This booklet discusses screening and early detection, symptoms, diagnosis, treatment, and rehabilitation. It also has information to help patients cope with breast cancer.
Words that may be new to readers are printed in italics. Definitions of these and other terms related to breast cancer are listed in the Glossary section. For some words, a "sounds-like" spelling is also given.
| Male Breast Cancer
Breast cancer affects more than 1,000 men in this country each year. Although this booklet was written mainly for women, much of the information on symptoms, diagnosis, treatment, and living with the disease applies to men as well. (The Early Detection section does not apply to men. Experts do not recommend routine screening for men.) |
Cancer research has led to real progress against breast cancer--better survival and improved quality of life. And knowledge about breast cancer is increasing. The Cancer Information Service and other NCI resources listed in the National Cancer Institute Information Resources section can provide the latest, most accurate information on breast cancer.
The CIS staff uses a National Cancer
Institute cancer information database called PDQ and other NCI resources
to answer callers' questions. The staff can send callers information from
PDQ and other NCI materials about cancer, its treatment, and living with
the disease, including those listed in the Other Booklets section.
What Is Cancer?
Cancer is a group of many different diseases that have some important things in common. They all arise in cells, the body's basic unit of life. To understand different types of cancer, it is helpful to know about normal cells and what happens when they become cancerous.
The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed. These cells may form a mass of extra tissue called a growth or tumor. Tumors can be benign or malignant.
- Benign tumors are not cancer. They can usually be removed, and in most cases, they don't come back. Most important, the cells in benign tumors do not invade other tissues and do not spread to other parts of the body. Benign breast tumors are not a threat to life.
- Malignant tumors are cancer. Cells in these tumors can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how breast cancer spreads and forms secondary tumors in other parts of the body. The spread of cancer is called metastasis.
This booklet deals with breast cancer. For
more information about benign breast lumps and other benign breast
changes, read NCI's booklet, Understanding Breast Changes: A Health
Guide for All Women, which is available from the Cancer Information
Service at 1-800-4-CANCER.
The Breasts
Each breast has 15 to 20 overlapping sections called lobes. Within each lobe are many smaller lobules, which end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces around the lobules and ducts. There are no muscles in the breast, but muscles lie under each breast and cover the ribs.
Each breast also contains blood vessels and vessels that carry colorless fluid called lymph. The lymph vessels lead to small bean-shaped organs called lymph nodes. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest. Lymph nodes are also found in many other parts of the body.
![[Diagram of breast]](http://www.tjclarkminerals.com/images/bre1.gif)
Types of Breast Cancer
The most common type of breast cancer begins in the lining of the ducts and is called ductal carcinoma. Another type, called lobular carcinoma, arises in the lobules.
When breast cancer spreads outside the breast, cancer cells are often found in the lymph nodes under the arm (axillary lymph nodes). If the cancer has reached these nodes, it may mean that cancer cells have spread to other parts of the body--other lymph nodes and other organs, such as the bones, liver, or lungs--via the lymphatic system or the bloodstream.
Cancer that spreads is the same disease and
has the same name as the original (primary) cancer. When breast cancer
spreads, it is called metastatic breast cancer, even though the secondary
tumor is in another organ. Doctors sometimes call this "distant"
disease.
Risk Factors for Breast Cancer
The risk of breast cancer increases gradually as a woman gets older. This disease is uncommon in women under the age of 35. All women age 40 and older are at risk for breast cancer. However, most breast cancers occur in women over the age of 50, and the risk is especially high for women over age 60.
Research has shown that the following conditions place a woman at increased risk for breast cancer:
- Personal history of breast cancer. Women who have had breast cancer face an increased risk of getting breast cancer again.
- Genetic alterations. Changes in certain genes (BRCA1, BRCA2, and others) make women more susceptible to breast cancer. In families in which many women have had the disease, gene testing can show whether a woman has specific genetic changes known to increase the susceptibility to breast cancer. Doctors may suggest ways to try to delay or prevent breast cancer, or improve the detection of breast cancer in women who have the genetic alterations. For more information about gene testing, read the Causes and Prevention section under The Promise of Cancer Research.
- Family history. A woman's risk for developing 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 at a young age.
- Certain breast changes. Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) or having had two or more breast biopsies for other benign conditions may increase a woman's risk for developing cancer.
Other factors associated with an increased risk for breast cancer include:
- Breast density. Women age 45 and older whose mammograms show at least 75 percent dense tissue are at increased risk. Dense breasts contain many glands and ligaments, which makes breast tumors difficult to "see," and the dense tissue itself is associated with an increased chance of developing breast cancer.
- Radiation therapy. Women whose breasts were exposed to radiation during their childhood, especially those who were treated with radiation for Hodgkin's disease, are at an increased risk for developing breast cancer throughout their lives. Studies show that the younger a woman was when she received her treatment, the higher her risk for developing breast cancer later in life.
- 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.
Also at a somewhat increased risk for developing breast cancer are women who started menstruating at an early age (before age 12), experienced menopause late (after age 55), never had children, or took hormone replacement therapy or birth control pills for long periods of time. Each of these factors increases the amount of time a woman's body is exposed to estrogen. The longer this exposure, the more likely she is to develop breast cancer.
In most cases, doctors cannot explain why a
woman develops breast cancer. Studies show that most women who develop
breast cancer have none of the risk factors listed above, other
than the risk that comes with growing older. Also, most women with known
risk factors do not get breast cancer. Scientists are conducting research
into the causes of breast cancer to learn more about risk factors and ways
of preventing this disease.
Early Detection
When breast cancer is found and treated early, the chances for survival are better. Women can take an active part in the early detection of breast cancer by having regular screening mammograms and clinical breast exams (breast exams performed by health professionals). Some women also perform breast self-exams.
A screening mammogram is the best tool available for finding breast cancer early, before symptoms appear. A mammogram is a special kind of x-ray. It is different from a chest x-ray or x-rays of other parts of the body. Screening mammograms are used to look for breast changes in women who have no signs of breast cancer.
Mammograms can often detect breast cancer before it can be felt. Also, a mammogram can show small deposits of calcium in the breast. Although most calcium deposits are benign, a cluster of very tiny specks of calcium (called microcalcifications) may be an early sign of cancer.
Although mammograms are the best way to find breast cancer early, they do have some limitations. A mammogram may miss some cancers that are present (false negative) or may find things that turn out not to be cancer (false positive). And detecting a tumor early does not guarantee that a woman's life will be saved. Some fast-growing cancers may already have spread to other parts of the body before being detected.
Still, regularly scheduled screening mammograms, together with clinical breast exams, offer the best chance of finding and treating breast cancer early. Studies show that mammograms reduce the risk of dying from breast cancer. The National Cancer Institute recommends that women in their forties and older have mammograms on a regular basis, every 1 to 2 years.
Women should talk with their doctor about factors that can increase the risk for breast cancer. Women of any age who are at higher risk for this disease should ask their doctor when to begin and how often to have screening mammograms and breast exams.
Some women perform monthly breast
self-exams to check for any changes in their breasts. When doing a breast
self-exam, it's important to remember that each woman's breasts are
different, and that changes can occur because of aging, the menstrual
cycle, pregnancy, menopause, or taking birth control pills or
other hormones. It is normal for the breasts to feel a little lumpy
and uneven. Also, it is common for a woman's breasts to be swollen and
tender right before or during her menstrual period. Remember that for
women in their forties and older, a monthly breast self-exam is not a
substitute for regularly scheduled screening mammograms and clinical
breast exams by a health professional.
Symptoms
Early breast cancer usually does not cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for:
- A lump or thickening in or near the breast or in the underarm area;
- A change in the size or shape of the breast;
- Nipple discharge or tenderness, or the nipple pulled back (inversion) into the breast;
- Ridges or pitting of the breast (the skin looks like the skin of an orange; or
- A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly).
A woman should see her doctor about any
symptoms like these. Most often, they are not cancer, but it's important
to check with the doctor so that any problems can be diagnosed and treated
as early as possible.
Diagnosis
An abnormal area on a mammogram, a lump, or other changes in the breast can be caused by cancer or by other, less serious problems. To find out the cause of any of these signs or symptoms, a woman's doctor does a careful physical exam and asks about her personal and family medical history.
- Palpation. The doctor can tell a lot about a lump (its size, its texture, and whether it moves easily) by palpation, carefully feeling the lump and the tissue around it. Benign lumps often feel different from cancerous ones.
- Mammography. X-rays of the breast can give the doctor important information about a breast lump. If an area on the mammogram looks suspicious or is not clear, additional mammograms may be needed.
- Ultrasonography. Using high-frequency sound waves, ultrasonography can often show whether a lump is solid or filled with fluid. This exam may be used along with mammography.
Based on these exams, the doctor may decide that no further tests are needed and no treatment is necessary. (In such cases, the doctor may need to check the woman regularly to watch for any changes.)
Often, however, fluid or tissue must be removed from the breast to make a diagnosis. A woman's doctor may refer her for further evaluation to a surgeon or other health care professional who has experience with breast diseases. These doctors may perform:
- Fine needle aspiration. A thin needle is used to remove fluid from a breast lump. This procedure may show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). Clear fluid removed from a cyst may not need to be checked by a lab.
- Needle biopsy. Using special techniques, tissue can be removed with a needle from an area that is suspicious on a mammogram but cannot be felt. Tissue removed in a needle biopsy goes to a lab to be checked by a pathologist for cancer cells.
- Surgical biopsy. The surgeon cuts out part or all of a lump or suspicious area. A pathologist examines the tissue under a microscope to check for cancer cells.
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When a woman needs a biopsy, these are some questions she may want to ask her doctor:
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When Cancer Is Found
When cancer is found, the pathologist can tell what kind of cancer it is (whether it began in a duct or a lobule) and whether it is invasive (has invaded nearby tissues in the breast).
Special lab tests of the tissue help the doctor learn more about the cancer. For example, hormone receptor tests (estrogen and progesterone receptor tests) can help predict whether the cancer is sensitive to hormones. Positive test results mean hormones help the cancer grow, and the cancer is likely to respond to hormonal therapy. More information about hormonal therapy can be found in the Treatment section. Other lab tests are sometimes done to help the doctor predict whether the cancer is likely to grow slowly or quickly. The doctor may order x-rays and blood tests. The doctor may also do special exams of the bones, liver, or lungs because breast cancer may spread to these areas.
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If the diagnosis is cancer, the patient may want to ask these questions:
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The patient's doctor may refer her to other
doctors who specialize in treating cancer, or she may ask for a referral.
Treatment generally begins within a few weeks after the diagnosis. There
will be time for the woman to talk with the doctor about her treatment
choices, to get a second opinion, and to prepare herself and her loved
ones.
Treatment
Through continuing research into new treatment methods, women now have more treatment options and hope for survival than ever before. The treatment options for each woman depend on the size and location of the tumor in her breast, the results of lab tests (including hormone receptor tests), and the stage (or extent) of the disease. To develop a treatment plan to fit each patient's needs, the doctor also considers a woman's age and menopausal status, her general health, and the size of her breasts.
Many women want to learn all they can about their disease and their treatment choices so that they can take an active part in decisions about their medical care. They are likely to have many questions and concerns about their treatment options.
The doctor is the best person to answer questions about treatment for a particular patient: what her treatment choices are, how successful her treatment is expected to be, and how much it is likely to cost. Most patients also want to know how they will look after treatment and whether they will have to change their normal activities. Also, the patient may want to talk with her doctor about taking part in a clinical trial, a research study involving people, of new treatment methods. Look at the Clinical Trials section of The Promise of Cancer Research for more information.
Calling the National Cancer Institute's Cancer Information Service at 1-800-4-CANCER is another way to gather up-to-date treatment information, including information about current clinical trials. Cancer information specialists can provide thorough, personalized answers to questions about breast cancer treatment. They can suggest other sources of information and support. They can also talk with callers about questions to ask the doctor. The National Cancer Institute also has a Web site at http://cancertrials.nci.nih.gov that offers detailed information about clinical trials for patients, health professionals, and the public.
Many patients find it helpful to make a list of questions before seeing the doctor. To make it easier to remember what the doctor says, patients may take notes or ask whether they may use a tape recorder. Some patients also find that it helps to have a family member or friend with them when they see the doctor--to take part in the discussion, to take notes, or just to listen.
Here are some questions a woman
may want to ask the doctor before treatment begins:
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There is a lot to learn about breast cancer and its treatment. Patients should not feel that they need to ask all their questions or understand all the answers at once. They will have many other chances to ask the doctor to explain things that are not clear and to ask for more information.
Planning Treatment
Before starting treatment, the patient might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient requests it. It may take a week or two to arrange to see another doctor. Studies show that a brief delay (up to several weeks) between biopsy and treatment does not make breast cancer treatment less effective. There are a number of ways to find a doctor for a second opinion:
- The patient's doctor may refer her to one or more specialists. Specialists who treat breast cancer include surgeons, medical oncologists, plastic surgeons, and radiation oncologists. Sometimes these doctors work together at cancer centers or special centers for breast diseases.
- The Cancer Information Service, at 1-800-4-CANCER, can tell callers about treatment facilities, including cancer centers and other NCI-supported programs, in their area.
- Patients can get the names of specialists from their local medical society, a nearby hospital, or a medical school.
- The Official ABMS Directory of Board Certified Medical Specialists lists doctors' names along with their specialty and their background. This resource, produced by the American Board of Medical Specialties, is available in most public libraries.
Methods of Treatment
Methods of treatment for breast cancer are local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area. Surgery and radiation therapy are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the body. Chemotherapy and hormonal therapy are systemic treatments. A patient may have just one form of treatment or a combination. Different forms of treatment may be given at the same time or one after another.
Surgery is the most common treatment for breast cancer. Several types of surgery may be used. The doctor can explain each of them in detail, discuss and compare the benefits and risks of each type, and describe how each will affect the patient's appearance. An operation to remove the breast (or as much of the breast as possible) is a mastectomy. Breast reconstruction is often an option at the same time as the mastectomy, or later on. An operation
Nutrition Supplementation:
Beta-Carotene or Vitamin A
A,
B1,
B2,
B3,
C
and E
together with zinc, selenium and molybdenum in various combinations
were tested. (A)
retinol and zinc; (B)
riboflavin and niacin;
(C) vitamin
C and molybdenum; and vitamin
A, vitamin
E,
vitamin
E supplement of 100-200 IU per day.
Research has shown that deficiencies in micronutrients such as zinc and vitamins A and D reduce natural killer cell function, whereas supplemental zinc and vitamin C enhance their activity
Selenium is one of the most powerful anti-cancer substances ever discovered and has a role to play in treatment as well as prevention.
Coenzyme Q10 is another antioxidant with immune stimulating abilities. Coenzyme Q10 may work by increasing oxidative metabolism and free radical damage within these cancer cells.