Breast Cancer in Women

What is breast cancer?

When abnormal cells grow uncontrollably, they are called cancers. Cancer of the breast is the most common cancer in women. Each year, around 200,000 American women learn that they have this disease.

Breast cancer is a treatable and curable disease. 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 organs such as the liver, brain, lungs, and bones. If breast cancer is found early, before it spreads, it can be cured.

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 develop 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 in the genes called BRCA1 and BRCA2. Blood tests usually show these gene abnormalities 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 age 50. (Four out of five breast cancers occur in women over age 50.)
• 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.

What are the 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 grow slowly or rapidly.

Other signs of breast cancer include:

• color change, dimpling, or puckering of the skin in an area of the breast
• a change in the size or shape of the breast
• discharge from the nipple
• a nipple that has recently become inverted (the nipple retracts or pulls inward when stimulated)
• a lump felt in the armpit.

Pain, tenderness, and soreness of the breast without a lump are not usually symptoms of cancer and occur commonly. However, all breast signs or symptoms that last more than a few days need to be evaluated 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 on a screening mammogram. A mammogram is a special X-ray of the breast to look for breast cancer.

Mammograms detect most cancerous growths in the breasts. Screening mammograms usually detect cancers earlier than a lump can be felt. Mammograms are also used to check lumps that are felt.

Most breast lumps are not cancer. Often they are fluid-filled cysts in the breast tissue that get larger and smaller with the menstrual cycle. However, any lump that does not go away should be checked. Other ways of checking lumps are:

• ultrasound exam
• needle or surgical biopsy
• magnetic resonance imaging (MRI).

These tests may be done even if a lump that has been felt is not seen on the mammogram.

When you have a needle biopsy, you are given a local anesthetic to numb the area of your breast being tested. Then your healthcare provider inserts a needle into the breast lump and takes fluid or tissue from the lump. If fluid fills the needle, 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 by a pathologist.

If you have a surgical biopsy, your surgeon will numb 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 if hormones affect the behavior of the cancerous cells. The estrogen receptor (ER) test is one of these tests. 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 or oncologist (cancer specialist) is usually also consulted. Treatment decisions will take into account:

• your age
• the stage of the cancer (how advanced the cancer is)
• if the cancer grows with hormones
• 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 the cancerous tissue only) or mastectomy (removing the entire breast). A few or many lymph nodes in the armpit area will also be removed. Other possible treatments are radiation therapy, chemotherapy (anticancer drugs), and hormone therapy. These different treatments may be used alone or together.

If you are considering mastectomy, you should discuss the options for breast reconstruction surgery with your surgeon.

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 or other places in the body)
• the type of breast cancer
• estrogen-receptor and progesterone-receptor levels in the tumor tissue (the higher the levels, the better the prognosis)
• your age, general health, and whether you are still having menstrual periods
• whether the cancer has just been diagnosed or has recurred (come back).

Breast cancer survival and the chance of cure keep improving. As more women do regular self-exams, more cancers are found early. As mammograms and other screening methods (such as MRI) improve, more cancers are being detected before they can even be felt. Finding and treating breast cancer early greatly increases your chances of survival and cure.

How can I take care of myself?

If you have been diagnosed with breast cancer:

• Discuss your cancer and treatment options with your healthcare provider so that you understand them. You may want to get a second opinion.
• Tell your healthcare provider if your treatment causes discomfort. Usually there are ways to relieve the discomfort.
• Get regular checkups after your treatment is finished.
• Continue monthly self-exams, even if both of your breasts have been removed, to look for 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:

• Do a breast self-exam every month.
• 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.
• All women age 40 to 70 years old, who are in good health, should be screened for breast cancer with mammography every 1 to 2 years after counseling by their healthcare provider about the possible risks and benefits of the procedure. Comparing mammograms from year to year can help detect early cancer.

  If you are over 70, ask your healthcare provider how often you should have a mammogram.

  If you have a higher than average risk for breast cancer and are 25 years old or older, ask your healthcare provider when you should start having mammograms and how often you should have them. Your provider may recommend MRI screening as well.

• 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 (half an hour, 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 produce estrogen, which promotes breast cancer.
• Eat a healthy diet that includes low-fat dairy products and lots of fruits and vegetables.
• If you have a baby, consider breast-feeding. It helps lower your risk of breast cancer.
• Avoid hormone (estrogen and progesterone) replacement therapy if possible. It may increase breast cancer risk.