Cancer - breast; Carcinoma - ductal; Carcinoma - lobular; DCIS; LCIS; HER2-positive breast cancer; ER-positive breast cancer; Ductal carcinoma in situ; Lobular carcinoma in situOverview
Breast cancer is a cancer that starts in the tissues of the breast.
There are two main types of breast cancer:
In rare cases, breast cancer can start in other areas of the breast.
Breast cancer may be invasive or noninvasive. Invasive means it has spread to other tissues. Noninvasive means it has not yet spread. Noninvasive breast cancer is referred to as "in situ."
Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancers have estrogen receptors on the surface of their cells. They are called estrogen receptor-positive cancer or ER-positive cancer.
Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells -- including cancer cells -- grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type.
Review Date: 12/27/2009
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital.
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Over the course of a lifetime, 1 in 8 women will be diagnosed with breast cancer.
Risk factors you cannot change include:
Other risk factors include:
Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and pesticides.
The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer. See:
Early breast cancer usually does not cause symptoms. This is why regular breast exams are important. As the cancer grows, symptoms may include:
Men get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.
Symptoms of advanced breast cancer may include:
Contact your health care provider for an appointment if:
Also call your health care provider if you develop symptoms after being treated for breast cancer, such as:
Treatment is based on many factors, including type and stage of the cancer, whether the cancer is sensitive to certain hormones, and whether or not the cancer overproduces (overexpresses) a gene called HER2/neu.
In general, cancer treatments may include:
Hormonal therapy is prescribed to women with ER-positive breast cancer to block certain hormones that fuel cancer growth.
Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anticancer drugs that target certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). It may be used for women with HER2-positive breast cancer.
Cancer treatment may be local or systemic.
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. 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.
After treatment, some women will continue to take medications such as tamoxifen for a period of time. All women will continue to have blood tests, mammograms, and other tests following treatment.
Women who have had a mastectomy may have reconstructive breast surgery, either at the same time as the mastectomy or later.
Many risk factors -- such as your genes and family history -- cannot be controlled. However, a healthy diet and a few lifestyle changes may reduce your overall chance of cancer in general.
Breast cancer is more easily treated and often curable if it is found early.
Early detection involves:
Most experts recommend that women age 20 and older examine their breasts once a month during the week following the menstrual period.
Women between the ages 20 and 39 should have a doctor examine their breasts at least once every 3 years.
After age 40:
Certain women at high risk for breast cancer may have a breast MRI along with their yearly mammogram. Ask your doctor if you need an MRI.
Screening for breast cancer is a topic filled with controversy. 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.
Tamoxifen is approved for breast cancer prevention in women aged 35 and older who are at high risk.
Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy, which is the surgical removal of the breasts. Possible candidates for this procedure may include those who have already had one breast removed due to cancer, women with a strong family history of breast cancer, and persons with genes or genetic mutations that raise their risk of breast cancer.
New, improved treatments are helping persons with breast cancer live longer than ever before. However, even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns even after the entire tumor is removed and nearby lymph nodes are found to be cancer-free.
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 used to determine the risk for recurrence and the likelihood of successful treatment include:
After considering all of the above, your doctor can discuss your risk of having a recurrence of breast cancer.
You may experience side effects or complications from cancer treatment. For example, radiation therapy may cause temporary swelling of the breast (lymphedema), and aches and pains around the area.
Lymphedema may start 6 to 8 weeks after surgery or after radiation treatment for cancer.
It can also start very slowly after your cancer treatment is over. You may not notice symptoms until 18 to 24 months after treatment. Sometimes it can take years to develop.
Ask your doctor about the side effects you may have during treatment.
The doctor will ask you about your symptoms and risk factors, and then perform a physical exam, which includes both breasts, armpits, and the neck and chest area. Additional tests may include:
If your doctor learns that you do have breast cancer, additional tests will be done to see if the cancer has spread. This is called staging. Staging helps guide future treatment and follow-up and gives you some idea of what to expect in the future.
Breast cancer stages range from 0 to IV. The higher the staging number, the more advanced the cancer.