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Alternative names Return to top
Cancer - breastDefinition Return to top
Breast cancer is a malignant growth that begins in the tissues of the breast. Over the course of a lifetime, one in eight women will be diagnosed with breast cancer.Causes, incidence, and risk factors Return to top
There are several different types of breast cancer. Ductal carcinoma begins in the cells lining the ducts that bring milk to the nipple and accounts for more than 75% of breast cancers.
Lobular carcinoma begins in the milk-secreting glands of the breast but is otherwise fairly similar in its behavior to ductal carcinoma. Other varieties of breast cancer can arise from the skin, fat, connective tissues, and other cells present in the breast.
Risk factors for breast cancer include:
The Gail Model is a simple breast cancer risk assessment tool that is available online and takes into account the most important risk factors.
Symptoms Return to top
Signs and tests Return to top
Any worrisome breast changes should be confirmed and investigated by a medical professional. After getting as much information as possible about the symptom and any risk factors, the physician performs a physical examination including both breasts, armpits, and the area of the neck and chest. Additional tests and treatment may then be recommended:If breast cancer is diagnosed, additional testing is performed, including chest X-ray and blood tests. Surgery, radiation, chemotherapy, or a combination of these may then be recommended, not only for treatment, but also to help determine the stage of disease. Staging is important to help guide future treatment and follow-up, and to give some idea of what to expect in the future.
Stages of Breast Cancer (from the American Joint Committee on Cancer):
Many additional factors besides staging can influence the recommended treatment and the likely outcome. These can include the precise cell type and appearance of the cancer, whether the cancer cells respond to hormones, and the presence or absence of genes known to cause breast cancer.
Treatment Return to top
The choice of initial treatment is based on many factors. For stage I, II, or III cancers, the main considerations are to adequately treat the cancer and prevent a recurrence either at the place of the original tumor (local) or elsewhere in the body (metastatic). For stage IV cancer, the goal is to improve symptoms and prolong survival. However, in most cases, stage IV breast cancer cannot be cured.Most women receive a combination of these treatments. For stage 0 breast cancer, mastectomy or lumpectomy plus radiation is the standard treatment. However, there is some controversy on how best to treat DCIS. For stage 1 and 2 disease, lumpectomy (plus radiation) or mastectomy with at least "sentinel node" lymph node removal is standard treatment.
Chemotherapy, hormone therapy, or both may be recommended following surgery. The presence of breast cancer in the axillary lymph nodes is very useful for staging and the appropriate follow-up treatment.
Stage III patients are ususally treated with surgery followed by chemotherapy with or without hormonal therapy. Radiation therapy may also be considered under special circumstances.
Stage IV breast cancer may be treated with surgery, radiation, chemotherapy, hormonal therapy, or a combination of these (depending on the situation).
Support Groups Return to top
The stress of breast cancer can often be helped by joining a support group where members share common experiences and problems. See cancer support group.Expectations (prognosis) Return to top
The clinical stage of breast cancer is the best indicator for prognosis (probable outcome), in addition to some other factors. Five-year survival rates for individuals with breast cancer who receive appropriate treatment are approximately:The axillary (armpit) lymph nodes are the main passageway that breast cancer cells must use to reach the rest of the body. Their involvement at any time strongly affects the prognosis.
Chemotherapy and hormone therapy can improve prognosis in all patients and increase the likelihood of cure in patients with stage I, II, and III disease.
Complications Return to top
Even with aggressive and appropriate treatments, breast cancer often spreads (metastasizes) to other parts of the body such as the lungs, liver and bones. The recurrence rate is about 5% after total mastectomy and removing armpit lymph nodes when the nodes are found not to have cancer. The recurrence rate is 25% in those with similar treatment when the nodes have cancer.Calling your health care provider Return to top
See your health care provider if you are a man or a woman who notices any of the symptoms which could indicate breast cancer or:Prevention Return to top
Many risk factors cannot be controlled. Some experts in the field of diet and cancer agree that changes in diet and lifestyle may reduce the incidence of cancer generally.
Efforts have focused on early detection since breast cancer is more easily treated and often curable if it is found early. Breast self-examination (BSE), clinical breast examination (CBE) by a medical professional, and screening mammography are the three tools of early detection.
Most recommend breast self-examinations (BSE) once a month -- the week following your menstrual period if you are age 20 or older.
Regular clinical breast examinations (CBE) by a health professional are recommended for women between ages 20 and 39, at least every 3 years. After age 40, women should have a CBE by a health professional every year.
Mammography is the most effective way of detecting breast cancer early. The American Cancer Society recommends mammogram screening every year for all women age 40 and older.
The National Cancer Institute (NCI) recommends mammogram screening every 1-2 years for women age 40 and older. For those with risk factors, including a close family member with the disease, annual mammograms should begin 10 years earlier than the age at which the relative was diagnosed.
Questions have been raised about the benefit of screening mammography. Some respected medical organizations such as PDQ, part of the NCI, no longer recommend screening mammography. This is a topic fraught with controversy, and a woman needs to have an informed and balanced discussion with her doctor, along with doing additional reading and researching on her own, to determine if mammography is right for her.
Two drugs are being studied currently that have been shown to reduce the risk of breast cancer: tamoxifen (Nolvadex ®) and raloxifene (Evista ®). Both are anti-estrogens in breast tissue.
Tamoxifen is already widely used to prevent recurrence in women who have been treated for breast cancer. Many other newer hormonal agents, such as aromatase inhibitors and others, are being used after Tamoxifen is stopped, or even in place of Tamoxifen. For some women at very high risk of breast cancer, preventive use of these drugs may be appropriate. This should be discussed with a qualified physician.
Preventive Mastectomy, which is the surgical removal of one or both breasts, is an option to prevent breast cancer for women who are at very high risk for breast cancer.
Possible candidates for this procedure are women who have already had one breast removed due to cancer, women with a strong family history of breast cancer and those who have a mutation in genes p53, BRCA1, or have gene BRCA2.
For additional information on breast cancer, see the website of the American Cancer Society.
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Page last updated: 28 October 2004 |