules, glands, or connective tissue around the duct.

Tumor – Also known as a neoplasm, a tumor is an abnormal mass of tissue cells that can form anywhere on the body. Tumors come in two types, solid or fluid- filled, and are classified as either cancerous or non-cancerous (benign).

Benign – A tumor is considered benign if it is non-cancerous. Unlike a cancerous tumor, the cells of a benign tumor lack the ability to spread (metastasize) to surrounding tissues. However, benign tumors can still grow and cause discomfort or distress to surrounding organs and tissues.

Lobular carcinoma – When breast cancer cells appear in the lobules of the breast, where milk is produced, it is known as Lobular Carcinoma (ILC).

Invasive – A term used to designate when a cancer has begun to grow and spread (metastasize) to other tissue areas and organs in the body.

Metastatic – A term used to denote the point when a cancer begins to spread (metastasizes) from the point of origin to another tissue or organ.

Malignancy – Cancerous cells that are able to spread (metastasize) to other tissues or organs within the body, causing the invasion or destruction of those tissues or organs.

3. Breast Cancer Symptoms

In its early stages, breast cancer usually has no symptoms. As a tumor develops, you may note the following signs:

  • Lumps on the breast or underarm that persist after your menstrual cycle. Most lumps are unable to be detected at first by self-exam and are usually first identified on an imaging test such as a mammogram.
  • Unusual swelling and tenderness in the armpits.
  • Unexplained pain or tenderness of the breast or nipple.
  • Noticeable changes in the physical appearance of the breast, such as dimpling or flattening of the breast’s surface.
  • Noticeable changes in the size, shape, or skin texture on the breast.
  • Breasts become unusually hot or cold to the touch.
  • The skin of the breast becomes unusually reddish and pitted, like the skin of an orange (this may be a sign of advanced stage breast cancer)
  • Changes in the appearance of the nipple, such as turning inward, dimpling, ulceration, and itching or burning sensations.
  • Clear, bloody, or unusually colored discharge from the nipples.
  • Any unusual blemishes or markings that are clearly different from other areas of the breast.

Breast cancer screening (tests, examination) is designed to find a cancer before you show any symptoms. According to the American Cancer Society “Breast cancers that are found because they can be felt tend to be larger and are more likely to have already spread beyond the breast. In contrast, breast cancers found during screening exams are more likely to be small and still confined to the breast. The size of a breast cancer and how far it has spread are important factors in predicting the prognosis (outlook) for a woman with this disease”. (From www.cancer.org)

The American Cancer Society and the Centers for Disease Control generally agree on recommendations for early breast cancer detection:

  • Breast self-exams (BSE) should begin at age 20 and be a regular monthly occurrence for all women. Women should be told about the proper method to conduct a BSE, as well as the benefits and limitations of this type of exam. If a woman notices any abnormalities listed above during her BSE, she should schedule an appointment for a clinical exam with her healthcare professional. (CDC generally agrees)
  • Starting at age 20 and continuing into their 30’s, women should have a clinical breast exam (CBE) by their family doctor or gynecologist every three years as part of a regular, comprehensive health exam. After age 40, these CBEs should take place once a year. (CDC recommends that you discuss this exam with your doctor as to when and how often)
  • Starting at age 40, women should talk to their doctor about starting a screening mammogram during their yearly health exam. These mammograms should continue annually as long as the woman is in good health, unless otherwise advised by her doctor. (CDC recommends that when you are age 40-49, you should discuss with your doctor how often and when to start screening mammograms; after age 50 every two years)
  • The American Cancer Society states that if a woman has any known risk factors for developing breast cancer, she should talk to her doctor about obtaining an annual MRI and mammogram. (CDC has no similar recommendation
  • According to The American Cancer Society, there is no significant benefit of MRI screening for women whose lifetime breast cancer risk is at 15 percent or less. (CDC has no similar recommendation)

Because there are some differing opinions on tests and examinations needed for early detection of breast cancer, you should fully discuss all of these options with your health professional.

4. How is breast cancer diagnosed?

Once screening tests and images are done to detect an abnormality, a biopsy is done of the abnormal tissue. This biopsy is the only way to tell definitively that you have cancer.

Once the tissue has been determined to be cancerous, tests are done to determine if the cancer has spread (metastasized) to any other areas of the body and the extent of the spread. This type of testing is called “staging”.

The stage your breast cancer is in is determined by considering the following factors:

  • The size of the tumor or tumors;
  • Whether or not the cancer cells have spread to the underarm (axillary) lymph nodes;
  • Whether or not the breast cancer cells have metastasized to other parts of your body.

The stages of cancer determine prognosis and treatment options. Here are the following stages of cancer:

Stage 0 – Cancer is isolated to the site of abnormality, and is non-invasive.

Stage 1 – This stage describes an early stage of breast cancer in which the tumor is measured at no more than 3/4 inch in diameter, and no lymph nodes are involved. At this stage, the cancer is considered invasive, although it has not yet spread outside the breast.

Stage 2 – Breast cancer is classified as stage 2 if any of the following are true:

  • The cancerous cells have spread to the lymph nodes in the underarm, but the tumor still measures less than 3/4 inch in diameter.
  • Cancer cells have been found in the underarm lymph nodes but no tumor has been found in the breast tissue itself.
  • The tumor’s size has reached greater than 3/4 inch in diameter but is not larger than 2 inches in diameter. It may or may not have spread to the lymph nodes in the underarm at this size.
  • The tumor measures greater than 2 inches in diameter but has not spread to the underarm lymph nodes.

Stage 3 – At stage 3, the cancer has not yet spread to any distant sites. There are three sub-categories of stage 3 breast cancer – A, B, and C – and your doctor will categorize your type based on a number of criteria.

Stage 3A breast cancer is where the tumor has grown larger than 2 inches in diameter and has spread to any of the three lymph nodes found in the underarms.

Stage 3B breast cancer is when the cancerous cells have spread to the tissues surrounding the breast – the skin near the arms, shoulders, and chest muscles. Cancerous cells may have spread to the lymph nodes within the breast or underarm. At this stage, a tumor of any size can be present.

Stage 3C breast cancer is also a tumor of any size that has spread to the lymph nodes. At this point, the cancer cells must have spread to:

  • 10 or more lymph nodes in the underarm.
  • Lymph nodes near the neck or above/below the collarbone.
  • Lymph nodes that are within the breast itself in addition to lymph nodes in the underarm.

Stage 4 – The most critical stage of breast cancer. At stage 4 the cancer has spread to more distant parts of the body and caused secondary tumors to develop in major organs such as the lungs, liver, or brain and cancerous cells to spread in the bones.

5. What is the common treatment for breast cancer?

Stage 0 treatment involves:

  • Surgery – used to remove small lumps in a procedure known as a lumpectomy which targets and removes the abnormal cancer cells and some of the surrounding healthy tissue. Some women choose to have a mastectomy, which is the full removal of the breast, to reduce their chances that the cancer will come back. Mastectomy is also used if a lumpectomy is unable to remove all of the in-situ cancer.
  • Radiation therapy – used in conjunction with a lumpectomy to target any potentially missed cancer cells and also help reduce the risk of recurrent cancer.
  • Endocrine therapy – a doctor administers doses of tamoxifen (a chemical agent) after surgery. This is done in order to help reduce the risk of cancer developing in the other breast.
  • Biological therapy – currently in development where the use of herceptin, a drug that attacks the HER2 gene, may help reduce the expression of that gene. The HER2 gene is present in over half of the breast cancer patients with ductal cancer in-situ (DCIS). Success of current herceptin clinical trials may make this a more common therapy choice in the future.

Lobular cancer in-situ raises the risk of getting invasive breast cancer. Treatment may include:

  • Endocrine therapy – the use of any combination of the tamoxifen, examestane, or raloxifene medications to lower the risk of cancer advancement or further spread.
  • Bilateral mastectomy – this procedure has become more popular as a preventative measure for women at high risk of breast cancer. In this procedure, both breasts are removed at the same time. Historically this has been the treatment of choice to prevent breast cancer from developing in either breast. However, with the increased use of endocrine therapy to reduce the risk of spread and development, experts now believe that this procedure is more extreme than most women need to reduce their breast cancer risk.

Treatment for Stage 1 breast cancer, which is a very early stage of breast cancer, also involves surgery, chemotherapy, endocrine therapy, radiation therapy.

Treatment for stage 2 breast cancer, a larger tumor but still isolated in the breast, includes a variety again of the above treatments for Stage 0 and Stage 1.

Treatment for stage 3 breast cancer, a cancer that involves an even larger tumor size and involvement with the breast lymph nodes, has a goal of shrinking and eliminating the size of the tumor. It involves basically the same choices of treatment as Stages 0-2.

Treatment for stage 4 breast cancer is more complex due to the spread of the cancer to more distant parts of the body such as the brain, lungs, liver, and bones. Therefore, surgery and radiation are typically not useful at this stage, and a combination of wide-reaching treatments such as chemotherapy, biological therapy, and endocrine therapy are used. These treatments are used to shrink the cancer and help slow the progression or the disease, improve the patient’s lifespan, and improve the quality of life.

Survival rates in eight years range from 100% with stage 0, to 40% for stage 3. Stage 4 is more complicated and severe.

6. Breast Cancer – What has to be proven for you to be considered disabled by Social Security?

The Social Security Administration has developed a list of medical conditions that are highly likely to result in health complications that would disable a person from performing a job and earning a substantial income. This list of conditions are ones that are expected to be permanent, or expected to result in death, or have a certain length of time that it must last. Each medical condition on this list has a complete description of what symptoms or conditions have to be present with your medical condition for you to “meet the listing”. The complete medical listing for breast cancer, medical listing 13.10, is found on this Social Security Administration website and is printed below for discussion:

http://www.socialsecurity.gov/disability/professionals/bluebook/13.00-NeoplasticDiseases-Malignant- Adult.htm#13_10

If you do not “meet” this listing, you may still be considered disabled if you are not able to do your past relevant work, or you are not able to do any other work that you may have the education or experience to do.

6a. Social Security’s Rules for Breast Cancer

13.10 Breast (except sarcoma—13.04) (See 13.00K4. – Bilateral primary breast cancer. We evaluate bilateral primary breast cancer (synchronous or metachronous) under 13.10A, which covers local primary disease, and not as a primary disease that has metastasized).

A. Locally advanced carcinoma (inflammatory carcinoma, tumor of any size with direct extension to the chest wall or skin, tumor of any size with metastases to the ipsilateral internal mammary nodes).

Or

B. Carcinoma with metastases to the supraclavicular or infraclavicular nodes, to 10 or more axillary nodes, or with distant metastases.

Or

C. Recurrent carcinoma, except local recurrence that remits with antineoplastic therapy.

6b. Chad Brown’s Explanation of Social Security’s Rules

For you to “meet the listing” and thereby qualify for Social Security disability benefits, you must have breast cancer as described in A, B, or C:

A. Locally advanced breast cancer (inflammatory cancer, tumor of any size that has spread (metastases) to the chest wall or skin, tumor of any size with metastases to the mammary lymph nodes).

Or

B. Cancer that has spread to the collarbone lymph nodes (both above and below), to 10 or more lymph nodes found in the armpits, or with distant spreading.

Or

C. Cancer that was once in remission has now reoccurred and now does not respond to chemotherapy.

7. Internet Resources for Breast Cancer

For other general information about Social Security and Supplemental Security Income disability programs and how the law firm of Chad Brown Law can help you, visit:

http://chadbrownlaw.com/

For a complete listing of conditions that Social Security considers disabling, go to Social Security’s website at:

http://www.socialsecurity.gov/disability/professionals/bluebook/AdultListings.htm

For more general information about breast cancer, go to these websites:

http://www.webmd.com/breast-cancer/guide/breast-cancer-overview-facts

http://www.cancer.org/index

8. Community Resources for Breast Cancer

Visit the local chapter of the American Cancer Society at:

http://www.cancer.org/myacs/index

For a North Carolina directory of services available for breast cancer patients, visit this website:

http://bcresourcedirectory.org/directory/16-organizations.htm

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