Breast cancer

Breast anatomy
Breast cancer is cancer that forms in the cells of the breasts.
After skin cancer, breast cancer is the most common cancer diagnosed in women in the United
States. Breast cancer can occur in both men and women, but it's far more common in women.
Substantial support for breast cancer awareness and research funding has helped create advances
in the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased, and
the number of deaths associated with this disease is steadily declining, largely due to factors such
as earlier detection, a new personalized approach to treatment and a better understanding of the
disease.
Signs and Symptoms
Signs and symptoms of breast cancer may include:
 A breast lump or thickening that feels different from the surrounding tissue
 Change in the size, shape or appearance of a breast
 Changes to the skin over the breast, such as dimpling
 A newly inverted nipple
 Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple
(areola) or breast skin
 Redness or pitting of the skin over your breast, like the skin of an orange

Causes
Doctors know that breast cancer occurs when some breast cells begin to grow abnormally. These
cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or
mass. Cells may spread (metastasize) through breast to lymph nodes or to other parts of the body.
Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal
carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular
carcinoma) or in other cells or tissue within the breast.
Researchers have identified hormonal, lifestyle and environmental factors that may increase risk
of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet
other people with risk factors never do. It's likely that breast cancer is caused by a complex
interaction of genetic makeup and the environment.
Inherited breast cancer
Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations passed
through generations of a family.
A number of inherited mutated genes that can increase the likelihood of breast cancer have been
identified. The most well-known are breast cancer gene 1 (BRCA1) and breast cancer gene 2
(BRCA2), both of which significantly increase the risk of both breast and ovarian cancer.
If one has a strong family history of breast cancer or other cancers, doctor may recommend a
blood test to help identify specific mutations in BRCA or other genes that are being passed
through the family.
Risk factors
A breast cancer risk factor is anything that makes it more likely to get breast cancer. But having
one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast
cancer. Many women who develop breast cancer have no known risk factors other than simply
being women.
Factors that are associated with an increased risk of breast cancer include:
  Being female. Women are much more likely than men are to develop breast cancer.
 Increasing age. Breast cancer increases with age.
 A personal history of breast conditions. A breast biopsy that found lobular carcinoma
in situ (LCIS) or atypical hyperplasia of the breast, have an increased risk of breast
cancer. A personal history of breast cancer. Breast cancer in one breast, have an increased
risk of developing cancer in the other breast.
 A family history of breast cancer. If a mother, sister or daughter was diagnosed with
breast cancer, particularly at a young age, risk of breast cancer is increased. Still, the
majority of people diagnosed with breast cancer have no family history of the disease.
 Inherited genes that increase cancer risk. Certain gene mutations that increase the risk
of breast cancer can be passed from parents to children. The most well-known gene
mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase risk
of breast cancer and other cancers, but they don't make cancer inevitable.
 Radiation exposure. If one received radiation treatments to the chest as a child or young
adult, their risk of breast cancer is increased.
 Obesity. Being obese increases risk of breast cancer.
 Beginning period at a younger age. Beginning period before age 12 increases risk of
breast cancer.
 Beginning menopause at an older age. If one began menopause at an older age, one is
more likely to develop breast cancer.
 Having first child at an older age. Women who give birth to their first child after age 30
may have an increased risk of breast cancer.
 Having never been pregnant. Women who have never been pregnant have a greater risk
of breast cancer than do women who have had one or more pregnancies.
 Postmenopausal hormone therapy. Women who take hormone therapy medications
that combine estrogen and progesterone to treat the signs and symptoms of menopause
have an increased risk of breast cancer. The risk of breast cancer decreases when women
stop taking these medications.
 Drinking alcohol. Drinking alcohol increases the risk of breast cancer.

Prevention
Breast cancer risk reduction for women with an average risk
Breast self-exam

Making changes in daily life may help reduce risk of breast cancer. For example:
 Breast cancer screening. Breast cancer screening exams and tests, such as clinical breast
exams and mammograms.
 Become familiar with breasts through breast self-exam for breast
awareness. Women may choose to become familiar with their breasts by occasionally
inspecting their breasts during a breast self-exam for breast awareness. If there is a new
change, lumps or other unusual signs in your breasts, talk to your doctor promptly.
Breast awareness can't prevent breast cancer, but it may help to better understand the
normal changes that breasts undergo and identify any unusual signs and symptoms.
 Drink alcohol in moderation, if at all. Limit the amount of alcohol drink to no more
than one drink a day, if one chooses to drink.
 Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of
the week.
  Limit postmenopausal hormone therapy. Combination hormone therapy may increase
the risk of breast cancer. Talk with doctor about the benefits and risks of hormone
therapy. Some women experience bothersome signs and symptoms during menopause
and, for these women, the increased risk of breast cancer may be acceptable in order to
relieve menopause signs and symptoms.
To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for
the shortest amount of time.
 Maintain a healthy weight. If one weight is healthy, work to maintain that weight.
Reduce the number of calories you eat each day and slowly increase the amount of
exercise.
 Choose a healthy diet. Women who eat a Mediterranean diet supplemented with extra-
virgin olive oil and mixed nuts may have a reduced risk of breast cancer. The
Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables,
whole grains, legumes, and nuts. People who follow the Mediterranean diet choose
healthy fats, such as olive oil, over butter and fish instead of red meat.

Breast cancer risk reduction for women with a high risk

Options to reduce breast cancer risk, such as:
 Preventive medications (chemoprevention). Estrogen-blocking medications, such as
selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast
cancer in women with a high risk of the disease.
These medications carry a risk of side effects,
 Preventive surgery. Women with a very high risk of breast cancer may choose to have
their healthy breasts surgically removed (prophylactic mastectomy). They may also
choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the
risk of both breast cancer and ovarian cancer.

Diagnosing breast cancer

Tests and procedures
Tests and procedures used to diagnose breast cancer include:
 Breast exam. Your doctor will check both of your breasts and lymph nodes in your
armpit, feeling for any lumps or other abnormalities.
 Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly
used to screen for breast cancer. If an abnormality is detected on a screening
mammogram, your doctor may recommend a diagnostic mammogram to further evaluate
that abnormality.
 Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep
within the body. Ultrasound may be used to determine whether a new breast lump is a
solid mass or a fluid-filled cyst.
 Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive
way to make a diagnosis of breast cancer. During a biopsy, your doctor uses a specialized
 needle device guided by X-ray or another imaging test to extract a core of tissue from the
suspicious area. Often, a small metal marker is left at the site within your breast so the
area can be easily identified on future imaging tests.
Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells
are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in the
breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have
hormone receptors or other receptors that may influence your treatment options.
Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to
create pictures of the interior of your breast. Before a breast MRI, you receive an injection of
dye. Unlike other types of imaging tests, an MRI doesn't use radiation to create the images.

Other tests and procedures may be used depending on situation.

Staging breast cancer
Once the doctor has diagnosed breast cancer, he or she works to establish the extent (stage) of
cancer. Cancer's stage helps determine prognosis and the best treatment options.
Complete information about cancer's stage may not be available until after you undergo breast
cancer surgery.
Tests and procedures used to stage breast cancer may include:
 Blood tests, such as a complete blood count
 Mammogram of the other breast to look for signs of cancer
 Breast MRI
 Bone scan
 Computerized tomography (CT) scan
 Positron emission tomography (PET) scan
Not all women will need all of these tests and procedures. Doctor selects the appropriate tests
based on specific circumstances and taking into account new symptoms one may be
experiencing.
Breast cancer stages range from 0 to IV with 0 indicating cancer that is noninvasive or
contained within the milk ducts. Stage IV breast cancer, also called metastatic breast cancer,
indicates cancer that has spread to other areas of the body.
Breast cancer staging also takes into account cancer's grade; the presence of tumor markers, such
as receptors for estrogen, progesterone and HER2; and proliferation factors.

Treatment
Doctor determines breast cancer treatment options based on type of breast cancer, its stage and
grade, size, and whether the cancer cells are sensitive to hormones.
Most women undergo surgery for breast cancer and many also receive additional treatment after
surgery, such as chemotherapy, hormone therapy or radiation. Chemotherapy might also be used
before surgery in certain situations.
There are many options for breast cancer treatment, and may feel overwhelmed as one makes
complex decisions about treatment. Consider seeking a second opinion from a breast specialist in
a breast center or clinic.
Breast cancer surgery
 Lumpectomy
 Mastectomy
 Sentinel node biopsy
Radiation therapy
Operations used to treat breast cancer include:
Removing the breast cancer (lumpectomy). During a lumpectomy, which may be referred to as
breast-conserving surgery or wide local excision, the surgeon removes the tumor and a small
margin of surrounding healthy tissue.
A lumpectomy may be recommended for removing smaller tumors. Some people with larger
tumors may undergo chemotherapy before surgery to shrink a tumor and make it possible to
remove completely with a lumpectomy procedure.
Removing the entire breast (mastectomy). A mastectomy is an operation to remove all of your
breast tissue. Most mastectomy procedures remove all of the breast tissue — the lobules, ducts,
fatty tissue and some skin, including the nipple and areola (total or simple mastectomy).
Newer surgical techniques may be an option in selected cases in order to improve the appearance
of the breast. Skin-sparing mastectomy and nipple-sparing mastectomy are increasingly common
operations for breast cancer.
Removing a limited number of lymph nodes (sentinel node biopsy). To determine whether
cancer has spread to your lymph nodes, your surgeon will discuss with you the role of removing
the lymph nodes that are the first to receive the lymph drainage from your tumor.
If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining
lymph nodes is small and no other nodes need to be removed.
Removing several lymph nodes (axillary lymph node dissection). If cancer is found in the
sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph
nodes in your armpit.
Removing both breasts. Some women with cancer in one breast may choose to have their other
(healthy) breast removed (contralateral prophylactic mastectomy) if they have a very increased
risk of cancer in the other breast because of a genetic predisposition or strong family history.
Most women with breast cancer in one breast will never develop cancer in the other breast.
Complications of breast cancer surgery depend on the procedures chosen. Breast cancer surgery
carries a risk of pain, bleeding, infection and arm swelling (lymphedema).
Radiation therapy
Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer
cells. Radiation therapy is typically done using a large machine that aims the energy beams at
your body (external beam radiation). But radiation can also be done by placing radioactive
material inside the body (brachytherapy).
External beam radiation of the whole breast is commonly used after a lumpectomy. Breast
brachytherapy may be an option after a lumpectomy if you have a low risk of cancer recurrence.
Chemotherapy
Chemotherapy uses drugs to destroy fast-growing cells, such as cancer cells. If the cancer has a
high risk of returning or spreading to another part of your body, the doctor may recommend
chemotherapy after surgery to decrease the chance that the cancer will recur.
Chemotherapy is sometimes given before surgery in women with larger breast tumors. The goal
is to shrink a tumor to a size that makes it easier to remove with surgery.
Chemotherapy is also used in women whose cancer has already spread to other parts of the body.
Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the
cancer is causing.
Hormone therapy
Hormone therapy — perhaps more properly termed hormone-blocking therapy — is used to treat
breast cancers that are sensitive to hormones. Doctors refer to these cancers as estrogen receptor
positive (ER positive) and progesterone receptor positive (PR positive) cancers.
Hormone therapy can be used before or after surgery or other treatments to decrease the chance
of your cancer returning. If the cancer has already spread, hormone therapy may shrink and
control it.
Treatments that can be used in hormone therapy include:
 Medications that block hormones from attaching to cancer cells (selective estrogen
receptor modulators)
 Medications that stop the body from making estrogen after menopause (aromatase
inhibitors)
 Surgery or medications to stop hormone production in the ovaries
Immunotherapy
Immunotherapy uses immune system to fight cancer. The body's disease-fighting immune
system may not attack cancer because the cancer cells produce proteins that blind the immune
system cells. Immunotherapy works by interfering with that process.
Immunotherapy might be an option if one has triple-negative breast cancer, which means that the
cancer cells don't have receptors for estrogen, progesterone or HER2.
Supportive (palliative) care
Palliative care is specialized medical care that focuses on providing relief from pain and other
symptoms of a serious illness. Palliative care specialists work with patient, their family and other
health workers to provide an extra layer of support that complements the ongoing care. Palliative
care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or
radiation therapy.
When palliative care is used along with all of the other appropriate treatments, people with
cancer may feel better and live longer.
Palliative care is provided by a team of health workers professionals. Palliative care teams aim to
improve the quality of life for people with cancer and their families. This form of care is offered
alongside curative or other treatments that may be receiving.

Alternative medicine
No alternative medicine treatments have been found to cure breast cancer. But complementary
and alternative medicine therapies may help cope with side effects of treatment when combined
with doctor's care.
Alternative medicine for fatigue
Many breast cancer survivors experience fatigue during and after treatment that can continue for
years. When combined with doctor's care, complementary and alternative medicine therapies
may help relieve fatigue.