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 2 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.
Causes
Breast cancer risk factors are things that increase the chance that you could develop breast cancer:
Breast cancer risk factors
Carcinoma-lobular - risk; DCIS; LCIS - risk; Ductal carcinoma in situ - risk; Lobular carcinoma in situ - risk; Breast cancer - prevention
- 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.
Breast lump
A breast lump is swelling, a growth, or a lump in the breast. Breast lumps in both men and women raise concern for breast cancer, even though most l...
- 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 MRI
A breast MRI (magnetic resonance imaging) scan is an imaging test that uses powerful magnets and radio waves to create pictures of the breast and sur...
-
Breast ultrasound
to show whether the lump is solid or fluid-filled
Breast ultrasound
Breast ultrasound is a test that uses sound waves to examine the breasts.
-
Breast biopsy, using methods such as needle aspiration,
ultrasound-guided
,
stereotactic
, or open
Ultrasound-guided
A breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders. There are several types of breast biopsi...
Stereotactic
A breast biopsy is the removal of breast tissue to examine it for signs of breast cancer or other disorders. There are several types of breast biops...
-
CT scan
to check if the cancer has spread outside the breast
CT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
-
Mammography
to screen for breast cancer or help identify the breast lump
Mammography
A mammogram is an x-ray picture of the breasts. It is used to find breast tumors and cancer.
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PET scan
to check if the cancer has spread
PET scan
A breast positron emission tomography (PET) scan is an imaging test that uses a radioactive substance (called a tracer) to look for breast cancer. T...
-
Sentinel
lymph node biopsy
to check if the cancer has spread to the lymph nodes
Lymph node biopsy
A lymph node biopsy is the removal of lymph node tissue for examination under a microscope. The lymph nodes are small glands that make white blood ce...
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
.
Hormone therapy
Hormonal therapy - breast cancer; Hormone treatment - breast cancer; Endocrine therapy; Hormone-sensitive cancers-therapy; ER positive-therapy; Aroma...
-
Chemotherapy
, which uses medicines to kill cancer cells.
Chemotherapy
The term chemotherapy is used to describe cancer-killing drugs. Chemotherapy may be used to:Cure the cancerShrink the cancerPrevent the cancer from ...
-
Radiation therapy
, which is used to destroy cancerous tissue.
Radiation therapy
Radiation therapy uses high-powered x-rays, particles, or radioactive seeds to kill cancer cells.
-
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.
Lumpectomy
Breast lump removal is surgery to remove a lump that may be breast cancer. Tissue around the lump is also removed. This surgery is called a lumpect...
Mastectomy
A mastectomy is surgery to remove the entire breast. Most of the time, some of the skin and the nipple are also removed. The surgery is most often ...
- 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.
Cancer support group
The following organizations are good resources for information on cancer:American Cancer Society -- www. cancer. orgCancerCare -- www. cancercare. or...
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.
Mammogram
A mammogram is an x-ray picture of the breasts. It is used to find breast tumors and cancer.
Tests to screen for breast cancer
Mammogram - breast cancer screening; Breast exam - breast cancer screening; MRI - breast cancer screening
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 (women at high risk for breast cancer should not drink alcohol at all)
References
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;160:271-281. PMID: 24366376 www.ncbi.nlm.nih.gov/pubmed/24366376 .
National Cancer Institute. PDQ breast cancer treatment. Bethesda, MD: National Cancer Institute. Date last modified: December 31, 2015. www.cancer.gov/types/breast/hp/breast-treatment-pdq . Accessed: January 18, 2016.
National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): Breast cancer. Version 1.2016. www.nccn.org/professionals/physician_gls/pdf/breast.pdf . Accessed: January 18, 2016.
Siu AL, on behalf of the U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med . [Epub ahead of print 12 January 2016] doi:10.7326/M15-2886. PMID: 26757170 www.ncbi.nlm.nih.gov/pubmed/26757170 .
Wolff AC, Comchek SM, Davidson NE, et al. Cancer of the breast. In: Niederhuber JE, Armitage JO, Doroshow JH, et al, eds. Abeloff's Clinical Oncology . 5th ed. Philadelphia, PA: Elsevier; 2014:chap 91.
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Breast cancer
Animation
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Female Breast - illustration
The female breast is either of two mammary glands (organs of milk secretion) on the chest.
Female Breast
illustration
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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
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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
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Breast self-exam - illustration
Monthly breast self-exams should always include: 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 - illustration
Monthly breast self-exams should always include: 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 - illustration
Monthly breast self-exams should always include: 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 - 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
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Breast lump removal - Series
Presentation
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Mastectomy - Series
Presentation
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Sentinel node biopsy - illustration
Sentinel node biopsy is a technique which helps determine if a cancer has spread (metastasized), 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
-
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 - 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 - 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 - illustration
Monthly breast self-exams should always include: 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 - illustration
Monthly breast self-exams should always include: 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 - illustration
Monthly breast self-exams should always include: 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 - 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 - illustration
Sentinel node biopsy is a technique which helps determine if a cancer has spread (metastasized), 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
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Breast cancer
(Alt. Medicine)
Review Date: 12/4/2015
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.