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Breast cancer

Cancer - breast; Carcinoma - ductal; Carcinoma - lobular; DCIS; LCIS; HER2-positive breast cancer; ER-positive breast cancer; Ductal carcinoma in situ; Lobular carcinoma in situ

Breast cancer is cancer that starts in the tissues of the breast. There are two 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.

Know Your Breast Cancer Risk

  • The older you get, the greater your breast cancer risk.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Most advanced cases of breast cancer are found in women over age 50. To help find breast cancer early, all women over 40 should talk with their doctor about what they should do for breast cancer screening. If you have certain risk factors, your doctor may recommend starting breast cancer screening earlier.
  • Men cannot get breast cancer.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Men can get breast cancer. But their risk is 100 times smaller than a woman's risk.
  • Your breast cancer risk is higher if you have a family history of:

     

    A. Ovarian cancer

     

    B. Colon cancer

     

    C. Uterine cancer

     

    D. Breast cancer

     

    E. All of the above

    Correct Answer
    The correct answer is all of the above. Tell your doctor if a close relative has had ovarian, colon, uterine, or breast cancer. You may benefit from enhanced breast cancer screening, such as magnetic resonance imaging (MRI).
  • Most women with breast cancer have a family history of the disease.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Only 20-30% of women with breast cancer have a family history of the disease. So it's important to be aware of changes in your breasts and get regular mammograms, even if you have no family history.
  • The BRCA gene plays a role in your lifetime breast cancer risk:

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Genes called BRCA1 and BRCA2 make proteins that protect against cancer. Having a mutation in one of these genes increases your risk of breast cancer by as much as 80%. If you are of Ashkenazi Jewish descent or have a family history of breast cancer, you may want to talk with your doctor about genetic testing.
  • Your breast cancer risk is higher if you got your first period after age 13.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is false. Being a late bloomer lowers your breast cancer risk. Your risk is higher if you got your first period before age 12. Going through menopause late (after age 55) also increases your risk.
  • Having your first child before age 30:

     

    A. Increases your breast cancer risk.

     

    B. Decreases your breast cancer risk.

     

    C. Has no impact on breast cancer risk.

    Correct Answer
    The correct answer is decreases your breast cancer risk. Women who have no children or have them after age 30 are more likely to get breast cancer. Becoming pregnant at an earlier age and being pregnant more than once can reduce your risk.
  • Hormone therapy for menopause can raise your breast cancer risk.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. Using hormones to treat the symptoms of menopause for a long period of time can raise your breast cancer risk a small amount. Most guidelines consider hormone therapy safe for breast cancer risk when taken for up to 5 years.
  • Alcohol may raise your breast cancer risk if you have more than:

     

    A. 1 to 2 drinks a week

     

    B. 1 to 2 drinks a day

     

    C. 3 to 4 drinks a day

    Correct Answer
    The correct answer is 1 to 2 drinks a day. You can lower your breast cancer risk by sticking to one drink a day or less. Women with a high risk of developing breast cancer should consider avoiding alcohol altogether.
  • Putting on too much weight can raise your breast cancer risk.

     

    A. True

     

    B. False

    Correct Answer
    The correct answer is true. There is a link between obesity and breast cancer, although doctors aren't sure why. One theory is that obese women produce more estrogen, which fuels the development of breast cancer. Consider it one more reason to strive for a healthy weight.
  • Which is most likely to raise your breast cancer risk?

     

    A. Underwire bras

     

    B. Antiperspirants

     

    C. Breast implants

     

    D. None of the above

    Correct Answer
    The correct answer is none of the above. Feel free to wear any style of bra you like without increasing your risk of breast cancer. Breast implants and daily antiperspirant use also have no effect.
  • Which could be a sign of breast cancer?

     

    A. Change in breast size or shape

     

    B. Redness or dimpling of the breast

     

    C. Fluid coming from the nipple

     

    D. A firm lump in the breast or armpit

     

    E. All of the above

    Correct Answer
    The correct answer is all of the above. See your doctor if you have any of these symptoms. But keep in mind that early breast cancer most often has no symptoms. That's why regular screenings are important.

Causes

Breast cancer risk factors are things that increase the chance that you could develop breast cancer:

  • Some risk factors you can control, such as drinking alcohol. Others, such as family history, you cannot control.
  • The more risk factors you have, the more your risk increases. But, it does not mean you will develop cancer. Many women who develop breast cancer do not have any known risk factors or a family history.
  • Understanding your risk factors can help you know how to prevent breast cancer.

Breast implants, using antiperspirants, and wearing underwire bras do not increase the risk for breast cancer. There is also no evidence of a direct link between breast cancer and pesticides.

Symptoms

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.

In men, breast cancer symptoms include breast lump and breast pain and tenderness.

Symptoms of advanced breast cancer may include:

  • Bone pain
  • Breast pain or discomfort
  • Skin ulcers
  • Swelling of the lymph nodes in the armpit (next to the breast with cancer)
  • Weight loss

Exams and Tests

The health care provider will ask about your symptoms and risk factors. Then the provider will perform a physical exam. The exam includes both breasts, armpits, and the neck and chest area.

Women are encouraged to perform breast self-exams each month. However, the importance of self-exams for detecting breast cancer is debatable.

Tests used to diagnose and monitor people with breast cancer may include:

  • Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram
  • Breast ultrasound to show whether the lump is solid or fluid-filled
  • Breast biopsy, using methods such as needle aspiration, ultrasound-guided, stereotactic, or open
  • CT scan to check if the cancer has spread outside the breast
  • Mammography to screen for breast cancer or help identify the breast lump
  • PET scan to check if the cancer has spread
  • Sentinel lymph node biopsy to check if the cancer has spread to the lymph nodes

If your doctor learns that you do have breast cancer, more tests will be done. This is called staging, which checks if the cancer has spread. Staging helps guide treatment and follow-up. It also gives you an idea of what to expect in the future.

Breast cancer stages range from 0 to IV. The higher the stage, the more advanced the cancer.

Treatment

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:

  • Hormone therapy.
  • 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.

Support Groups

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.

Outlook (Prognosis)

New, improved treatments are helping people with breast cancer live longer. Even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns, even after the entire tumor has been removed and nearby lymph nodes are found to be cancer-free.

Some women who have had breast cancer develop a new breast cancer that is not related to the original tumor.

How well you do after being treated for breast cancer depends on many things. The more advanced your cancer, the poorer the outcome. Other factors that determine the risk for recurrence and the likelihood of successful treatment include:

  • Location of the tumor and how far it has spread
  • Whether the tumor is hormone receptor-positive or -negative
  • Tumor markers
  • Gene expression
  • Tumor size and shape
  • Rate of cell division or how quickly the tumor is growing

After considering all of the above, your provider can discuss your risk of having a recurrence of breast cancer.

Possible Complications

You may experience side effects or complications from cancer treatment. These may include temporary pain or swelling of the breast and surrounding area. Ask your provider about the possible side effects from treatment.

When to Contact a Medical Professional

Contact your provider if:

  • You have a breast or armpit lump
  • You have nipple discharge

After being treated for breast cancer, call your provider if you develop symptoms such as:

  • Nipple discharge
  • Rash on the breast
  • New lumps in the breast
  • Swelling in the area
  • Pain, especially chest pain, abdominal pain, or bone pain

Prevention

Talk to your provider about how often you should have a mammogram or other tests to screen for breast cancer. Early breast cancers found by a mammogram have a good chance of being cured.

Tamoxifen is approved for breast cancer prevention in women age 35 and older who are at high risk. Discuss this with your provider.

Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy. This is surgery to remove the breasts before breast cancer is diagnosed. Possible candidates include:

  • Women who have already had one breast removed due to cancer
  • Women with a strong family history of breast cancer
  • Women with genes or genetic mutations that raise their risk for breast cancer (such as BRCA1 or BRCA2)

Many risk factors, such as your genes and family history, cannot be controlled. But making healthy lifestyle changes may reduce your overall chance of getting cancer. This includes:

  • Eating healthy foods
  • Maintaining a healthy weight
  • Limiting alcohol consumption to 1 drink per day

References

Makhoul I. Therapeutic strategies for breast cancer. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 24.

Moyer VA; U.S. Preventive Services Task Force. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(4):271-281. PMID: 24366376 www.ncbi.nlm.nih.gov/pubmed/24366376.

National Cancer Institute website. PDQ breast cancer treatment. Updated March 15, 2019. Accessed April 12, 2019. www.cancer.gov/types/breast/hp/breast-treatment-pdq.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): Breast cancer. Version 1.2019. Accessed April 12, 2019. www.nccn.org/professionals/physician_gls/pdf/breast.pdf.

Siu AL; U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279-296. PMID: 26757170 www.ncbi.nlm.nih.gov/pubmed/26757170.

  • Breast cancer

    Breast cancer

    Animation

  •  

    Breast cancer - Animation

    Of all the different types of cancers, breast cancer is one of the most talked about, and with good reason. One out of every eight women will develop breast cancer sometime in their life. That's why every woman should be thinking about how to protect herself from this disease. Breast cancer is cancer that forms in the breast. Usually, it begins in the tubes that transport milk from the breast to the nipple. If the cancer spreads to other parts of the breast or body, it's called invasive breast cancer. Some breast cancers are more aggressive, growing more quickly than others. Although women are 100 times more likely to develop breast cancer, men can also get the disease because they do have breast tissue. You're more likely to get breast cancer if you're over 50, you started your periods before age 12, or you have a close family member with the disease. Drinking more than a couple of glasses of alcohol a day and using hormone replacement therapy for several years also may increase your risk. The telltale sign of breast cancer is a lump in your breast or armpit. You may also notice a change in the shape, size, or texture of your breast, or have fluid coming from your nipple when you're not breastfeeding. If you notice any changes in your breasts, call your doctor. You'll probably need to have an imaging scan, such as a mammogram, MRI, or ultrasound. A piece of tissue may be removed from your breast, called a biopsy. With these tests, your doctor can tell whether you have breast cancer, and if so, determine whether or not it has spread. So, how do we treat breast cancer? That really depends on the type of cancer, and how quickly it's spreading. Your doctor may recommend that you have the cancer removed with surgery. Sometimes it's enough just to remove the lump. That's called a lumpectomy. In other cases, the doctor will need to remove the entire breast to get rid of all the cancer or prevent it from coming back. That's called a mastectomy. Other treatments for breast cancer include chemotherapy, medicines that kill cancer cells, and radiation therapy, which uses energy to destroy cancer. Women whose cancer is fueled by the hormone estrogen may receive hormone therapy to block the effects of estrogen on their cancer. Today's breast cancer treatments are better than ever. Many women who have breast cancer go on to live long, healthy lives. The outlook really depends on how fast the tumor is growing, and how far it has spread. That's why it's so important to report any changes in your breasts to your doctor as soon as you notice them. Women who are at an especially high risk for breast cancer because of their family history can talk to their doctor about taking medicine or even having surgery to reduce their risk.

  • Female Breast

    Female Breast - illustration

    The female breast is either of two mammary glands (organs of milk secretion) on the chest.

    Female Breast

    illustration

  • Needle biopsy of the breast

    Needle biopsy of the breast - illustration

    A needle biopsy is performed under local anesthesia. Simple aspirations are performed with a small gauge needle to attempt to draw fluid from lumps that are thought to be cysts. Fine needle biopsy uses a larger needle to make multiple passes through a lump, drawing out tissue and fluid. Withdrawn fluid and tissue is further evaluated to determine if there are cancerous cells present.

    Needle biopsy of the breast

    illustration

  • Open biopsy of the breast

    Open biopsy of the breast - illustration

    An open biopsy can be performed under local or general anesthesia and will leave a small scar. Prior to surgery, a radiologist often first marks the lump with a wire, making it easier for the surgeon to find.

    Open biopsy of the breast

    illustration

  • Breast self-exam

    Breast self-exam - illustration

    Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

    Breast self-exam

    illustration

  • Breast self-exam

    Breast self-exam - illustration

    Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

    Breast self-exam

    illustration

  • Breast self-exam

    Breast self-exam - illustration

    Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

    Breast self-exam

    illustration

  • Lumpectomy

    Lumpectomy - illustration

    Lumpectomy is a surgical procedure performed on a solid breast mass to determine if it is malignant. The suspicious lump and some surrounding tissue is excised and analyzed.

    Lumpectomy

    illustration

  • Breast lump removal - Series

    Breast lump removal - Series

    Presentation

  • Mastectomy - Series

    Mastectomy - Series

    Presentation

  • Sentinel node biopsy

    Sentinel node biopsy - illustration

    Sentinel node biopsy is a technique which helps determine if a cancer has spread (metastisized), or is contained locally. When a cancer has been detected, often the next step is to find the lymph node closest to the tumor site and retrieve it for analysis. The concept of the sentinel node, or the first node to drain the area of the cancer, allows a more accurate staging of the cancer, and leaves unaffected nodes behind to continue the important job of draining fluids. The procedure involves the injection of a dye (sometimes mildly radioactive) to pinpoint the lymph node which is closest to the cancer site. Sentinel node biopsy is used to stage many kinds of cancer, including lung and skin (melanoma).

    Sentinel node biopsy

    illustration

  • Breast cancer

    Animation

  •  

    Breast cancer - Animation

    Of all the different types of cancers, breast cancer is one of the most talked about, and with good reason. One out of every eight women will develop breast cancer sometime in their life. That's why every woman should be thinking about how to protect herself from this disease. Breast cancer is cancer that forms in the breast. Usually, it begins in the tubes that transport milk from the breast to the nipple. If the cancer spreads to other parts of the breast or body, it's called invasive breast cancer. Some breast cancers are more aggressive, growing more quickly than others. Although women are 100 times more likely to develop breast cancer, men can also get the disease because they do have breast tissue. You're more likely to get breast cancer if you're over 50, you started your periods before age 12, or you have a close family member with the disease. Drinking more than a couple of glasses of alcohol a day and using hormone replacement therapy for several years also may increase your risk. The telltale sign of breast cancer is a lump in your breast or armpit. You may also notice a change in the shape, size, or texture of your breast, or have fluid coming from your nipple when you're not breastfeeding. If you notice any changes in your breasts, call your doctor. You'll probably need to have an imaging scan, such as a mammogram, MRI, or ultrasound. A piece of tissue may be removed from your breast, called a biopsy. With these tests, your doctor can tell whether you have breast cancer, and if so, determine whether or not it has spread. So, how do we treat breast cancer? That really depends on the type of cancer, and how quickly it's spreading. Your doctor may recommend that you have the cancer removed with surgery. Sometimes it's enough just to remove the lump. That's called a lumpectomy. In other cases, the doctor will need to remove the entire breast to get rid of all the cancer or prevent it from coming back. That's called a mastectomy. Other treatments for breast cancer include chemotherapy, medicines that kill cancer cells, and radiation therapy, which uses energy to destroy cancer. Women whose cancer is fueled by the hormone estrogen may receive hormone therapy to block the effects of estrogen on their cancer. Today's breast cancer treatments are better than ever. Many women who have breast cancer go on to live long, healthy lives. The outlook really depends on how fast the tumor is growing, and how far it has spread. That's why it's so important to report any changes in your breasts to your doctor as soon as you notice them. Women who are at an especially high risk for breast cancer because of their family history can talk to their doctor about taking medicine or even having surgery to reduce their risk.

  • Female Breast

    Female Breast - illustration

    The female breast is either of two mammary glands (organs of milk secretion) on the chest.

    Female Breast

    illustration

  • Needle biopsy of the breast

    Needle biopsy of the breast - illustration

    A needle biopsy is performed under local anesthesia. Simple aspirations are performed with a small gauge needle to attempt to draw fluid from lumps that are thought to be cysts. Fine needle biopsy uses a larger needle to make multiple passes through a lump, drawing out tissue and fluid. Withdrawn fluid and tissue is further evaluated to determine if there are cancerous cells present.

    Needle biopsy of the breast

    illustration

  • Open biopsy of the breast

    Open biopsy of the breast - illustration

    An open biopsy can be performed under local or general anesthesia and will leave a small scar. Prior to surgery, a radiologist often first marks the lump with a wire, making it easier for the surgeon to find.

    Open biopsy of the breast

    illustration

  • Breast self-exam

    Breast self-exam - illustration

    Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

    Breast self-exam

    illustration

  • Breast self-exam

    Breast self-exam - illustration

    Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

    Breast self-exam

    illustration

  • Breast self-exam

    Breast self-exam - illustration

    Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

    Breast self-exam

    illustration

  • Lumpectomy

    Lumpectomy - illustration

    Lumpectomy is a surgical procedure performed on a solid breast mass to determine if it is malignant. The suspicious lump and some surrounding tissue is excised and analyzed.

    Lumpectomy

    illustration

  • Breast lump removal - Series

    Presentation

  • Mastectomy - Series

    Presentation

  • Sentinel node biopsy

    Sentinel node biopsy - illustration

    Sentinel node biopsy is a technique which helps determine if a cancer has spread (metastisized), or is contained locally. When a cancer has been detected, often the next step is to find the lymph node closest to the tumor site and retrieve it for analysis. The concept of the sentinel node, or the first node to drain the area of the cancer, allows a more accurate staging of the cancer, and leaves unaffected nodes behind to continue the important job of draining fluids. The procedure involves the injection of a dye (sometimes mildly radioactive) to pinpoint the lymph node which is closest to the cancer site. Sentinel node biopsy is used to stage many kinds of cancer, including lung and skin (melanoma).

    Sentinel node biopsy

    illustration

A Closer Look

 

Talking to your MD

 

Tests for Breast cancer

 

 

Review Date: 10/21/2017

Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Internal review and update on 01/19/2019 by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 04/12/2019.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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