About Breast Cancer
Breast Cancer Update
Breast cancer is a complicated disease, but doctors are better at treating it than ever before. We now know that breast cancer is not just one disease, but a group of diseases. Each kind of breast cancer has a tumor with different characteristics that make it act in a certain way. Some types of breast cancer can be treated with targeted treatments that often have fewer side effects.
It is important for all women to learn more about breast cancer and take control of their health. You may want to take steps to understand your own risk for breast cancer and reduce it how you can. You can also ask your doctors to talk with you about getting screened, and why or why not it makes sense for you.
Common Questions About Breast Cancer
1. What is breast cancer?
Cancer happens when abnormal cells start to grow out of control. Breast cancer begins when these abnormal cells group into a tumor in the milk ducts or lobules of the breast. If the tumor cells stay in the ducts or lobules, they are called “in situ.” If they grow into the normal breast tissue, they are called “invasive.”
Doctors believe that there will be 245,000 cases of invasive breast cancer and more than 61,000 cases of breast cancer in situ in the U.S. in 2016. An American woman has a 12% chance of getting breast cancer if she lives to 80 years old.
Cancer cells become “metastatic” if they spread to another part of the body, like the bones, liver, brain, or lungs. When these cells spread, they become more dangerous because they are hard to stop.
What factors affect my risk of getting breast cancer?
Please know: having any or all of these risk factors does NOT mean you will get breast cancer. 75% of women who have breast cancer did not have any risk factors. But some factors may increase your risk of breast cancer.
-Sex: Females have a higher risk for breast cancer than males do.
-Age: Older women have a higher risk for breast cancer than younger women do.
-Genes: If women in your family have had breast cancer, you might have a higher risk. Sometimes, breast cancer is linked to a change or “mutation” in genes we inherit from our families, especially the BRCA1, BRCA2, and PALB2 genes. Mutations in these genes can also increase a woman’s risk of ovarian cancer or a man’s risk for prostate cancer. You can ask a doctor about getting tested for mutations in these genes.
-Personal cancer history: If you have had breast cancer before, you have a higher risk. If you have had a tumor in situ before, you also have a higher risk.
-Hormones: If you got your period early or had menopause late, you have a higher risk. If you used hormone replacement therapy after menopause, you have a higher risk.
-Chest radiation: If you had radiation on your chest for another medical condition, you have a higher risk.
-Ethnicity: White women have a higher risk of breast cancer than black women. But black women are more likely to die of breast cancer, because they may not receive treatment until later stages of the disease, or they may have a tougher form of it. Asian, Native-American, and Latina women are less likely to get the disease and to die of it.
-Weight: If you are overweight or obese, you have a higher risk.
-Exercise: If you are rarely active, you have a higher risk.
-Alcohol: If you drink a lot of alcohol, you have a higher risk.
-Child-bearing: If you have never given birth, or if you gave birth after age 35, you have a higher risk.
-Breastfeeding: If you have never breastfed, you have a higher risk.
Experts also believe there are links between toxins in a person’s environment and his/her risk of cancer, and between a person’s lifestyle and his/her risk. They also think that women who have had breast cancer can lower their risk of getting it again (“recurrence”) by changing their lifestyle.
3. How can I lower my risk of breast cancer?
Some risk factors are under your control! You may be able to lower your risk by doing these things:
-Limit your alcohol use. Try to have fewer than 3-4 drinks each week, no matter if it is beer, wine, or liquor. Try to measure out your drinks; it is easy to “free-pour” more than one serving into a drink.
-Exercise moderately for 3-4 hours each week. Moderate exercise is anything that gets your heart rate up to 50 to 60 percent higher than its resting rate.
-Avoid hormone replacement therapy after menopause.
-Keep a healthy body weight.
-If you are pregnant and able, choose to breastfeed.
4. How can I tell if there is a change in my breasts?
All women should know the look and feel of their bodies, including their breasts. They should also have their doctor do a clinical exam of their breasts on a regular basis.
The best way to screen for breast cancer is through a mammogram. Mammograms can help find tumors in women who don’t show any symptoms of cancer. But some doctors disagree about screening rules. You can ask your doctor if a mammogram is right for you at your age and risk level, and how often you should have them.
There are special screening rules for people who are at a high risk for breast cancer or who have found a lump or other symptom in their breasts. Mammograms can help diagnose the issue, but a doctor may also suggest other tests, like a sonogram or an MRI. Women with dense breast tissue may be told to get digital mammograms or 3-D tomosynthesis. These are screening tools that are better able to detect cancer in women with dense breasts.
5. What are the symptoms of breast cancer?
-A lump in your breast
-Swelling under your arm
-Pain in your breast or nipple
-New dimples in the skin on your breast
-The skin on your breast becoming swollen, red, or hot
-Sudden changes in your breast size
-Changes in shape in only one of your breasts
-Having your nipple newly turn inward (invert)
-Non-milky liquid coming from your nipple
Not all breast cancer shows itself as a lump. Having any of these symptoms does not mean you have breast cancer. Most breast cancer is found in women who did not have symptoms. But if you do show a symptom, talk to your doctor as soon as you can.
6. How does a doctor diagnose breast cancer?
Diagnosing breast cancer is a process. Most women who are diagnosed with breast cancer do not have any symptoms; their cancer is found during routine screening, like a mammogram. If you do have symptoms, or if your mammogram shows something in your breast, tell your doctor as soon as you can. Your doctor should do a physical exam, find out your medical history, and tell you if you need further screening.
When a mammogram shows something like a lump, a doctor will then take a biopsy. A biopsy removes a few sample cells from the suspicious area on your breast. A kind of doctor called a pathologist looks at the biopsied cells under a microscope and decides if the cells are cancer or not. 80% of the time, the cells are not cancer—they are “benign.”
Finding breast cancer when it is still small can give you more treatment options and making you more likely to respond well to them. If the cells are “malignant,” or cancerous, your doctor might send the tissue sample out for more tests to learn what kinds of treatment your tumor cells might respond to.
Some breast cancer cells depend on hormones like estrogen or progesterone to grow. All cells also have proteins that can be switched on or off; in some breast cancer cells, the HER2 protein is switched on, encouraging the tumor to keep growing. There are treatments specifically for these cells.
Your doctor might also want to remove more tumor tissue and send it for an OnctotypeTM or MammaprintTM test. These tests help a doctor understand the genetic makeup of the cancer cells so she or he can predict how the cells will behave.
7. How is breast cancer treated?
Breast cancer treatment takes two forms: local, and systemic.
Local treatment means surgery and/or radiation. You can have a lumpectomy, which removes only the tumor and leaves the healthy part of the breast, or a mastectomy, which removes the whole breast.
Your doctor may also remove your lymph nodes, which are under the arm, to make sure there is no cancer there. But removing the lymph nodes can cause your arms to swell, a painful condition called lymphedema. A sentinel node biopsy can tell your doctor if your lymph nodes contain cancer, without this risk.
If you have a mastectomy, you might also decide to have your breast(s) reconstructed. A nipple-sparing mastectomy or skin-sparing mastectomy can make reconstruction easier. There are also several types of reconstruction you can choose from. One type uses your own tissue (flaps) to reconstruct; another involves a saline or silicone implant. Talk to your doctor to decide which of these options, if any, are right for you.
If you have a lumpectomy, you will usually need radiation too. Radiation lowers your risk of getting cancer a second time if you have an invasive breast cancer. A doctor may suggest radiation in other situations as well: if your lymph nodes contain cancer, if your tumor is larger than 5 cm, or if there are some cancer cells around the edge of where the tumor was removed.
Systemic treatments travel through the bloodstream to attack any cancer cells that spread beyond the breast.
Chemotherapy uses drugs to kill cancer cells. Chemo can cause intense nausea, so patients also take anti-nausea medicine with their drugs.
Women whose breast cancer tumors need estrogen to grow take hormone (endocrine) therapy. This treatment blocks estrogen from feeding the tumor’s growth. Hormone therapy usually lasts for 5 years, but if the woman has a high chance of getting cancer again, she may take it for 10.
Targeted therapy attacks only specific types of cancer cells so that normal cells stay healthy. For example, one targeted therapy attaches itself to the HER2 protein to switch it off; this shuts down the tumor’s urge to grow.
8. How do I know how often to get screened for breast cancer?
Talk to your doctor about your personal health history, family history, and the benefits and drawbacks of screening. Together, you should make a screening plan that is best for you.
9. I have a close relative who had breast cancer. Does this mean I will get it too?
No. 75% of women who get breast cancer did not have any risk factors. Only 5-10% of breast cancer is related to inherited mutations in a person’s genes. If you have a close relative who had breast cancer, she or he should try to get tested for a mutation. If your relative does not a mutation, then your own risk level may be normal, and you may not want any testing. But if you are worried that you inherited a gene mutation, you can talk a genetic counselor. She or he can help you understand your family history on both your mother’s and father’s sides.