Breast Cancer in Women

What is breast cancer?

Breast cancer is a growth of abnormal cells in the breast. It is the most common cancer in women.

Breast cancer is treatable and curable. Early detection is the key to a cure. The cancer usually starts as a small lump. However, with time the lump may grow and spread to nearby areas, such as the skin or the lymph nodes under the arm. The tumor may also spread to other parts of the body, such as the liver, brain, lungs, and bones. If breast cancer is found early, before it spreads, there is a good chance of a cure.

How does it occur?

The cause of breast cancer is not known. Any woman can get breast cancer, but some women are more likely to have it than others. You may have a higher risk of breast cancer if:

• You have a mother, sister, or daughter who has had breast cancer.
• You or a parent, sister, brother, son, or daughter has changes (mutations) in the genes called BRCA1 and BRCA2. Blood tests usually show these gene changes in families with many women who have had breast or ovarian cancer.
• You have had breast cancer before.
• You had your first menstrual period before age 13.
• Your menopause (when you stopped having periods) was after the age of 55.
• You are over 50 years old.
• You never gave birth to a child or you had your first child after age 30.
• You did not breast-feed.
• You had radiation therapy to the chest (including your breasts) before age 30.
• You have taken hormone therapy with estrogen or progesterone after menopause.
• You are overweight after going through menopause.
• You are physically inactive.
• You drink alcohol, especially if you are past menopause.

What are the signs and symptoms?

Most often the first sign of breast cancer is a lump in the breast. The lump is found most often in the upper, outer part of the breast. It is not usually painful. It may get bigger slowly or quickly, or it may not get bigger.

Other signs of breast cancer include:

• color change, dimpling, or puckering of the skin in some part of the breast
• a change in the size or shape of the breast
• discharge from the nipple
• a nipple that has recently become inverted, which means the nipple seems to go into, rather than out from, the breast.
• a lump in the armpit.

It’s common to have pain, tenderness, and soreness of the breast without a lump. These symptoms are not usually symptoms of cancer. However, all breast signs or symptoms that last more than a few days need to be checked by your healthcare provider.

How is it diagnosed?

Many women find their own breast cancers, either by chance or from a breast self-exam. Sometimes breast cancers are found at a routine physical exam or with a screening mammogram.

A mammogram is a special X-ray of the breast to look for breast cancer or to check a lump felt in the breast. Mammograms detect most, but not all, cancerous growths in the breasts. Screening mammograms usually find cancers earlier than a lump can be felt.

Most breast lumps are not cancer. Often they are fluid-filled cysts that get larger and smaller with the menstrual cycle. However, any lump should be checked. In addition to mammograms, lumps may be checked with:

• ultrasound exam
• magnetic resonance imaging (MRI)
• needle or surgical biopsy to remove fluid or tissue for tests.

When you have a needle biopsy, you are given a local anesthetic to numb the area of the breast being tested. Then your healthcare provider uses a needle to take fluid or tissue from the lump. If fluid is found, the lump is probably a cyst and not cancer. (Removing the fluid also makes fluid-filled lumps go away.) Tissue withdrawn by the needle will be examined in the lab.

If you have a surgical biopsy, your surgeon will numb that area of your breast with a local anesthetic, make a cut in the breast, and remove some or all of the lump. The tissue from the lump will be examined under a microscope. If the biopsy sample shows cancerous tissue, tests will be done to see how hormones affect the cancer cells. The estrogen receptor (ER) test is one of these tests. Another test is the progesterone receptor (PR) test. If the cells have estrogen receptors, the cells may need the hormone estrogen to grow. The cancer will also be tested to see if an abnormal (mutated) gene called HER2 is present. You will probably also have lymph nodes removed from your armpit to see if cancer has spread beyond the breast. Two procedures for removing lymph nodes are axillary node dissection and sentinel node biopsy.

How is it treated?

If a breast lump is cancerous, the decisions for treatment will be made by you and your healthcare provider. A surgeon, medical oncologist, and radiation oncologist are usually consulted. (Oncologists are cancer specialists.) Treatment decisions will take into account:

• your age
• the stage of the cancer (how advanced the cancer is)
• the effect of hormones on the cancer
• the type of breast cancer
• whether the cancer has spread to lymph nodes or other parts of your body.

Possible surgical treatments are lumpectomy (removing only the cancerous tissue rather than the whole breast) and mastectomy (removing all of the breast). Some lymph nodes in the armpit area will also be removed. If you may have a mastectomy, talk to your healthcare provider about the options for breast reconstruction.

Other treatments are:

• radiation therapy, which is the use of high-energy rays to kill cancer cells
• chemotherapy (anticancer drugs), which uses drugs to kill cancer cells
• hormone therapy, which uses medicine that stops hormones in your body from helping tumors grow (commonly used drugs are Tamoxifen and Arimidex)
• biological therapy, such as the drug trastuzumab (Herceptin), given IV, which can stop abnormal genes in the cancer from making the cancer grow.

Often, more than 1 type of treatment is used.

If you have been taking estrogen, you will need to stop taking it.

How long will the effects last?

The chance of cure depends on:

• the stage of the cancer (whether it is in the breast only or has spread to lymph nodes)
• the type of breast cancer
• estrogen-receptor and progesterone-receptor levels in the tumor tissue (the higher the levels, the better your chances for cure)
• your age, general health, and whether you are still having menstrual periods
• whether the cancer has just been diagnosed or has recurred (come back).

Recurrent breast cancer or stage IV disease is not curable.

Breast cancer survival and the chance of cure when the cancer is found early keep getting better. As mammograms and other screening methods (such as MRI) improve, more cancers are being found. Finding and treating breast cancer early greatly increases the chances of survival and cure.

How can I take care of myself?

If you have been diagnosed with breast cancer:

• Talk about your cancer and treatment options with your healthcare provider and make sure you understand your choices. You may want to get a second opinion.
• Follow the full course of treatment prescribed by your healthcare provider.
• Eat a healthy diet.
• Know that having the cancer adds a lot of stress to your life. Take more time for your important relationships and for rest. Spend time with people and activities you enjoy.
• Talk with your family and your healthcare providers about your concerns. Ask your healthcare provider any questions you have about the disease, treatments, side effects of the treatments, sexuality, support groups, and anything else that concerns you.
• Tell your provider if your treatment causes discomfort. Usually there are ways to relieve the discomfort.
• Get regular checkups after your treatment is finished.
• Regularly examine your breasts (or breast area if your breasts have been removed). This will help you discover any signs that the cancer has come back or a new cancer has started.

There are many support services for women with breast cancer. You can find the names of groups and agencies from your healthcare provider or through your local American Cancer Society office.

To help detect breast cancer early:

• Have a breast exam by your healthcare provider at least every 3 years if you are 20 to 39 years old and every year after the age of 40.
• Get mammograms as often as your healthcare provider recommends. If you have a very high risk of breast cancer, may also need to be screened with MRI.
• Ask your healthcare provider about doing breast self-exams. These exams are not as strongly recommended as they used to be. However, your provider may recommend doing them to help you be more familiar with your body. They could help you notice changes that need to be checked.
• Never ignore a lump or change in the look or feel of your breast. Remember that a cancerous tumor is usually not painful.

For more information on cancer, contact national and local organizations such as:

• American Cancer Society, Inc.
  Phone: 800-ACS-2345 (800-227-2345)
  Web site: http://www.cancer.org
• National Cancer Institute
  Phone: 1-800-4CANCER, or 1-800-422-6237 (TTY: 1-800-332-8615)
  English Web site: http://www.cancer.gov

How can I help prevent breast cancer?

• Become a lifelong exerciser. Moderate exercise (for example, half an hour of fast walking most days of the week) may lower your risk.
• Keep a healthy weight. Women who gain 20 to 30 pounds after their teens are more likely to get breast cancer than those who don't gain this much weight. This is because fat cells make estrogen, which can help breast cancer grow.
• Eat a healthy diet that includes low-fat dairy products and lots of fruits and vegetables.
• If you have a baby, breast-feeding can help lower your risk of breast cancer.
• Avoid hormone replacement therapy (estrogen and progesterone) if possible. It may increase your risk of breast cancer.