Iowa Health Book: Cancer Center
National Cancer Institute
Peer Review Status: Externally reviewed by the
National Cancer Institute
This booklet was written and published by the National Cancer Institute (NCI). The NCI is the U.S. Government's main agency for cancer research and information about cancer. The NCI's publications are free. They may be copied or reproduced without written permission.
This booklet is about breast cancer. You may have questions about this disease. You can call the Cancer Information Service to talk with someone about breast cancer. The number is 1-800-442-6237 (1-800-4-CANCER). The call is free. The staff can talk with you in English or Spanish.
Contents
Breast cancer is the most common type of cancer among women in the United States. The National Cancer Institute (NCI) has written this booklet to help women with breast cancer and their families and friends better understand this disease. We hope others will read it as well to learn more about breast cancer.
This booklet describes breast cancer symptoms, diagnosis, treatment, and rehabilitation. Other NCI booklets about cancer, its treatment, and living with the disease are listed inside the back cover. We know that booklets like these cannot answer every question about breast cancer. They cannot take the place of talks with doctors, nurses, and other members of the health care team. We hope our booklets will help with those talks.
Our knowledge about breast cancer keeps increasing. For up-to-date information, call the NCI-supported Cancer Information Service (CIS) at 1-800-4-CANCER (1-800-422-6237).
*Words that may be new to readers are printed in bold. Definitions of these and other terms related to breast cancer appear in the section entitled "Definitions of Terms." For some words, a "sounds-like" spelling is also given.
What Is Cancer?
Cancer is a group of diseases. It occurs when cells become abnormal
and divide without control or order.
Every organ in the body is made up of various kinds of cells. Cells normally divide in an orderly way to produce more cells only when they are needed. This process helps keep the body healthy.
If cells divide when new cells are not needed, they form too much tissue. The mass of extra tissue, called a tumor, can be benign or malignant.
The Breasts
Each breast has 15 to 20 sections, called lobes, that are
arranged like the petals of a daisy. Each lobe has 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
between 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 lymph. The lymph vessels lead to small bean-shaped organs called lymph nodes. Clusters of lymph nodes are found under the arm, above the collarbone, and in the chest. Lymph nodes are also found in many other parts of the body.
Types of Breast Cancer
There are more than 100 different types of cancer, including several
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.
Cancers that begin in other tissues in the breast are rare and are
not discussed in this booklet.
When breast cancer spreads outside the breast, cancer cells are often found in the lymph nodes under the arm. 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.
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 may call this problem "distant" disease.
Early Detection
When breast cancer is found and treated early, a woman has more
treatment choices and a good chance of complete recovery. So it is
important to detect breast cancer as early as possible. The National
Cancer Institute encourages women to take an active part in early
detection. They should talk with their doctor about this disease, the
symptoms to watch for, and an appropriate schedule of checkups. The
doctor's advice will be based on the woman's age, medical history,
and other factors.
Women should ask the doctor about
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.
Mammography involves two x-rays of each breast, one taken from the side and one from the top. The breast must be squeezed between two plates for the pictures to be clear. While this squeezing may be a bit uncomfortable, it lasts only a few seconds. In many cases, mammograms can show breast tumors before they cause symptoms or can be felt. A mammogram can also show small deposits of calcium in the breast. A cluster of very tiny specks of calcium (called microcalcifications) may be an early sign of cancer.
Mammography should be done only by specially trained people using machines designed just for taking x-rays of the breast. The pictures should be checked by a qualified radiologist. Women should talk with their doctor or call the Cancer Information Service for help in finding out where to get a mammogram.
Mammography is an excellent tool, but we know that it cannot find every abnormal area in the breast. So another important step in early detection is for women to have their breasts examined regularly by a doctor or nurse.
Between visits to the doctor, women should examine their breasts every month. (An easy-to-follow breast self-examination guide begins at the end of this file.) It's important to remember that every woman's breasts are different. And each woman's breasts change because of age, the menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for the breasts to feel lumpy and uneven. Also, it's common for a woman's breasts to be swollen and tender right before or during her menstrual period. These are some of the reasons why many women are not certain what their breasts are supposed to feel like. By doing monthly BSE, a woman learns what is normal for her breasts, and she is more likely to detect a change. Any changes should be reported to the doctor.
Symptoms
Early breast cancer usually does not cause pain. In fact, when
it first develops, breast cancer may cause no symptoms at all. But as
the cancer grows, it can cause changes that women should watch for:
A woman should see her doctor if she notices any of these changes. Most often, they are not cancer, but only a doctor can tell for sure.
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. In addition to checking general signs of
health, the doctor may do one or more of the breast exams described
below to help make a diagnosis.
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 want to check the woman regularly to watch for any changes. Often, however, the doctor must remove fluid or tissue from the breast to make a diagnosis.
When a woman needs a biopsy, these are some questions she may want to ask her doctor:
When Cancer Is Found
When cancer is present, 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 laboratory tests of the tissue help the doctor learn more about the cancer. For example, hormone receptor tests (estrogen and progesterone receptor tests) can show whether the cancer is sensitive to hormones. Positive test results mean hormones help the cancer grow and the cancer is likely to respond to hormone treatment. Other lab tests are sometimes done to help the doctor predict whether the cancer is likely to grow slowly or quickly.
If the diagnosis is cancer, the patient may want to ask these questions:
The patient's doctor may refer her to doctors who specialize in treating breast cancer. Treatment generally follows within a few weeks after the diagnosis. The woman will have time to talk with the doctor about her treatment choices, to consider getting a second opinion, and to prepare herself and her loved ones.
Treatment
Many treatment methods are used for breast cancer. Treatment depends
on the size and location of the tumor in the breast, the results of
lab tests (including hormone receptor tests) done on the cancer
cells, and the stage (or extent) of the disease. The patient
may have further tests to find out whether the cancer has spread. For
example, the doctor usually orders x-rays of the lungs and blood
tests to check the liver. In some cases, the doctor orders other
special exams of the liver, lungs, or bones because breast cancer
tends to spread to these areas. To develop a treatment plan to fit
each patient's needs, the doctor also considers the woman's age and
general health as well as her feelings about the treatment options.
Women with breast cancer are likely to have many questions and concerns about their treatment plan. They want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. The doctor is the best person to answer questions about how the disease can be treated, how successful the treatment is expected to be, and how much it is likely to cost. Also, the patient may want to talk with her doctor about taking part in a research study of new treatment methods. Information about such studies, called clinical trials, appears below.
Many patients find it helps to make a list of questions before seeing the doctor. Taking notes during talks with the doctor can make it easier to remember what the doctor says. 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:
Most patients also want to know how they will look after treatment and whether they will have to change their normal activities. There's 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. It may take a week or two
to arrange to see another doctor. Studies show that a brief delay
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:
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 all over the body.
Chemotherapy and hormone therapy are systemic
treatments. A patient may have just one form of treatment or a
combination, depending on her needs.
Surgery is the most common treatment for breast cancer. An operation to remove the breast is a mastectomy; an operation to remove the cancer but not the breast is called breast-sparing surgery. Breast-sparing surgery usually is followed by radiation therapy to destroy any cancer cells that may remain in the area. In most cases, the surgeon also removes lymph nodes under the arm to help determine the stage of the disease.
Several types of surgery are used to treat breast cancer. The doctor can explain them in detail and can tell the patient how each will affect her appearance.
Lumpectomy
Partial mastectomy
Total mastectomy
Modified radical mastectomy
These are some questions a woman may want to ask her doctor before surgery:
In radiation therapy (also called radiotherapy), high energy rays are used to damage cancer cells and stop them from growing. Radiation may come from a machine outside the body (external radiation). It can also come from radioactive materials placed directly in the breast in thin plastic tubes (implant radiation). Sometimes the patient receives both kinds of radiation therapy.
Patients go to the hospital or clinic each day for external radiation treatments. When this therapy follows breast sparing surgery, the treatments are given 5 days a week for 5 to 6 weeks. At the end of that time, an extra "boost" of radiation is often given to the tumor site. The boost may be either external or internal (using an implant). Patients stay in the hospital for a short time for implant radiation.
Before radiation therapy, a patient may want to ask her doctor these questions:
Chemotherapy is the use of drugs to kill cancer cells. In most cases, breast cancer is treated with a combination of drugs. The drugs may be given by mouth or by injection into a vein or muscle. Either way, chemotherapy is a systemic therapy, because the drugs enter the bloodstream and travel through the body.
Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment, and so on. Most patients have chemotherapy in an outpatient part of the hospital, at the doctor' s office, or at home. Depending on which drugs are given and the woman' s general health, however, she may need to stay in the hospital during her treatment.
Hormone therapy is used to keep cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work or surgery to remove the ovaries, which make hormones. Like chemotherapy, hormone therapy is a systemic treatment; it can affect cancer cells throughout the body.
Patients may want to ask these questions about chemotherapy or hormone therapy:
Treatment Choices
Treatment decisions are complex. These decisions are affected by the
experience and judgment of the doctor and by the desires of the
patient. The choices available for a particular patient depend on a
number of factors. These include the woman's age and menopausal
status, her general health, the location of the tumor, and the size
of her breast. Certain features of the cancer cells (such as whether
they depend on hormones and how fast they are growing) are also
considered. The most important factor is the stage of the cancer. The
stage is based on the size of the tumor and whether the cancer is
only in the breast or has spread to other organs. On the following
pages are brief descriptions of the treatments most often used for
each stage of breast cancer.
Patients with carcinoma in situ may have breast sparing surgery or mastectomy. The type of surgery depends mainly on whether the cancer developed in a duct (intraductal carcinoma) or a lobule (lobular carcinoma in situ). In some cases, some of the underarm lymph nodes are removed, and radiation therapy may be recommended.
Women with early stage breast cancer may have breast-sparing surgery followed by radiation therapy as their primary local treatment, or they may have a mastectomy. These treatments are equally effective. With either approach, lymph nodes under the arm generally are removed.
In addition, some women with stage I and most with stage II breast cancer have chemotherapy and/or hormone therapy in addition to their local treatment. This added treatment is called adjuvant therapy. It is given to prevent the cancer from recurring by killing undetected cancer cells that may have begun to spread.
Patients with stage III breast cancer usually have both local treatment to remove or destroy the cancer in the breast and systemic treatment to stop the disease from spreading. The local treatment may be mastectomy and/or radiation therapy to the breast; also, the lymph nodes under the arm may be removed or treated with radiation. The systemic treatment may be chemotherapy, hormone therapy, or both; it may be given before local treatment.
Women who have stage IV breast cancer receive chemotherapy and/or hormone therapy to shrink the tumor or destroy cancer cells. They may have surgery or radiation therapy to control the cancer in the breast. Radiation may also be useful to control tumors in other parts of the body.
When the cancer returns only in the breast area, it is called a local recurrence. If the disease returns in another part of the body, it is called metastatic breast cancer (or distant disease). The doctor will choose one type of treatment or a combination of treatments to meet the woman's needs.
Side Effects of Treatment
It is hard to limit the effects of cancer treatment so that only
cancer cells are removed or destroyed. Because healthy cells and
tissues may also be damaged, treatment often causes unpleasant side
effects.
Removal of a breast can cause a woman's weight to shift and be out of balance especially if she has large breasts. This imbalance can also cause discomfort in a woman's neck and back. Also, the skin in the breast area may be tight, and the muscles of the arm and shoulder may feel stiff. After a mastectomy, a few women have some permanent loss of strength in these muscles, but for most women, reduced strength and limited movement are temporary. The doctor, nurse, or physical therapist can recommend exercises to help a woman regain movement and strength in her arm and shoulder.
Because nerves are injured or cut during surgery, a woman may have numbness and tingling in the chest, underarm, shoulder, and arm. These feelings usually go away within a few weeks or months, but some numbness may be permanent.
Removing the lymph nodes under the arm slows the flow of lymph. In some women, lymph builds up in the arm and hand and causes swelling (lymphedema). Also, it is harder for the body to fight infection after the lymph nodes have been removed, so women need to protect the arm and hand on the treated side from injury-for the rest of their lives. They should ask the doctor how to handle any cuts, scratches, insect bites, or other injuries that may occur. Also, they should contact the doctor if an infection develops.
The radiation oncologist will explain the possible side effects of radiation therapy for breast cancer - including uncommon side effects that may involve the heart, lungs, and ribs - before treatment begins. Some of the more common side effects are described here. For example, during radiation therapy, patients may become very tired, especially in the later weeks of treatment. Resting is important, but doctors usually advise their patients to try to stay reasonably active. Women should match their activities to their energy level. It's common for radiation to cause the skin in the treated area to become red and dry, tender, and itchy. Toward the end of treatment, the skin may become moist and "weepy." This area should be exposed to the air as much as possible. Patients should avoid wearing a bra or clothes that may rub; loose-fitting cotton clothes are usually best. Good skin care is important at this time, but patients should not use any lotions or creams without the doctor' s advice, and they should not use any deodorant on the treated side. The effects of radiation therapy on the skin are temporary. The area will heal when the treatment is over.
Following radiation therapy, the treated breast may be firmer. Also, it may be larger (due to fluid buildup) or smaller (because of tissue changes) than before. For some women, the breast skin is more sensitive after radiation treatment; for others, it is less sensitive.
The side effects of chemotherapy depend mainly on the drugs the patient receives. In addition, as with other types of treatment, side effects vary from person to person. In general, anticancer drugs affect rapidly dividing cells. These include blood cells, which fight infection, cause the blood to clot, and carry oxygen to all parts of the body. When blood cells are affected by anticancer drugs, patients are more likely to get infections, bruise or bleed easily, and have less energy. Cells in hair follicles and cells that line the digestive tract also divide rapidly. As a result of chemotherapy, patients may lose their hair and may have other side effects, such as loss of appetite, nausea, vomiting, or mouth sores. These generally are short-term side effects. They gradually go away during the recovery part of the chemotherapy cycle or after the treatment is over.
Some anticancer drugs can damage the ovaries. If the ovaries fail to produce hormones, the woman may have symptoms of menopause, such as hot flashes and vaginal dryness. Her periods may become irregular or may stop, and she may not be able to become pregnant. In women over the age of 35 or 40, some of these effects, such as infertility, are likely to be permanent.
Hormone therapy can cause a number of side effects. They depend largely on the specific drug or type of treatment, and they vary from patient to patient. Tamoxifen is the most commonly used form of hormone treatment. This drug blocks the body' s use of estrogen but does not stop estrogen production. Its side effects usually are not severe. Tamoxifen may cause hot flashes, vaginal discharge or irritation, and irregular periods, but it does not cause menopause or infertility. Young women whose ovaries are removed to deprive the cancer cells of estrogen experience menopause immediately. The side effects they have - including hot flashes and vaginal dryness - are likely to be more severe than those of natural menopause.
Loss of appetite can be a problem for cancer patients. They may not feel hungry when they are uncomfortable or tired. Also, some of the common side effects of cancer treatment, such as nausea and vomiting, can make it hard to eat. The doctor may suggest medicine to help with these problems because good nutrition is important. Patients who eat well often feel better and have more energy. They also may be better able to withstand the side effects of their treatment. Eating well means getting enough calories and protein to help prevent weight loss, regain strength, and rebuild normal tissues. Many patients find that eating several small meals and snacks during the day works better than trying to have three large meals.
The side effects of cancer treatment are different for each person, and they may even be different from one treatment to the next. Doctors try to plan treatment to keep problems to a minimum. They also watch patients carefully so they can help with any problems that occur. Doctors, nurses, and dietitians can explain the side effects of treatment and can suggest ways to deal with them. The NCI booklets Radiation Therapy and You, Chemotherapy and You, and Eating Hints have helpful information about cancer treatment and coping with side effects.
After Treatment
Rehabilitation is a very important part of breast cancer treatment.
The medical team makes every effort to help women return to their
normal activities as soon as possible. Recovery will be different for
each woman, depending on the extent of the disease, the treatment she
had, and other factors.
Exercising after surgery can help a woman regain motion and strength in her arm and shoulder. It can also reduce pain and stiffness in her neck and back. Carefully planned exercises should be started as soon as the doctor says the woman is ready, often within a day or so after surgery. Exercising begins slowly and gently and can even be done in bed. Gradually, exercising can be more active, and regular exercise should become part of a woman's normal routine. (Women who have a mastectomy and immediate breast reconstruction-plastic surgery to rebuild the breast-need special exercises, which the doctor or nurse will explain.)
Lymphedema after surgery can be reduced or prevented with certain exercises and by resting with the arm propped up on a pillow. If lymphedema occurs later on, the doctor may suggest exercises and other ways to deal with this problem. For example, some women with lymphedema wear an elastic sleeve or use an elastic cuff to improve lymph circulation. The doctor also may suggest other approaches-such as medication or use of a machine that compresses the arm.
After a mastectomy, some women decide to wear a breast form (prosthesis). Others prefer to have breast reconstruction - either at the same time as the mastectomy or later on. Each plan has its pros and cons, and what is right for one woman may not be right for another. What's important is that nearly every woman treated for breast cancer has a choice. It may be helpful to talk with a plastic surgeon before the mastectomy, but reconstruction is still possible years later.
Various procedures are used to reconstruct the breast. Some use artificial implants; others use tissue moved from another part of the woman' s body. The woman should ask the plastic surgeon to explain the risks and benefits of each type of reconstruction. The Cancer Information Service can suggest sources of printed information about breast reconstruction and can tell callers about breast cancer support groups. Members of such groups are often willing to share their personal experiences with breast reconstruction.
Follow-up Care
Regular follow-up exams are very important after breast cancer
treatment. The doctor will continue to check the woman closely to be
sure that the cancer has not returned. Regular checkups usually
include exams of the chest, underarm, and neck. From time to time,
the woman has a complete physical exam, blood and urine tests,
mammography, and a chest x-ray. The doctor sometimes orders scans
(special x-rays) and other exams as well.
A woman who has had cancer in one breast has a higher than-average risk of developing cancer in her other breast. She should continue to practice breast self-examination, checking both the treated area and her other breast each month. She should report any changes to her doctor right away.
Also, a woman who has had breast cancer should tell her doctor about other physical problems if they come up, such as pain, loss of appetite or weight, changes in menstrual periods, or blurred vision. She should also report dizziness, coughing or hoarseness, headaches, or digestive problems that seem unusual or that don't go away. These symptoms may be a sign that the cancer has returned, but they can also be signs of many other problems. Only the doctor can tell for sure.
Living With Cancer
The diagnosis of breast cancer can change a woman's life and the
lives of those close to her. These changes can be hard to handle.
It's common for the woman and her family and friends to have many
different and sometimes confusing emotions.
At times, patients and their loved ones may be frightened, angry, or depressed. These are normal reactions when people face a serious health problem. Most people find it helps to share their thoughts and feelings with loved ones. Sharing can help everyone feel more at ease and can open the way for others to show their concern and offer their support.
Sometimes women who have had breast cancer are afraid that changes to their body will affect not only how they look but how other people feel about them. They may be concerned that breast cancer and its treatment will affect their sexual relationships. Most couples find that talking about these concerns helps them find ways to express their love during and after treatment.
Cancer patients may worry about holding a job, caring for their families, or starting new relationships. Worries about tests, treatments, hospital stays, and medical bills are also common. Doctors, nurses, or other members of the health care team can help calm fears and ease confusion about treatment, working, or daily activities. Also, meeting with a nurse, social worker, counselor, or member of the clergy can be helpful to patients who want to talk about their feelings or discuss their concerns about the future or about personal relationships.
Members of the health care team can provide information and suggest other resources. In addition, the public library is a good source of books and articles on living with cancer. Cancer patients and their families can also find helpful suggestions in the NCI booklets below.
Support for Breast Cancer Patients
Finding the strength to deal with the changes brought about by breast
cancer can be easier for patients and those who love them when they
have appropriate support services.
Many patients find it helpful to talk with others who are facing problems like theirs. Cancer patients often get together in self-help and support groups, where they can share what they have learned about cancer and its treatment and about coping with the disease. Often a social worker or nurse meets with the group.
The American Cancer Society's Reach to Recovery program offers special help for breast cancer patients. Trained volunteers, who have had breast cancer themselves, visit patients at the doctor's request and lend emotional support to women before and after treatment.
They share their experiences with breast cancer treatment and rehabilitation and with breast reconstruction. Information about the American Cancer Society appears below.
Friends and relatives, especially those who have had cancer themselves, can also be very supportive. It's important to keep in mind, however, that each patient is different. Treatments and ways of dealing with cancer that work for one person may not be right for another even if they both have the same kind of cancer. It is always a good idea to discuss the advice of friends and family members with the doctor.
Often, the doctor's staff or a social worker at the hospital or clinic can suggest local and national groups that can help with emotional support, rehabilitation, financial aid, transportation, or home care. Information about programs and services for breast cancer patients and their families is also available through the Cancer Information Service.
What the Future Holds
Researchers are finding better ways to detect and to treat breast
cancer, and the chances of recovery keep improving. Still, it is
natural for patients to be concerned about their future.
Sometimes patients use statistics they have heard to try to figure out their own chances of being cured. It is important to remember, however, that statistics are averages based on large numbers of patients. They can't be used to predict what will happen to a particular woman because no two cancer patients are alike. The doctor who takes care of the patient and knows her medical history is in the best position to talk with her about the chance of recovery (prognosis). Women should feel free to ask the doctor about their prognosis, but they should keep in mind that not even the doctor knows exactly what will happen. Doctors often talk about surviving cancer, or they may use the term remission. Doctors use these terms because, although many breast cancer patients are cured, the disease can recur.
The Promise of Cancer Research
Scientists at hospitals and medical centers all across the country
are studying breast cancer. They are trying to learn more about what
causes this disease and how to prevent it. They are also looking for
better ways to diagnose and treat it.
Causes and Prevention
Each year, more than 180,000 women in the United States find out they
have breast cancer. Although this disease also occurs in about 1000
men in this country each year, more than 99 percent of all breast
cancer patients are women.
Scientists do not know what causes breast cancer, and doctors can seldom explain why one person gets this disease and another doesn't. It is clear, however, that breast cancer is not caused by bumping, bruising, or touching the breast. And this disease is not contagious; no one can "catch" breast cancer from another person.
By studying large numbers of women all over the world, researchers have found certain risk factors that increase a woman' s chance of developing breast cancer. Women with these risk factors have a higher than average chance of getting this disease. However, studies also show that most women with these risk factors do not get breast cancer. And many women who get breast cancer have none of the risk factors we know about.
The following are some of the known risk factors for this disease:
Other risk factors for breast cancer include starting to menstruate at an early age (before 12) or having a late menopause (after 55). The risk is also greater in women who had their first child after the age of 30 and those who never had children. Because these factors are all related to a woman's natural hormones, many people are concerned about medicines that contain hormones (either for birth control or as estrogen replacement therapy to control symptoms of menopause), especially if women take them for many years. At this time, no one knows for sure whether taking hormones affects the risk of breast cancer. Scientists hope to find the answer to this important question by studying a large number of women taking part in hormone-related research.
Research suggests that a person's diet may affect the chances of getting some types of cancer. Breast cancer appears to be more likely to develop in women whose diet is high in fat. Older women who are overweight also seem to have a greater risk. Although the possible link between diet and breast cancer is still under study, some scientists believe that choosing a low-fat diet, eating well-balanced meals with plenty of fruits and vegetables, and maintaining ideal weight can lower a woman's risk.
Some studies suggest a slightly higher risk of breast cancer among women who drink alcohol. The risk appears to go up with the amount of alcohol consumed, so women who drink should do so only in moderation.
Many women are concerned about benign breast conditions. For most women, the ordinary "lumpiness" they feel in their breasts does not increase their risk of breast cancer. However, women who have had breast biopsies that show certain benign changes in breast tissues, such as atypical hyperplasia, do have an increased risk of breast cancer.
Women who are at high risk for breast cancer are taking part in a study of the drug tamoxifen, which is often used to treat breast cancer patients. This nationwide study is designed to help doctors learn whether tamoxifen can prevent breast cancer in these women. The Cancer Information Service can provide information about this study.
Detection
When breast cancer is found early, patients have more treatment
choices and their chance of complete recovery is better. Because
breast cancer often occurs in women with none of the known risk
factors, it is important for all women to ask their doctor about
mammography, breast exams by a doctor or nurse, and breast
self-examination.
Unfortunately, the tests we have now cannot reveal every breast cancer at an early stage. Scientists are trying to find better ways to detect breast cancers when they are very small. For example, they are looking for ways to make mammography more accurate. They are also exploring new techniques to produce detailed pictures of the tissues in the breast.
In addition, researchers are studying tumor markers, substances that may be present in abnormal amounts in the blood or urine of a woman who has breast cancer. Several markers have been studied, and this research is continuing. At this time, however, no blood or urine test is reliable enough to reveal early breast cancer.
Treatment
Researchers also are looking for more effective ways to treat breast
cancer. In addition, they are exploring ways to reduce the side
effects of treatment and improve the quality of patients' lives. When
laboratory research shows that a new treatment method has promise,
cancer patients receive the treatment in clinical trials. These
trials are designed to answer scientific questions and to find out
whether the new approach is both safe and effective. Often, clinical
trials compare a new treatment with a standard approach. Patients who
take part in clinical trials make an important contribution to
medical science and may have the first chance to benefit from
improved treatment methods.
Trials to study new treatments for patients with all stages of breast cancer are under way. Researchers are testing new treatment methods, new doses and treatment schedules, and new ways of combining treatments. They are working with various anticancer drugs and drug combinations as well as several types of hormone therapy. They are also exploring new ways to combine chemotherapy with hormone therapy and radiation therapy. Some trials include biological therapy, treatment with substances that boost the immune system's response to cancer.
In a number of trials, doctors are trying to learn whether very high doses of anticancer drugs are more effective than the usual doses in destroying breast cancer cells. Because these higher doses seriously damage the patient's bone marrow, where blood cells are formed, researchers are testing ways to replace the bone marrow or to help it recover. These new approaches (bone marrow transplantation, peripheral stem cell support, and the use of colony-stimulating factors) are described in the section on medical terms below.
Cancer patients may want to read an NCI booklet called What Are Clinical Trials All About?, which explains some of the possible benefits and risks of treatment studies. Those who are interested in taking part in a trial should discuss this option with their doctor.
One way to learn about clinical trials is through PDQ, a computerized resource developed by NCI. PDQ contains information about cancer treatment and an up-to-date list of trials all over the country. Doctors can obtain an access code and use a personal computer to get PDQ information. Also, the Cancer Information Service can provide PDQ information to doctors, patients, and the public.
Definitions of Terms
Adjuvant therapy (ADju-vant): Treatment given in addition to the primary treatment.
Areola (a-REE-oe-la): The area of dark-colored skin that surrounds the nipple.
Aspiration (as-per-AY-shun): Removal of fluid from a lump, often a cyst, with a needle.
Atypical hyperplasia (hy-per-PLAY-zha): A benign (noncancerous) condition in which breast tissue has certain abnormal features. This condition increases the risk of breast cancer.
Axilla (ak-SIL-a): The underarm.
Benign (bee-NINE): Not cancerous; does not invade nearby tissue or spread to other parts of the body.
Biological therapy (by-o-LOJ-i-kal): Treatment to stimulate or restore the ability of the immune system to fight infection and disease. Also called immunotherapy.
Biopsy (BY-op-see): The removal of a sample of tissue, which is then examined under a microscope to check for cancer cells. Excisional biopsy is surgery to remove an entire lump and a margin of normal tissue around it. In incisional biopsy, which is done less often for breast tumors, the surgeon removes part of the tumor. Removal of tissue with a needle is called a needle biopsy.
Bone marrow: The soft, sponge-like material inside some bones. Blood cells are produced in the bone marrow.
Bone marrow transplantation (tranz-plan-TAY-shun): A procedure in which doctors replace marrow destroyed by high doses of anticancer drugs or radiation. The replacement marrow may be taken from the patient before treatment or may be donated by another person. When the patient's own marrow is used, the procedure is called autologous (aw TAHL-o-gus) bone marrow transplantation .
Cancer: A term for more than l 00 diseases in which abnormal cells divide without control. Cancer cells can spread through the bloodstream and lymphatic system to other parts of the body.
Carcinoma (kar-sin-OE-ma): Cancer that begins in the lining or covering of an organ.
Carcinoma in situ (kar-sin-OE-ma in SY-too): Cancer that involves only the tissue in which it began; it has not spread to other tissues. Lobular carcinoma in situ develops in the lobules of the breast. Ductalcarcinoma in situ (also called intraductal carcinoma) arises in the ducts.
Chemotherapy (kee-moe-THER-a-pee): Treatment with anticancer drugs.
Clinical trials: Research studies that involve patients. Each study is designed to answer scientific questions ant to find better ways to prevent or treat cancer.
Colony-stimulating factors: Laboratory-made substances similar to substances in the body that stimulate the production of blood cells. Treatment with colony-stimulating factors can help cells in the bone marrow recover from the effects of chemotherapy and radiation therapy.
Cyst (sist): A closed sac or capsule filled with fluid.
Diaphanography (dy-a-fan-OG-ra-fee): An exam that involves shining a bright light through the breast to reveal features of the tissues inside. This technique is under study; its value in detecting breast cancer has not been proven. Also called transillumination.
Duct: A tube in the breast through which milk passes from the lobules to the nipple. Cancer that begins in a duct is called ductal carcinoma.
Estrogen (ES-troejin): A female hormone.
Gynecologist (guy-ni-KOL-ojist): A doctor who specializes in treating diseases of the female reproductive organs.
Hair follicle (FOL-i-kul): A sac from which a hair grows.
Hormones: Chemicals produced by glands in the body. Hormones control the actions of certain cells or organs.
Hormone receptor test: A test to measure the amount of certain proteins, called hormone receptors, in breast cancer tissue. Hormones can attach to these proteins. A high level of hormone receptors means hormones probably help the cancer grow.
Hormone therapy: Treatment of cancer by removing, blocking, or adding hormones.
Infertility: The inability to have children.
Lobe: A part of the breast; each breast contains 15 to 20 lobes.
Lobule (LOB-yool): A subdivision of the lobes of the breast. Cancer that begins in a lobule is called lobular carcinoma.
Local therapy: Treatment that affects cells in the tumor and the area close to it.
Lumpectomy (lump-EK-toe-mee): Surgery to remove only the cancerous breast lump; usually followed by radiation therapy.
Lymph (limf): The almost colorless fluid that travels through the lymphatic system and carries cells that help fight infection and disease.
Lymph nodes: Small, bean-shaped organs located along the channels of the lymphatic system. Bacteria or cancer cells that enter the lymphatic system may be found in the nodes. Also called lymph glands.
Lymphatic system (lim-FAT-ik): The tissues and organs (including the bone marrow, spleen, thymus, and lymph nodes) that produce and store cells that fight infection and disease. The channels that carry lymph also are part of this system.
Lymphedema (lim-fa-DEE-ma): Swelling of the hand and arm caused by extra fluid that may collect in tissues when underarm lymph nodes are removed or blocked; sometimes called "milk arm."
Malignant (ma-LIG-nant): Cancerous; can spread to other parts of the body.
Mammogram (MAM-o-gram): An x-ray of the breast.
Mammography (mam-OG-ra-fee): The use of x-rays to create a picture of the breast.
Mastectomy (mas-TEK-to-mee): Surgery to remove the breast.
Menopause: The time of a woman's life when menstrual periods stop; also called "change of life."
Menstrual cycle (MEN-stroo-al): The hormone changes that lead up to a woman's having a period. For most women, one cycle takes 28 days.
Metastasis (meh-TAS-ta-sis): The spread of cancer from one part of the body to another. Cells in the metastatic (secondary) tumor are like those in the original (primary) tumor.
Microcalcifications (MY-krow-kal-si-fi-KA-shunz): Tiny deposits of calcium in the breast that cannot be felt but can be detected on a mammogram. A cluster of these very small specks of calcium may indicate that cancer is present.
Oncologist (on-KOL-ojist): A doctor who specializes in treating cancer.
Ovaries (OE-va-reez): The pair of female reproductive organs that produce eggs and hormones.
Palpation (pal-PAY-shun): A simple technique in which a doctor presses on the surface of the body to feel the organs or tissues underneath.
Pathologist (path-OL-ojist): A doctor who identifies diseases by studying cells and tissues under a microscope.
Peripheral stem cell support (per-IF-er-al): A method for replacing bone marrow destroyed by cancer treatment. Certain cells (stem cells) in the blood that are similar to those in bone marrow are removed from the patient's blood before treatment. The cells are given back to the patient after treatment to help the bone marrow recover and continue producing healthy blood cells.
Progesterone (proe-JES-ter-own): A female hormone.
Prognosis (prog-NOE-sis): The probable outcome or course of a disease; the chance of recovery.
Prosthesis (pros-THEE-sis): An artificial replacement of a part of the body. A breast prosthesis is a breast form worn under clothing.
Radiation therapy (ray-dee-AY-shun): Treatment with high-energy rays to kill cancer cells. Radiation therapy that uses a machine located outside the body to aim highenergy rays at the cancer is called external radiation. When radioactive material is placed in the breast in thin plastic tubes, the treatment is called implant radiation.
Radiologist: A doctor who specializes in creating and interpreting pictures of areas inside the body. The pictures are produced with x-rays, sound waves, or other types of energy.
Remission: Disappearance of the signs and symptoms of cancer. When this happens, the disease is said to be "in remission." A remission can be temporary or permanent.
Risk factor: Something that increases a person's chance of developing a disease.
Stage: The extent of the cancer. The stage of breast cancer depends on the size of the cancer and whether it has spread from its original site to other parts of the body.
Stem cells: Cells that produce new cells that become specialized.
Surgery: An operation.
Systemic therapy (sis-TEM-ik): Treatment that reaches and affects cells all over the body.
Thermography (ther-MOG-ra-fee): A test to measure and display heat patterns of tissues near the surface of the breast. Abnormal tissue generally is warmer than healthy tissue. This technique is under study; its value in detecting breast cancer has not been proven.
Tissue (TISH-oo): A group or layer of cells that performs a specific function.
Tumor: An abnormal mass of tissue.
Ultrasonography (ul-tra-son-OG-ra-fee): A test in which sound waves are bounced off tissues and the echoes are converted into a picture (sonogram). These pictures are shown on a monitor like a TV screen. Tissues of different den-sities look different in the picture because they reflect sound waves differently. A sonogram can show whether a breast lump is a fluid-filled cyst or a solid mass.
Xeroradiography (ZEE-roe-ray-dee-OG-ra-fee): A type of mammography in which a picture of the breast is recorded on paper rather than on film.
X-ray: High-energy radiation. It is used in low doses to diagnose diseases and in high doses to treat cancer.
Resources
Information about cancer is available from several sources, including
the ones listed below. You may wish to check for additional
information at your local library or bookstore or from support groups
in your community.
Cancer Information Service (CIS)
The Cancer Information Service, a program of the National Cancer
Institute, provides a nationwide telephone service for cancer
patients and their families and friends, the public, and health
professionals. The staff can answer questions and can send booklets
about cancer. They also know about local resources and services. One
toll-free number, 1-800-4-CANCER (1-800-422-6237), connects callers
all over the country to the office that serves their area.
Spanish-speaking staff members are available.
American Cancer Society (ACS)
The American Cancer Society is a voluntary organization with a
national office and local units all over the country. It supports
research, conducts educational programs, and offers many services to
patients and their families. It provides free booklets on breast
cancer and on sexuality. To obtain booklets or to learn about Reach
to Recovery or other services and activities in local areas, call the
Society's toll-free number, 1-800-ACS-2345 (1-800-227-2345), or the
number listed under American Cancer Society in the white pages of the
local telephone book.
Other Booklets
The National Cancer Institute booklets listed below and others that
deal with breast cancer are available free of charge by calling
1-800-4-CANCER.
Booklets About Cancer Treatment
Booklets About Living With Cancer
Breast Self-Examination (BSE) Instructions
Please open and tear out the BSE chart on the following pages.
For easy reference, tape it on you medicine cabinet or any convenient
location to remind yourself to do BSE. Women taking charge of their
own health are doing BSE regularly. They are also eating healthy
foods and not smoking.
Remember, BSE is not a substitute for routine mammograms or regular breast exams by a doctor.
Breast Self-Examination (BSE) Instructions
Breast Self-Examination
Do breast self-examination (BSE) once a month. Become familiar with
how your breasts usually look an feel. Do BSE to look for any change
from what looks and feels normal for you.
If you still menstruate, the best time to do BSE is 2 or 3 days after your period ends. These are the days when your breasts are least likely to be tender or swollen.
If you no longer menstruate, pick a certain day - such as the first day of each month - to remind yourself to do BSE.
If you are taking hormones, talk with your doctor about when to do BSE.
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