This topic is for women
who have been diagnosed with breast cancer for the first time. If you are
looking for information on breast cancer that has spread or come back after
treatment, see the topic
Breast Cancer, Metastatic or Recurrent.
For male breast cancer, see the topic Breast Cancer in Men.
Breast cancer occurs when abnormal cells grow out of control in one or both
breasts. They can invade nearby tissues and form a mass, called a malignant
tumor. The cancer cells can spread (metastasize) to the
lymph nodes and other parts of the body.
Breast cancer that begins in the ducts of the breast is called ductal carcinoma. It is the most common type of breast cancer. This topic focuses on breast cancer that begins in the ducts.
Breast cancer is many women's worst fear. But experts have made great progress in treating cancer. If it is found early, breast cancer can often be successfully treated, and it is not always necessary to remove the breast.
Doctors don't know exactly what
causes breast cancer. But some things are known to increase the chance that you
will get it. These are called risk factors. Risk factors
that you cannot change include getting older and having changes to certain genes. Risk factors you can change include using certain types of
hormone therapy after menopause, being overweight, and not getting enough physical activity.1
But many women who have risk factors don't get breast cancer. And many women who get breast cancer don't have any
known risk factors other than being female and getting
Breast cancer can
See your doctor right away if you notice any of these
During a regular physical exam, your doctor can check your breasts to look for lumps or changes. Depending on your age and risk factors, the doctor may advise you to have a mammogram, which is an X-ray of the breast. A mammogram can often find a lump that is too small to be felt. Sometimes a woman finds a lump during a breast self-exam.
If you or your doctor finds a lump or another change, the doctor will want to take a sample of the cells in your breast (biopsy). The results of the biopsy help your doctor know if you have cancer and what type of cancer it is.
You may have other tests to find out the stage of the cancer. The stage is a way for doctors to describe how far the cancer has spread. Your treatment choices will be based partly on the type and stage of cancer.
You and your doctor will decide which mix of treatments is right for you based on many things. These include facts about your cancer as well as your family history, other health problems, and your feelings about keeping your breast.
is usually treated with surgery, radiation therapy, chemotherapy, hormone therapy, or targeted therapy.
In some cases, you may need to decide whether to have surgery to remove just the cancer (breast-conserving surgery, or lumpectomy) or surgery that removes the entire breast (mastectomy).
Treatments can cause side effects. Your doctor can let you know what problems to expect and help you find ways to manage them.
When you find out that you have cancer, you may feel many emotions and may need some help coping. Talking with other women who are going through the same thing may help. Your doctor or your local branch of the American Cancer Society can help you find a support group.
At this time, there is no sure way to prevent breast cancer.
Some risk factors, such as your age and being female, cannot be controlled. But you may be able to do things to stay as healthy as you can, such as having a healthy diet and being active. Knowing your risk of getting breast cancer also can help you choose what steps to take.
Talk to your doctor about your risk. Find out when to start
having mammograms and how often you need one. If your doctor confirms that you have a high or very high risk, ask about ways to reduce your risk, such as getting extra screening, taking medicine, or having surgery.
If you have a strong family history of breast cancer,
ask your doctor about genetic testing. A blood test can check for changes in
the BRCA genes that may increase your chance of getting breast cancer and
Learning about breast cancer:
Living with breast cancer:
Health Tools help you make wise health decisions or take action to improve your health.
The exact cause of
breast cancer is not known. A woman's age and health history play a part. The chances
that you will get breast cancer increase as you age. In the United States,
1 woman out of 8 will be diagnosed with breast cancer at some
point in her life.2
To learn more, see What Increases Your Risk.
The first sign of
breast cancer is often a painless lump. But early
breast cancer is often found on a
mammogram before a lump can be felt.
Other symptoms of breast cancer may not appear until the cancer is more
advanced. These include:
Symptoms such as changes in the skin of the breast or the nipple may be a sign of inflammatory breast cancer. For more information, see the topic
Inflammatory Breast Cancer.
occurs when cells in the breast grow abnormally. As the breast cancer grows, it
can spread to nearby tissues and
lymph nodes. Advanced breast cancer can affect the bones, liver, and brain.
Your doctor will find out more about your breast cancer when
the cancer cells are examined under the microscope. Tests for hormone receptors and gene changes are usually done after surgery. For the tests, your doctor uses tissue taken from your breast.
Your doctor will also stage the cancer to see how far it has spread within
the breast, to nearby tissues, and to other organs. Your doctor will find the stage by using tests, such
as chest X-rays or CT scans. The stage of your cancer will help guide your treatment
Although the exact cause of
breast cancer is not known, most experts agree that several things can increase your risk of breast cancer.
For more information about your personal risk level, go
Call your doctor if you have:
Health professionals who can perform a breast exam include
Mammograms are usually read by
You may see a general surgeon, a breast surgeon, or a
radiologist if further evaluation of a breast problem is needed.
Breast cancer is treated by surgeons,
medical oncologists, and
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You may have a screening test to look for breast cancer. (Screening tests help your doctor look for a certain disease before any symptoms appear.) The earlier
breast cancer is found, the more easily and
successfully it can be treated.
type and frequency of breast cancer screening that is best for you changes as
you age. The most common ways to find breast cancer early include:
If your doctor thinks that you
have breast cancer, you may have other tests, including:
If your doctor thinks that breast cancer may have spread
to other organs in your body (metastasized), he or she may order additional
testing, including a bone scan or CT scans.
If you have had breast cancer in one breast, you have an increased risk for developing breast cancer again. Breast cancer can come back in the same breast, on the chest wall, in your other breast, or somewhere else in your body. You can expect to have:
If you find any unusual changes in the treated area or in your other breast, or if you have swollen lymph glands or bone pain, call your doctor to discuss these changes. For more information, see the topic Breast Cancer, Metastatic or Recurrent.
It is important to know what your breasts normally look and feel like. When you know what is normal for you, you are better able to notice changes. Tell your doctor right away if you notice any changes in your breasts.
When making decisions about treatment, you and your doctor will consider many things, such as your age and health, the type of breast cancer you have, and how likely it is to spread.
Breast cancer is usually treated with surgery, radiation therapy, chemotherapy, hormone therapy, or targeted therapy.
In some cases, chemotherapy or hormone therapy is used before surgery to shrink the breast cancer. This may mean that less breast tissue has to be removed during surgery.
Depending on the tumor's size and whether cancer has spread to your lymph nodes, you may have several treatment options. Hormone therapy, chemotherapy, or a combination of the two treatments may be used after surgery to destroy any remaining cancer cells. This also lowers the chances that the cancer will come back. Your doctor may suggest gene tests to find out if chemotherapy will help.
Treatments can have side effects, such as nausea and vomiting and hair loss. For more information on how to manage side effects, see Home Treatment.
Additional information about breast cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/breast.
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.
If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.
Having cancer can change your life in many ways. For support in managing these changes, see the topic
Getting Support When You Have Cancer.
Your feelings about your body may change
after treatment for breast cancer. Managing body image issues may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may be able to refer you to groups that can offer support and information.
Sexual problems can be caused by the physical or emotional effects of cancer or its treatment. Some women may feel less sexual pleasure or lose their desire to be intimate. For more information, see the topic Sexual Problems in Women.
After the initial treatment for
breast cancer, you may see your
radiation oncologist, or
surgeon at regularly scheduled intervals, depending on
your individual situation. Your checkups will happen less often as time goes by.
As part of your follow-up, you may have regular physical exams and mammograms.
It's also important to do
regular self-exams. That way, if the cancer does come back, you have a better chance of finding it early enough for successful treatment. Early signs
of recurrence may appear in the incision area itself, the opposite breast,
under your arm, or in the area above the collarbone.
problems develop, you may have additional tests, such as blood tests,
CT scans, or
If your breast cancer tested positive for estrogen and progesterone receptors, your doctor may prescribe medicines that can lower your risk of the cancer coming back. For more information, see Medications.
information about the treatment of metastatic or recurrent breast cancer, see
Breast Cancer, Metastatic or Recurrent.
You cannot control some things that put you
at risk for
breast cancer, such as your age and being female. But
you can make personal choices that lower your risk of breast cancer.
If you are concerned about your risk for breast cancer, talk with your doctor. He or she can help you understand your risk if you have a strong family history of breast cancer. Based on your risk, your doctor will recommend a screening schedule for you.
Your doctor may talk with you about genetic testing, the risks and benefits of taking hormone therapy, or even surgery if your risk is very high.
For more information, see:
The side effects of breast cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects, such as medicines to control and prevent nausea and vomiting.
Other problems that can be treated at home include:
Medicines are used to treat breast cancer and also to help relieve side effects of treatment.
of medicines is typically used to treat breast cancer. The number of
cycles of treatment will depend on the medicines that are used and how the
medicines are given. Chemotherapy often uses several medicines together. Some of the most commonly used medicines
side effects of chemotherapy depend mainly on the medicines you receive. As
with other types of treatment, side effects vary from person to person. Your doctor may also prescribe medicines to control and prevent nausea and vomiting.
Tamoxifen or an
aromatase inhibitor is recommended for
estrogen receptor-positive (ER+) breast cancer. These
medicines stop estrogen from fueling ER+ breast cancer.
Hormone-blocking treatments, such as tamoxifen or an
aromatase inhibitor, may cause fewer side effects than chemotherapy. If you are deciding
what type of medicine to use, weigh the benefits and risks of these medicines for your type of cancer.
Targeted therapies use medicines or substances that go directly to the cancer cells and don't harm normal cells. They include
monoclonal antibodies and tyrosine kinase inhibitors.
Most people with
breast cancer have surgery to remove the cancer. You may have breast-conserving surgery or surgery to remove the entire breast. Some of the lymph nodes under the arm may also be removed to check for cancer cells.
The kind of surgery you have may depend on the size and location of your cancer and your personal preferences.
Talk to your doctor about what your breast might look like after
Mastectomy procedures include:
After mastectomy, a new breast can be reconstructed. Your surgeon will rebuild the shape of your breast using artificial implants or tissue from other parts of your body.
If you want breast reconstruction, talk to your doctor before your surgery is planned. You may be able to have breast reconstruction immediately following your mastectomy.
Or your doctor may suggest that you wait until later for breast reconstruction if you are going to have further treatment, such as radiation. If so, you may want to use a breast prosthesis until you have your reconstruction.
For more information about
reconstructive surgery, see the topic
Cosmetic Surgery and Procedures.
Radiation treatment is the use of high-energy X-rays to destroy cancer cells and
shrink tumors. It lowers the risk of your cancer coming back in the breast or
chest wall. Radiation therapy is used after breast-conserving surgery and
sometimes after mastectomy, depending on how advanced the
breast cancer is at the time of surgery.
The way radiation therapy is
given will depend on the type and stage of your cancer.
The most common way to
give radiation treatment is called external beam radiation. This method of treatment exposes the skin on the chest and
under the arm to a carefully focused beam of radiation.
Sometimes tiny radioactive
pellets are placed in or near the tumor site. This is called brachytherapy, internal radiation, or
Brachytherapy is often used with external
Radiation treatment can cause many side effects. Your breast may swell and feel heavy. Fatigue is common. For information about managing side effects, see Home Treatment.
You may be interested in participating in
research studies called clinical trials. Clinical trials are designed to find
better ways to treat cancer patients and are based on the most up-to-date
information. Women who want to help with breast cancer research and those who are not cured using
standard treatments may want to participate in clinical trials. These are
ongoing in most parts of the United States and in some other countries for all
stages of breast cancer.
Check with your doctor to see
whether clinical trials are available in your area and whether you might be
People sometimes use complementary therapies
along with medical treatment to help relieve symptoms and side effects of
cancer treatments. Some of the complementary therapies that may be helpful
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
FORCE is an organization that provides educational and emotional support for women who are making decisions about surgery to prevent breast or ovarian cancer because they are at high risk. This website also has resources for women who have cancer and are concerned about their cancer coming back. There are online resources as well as a helpline, newsletters, and information on local groups and annual conferences.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free number have information about services and activities
in local areas and can provide referrals to local ACS divisions.
Breastcancer.org is a website dedicated to helping women
understand breast cancer and make good decisions about their treatment. This
site provides information from medical professionals on all aspects of
breast cancer, from screening and surgery to sex and intimacy. The site also offers links
to chat rooms, discussion boards, and "Ask the Expert" online conferences.
The National Breast Cancer Coalition (NBCC)
asks the government for increased funding for breast cancer research. The NBCC
also works with researchers to advance the science of breast cancer research
and to improve access to high-quality health care and breast cancer clinical
trials for women. This website offers news and research on breast cancer. It also has information about current controversies in breast cancer and provides expert opinions.
The NBCC has a sister organization, the National Breast
Cancer Coalition Fund (NBCCF). Together these two groups help women take a leadership role
among government leaders, scientists, and doctors.
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people who have cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
The National Lymphedema Network (NLN) provides education and
guidance to people with lymphedema, health professionals, and the general
public. The NLN provides information on the prevention and management of
primary and secondary lymphedema and supports research to find causes and
treatments for lymphedema.
CitationsAmerican Cancer Society (2011). Breast cancer: Early detection. Available online: http://www.cancer.org/acs/groups/cid/documents/webcontent/003165-pdf.pdf.National Cancer Institute (2010). SEER Stat Fact Sheets: Breast from SEER Cancer Statistics Review, 1975–2007. Bethesda, MD: National Cancer Institute. Available online: http://seer.cancer.gov/statfacts/html/breast.html.National Cancer Institute (2006). Probability of
breast cancer in American women. National Cancer Institute Fact Sheet. Available online:
http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer.Dizon DS, et al. (2009). Breast cancer. In RR Barakat et al., eds., Principles and Practice of Gynecologic Oncology, 5th ed., pp. 897–945. Philadelphia: Lippincott Williams and Wilkins.Wolff AC, et al. (2007). American Society of Clinical Oncology/College of American Pathologists Guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Journal of Clinical Oncology, 25(1): 118–145.Other Works ConsultedAmerican Cancer Society (2009). Breast Cancer Facts and Figures 2009–2010. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@nho/documents/document/f861009final90809pdf.pdf.Golshan M (2010). Mastectomy. In JR Harris et al., eds., Diseases of the Breast, 4th ed., pp. 501–506. Philadelphia: Lippincott Williams and Wilkins.Morrow M, Harris JR (2010). Ductal carcinoma in situ and microinvasive carcinoma. In JR Harris et al., eds., Diseases of the Breast, 4th ed., pp. 349–362. Philadelphia: Lippincott Williams and Wilkins.National Cancer Institute (2010). Lymphedema PDQ—Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/supportivecare/lymphedema/healthprofessional.National Cancer Institute (2011). Breast Cancer PDQ: Treatment – Health Professional Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/breast/HealthProfessional.National Cancer Institute (2011). Breast Cancer PDQ: Treatment—Patient Version. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient.National Cancer Institute (2011). Male Breast Cancer Treatment PDQ—Health Professional Version. Available online: http://nci.nih.gov/cancertopics/pdq/treatment/malebreast/HealthProfessional.National Cancer Institute (2011). Male Breast Cancer Treatment PDQ—Patient Version. Available online: http://nci.nih.gov/cancertopics/pdq/treatment/malebreast/Patient.National Comprehensive Cancer Network (2011). Breast cancer risk reduction. NCCN Clinical Practice Guidelines in Oncology, Version 1. Available online: http://www.nccn.org/professionals/physician_gls/pdf/breast_risk.pdf.National Comprehensive Cancer Network (2011). Breast cancer screening and diagnosis. NCCN Clinical Practice Guidelines in Oncology, Version 1. Available online: http://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf.National Comprehensive Cancer Network (2011). Breast cancer. NCCN Clinical Practice Guidelines in Oncology, Version 2. Available online: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.Patel SA, Topham NS (2010). Breast reconstruction. In JR Harris et al., eds., Diseases of the Breast, 4th ed., pp. 529–539. Philadelphia: Lippincott Williams and Wilkins. U.S. Preventive Services Task Force (2009). Screening for breast cancer. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm.Willett WC, et al. (2010). Nongenetic factors in causation of breast cancer. In JR Harris et al., eds., Diseases of the Breast, 4th ed., pp. 248–290. Philadelphia: Lippincott Williams and Wilkins.
October 22, 2012
E. Gregory Thompson, MD - Internal Medicine & Catherine D. Serio, PhD - Behavioral Health
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