Breast Cancer: Breast Cancer Treatment

There are two major goals of breast cancer treatment:

1) To rid the body of the cancer as completely as possible.
2) To prevent cancer from returning.

How Is Treatment Determined?

The type of treatment recommended to you by your cancer specialist will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells and the stage or extent of the disease. Your doctor usually considers your age and general health as well as your feelings about the treatment options.

Be sure to discuss your treatment options with your cancer specialist.
What Are the Types of Breast Cancer Treatment?

Breast cancer treatments are local or systemic.

Local treatments are used to remove, destroy or control the cancer cells in a specific area, such as the breast. They include:

* Surgery, either mastectomy or lumpectomy also called breast conserving therapy or partial mastectomy) with or without lymph node removal.
* Radiation therapy

Systemic treatments are used to destroy or control cancer cells all over the body. They include:

* Chemotherapy which uses drugs to to kill cancer cells. Side effects can include nausea, hair loss, early menopause, hot flashes, fatigue and temporarily lowered blood counts.
* Hormone therapy , including tamoxifen, and the aromatase inhibitors Arimidex, Aromasin and Femara. Hormone therapy uses drugs to prevent hormones, especially estrogen, from promoting the growth of breast cancer cells that may remain after breast cancer surgery. Side effects can include hot flashes and vaginal dryness.
* Biological Therapy such as Herceptin, works by using the body's immune system to destroy cancer cells. Herceptin targets breast cancer cells that have high levels of a protein called HER2.

Systemic therapy can be given after local treatment (adjuvant therapy) or before (neoadjuvant therapy). Adjuvant therapy is used after local treatments to kill any cancer cells that remain in the body and may be in other parts of the body.

A patient may have just one form of treatment or a combination, depending on her needs.
Tips to Remember about Choosing Breast Cancer Treatment

Although there are some typical treatment regimens used to treat breast cancer, women do have choices.

* Be sure to discuss with your doctor all the risks and benefits of each option and how they relate to your own lifestyle.
* Consider joining a support group to help you address the emotional issues surrounding your diagnosis and in choosing therapy.
* Ask your doctor about participating in a clinical trial.

Breast Problems

Breast lumps or changes are a common health worry for most women. Women may have many kinds of breast lumps and other breast changes throughout their lives, including changes that occur with menstrual periods, pregnancy, and aging. Most breast lumps and breast changes are normal.



Common, noncancerous (benign) breast changes include:

* Sacs filled with fluids (cysts).
* Generalized breast lumpiness.
* Painless, movable, and firm round lumps (fibroadenomas).
* Damaged fatty tissue (fat necrosis).
* Growths inside the ducts (intraductal papillomas).
* Enlargement of lymph nodes in the breast.
* Breast pain (mastalgia).
* Breast infections (mastitis) or abscesses.
* Nipple discharge.
* Inflamed blood vessels (thrombophlebitis).

Breast development is the first sign of puberty in young girls. Usually, breasts begin as small, tender bumps under one or both nipples that will get bigger over the next few years. It is not unusual for one breast to be larger than the other or for one side to develop before the other. A girl may worry that a lump under the nipple is abnormal or a sign of a serious medical problem when it is a part of normal breast development.

In men, enlargement of male breast tissue (gynecomastia) is a noncancerous breast change. During puberty, young men commonly have smooth, round lumps or "breast buds" under the nipple. These develop because of rapid changes in hormone levels. They are not dangerous and usually disappear in a few months.

Many women with breast pain or breast lumps worry about breast cancer. The incidence of breast cancer in the United States has gradually increased during the past 30 years and is the second leading cause of cancer deaths in women. Breast cancer represents approximately 30% of new cancer diagnosed in women. Approximately 1 man gets breast cancer for every 100 cases of breast cancer in women.

The earlier breast cancer is detected, the more easily and successfully it can be treated.

There are 2 methods of early detection:

* Clinical breast examination (CBE). During your routine physical examination, your doctor may do a clinical breast examination. During a CBE, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes.
* Mammogram. A mammogram is an X-ray of the breast that can often find tumors that are too small for you or your doctor to feel. Most women should begin having mammograms at the age of 40. If you are younger than age 40 and have risk factors for breast cancer, talk with your doctor about starting screening before age 40.

Breast self-examination (BSE) involves checking your breasts for lumps or changes while standing and lying in different positions and while looking at your breasts in a mirror. Once you know what your breasts normally look and feel like, any new lump or change in appearance should be evaluated by a doctor. Most breast problems or changes are not caused by cancer. However, BSE should not be used in place of clinical breast examination and mammography. Studies have not shown that BSE alone reduces the number of deaths from breast cancer.

One of the biggest risk factors for breast cancer is age. Breast cancer is a common disease in women older than 50. At least 1 out of every 8 women in the United States will develop breast cancer if she lives long enough. The chance that a woman will develop breast cancer by age 30 is about 1 in 250. The risk that a woman will develop breast cancer by age 40 is about 1 in 70.1

Early breast cancer is often seen on a mammogram before there are any symptoms. The most common symptom of breast cancer is a painless lump. However, sometimes painful lumps are cancerous. Other symptoms of breast cancer include:

* A lump or thickening in the breast or armpit that is new or unusual.
* A change in the size or shape of the breast.
* Skin changes, such as a dimple or pucker in the skin of the breast.
* Discharge or bleeding from the nipple that comes out without squeezing the nipple (spontaneous discharge).
* A change in the nipple.
* Scaling or crusting of the nipple.
* A change in the color or feel of the skin of the breast or the darker area around the nipple (areola).
* A breast lump in a man.

Treatment of a breast problem depends on the cause of the problem.

Breast Cancer Screening

Breast Cancer Screening (PDQ) - Breast Cancer Screening

Different tests are used to screen for cancer.

Some screening tests are used because they have been shown to be helpful both in finding cancers early and in decreasing the chance of dying from these cancers. Other tests are used because they have been shown to find cancer in some people; however, it has not been proven in clinical trials that use of these tests will decrease the risk of dying from cancer.

Scientists study screening tests to find those with the fewest risks and most benefits. Cancer screening trials also are meant to show whether early detection (finding cancer before it causes symptoms) decreases a person’s chance of dying from the disease. For some types of cancer, finding and treating the disease at an early stage may result in a better chance of recovery.

Clinical trials that study cancer screening methods are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site.

Three tests are commonly used to screen for breast cancer:

Mammogram

A mammogram is an x-ray of the breast. This test may find tumors that are too small to feel. A mammogram may also find ductal carcinoma in situ, abnormal cells in the lining of a breast duct, which may become invasive cancer in some women. The ability of a mammogram to find breast cancer may depend on the size of the tumor, the density of the breast tissue, and the skill of the radiologist.

Clinical breast exam (CBE)

A clinical breast exam is an exam of the breast by a doctor or other health professional. The doctor will carefully feel the breasts and under the arms for lumps or anything else that seems unusual.

Breast self-exam (BSE)

Breast self-exam is an exam to check your own breasts for lumps or anything else that seems unusual.

If a lump or other abnormality is found using one of these 3 tests, ultrasound may be used to learn more. It is not used by itself as a screening test for breast cancer. Ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

New screening tests are being studied in clinical trials.

MRI (magnetic resonance imaging)

MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI). Screening trials of MRI in women with a high genetic risk of breast cancer have shown that MRI is more sensitive than mammography for finding breast tumors.

MRI scans are used to make decisions about breast masses that have been found by a clinical breast exam or a breast self-exam. MRIs also help show the difference between cancer and scar tissue. MRI does not use any x-rays.

Tissue sampling

Breast tissue sampling is taking cells from breast tissue to examine under a microscope. Abnormal cells in breast fluid have been linked to an increased risk of breast cancer in some studies. Scientists are studying whether breast tissue sampling can be used to find breast cancer at an early stage or predict the risk of developing breast cancer. Three methods of tissue sampling are under study:

* Fine-needle aspiration: A thin needle is inserted into the breast tissue around the areola (darkened area around the nipple) to withdraw cells and fluid.
* Nipple aspiration: The use of gentle suction to collect fluid through the nipple. This is done with a device similar to the breast pumps used by nursing women.
* Ductal lavage: A hair-size catheter (tube) is inserted into the nipple and a small amount of salt water is released into the duct. The water picks up breast cells and is removed.

Breast Cancer

Breast Cancer Facts

What Is Breast Cancer?

Each month, a woman's breasts go through temporary changes associated with menstruation, and a lump may form. While the vast majority of these growths are not cancerous, any lump should be examined immediately.

Lumps are most common in the lobules -- small sacs that produce milk -- or the ducts that carry milk to the nipple. But they occasionally start in other tissue. The two main categories of breast cancer are lobular and ductal carcinomas.



Breast cancer usually begins with the formation of a small, confined tumor. Some tumors are benign, meaning they do not invade other tissue; others are malignant, or cancerous. Malignant tumors have the potential to metastasize, or spread. Once such a tumor grows to a certain size, it is more likely to shed cells that spread to other parts of the body through the bloodstream and lymphatic system. Different types of breast cancer grow and spread at different rates; some take years to spread beyond the breast, while others move quickly.

Men can get breast cancer, too, but they account for less than one-half of one percent of all cases. Among women, breast cancer is the most common cancer and the second leading cause of cancer deaths -- behind lung cancer.

If eight women were to live to be at least 85, one of them would be expected to develop the disease at some point during her life. Two-thirds of women with breast cancer are over 50, and most of the rest are between 39 and 49.

Fortunately, breast cancer is very treatable if detected early. Localized tumors can usually be treated successfully before the cancer spreads; and in nine in 10 cases, the woman will live at least another five years. Experts usually consider a five-year survival to be a cure.

Once the cancer begins to spread, getting rid of it completely is more difficult, although treatment can often control the disease for years. Improved screening procedures and treatment options mean that at least seven out of 10 women with breast cancer will survive more than five years after initial diagnosis, and half will survive more than 10 years.

What Causes Breast Cancer?

Although the precise causes of breast cancer are unclear, we know what the main risk factors are. Still, most women considered at high risk for breast cancer do not get it, while many who do have no known risk factors. Among the most significant factors are advancing age and a family history of breast cancer. Risk increases slightly for a woman who has had a benign breast lump and increases significantly for a woman who has previously had cancer of the breast or the ovaries.

A woman whose mother, sister, or daughter has had breast cancer is two to three times more likely to develop the disease, particularly if more than one first-degree relative has been affected. Researchers have now identified two genes responsible for some instances of familial breast cancer -- called BRCA1 and BRCA2. About one woman in 200 carries it. Having the gene predisposes a woman to breast cancer but does not ensure that she will get it.

Generally, women over 50 are more likely to get breast cancer than younger women, and African-American women are more likely than Caucasions to get breast cancer before menopause.

A link between breast cancer and hormones is gradually becoming clearer. Researchers think that the greater a woman's exposure to the hormone estrogen, the more susceptible she is to breast cancer. Estrogen tells cells to divide; the more the cells divide, the more likely they are to be abnormal in some way, possibly becoming cancerous.

A woman's exposure to estrogen and progesterone rises and falls during her lifetime, influenced by the age she starts and stops menstruating, the average length of her menstrual cycle, and her age at first childbirth. A woman's risk for breast cancer is increased if she starts menstruating before age 12, has her first child after 30, stops menstruating after 55, or has a menstrual cycle shorter or longer than the average 26-29 days. Current information indicates that the hormones in birth control pills probably do not increase the risk. Some studies suggest that taking hormone replacement therapy after menopause may increase risk, especially when taken for more than 5 years. The jury is still somewhat out on this matter though. Heavy doses of radiation therapy may also be a factor, but low-dose mammograms pose almost no risk.

The link between diet and breast cancer is debated. Obesity is a noteworthy risk factor, and drinking alcohol regularly -- more than a couple of drinks a day -- may promote the disease. Many studies have shown that women whose diets are high in fat are more likely to get the disease. Researchers suspect that if a woman lowers her daily calories from fat -- to less than 20%-30% -- her diet may help protect her from developing breast cancer.

Breast Cancer Symptoms & Signs

What Are the Symptoms of Breast Cancer?

In its early stages, breast cancer usually has no symptoms. As a tumor develops, you may note the following signs:

* A lump in the breast or underarm that persists after your menstrual cycle; often the first apparent symptom of breast cancer, breast lumps are painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
* Swelling in the armpit.
* Although lumps are usually painless, pain or tenderness in the breast can be a sign of breast cancer.
* A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.
* Any change in the size, contour, texture, or temperature of the breast; a reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
* A change in the nipple, such as an indrawn or dimpled look, itching or burning sensation, or ulceration; scaling of the nipple is symptomatic of Paget's disease, a localized cancer.
* Unusual discharge from the nipple that may be clear, bloody, or another color. It's usually caused by benign conditions but could be due to cancer in some cases.
* A marble-like area under the skin.
* An area that is distinctly different from any other area on either breast.

Call Your Doctor If:

* One or both breasts develop an abnormal lump or persistent pain, or look or feel abnormal. The cause often is something other than cancer but should be identified.
* You have swollen lymph glands in your armpits. Any such swelling could be associated with cancer.