Topic Overview
Is this topic for you?
This topic is for people who have been diagnosed with breast
cancer for the first time. If you are looking for information on breast cancer
that has spread or come back after treatment, see the topic
Breast Cancer, Metastatic or Recurrent.
What is breast cancer?
Breast
cancer 
occurs when abnormal cells grow out of control in one or both
breasts. They can invade nearby tissues and form a mass, called a malignant
tumor. The cancer cells can spread (metastasize) to the
lymph nodes and other parts of the body.
Breast cancer is many women’s worst fear. But experts have made
great progress in treating cancer. If it is found early, breast cancer can
often be cured, and it is not always necessary to remove the breast.
What causes breast cancer?
Doctors do not know exactly what causes breast cancer. But some
things are known to increase the chance that you will get it. These are called
risk factors. The main risk factors for breast cancer include:1
- Aging. Most breast cancer occurs in women older than 50, and
the risk is greatest in women older than 60.2
- Family history of breast cancer. You have a higher risk if a
close family member, especially your mother or sister, has had breast
cancer.
- Female hormones. Your risk is higher if you have used
hormone replacement therapy for more than 4 years,
started your period before age 12, or began
menopause after age 55.1
- Gene changes. Women who inherit certain
genes called BRCA1 and BRCA2 are more likely to have
breast cancer.
Some other things are known to increase your risk, such as being
overweight or inactive or drinking alcohol. But many women who have risk
factors do not get breast cancer. And many women who get breast cancer do not
have any known risk factors.
What are the symptoms?
Breast cancer often causes:
- A change in the way the breast feels. The most common symptom
is a painless lump or thickening in the breast or underarm.
- A change in the way the breast looks. The skin on the breast
may dimple or look like an orange peel. There may be a change in the size or
shape of the breast.
- A change in the nipple. It may turn in. The skin around it may
look scaly. Clear or bloody fluid may come out of the nipple.
See your doctor right away if you notice any of these
changes.
Many people think that only women get breast cancer. But about 1
in every 100 cases of breast cancer occurs in men. So any breast lump in an
adult male should be checked.3, 4
How is breast cancer diagnosed?
During a regular physical exam, your doctor can check your
breasts to look for lumps or changes. Depending on your age and risk factors,
the doctor may recommend that you have a
mammogram, which is an X-ray of the breast. A
mammogram can often find a lump that is too small to be felt. Sometimes a woman
finds a lump during a breast self-exam.
If you or your doctor finds a lump or other change, the doctor
will want to take a sample of the cells in your breast. This is called a
biopsy. Sometimes the doctor will put a needle into
the lump to take out some fluid or tissue (needle biopsy). In other cases, a
surgeon may take out the whole lump through a small cut in your breast. The
results of the biopsy help your doctor know if you have cancer and what type of
cancer it is.
You may have other tests to find out the stage of the cancer. The
stage is a way for doctors to describe how far the cancer has spread. Your
treatment choices will be based partly on the type and stage of the
cancer.
How is it treated?
Most people who have breast cancer have surgery to remove the
cancer. The surgeon may also take out some or all of the lymph nodes under your
arm to find out if the cancer has spread to this area. After surgery, you may
have
radiation therapy to destroy cancer cells. You may
also get
chemotherapy or
hormone therapy. These are powerful medicines that
travel through your body to kill cancer cells. You might have radiation,
chemotherapy, or hormone therapy before surgery to help shrink the cancer.
Depending on the stage of your cancer, you may have a choice
of:
- Surgery to remove just the cancer from the breast
(breast-conserving surgery, or lumpectomy). You will need to have several weeks
of radiation after surgery.
- Surgery to remove the breast (mastectomy). If you choose
mastectomy, you can have an operation to make a new breast. This is called
breast reconstruction. Sometimes radiation is not needed after a
mastectomy.
In years past, having breast cancer meant that you would have to
have your breast removed. In many cases, this is no longer true. Studies now
show that for early-stage breast cancer, breast-conserving surgery followed by
radiation therapy is as good as mastectomy.1
You and your doctor will decide which mix of treatments is right
for you based on many factors. These include facts about your cancer as well as
your family history, other health problems, and your feelings about keeping
your breast. Learn all you can about breast cancer and its treatment so you can
make the choices that are right for you.
Treatments for breast cancer can cause side effects. Your doctor
can let you know what problems to expect and help you find ways to manage
them.
Finding out that you have breast cancer can cause a range of
feelings, from sadness and fear to anger and despair. If your emotions are
making it hard for you to move ahead, be sure to tell your doctor. You may be
able to get counseling or find a support group. Talking with other people who
have faced the same choices can be a big help.
Can breast cancer be prevented?
You cannot control some things that put you at risk for breast
cancer, such as your sex and age. But you can change others. To stay as healthy
as you can:
- Eat a healthy diet with lots of fruits, vegetables, and whole
grains.
- Be active. Try to get 30 minutes of exercise at least 5 days a
week.
- Stay at a healthy weight. Getting regular exercise and watching
what you eat can help.
- If you drink alcohol, limit the amount. After menopause, even
having one drink a day or less may increase the risk for breast cancer.
Still, there is no sure way to prevent breast cancer, so it is
very important to have regular exams and mammograms. Discuss your risk factors
with your doctor to find out how often you should have a mammogram.
If you have a strong family history of breast cancer, ask your
doctor about genetic testing. A blood test can check for changes in the BRCA
genes that may increase your chance of getting breast cancer.
Frequently Asked Questions
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Learning about breast cancer:
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Being diagnosed:
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Getting treatment:
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Living with breast cancer:
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Health Tools
Health tools help you make wise health decisions or take action to improve your health.
Cause
The exact cause of
breast cancer is not known. Female
hormones and increasing age play a part. The chances
that you will develop breast cancer increase as you age. In the United States,
about 1 in every 8 women who live to be 80 will have been diagnosed with breast
cancer at some point in her life.5
Family history also plays a role in the development of breast
cancer. You are more likely to have breast cancer if your mother, father, or
sister has breast cancer. Also, women who carry certain
genes called BRCA1 and BRCA2 are more likely to have
breast cancer. If you have a strong family history of breast or ovarian cancer,
you may want to be tested for these genes. People who inherit specific changes,
or mutations, in one or both of these genes have a greater risk of developing
breast cancer.
Studies show that women who take
hormone replacement therapy with estrogen and
progesterone have an increased risk of breast cancer. Women who take estrogen
alone may not have an increased risk.1
Many people believe that only women have breast cancer. But,
although rare, about 1% of all
breast cancer occurs in men. Most men who have breast
cancer are older than 65, but it can appear in younger men. For this reason,
any breast lump in an adult man is considered abnormal.3, 4
Symptoms
The first sign of
breast cancer is often a painless lump. However, early
breast cancer is often found on a
mammogram before a lump can be felt.
Other symptoms of breast cancer may not appear until the cancer is
more advanced. These include:
- A thickening in the breast or armpit.
- A change in the size or shape of the breast.
- Changes in the skin of the breast, such as a dimple or skin that
looks like orange peel.
- A change in the nipple, such as scaling of the skin, a nipple
that turns in, or discharge or bleeding.
- A change in the color or feel of the skin around the nipple
(areola).
About 1% of
breast cancer occurs in men. Although most men
diagnosed with breast cancer are older than 65, the disease can appear in
younger men. For this reason, any breast lump in an adult male is considered
abnormal.3, 4
Inflammatory breast cancer is a specific type of breast cancer that
involves the skin of the breast. It occurs when breast cancer cells form
"nests" and block the lymphatic drainage from the skin of the breast. Symptoms
include redness, tenderness, and warmth. Thickening of the skin of the breast
(an orange-peel appearance), rapid breast enlargement, and ridging of the skin
of the breast may also be present. Some women may also develop a lump in the
breast.
What Happens
Breast cancer occurs when cells in the breast grow
abnormally. As the breast cancer grows, it can spread to nearby tissues and
lymph nodes. Advanced breast cancer can affect the bones, liver, and brain.
Fortunately, when found at an early stage, breast cancer is highly curable.
Your doctor will learn more about how your breast cancer may
behave when the cancer cells are examined under the microscope. This is called
classification. It tells your doctor how rapidly the
cancer cells are growing and dividing and where they may have started in the
breast tissue. Tests for hormone receptors and other markers are also done. All
of this information will help you and your doctor make decisions about
treatment.
The
stage indicates how far the cancer has spread within
the breast, to nearby tissues, and to other organs. Your doctor will determine
the stage of your breast cancer by gathering information from other tests, such
as axillary lymph node surgery, blood tests,
bone scans, and
X-rays. The stage of your cancer is one of the most
important pieces of information that will help guide your treatment options.
What Increases Your Risk
Although the exact cause of
breast cancer is not known, most experts agree that
there are several factors that increase your risk of breast cancer.
- Your risk of breast cancer increases as you age. Although it
does occur, breast cancer is rare in women younger than 35. Most breast cancers
are seen in women older than 50, and the risk is greatest in women older than
60.2
- Breast cancer occurs more frequently in white women than in
black, Hispanic, or Asian women. However, black women are more likely to get
breast cancer at a younger age and are also more likely to die of breast
cancer.6
- Although breast cancer can occur in men, most breast cancer is
found in women.
Conditions that increase the risk of developing breast cancer
include:
-
Personal history of breast cancer. Women
who have had breast cancer in one breast have an increased chance of having
another breast cancer. The breast cancer can come back in the same breast, in
the opposite breast, or in other areas of the body, such as the lungs, liver,
brain, or bones.
-
Family history. A woman's risk of breast
cancer increases if her mother, sister, daughter, or two or more other close
relatives, such as cousins, have a history of breast cancer, especially if they
were diagnosed with breast cancer before age 50. If you have a family history
of breast cancer, talk to your doctor about
how
it affects your risk.
- Women who inherit specific changes (genetic
mutations) in the
BRCA1 and BRCA2 genes are much more likely to have
breast cancer. They are also more likely to have
colon or
ovarian cancer. However, most women who have a family
history of breast cancer do not have changes in BRCA genes.
- Mutations in the BRCA1 and BRCA2 genes are more common in
certain ethnic groups, such as Ashkenazi Jews.7
- Genetic tests are available to determine whether you
have the genetic mutations long before any cancer appears. In families where
many women have had breast or ovarian cancer, genetic testing can show whether
a woman has specific genetic changes known to increase the risk of breast
cancer. Doctors may suggest ways to try to prevent or delay breast cancer or to
improve the detection of breast cancer in women who have the genetic mutations.
Should I
have a gene test for breast and ovarian cancer?
-
Breast changes. Women who have
atypical hyperplasia,
ductal carcinoma in situ (DCIS), or
lobular carcinoma in situ (LCIS) or who have had two
or more breast
biopsies for other noncancerous conditions are more
likely to have breast cancer.
Other factors that increase the risk of breast cancer
include:
-
Radiation therapy. Women whose breasts
were exposed to significant amounts of radiation at a young age, especially
those who were treated for
Hodgkin's lymphoma, have an increased risk for
developing breast cancer. Studies show that the younger a woman was when she
received her treatment, the higher her risk for developing breast cancer later
in life.6
-
Late childbearing. Women who had their
first child after the age of 30 have a greater chance of developing breast
cancer than women who had their children at a younger age.
-
Hormones.
- The use of
hormone replacement therapy for more than 4 years
causes an increased risk of developing breast cancer. This increased risk
occurs with current use of hormones and returns to normal over time after
hormones are stopped.1
- Beginning menstruation before age 12 and beginning
menopause later than age 55 increase a woman's risk of
breast cancer.
Diet and lifestyle are being studied as
risk factors.
- Postmenopausal weight gain, especially after natural menopause
or after age 60, may increase breast cancer risk.8
- Lifestyle choices, such as eating a high-fat diet or drinking
alcohol, may increase breast cancer risk.9
When To Call a Doctor
The most common symptom of
breast cancer is a painless lump. However, early
breast cancer is often found on a
mammogram before a lump can be felt. Other breast
problems that need to be evaluated by a doctor include:
- A thickening in the breast or armpit.
- A change in the size or shape of the breast.
- Changes in the skin of the breast, such as a dimple or skin that
looks like orange peel.
- A change in the nipple, such as scaling of the skin, a nipple
that turns in, or discharge or bleeding.
- A change in the color or feel of the skin around the
nipple.
Any breast lump in an adult male is considered abnormal and needs
to be evaluated by a doctor.3, 4
Watchful Waiting
If you notice any changes in your breasts, call your doctor to
arrange for an evaluation.
Who To See
Health professionals who can perform a breast exam include
a:
Mammograms are usually read by
radiologists.
You may see a general surgeon, a breast surgeon, or a radiologist
if further evaluation of a breast problem is needed.
Breast cancer is treated by surgeons,
medical oncologists, and
radiation oncologists.
To prepare for your appointment, see the topic Making the Most of Your Appointment
Exams and Tests
Screening tests
The earlier
breast cancer is found, the more easily and
successfully it can be treated. The most common methods for detecting breast
cancer include:
-
Mammogram. A mammogram is an X-ray of the breast that
can often find tumors that are too small for you or your doctor to feel. Your
doctor may suggest that you have a screening mammogram, especially if you have
any risk factors for breast cancer. The usefulness of
mammograms may vary depending on your age; this issue is still being debated by
experts.
-
Clinical breast exam (CBE). During a clinical breast
exam, your doctor will carefully feel your breasts and under your arms to check
for lumps or other unusual changes.
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Magnetic resonance imaging (MRI) of the breast. MRI is
a test that uses a magnetic field and pulses of radio wave energy to provide
pictures of the inside of the breast. It may be more sensitive than a mammogram
for finding breast cancer in women who have a strong family history of breast
cancer. However, MRI may find small irregularities that are not breast cancer.
This can lead to further testing. MRI is also more expensive and not as readily
available as mammography. For these reasons, most experts do not recommend the
use of MRI for screening for breast cancer.10, 11
The
type
and frequency of breast cancer screening that is best for you changes as
you age.
A
breast self-exam (BSE) is a simple procedure to help
you detect breast lumps. Medical experts disagree about the need for or the
effectiveness of regular breast self-exams. Studies have failed to show that
BSE alone reduces the number of deaths from breast cancer. Therefore, BSE
should not be used in place of clinical breast exam and mammography.
Diagnostic tests
If your doctor thinks that you have breast cancer, you may have
other tests, including:
- A
mammogram, if you have not already had one.
- An
ultrasound. You may have an ultrasound of the breast
if a lump is found during a clinical breast exam or on a mammogram. Breast
ultrasound is often used to distinguish between solid lumps and fluid-filled
(cystic) lumps.
- An
MRI of the breast, which is sometimes used to get more
information about a breast lump or to evaluate problems in women who have
breast implants. MRI of the breast may be most useful for women who test
positive for the BRCA1 or BRCA2 gene.11
- A
breast biopsy. If a lump is found in your breast, your
doctor will need to remove a small sample of the lump (biopsy) and look at it
under the microscope to see whether any cancer cells are present. A needle
biopsy is done by inserting a needle into the breast and removing some of the
tissue. Tests that may be performed on any breast cancer cells that are found
include:
- Estrogen and progesterone receptor status. The
hormones estrogen and progesterone stimulate the growth of normal breast cells
and some breast cancers. If your breast cancer tests positive for estrogen or
progesterone receptors, you may be able to stop the growth of the cancer cells
with
hormone therapy, such as an aromatase inhibitor or
tamoxifen. Estrogen or progesterone receptor-positive (ER/PR+) breast cancer
also sometimes responds better to chemotherapy, which may be a less aggressive
cancer than breast cancer that is not affected by estrogen or progesterone.
This is an important piece of information that will help you and your doctor
plan treatment.
- HER-2 receptor status. HER-2/neu is a protein that
regulates the growth of some breast cancer cells. About 25% of women with
breast cancer have too much (overexpression) of this growth-promoting protein.
- A lymph node biopsy to see whether breast cancer cells have
spread to the lymph nodes under the arm (axillary lymph nodes). The two methods
used are:
- Surgery to remove most of the lymph nodes in the underarm.
This is called an
axillary lymph node biopsy.
- Surgery to take a sample of just one or two of the lymph
nodes that are most likely to contain cancer cells. This is called a
sentinel node biopsy. Several studies have shown that
sentinel lymph node biopsy is as safe and accurate as axillary lymph node
dissection for staging breast cancer. Other studies are ongoing. Sentinel lymph
node biopsy is less likely than axillary lymph node dissection to impair arm
mobility, cause pain, or result in problems with swelling of the arm and
hand.12
- A
complete blood count (CBC) to provide important
information about the kinds and numbers of cells in your blood, including
red blood cells,
white blood cells, and
platelets.
- A
chemistry screen, to measure the levels of several
substances (such as those involved in liver functions) in your blood.
- A
chest X-ray, to provide a picture of organs and
structures within your chest, including your heart and lungs, your blood
vessels, and the thin sheet of muscle just below your lungs (diaphragm).
Tests if your doctor suspects that breast cancer has spread
If your doctor thinks that breast cancer may have spread to other
organs in your body (metastasized), he or she may order additional testing,
including a:
-
CT scan to provide detailed pictures of the organs and
structures in your chest, abdomen, and pelvis.
-
Bone scan to detect cancer that has spread
(metastasized) to the bones.
-
CT scan or
MRI of the brain to provide detailed pictures of your
brain and to check for cancer that may have spread to your brain.
What to think about
You have an increased risk for developing breast cancer again if
you have had breast cancer in one breast. Breast cancer can come back in the
same breast, on the chest wall, in your other breast, or somewhere else in your
body (metastatic or recurrent breast cancer).
To be sure that the cancer has not returned, you will have regular checkups
that include physical exams and mammograms.
If you find any unusual changes in the treated area or in your
other breast, or if you have swollen lymph glands or bone pain, call your
doctor to discuss these changes. For more information, see the topic
Breast Cancer, Metastatic or Recurrent.
Early Detection
Early detection is an important factor in the success of breast
cancer treatment. The earlier breast cancer is found, the more easily and
successfully it can be treated. The three methods used for early detection
are:
- Mammogram. A mammogram is an X-ray of the breast that can
often find tumors that are too small for you or your doctor to feel. Your
doctor may suggest that you have a screening mammogram if you are older than
40, especially if you have any
risk
factors for breast cancer. Screening mammograms are most useful after
age 50, but most experts recommend starting screening at age 40.
- Clinical breast exam (CBE). During a clinical breast exam, your
doctor will carefully feel your breasts and under your arms to check for lumps
or other unusual changes.
- Breast self-exam (BSE). A breast self-exam is a simple
procedure to help you detect breast lumps. BSE should not be used in place of
clinical breast exam and mammography. Although studies have not shown that BSE
reduces the number of deaths from breast cancer, it may help familiarize you
with your normal breast tissue. This will help you identify any new or unusual
changes in your breasts.11
The
type
and frequency of breast cancer screening that is best for you changes as
you age.
Treatment Overview
Breast cancer is usually treated with surgery,
medications, and radiation therapy. Because of improved screening methods,
diagnosis at an early stage, and improved treatment techniques, the number of
deaths from breast cancer has been steadily declining over the past few years.
Decisions about how to treat breast cancer are based on a combination of
factors that include specific information about the cancer, your preferences,
and your health.6
When making decisions about treatment for your breast cancer, you
and your doctor will consider:
- The size and location of your breast cancer (stage).
- How aggressive the breast cancer is.
- Whether your breast cancer has
receptors to the hormones estrogen and progesterone,
called estrogen receptor/progesterone receptor (ER/PR) status.
- Whether your breast cancer cells contain human epidermal growth
factor (HER-2/neu).
- Whether your breast cancer has spread to the
lymph
nodes in your underarm area (axilla).
You and your doctor will also consider your personal preferences
and health when developing a treatment plan for you. This will include:
- Your feelings about keeping your breast.
- Your personal and family history of breast cancer.
- Whether you have other serious health problems.
Most people with breast cancer have surgery to remove the cancer
from the breast. Some or all of the lymph nodes under the arm are also usually
removed to find out whether the breast cancer has spread to this area.
Even if all the cancer that can be seen at the time of your
surgery is removed, you may be treated with
radiation therapy.
Chemotherapy or
hormone therapy may also be recommended to make sure
that the breast cancer cells have been destroyed. You may also be given
chemotherapy or hormone therapy to shrink your breast cancer before surgery.
This is called
neoadjuvant therapy.
Initial treatment
Initial treatment of
breast cancer may include:
- Surgery to remove the cancer. This may be done by removing the
whole breast (mastectomy) or just the part of the breast that
contains the breast cancer (breast-conserving surgery, or
lumpectomy). Some of the lymph nodes under the arm
will also be removed using either
axillary lymph node dissection or
sentinel node biopsy.
-
Radiation therapy, which is the use of high-dose
X-rays to destroy cancer cells and shrink tumors.
-
Chemotherapy, which is the use of medicine to destroy
cancer cells. Chemotherapy is called a systemic treatment because the medicines
enter the bloodstream, travel through the body, and can destroy cancer cells
outside the target area.
-
Hormone therapy with an
aromatase inhibitor or
tamoxifen to change the way hormones in the body cause
cancer growth.
- Treatment with
Herceptin if your breast cancer tests positive for
human epidermal growth factor (HER-2/neu).
-
What
type of surgery should I have to treat early-stage breast cancer?
-
Should I
use chemotherapy for early-stage breast cancer?
The diagnosis of breast cancer is devastating and scary. Most
women will experience some denial, anger, and grief. There is no "normal" or
"right" way to react to a diagnosis of cancer. There are many steps you can
take to help with your
emotional reaction to breast cancer. You may find that
talking with family and friends helps you with your emotions. Some women may
find that spending time alone is what they need.
If your reaction interferes with your ability to make decisions
about your health, it is important to talk with your doctor. Your cancer
treatment center may offer psychological or financial services. You may also
contact your local chapter of the American Cancer Society to help you find a
support group. Talking with other people who may have had similar feelings can
be very helpful.13
One of the biggest concerns about treatment for cancer is
managing side effects, especially nausea and vomiting. Some women find that
home
treatment is enough to reduce mild nausea. Other women need to use
prescription medicines for nausea and vomiting.
Everyone is different. Work with your doctor to develop a plan that works for
you. For more ways to help manage side effects caused by breast cancer or
breast cancer treatment, see the Home Treatment section of this topic.
Ongoing treatment
After the initial treatment for
breast cancer, you may see your
family doctor,
general practitioner,
medical oncologist,
radiation oncologist, or
surgeon at regularly scheduled intervals, depending on
your individual situation. The length of time between visits will gradually
lengthen until at 5 years, if no new problems develop, you are seeing your
doctor once each year. As part of your follow-up, you may have:
- Physical exams. The frequency of your physical exams depends on
your general health and the type of breast cancer you have. In general, you
will see your doctor every 3 to 6 months for 3 years and then every 6 months
until 5 years have passed since your diagnosis of breast cancer. You may see
your doctor once a year at this point.
-
Mammograms to screen for breast cancer and investigate
lumps that can be felt during a breast exam.
After treatment for breast cancer, it is important to do monthly
breast self-exams. Regular self-exams may help you
detect signs of recurrence. Early signs of recurrence may appear in the
incision area itself, the opposite breast, under your arm, or in the area above
the collarbone.
If new problems develop, you may have additional tests, such as
blood tests,
bone scans,
chest X-rays,
CT scans, or
MRI tests.
If your breast cancer cells test
positive for estrogen and progesterone receptors
(ER/PR+), any remaining cancer cells may grow because of estrogen in
your body. Medicines such as
tamoxifen or other
hormone therapy may be a good treatment option because
they block the effect of these hormones on the cancer cells. Recent studies
have shown that an
aromatase inhibitor, such as exemestane (Aromasin),
works even better than tamoxifen in postmenopausal women who are also estrogen
receptor-positive (ER+).14, 15, 16 Talk with your doctor about the
risks and benefits of these medicines if your breast cancer is ER/PR+.
Treatment if the condition gets worse
For information about the treatment of metastatic or recurrent
breast cancer, see the topic
Breast Cancer, Metastatic or Recurrent.
What to Think About
Even if your doctor removes all the cancer that can be seen at
the time of the operation, you may need additional treatment. Radiation
therapy, chemotherapy, hormone therapy, or a combination of the three therapies
may be used after surgery to try to destroy any cancer cells that may be left
in your body. This is called adjuvant therapy and is used to reduce the chances
that your breast cancer will come back. Talk with your doctor about the risks
and benefits of each type of treatment. Your personal preferences and
considerations are important when choosing a treatment that is right for
you.
-
Should I
use chemotherapy for early-stage breast cancer?
You may also make decisions about using chemotherapy or hormone
therapy to shrink your breast cancer before surgery (neoadjuvant therapy). Talk with your doctor about the
risks and benefits of each type of treatment.
The likelihood that your breast cancer will return after
treatment depends on a number of factors, including the size and grade of your
breast cancer, whether you had breast cancer cells in your lymph nodes, how
many lymph nodes were involved with breast cancer, and how well you respond to
the treatment.
Prevention
Breast cancer is sometimes linked to known risk
factors, such as genetics. You can control many risk factors, but not all can
be avoided.7
Hormones. The following changes in hormone
stimulation affect the risk for developing breast cancer.
- Using
hormone replacement therapy increases the risk of
developing breast cancer. Hormones change the way cells within the breast grow
and divide. The risk is greatest when combinations of estrogen and progesterone
are used.1, 17
- Beginning menstruation before age 12 or beginning menopause after
age 55 may increase a woman's risk of breast cancer.
- Having a full-term pregnancy before age 30 may decrease the risk
for developing breast cancer.6
- Breast-feeding may decrease the risk of breast cancer. The
benefit appears to be greatest in women who have breast-fed for longer than 12
months or who breast-fed several children.18
Diet and lifestyle. Diet is being studied
as a risk factor for breast cancer.
- Weight gain, especially after
menopause or after age 60, may increase breast cancer
risk.8 Increased exercise can help you control your
weight and decrease your risk of breast cancer.19
- Studies show that in populations that have a high-fat diet, women
are more likely to die of breast cancer than women in populations that have a
low-fat diet. It is not known whether a diet that is low in fat will prevent
breast cancer.
- Studies suggest that alcohol intake causes a slight increase in
the risk of developing breast cancer. Current or recent heavy drinking appears
to have greater impact on breast cancer risk than drinking as a young adult.
Reducing the amount of alcohol that you drink at any age may help decrease your
risk of breast cancer.6, 7
Preventing recurrence
If your breast cancer cells test
positive for estrogen and progesterone receptors
(ER/PR+), any remaining cancer cells you have after treatment may grow
because of estrogen in your body.
Medicines such as
tamoxifen or other
hormone therapy may be a good treatment choice,
because they block the effect of these hormones on the cancer cells.
Recent studies have shown that an
aromatase inhibitor, such as exemestane (Aromasin),
works even better than tamoxifen in postmenopausal women who are also estrogen
receptor-positive (ER+).14, 15, 16 Talk with your doctor about the
risks and benefits of these medicines if your breast cancer is ER/PR+.
Women who have an increased risk for breast
cancer
A few women are more likely than average to get breast cancer
because of their family history. For these women, taking steps to prevent
breast cancer may be especially important.
A woman's risk of breast cancer increases if her mother, sister,
daughter, or two or more other close relatives, such as cousins, have a history
of breast cancer, especially if they were diagnosed with breast cancer before
age 50. If you have a family history of breast cancer, talk to your doctor
about how it affects your risk.
Some women inherit specific changes (genetic mutations) in the
BRCA1 and BRCA2 genes. These women are much more
likely to get breast cancer. They are also more likely to get
colon or
ovarian cancer
Genetic tests are available to determine whether you
have the genetic mutations long before any cancer appears. In families where
many women have had breast or ovarian cancer, genetic testing can show whether
a woman has specific genetic changes known to increase the risk of breast
cancer. Doctors may suggest ways to try to prevent or delay breast cancer or to
improve the detection of breast cancer in women who have the genetic mutations.
-
Should I
have a gene test for breast and ovarian cancer?
If you are at high risk for breast and/or ovarian cancer because of
your family history or because you have inherited a changed BRCA gene, talk to
your doctor about your options. They include:
- Extra checkups and testing.
- Medicine.
- Surgery.
-
What
should I do if I'm at high risk for breast cancer?
Tamoxifen.
Tamoxifen is a medicine that blocks the effect of
estrogen on breast cancer cells and normal breast
cells. Tamoxifen lowers the risk of breast cancer in women who have an
increased risk of this disease. But, this medicine may also increase the risk
of some other serious diseases, including
endometrial cancer,
stroke, and
blood clots in veins and
in the lungs. If you are concerned that you may have
an increased risk of developing breast cancer, talk with your doctor about
whether you should take tamoxifen to prevent breast cancer. It is important to
consider both the benefits and risks of treatment with tamoxifen.
Raloxifene. A large clinical trial called
STAR (the Study of Tamoxifen and Raloxifene) is being done in the United
States, Canada, and Puerto Rico. This study is looking at whether raloxifene,
which is used to treat osteoporosis, might lower the risk of breast cancer as
tamoxifen does, but with fewer side effects. Early results reported by the
National Cancer Institute suggest that, for postmenopausal women, raloxifene is
as effective as tamoxifen, with fewer side effects.20
Surgery to remove the breasts. Some women
with a strong family history of breast cancer may decide to have surgery to
remove their breasts. This called a preventive or prophylactic mastectomy. It
reduces the risk of developing breast cancer by approximately 90% in women who
have a strong family history of breast cancer. A cancer risk assessment,
genetic test, and psychological counseling are
recommended for women who may be considering this treatment option.21
Surgery to remove the ovaries.
Genetic mutations that increase the risk of breast
cancer also increase the risk of
ovarian cancer. Hormones produced by the ovaries
increase the risk of breast cancer. Removal of the ovaries (prophylactic
oophorectomy) reduces the risk of breast or ovarian cancer in women with a
genetic mutation. Such a decision is best made after a cancer risk assessment,
genetic test, and counseling.22
Home Treatment
During treatment for any stage of
breast cancer, you can use home treatment to help
manage the side effects that may occur with cancer treatment. Home treatment
may be all that is needed to manage the following common problems. Be sure to
follow any instructions and take any medicines your doctor has given you to
treat these symptoms. In general, healthy habits such as eating a balanced diet
and getting enough sleep and exercise may help control your symptoms.13
-
Nausea or vomiting. If you have problems
with nausea and vomiting while you are taking
chemotherapy or receiving
radiation therapy, let your doctor know. Medicines are
available to prevent and treat nausea and vomiting that may be caused by
treatment. It is important to let your doctor know if you have nausea or
vomiting in spite of the use of these medicines.
Home
treatment for nausea or vomiting includes watching for and treating
early signs of
dehydration, such as a dry mouth, sticky saliva, and
reduced urine output with dark yellow urine. For more information on how to
deal with these side effects, see:
Controlling nausea and vomiting caused by chemotherapy
-
Diarrhea. Some chemotherapy medicines can
cause diarrhea. Let your doctor know if you have diarrhea while you are on
treatment. (Radiation therapy to the chest should not cause diarrhea.)
Home
treatment for diarrhea includes resting your stomach and being alert for
signs of dehydration. Check with your doctor before using any nonprescription
medicines for your diarrhea.
-
Constipation. Pain medicines,
chemotherapy, and medicines used to treat nausea and vomiting related to
chemotherapy can sometimes cause constipation. Let your doctor know if you have
problems with constipation after surgery or while you are on chemotherapy.
(Radiation therapy to the chest should not cause constipation.)
Home
treatment for constipation includes gentle exercise along with getting
enough fluids and eating a diet that is high in fruits, vegetables, and fiber.
Check with your doctor before using a laxative for your constipation.
-
Fatigue. Breast cancer and treatment for
it can cause fatigue. Your emotional reaction to a diagnosis of breast cancer
and the stress related to treatment may make you feel tired. Some fatigue is
expected after surgery and during both chemotherapy and radiation therapy.
Fatigue is often worse at the end of treatment or just after treatment is
completed.
Home
treatment for fatigue includes making sure you get extra rest while you
are receiving chemotherapy or radiation therapy. Let your symptoms be your
guide. You may be able to stick to your usual routine and just get some extra
sleep. Let your doctor know if you are having trouble with fatigue.
Other issues that arise may include:
-
Hair
loss from chemotherapy. Hair loss can be emotionally distressing. Not
all chemotherapy medicines cause hair loss, and some people have only mild
thinning that is noticeable only to them. Talk to your doctor about whether
hair loss is an expected side effect with the medicines you will receive. Other
treatments for breast cancer, including hormone therapy (such as tamoxifen) and
radiation therapy, do not cause hair loss.
- Swelling of the arm (lymphedema). Normally,
lymph nodes filter fluid as it flows through them,
trapping bacteria, viruses, and other foreign substances, which are then
destroyed by white blood cells called lymphocytes. Without normal lymph
drainage, fluid can build up in the affected arm, and lymphedema can develop.
Because lymph nodes are removed from under the arm to help determine the stage
of your breast cancer, you can develop lymphedema. Medicines such as tamoxifen,
radiation therapy, and injury to the lymph nodes can
also cause lymphedema. Not everyone will have a problem with lymphedema. You
can reduce your risk of developing lymphedema by protecting your arm on the
side where you had surgery and letting your doctor know right away if you have
swelling or redness in that arm.
- How to
manage lymphedema
- Sleep problems. If you have trouble sleeping, you may find that
having a regular bedtime, getting some exercise during the day, avoiding naps,
and using other tips to
relieve sleep problems may help you sleep more easily.
Tell your doctor if you have persistent difficulty sleeping.
Discovering that you have breast cancer and then having treatment
for it can be very stressful.
- You may be able to reduce your stress by talking about your
feelings to others. Stress and tension affect our emotions. By discussing your
feelings with others, you may be able to understand and cope with them.
Learning relaxation techniques may also help you reduce your stress.
- Expressing yourself through writing, crafts, dance, or art is a
good tension reliever. Some dance, writing, or art groups that are specifically
for individuals diagnosed with cancer may be available.
- Join a support group. Talking about a problem with your spouse, a
good friend, or other people with similar problems is a valuable way to reduce
tension and stress. Social support is very important both during and after
treatment. Talk to your doctor or contact the American Cancer Society to find
out about support groups in your area. If you have access to the Internet, you
may also find an online support group.
- Your feelings about your body may change after a diagnosis of
breast cancer and the need for treatment.
Adapting to your body image changes may involve
talking openly about your concerns with your partner and discussing your
feelings with your doctor. Your doctor may also be able to refer you to
organizations that can offer additional support and information.
For more information about how to find support groups and
activities, see the Other Places to Get Help section of this topic.
Not all forms of cancer or cancer treatment cause pain. If pain
occurs, many treatments are available to relieve it. Be sure to follow any
instructions and take any medicines your doctor has given you to treat pain.
You may use
home
treatment for pain to improve your physical and mental well-being. Be
sure to discuss any home treatment you use for pain with your doctor.
Complementary therapies, such as
acupuncture,
herbs,
biofeedback,
meditation,
yoga, and
vitamins, are sometimes used along with medical
treatment. Some people feel that they benefit from some of these therapies.
Before you try a complementary therapy, talk with your doctor about the
possible value and potential side effects. Let your doctor know if you are
already using any such therapies.
Complementary therapies are not meant to take the place of standard
medical treatment, but they may improve your quality of life and help you deal
with the stress and side effects of cancer treatment.
Medications
Treatment before surgery for breast cancer (neoadjuvant treatment)
The use of chemotherapy or
hormone therapy to shrink
breast cancer before surgery (neoadjuvant
therapy) may be an option. This may allow you to save your breast if
your cancer is large. Talk with your doctor about the risks and benefits of
neoadjuvant therapy and whether it is an option for you.
Treatment after surgery for breast cancer (adjuvant treatment)
Depending on a variety of factors, such as tumor size, grade, and
lymph node involvement, you may have several treatment options. Chemotherapy,
hormone therapy, or a combination of the two therapies may be used after
surgery to try to destroy any cancer cells that may be left in your body. This
is called adjuvant therapy, and it is used to reduce the chances that your
breast cancer will come back. Talk with your doctor about the risks and
benefits of each type of treatment. Your personal preferences and
considerations are important when choosing a treatment that is right for
you.
-
Should I
use chemotherapy for early-stage breast cancer?
Medicines to treat breast cancer
A combination of medicines is generally used to treat breast
cancer. The most commonly used combinations are:
Hormone therapy with
tamoxifen or an
aromatase inhibitor may be an option if your breast
cancer is
estrogen receptor-positive (ER+). Aromatase inhibitors
are not effective for women who have not yet completed menopause.16, 14, 15
Herceptin may be used after surgery and chemotherapy
if your breast cancer tests positive for human epidermal growth factor (HER-2/neu).
Medicines to control nausea and vomiting
Treatment of breast cancer can
cause
nausea and vomiting. Your doctor will prescribe medicines to be taken
with your treatments and when you get home to help relieve any nausea that you
may have. Medicines to control and prevent nausea and vomiting may include:
-
Serotonin antagonists, such as ondansetron (Zofran),
granisetron (Kytril), or dolasetron (Anzemet). These medicines work by blocking
the effects of a chemical (serotonin) produced in the brain and in the stomach
that controls vomiting. They are often more effective when they are combined
with corticosteroids, such as dexamethasone (Hexadrol or
Decadron), which reduce swelling in the part of the brain that controls nausea.
-
Phenothiazines, such as Compazine and Phenergan. These
medicines stop nausea and vomiting by reducing the activity of the central
nervous system.
-
Metoclopramide (Reglan), which increases the movements
or contractions of the stomach and intestines. This decreases the amount of
time it takes for the stomach contents to move through the digestive tract.
-
Dimenhydrinate (Dramamine), which is often used to
treat motion sickness. It relieves nausea by blocking motion signals to the
brain.
What to Think About
The
side
effects of chemotherapy depend mainly on the medicines you receive. As
with other types of treatment, side effects vary from person to person.
Hormone blocking treatments, such as
tamoxifen or an
aromatase inhibitor, act on cells all over the body
but generally cause fewer side effects than chemotherapy. Treatment with
tamoxifen may slightly increase your chance of getting cancer of the lining of
the uterus (endometrial cancer). You will need a pelvic exam every
year. Tell your doctor as soon as possible if you have any vaginal bleeding,
other than normal menstrual bleeding. Other side effects from tamoxifen include
a slightly higher risk of blood clots in the legs or lungs and
cataracts in the eyes. Aromatase inhibitors increase
the risk of thinning bones (osteoporosis) and fractures.
Neither chemotherapy nor hormone therapy is likely to cure breast
cancer that has spread to another area of the body (metastasized), but either
therapy can reduce symptoms and may prolong life.
Surgery
Most people with
breast cancer have surgery to remove the cancer. Some
of the lymph nodes under the arm are also removed (axillary lymph node
dissection or
sentinel lymph node biopsy) and examined under the
microscope to see whether cancer cells are present.12
Even if your doctor removes all the cancer that can be seen at the
time of your surgery, you may be given treatment with radiation therapy,
chemotherapy, or hormone therapy after surgery (adjuvant therapy) to try to
destroy any cancer cells that may be left.
-
What
type of surgery should I have to treat early-stage breast cancer?
Surgery that allows you to keep your breast
Procedures include:
-
Breast-conserving surgery (lumpectomy) , which is the
removal of the lump in the breast along with some of the tissue around it. This
is sometimes called excisional biopsy or wide excision. It is followed by
radiation therapy to the remaining breast tissue.
-
Partial or segmental mastectomy, which
is the removal of the area of the breast that contains cancer as well as some
of the breast tissue around the tumor and the lining over the chest muscles
below the tumor. Some of the lymph nodes under the arm are also removed and
examined under the microscope (axillary lymph node dissection or sentinel lymph
node biopsy). In most cases, radiation therapy follows.
For
stages I, II, and IIIA breast cancer,
breast-conserving surgery (lumpectomy) with radiation therapy has
the same survival rate as
mastectomy and some of the same
side
effects.23
Removal of the breast (mastectomy)
Procedures include:
-
Total or simple mastectomy, which is
the removal of the whole breast.
-
Modified
radical mastectomy , which is the removal of the breast, some of the
lymph nodes under the arm, the lining over the chest muscles, and sometimes
part of the chest wall muscles.
-
Radical mastectomy (Halsted radical
mastectomy), which is the removal of the breast, chest muscles, and all of the
lymph nodes under the arm. For many years, this was the most common operation
for breast cancer. Radical mastectomy is rarely used now because it does not
improve survival or risk for recurrence when compared with other surgical
treatments.
Breast reconstruction
You may wish to talk to your doctor about
breast reconstruction before making a decision about
which type of surgery to have for breast cancer. If you choose to have a
mastectomy, a different surgeon with special expertise in reconstructive
surgery may perform this operation at the same time as the mastectomy or after
the mastectomy.
Your choice will depend on the size and shape of your breasts,
the size and shape of your body, how active you are, and other details, such as
whether you have chemotherapy or radiation. If you choose to have a mastectomy,
discuss reconstructive surgery and the use of a breast prosthesis with your
doctor. For more information about reconstructive surgery, see the topic
Cosmetic Surgery and Procedures.
Other Treatment
Radiation therapy
Radiation therapy is the use of high-energy X-rays to
destroy cancer cells and shrink tumors. It is used after breast-conserving
surgery and sometimes after mastectomy, depending on how advanced your
breast cancer is at the time of your surgery. You will
usually have radiation treatments every day, 5 days each week, for about 6
weeks. Radiation therapy also may be combined with other treatments, such as
chemotherapy or hormone therapy.
The most common way to give radiation therapy is called external
beam radiation. This method of treatment exposes the skin on the chest and
under the arm to a carefully focused beam of radiation. You will not be able to
see the radiation, but your skin will look slightly sunburned in the treated
area (called the radiation field). Small marks are tattooed onto the skin to
help identify the radiation area.
Sometimes tiny radioactive pellets are placed in or near the
tumor site. This is called brachytherapy, internal radiation, or interstitial
radiation. Giving an extra boost of radiation near where the tumor was removed
may help keep the breast cancer from returning to that area. Brachytherapy is
often used with external beam radiation.
Radiation therapy can cause many
side
effects. Fatigue is common, especially toward the end of your treatment
and for several weeks afterward. Balancing rest with activity is important; try
to match your activities to your energy levels. Be patient; it may take you a
few weeks to fully recover.
The skin on your breast and under your arm may become red, dry,
tender, and itchy. Toward the end of treatment, the skin may become moist and
"weepy." These effects are temporary, and the area will gradually heal when
treatment is completed. Expose the area to air as much as possible to help the
skin heal. Some types of clothing may rub the skin and cause irritation, so you
may want to wear loose-fitting cotton clothes. You may feel more comfortable if
you do not wear a bra until your skin heals.
Complementary therapy
Complementary therapies, such as
acupuncture,
herbs,
biofeedback,
meditation,
yoga, and
vitamins, are sometimes used along with medical
treatment. Some people feel that they benefit from some of these therapies.
Before you try a complementary therapy, talk to your doctor about
the possible value and potential side effects. Let your doctor know if you are
already using any such therapies.
Complementary therapies are not meant to take the place of
standard medical treatment, but they may improve your quality of life and help
you deal with the stress and side effects of cancer treatment.
Clinical trials
Other treatments for breast cancer are being tested in
clinical trials. Ongoing trials may include:
- "Partial breast" radiation procedures. Several methods are
being tested that use radioactive implants (brachytherapy) and concentrated
high-energy X-rays (limited field external radiation) for 1 to 5 days to
replace the standard 4 to 6 weeks of traditional radiation therapy. The goal of
these clinical trials is to keep the cancer from returning but reduce the side
effects as much as possible.
- The use of a medicine in a different way or the use of a new
medicine, such as a
biologic response modifier. A biological response
modifier uses materials produced by your body or made in a lab to boost,
direct, or restore your body's natural defenses against breast cancer.
Check with your doctor to see whether clinical trials are
available in your area and whether you might be eligible.
Other Places To Get Help
Organizations
| American Cancer Society |
| Phone: | 1-800-ACS-2345 (1-800-227-2345) |
| Web Address: | www.cancer.org |
| |
The American Cancer Society conducts educational programs and
offers many services to people with cancer and to their families. Staff at the
toll-free number have information about services and activities in local areas
and can provide referrals to local ACS divisions. |
|
| National Alliance of Breast Cancer Organizations
(NABCO) |
| Phone: | (212) 889-0606 |
| E-mail: | NABCOinfo@aol.com |
| Web Address: | http://www.nabco.org/ |
| |
Founded in 1986, the National Alliance of Breast Cancer
Organizations (NABCO) is the leading nonprofit information and education
resource on breast cancer. It is a network of nearly 400 member organizations
and agencies in the United States that provides education to the public, as
well as information, resources, and referrals to medical professionals and
their organizations. All NABCO services are offered free of charge. NABCO also
works on the community, state, and federal levels for regulatory change and
legislation to benefit those with cancer, survivors, and those at risk. |
|
| National Breast Cancer Coalition (NBCC)
|
| 1101 17th Street, N.W. |
|
Suite 1300 |
| Washington, DC 20036 |
| Phone: | 1-800-622-2838
(202) 296-7477 |
| Fax: | (202) 265-6854 |
| Web Address: | http://www.natlbcc.org |
| |
The National Breast Cancer Coalition (NBCC) is a grassroots
advocacy organization dedicated to fighting breast cancer. |
|
| National Cancer Institute (NCI) |
| NCI Publications Office |
| 6116 Executive Boulevard |
|
Suite 3036A |
| Bethesda, MD 20892-8322 |
| Phone: | 1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday |
| TDD: | 1-800-332-8615 |
| E-mail: | cancergovstaff@mail.nih.gov |
| Web Address: | http://www.cancer.gov (or
https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help
online) |
| |
The National Cancer Institute (NCI) is a U.S. government agency
that provides up-to-date information about the prevention, detection, and
treatment of cancer. NCI also offers supportive care to people with cancer and
to their families. NCI information is also available to doctors, nurses, and
other health professionals. NCI provides the latest information about clinical
trials. The Cancer Information Service, a service of NCI, has trained staff
members available to answer questions and send free publications.
Spanish-speaking staff members are also available. |
|
| Y-ME National Breast Cancer Organization,
Inc. |
| 212 West Van Buren Street |
|
Suite 1000 |
| Chicago, IL 60607-3903 |
| Phone: | 1-800-221-2141 (English, with interpreters in over 100 languages)
1-800-986-9505 (Spanish) |
| Fax: | (312) 986-8338 |
| Web Address: | http://www.y-me.org |
| |
Y-ME National Breast Cancer Organization's mission is to ensure—through information, empowerment, and peer support—that no one faces breast cancer alone. Y-ME has a 24-hour hotline staffed entirely by trained breast cancer survivors. Additionally, affiliates throughout the nation provide services such as support groups, breast health awareness workshops, wigs and breast prostheses for women with limited resources, and advocacy on breast cancer related policies in their respective communities. For breast cancer support or information including publications and newsletters, visit www.y-me.org. |
|
Related Information
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Credits
| Author | Sydney Youngerman-Cole, RN, BSN, RNC |
| Editor | Susan Van Houten, RN, BSN, MBA |
| Associate Editor | Terrina Vail |
| Primary Medical Reviewer | Joy Melnikow, MD, MPH
- Family Medicine |
| Specialist Medical Reviewer | Douglas A. Stewart, MD
- Medical Oncology |
| Last Updated | November 17, 2005 |
