Life cycle of the ‘cell from hell’

Note: This is an updated reprint of a column written by Shirley Ruedy, retired Cancer Update columnist, and the late Dr. Campbell Watts, a Cedar Rapids surgeon whose longtime interest was breast cancer. The column runs in recognition of Breast Cancer Awareness Month.

This is the story of Julie and the cell from hell. “Julie” is hypothetical. Cancers … and certainly breast cancer … are not. More than a million American women are walking around at any given moment with breast cancer in some stage of development.

The life journey of a breast cancer, from the moment of its inception to discovery, can take from nine to 12 years. Let's follow the hypothetical case of Julie, 38, a bank teller married to “Steve,“ with two children, 5 and 3. We'll follow her to three points where the tumor could be detected: by mammogram, by a physician and by breast self-examination, or BSE.

Inception … Breast cancer is thought to arise from a single cell whose growth genes have been damaged by a series of changes in the cell's DNA. This newly-created renegade cell can now divide endlessly without aging. It has become immortal.

Julie, a vivacious brunette, has returned to bank work now that her oldest is in school. Everyone says she's a people person and life is full … and good.

Prevascular Phase … inception to four years. During its first three to four years, the newly-formed breast tumor exists in the extracellular space as an innocuous tiny cluster of slowly expanding cancer cells. It can't spread to distant sites because it contains no blood vessels or lymph channels. The tumor grows slowly: It must obtain its nutrition by osmosis from the surrounding fluid.

When the tumor size approaches the head of a common household pin (1.2 mm), growth is arrested because the tumor cells can no longer obtain sufficient oxygen and nutrients by osmosis. If the tumor fails to acquire a blood supply, growth will be suspended indefinitely.

A real go-getter, Julie progresses rapidly at the bank and is now head teller. Life has gotten even busier because the kids are now both in school. She does BSE sporadically. She does not have a clue as to the “enemy within.”

Fourth to fifth year … The genes of some of the tumor cells are genetically activated to produce powerful proteins. These proteins stimulate neighboring blood vessels to converge upon and invade the tumor, giving it a blood supply. Now the tumor not only grows more rapidly, being better oxygenated, but those cells that secrete powerful enzymes can now invade the blood vessels … and produce systemic disease.

Thus, by the time the tumor is pinhead-size, it's possible for it to spread to distant sites via the blood and lymph. It is tiny, but mighty.

Steve works with a woman who was just diagnosed with breast cancer, and he urges Julie to have regular mammograms now that she's over 40. She promises to. Unbeknown to her, the particular cancer cells within her are doubling in number every 100 to 300 days … from 1 million to 2 million, from 5 million to 10 million, and so on.

Sixth year … The tumor is now about two times the size of the head of a common pin (2.4 mm). It is now possible to detect some of these tumors by mammography, especially if the tumor contains microcalcifications.

These common calcium deposits, seen usually in a scattered pattern, can be quite innocent, but tend to cluster in a tumor area, and thus if bunched, are a ``red flag.''

Julie's been working for six years now and has gotten another promotion. With so much to do, she just hasn't gotten in for that mammogram. The new digital mammography picks up 15 percent to 20 percent more cancers in dense breasts than film mammography. It has similar results in women under 50 who are perimenopausal (within 12 months of either side of menopause).

If Julie had either a film or digital mammogram, her chances for five-year survival would be well over 90 percent. (In Cedar Rapids, all four mammography sites offer digital mammography and also Digital Breast Tomosynthesis, which further improves breast cancer detection in all patients, but particularly those with dense breast tissue.)

Seventh year … The tumor is approximately 5 to 6 mm (a pencil eraser is 6 mm). Now, many of these tumors, depending on the woman’s mammographic breast density, can be detected by a mammogram.

The couple have a new house, the kids are in Scouts and track, and Steve has been promoted, too. Julie could still have an excellent prognosis if she had a mammogram. Now, depending on breast density, standard mammography picks up 85 percent to 90 percent of all tumors, but this decreases in patients with dense breast tissue. This is why all facilities in Cedar Rapids provide additional screening exams in patients with dense breast tissue, including Automated Breast Ultrasound Screening (ABUS) and Abbreviated Breast MRI.

Eighth year … The tumor is about two times (1.2 cm) the size of a pencil eraser. The majority can be detected by mammography; some, unfortunately not all, by palpation … by hand.

Julie is 46 now. If she saw her doctor, he might well find the hard lump. And about 90 percent of the time, a mammogram would detect it. Julie could still be called clinically early and she'd be back with her beloved family, friends and job … shaken but with a good prognosis.

Ninth to 12th year … Some cancers cannot be detected by palpation until they reach a diameter of 2 centimeters, 3 centimeters, or even larger because they are camouflaged within the breast tissue. The vast majority is seen on a mammogram.

If Julie, now around 50, examined herself at this point, she would probably find what most women dread: a lump. The mammogram would have an 85 to 90 percent chance of picking it up. Depending on the size, location, type, and breast density, treatment can still be effective. The cell from hell can be overcome.

Authorities say that if all the women who should use mammography did so, deaths from breast cancer could be reduced by 30 percent.

Getting help

Eastern Iowa is a resource-rich area for women in need of financial assistance for breast care and mammography costs.

Especially for You: For financially disadvantaged women who use health care facilities in the Cedar Rapids area. They’re eligible for free screening, diagnostic mammograms, ultrasounds and other breast and gynecological-related procedures at Mercy Women’s Center and other participating providers. Information: Mercy Women’s Center

(319) 398-6690 or visit https://www.especiallyforyourace.org/efy/fund/

Care for Yourself: The Iowa Breast and Cervical Cancer Early Detection Program: NO COST mammograms and Pap tests to uninsured, underinsured women with qualifying household incomes ($2,832 monthly net income from your job; add $983 to maximum monthly income for each additional household member.) Women must fit the above guidelines or be unable to pay deductibles/co-payments. Information:

1-(866) 339-7909 or visit www.idph.iowa.gov/cfy

Susan G. Komen Fund: For women needing mammograms, financial assistance for mammograms or information about breast cancer, call 1-(877) 465-6636 or visit komen.org.

In Johnson County: For information, call the Visiting Nurse Association,

(319) 337-9686 or 1-(866) 862-6877; or visit https://bit.ly/3EnBGDb.