Breast Cancer

Introduction

Breast cancer forms in the tissues of the breast. It can occur in both men and women.

Different types of breast cancer include:

Ductal carcinoma in situ (DCIS) is non-invasive and often considered a pre-cancer.

Abnormal cells are present in the breast duct but have not spread beyond the lining of the duct to surrounding tissue. DCIS is most often diagnosed by screening mammograms.

Invasive ductal carcinoma is the most common type of breast cancer among women.

It forms in the tubes that carry milk in the breast.

In its earliest form, it is diagnosed on screening mammograms. But it may also present as a mass you can feel.

​​​​​Invasive lobular carcinoma forms in the glands or lobules of the breast.

Inflammatory breast cancer grows in sheets instead of lumps and looks like a rash.

Its symptoms are noticeable and usually lead a person to seek medical attention. They include:

  • A sudden increase in breast size
  • Continuous itchiness in the skin of the breast
  • Excessive warmth to the breast
  • More hardness or firmness to the breast than usual
  • A change in skin texture, like the skin of an orange

Risk Factors

Research is improving our knowledge of the causes of breast cancer. While most breast cancer cases develop spontaneously, there are some known risk factors:

Family history and genetic susceptibility -

  • About 5-10% of all breast cancers are caused by a hereditary genetic mutation.
  • Women with the BRCA1 and BRCA2 gene mutations have an increased risk of developing breast cancer.
  • People with a strong family history may want to learn more about genetic screening. A strong family history is defined as multiple first-degree relatives (sisters, mother, daughters and grandmothers), on either the maternal or paternal side, who have a history of breast cancer and/or ovarian cancer.
  • This is especially important if any member of the family was diagnosed with breast cancer before menopause or any male in the family was diagnosed with breast cancer.

Personal history of breast abnormalities - Ductal carcinoma in situ (DCIS) and lobular neoplasia are associated with increased risk.

Age - The risk of developing breast cancer increases with age. Most breast cancer cases occur in women older than age 60.

Age at first menstrual period - Women who had their first menstrual period before age 12 have a slightly increased risk of breast cancer.

Breast density - Women with dense breasts may have an increased risk of developing breast cancer than women with average breast density. Many states now require that the radiologist send a letter to inform the person of their increased risk. This may lead to additional screening with ultrasound or even MRI. This is an area that is currently changing and practices may vary depending on where you live or seek care.

Childbirth - Women who have never given birth or who gave birth to their first child after age 30 are at a slightly increased risk of developing breast cancer.

Race - White women have a greater risk of developing breast cancer than black women. However, black women diagnosed with breast cancer are more likely to have an aggressive subtype of breast cancer.

Signs & Symptoms

The classic symptom for breast cancer is a lump found in the breast or armpit.

The following symptoms require a medical exam and evaluation:

  • Swelling or lump (mass) in the breast
  • Swelling in the armpit (lymph nodes)
  • Nipple discharge (spontaneous and from one side only)
  • Pain in the nipple
  • Inverted nipple and/or scaly or pitted skin on nipple
  • Unusual breast pain or discomfort
older black woman smiling outside

Screening

There are many ways to detect or screen for breast cancer. Regular monitoring is the best way to catch breast cancer early, when it is most treatable.

Breast Self-Exam - A monthly breast self-exam will help you notice changes to your breasts’ texture, size and skin condition. Women who do breast self-exams know how their breasts normally look and feel and can see changes sooner. Do not hesitate to talk to a doctor or nurse if you have a question about your breasts.


Clinical Breast Exam - A doctor checks the breasts, underarms and collarbone area for abnormalities. A clinical breast exam should be a part of a regular visit to a gynecologist or a primary care doctor.


Screening Mammogram - A mammogram is a breast x-ray that can show a lump or abnormality. A mammogram can show a breast lump or abnormality before it can be felt. Talk to your doctor to find out when to have a mammogram.  

Diagnosis & Testing

If you have a symptom or an abnormal mammogram, your doctor may order additional tests, such as:

  • Diagnostic Mammogram - Like screening mammograms, diagnostic mammograms are x-rays of the breast. A diagnostic mammogram is often done after a screening mammogram. The radiologist may use different techniques or views to take more detailed images to learn more about any lumps or abnormalities in the breast.
  • Ultrasound - Sound waves and a computer are used to create a picture of the breast. The picture can show whether a lump is solid or filled with fluid. Cysts (fluid-filled sacs) are usually not cancerous. Solid masses may be.
  • MRI - Magnetic Resonance Imaging uses magnets and radio waves to produce detailed images of the breast. MRIs are often used to screen high-risk women or to gather more information about a suspicious finding on a mammogram. Because MRI does not expose a woman to radiation, it may be used to evaluate a breast lump during pregnancy.
  • Biopsy - A pathologist looks at a sample of tissue under a microscope to check for cancer cells. If cancer cells are found, the pathologist will study them to learn as much as possible about the cancer in order to determine the best course of treatment. A biopsy can be done in several ways:
    • Fine needle aspiration - A thin needle is used to sample a breast lump to determine if there is cancer present.
    • Core Biopsy - Also called needle biopsy, a thick needle is used to remove a sample of breast tissue.
    • Surgical Biopsy - A surgeon makes an incision and removes a sample of tissue from the lump or lump area. This procedure is done in an operating room and requires some form of sedation or anesthesia.

After a biopsy, the doctor will run several tests on the breast cancer cells. This is to learn what treatments may or may not work, how quickly the cancer may grow and spread, and the likelihood that the cancer may return. If your cancer spreads to the bone, please see bone metastases. Doctors will also test breast cancer cells for the following characteristics to help determine the best treatment approach:

  • ER-positive and PR-positive: If the cancer cells have more hormone receptors—estrogen receptors (ER) or progesterone receptors (PR) – than a normal cell, the breast cancer will be classified as estrogen receptor-positive or progesterone receptor-positive. A treatment to block these hormones or their receptors may be recommended.
  • HER2: Like ER/PR receptors, some cancer cells have too many HER2 receptors. These are called HER2-positive cancers. HER2 receptors tell the cell to grow and divide. Therefore, cancers that are HER2-positive are more likely to grow and spread more rapidly. HER2-positive breast cancers can be more aggressive, but also respond to specific HER-2 targeted drugs.
  • Triple Negative: This cancer tests negative for additional estrogen receptors, progesterone receptors and HER2 receptors and is treated with a combination of surgery, chemotherapy and radiation.

Treatment & Side Effects

One of the many decisions you will make about your cancer treatment is choosing a health care team. They should have the expertise and personal touch to make you feel comfortable and respected. It is critical to trust the people who are treating you and to be able to communicate with them.

You have the right to a second, and even third, opinion at any point in your cancer experience. This can help you confirm your diagnosis, understand treatment options, learn about clinical trials, and help you choose the right health care team.

Treatment options vary depending on cancer stage, cell type, age, and general health.

 

“Take things one step at a time. Try not to be overwhelmed by the tidal wave of technical information coming your way. Finally you know your body best; you have to be your own advocate.”

CSC Cancer Experience Registry Member, breast cancer

Surgery is an important part of treatment for early stage breast cancer. As with other types of surgery, side effects include pain or discomfort, risk of infection and some mobility restrictions right after surgery. There are two main types of surgery:

  • Lumpectomy - This operation is also called breast-sparing surgery, breast-conserving surgery, and segmental or partial mastectomy. The tumor and some surrounding tissue are removed, but not the entire breast.
  • Mastectomy - In this operation, the entire breast is removed. Often, the surgeon removes lymph nodes under the arm as well. After surgery, some people undergo radiation therapy. Some also choose to have plastic surgery to rebuild the shape of the breast. Visit our breast reconstruction page to learn more.

Chemotherapy involves the use of drugs to destroy cancer cells. It is a systemic (whole body) treatment. In breast cancer, side effects may also include damage to the ovaries. This can cause infertility or early menopause.

Learn About Chemotherapy

Hormone therapy is the use of drugs that block hormones that drive cancer growth.

In breast cancer, doctors use drugs that block the production or function of estrogen, which can fuel breast cancer growth. In women who have not yet entered menopause, most estrogen in the body is made by the ovaries. In women who have undergone menopause, estrogen levels are lower, and most estrogen in the body is made in other tissues. Different drugs are used to block estrogen in premenopausal and postmenopausal women.

There are many types of hormone therapy that may be used. The side effects depend on the drug or treatment type. They can be similar to menopause and may include hot flashes, mood changes, and vaginal dryness.

Radiation therapy is the use of high-energy rays to kill or damage cancer cells. 

In breast cancer, most people receive some form of radiation therapy after surgery. This is also called "adjuvant" therapy - meaning after surgery. Bras and other clothing may rub the treated area and cause soreness.

Learn About Radiation Therapy

Targeted therapy aims to more precisely attack cancer cells. These drugs target changes in the genes or proteins of cancer cells that help them grow, divide, and spread.

Learn About Targeted Therapy

Be sure to ask about clinical trials. These are research studies to test new treatments or learn how to use current treatments better. In some cases, the treatments with the best chance of success may be available only through clinical trials. Trials are offered for many cancers, at many different stages. Everyone is not eligible for every trial. If you have cancer that has come back or spread, it is especially important to ask about clinical trials.

Learn About Clinical Trials

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