What is breast cancer?
Women have a 1-in-70 chance of getting breast cancer at age 40, and the risk through a woman’s whole life is 1 in 8. Less than 1 percent of breast cancer cases happen in men. The chances of getting breast cancer go up as you get older.
Types of Breast Cancer
There are many types of breast cancer. Without treatment, the most common types will form a lump called a tumor.
The most common type for both men and women starts in the lining of the milk ducts of the breast and is called ductal carcinoma. The second most common type for women starts in the lobes, which are the glands that make milk, and is called lobular carcinoma. Other types of breast cancer include:
- Tubular carcinoma
- Medullary carcinoma
- Papillary carcinoma
- Cribriform carcinoma
- Inflammatory breast cancer
- Paget’s disease of the nipple
- Phyllodes tumors
When to See a Doctor
Starting at age 40, women need to see a doctor every year for a check-up and a kind of x-ray of the breast called a mammogram [MAM-uh-gram]. Women who are at high risk of getting breast cancer may also need to get a breast MRI.
Beyond a routine check-up, you should see your doctor soon if you notice one or more the symptoms of breast cancer that are listed above.
The signs of breast cancer are shared by other medical problems such as infections or cysts. Even if your symptom turns out not to be caused by breast cancer, it is always important to have changes in your breast checked as soon as possible.
Men who have one or more symptoms of breast cancer described above should see a doctor to have an exam.
What to Expect
If your doctor thinks you may have breast cancer, they will order a biopsy. The biopsy results, if they show that you have cancer, will guide the start of your treatment plan. The results report can tell you what type of breast cancer it is, if it is invasive, and other details.
Finding the stage of your cancer will also help to guide your treatment plan. The stages are 0, I, II, III, and IV. The stage is judged by how big the cancer is and whether it:
- Is in situ or invasive.
- Has spread to the lymph nodes.
- Has spread to another body part.
The earliest stage, Stage 0, is used for cancer that is in situ, which means that it is not invasive. From Stage I on, the cancer is invasive, meaning it has moved into the tissue around the original site. At Stage IV, the cancer has moved into another part of the body.
After finding out you have breast cancer, your next visit will most likely be with a breast surgeon. They will talk to you about what kind of surgery you need to remove the cancer. You may also want to talk about breast reconstruction with a plastic surgeon before your surgery.
Unless it is clear that your stage is 0 or IV, your doctor will probably tell you that you have early or late stage breast cancer, and the specific stage will be diagnosed after you have surgery to remove the cancer and some of the nearby lymph nodes.
Understanding Breast Cancer
Symptoms
Because there are many kinds of breast cancer, the symptoms can vary. Very early on, you may not have any symptoms.
Breast cancer symptoms that you should look for on your own include:
- Swelling
- Skin redness or irritation
- Thickening of the skin
- Dimpling of the skin
- Pain, in the breast or nipple
- Changes in the nipple, such as it turning inward
- Discharge from the nipple that’s not breast milk
- A lump in the breast, in or near the armpit, or near the collar bone
Breast Cancer Awareness
To get an idea of how your breast feels and looks normally, it is a good idea to do a self-exam every month. Changes in your body, including breastfeeding and aging, can change the way your breasts look and feel. Some doctors recommend doing this exam within 2 or 3 days of your period’s end. Talk with your doctor about what is timing is right for you, and make a habit of it.
A more important part of breast cancer awareness is seeing your doctor regularly to be screened for breast cancer. This screening will involve an exam of your breast by your doctor, and it may also include a mammogram, an ultrasound, or an MRI of your breast.
Causes
What makes a cell grow out of control is called a gene mutation. Most of the time, doctors don’t know what causes a mutation. Some women get a gene mutation such as BRCA [BRAK-uh] from a parent. Having it does not mean that you have or will get breast cancer, but it increases your risk.
When they start to form, cancer cells grow faster than healthy cells. Most of the time, they form a lump called a tumor. It’s important to remember that any cell is very, very tiny. It often takes many years for a cancer cell to grow (by one cell splitting into two cells) to become a lump.
When the lump gets big enough, it can break out of the place it started and spread into the tissue around it. This makes it invasive cancer, which is Stage 1. Sometimes a single cell can break off from the tumor and start to travel through the body. Most of the time, it travels in a fluid called lymph, which is why your surgeon will likely remove some of your lymph nodes to check for cancer.
This traveling through the breast and possibly into another body part can take years. When you are first diagnosed with breast cancer, you will most likely have time to make important decisions about the treatment plan that is right for you.
Diagnosis and Tests
If your doctor thinks that you might have breast cancer, they will order diagnostic testing. If you found the possible problem, you might start with a mammogram, an ultrasound, or an MRI of your breast. Younger women with denser breast tissue tend to get clearer pictures with an ultrasound.
Biopsy Tests
If a mammogram or ultrasound shows a possible problem, then your doctor will order a breast biopsy. A biopsy is a procedure where a sample of the affected tissue will be removed for testing. After taking a sample, the doctor will often place a metal clip next to the tumor to help with future study.
The test on your sample will be done by a kind of doctor called a pathologist [puh-THOL-uh-jist] who will write a report with your biopsy results.
The details in your report will include:
- What type of cancer it is
- If it has invaded the normal tissue around it
- What the grade is (how active the cancer cells are)
- What kind of hormone receptors your cancer has
The writing on the report can seem very technical. It’s okay to ask for help understanding it. Your doctor can explain what the report says.
The good news is that 8 out of 10 breast biopsies done in the U.S. show no cancer, but it’s always important to check.
Other Tests
Other tests might be done to help guide your treatment plan. Some of the tests you might have done include:
- Genetic testing. Before your surgery, you might have genetic testing done. This test will tell you if you have a known gene mutation that puts you at higher risk for breast cancer, such as a BRCA gene mutation. (Knowing your risk can help you decide on what kind of surgery you want.)
- Genomic [ji-NOH-mik] testing. This can also be called tumor profiling. After your surgery, the cancer cells that were taken out of you might be sent to a lab for genomic testing. This test will give you a score, which is a number that can help you and your doctor decide if chemotherapy or other approaches are right for you.
- Imaging studies. Before your biopsy, you had a mammogram or an ultrasound done on your breasts. An MRI or a CT scan might be needed to give your doctor another picture.
- PET scan. For this test, you will be given an injection or a drink with that has both radioactive material and sugar. Cancer cells will pick up the sugar faster than regular cells. This test can find cancer in the body because the radioactive material that was absorbed with the sugar will light up in a PET scan.
Prevention
Preventing breast cancer is difficult. First, you have to understand your risk factors. Women under 40 have a very small chance of getting breast cancer. Throughout a long life, this chance goes up to about 12 percent.
Some risk factors are things that you can control. Making healthy decisions about the following risk factors will lower your risk:
- Weight
- Diet
- Exercise level
- Alcohol consumption
- Smoking
- Exposure to estrogen
Risks that you can’t change include:
- Your age (risk goes up as we age because of wear and tear on the body)
- Starting your period very young, before age 12
- Going through menopause after 55
- Having a gene mutation such as BRCA1 or BRCA2
Some women are at higher risk because they have inherited a gene mutation. If you have a strong family history of breast cancer, you might have a gene mutation. You can have genetic testing done to find out for sure. Talk to your doctor to find out more about genetic testing.
If you have a strong family history of or a gene mutation that might cause breast cancer, your doctor might prescribe a hormonal therapy medicine for you. Another option to greatly lower your risk is a surgery called prophylactic [proh-fuh-LAK-tik] (meaning preventive) mastectomy.
Practicing breast cancer awareness by doing a self-exam each month and seeing your doctor each year will not prevent breast cancer. But it might help find breast cancer in its early stages. Survival rates for women 5 years after treatment are nearly 100 percent for Stage 0 and Stage I.