So many women you know may have had breast cancer; friends and neighbours, co-workers, relatives. It seems as if every time you turn around, breast cancer is being talked about in the newspaper or on TV. You may be fearful of developing breast cancer for the first time or of receiving a diagnosis after a mammogram or other testing. If you’ve had breast cancer, you may be fearful of a possible recurrence or even of the possibility that breast cancer could take your life.
Even though you may have some of these fears, you are not necessarily going to get breast cancer. If you have had breast cancer before, it doesn’t mean that the cancer will recur. Still, it's normal to have concerns about a disease that you hear about and see around you relatively often and that you may have experienced yourself or through a loved one. Don't let the discussion of fear in this section feed into your own fears.
Breast cancers are potentially life-threatening malignancies that develop in one or both breasts.
The structure of the female breast is important in understanding breast cancer. A mature human female's breast consists of fat, connective tissue and thousands of lobules - tiny glands which produce milk. The milk of a breastfeeding mother goes through tiny ducts (tubes) and is delivered through the nipple.
The breast, like any other part of the body, consists of billions of microscopic cells. These cells multiply in an orderly fashion - new cells are made to replace the ones that died.
In cancer, the cells multiply uncontrollably, and there are too many cells, progressively more and more than there should be.
Breast cancer usually begins with the formation of a small, confined tumor (lump), or as calcium deposits (micro-calcifications) and then spreads through channels within the breast to the lymph nodes or through the blood stream to other organs. The tumor may grow and invade tissue around the breast, such as the skin or chest wall. Different types of breast cancer grow and spread at different rates -- some take years to spread beyond the breast while others grow and spread quickly.
Breast cancer survival rates have increased, and the number of deaths steadily has been declining, which is largely due to a number of factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease.
There are 2 main types of breast cancer:
Ductal carcinoma starts in the tubes (ducts) that carry milk from the breast to the nipple. Most breast cancers are of this type.
Lobular carcinoma starts in the parts of the breast, called lobules, which produce milk.
In rare cases, breast cancer can start in other areas of the breast.
Men can get breast cancer, too, but they account for just one percent of all breast cancer cases. Among women, breast cancer is the most common cancer and the second leading cause of cancer deaths after lung cancer.
Are you worried about a lump or other symptom you think might be breast cancer? Find out what the symptoms of breast cancer are and what to do if you think you have one.
While breast cancer is rare in men, it does happen. Any cell in your body can become cancerous. So even though men have a very small amount of breast tissue, cancer can develop there. The risk of a man getting breast cancer in his lifetime is about 1 per 1000.
Because breast cancer is so uncommon in men, it’s often not diagnosed until the cancer is in a later stage. This makes it more difficult to treat.
Early breast cancer often does not cause symptoms. This is why regular breast exams and mammograms are important, so cancers that don't have symptoms may be found earlier.
As the cancer grows, symptoms may include:
Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt.
Change in the size, shape, or feel of the breast or nipple. For example, you may have redness, dimpling, or puckering that looks like the skin of an orange.
Fluid from the nipple. Fluid may be bloody, clear to yellow, green, or look like pus.
Symptoms of advanced breast cancer may include:
Breast pain or discomfort
Swelling of the lymph nodes in the armpit (next to the breast with cancer)
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 and continue to accumulate, forming a lump or mass. The cells 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 (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.
Researchers have identified hormonal, lifestyle and environmental factors that may 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.
A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But having one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer.
Factors that are associated with an increased risk of breast cancer include:
Being female. Women are much more likely than men are to develop breast cancer.
Increasing age. Your risk of breast cancer increases as you age.
A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most common gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
Obesity. Being obese increases your risk of breast cancer.
Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
Beginning menopause at an older age. If you began menopause at an older age, you're more likely to develop breast cancer.
Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.
Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
Drinking alcohol. Drinking alcohol increases the risk of breast cancer.
DIAGNOSING BREAST CANCER
Most people think their risk of getting breast cancer for the first time is higher than it really is. Try to get a realistic idea of your risk from your doctor. Your risk is affected by many factors. Many people who review their risk factors find out that their risk is lower than they'd expect.
The fear of being diagnosed with breast cancer makes some people avoid going to the doctor. But the sooner you see a doctor, the sooner you can know what your situation is. Never let fear stop you from making a good choice when it comes to your healthcare.
Tests and procedures used to diagnose breast cancer include:
Breast exam. Your doctor will check both of your breasts and lymph nodes in the armpit, feeling for any lumps or other abnormalities.
Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality.
Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst.
Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to make a diagnosis of breast cancer. Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options.
Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye.
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:
Blood tests, such as a complete blood count
Mammogram of the other breast to look for signs of cancer
Computerized tomography (CT) scan
Positron emission tomography (PET) scan
Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances and taking into account new symptoms you may be experiencing.
Breast cancer stages range from 0 to IV with 0 indicating cancer that is noninvasive or contained within the milk ducts. Stage IV breast cancer also called metastatic breast cancer, indicates cancer that has spread to other areas of the body.
Breast Cancer Stages
The stages are the number zero and the Roman numerals I, II, III, or IV (often followed by A, B, or C). In general, the higher the number, the more advanced the cancer. But there’s more to it than that.
Stage 0. The cancer has been diagnosed early. It started in the breast ducts or milk glands and has stayed there. You’re likely to hear or see the words in situ, meaning “in the original place.”
Stage I. Starting at this level, breast cancer is called invasive, meaning it has broken free to attack healthy tissue.
Stage 1A means the cancer has spread into the fatty breast tissue. The tumor itself is no larger than a shelled peanut, or there may be no tumor
Stage IB means some cancer cells, but just tiny amounts, have been found in a few lymph nodes.
Stage II. The cancer has grown, spread, or both.
IIA means the tumor in the breast is still small, if there's one at all. There may be no cancer in the lymph nodes, or it may have spread to as many as three.
A stage IIB breast tumor is bigger -- it may be the size of a walnut or as big as a lime. It may or may not be in any lymph nodes.
Stage III. The cancer has not spread to bones or organs, but it’s considered advanced, and it’s harder to fight.
IIIA means the cancer has been found in up to nine of the lymph nodes that form a chain from your underarm to your collarbone. Or it has spread to or enlarged the lymph nodes deep in your breast. In some cases there is a large tumor in the breast, but other times there’s no tumor.
IIIB means the tumor has grown into the chest wall or skin around your breast, even if it hasn’t spread to the lymph nodes.
IIIC means cancer has been found in 10 or more lymph nodes, or has spread above or below your collarbone. It’s also IIIC if fewer lymph nodes outside the breast are affected but those inside it are enlarged or cancerous.
Stage IV. Breast cancer cells have spread far away from the breast and lymph nodes right around it. The most common sites are the bones, lungs, liver, and brain. This stage is described as “metastatic,” meaning it has spread beyond the region of the body where it was first found.
TNM System for Breast Cancer
Doctors also group cancers by the letters T, N, or M. Each of those letters tells you something about your cancer.
“T” stands for tumor, or the lump of cancer found in the breast itself. The higher the number assigned after it, the bigger or wider the mass.
“N” stands for nodes, as in lymph nodes. These small filters are found throughout the body, and they're especially dense in and around the breast. They're meant to catch cancer cells before they travel to other parts of the body. Here, too, a number (0-III) tells you whether the cancer has spread to lymph nodes near the breast and, if so, how many.
“M” stands for metastasis. The cancer has spread beyond the breast and lymph nodes.
Treatments for men and women are generally the same.
If eight women were to live to be at least 85, one of them would be expected to develop the disease at some point during her life. Two-thirds of women with breast cancer are over 50, and most of the rest are between 39 and 49.
Fortunately, breast cancer is very treatable if detected early. Localized tumors can usually be treated successfully before the cancer spreads. However, late recurrences of breast cancer are common.
Once the cancer begins to spread, treatment becomes difficult, although treatment can often control the disease for years.
Treatment is based on many factors, including:
Type of breast cancer
Stage of the cancer (staging is a tool your providers use to find out how advanced the cancer is)
Whether the cancer is sensitive to certain hormones
Whether the cancer overproduces (overexpresses) the HER2/neu protein
Cancer treatments may include:
Chemotherapy, which uses medicines to kill cancer cells.
Radiation therapy, which is used to destroy cancerous tissue.
Surgery to remove cancerous tissue: A lumpectomy removes the breast lump. Mastectomy removes all or part of the breast and possibly nearby structures. Nearby lymph nodes may also be removed during surgery.
Targeted therapy uses medicine to attack the gene changes in cancer cells. Hormone therapy is an example of targeted therapy. It blocks certain hormones that fuel cancer growth.
Cancer treatment can be local or systemic:
Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment. They are most effective when the cancer has not spread outside the breast.
Systemic treatments affect the entire body. Chemotherapy and hormonal therapy are types of systemic treatment.
Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning (recurring). For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.
Stage 0 and ductal carcinoma: Lumpectomy plus radiation or mastectomy is the standard treatment.
Stage I and II: Lumpectomy plus radiation or mastectomy with lymph node removal is the standard treatment. Chemotherapy, hormonal therapy, and other targeted therapy may also be used after surgery.
Stage III: Treatment involves surgery, possibly followed by chemotherapy, hormone therapy, and other targeted therapy.
Stage IV: Treatment may involve surgery, radiation, chemotherapy, hormone therapy, other targeted therapy, or a combination of these treatments.
After treatment, some women continue to take medicines for a time. All women continue to have blood tests, mammograms, and other tests after treatment to monitor for the return of cancer or development of another breast cancer.
Women who have had a mastectomy may have reconstructive breast surgery. This will be done either at the time of mastectomy or later.
You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.