Breast cancer is the disease that many women fear most, though they're more likely to die of cardiovascular disease, which kills more women than do all forms of cancer combined. Still, breast cancer is second only to lung cancer as a cause of cancer deaths in American women. Breast cancer can also occur in men, although it rarely does. Experts predict 178,000 women and 2,000 men will develop breast cancer in the United States in 2007.
Yet there's more reason for optimism than ever before. In the last 30 years, doctors have made great strides in early diagnosis and treatment of the disease and in reducing breast cancer deaths. In 1975, a diagnosis of breast cancer usually meant radical mastectomy — removal of the entire breast along with underarm lymph nodes and muscles underneath the breast. Today, radical mastectomy is rarely performed. Instead, there are more and better treatment options, and many women are candidates for breast-sparing operations.
What is being done to better understand and prevent breast cancer
Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). They are studying new ways to prevent, detect, diagnose, and treat breast cancer. Some are also studying therapies that may improve the quality of life for women during or after cancer treatment.
Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to advances and researchers continue to search for more effective methods for dealing with cancer.
Women who join clinical trials may be among the first to benefit if a new approach is effective. And even if people in a trial do not benefit directly, they still make an important contribution by helping doctors learn more about breast cancer and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.
If you are interested in being part of a clinical trial, talk with your doctor. Trials are available for all stages of breast cancer.
Research on prevention
Scientists are looking for drugs that may prevent breast cancer. For example, they are testing several different drugs that lower hormone levels or prevent a hormone's effect on breast cells.
In one large study, the drug tamoxifen reduced the number of new cases of breast cancer among women who were at an increased risk of the disease. Doctors are studying whether the drug raloxifene is as effective as tamoxifen. This study is called STAR (Study of Tamoxifen and Raloxifene).
Research on detection, diagnosis, and staging
At this time, mammograms are the most effective tool we have to detect changes in the breast that may be cancer. In women at high risk of breast cancer, researchers are studying the combination of mammograms and ultrasound. Researchers are also exploring positron emission tomography (PET) and other ways to make detailed pictures of breast tissue.
In addition, researchers are studying tumor markers. Tumor markers may be found in blood, in urine, or in fluid from the breast (nipple aspirate). High amounts of these substances may be a sign of cancer. Some markers may be used to check breast cancer patients for signs of disease after treatment. At this time, however, no tumor marker test is reliable enough to be used routinely to detect breast cancer.
Ductal lavage also is under study. This technique collects cells from breast ducts. A liquid flows through a catheter (very thin, flexible tube) into the opening of a milk duct on the nipple. The liquid and breast cells are withdrawn through the tube. A pathologist checks the cells for cancer or changes that may suggest an increased risk of cancer.
Research on treatment
Researchers are studying many types of treatment and their combinations:
Surgery: Different types of surgery are being combined with other treatments.
Radiation therapy: Doctors are studying whether radiation therapy can be used instead of surgery to treat cancer in lymph nodes. They are looking at the effectiveness of radiation therapy to a larger area around the breast. In women with early breast cancer, doctors are studying whether radiation therapy to a smaller part of the breast may be helpful.
Chemotherapy: Researchers are testing new anticancer drugs and doses. They are working with drugs and combinations of drugs. They are looking at new drug combinations before surgery. They are also looking at new ways of combining chemotherapy with hormone therapy or radiation therapy.
Hormone therapy: Researchers are testing several types of hormone therapy, including aromatase inhibitors.
Biological therapy: New biological treatments also are under study. For example, researchers are studying cancer vaccines that help the immune system kill cancer cells.
In addition, researchers are looking at ways to lessen the side effects from treatment, such as lymphedema from surgery. They are looking at ways to reduce pain and improve quality of life. One method under study is sentinel lymph node biopsy. Today, surgeons have to remove many lymph nodes under the arm and check each of them for cancer. Researchers are studying whether checking only the node to which cancer is most likely to spread (sentinel lymph node) will allow them to predict whether cancer has spread to other nodes. If this new procedure works as well as standard treatment, surgeons may be able to remove fewer lymph nodes. This could reduce lymphedema for many patients.
National Cancer Institute information resources
You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.
Clinical trials are designed to answer important questions and to find out whether new approaches are safe and effective. Research already has led to advances and researchers continue to search for more effective methods for dealing with cancer.
Women who join clinical trials may be among the first to benefit if a new approach is effective. And even if people in a trial do not benefit directly, they still make an important contribution by helping doctors learn more about breast cancer and how to control it. Although clinical trials may pose some risks, researchers do all they can to protect their patients.
If you are interested in being part of a clinical trial, talk with your doctor. Trials are available for all stages of breast cancer.
Research on prevention
Scientists are looking for drugs that may prevent breast cancer. For example, they are testing several different drugs that lower hormone levels or prevent a hormone's effect on breast cells.
In one large study, the drug tamoxifen reduced the number of new cases of breast cancer among women who were at an increased risk of the disease. Doctors are studying whether the drug raloxifene is as effective as tamoxifen. This study is called STAR (Study of Tamoxifen and Raloxifene).
Research on detection, diagnosis, and staging
At this time, mammograms are the most effective tool we have to detect changes in the breast that may be cancer. In women at high risk of breast cancer, researchers are studying the combination of mammograms and ultrasound. Researchers are also exploring positron emission tomography (PET) and other ways to make detailed pictures of breast tissue.
In addition, researchers are studying tumor markers. Tumor markers may be found in blood, in urine, or in fluid from the breast (nipple aspirate). High amounts of these substances may be a sign of cancer. Some markers may be used to check breast cancer patients for signs of disease after treatment. At this time, however, no tumor marker test is reliable enough to be used routinely to detect breast cancer.
Ductal lavage also is under study. This technique collects cells from breast ducts. A liquid flows through a catheter (very thin, flexible tube) into the opening of a milk duct on the nipple. The liquid and breast cells are withdrawn through the tube. A pathologist checks the cells for cancer or changes that may suggest an increased risk of cancer.
Research on treatment
Researchers are studying many types of treatment and their combinations:
Surgery: Different types of surgery are being combined with other treatments.
Radiation therapy: Doctors are studying whether radiation therapy can be used instead of surgery to treat cancer in lymph nodes. They are looking at the effectiveness of radiation therapy to a larger area around the breast. In women with early breast cancer, doctors are studying whether radiation therapy to a smaller part of the breast may be helpful.
Chemotherapy: Researchers are testing new anticancer drugs and doses. They are working with drugs and combinations of drugs. They are looking at new drug combinations before surgery. They are also looking at new ways of combining chemotherapy with hormone therapy or radiation therapy.
Hormone therapy: Researchers are testing several types of hormone therapy, including aromatase inhibitors.
Biological therapy: New biological treatments also are under study. For example, researchers are studying cancer vaccines that help the immune system kill cancer cells.
In addition, researchers are looking at ways to lessen the side effects from treatment, such as lymphedema from surgery. They are looking at ways to reduce pain and improve quality of life. One method under study is sentinel lymph node biopsy. Today, surgeons have to remove many lymph nodes under the arm and check each of them for cancer. Researchers are studying whether checking only the node to which cancer is most likely to spread (sentinel lymph node) will allow them to predict whether cancer has spread to other nodes. If this new procedure works as well as standard treatment, surgeons may be able to remove fewer lymph nodes. This could reduce lymphedema for many patients.
National Cancer Institute information resources
You may want more information for yourself, your family, and your doctor. The following National Cancer Institute (NCI) services are available to help you.
What about support for women with breast cancer
Learning you have breast cancer can change your life and the lives of those close to you. These changes can be hard to handle. It is normal for you, your family, and your friends to have many different and sometimes confusing feelings.
You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.
Friends and relatives can be very supportive. Also, you may find it helps to discuss your concerns with others who have cancer. Women with breast cancer often get together in support groups to share what they have learned about coping with their disease and the effects of their treatment. It is important to keep in mind, however, that each woman is different. Ways that one woman deals with cancer may not be right for another. You may want to ask your health care provider about advice you receive from other women with breast cancer.
Several organizations offer special programs for women with breast cancer. Women who have had the disease serve as trained volunteers. They may talk with or visit women with breast cancer, provide information, and lend emotional support. They often share their experiences with breast cancer treatment, breast reconstruction, and recovery.
You may be afraid that changes to your body will affect not only how you look but also how other people feel about you. You may worry that breast cancer and its treatment will affect your sexual relationships. Many couples find it helps to talk about their concerns. Some find that counseling or a couples' support group can be helpful.
You may worry about caring for your family, keeping your job, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful if you want to talk about your feelings or concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.
Friends and relatives can be very supportive. Also, you may find it helps to discuss your concerns with others who have cancer. Women with breast cancer often get together in support groups to share what they have learned about coping with their disease and the effects of their treatment. It is important to keep in mind, however, that each woman is different. Ways that one woman deals with cancer may not be right for another. You may want to ask your health care provider about advice you receive from other women with breast cancer.
Several organizations offer special programs for women with breast cancer. Women who have had the disease serve as trained volunteers. They may talk with or visit women with breast cancer, provide information, and lend emotional support. They often share their experiences with breast cancer treatment, breast reconstruction, and recovery.
You may be afraid that changes to your body will affect not only how you look but also how other people feel about you. You may worry that breast cancer and its treatment will affect your sexual relationships. Many couples find it helps to talk about their concerns. Some find that counseling or a couples' support group can be helpful.
What about follow-up care
Follow-up care after treatment for breast cancer is important. Recovery is different for each woman. Your recovery depends on your treatment, whether the disease has spread, and other factors.
Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer.
You should report any changes in the treated area or in your other breast to the doctor right away. Tell your doctor about any health problems, such as pain, loss of appetite or weight, changes in menstrual cycles, unusual vaginal bleeding, or blurred vision. Also talk to your doctor about headaches, dizziness, shortness of breath, coughing or hoarseness, backaches, or digestive problems that seem unusual or that don't go away. Such problems may arise months or years after treatment. They may suggest that the cancer has returned, but they can also be symptoms of other health problems. It is important to share your concerns with your doctor so problems can be diagnosed and treated as soon as possible.
Follow-up exams usually include the breasts, chest, neck, and underarm areas. Since you are at risk of getting cancer again, you should have mammograms of your preserved breast and your other breast. You probably will not need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. Your doctor may order other imaging procedures or lab tests.
Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment. Your doctor will monitor your recovery and check for recurrence of the cancer.
You should report any changes in the treated area or in your other breast to the doctor right away. Tell your doctor about any health problems, such as pain, loss of appetite or weight, changes in menstrual cycles, unusual vaginal bleeding, or blurred vision. Also talk to your doctor about headaches, dizziness, shortness of breath, coughing or hoarseness, backaches, or digestive problems that seem unusual or that don't go away. Such problems may arise months or years after treatment. They may suggest that the cancer has returned, but they can also be symptoms of other health problems. It is important to share your concerns with your doctor so problems can be diagnosed and treated as soon as possible.
Follow-up exams usually include the breasts, chest, neck, and underarm areas. Since you are at risk of getting cancer again, you should have mammograms of your preserved breast and your other breast. You probably will not need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. Your doctor may order other imaging procedures or lab tests.
Nutrition and physical activity
It is important for women with breast cancer to take care of themselves. Taking care of yourself includes eating well and staying as active as you can.
You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, dietitian, or other health care provider can suggest ways to deal with these problems.
Many women find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it
You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods do not taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth sores) can make it hard to eat well. Your doctor, dietitian, or other health care provider can suggest ways to deal with these problems.
Many women find they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know about it
What about complementary and alternative medicine
Some women with breast cancer use complementary and alternative medicine (CAM):
An approach is generally called complementary medicine when it is used along with standard treatment.
An approach is called alternative medicine when it is used instead of standard treatment.
Acupuncture, massage therapy, herbal products, vitamins or special diets, visualization, meditation, and spiritual healing are types of CAM.
Many women say that CAM helps them feel better. However, some types of CAM may change the way standard treatment works. These changes could be harmful. And some types of CAM could be harmful even if used alone.
Some types of CAM are expensive. Health insurance may not cover the cost.
You also may request materials from the Federal Government's National Center for Complementary and Alternative Medicine. You can reach their clearinghouse toll-free at 1-888-644-6226 (voice) and 1-866-464-3615 (TTY). In addition, you can visit the Center's Web site at http://www.nccam.nih.gov, or send an email to
An approach is generally called complementary medicine when it is used along with standard treatment.
An approach is called alternative medicine when it is used instead of standard treatment.
Acupuncture, massage therapy, herbal products, vitamins or special diets, visualization, meditation, and spiritual healing are types of CAM.
Many women say that CAM helps them feel better. However, some types of CAM may change the way standard treatment works. These changes could be harmful. And some types of CAM could be harmful even if used alone.
Some types of CAM are expensive. Health insurance may not cover the cost.
You also may request materials from the Federal Government's National Center for Complementary and Alternative Medicine. You can reach their clearinghouse toll-free at 1-888-644-6226 (voice) and 1-866-464-3615 (TTY). In addition, you can visit the Center's Web site at http://www.nccam.nih.gov, or send an email to
What about breast reconstruction
Some women who plan to have a mastectomy decide to have breast reconstruction. Other women prefer to wear a breast form (prosthesis). Others decide to do nothing. All of these options have pros and cons. What is right for one woman may not be right for another. What is important is that nearly every woman treated for breast cancer has choices.
Breast reconstruction may be done at the same time as the mastectomy, or later on. If you are thinking about breast reconstruction, you should talk to a plastic surgeon before the mastectomy, even if you plan to have your reconstruction later on.
There are many ways to reconstruct the breast. Some women choose to have implants. Implants may be made of saline or silicone. The safety of silicone breast implants has been under review by the Food and Drug Administration (FDA) for several years. If you are thinking about having silicone implants, you may want to talk with your doctor about the FDA findings. Your doctor can tell you if silicone implants are an option. You also can read information from the FDA on breast implants at http://www.fda.gov/cdrh/breastimplants/.
You also may have breast reconstruction with tissue that the plastic surgeon moves from another part of your body. Skin, muscle, and fat can come from your lower abdomen, back, or buttocks. The surgeon uses this tissue to create a breast shape.
Which type of reconstruction is best depends on your age, body type, and the type of surgery you had. The plastic surgeon can explain the risks and benefits of each type of reconstruction.
Breast reconstruction may be done at the same time as the mastectomy, or later on. If you are thinking about breast reconstruction, you should talk to a plastic surgeon before the mastectomy, even if you plan to have your reconstruction later on.
There are many ways to reconstruct the breast. Some women choose to have implants. Implants may be made of saline or silicone. The safety of silicone breast implants has been under review by the Food and Drug Administration (FDA) for several years. If you are thinking about having silicone implants, you may want to talk with your doctor about the FDA findings. Your doctor can tell you if silicone implants are an option. You also can read information from the FDA on breast implants at http://www.fda.gov/cdrh/breastimplants/.
You also may have breast reconstruction with tissue that the plastic surgeon moves from another part of your body. Skin, muscle, and fat can come from your lower abdomen, back, or buttocks. The surgeon uses this tissue to create a breast shape.
Which type of reconstruction is best depends on your age, body type, and the type of surgery you had. The plastic surgeon can explain the risks and benefits of each type of reconstruction.
Recurrent breast cancer
Recurrent cancer is cancer that has come back after it could not be detected. Treatment for the recurrent disease depends mainly on the location and extent of the cancer. Another main factor is the type of treatment the woman had before.
If breast cancer comes back only in the breast after breast-sparing surgery, the woman may have a mastectomy. Chances are good that the disease will not come back again.
If breast cancer recurs in other parts of the body, treatment may involve chemotherapy, hormone therapy, or biological therapy. Radiation therapy may help control cancer that recurs in the chest muscles or in certain other areas of the body.
Treatment can seldom cure cancer that recurs outside the breast. Supportive care is often an important part of the treatment plan. Many patients have supportive care to ease their symptoms and anticancer treatments to slow the progress of the disease. Some receive only supportive care to improve their quality of life.
If breast cancer comes back only in the breast after breast-sparing surgery, the woman may have a mastectomy. Chances are good that the disease will not come back again.
If breast cancer recurs in other parts of the body, treatment may involve chemotherapy, hormone therapy, or biological therapy. Radiation therapy may help control cancer that recurs in the chest muscles or in certain other areas of the body.
Treatment can seldom cure cancer that recurs outside the breast. Supportive care is often an important part of the treatment plan. Many patients have supportive care to ease their symptoms and anticancer treatments to slow the progress of the disease. Some receive only supportive care to improve their quality of life.
Treatment choices by stage
Your treatment options depend on the stage of your disease and these factors:
The size of the tumor in relation to the size of your breast
The results of lab tests (such as whether the breast cancer cells need hormones to grow)
Whether you have gone through menopause
Your general health
Below are brief descriptions of common treatments for each stage. Other treatments may be appropriate for some women. Clinical trials can be an option at all stages of breast cancer.
Stage 0
Stage 0 breast cancer refers to lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS):
LCIS: Most women with LCIS do not have treatment. Instead, the doctor may suggest regular checkups to watch for signs of breast cancer.
Some women take tamoxifen to reduce the risk of developing breast cancer. Others may take part in studies of promising new preventive treatments.
Having LCIS in one breast increases the risk of cancer for both breasts. A very small number of women with LCIS try to prevent cancer with surgery to remove both breasts. This is a bilateral prophylactic mastectomy. The surgeon usually does not remove the underarm lymph nodes.
DCIS: Most women with DCIS have breast-sparing surgery followed by radiation therapy. Some women choose to have a total mastectomy. Underarm lymph nodes are not usually removed. Women with DCIS may receive tamoxifen to reduce the risk of developing invasive breast cancer.
Stages I, II, IIIA, and operable IIIC
Women with Stage I, II, IIIA, and operable (can treat with surgery) IIIC breast cancer may have a combination of treatments. Some may have breast-sparing surgery followed by radiation therapy to the breast. This choice is common for women with Stage I or II breast cancer. Others decide to have a mastectomy.
With either approach, women (especially those with Stage II or IIIA breast cancer) often have lymph nodes under the arm removed. The doctor may suggest radiation therapy after mastectomy if cancer cells are found in 1 to 3 lymph nodes under the arm, or if the tumor in the breast is large. If cancer cells are found in more than 3 lymph nodes under the arm, the doctor usually will suggest radiation therapy after mastectomy.
The choice between breast-sparing surgery (followed by radiation therapy) and mastectomy depends on many factors:
The size, location, and stage of the tumor
The size of the woman's breast
Certain features of the cancer
How the woman feels about saving her breast
How the woman feels about radiation therapy
The woman's ability to travel to a radiation treatment center
Some women have chemotherapy before surgery. This is neoadjuvant therapy (treatment before the main treatment). Chemotherapy before surgery may shrink a large tumor so that breast-sparing surgery is possible. Women with large Stage II or IIIA breast tumors often choose this treatment.
After surgery, many women receive adjuvant therapy. Adjuvant therapy is treatment given after the main treatment to increase the chances of a cure. Radiation treatment can kill cancer cells in and near the breast. Women also may have systemic treatment such as chemotherapy, hormone therapy, or both. This treatment can destroy cancer cells that remain anywhere in the body. It can prevent the cancer from coming back in the breast or elsewhere.
Stages IIIB and inoperable IIIC
Women with Stage IIIB (including inflammatory breast cancer) or inoperable Stage IIIC breast cancer usually have chemotherapy. (Inoperable cancer means it cannot be treated with surgery.)
If the chemotherapy shrinks the tumor, the doctor then may suggest further treatment:
Mastectomy: The surgeon removes the breast. In most cases, the lymph nodes under the arm are removed. After surgery, a woman may receive radiation therapy to the chest and underarm area.
Breast-sparing surgery: The surgeon removes the cancer but not the breast. In most cases, the lymph nodes under the arm are removed. After surgery, a woman may receive radiation therapy to the breast and underarm area.
Radiation therapy instead of surgery: Some women have radiation therapy but no surgery. The doctor also may recommend more chemotherapy, hormone therapy, or both. This therapy may help prevent the disease from coming back in the breast or elsewhere.
Stage IV
In most cases, women with Stage IV breast cancer have hormone therapy, chemotherapy, or both. Some also may have biological therapy. Radiation may be used to control tumors in certain parts of the body. These treatments are not likely to cure the disease, but they may help a woman live longer.Many women have supportive care along with anticancer treatments. Anticancer treatments are given to slow the progress of the disease. Supportive care helps manage pain, other symptoms, or side effects (such as nausea). It does not aim to extend a woman's life. Supportive care can help a woman feel better physically and emotionally. Some women with advanced cancer decide to have only supportive care
The size of the tumor in relation to the size of your breast
The results of lab tests (such as whether the breast cancer cells need hormones to grow)
Whether you have gone through menopause
Your general health
Below are brief descriptions of common treatments for each stage. Other treatments may be appropriate for some women. Clinical trials can be an option at all stages of breast cancer.
Stage 0
Stage 0 breast cancer refers to lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS):
LCIS: Most women with LCIS do not have treatment. Instead, the doctor may suggest regular checkups to watch for signs of breast cancer.
Some women take tamoxifen to reduce the risk of developing breast cancer. Others may take part in studies of promising new preventive treatments.
Having LCIS in one breast increases the risk of cancer for both breasts. A very small number of women with LCIS try to prevent cancer with surgery to remove both breasts. This is a bilateral prophylactic mastectomy. The surgeon usually does not remove the underarm lymph nodes.
DCIS: Most women with DCIS have breast-sparing surgery followed by radiation therapy. Some women choose to have a total mastectomy. Underarm lymph nodes are not usually removed. Women with DCIS may receive tamoxifen to reduce the risk of developing invasive breast cancer.
Stages I, II, IIIA, and operable IIIC
Women with Stage I, II, IIIA, and operable (can treat with surgery) IIIC breast cancer may have a combination of treatments. Some may have breast-sparing surgery followed by radiation therapy to the breast. This choice is common for women with Stage I or II breast cancer. Others decide to have a mastectomy.
With either approach, women (especially those with Stage II or IIIA breast cancer) often have lymph nodes under the arm removed. The doctor may suggest radiation therapy after mastectomy if cancer cells are found in 1 to 3 lymph nodes under the arm, or if the tumor in the breast is large. If cancer cells are found in more than 3 lymph nodes under the arm, the doctor usually will suggest radiation therapy after mastectomy.
The choice between breast-sparing surgery (followed by radiation therapy) and mastectomy depends on many factors:
The size, location, and stage of the tumor
The size of the woman's breast
Certain features of the cancer
How the woman feels about saving her breast
How the woman feels about radiation therapy
The woman's ability to travel to a radiation treatment center
Some women have chemotherapy before surgery. This is neoadjuvant therapy (treatment before the main treatment). Chemotherapy before surgery may shrink a large tumor so that breast-sparing surgery is possible. Women with large Stage II or IIIA breast tumors often choose this treatment.
After surgery, many women receive adjuvant therapy. Adjuvant therapy is treatment given after the main treatment to increase the chances of a cure. Radiation treatment can kill cancer cells in and near the breast. Women also may have systemic treatment such as chemotherapy, hormone therapy, or both. This treatment can destroy cancer cells that remain anywhere in the body. It can prevent the cancer from coming back in the breast or elsewhere.
Stages IIIB and inoperable IIIC
Women with Stage IIIB (including inflammatory breast cancer) or inoperable Stage IIIC breast cancer usually have chemotherapy. (Inoperable cancer means it cannot be treated with surgery.)
If the chemotherapy shrinks the tumor, the doctor then may suggest further treatment:
Mastectomy: The surgeon removes the breast. In most cases, the lymph nodes under the arm are removed. After surgery, a woman may receive radiation therapy to the chest and underarm area.
Breast-sparing surgery: The surgeon removes the cancer but not the breast. In most cases, the lymph nodes under the arm are removed. After surgery, a woman may receive radiation therapy to the breast and underarm area.
Radiation therapy instead of surgery: Some women have radiation therapy but no surgery. The doctor also may recommend more chemotherapy, hormone therapy, or both. This therapy may help prevent the disease from coming back in the breast or elsewhere.
Stage IV
In most cases, women with Stage IV breast cancer have hormone therapy, chemotherapy, or both. Some also may have biological therapy. Radiation may be used to control tumors in certain parts of the body. These treatments are not likely to cure the disease, but they may help a woman live longer.Many women have supportive care along with anticancer treatments. Anticancer treatments are given to slow the progress of the disease. Supportive care helps manage pain, other symptoms, or side effects (such as nausea). It does not aim to extend a woman's life. Supportive care can help a woman feel better physically and emotionally. Some women with advanced cancer decide to have only supportive care
Biological therapy
Biological therapy helps the immune system fight cancer. The immune system is the body's natural defense against disease.
Some women with breast cancer that has spread receive a biological therapy called Herceptin® (trastuzumab). It is a monoclonal antibody. It is made in the laboratory and binds to cancer cells.
Herceptin is given to women whose lab tests show that a breast tumor has too much of a specific protein known as HER2. By blocking HER2, it can slow or stop the growth of the cancer cells.
Herceptin is given by vein. It may be given alone or with chemotherapy.
The first time a woman receives Herceptin, the most common side effects are fever and chills. Some women also have pain, weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, or rashes. Side effects usually become milder after the first treatment.
Herceptin also may cause heart damage. This may lead to heart failure. Herceptin can also affect the lungs. It can cause breathing problems that require a doctor at once. Before you receive Herceptin, your doctor will check for your heart and lungs. During treatment, your doctor will watch for signs of lung problems.
Some women with breast cancer that has spread receive a biological therapy called Herceptin® (trastuzumab). It is a monoclonal antibody. It is made in the laboratory and binds to cancer cells.
Herceptin is given to women whose lab tests show that a breast tumor has too much of a specific protein known as HER2. By blocking HER2, it can slow or stop the growth of the cancer cells.
Herceptin is given by vein. It may be given alone or with chemotherapy.
The first time a woman receives Herceptin, the most common side effects are fever and chills. Some women also have pain, weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, or rashes. Side effects usually become milder after the first treatment.
Herceptin also may cause heart damage. This may lead to heart failure. Herceptin can also affect the lungs. It can cause breathing problems that require a doctor at once. Before you receive Herceptin, your doctor will check for your heart and lungs. During treatment, your doctor will watch for signs of lung problems.
Hormone therapy
Some breast tumors need hormones to grow. Hormone therapy keeps cancer cells from getting or using the natural hormones they need. These hormones are estrogen and progesterone. Lab tests can show if a breast tumor has hormone receptors. If you have this kind of tumor, you may have hormone therapy.
This treatment uses drugs or surgery:
Drugs: Your doctor may suggest a drug that can block the natural hormone. One drug is tamoxifen, which blocks estrogen. Another type of drug prevents the body from making the female hormone estradiol. Estradiol is a form of estrogen. This type of drug is an aromatase inhibitor. If you have not gone through menopause, your doctor may give you a drug that stops the ovaries from making estrogen.
Surgery: If you have not gone through menopause, you may have surgery to remove your ovaries. The ovaries are the main source of the body's estrogen. A woman who has gone through menopause does not need surgery. (The ovaries produce less estrogen after menopause.)
The side effects of hormone therapy depend largely on the specific drug or type of treatment. Tamoxifen is the most common hormone treatment. In general, the side effects of tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Other side effects are irregular menstrual periods, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Not all women who take tamoxifen have side effects.
It is possible to become pregnant when taking tamoxifen. Tamoxifen may harm the unborn baby. If you are still menstruating, you should discuss birth control methods with your doctor.
Serious side effects of tamoxifen are rare. However, it can cause blood clots in the veins. Blood clots form most often in the legs and in the lungs. Women have a slight increase in their risk of stroke.
Tamoxifen can cause cancer of the uterus. Your doctor should perform regular pelvic exams. You should tell your doctor about any unusual vaginal bleeding between exams.
When the ovaries are removed, menopause occurs at once. The side effects are often more severe than those caused by natural menopause. Your health care provider can suggest ways to cope with these side effects.
This treatment uses drugs or surgery:
Drugs: Your doctor may suggest a drug that can block the natural hormone. One drug is tamoxifen, which blocks estrogen. Another type of drug prevents the body from making the female hormone estradiol. Estradiol is a form of estrogen. This type of drug is an aromatase inhibitor. If you have not gone through menopause, your doctor may give you a drug that stops the ovaries from making estrogen.
Surgery: If you have not gone through menopause, you may have surgery to remove your ovaries. The ovaries are the main source of the body's estrogen. A woman who has gone through menopause does not need surgery. (The ovaries produce less estrogen after menopause.)
The side effects of hormone therapy depend largely on the specific drug or type of treatment. Tamoxifen is the most common hormone treatment. In general, the side effects of tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Other side effects are irregular menstrual periods, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Not all women who take tamoxifen have side effects.
It is possible to become pregnant when taking tamoxifen. Tamoxifen may harm the unborn baby. If you are still menstruating, you should discuss birth control methods with your doctor.
Serious side effects of tamoxifen are rare. However, it can cause blood clots in the veins. Blood clots form most often in the legs and in the lungs. Women have a slight increase in their risk of stroke.
Tamoxifen can cause cancer of the uterus. Your doctor should perform regular pelvic exams. You should tell your doctor about any unusual vaginal bleeding between exams.
When the ovaries are removed, menopause occurs at once. The side effects are often more severe than those caused by natural menopause. Your health care provider can suggest ways to cope with these side effects.
Chemotherapy
Chemotherapy uses anticancer drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given as a pill or by injection into a vein (IV). Either way, the drugs enter the bloodstream and travel throughout the body.
Women with breast cancer can have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some women need to stay in the hospital during treatment.
Side effects depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:
Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of the body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Years after chemotherapy, some women have developed leukemia (cancer of the blood cells).
Cells in hair roots: Chemotherapy can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.
Your doctor can suggest ways to control many of these side effects.
Some drugs used for breast cancer can cause tingling or numbness in the hands or feet. This problem usually goes away after treatment is over. Other problems may not go away. In some women, the drugs used for breast cancer may weaken the heart.
Some anticancer drugs can damage the ovaries. The ovaries may stop making hormones. You may have symptoms of menopause. The symptoms include hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or may stop. Some women become infertile (unable to become pregnant). For women over the age of 35, infertility is likely to be permanent.On the other hand, you may remain fertile during chemotherapy and be able to become pregnant. The effects of chemotherapy on an unborn child are not known. You should talk to your doctor about birth control before treatment begins
Women with breast cancer can have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Some women need to stay in the hospital during treatment.
Side effects depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:
Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of the body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Years after chemotherapy, some women have developed leukemia (cancer of the blood cells).
Cells in hair roots: Chemotherapy can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.
Your doctor can suggest ways to control many of these side effects.
Some drugs used for breast cancer can cause tingling or numbness in the hands or feet. This problem usually goes away after treatment is over. Other problems may not go away. In some women, the drugs used for breast cancer may weaken the heart.
Some anticancer drugs can damage the ovaries. The ovaries may stop making hormones. You may have symptoms of menopause. The symptoms include hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or may stop. Some women become infertile (unable to become pregnant). For women over the age of 35, infertility is likely to be permanent.On the other hand, you may remain fertile during chemotherapy and be able to become pregnant. The effects of chemotherapy on an unborn child are not known. You should talk to your doctor about birth control before treatment begins
Radiation therapy
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Most women receive radiation therapy after breast-sparing surgery. Some women receive radiation therapy after a mastectomy. Treatment depends on the size of the tumor and other factors. The radiation destroys breast cancer cells that may remain in the area.
Some women have radiation therapy before surgery to destroy cancer cells and shrink the tumor. Doctors use this approach when the tumor is large or may be hard to remove. Some women also have chemotherapy or hormone therapy before surgery.
Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:
External radiation: The radiation comes from a large machine outside the body. Most women go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.
Internal radiation (implant radiation): Thin plastic tubes (implants) that hold a radioactive substance are put directly in the breast. The implants stay in place for several days. A woman stays in the hospital while she has implants. Doctors remove the implants before she goes home.
Side effects depend mainly on the dose and type of radiation and the part of your body that is treated.
It is common for the skin in the treated area to become red, dry, tender, and itchy. Your breast may feel heavy and tight. These problems will go away over time. Toward the end of treatment, your skin may become moist and "weepy." Exposing this area to air as much as possible can help the skin heal.
Bras and some other types of clothing may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time. Gentle skin care also is important. You should check with your doctor before using any deodorants, lotions, or creams on the treated area. These effects of radiation therapy on the skin will go away. The area gradually heals once treatment is over. However, there may be a lasting change in the color of your skin.
You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
Although the side effects of radiation therapy can be distressing, your doctor can usually relieve them.
Some women have radiation therapy before surgery to destroy cancer cells and shrink the tumor. Doctors use this approach when the tumor is large or may be hard to remove. Some women also have chemotherapy or hormone therapy before surgery.
Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:
External radiation: The radiation comes from a large machine outside the body. Most women go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.
Internal radiation (implant radiation): Thin plastic tubes (implants) that hold a radioactive substance are put directly in the breast. The implants stay in place for several days. A woman stays in the hospital while she has implants. Doctors remove the implants before she goes home.
Side effects depend mainly on the dose and type of radiation and the part of your body that is treated.
It is common for the skin in the treated area to become red, dry, tender, and itchy. Your breast may feel heavy and tight. These problems will go away over time. Toward the end of treatment, your skin may become moist and "weepy." Exposing this area to air as much as possible can help the skin heal.
Bras and some other types of clothing may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time. Gentle skin care also is important. You should check with your doctor before using any deodorants, lotions, or creams on the treated area. These effects of radiation therapy on the skin will go away. The area gradually heals once treatment is over. However, there may be a lasting change in the color of your skin.
You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.
Although the side effects of radiation therapy can be distressing, your doctor can usually relieve them.
Treatment methods
Women with breast cancer have many treatment options. These include surgery, radiation therapy, chemotherapy, hormone therapy, and biological therapy. These options are described below. Many women receive more than one type of treatment.
The choice of treatment depends mainly on the stage of the disease. Treatment options by stage are described below.
Your doctor can describe your treatment choices and the expected results. You may want to know how treatment may change your normal activities. You may want to know how you will look during and after treatment. You and your doctor can work together to develop a treatment plan that reflects your medical needs and personal values.
Cancer treatment is either local therapy or systemic therapy:
Local therapy: Surgery and radiation therapy are local treatments. They remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
Systemic therapy: Chemotherapy, hormone therapy, and biological therapy are systemic treatments. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic treatments also are used for cancer that has spread.
Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.
Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.
At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns.
You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods.
Surgery
Surgery is the most common treatment for breast cancer. There are several types of surgery. Your doctor can explain each type, discuss and compare the benefits and risks, and describe how each will change the way you look:
Breast-sparing surgery: An operation to remove the cancer but not the breast is breast-sparing surgery. It is also called breast-conserving surgery, lumpectomy, segmental mastectomy, and partial mastectomy. Sometimes an excisional biopsy serves as a lumpectomy because the surgeon removes the whole lump.
The surgeon often removes the underarm lymph nodes as well. A separate incision is made. This procedure is called an axillary lymph node dissection. It shows whether cancer cells have entered the lymphatic system.
After breast-sparing surgery, most women receive radiation therapy to the breast. This treatment destroys cancer cells that may remain in the breast.
Mastectomy: An operation to remove the breast (or as much of the breast tissue as possible) is a mastectomy. In most cases, the surgeon also removes lymph nodes under the arm. Some women have radiation therapy after surgery.
Studies have found equal survival rates for breast-sparing surgery (with radiation therapy) and mastectomy for Stage I and Stage II breast cancer.
Sentinel lymph node biopsy is a new method of checking for cancer cells in the lymph nodes. A surgeon removes fewer lymph nodes, which causes fewer side effects. (If the doctor finds cancer cells in the axillary lymph nodes, an axillary lymph node dissection usually is done.)
In breast-sparing surgery, the surgeon removes the tumor in the breast and some tissue around it. The surgeon may also remove lymph nodes under the arm. The surgeon sometimes removes some of the lining over the chest muscles below the tumor.
In total (simple) mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed.
In modified radical mastectomy, the surgeon removes the whole breast, and most or all of the lymph nodes under the arm. Often, the lining over the chest muscles is removed. A small chest muscles also may be taken out to make it easier to remove the lymph nodes.
You may choose to have breast reconstruction. This is plastic surgery to rebuild the shape of the breast. It may be done at the same time as a mastectomy or later. If you are considering reconstruction, you may wish to talk with a plastic surgeon before having a mastectomy.
The time it takes to heal after surgery is different for each woman. Surgery causes pain and tenderness. Medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more relief. Any kind of surgery also carries a risk of infection, bleeding, or other problems. You should tell your health care provider right away if you develop any problems.
You may feel off balance if you've had one or both breasts removed. You may feel more off balance if you have large breasts. This imbalance can cause discomfort in your neck and back. Also, the skin where your breast was removed may feel tight. Your arm and shoulder muscles may feel stiff and weak. These problems usually go away. The doctor, nurse, or physical therapist can suggest exercises to help you regain movement and strength in your arm and shoulder. Exercise can also reduce stiffness and pain. You may be able to begin gentle exercises within days of surgery.
Because nerves may be injured or cut during surgery, you may have numbness and tingling in your chest, underarm, shoulder, and upper arm. These feelings usually go away within a few weeks or months. But for some women, numbness does not go away.
Removing the lymph nodes under the arm slows the flow of lymph fluid. The fluid may build up in your arm and hand and cause swelling. This swelling is lymphedema. Lymphedema can develop right after surgery or months to years later.
You will need to protect your arm and hand on the treated side for the rest of your life:
Avoid wearing tight clothing or jewelry on your affected arm
Carry your purse or luggage with the other arm
Use an electric razor to avoid cuts when shaving under your arm
Have shots, blood tests, and blood pressure measurements on the other arm
Wear gloves to protect your hands when gardening and when using strong detergents
Have careful manicures and avoid cutting your cuticles
Avoid burns or sunburns to your affected arm and hand
You should ask your doctor how to handle any cuts, insect bites, sunburn, or other injuries to your arm or hand. Also, you should contact the doctor if your arm or hand is injured, swells, or becomes red and warm.
If lymphedema occurs, the doctor may suggest raising your arm above your heart whenever you can. The doctor may show you hand and arm exercises. Some women with lymphedema wear an elastic sleeve to improve lymph circulation. Medication, manual lymph drainage (massage), or use of a machine that gently compresses the arm may also help. You may be referred to a physical therapist or another specialist.
The choice of treatment depends mainly on the stage of the disease. Treatment options by stage are described below.
Your doctor can describe your treatment choices and the expected results. You may want to know how treatment may change your normal activities. You may want to know how you will look during and after treatment. You and your doctor can work together to develop a treatment plan that reflects your medical needs and personal values.
Cancer treatment is either local therapy or systemic therapy:
Local therapy: Surgery and radiation therapy are local treatments. They remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.
Systemic therapy: Chemotherapy, hormone therapy, and biological therapy are systemic treatments. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic treatments also are used for cancer that has spread.
Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.
Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them.
At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns.
You may want to talk to your doctor about taking part in a clinical trial, a research study of new treatment methods.
Surgery
Surgery is the most common treatment for breast cancer. There are several types of surgery. Your doctor can explain each type, discuss and compare the benefits and risks, and describe how each will change the way you look:
Breast-sparing surgery: An operation to remove the cancer but not the breast is breast-sparing surgery. It is also called breast-conserving surgery, lumpectomy, segmental mastectomy, and partial mastectomy. Sometimes an excisional biopsy serves as a lumpectomy because the surgeon removes the whole lump.
The surgeon often removes the underarm lymph nodes as well. A separate incision is made. This procedure is called an axillary lymph node dissection. It shows whether cancer cells have entered the lymphatic system.
After breast-sparing surgery, most women receive radiation therapy to the breast. This treatment destroys cancer cells that may remain in the breast.
Mastectomy: An operation to remove the breast (or as much of the breast tissue as possible) is a mastectomy. In most cases, the surgeon also removes lymph nodes under the arm. Some women have radiation therapy after surgery.
Studies have found equal survival rates for breast-sparing surgery (with radiation therapy) and mastectomy for Stage I and Stage II breast cancer.
Sentinel lymph node biopsy is a new method of checking for cancer cells in the lymph nodes. A surgeon removes fewer lymph nodes, which causes fewer side effects. (If the doctor finds cancer cells in the axillary lymph nodes, an axillary lymph node dissection usually is done.)
In breast-sparing surgery, the surgeon removes the tumor in the breast and some tissue around it. The surgeon may also remove lymph nodes under the arm. The surgeon sometimes removes some of the lining over the chest muscles below the tumor.
In total (simple) mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed.
In modified radical mastectomy, the surgeon removes the whole breast, and most or all of the lymph nodes under the arm. Often, the lining over the chest muscles is removed. A small chest muscles also may be taken out to make it easier to remove the lymph nodes.
You may choose to have breast reconstruction. This is plastic surgery to rebuild the shape of the breast. It may be done at the same time as a mastectomy or later. If you are considering reconstruction, you may wish to talk with a plastic surgeon before having a mastectomy.
The time it takes to heal after surgery is different for each woman. Surgery causes pain and tenderness. Medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more relief. Any kind of surgery also carries a risk of infection, bleeding, or other problems. You should tell your health care provider right away if you develop any problems.
You may feel off balance if you've had one or both breasts removed. You may feel more off balance if you have large breasts. This imbalance can cause discomfort in your neck and back. Also, the skin where your breast was removed may feel tight. Your arm and shoulder muscles may feel stiff and weak. These problems usually go away. The doctor, nurse, or physical therapist can suggest exercises to help you regain movement and strength in your arm and shoulder. Exercise can also reduce stiffness and pain. You may be able to begin gentle exercises within days of surgery.
Because nerves may be injured or cut during surgery, you may have numbness and tingling in your chest, underarm, shoulder, and upper arm. These feelings usually go away within a few weeks or months. But for some women, numbness does not go away.
Removing the lymph nodes under the arm slows the flow of lymph fluid. The fluid may build up in your arm and hand and cause swelling. This swelling is lymphedema. Lymphedema can develop right after surgery or months to years later.
You will need to protect your arm and hand on the treated side for the rest of your life:
Avoid wearing tight clothing or jewelry on your affected arm
Carry your purse or luggage with the other arm
Use an electric razor to avoid cuts when shaving under your arm
Have shots, blood tests, and blood pressure measurements on the other arm
Wear gloves to protect your hands when gardening and when using strong detergents
Have careful manicures and avoid cutting your cuticles
Avoid burns or sunburns to your affected arm and hand
You should ask your doctor how to handle any cuts, insect bites, sunburn, or other injuries to your arm or hand. Also, you should contact the doctor if your arm or hand is injured, swells, or becomes red and warm.
If lymphedema occurs, the doctor may suggest raising your arm above your heart whenever you can. The doctor may show you hand and arm exercises. Some women with lymphedema wear an elastic sleeve to improve lymph circulation. Medication, manual lymph drainage (massage), or use of a machine that gently compresses the arm may also help. You may be referred to a physical therapist or another specialist.
Getting a second opinion
Before starting treatment, you might want a second opinion about your diagnosis and treatment plan. Many insurance companies cover a second opinion if you or your doctor requests it. It may take some time and effort to gather medical records and arrange to see another doctor. You may have to gather your mammogram films, biopsy slides, pathology report, and proposed treatment plan. Usually it is not a problem to take several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective. To make sure, you should discuss this delay with your doctor. Some women with breast cancer need treatment right away.
There are a number of ways to find a doctor for a second opinion:
Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers. Information Specialists also can provide online assistance through LiveHelp at http://www.cancer.gov/cis.
A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. This Directory is in most public libraries. Also, ABMS offers this information at http://www.abms.org. (Click on "Who's Certified.")
NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment Facility If You Have Cancer."
There are a number of ways to find a doctor for a second opinion:
Your doctor may refer you to one or more specialists. At cancer centers, several specialists often work together as a team.
NCI's Cancer Information Service, at 1-800-4-CANCER, can tell you about nearby treatment centers. Information Specialists also can provide online assistance through LiveHelp at http://www.cancer.gov/cis.
A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
The American Board of Medical Specialties (ABMS) has a list of doctors who have had training and passed exams in their specialty. You can find this list in the Official ABMS Directory of Board Certified Medical Specialists. This Directory is in most public libraries. Also, ABMS offers this information at http://www.abms.org. (Click on "Who's Certified.")
NCI provides a helpful fact sheet called "How To Find a Doctor or Treatment Facility If You Have Cancer."
What are the methods for treating breast cancer
Many women with breast cancer want to take an active part in making decisions about their medical care. It is natural to want to learn all you can about your disease and treatment choices. Knowing more about breast cancer helps many women cope.
Shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen. You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon.
Shock and stress after the diagnosis can make it hard to think of everything you want to ask your doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, you may take notes or ask whether you may use a tape recorder. You may also want to have a family member or friend with you when you talk to the doctor - to take part in the discussion, to take notes, or just to listen. You do not need to ask all your questions at once. You will have other chances to ask your doctor or nurse to explain things that are not clear and to ask for more details.
Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon.
How is breast cancer staging determined
To plan your treatment, your doctor needs to know the extent (stage) of the disease. The stage is based on the size of the tumor and whether the cancer has spread. Staging may involve x-rays and lab tests. These tests can show whether the cancer has spread and, if so, to what parts of your body. When breast cancer spreads, cancer cells are often found in lymph nodes under the arm (axillary lymph nodes). The stage often is not known until after surgery to remove the tumor in your breast and the lymph nodes under your arm.
These are the stages of breast cancer:
Stage 0 is carcinoma in situ.
Lobular carcinoma in situ (LCIS): Abnormal cells are in the lining of a lobule. LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer for both breasts.
Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated.
Stage I is an early stage of invasive breast cancer. The tumor is no more than 2 centimeters (three-quarters of an inch) across. Cancer cells have not spread beyond the breast.
Stage II is one of the following:
The tumor in the breast is no more than 2 centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm.
The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer may have spread to the lymph nodes under the arm.
The tumor is larger than 5 centimeters (2 inches). The cancer has not spread to the lymph nodes under the arm.
Stage III may be a large tumor, but the cancer has not spread beyond the breast and nearby lymph nodes. It is locally advanced cancer.
Stage IIIA is one of the following:
The tumor in the breast is smaller than 5 centimeters (2 inches). The cancer has spread to underarm lymph nodes that are attached to each other or to other structures.
The tumor is more than 5 centimeters across. The cancer has spread to the underarm lymph nodes.
Stage IIIB is one of the following:
The tumor has grown into the chest wall or the skin of the breast.
The cancer has spread to lymph nodes behind the breastbone.
Inflammatory breast cancer is a rare type of Stage IIIB breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast.
Stage IIIC is a tumor of any size. It has spread in one of the following ways:
The cancer has spread to the lymph nodes behind the breastbone and under the arm.
The cancer has spread to the lymph nodes under or above the collarbone.
Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body.
Recurrent cancer is cancer that has come back (recurred) after a period of time when it could not be detected. It may recur locally in the breast or chest wall. Or it may recur in any other part of the body, such as the bone, liver, or lungs.
These are the stages of breast cancer:
Stage 0 is carcinoma in situ.
Lobular carcinoma in situ (LCIS): Abnormal cells are in the lining of a lobule. LCIS seldom becomes invasive cancer. However, having LCIS in one breast increases the risk of cancer for both breasts.
Ductal carcinoma in situ (DCIS): Abnormal cells are in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread outside the duct. They have not invaded the nearby breast tissue. DCIS sometimes becomes invasive cancer if not treated.
Stage I is an early stage of invasive breast cancer. The tumor is no more than 2 centimeters (three-quarters of an inch) across. Cancer cells have not spread beyond the breast.
Stage II is one of the following:
The tumor in the breast is no more than 2 centimeters (three-quarters of an inch) across. The cancer has spread to the lymph nodes under the arm.
The tumor is between 2 and 5 centimeters (three-quarters of an inch to 2 inches). The cancer may have spread to the lymph nodes under the arm.
The tumor is larger than 5 centimeters (2 inches). The cancer has not spread to the lymph nodes under the arm.
Stage III may be a large tumor, but the cancer has not spread beyond the breast and nearby lymph nodes. It is locally advanced cancer.
Stage IIIA is one of the following:
The tumor in the breast is smaller than 5 centimeters (2 inches). The cancer has spread to underarm lymph nodes that are attached to each other or to other structures.
The tumor is more than 5 centimeters across. The cancer has spread to the underarm lymph nodes.
Stage IIIB is one of the following:
The tumor has grown into the chest wall or the skin of the breast.
The cancer has spread to lymph nodes behind the breastbone.
Inflammatory breast cancer is a rare type of Stage IIIB breast cancer. The breast looks red and swollen because cancer cells block the lymph vessels in the skin of the breast.
Stage IIIC is a tumor of any size. It has spread in one of the following ways:
The cancer has spread to the lymph nodes behind the breastbone and under the arm.
The cancer has spread to the lymph nodes under or above the collarbone.
Stage IV is distant metastatic cancer. The cancer has spread to other parts of the body.
Recurrent cancer is cancer that has come back (recurred) after a period of time when it could not be detected. It may recur locally in the breast or chest wall. Or it may recur in any other part of the body, such as the bone, liver, or lungs.
Biopsy
Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. Fluid or tissue is removed from your breast to help find out if there is cancer.
Some suspicious areas can be seen on a mammogram but cannot be felt during a clinical breast exam. Doctors can use imaging procedures to help see the area and remove tissue. Such procedures include ultrasound-guided, needle-localized, or stereotactic biopsy.
Doctors can remove tissue from the breast in different ways:
Fine-needle aspiration: Your doctor uses a thin needle to remove fluid from a breast lump. If the fluid appears to contain cells, a pathologist at a lab checks them for cancer with a microscope. If the fluid is clear, it may not need to be checked by a lab.
Core biopsy: Your doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy.
Surgical biopsy: Your surgeon removes a sample of tissue. A pathologist checks the tissue for cancer cells.
An incisional biopsy takes a sample of a lump or abnormal area.
An excisional biopsy takes the entire lump or area.
If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. Abnormal cells are found in the lining of the ducts. Lobular carcinoma is another type. Abnormal cells are found in the lobules.
Some suspicious areas can be seen on a mammogram but cannot be felt during a clinical breast exam. Doctors can use imaging procedures to help see the area and remove tissue. Such procedures include ultrasound-guided, needle-localized, or stereotactic biopsy.
Doctors can remove tissue from the breast in different ways:
Fine-needle aspiration: Your doctor uses a thin needle to remove fluid from a breast lump. If the fluid appears to contain cells, a pathologist at a lab checks them for cancer with a microscope. If the fluid is clear, it may not need to be checked by a lab.
Core biopsy: Your doctor uses a thick needle to remove breast tissue. A pathologist checks for cancer cells. This procedure is also called a needle biopsy.
Surgical biopsy: Your surgeon removes a sample of tissue. A pathologist checks the tissue for cancer cells.
An incisional biopsy takes a sample of a lump or abnormal area.
An excisional biopsy takes the entire lump or area.
If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. Abnormal cells are found in the lining of the ducts. Lobular carcinoma is another type. Abnormal cells are found in the lobules.
Magnetic resonance imaging
Magnetic resonance imaging (MRI) uses a powerful magnet linked to a computer. MRI makes detailed pictures of breast tissue. Your doctor can view these pictures on a monitor or print them on film. MRI may be used along with a mammogram.
Ultrasound
An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues. A computer uses the echoes to create a picture. Your doctor can view these pictures on a monitor. The pictures may show whether a lump is solid or filled with fluid. A cyst is a fluid-filled sac. Cysts are not cancer. But a solid mass may be cancer. After the test, your doctor can store the pictures on video or print them out. This exam may be used along with a mammogram.
Diagnostic mammogram
Diagnostic mammograms are x-ray pictures of the breast. They take clearer, more detailed images of areas that look abnormal on a screening mammogram. Doctors use them to learn more about unusual breast changes, such as a lump, pain, thickening, nipple discharge, or change in breast size or shape. Diagnostic mammograms may focus on a specific area of the breast. They may involve special techniques and more views than screening mammograms
Clinical breast exam
Your health care provider feels each breast for lumps and looks for other problems. If you have a lump, your doctor will feel its size, shape, and texture. Your doctor will also check to see if it moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.
How is breast cancer diagnosed
If you have a symptom or screening test result that suggests cancer, your doctor must find out whether it is due to cancer or to some other cause. Your doctor may ask about your personal and family medical history. You may have a physical exam. Your doctor also may order a mammogram or other imaging procedure. These tests make pictures of tissues inside the breast. After the tests, your doctor may decide no other exams are needed. Your doctor may suggest that you have a follow-up exam later on. Or you may need to have a biopsy to look for cancer cells.
Breast self-exam
You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.
You should contact your health care provider if you notice any unusual changes in your breasts.
Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.
You should contact your health care provider if you notice any unusual changes in your breasts.
Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.
Clinical breast exam
During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.
Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.
Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.A thorough clinical breast exam may take about 10 minutes
Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.
Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.A thorough clinical breast exam may take about 10 minutes
Screening mammogram
To find breast cancer early, NCI recommends that:
Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays.
Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.
Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.
If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present.
Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:
A mammogram may miss some cancers. (The result is called a "false negative.")
A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.")
Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.
Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.
Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays.
Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.
Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.
If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present.
Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:
A mammogram may miss some cancers. (The result is called a "false negative.")
A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.")
Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.
Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.
What is the screening process for breast cancer
Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.
Your doctor may suggest the following screening tests for breast cancer:
Screening mammogram
Clinical breast exam
Breast self-exam
You should ask your doctor about when to start and how often to check for breast cancer.
Your doctor may suggest the following screening tests for breast cancer:
Screening mammogram
Clinical breast exam
Breast self-exam
You should ask your doctor about when to start and how often to check for breast cancer.
Reproductive and menstrual history
The older a woman is when she has her first child, the greater her chance of breast cancer.
Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
Women who went through menopause after age 55 are at an increased risk of breast cancer.
Women who never had children are at an increased risk of breast cancer.
Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.
Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.
Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.
Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.
Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.
Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.
But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.
If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.
Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
Women who went through menopause after age 55 are at an increased risk of breast cancer.
Women who never had children are at an increased risk of breast cancer.
Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.
Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.
Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.
Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.
Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.
Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.
But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.
If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.
Gene changes
Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes.
Certain breast changes
Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
Family history
A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
Personal history of breast cancer
A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast
What are risk factors for breast cancer
No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.
Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for breast cancer:Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause
Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for breast cancer:Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause
How is the breast designed
The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.
The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful What is the cancer process?
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.
Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Tumors can be benign or malignant.
· Benign tumors are not cancer:
Benign tumors are rarely life-threatening.
Generally, benign tumors can be removed. They usually do not grow back.
Cells from benign tumors do not invade the tissues around them.
Cells from benign tumors do not spread to other parts of the body.
· Malignant tumors are cancer:
Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
Malignant tumors often can be removed. But sometimes they grow back.
Cells from malignant tumors can invade and damage nearby tissues and organs.
Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
When breast cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs, and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.
The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful What is the cancer process?
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.
Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Tumors can be benign or malignant.
· Benign tumors are not cancer:
Benign tumors are rarely life-threatening.
Generally, benign tumors can be removed. They usually do not grow back.
Cells from benign tumors do not invade the tissues around them.
Cells from benign tumors do not spread to other parts of the body.
· Malignant tumors are cancer:
Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
Malignant tumors often can be removed. But sometimes they grow back.
Cells from malignant tumors can invade and damage nearby tissues and organs.
Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.
When breast cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs, and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.
Cancer
Cancer has been recognized as a disease for millennia: one of the oldest descriptions comes from an Egyptian papyrus describing breast tumours, and dated to 1500 BC or earlier. By the Second World War a drug was finally shown to work - albeit modestly - against cancer. Much has been done since to understand the disease; earlier detection, better surgery, radiation, chemotherapy and drugs means that more patients live longer. Yet in 2007, the World Health Organisation estimates that the runaway cell division that causes cancer kills more than 7 million people each year, accounting for around 12.5% of all deaths worldwide. Here Nature keeps track of our fight against the disease.
Outlook for patients with operable or early breast cancer
There are various factors which relate to survival in breast cancer. These include:
tumour size - the smaller the tumour the more likely a patient is to survive.
spread to axillary lymph nodes - the single best factor which predicts a person's survival is the presence or absence of cancer cells in the lymph glands. The more lymph glands which are affected, the worse is the outcome.
the tumour type.
the grade (whether it is a grade I which has a good prognosis or a grade III which has a poorer prognosis).
whether tumour cells are seen by the pathologist in lymph channels or blood vessels.
whether the tumour is slow growing or fast growing.
whether it expresses hormone receptors.
the genetic abnormalities in the cancer.
Outlook for patients with locally advanced breast cancerThe outlook is worse than for patients who present with operable breast cancer. Local recurrence of the disease after treatment is a problem even in patients who have had drug treatment, surgery and radiotherapy. Control rates of disease are however much better than they used to be when surgery was the initial treatment. The outlook is better in patients who have a good response to their initial drug treatment. In approximately 10 per cent of patients who receive chemotherapy, the drug treatment is so effective than when surgery is performed, no breast cancer cells can be identified in the breast or the lymph glands. Outlook for patients with metastatic breast cancerMetastasis is the process of further spread of the cancer within the body, away from the site at which the cancer starts. People whose cancers have already spread have a much worse outlook than those whose disease is apparently localised. There are differences in survival, depending on the site affected.
tumour size - the smaller the tumour the more likely a patient is to survive.
spread to axillary lymph nodes - the single best factor which predicts a person's survival is the presence or absence of cancer cells in the lymph glands. The more lymph glands which are affected, the worse is the outcome.
the tumour type.
the grade (whether it is a grade I which has a good prognosis or a grade III which has a poorer prognosis).
whether tumour cells are seen by the pathologist in lymph channels or blood vessels.
whether the tumour is slow growing or fast growing.
whether it expresses hormone receptors.
the genetic abnormalities in the cancer.
Outlook for patients with locally advanced breast cancerThe outlook is worse than for patients who present with operable breast cancer. Local recurrence of the disease after treatment is a problem even in patients who have had drug treatment, surgery and radiotherapy. Control rates of disease are however much better than they used to be when surgery was the initial treatment. The outlook is better in patients who have a good response to their initial drug treatment. In approximately 10 per cent of patients who receive chemotherapy, the drug treatment is so effective than when surgery is performed, no breast cancer cells can be identified in the breast or the lymph glands. Outlook for patients with metastatic breast cancerMetastasis is the process of further spread of the cancer within the body, away from the site at which the cancer starts. People whose cancers have already spread have a much worse outlook than those whose disease is apparently localised. There are differences in survival, depending on the site affected.
Treatment for locally advanced breast cancer
Some patients whose cancer is locally advanced because it has grown directly into the skin overlying the breast are suitable for surgery and are treated in an identical way to patients with early or operable breast cancer. The majority of patients with locally advanced breast cancer are treated with drug therapy followed by surgery and/or radiotherapy. Some patients with locally advanced breast cancer are treated by radiotherapy initially which can be followed by drug therapy and/or surgery. Drug therapy can consist of either hormonal therapy in slower growing hormone sensitive cancers or chemotherapy in hormone sensitive or more rapidly growing cancers.
Chemotherapy
Chemotherapy involves being given a combination of anti-cancer medicines, often up to three at a time. The prime target for such medicines is cancer cells that are actively growing and dividing. Unfortunately, anticancer medicines are not able to recognise cancer cells specifically and they also kill normally dividing cells such as the blood and hair cells. The art of the science behind successful cancer chemotherapy is combining medicines which are chosen to minimise the damage to blood cells while maximising damage to cancer cells. Chemotherapy may be preferable for more advanced cancer that is not hormone responsive and for aggressive disease, particularly if the cancer has spread to other sites, such as the liver. It is sometimes administered prior to surgery in order to shrink a tumour. As outlined above, this sometimes means that the surgeon is able to perform less extensive surgery in patients whose cancers respond. Cancer chemotherapy is usually given through an intravenous drip in the hand or arm on an outpatient basis. Treatments vary but each session usually lasts between one and two hours and is repeated every three weeks. Patients may be frightened because they have heard about very unpleasant side effects such as nausea, vomiting and hair loss. In fact, by no means everyone will experience all or even any of these problems. Some of the anti-cancer drugs that are in common use cause little or no hair thinning and anti-sickness medicine given with the chemotherapy works well. A common complaint in people receiving chemotherapy is of weight gain. This is due to the anti-sickness pills which are taken after the chemotherapy. Once the chemotherapy is finished, providing the patient remains active, they should return to their initial weight. One of the less well-known side effects of chemotherapy is to cause premature menopause. This means that periods are likely to stop at a much earlier age if you have had this type of treatment. Bringing forward the menopause is particularly likely to occur in women in their late 30s and 40s, but even younger women can find that their periods temporarily stop during chemotherapy.
Hormones
Most breast cancer is sensitive to the female hormone oestrogen. Sensitive cancer cells need oestrogen to stay alive and removal of oestrogen from the body or stopping any circulating oestrogen getting to the cancer cells is very effective at controlling or killing hormone-sensitive breast cancers. It is possible to determine whether a tumour is sensitive to hormones by performing a chemical test on the tumour. Tumours can be classified into oestrogen sensitive and oestrogen insensitive tumours. In premenopausal women who are still having regular menstrual periods, about half of all breast cancers are hormone sensitive. Over two thirds of tumours in postmenopausal women whose periods have stopped are oestrogen sensitive. The most commonly used medicine against oestrogen sensitive tumours is tamoxifen (eg Nolvadex D). This medicine is an anti-oestrogen in its effect on breast cancers and works by stopping oestrogen getting to the cancer cells. It appears to be a very safe medicine but can cause side effects which can be distressing and these include flushing (similar to those women experience during the menopause), vaginal dryness and vaginal discharge. Many women complain of weight gain on tamoxifen, but, in randomised studies, women taking tamoxifen put on a similar amount of weight to those women who were not receiving drug treatment. There is an increased incidence of eye problems and disturbance of vision. This is reversible if the medicine is stopped. The most serious possible side effects of tamoxifen are that it can slightly increase the incidence of cancer of the lining of the womb, and slightly increase the risk of a blood clot in the leg (deep vein thrombosis). However the risks of both these side effects are very low. Tamoxifen has been widely used throughout the world and is a very safe medicine for pre and postmenopausal women. Few women have to stop the medicine because of side effects. Women who have had surgery for early breast cancer are commonly given tamoxifen following the surgery to reduce the risk of recurrence of the cancer. The production of oestrogen in postmenopausal women requires an enzyme called aromatase. A new class of medicines for treating breast cancers blocks this aromatase enzyme. These medicines are called aromatase inhibitors and include letrozole (Femara), anastrazole (Arimidex) and exemestane (Aromasin). They are very effective in postmenopausal women with oestrogen sensitive tunours. The side effects include flushings, nausea and lack of appetite. Occasionally, women have to stop the medicine because of the constant feeling of sickness. In premenopausal women the major source of oestrogen is the ovaries. Either removing the ovaries or using an injectable medicine called goserelin (Zoladex), which stops the ovaries from producing oestrogen are effective treatments in hormone sensitive breast cancer. The medicine which stops the ovaries working has to be injected once a month. Side effects of this type of medicine or removal of the ovaries include the rapid onset of menopausal symptoms.
How is breast cancer treated with medicines
Medicines act on cancer cells, including those which have spread. We know that in some women there are small numbers of cancer cells that have spread beyond the breast but cannot be detected by scans. Medicines can kill these cells or prevent them from growing for many months and years after surgery with or without radiotherapy. This is called adjuvant treatment. In some patients with larger but operable breast cancers, the medicines can be used before surgery to shrink the cancer. This allows some women who would initially have required a mastectomy to be treated by less extensive surgery. If the cancer has already spread at the time it is first diagnosed or a patient who is treated for early breast cancer develops a recurrence of the cancer at some other site in the body, then the only practical way of treating these two groups of patients is by medicines. The medicines for treating breast cancer fall into two groups: hormones and chemotherapy. Whether the patient receives hormone therapy or chemotherapy will depend on the size of the tumour, type of tumour (including the grade) and whether the tumour has spread to involve the lymph glands.
Radiotherapy
Studies have shown that all patients treated by breast conserving surgery (lumpectomy or wide excision), should receive radiotherapy to the breast following surgery. This is given every day, Monday to Friday, over three to five weeks. After mastectomy, radiotherapy is given to patients who are considered to be at risk of recurrence. Radiotherapy kills cells that are growing and has greater effects on cancer than on surrounding tissue. After a few days of radiotherapy, the patient's skin may look red and feel a bit sore, rather like they have spent too long in the sun. Towards the end of treatment, there may also be some blistering of the skin. The radiotherapy staff will give all the necessary advice about how to look after the treated skin.
Surgery
Surgery can be an excision of the tumour with surrounding normal breast tissue (breast conservation) or removal of the whole breast (mastectomy). Clinical trials comparing mastectomy and breast conservation have shown that the two produce identical results. If the lump is relatively small it is usually possible for the surgeon to remove it along with a small amount of surrounding normal tissue. This is called lumpectomy, wide local excision or breast-conserving surgery. With a larger lump, this breast-conserving operation may not be possible because so much of the breast tissue would have been taken away that it would badly distort the breast. Once the lump and surrounding tissue is removed it needs to be examined under the microscope. In some women, the surrounding tissue is abnormal and a further operation is necessary. A mastectomy (removal of the whole breast) may be necessary if:
the cancer is too large to remove and leave a reasonable looking breast after surgery.
there is more than one lump in the breast.
the cancer is directly underneath the nipple.
the patient has previously had a lumpectomy or wide excision and the tissue round the cancer is abnormal.
As well as removing the lump or breast, the surgeon will also usually remove some or all axillary lymph glands, which are found under the arm. There are about 20 of these lymph glands and they are the most common place for cancer to spread. Knowing whether this has happened and, if so, how many glands are affected is important in both assessing the severity of the cancer and deciding on follow up treatment.If the surgeon needs to check whether the cancer has spread to these glands, then removing either a single gland which drains the cancer or a few of these glands is all that is needed. If however the surgeon wants to find out exactly how many lymph glands are affected, then it is necessary to remove all 20 lymph nodes from the axilla. If it has been decided to treat the patient by mastectomy, the surgeon will probably discuss with her the possibility of having her breast rebuilt at the same time. The results of breast rebuilding or reconstruction are usually more successful if this is performed straight away rather than left until many months or years later. There is no evidence that immediate breast reconstruction makes any recurrence of the cancer more likely. If the cancer does return, reconstruction does not make it harder to detect.
the cancer is too large to remove and leave a reasonable looking breast after surgery.
there is more than one lump in the breast.
the cancer is directly underneath the nipple.
the patient has previously had a lumpectomy or wide excision and the tissue round the cancer is abnormal.
As well as removing the lump or breast, the surgeon will also usually remove some or all axillary lymph glands, which are found under the arm. There are about 20 of these lymph glands and they are the most common place for cancer to spread. Knowing whether this has happened and, if so, how many glands are affected is important in both assessing the severity of the cancer and deciding on follow up treatment.If the surgeon needs to check whether the cancer has spread to these glands, then removing either a single gland which drains the cancer or a few of these glands is all that is needed. If however the surgeon wants to find out exactly how many lymph glands are affected, then it is necessary to remove all 20 lymph nodes from the axilla. If it has been decided to treat the patient by mastectomy, the surgeon will probably discuss with her the possibility of having her breast rebuilt at the same time. The results of breast rebuilding or reconstruction are usually more successful if this is performed straight away rather than left until many months or years later. There is no evidence that immediate breast reconstruction makes any recurrence of the cancer more likely. If the cancer does return, reconstruction does not make it harder to detect.
How is breast cancer treated with surgery and radiotherapy
Early breast cancer can be treated by a combination of local treatments to control the local disease and adjuvent treatments to kill any cells which may have spread. Local treatments consist of surgery and radiotherapy.
Can breast cancer be prevented
One particular medicine used to treat breast cancer, tamoxifen (eg Nolvadex D), has been shown in an American study to reduce the risk of developing breast cancer by approximately 50 per cent in women at high risk of developing the disease. Research with tamoxifen and some other breast cancer medicines is still being carried out to determine if these are suitable options for preventing breast cancer. However, tamoxifen is associated with some rare but serious side effects that may make it unsuitable as a preventive measure.Screening, as currently practised can reduce the mortality but not the incidence of breast cancer (and then only in the age group that is screened). Once a woman reaches the age of 50, she will be invited to take part in a breast screening programme. In the UK, this means having a mammogram every three years up to the age of 64, although the upper age limit of routine screening is currently being extended to 70 years throughout the UK.. The aim of screening by mammography is to pick up cancer while it is still small before it has a chance to spread. There are various reasons why women are not normally screened below the age of 50:
breast cancer is less common in younger women.
mammography is less likely to detect breast cancer in young women because the breast tissue is denser which can make breast cancer much more difficult to detect.
there is no evidence that breast screening below the age of 50 is cost effective.
breast cancer is less common in younger women.
mammography is less likely to detect breast cancer in young women because the breast tissue is denser which can make breast cancer much more difficult to detect.
there is no evidence that breast screening below the age of 50 is cost effective.
How does breast cancer develop
Initially, carcinoma cells are confined within the lobule and adjacent ducts. These are known as non-invasive cancers or 'carcinoma in situ'. As with invasive disease, there are two main types - ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). Under the microscope these look different and, clinically, these two types of non-invasive cancer behave differently and require different treatments. Certain types of DCIS develop characteristic tiny particles of calcium within them. These particles show up as tiny white dots on a mammogram. DCIS is much more common than LCIS. DCIS accounts for over one fifth of all types of cancer detected by breast screening. DCIS is treated by surgery which may be followed by radiotherapy and hormonal treatment. LCIS when diagnosed is usually treated by simple follow up with regular mammograms or with hormonal tablets (tamoxifen). Only rarely is surgery used for LCIS. DCIS is considered to be a pre-malignant breast disease. It is not early breast cancer, but if left untreated DCIS cells eventually spread into the surrounding connective tissue of the breast to form an invasive cancer. The time period in which DCIS changes into an invasive cancer appears to be over months and years rather than days or weeks. When an invasive cancer has developed, it is at this stage that there is a risk that cancer cells can spread to nearby lymph glands, the most common lymph glands affected being in the axillary (armpit) region. Cancer cells can also enter the blood stream through the blood vessels that supply the cancer and then move to other organs of the body where they grow and cause problems in these organs. The most common sites for breast cancer to spread to are the bones, lungs, liver and brain. Sarcomas if they spread do so mainly through the bloodstream.
Other tumours in the breast
A rare form of tumour in the breast arises from the supporting tissue and is called a sarcoma. These types of tumour are rare and account for much less than 1 per cent of all malignant tumours within the breast. These are usually best treated by surgery.
How is breast cancer treated
The treatment of the disease depends on the tumour type and the stage of disease - how far it has spread to involve either lymph glands or other organs in the body. There are various ways a cancer can be staged and classified. A simple way of staging or classifying breast cancer is to divide it into three groups.
Early or operable breast cancerThis describes cancer that is confined to the breast and/or the lymph glands in the axilla (arm pit) on the same side of the body
Locally advanced breast cancerThis has not apparently spread beyond the breast and axillary lymph glands but involves the skin or the chest wall of the breast. These cancers tend to have a worse outlook than early breast cancer and are usually best initially treated by drug therapy or radiotherapy rather than surgery. In locally advanced breast cancer the skin of the breast can either be directly involved by cancer or it is swollen or red. These changes occur because cancer cells get into the fluid channels that drain the breast (lymphatics) and block them, which causes the skin of the breast to be swollen and look like the skin of an orange (peau d'orange). Locally advanced breast cancers were initially treated with surgery but this treatment was successful in only about 30 per cent of patients. In the remainder, the cancer recurred in the areas immediately next to where the surgery was performed
Advanced breast cancerThis is where the cancer has spread beyond the breast and arm pit to other parts or organs of the body such as lymph glands in the neck, bone, lungs, liver and brain.
Early or operable breast cancerThis describes cancer that is confined to the breast and/or the lymph glands in the axilla (arm pit) on the same side of the body
Locally advanced breast cancerThis has not apparently spread beyond the breast and axillary lymph glands but involves the skin or the chest wall of the breast. These cancers tend to have a worse outlook than early breast cancer and are usually best initially treated by drug therapy or radiotherapy rather than surgery. In locally advanced breast cancer the skin of the breast can either be directly involved by cancer or it is swollen or red. These changes occur because cancer cells get into the fluid channels that drain the breast (lymphatics) and block them, which causes the skin of the breast to be swollen and look like the skin of an orange (peau d'orange). Locally advanced breast cancers were initially treated with surgery but this treatment was successful in only about 30 per cent of patients. In the remainder, the cancer recurred in the areas immediately next to where the surgery was performed
Advanced breast cancerThis is where the cancer has spread beyond the breast and arm pit to other parts or organs of the body such as lymph glands in the neck, bone, lungs, liver and brain.
What are the types of breast cancer
Breast cancer was originally described according to its appearances, so words like scirrhous (meaning woody) were used and still appear in the literature. More recently, breast cancer has been classified according to its appearances when under the microscope. Early pathologists classified breast cancers into 'invasive ductal' cancers and 'invasive lobular' cancers believing that invasive ductal cancers arose in ducts and invasive lobular cancers in the lobules. However, it is now clear that all invasive ductal and invasive lobular cancers arise either in the terminal duct or the lobule. As the terms invasive ductal and lobular are in such common usage and as they have different appearances under the microscope they are still used. A more logical classification divides tumours into those of 'special' and 'no special' type. Invasive carcinoma of no special type is also commonly referred to as invasive ductal carcinoma. It is the most common type and accounts for up to 85 per cent of all breast cancers. Special types of tumour have particular microscopic features and these include invasive lobular carcinoma, invasive tubular, cribriform, medullary and mucinous cancers, with other types being uncommon. Many of the special type cancers have a better prognosis - in other words the patient has a higher chance of survival. When a cancer is examined under the microscope, it is usually possible to assess how aggressive it is: in other words how far and how fast it is likely to spread. The tumour may be assigned to one of three grades ranging from grade I to grade III in order of seriousness. For instance, a grade I cancer is non-aggressive and unlikely to cause harm. In contrast, grade III tumours are aggressive and likely to cause harm, but can sometimes be controlled with effective treatment.
How is breast cancer diagnosed
If a woman has any breast symptoms it is very important that she consult her doctor so that the cause of these symptoms can be found. If breast cancer is found at an early stage this improves the chances of recovery. As a rule, the doctor will ask her a number of questions.
Does the lump vary in relation to her menstrual cycle?
What previous breast problems has she had?
Is there any breast cancer in her family?
How many children has she had?
Physical examinationThe doctor will look at her breasts, first with her arms by her sides, then above her head and, finally, with her arms pressing on her hips. By looking carefully at the outline of the breast in various positions, the doctor can often see changes in the outline of the breast, which will help identify the site and cause of any problems. Next, her breasts are examined while she is lying flat with her arms folded under her head.If, during this examination, the doctor finds a lump, he or she will concentrate on this area examining with the fingertips and measuring the lump. After checking her breasts, the doctor usually carefully examines the lymph glands under the patient's arm pit and those in the lower part of her neck. Should the patient need any further investigations, the breast specialist in the breast clinic will organise any tests that are necessary.
MammogramsIf the patient is over 35 and has not had a breast X-ray within the past year, the doctor may arrange for one to be performed. Breast X-rays are known as mammograms. Mammograms are a good way of identifying abnormalities in the breast, but they don't always tell whether they are benign or malignant. Further tests are sometimes necessary and these tests include ultrasound and fine needle aspiration cytology (FNAC).
Ultrasound scanningX-rays do not pass easily through the breasts of young women. Ultrasound scanning, which is familiar to many women by its use to look at babies during pregnancy, can also be used in the breast to tell whether a lump is fluid or solid. Ultrasound is not useful as a screening test. It is useful if an abnormal shadow is seen on the mammogram because ultrasound is an accurate way of judging whether any abnormality is benign and straightforward or whether it is more likely to be serious.
Needle tests (FNAC)Inserting a needle into the lump will show whether it is full of fluid (a cyst) or solid. The needle can allow a sample of cells to be removed for examination under the microscope (a process called cytology) and this is a very accurate method of finding out whether the lump is benign or malignant.If there is an abnormality on the mammogram, but no lump to feel, then using either the X-ray machine or the ultrasound machine, it is possible to guide the needle into the area of abnormality and to obtain enough cells or tissue to obtain a definite diagnosis. The very fine needles used for this procedure give rise to its name.Having the lump removed After investigation, the doctor may decide the lump is benign and that it can be left alone. Alternatively the doctor may suggest that the lump should be removed. This is called an excision biopsy and it can be performed either while the patient is awake under local anaesthesia or, more commonly, under a general anaesthetic. Before any operation, the patient will be asked to sign a consent form agreeing to the removal of the lump. It is important for the patient to know that the doctor performing the operation will only remove the lump and will not take any more tissue away without explaining any further procedure to the patient first and being given her consent
Does the lump vary in relation to her menstrual cycle?
What previous breast problems has she had?
Is there any breast cancer in her family?
How many children has she had?
Physical examinationThe doctor will look at her breasts, first with her arms by her sides, then above her head and, finally, with her arms pressing on her hips. By looking carefully at the outline of the breast in various positions, the doctor can often see changes in the outline of the breast, which will help identify the site and cause of any problems. Next, her breasts are examined while she is lying flat with her arms folded under her head.If, during this examination, the doctor finds a lump, he or she will concentrate on this area examining with the fingertips and measuring the lump. After checking her breasts, the doctor usually carefully examines the lymph glands under the patient's arm pit and those in the lower part of her neck. Should the patient need any further investigations, the breast specialist in the breast clinic will organise any tests that are necessary.
MammogramsIf the patient is over 35 and has not had a breast X-ray within the past year, the doctor may arrange for one to be performed. Breast X-rays are known as mammograms. Mammograms are a good way of identifying abnormalities in the breast, but they don't always tell whether they are benign or malignant. Further tests are sometimes necessary and these tests include ultrasound and fine needle aspiration cytology (FNAC).
Ultrasound scanningX-rays do not pass easily through the breasts of young women. Ultrasound scanning, which is familiar to many women by its use to look at babies during pregnancy, can also be used in the breast to tell whether a lump is fluid or solid. Ultrasound is not useful as a screening test. It is useful if an abnormal shadow is seen on the mammogram because ultrasound is an accurate way of judging whether any abnormality is benign and straightforward or whether it is more likely to be serious.
Needle tests (FNAC)Inserting a needle into the lump will show whether it is full of fluid (a cyst) or solid. The needle can allow a sample of cells to be removed for examination under the microscope (a process called cytology) and this is a very accurate method of finding out whether the lump is benign or malignant.If there is an abnormality on the mammogram, but no lump to feel, then using either the X-ray machine or the ultrasound machine, it is possible to guide the needle into the area of abnormality and to obtain enough cells or tissue to obtain a definite diagnosis. The very fine needles used for this procedure give rise to its name.Having the lump removed After investigation, the doctor may decide the lump is benign and that it can be left alone. Alternatively the doctor may suggest that the lump should be removed. This is called an excision biopsy and it can be performed either while the patient is awake under local anaesthesia or, more commonly, under a general anaesthetic. Before any operation, the patient will be asked to sign a consent form agreeing to the removal of the lump. It is important for the patient to know that the doctor performing the operation will only remove the lump and will not take any more tissue away without explaining any further procedure to the patient first and being given her consent
What are the symptoms of breast cancer
Generally, breast cancers are not painful and women do not feel unwell with them.
Breast cancer is now commonly diagnosed by breast screening in women who have no symptoms. Approximately 6 in every 1000 women between the ages of 50 and 64 who attend for screening will be found to have breast cancer the first time they attend screening.
A lump in the breast. In many cases, the woman herself will first suspect the disease because she notices a lump or an area of lumpiness or irregularity in her breast tissue. This may happen when she is examining her breasts or while washing or applying lotion to her breasts, or the lump may be visible.
Other signs of breast cancer include:
a change in the skin: there is often dimpling or indentation of the skin with the formation of wrinkles. The nipple might be pulled in or there may be a discharge from the nipple.
occasionally the nipple itself changes. A rash can affect the nipple or the nipple may weep.
the breast may swell and become red and inflamed or the skin may change and become like the skin of an orange. In some breast cancers this is due to a blockage of the drainage of fluid from the breast.
patients sometimes present with a lump under the arm which is a sign that the cancer has spread to the lymph glands.
Breast cancer is now commonly diagnosed by breast screening in women who have no symptoms. Approximately 6 in every 1000 women between the ages of 50 and 64 who attend for screening will be found to have breast cancer the first time they attend screening.
A lump in the breast. In many cases, the woman herself will first suspect the disease because she notices a lump or an area of lumpiness or irregularity in her breast tissue. This may happen when she is examining her breasts or while washing or applying lotion to her breasts, or the lump may be visible.
Other signs of breast cancer include:
a change in the skin: there is often dimpling or indentation of the skin with the formation of wrinkles. The nipple might be pulled in or there may be a discharge from the nipple.
occasionally the nipple itself changes. A rash can affect the nipple or the nipple may weep.
the breast may swell and become red and inflamed or the skin may change and become like the skin of an orange. In some breast cancers this is due to a blockage of the drainage of fluid from the breast.
patients sometimes present with a lump under the arm which is a sign that the cancer has spread to the lymph glands.
What are the risk factors leading to the development of breast cancer
Age
The incidence of breast cancer increases with age and doubles every 10 years until the menopause when the rate of increase slows.Approximately a quarter of breast cancers affect women under the age of 50, a half occur between the ages of 50 and 69 and the remaining quarter develop in women who are 70 years or older.
Geographical variation There is quite a difference in incidence and death rate of breast cancer between different countries. The biggest difference is between Eastern and Western countries. Recent, age-adjusted figures show that the rate of breast cancer per 100,000 women is 24.3 in Japan and 26.5 in China compared to 68.8 in England and Wales and 72.7 in Scotland and 90.7 in North America in white females. However, studies of women from Japan who emigrate to the US show that their rates of breast cancer rise to become similar to US rates within just one or two generations, indicating that factors relating to everyday activities are more important than inherited factors in breast cancer.
Reproductive factorsWomen who start menstruating early in life or who have a late menopause have an increased risk of breast cancer. Women who have natural menopause after the age of 55 are twice as likely to develop breast cancer as women who experience the menopause before the age of 45.
Age at first pregnancy Having no children and being older at the time of the first birth both increase the lifetime incidence of breast cancer. The risk of breast cancer in women who have their first child after the age of 30 is about twice that of women having their first child before the age of 20.The highest risk group are those who have their first child after the age of 35 and these women have an even higher risk than women who have no children. These observations indicate a ‘menstrual cycle effect’. During the monthly cycle a woman’s fluctuating hormone levels cause several changes within breast tissue, which are repeated every month. These changes possibly encourage or amplify abnormalities in the cell repair processes within breast tissue, which can in some cases lead to breast cancer later in life. Women who have fewer menstrual cycles before their first pregnancy, either through being older when they start menstruating or younger when they first get pregnant, run less chance of such an abnormality occurring.
Inherited risk Up to 10 per cent of breast cancer in Western countries is due to an inherited factor. This factor can be passed on from either parent and some family members pass on the abnormal gene without developing cancer themselves.It is not yet known how many breast cancer genes there are, but to date, two specific breast cancer genes have been identified (BRCA1 and BRCA2).
Previous breast disease Women with certain benign changes in their breasts are at increased risk of breast cancer. These women present with a breast lump, have an operation and the breast tissue removed shows severe overgrowth of the cells lining the breast lobule. The technical name for this type of breast condition is ‘severe atypical epithelial hyperplasia’. Although benign in itself, its occurrence in a particular woman multiplies her risk of developing breast cancer during her life by a factor of four.
Radiation Doubling of the risk of breast cancer was observed among teenage girls exposed to radiation during the second world war. Another study of women who received radiation to the chest as a result of repeated X-rays for tuberculosis, found that there was a risk among women who were first X-rayed between the ages of 10 and 14 years. Fortunately, as TB itself has been prevented, this risk is less relevant today. Other studies have shown that women with Hodgkin's disease who received radiation therapy to the chest have an excess risk of breast cancer. As they are surviving to older age they are now developing not only unilateral but bilateral breast cancer. The increase in risk depends on the dose and the age at which they received radiation. Data has also suggested that there is increased risk of breast cancer in the other breast in patients having radiation to one breast.
Lifestyle Although there is a close correlation between the incidence of breast cancer in a country and the dietary fat intake of that country, more detailed studies have shown that there does not appear to be a particularly strong or consistent relationship between fat intake in any individual and their risk of developing breast cancer.
WeightBeing overweight is associated with a doubling of the risk of breast cancer in postmenopausal women whereas amongst premenopausal women obesity is associated with reduced breast cancer incidence.
Alcohol intakeSome studies have shown a link between the amount of alcohol people drink and the incidence of breast cancer, but this relationship is not consistent and may be influenced by dietary factors other than alcohol.
HormonesWomen who take the contraceptive pill are at a slight increased risk while they take the Pill and they remain at risk for 10 years after coming of the Pill. The increased risk is, however, very small and cancers diagnosed in women taking the oral contraceptive Pill are less likely to have spread than those cancers diagnosed in women who have never used the oral contraceptive. The duration of use, age at first use, dose and type of hormone within the contraceptive appears to have no significant effect on breast cancer risk. Women who begin taking the Pill before the age of 20 appear to have a higher risk than women who begin taking oral contraceptives at an older age.
Hormone replacement therapyAmong current users of hormone replacement therapy (HRT) and those who have stopped using it one to four years previously, there is an increased risk of breast cancer. The risk increases 1.023 times for each year of HRT use. This increased risk is very similar to the effect of a delay in the menopause by one year. The risk of breast cancer in a woman who has not used HRT increases 1.028 times for each year she is older at the menopause. HRT using a combination of oestrogen and progestogen has been shown to be associated with a slightly higher risk of breast cancer than oestrogen-only HRT. Cancers diagnosed in women taking HRT tend to be less advanced clinically than those diagnosed in women who have not used HRT. Current evidence suggests that HRT does not increase breast cancer mortality.
The incidence of breast cancer increases with age and doubles every 10 years until the menopause when the rate of increase slows.Approximately a quarter of breast cancers affect women under the age of 50, a half occur between the ages of 50 and 69 and the remaining quarter develop in women who are 70 years or older.
Geographical variation There is quite a difference in incidence and death rate of breast cancer between different countries. The biggest difference is between Eastern and Western countries. Recent, age-adjusted figures show that the rate of breast cancer per 100,000 women is 24.3 in Japan and 26.5 in China compared to 68.8 in England and Wales and 72.7 in Scotland and 90.7 in North America in white females. However, studies of women from Japan who emigrate to the US show that their rates of breast cancer rise to become similar to US rates within just one or two generations, indicating that factors relating to everyday activities are more important than inherited factors in breast cancer.
Reproductive factorsWomen who start menstruating early in life or who have a late menopause have an increased risk of breast cancer. Women who have natural menopause after the age of 55 are twice as likely to develop breast cancer as women who experience the menopause before the age of 45.
Age at first pregnancy Having no children and being older at the time of the first birth both increase the lifetime incidence of breast cancer. The risk of breast cancer in women who have their first child after the age of 30 is about twice that of women having their first child before the age of 20.The highest risk group are those who have their first child after the age of 35 and these women have an even higher risk than women who have no children. These observations indicate a ‘menstrual cycle effect’. During the monthly cycle a woman’s fluctuating hormone levels cause several changes within breast tissue, which are repeated every month. These changes possibly encourage or amplify abnormalities in the cell repair processes within breast tissue, which can in some cases lead to breast cancer later in life. Women who have fewer menstrual cycles before their first pregnancy, either through being older when they start menstruating or younger when they first get pregnant, run less chance of such an abnormality occurring.
Inherited risk Up to 10 per cent of breast cancer in Western countries is due to an inherited factor. This factor can be passed on from either parent and some family members pass on the abnormal gene without developing cancer themselves.It is not yet known how many breast cancer genes there are, but to date, two specific breast cancer genes have been identified (BRCA1 and BRCA2).
Previous breast disease Women with certain benign changes in their breasts are at increased risk of breast cancer. These women present with a breast lump, have an operation and the breast tissue removed shows severe overgrowth of the cells lining the breast lobule. The technical name for this type of breast condition is ‘severe atypical epithelial hyperplasia’. Although benign in itself, its occurrence in a particular woman multiplies her risk of developing breast cancer during her life by a factor of four.
Radiation Doubling of the risk of breast cancer was observed among teenage girls exposed to radiation during the second world war. Another study of women who received radiation to the chest as a result of repeated X-rays for tuberculosis, found that there was a risk among women who were first X-rayed between the ages of 10 and 14 years. Fortunately, as TB itself has been prevented, this risk is less relevant today. Other studies have shown that women with Hodgkin's disease who received radiation therapy to the chest have an excess risk of breast cancer. As they are surviving to older age they are now developing not only unilateral but bilateral breast cancer. The increase in risk depends on the dose and the age at which they received radiation. Data has also suggested that there is increased risk of breast cancer in the other breast in patients having radiation to one breast.
Lifestyle Although there is a close correlation between the incidence of breast cancer in a country and the dietary fat intake of that country, more detailed studies have shown that there does not appear to be a particularly strong or consistent relationship between fat intake in any individual and their risk of developing breast cancer.
WeightBeing overweight is associated with a doubling of the risk of breast cancer in postmenopausal women whereas amongst premenopausal women obesity is associated with reduced breast cancer incidence.
Alcohol intakeSome studies have shown a link between the amount of alcohol people drink and the incidence of breast cancer, but this relationship is not consistent and may be influenced by dietary factors other than alcohol.
HormonesWomen who take the contraceptive pill are at a slight increased risk while they take the Pill and they remain at risk for 10 years after coming of the Pill. The increased risk is, however, very small and cancers diagnosed in women taking the oral contraceptive Pill are less likely to have spread than those cancers diagnosed in women who have never used the oral contraceptive. The duration of use, age at first use, dose and type of hormone within the contraceptive appears to have no significant effect on breast cancer risk. Women who begin taking the Pill before the age of 20 appear to have a higher risk than women who begin taking oral contraceptives at an older age.
Hormone replacement therapyAmong current users of hormone replacement therapy (HRT) and those who have stopped using it one to four years previously, there is an increased risk of breast cancer. The risk increases 1.023 times for each year of HRT use. This increased risk is very similar to the effect of a delay in the menopause by one year. The risk of breast cancer in a woman who has not used HRT increases 1.028 times for each year she is older at the menopause. HRT using a combination of oestrogen and progestogen has been shown to be associated with a slightly higher risk of breast cancer than oestrogen-only HRT. Cancers diagnosed in women taking HRT tend to be less advanced clinically than those diagnosed in women who have not used HRT. Current evidence suggests that HRT does not increase breast cancer mortality.
How common is breast cancer
Breast cancer is the most prevalent cancer among women and affects approximately one million women worldwide.Breast cancer accounts for 30 per cent of all female cancers in the UK and approximately 1 in 9 women in the UK will get breast cancer sometime during their life.
What is breast cancer
The breast is a gland that consists of breast tissue supported by connective tissue (flesh) surrounded by fat. The easiest way to understand how the inside of the breast is formed is by comparing it to an upturned bush. Its leaves are known as lobules and they produce milk that drains into ducts that are the branches of the breast tree. These in turn drain into 12 or 15 major or large ducts which empty onto the surface of the nipple, just like the branches of a tree drain to the trunk. Breast cancer develops from the cells that line the breast, lobules and the draining ducts. Cancer cells that remain confined to the lobule and the ducts are called 'in situ' or 'non-invasive'. They are sometimes also referred to as pre-cancers in recognition of the fact that these cells have not yet gained the ability to spread to other parts of the body, which is the feature that most people associate with cancer. An invasive cancer is one where the cells have moved outside the ducts and lobules into the surrounding breast tissue.
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