Breast Cancer:

What is Breast Cancer?

Women should do a self-exam to check their breasts for lumps, changes in size or shape, or any other changes in the breasts or armpit.

Breast cancer is an uncontrolled growth of cells that starts in the breast tissue.These
cells usually form a tumor that can often be seen on an x-ray or felt as a
lump. The tumor is malignant (cancer) if the cells can grow into (invade)
surrounding tissues or spread (metastasize) to distant areas of the body. Breast
cancer occurs almost entirely in women, but men can get breast cancer too.

Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy. The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.

Symptoms

Perhaps the most recognized symptom of breast cancer is a lump or mass in the breast tissue. While many women go to their doctor after finding a lump, they should also be aware of any other changes to the breast or nipple.

With the different types of breast cancer come a variety of related symptoms. For example, invasive ductal carcinoma (IDC), which forms in the milk ducts, may cause a distinct breast lump that you can feel. Invasive lobular carcinoma (ILC), which forms in the milk-producing glands, may cause a thickening in the breast.

Some common breast cancer signs and symptoms include:

• Skin changes, such as swelling, redness, or other visible differences in one or both breasts
• An increase in size or change in shape of the breast(s)
• Changes in the appearance of one or both nipples
• Nipple discharge other than breast milk
• General pain in/on any part of the breast
• Lumps or nodes felt on or inside of the breast

Symptoms more specific to invasive breast cancer are as follows:

• Irritated or itchy breasts
• Change in breast color
• Increase in breast size or shape (over a short period of time)
• Changes in touch (may feel hard, tender or warm)
• Peeling or flaking of the nipple skin
• A breast lump or thickening
• Redness or pitting of the breast skin (like the skin of an orange)

Causes 

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.

Inherited breast cancer

Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family.

A number of inherited mutated 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 significantly increase the risk of both breast and ovarian cancer.

If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific mutations in 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 and guide you on appropriate genetic testing.

Risk factors

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. 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:

• 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.

Prevention 

1. Keep Weight in Check

It’s easy to tune out because it gets said so often, but maintaining a healthy weight is an important goal for everyone. Being overweight can increase the risk of many different cancers, including breast cancer, especially after menopause.

2. Be Physically Active

Exercise is as close to a silver bullet for good health as there is, and women who are physically active for at least 30 minutes a day have a lower risk of breast cancer. Regular exercise is also one of the best ways to help keep weight in check.

3. Eat Your Fruits & Vegetables – and Avoid Too Much Alcohol

A healthy diet can help lower the risk of breast cancer.  Try to eat a lot of fruits and vegetables and keep alcohol at moderate levels or lower (a drink a day or under).  While moderate drinking can be good for the heart in older adults, even low levels of intake can increase the risk of breast cancer.  If you don’t drink, don’t feel you need to start. If you drink moderately, there’s likely no reason to stop. But, if you drink more, you should cut down or quit.

4. Don’t Smoke

Smokers and non-smokers alike know how unhealthy smoking is.  On top of lowering quality of life and increasing the risk of heart disease, stroke, and at least 15 cancers – including breast cancer – it also causes smelly breath, bad teeth, and wrinkles. Now that’s motivation to stay smoke-free or work to get smoke-free.

5. Breastfeed, If Possible

Breastfeeding for a total of one year or more (combined for all children) lowers the risk of breast cancer. It also has great health benefits for the child.

6. Avoid Birth Control Pills, Particularly After Age 35 or If You Smoke

Birth control pills have both risks and benefits. The younger a woman is, the lower the risks are. While women are taking birth control pills, they have a slightly increased risk of breast cancer. This risk goes away quickly, though, after stopping the pill. The risk of stroke and heart attack is also increased while on the pill – particularly if a woman smokes. However, long-term use can also have important benefits, like lowering the risk of ovarian cancer, colon cancer and uterine cancer – not to mention unwanted pregnancy – so there’s also a lot in its favor. If you’re very concerned about breast cancer, avoiding birth control pills is one option to lower risk.

7. Avoid Post-Menopausal Hormones

Post-menopausal hormones shouldn’t be taken long term to prevent chronic diseases, like osteoporosis and heart disease. Studies show they have a mixed effect on health, increasing the risk of some diseases and lowering the risk of others, and both estrogenonly hormones and estrogen-plus-progestin hormones increase the risk of breast cancer. If women do take post-menopausal hormones, it should be for the shortest time possible. The best person to talk to about the risks and benefits of post-menopausal hormones is your doctor.

8. Tamoxifen and Raloxifene for Women at High Risk

Although not commonly thought of as a “healthy

behavior,” taking the prescription drugs tamoxifen

and raloxifene can significantly lower the risk of

breast cancer in woman at high risk of the disease.

Approved by the FDA for breast cancer prevention,

these powerful drugs can have side effects, so

they aren’t right for everyone. If you think you’re

at high risk, talk to your doctor to see if tamoxifen or raloxifene may be right for you.

 Treatment

Which treatments are used for breast cancer?

There are several ways to treat breast cancer, depending on its type and stage.

Local treatments: Some treatments are called local therapies, meaning they treat the tumor without affecting the rest of the body. Types of local therapy used for breast cancer include:

• Surgery
• Radiation therapy

These treatments are more likely to be useful for earlier stage (less advanced) cancers, although they might also be used in some other situations.

Systemic treatments: Breast cancer can also be treated using drugs, which can be given by mouth or directly into the bloodstream. These are called systemic therapies because they can reach cancer cells anywhere in the body. Depending on the type of breast cancer, several different types of drugs might be used, including:

• Chemotherapy
• Hormone therapy
• Targeted therapy

Many women will get more than one type of treatment for their cancer.

How is breast cancer typically treated?

Most women with breast cancer will have some type of surgery to remove the tumor. Depending on the type of breast cancer and how advanced it is, you may need other types of treatment as well, either before or after surgery, or sometimes both. Surgery is less likely to be a main part of the treatment for more advanced breast cancers.

Typical treatment plans are based on the type of breast cancer, its stage, and any special situations:

• Invasive breast cancer (stages I-IV)
• Ductal carcinoma in situ (DCIS)
• Lobular carcinoma in situ (LCIS)
• Inflammatory breast cancer
• Breast cancer during pregnancy

Your treatment plan will depend on other factors as well, including your overall health and personal preferences.

Who treats breast cancer?

Doctors on your cancer treatment team might include:

• A breast surgeon: a doctor who uses surgery to treat breast cancer
• A radiation oncologist: a doctor who uses radiation to treat cancer
• A medical oncologist: a doctor who uses chemotherapy and other medicines to treat cancer

Many other specialists might be part of your treatment team as well, including physician assistants, nurse practitioners, nurses, psychologists, social workers, nutritionists, and other health professionals. See Health Professionals Associated With Cancer Care for more on this.

Making treatment decisions

It’s important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. It’s also very important to ask questions if there is anything you’re not sure about. See Questions to Ask Your Doctor About Breast Cancer for ideas.

Getting a second opinion

You may also want to get a second opinion. This can give you more information and help you feel more certain about the treatment plan you choose. If you aren’t sure where to go for a second opinion, ask your doctor for help.

Thinking about taking part in a clinical trial

Clinical trials are carefully controlled research studies that are done to get a closer look at promising new treatments or procedures. Clinical trials are one way to get state-of-the art cancer treatment. In some cases they may be the only way to get access to newer treatments. They are also the best way for doctors to learn better methods to treat cancer. Still, they are not right for everyone.

Considering complementary and alternative methods

You may hear about alternative or complementary methods to treat your cancer or relieve symptoms that your doctor hasn’t mentioned. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.

Complementary methods refer to treatments that are used along with your regular medical care. Alternative treatments are used instead of a doctor’s medical treatment. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be dangerous.

Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known (or not known) about the method, which can help you make an informed decision. See Complementary and Alternative Medicine to learn more.

Choosing to stop treatment or choosing no treatment at all

For some people, when treatments have been tried and are no longer controlling the cancer, it could be time to weigh the benefits and risks of continuing to try new treatments. Whether or not you continue treatment, there are things you can do to help maintain or improve your quality of life. Learn more in If Cancer Treatments Are No Longer Working.

Some people, especially if the cancer is advanced, might not want to be treated at all. There are many reasons people might choose to not get cancer treatment, but it’s important to talk to your doctors and make that decision. Remember that even if you choose not to treat the cancer, you can still get supportive care to help with pain or other symptoms. 

Help for getting through breast cancer treatment

Your cancer care team will be your first source of information and support, but there are many places where you can get more help when you need it. Hospital- or clinic-based support services are an important part of your care. These might include nurse or social work services, financial aid, nutritional advice, rehab, or spiritual help.