Filed under: Cancer & Chemo
Breast cancer is cancer that forms in the cells of the breasts. There are numerous types of breast cancer, but cancer that begins in the milk ducts (ductal carcinoma) is the most common type.
After skin cancer, breast cancer is the most common cancer diagnosed in women in the United States. Breast cancer can occur in both men and women, but it's far more common in women.
Public support for breast cancer awareness and research funding has helped improve the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased and the number of deaths has been declining, thanks to a number of factors such as earlier detection, new treatments and a better understanding of the disease.
Signs and symptoms of breast cancer may include:
When to see a doctor
Although the majority of breast changes don't turn out to be cancer, make an appointment to see your doctor if you find a lump or other change in your breast. Even if you've just had a mammogram with normal results, it's still important to have your doctor evaluate any changes.
It's not clear what causes breast cancer. Doctors know that breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells do. The accumulating cells form a tumor that may spread (metastasize) through your breast, to your lymph nodes or to other parts of your body.
Breast cancer most often begins with cells in the milk-producing ducts. Doctors call this type of breast cancer invasive ductal carcinoma. Breast cancer may also begin in the milk glands known as lobules (invasive lobular carcinoma) within the breast.
Researchers have identified things that can increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.
Inherited breast cancer
Doctors estimate that only 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family. A number of inherited defective genes that can increase the likelihood of breast cancer have been identified. The most common are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which increase the risk of both breast and ovarian cancer.
If you have a strong family history of breast cancer or other cancers, blood tests may help identify defective BRCA or other genes that are being passed through your family. Consider asking your doctor for a referral to a genetic counselor, who can review your family health history. A genetic counselor can also discuss the benefits, risks and limitations of genetic testing with you. It's important to remember that the genetic tests help to identify a high-risk individual or family, but they don't definitively predict who will or will not get breast cancer.
A risk factor is anything that makes it more likely you'll get a particular disease. But having one or even several risk factors doesn't necessarily mean you'll develop cancer — many women who develop breast cancer have no known risk factors other than simply being women.
Factors that are associated with an increased risk of breast cancer include:
Other risk factors that have been suggested, but don't play any role in the development of breast cancer include tightfitting bras, antiperspirants, breast implants and shift work.
Consulting with your health care team
Women with breast cancer may have appointments with their primary care doctors, as well as several other doctors and other health professionals, including:
What you can do to prepare
Questions to ask your doctor
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For breast cancer, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask additional questions that may occur to you during your appointment.
Diagnosing breast cancer
Tests and procedures used to diagnose breast cancer include:
Other tests and procedures may be used depending on your situation.
Staging breast cancer
Once your doctor has diagnosed your breast cancer, he or she works to establish the extent (stage) of your cancer. Your cancer's stage helps determine your prognosis and the best treatment options. Complete information about your cancer's stage may not be available until after you undergo breast cancer surgery.
Tests and procedures used to stage breast cancer may include:
Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances.
Breast cancer stages range from 0 to IV, with 0 indicating cancer that is very small and noninvasive. Stage IV breast cancer, also called metastatic breast cancer, indicates cancer that has spread to other areas of the body.
Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage, whether the cancer cells are sensitive to hormones, your overall health and your own preferences. Most women undergo surgery for breast cancer and also receive additional treatment, such as chemotherapy, hormone therapy or radiation.
There are many options for breast cancer treatment, and you may feel overwhelmed as you make complex decisions about your treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Talk to other women who have faced the same decision.
Breast cancer surgery
Operations used to treat breast cancer include:
Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the sentinel node, your surgeon may remove additional lymph nodes in your armpit. However, there is good evidence that removal of additional affected lymph nodes does not improve survival in cases of early breast cancer following a lumpectomy, chemotherapy and whole-breast irradiation for tumors less than 2 inches (5 centimeters) in size, and where the cancer has spread to just a few lymph nodes in the armpit. In such cases, chemotherapy and radiation treatment after the lumpectomy have proved to be equally effective. This avoids the serious side effects, including chronic swelling of the arm (lymphedema), that often occur after lymph node removal.
However, axillary lymph node dissection may still be performed if the sentinel lymph node contains cancer following a mastectomy, in the case of larger breast tumors or when a lymph node is large enough to be felt on physical exam. It may also be performed in situations when a woman elects to receive partial breast irradiation.
Complications of breast cancer surgery depend on the procedures you choose. Surgery carries a risk of bleeding and infection.
Some women choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon. Consider a referral to a plastic surgeon before your breast cancer surgery. Your options may include reconstruction with a synthetic breast implant or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.
Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachytherapy).
External beam radiation is commonly used after lumpectomy for early-stage breast cancer. Doctors may also recommend radiation therapy after mastectomy for larger breast cancers. When external beam radiation is used after a woman has tested negative on a sentinel node biopsy, there is evidence that the chance of cancer occurring in other lymph nodes is significantly reduced.
Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more-serious problems may occur, including arm swelling (lymphedema), broken ribs, and damage to the lungs or nerves.
Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high chance of returning or spreading to another part of your body, your doctor may recommend chemotherapy to decrease the chance that the cancer will recur. This is known as adjuvant systemic chemotherapy.
Chemotherapy is sometimes given before surgery in women with larger breast tumors. Doctors call this neoadjuvant chemotherapy. The goal is to shrink a tumor to a size that makes it easier to remove with surgery. This may also increase the chance of a cure. Research is ongoing into neoadjuvant chemotherapy to determine who may benefit from this treatment.
Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing.
Chemotherapy side effects depend on the drugs you receive. Common side effects include hair loss, nausea, vomiting, fatigue and a small increased risk of developing infection.
Hormone therapy — perhaps more properly termed hormone-blocking therapy — is often used to treat breast cancers that are sensitive to hormones. Doctors sometimes refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.
Hormone therapy can be used after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.
Treatments that can be used in hormone therapy include:
Targeted drug treatments attack specific abnormalities within cancer cells. Targeted drugs approved to treat breast cancer include:
Side effects of targeted drugs depend on the drug you receive. Targeted drugs can be very expensive and aren't always covered by health insurance.
Clinical trials are used to test new and promising agents in the treatment of cancer. Clinical trials represent the cutting edge of cancer treatment, but they're by definition unproven treatments that may or may not be superior to currently available therapies. Talk with your doctor about clinical trials to see if one is right for you.
Examples of treatments being studied in breast cancer clinical trials include:
There are no alternative medicine treatments that have been found to cure breast cancer. What's more, some alternative medicine may cause adverse reactions with standard treatments, or might cause you to delay getting treatments that have been proven effective. If you're considering any type of alternative therapy, be sure to discuss the pros and cons with your doctor.
But complementary and alternative medicine therapies may help you cope with side effects of treatment when combined with your doctor's care.
Alternative medicine for fatigue
Many breast cancer survivors experience fatigue during and after treatment that can continue for years. When combined with your doctor's care, complementary and alternative medicine therapies may help relieve fatigue. Ask your doctor about:
A breast cancer diagnosis can be overwhelming. And just when you're trying to cope with the shock and the fears about your future, you're asked to make important decisions about your treatment.
Every woman finds her own way of coping with a breast cancer diagnosis. Until you find what works for you, it might help to:
Breast cancer prevention for women with an average risk
Making changes in your daily life may help reduce your risk of breast cancer. Try to:
Breast cancer prevention for women with a high risk
If your doctor has assessed your family history and other factors and determined that you may have an increased risk of breast cancer, options to reduce your risk include:
Catch cancer early
Although you can't prevent the development of breast cancer with screening or breast self-exams, these techniques may help you and your doctor find breast cancer in its earliest and more-treatable stages.
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