October is Breast Cancer Awareness Month. Every October, we are reminded to spread the word about breast cancer prevention and early detection. That awareness extends to our dogs as well.
What is a mammary tumor (breast cancer)?
A mammary tumor develops as a result of abnormal replication of the cells that make up the breast tissue. Mammary tumors can be benign (non-cancerous) or malignant (cancerous). These two forms of the disease have different diagnostics, treatments, management, and prognosis.
There are several different types of malignant mammary tumors, with carcinomas being the most common. Carcinomas arise from epithelial (skin) cells, tubules of the mammary glands, or other cells found in the mammary chain. There are other cancers that can affect mammary glands, including osteosarcomas.
What causes this cancer?
The exact causes for the development of mammary tumors in dogs are not fully understood. It is well known that exposure to specific hormones, namely progesterone, increases the risk for developing mammary cancers in dogs. This is because progesterone stimulates growth factors (molecules that stimulate specific processes in the body) that cause mammary cells to multiply (i.e., replicate).
The incidence of these tumors is related to whether a dog is intact or has had an ovariohysterectomy (i.e., has been spayed). Dogs spayed prior to their first heat (also called estrus) have only a 0.5% risk of developing mammary tumor(s). However, after a first or second heat, this dramatically increases to a risk of 8% and 26%, respectively. Age also appears to play a role; the risk of tumor development significantly increases once a dog reaches 7 years of age and continues increasing until 11-13 years of age. This increased risk is breed dependent indicating that there is a genetic component.
Certain breeds appear to be more commonly affected, including Chihuahuas, Poodles, Dachshunds, Yorkshire Terriers, Cocker Spaniels, Brittany Spaniels, English Setters, Boxer Dogs, and Doberman Pinchers. Research in veterinary medicine continues, but to-date we still know little about which genes and mutations can lead to the development of mammary tumors in dogs. In human medicine, research has established a definite relationship between the BRCA gene (or breast cancer gene) and the development of breast cancer
What are the signs that my dog has this type of tumor?
The most common clinical sign of a malignant mammary tumor is one (or more) palpable masses underneath the skin of the abdomen. They may be next to or within the nipple and follow along the mammary chain. The size of the mass(es) and their appearance may vary, but they are usually firm and nodular. Occasionally the skin over the mass may ulcerate (open) and bleed, and the affected area may feel warm to the touch and become painful. The mammary gland may even develop a discharge.
If the tumor has metastasized (spread to other areas of the body), other signs may become evident. Your dog may generally feel unwell, eat less, become lethargic, and lose weight. If the lungs are involved, your dog may have problems with breathing or develop a cough.
How is this type of tumor diagnosed?
These tumors are typically found as either singular or multiple nodules along your dog’s abdomen during a physical exam. Other procedures are then performed to determine the type of tumor and whether it is benign or malignant.
A common procedure to diagnose this tumor is a fine needle aspiration (FNA). FNA involves taking a small needle with a syringe and suctioning a sample of cells directly from the tumor and placing them on a microscope slide. A veterinary pathologist then examines the slide under a microscope.
In some cases, results from FNA may not be entirely clear and a biopsy or removal of the entire tumor may be necessary. Pieces of the tumor are then examined by a veterinary pathologist under the microscope. This is called histopathology. Histopathology is not only helpful to make a diagnosis but can indicate whether it is benign or malignant, and therefore how the tumor is likely to behave.
Given the risk of metastasis (spread to other areas of the body) with malignant mammary tumors, your veterinarian may also recommend staging (searching for potential spread to other locations in the body). This may include bloodwork, urinalysis, X-rays of the lungs, and possibly an abdominal ultrasound. The lymph nodes associated with the mammary glands may be sampled by FNA even if they seem normal.
How do malignant mammary tumors typically progress?
The way malignant mammary tumors typically progress is entirely dependent on the type and size of the tumor(s), and whether metastasis has occurred. Larger tumors (those greater than 3 cm) and those with evidence of spread have a poor prognosis. Tumors smaller than 1 cm have a better prognosis. Detecting and treating these tumors when they are small and before spread has occurred will provide your dog with the best chance for long-term control.
What are the treatments for this type of tumor?
For dogs with solitary mammary tumors, surgery is by far the best treatment. If there is only one small mass and staging shows no evidence of spread, surgery may be the only treatment your dog receives.
For dogs with multiple tumors of one or both mammary chains, the associated – or all – of the mammary glands may need to be removed. If your dog is intact, an ovariohysterectomy (spay) is recommended and may be done at the same time as the mammary gland removal.
For dogs with larger tumors or evidence of spread to other areas of the body, chemotherapy is typically recommended. There is increasing evidence that radiation therapy may provide some benefit for dogs with inflammatory carcinomas in addition to chemotherapy. Your veterinarian will discuss the options that are best suited for your dog’s particular situation.
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