No one wants to hear the words: “You have cancer.” But about 1 in 8 American women will learn they have breast cancer, according to the Centers for Disease Control and Prevention.
“Breast cancer, which is the most common form of cancer in women after skin cancer, occurs when cells grow out of control and mutate to become cancerous,” explains Dr. Linnea I. Chap, a board-certified medical oncologist and director of breast cancer and women’s oncology with the Beverly Hills Cancer Center in California.
If you’ve recently gotten the news that breast cancer is part of your story, read on for more details about what’s happening in your body and what’s ahead for your health.
[READ: Surprising Breast Cancer Risk Factors]
The Signs and Symptoms of Breast Cancer
Breast cancer doesn’t always produce obvious signs and symptoms, but some common indications that you might have breast cancer include:
— A lump or thickness in or near the breast or under the arm
— An unexplained change in the size of the breast, particularly on one side only
— Dimpling or puckering of the breast
— Nipple discharge that is not breast milk and occurs without squeezing the nipple
— Changes to the skin, including redness, flaking, thickening or pitting that makes it look like an orange rind
— Changes to the nipple that make it appear red, thick, scaly or sunken
Some of these symptoms can also occur because of benign conditions.
“However, any persistent changes or unusual symptoms should be evaluated by a health care professional,” says Dr. Hang T. Dang, a breast surgical oncologist and medical director of the breast oncology program at Providence St. Joseph Hospital in Orange County, California.
[Read: Where to Go for Cancer Treatment.]
What Factors Might Increase My Risk of Breast Cancer?
Many factors can contribute to your risk of developing breast cancer, including:
— Age. The median age at diagnosis among breast cancer patients is 62, according to the National Cancer Institute.
— Genetics. There are more than a dozen genes that can substantially raise the risk for developing breast cancer. The most well-known genes associated with hereditary breast cancer are the BRCA1 and BRCA2 gene, which may also contribute to the development of ovarian cancer. Mutations on other genes have also been associated with breast cancer; these include PTEN, TP53, PALB2, BRIP1, ATM, CHEK2, CDH1, STK11 and NF1.
— Personal and family history. If you or someone in your family has had breast cancer, your risk of developing the disease rises. People with a family history of ovarian or prostate cancer may also have a higher risk of developing breast cancer.
— Hormones. People who begin menstruating prior to age 12 and those who enter menopause after age 55 have more lifetime exposure to hormones that can elevate risk for certain types of breast cancer. Taking birth control pills, getting pregnant after age 30 and not getting pregnant at all may also impact your breast cancer risk.
— Breast density. People with dense breast tissue have higher rates of breast cancer because it may be more difficult to detect on routine mammograms.
— Weight. People with obesity are at higher risk of developing cancer because adipose tissue, or fat, secretes hormones and increases inflammation in the body that can contribute to the development of cancer.
— Diet. Not only can diet lead to weight gain, but eating certain foods, such as highly processed items that contain excess sugar, may also increase your risk of breast cancer. Cancer cells love to feed on sugar, so some experts say removing excess sugar from your diet could help you avoid breast cancer.
— Vitamin D levels. People with lower levels of vitamin D in their diet and their body may be more likely to develop breast cancer.
— Environmental exposures. Certain environmental factors can also influence breast cancer risk, including exposure to radon (a radioactive gas), certain industrial chemicals, air pollution and other compounds.
— Radiation exposure. Previous radiation treatment to the chest area, especially during childhood or adolescence, can increase risk of breast cancer later in life.
In most cases, it’s believed that a combination of factors contribute to the development of breast cancer.
“It’s important for individuals with a family history of breast cancer and other risk factors to discuss their risk with (their) health care provider and consider genetic counseling and testing if appropriate,” Dang says.
A recent study from Stanford University suggests that genes and genetic factors may play a greater role than was previously thought. Researchers pointed to a new class of biomarkers that may predict the type of tumor a person is likely to develop. This capability could in turn lead to improved screening protocols and better treatments in the future.
How Is Breast Cancer Diagnosed?
Diagnosing breast cancer is typically a multistage process. It sometimes starts with a clinical exam, during which your provider will check your breasts and lymph nodes for lumps, changes in breast shape, changes in skin texture or nipple abnormalities. but most breast cancers are diagnosed during routine screening mammography. Self-breast exams are only 65% accurate, and mammograms are about 85% accurate.
There are several imaging test options available, including:
— Mammography. A mammogram uses X-rays to make pictures of the breast that may reveal lumps or other abnormalities that aren’t visible or palpable. The standard has become 3D mammography or mammogram with tomosynthesis.
— Ultrasound. This method uses sound waves to generate an image of the breast tissue that can help your provider distinguish between solid (possibly cancerous) or fluid-filled (usually benign) cysts and other lumps.
— MRI. Magnetic resonance imaging may be used for some high-risk individuals with dense breast tissue to get a deeper look at abnormalities that turn up on a mammogram or ultrasound.
Depending on what turns up in the images, you may need a biopsy. During this procedure, your doctor removes a small amount of tissue from the suspicious growth to examine under a microscope. There are a few different kinds of biopsies, including:
— Fine-needle aspiration. Using a thin needle, your doctor withdraws cells or fluid from the suspicious area. This is usually done by ultrasound.
— Core needle biopsy. Using a larger needle, your doctor removes a small sample of tissue. This is the most common type of biopsy used in diagnosing breast cancer. This is usually done by ultrasound.
— Stereotactic biopsy is done for lesions only found by mammogram.
— MRI guided biopsy for lesions that are only seen by breast MRI.
— Surgical biopsy. During a surgical biopsy, your doctor will remove a larger tissue sample for analysis.
Cells and tissue collected during the biopsy will be sent to a pathologist for analysis to determine whether cancer cells are present, and if so, which type of breast cancer you have. The biopsy analysis also typically includes information about other characteristics of the tumor, including:
— Hormonal receptors, specifically estrogen (ER) and progesterone (PR)
— Human Epidermal Growth Factor Receptor 2 (HER2), a protein that boosts cancer cell growth
— Ki67 is a stain that is done to see how fast the cells are growing at the time of biopsy. It can be used to determine if there is benefit to adding targeted drugs.
Because of the wealth of information that can be revealed, “the only truly accurate diagnosis is via a biopsy,” Chap says.
[SEE: How Do I Read My Breast Cancer Biopsy Report?]
What Are the Types of Breast Cancer?
Not all breast cancers are the same. Types include:
— Ductal carcinoma in situ (DCIS). This early, noninvasive breast cancer is confined to milk ducts and has not invaded surrounding breast tissue.
— Lobular carcinoma in situ (LCIS). This growth of abnormal cells in the breast lobules (milk-producing glands) “is not a true cancer,” Dang says. But it can increase your risk of developing invasive cancer.
— Invasive lobular carcinoma (ILC). This cancer begins in breast lobules and invades surrounding tissue.
— Invasive ductal carcinoma (IDC). The most common type of breast cancer, IDC starts in milk ducts and invades surrounding breast tissue. It accounts for up to 80% of diagnoses, Chap says.
There are also several subtypes of breast cancer, including:
— Luminal A. This type of cancer is driven by certain hormones, namely estrogen and progesterone. But it tests negative for HER2, which means HER2 is not feeding that cancer. These cancers are likely to benefit from anti-estrogen endocrine therapy.
— Luminal B. Another hormonally related breast cancer, Luminal B is ER-positive (positive for estrogen) and PR-negative (negative for progesterone). These cancers often have higher levels of Ki-67, a protein associated with cell division, indicating faster growth, and are more aggressive than luminal A cancers. Luminal B cancers are likely to benefit from chemotherapy.
— HER2 positive. This type of cancer is HER2 positive and may be positive or negative for either ER or PR. Chemo with HER2-targeted therapy is usually advised.
— Triple negative. This more aggressive and harder-to-treat cancer is not influenced by estrogen, progesterone or HER2. Chemotherapy is usually used to treat it as well as immunotherapy.
— Inflammatory breast cancer. This rare and aggressive form of locally advanced breast cancer causes the breast to appear red and swollen.
— Paget’s disease. Another rare form of breast cancer, Paget’s disease primarily affects the skin of the nipple and areolar (the dark area surrounding the nipple). It is commonly associated with underlying ductal cancer (DCIS or IDC) and occurs when cancer cells from underlying breast tissue migrate to the surface of the nipple and cause the characteristic skin changes.
What Are the Stages of Breast Cancer?
Breast cancer progresses through a series of stages. Understanding what stage of breast cancer you have can help your doctor select the right treatments for you. The stages of breast cancer are:
— Stage 0. This is a precancerous stage used to describe carcinoma in situ.
— Stage 1. Small cancers confined to the breast tissue or lymph nodes closest to the breast may qualify as stage 1.
— Stage 2. In this stage, the cancer is growing but is still contained in the breast or has only extended to the nearby lymph nodes.
— Stage 3. Considered locally advanced, stage 3 cancers have moved beyond the region where the tumor originated and may have invaded nearby lymph nodes or muscle close to the breast.
— Stage 4. Also called metastatic breast cancer, stage 4 breast cancer is the final stage of the disease. Cancers at this stage have spread to distant organs, such as the brain, bones, lungs or liver. Although stage 4 breast cancer is terminal, new medications have extended life expectancy significantly.
[SEE: Questions to Ask Your Oncologist at Your First Cancer Appointment.]
How Is Breast Cancer Treated?
Generally speaking, patients will need to have a combination of treatments, “with the exact formulation based on the type and stage of cancer, the patient’s overall health and fitness level and whether or not she has started menopause,” Chap explains. “Ultimately, the treatment protocol is decided by the patient with options presented by her board-certified medical oncologist.”
Treatment for breast cancer may also take months or longer to complete.
The most common means of treating breast cancer include:
— Surgery. Your doctor may recommend that you undergo a lumpectomy or a mastectomy. A lumpectomy removes the tumor but leaves most of the breast intact, while a mastectomy removes the entire breast. In some cases, a bilateral mastectomy, in which both breasts are removed along with nearby lymph nodes, may be the preferred course of action. Your genetic testing might impact this decision also.
— Radiation. Radiation therapy uses targeted, high-energy light and X-rays to kill cancer cells where they grow.
— Endocrine therapy. Endocrine therapy is a drug-based regimen that suppresses the hormones that feed the cancer. Tamoxifen is one of the most commonly prescribed endocrine therapies.
— Chemotherapy. Chemotherapy is systemic treatment that uses powerful medications to kill cancer cells wherever they may be in the body. However, it also kills many other types of fast-growing cells, which can lead to its hallmark side effects — hair loss and nausea. Nevertheless, chemotherapy can be highly effective and is sometimes used before surgery to shrink a tumor or after surgery to kill any cancer cells that may have been left behind.
— Immunotherapy. This newer form of personalized treatment uses highly targeted medications that leverage the immune system to kill cancer cells. It may have fewer side effects than chemo for some people, but not everyone responds well to immunotherapy.
— Targeted therapy. These systemic treatments target specific molecules involved in cancer growth, such as HER2. Targeted drugs can block the growth of cancer cells that overexpress HER2. There are also targeted drugs for high-risk early stage estrogen positive breast cancer that are available that are called CDK4/6 inhibitors that were recently approved.
— Clinical trials. For some patients, taking part in an investigational trial of new or experimental drugs may offer additional treatment options.
What Are the Complications of Breast Cancer?
Breast cancer can be fatal, but for those who survive it, there can be other complications that arise. These may include:
— Neuropathy (nerve pain) from chemotherapy
— Lymphedema is a disruption to the normal flow of lymphatic fluid throughout the body that can occur when lymph nodes are removed. This can be exacerbated with the addition of radiation or chemotherapy to the treatment regimen.
— Bone problems, including pain and spinal cord compression if the cancer has metastasized
— Lung, liver and brain complications from spread of tumor
— Heart complications due to treatments, including a weakening of the heart muscle, arrhythmias and high blood pressure
Can Breast Cancer Be Cured?
While some doctors hesitate to use the word “cure” in conjunction with cancer, improved detection tools and advanced treatments have significantly increased the number of people who are able to survive a bout of breast cancer and go on to live full, healthy, cancer-free lives. Breast cancer is the most curable solid tumor that oncologists treat.
“Many cases of breast cancer, when detected early, are treatable and curable,” Dang says.
Curability depends on:
— Stage
— Cancer subtype (hormonal and HER2 status)
— The individual’s overall health
— How the patient responds to treatment
[READ: Best Diet for Breast Cancer.]
How Can I Reduce My Risk of Breast Cancer?
Prevention is always the best medicine, but because there are so many factors at work — some of which you can’t control, such as your age and genetic makeup — you can’t always avoid breast cancer.
Still, there are some lifestyle changes you can make to reduce the likelihood of developing breast cancer, including:
— Controlling your weight. Obesity is a known risk factor for breast cancer, because most cases of breast cancer are hormonally driven and fat cells can produce estrogen that can feed the cancer. Therefore, it’s important to manage your weight.
— Eating right.Eating a healthy diet is always a good idea, and some foods have been connected with certain types of cancer. Following a balanced diet can also help you manage your weight.
— Moving more.Exercise is an important factor in weight management, but it may also offer some protection against breast cancer recurrence.
— Getting enough sleep. Studies have shown that chronic sleep deprivation may contribute to an increased risk of cancer because the body can’t repair damage to cells without adequate rest. That damage can accumulate over time and lead to the development of cancer.
— Drinking less alcohol. Research suggests drinking alcohol can elevate risk of breast cancer.
— Breastfeeding.Breastfeeding has been linked with a reduced risk of developing breast cancer later in life, so feeding your baby may be one way to help prevent the disease.
Screening for Breast Cancer
Early detection is key for better treatment and improved patient outcomes. These strategies include:
— Conducting regular breast self-exams
— Regular clinical breast exams from your health care provider
— Undergoing routine screening, particularly mammograms, as advised by your doctor
— Seeking consultation with a breast surgeon to calculate your risk and to give advice on the best screening if you have a strong family history
The U.S. Preventive Services Task Force, as well as the American College of Radiology and the American Cancer Society, recommend starting screenings at age 40. Oncologists usually recommend yearly mammograms. So, if you’re nearing your fourth decade, it’s time to make an appointment with your health care provider.
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A Patient’s Guide to Breast Cancer originally appeared on usnews.com
Update 07/26/24: This story was previously published at an earlier date and has been updated with new information.
