What is breast cancer?

Breast cancer occurs when abnormal cells grow out of control in the breast. These cancer cells can spread within the breast, to nearby lymph nodes and other tissues, and to other parts of the body.

Being treated for cancer can weaken your body, and you may feel very tired. Get the rest your body needs so you can feel better.

Finding out that you have cancer is scary. You may feel many emotions and may need some help coping. Seek out family, friends, and counselors for support. You also can do things at home to make yourself feel better while you go through treatment. Call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org for more information.

Often breast cancer is found in an early stage, and the cancer can be removed with surgery. In some cases, breast cancer may grow and spread to nearby tissues and lymph nodes. Advanced breast cancer can spread to the bones, liver, and brain.

Your doctor will look at the stage of the cancer to see how far it has spread. Your doctor may also do tests on tissues removed during surgery to look for hormone receptors and gene changes. These test results, and whether your cancer has spread, will help guide your treatment options.

The most common symptom is a painless lump or thickening in the breast or underarm. But early breast cancer is often found on a mammogram before a lump can be felt. The size, shape, or appearance of the breast may also change. Or the nipple may turn in, look scaly, or leak fluid.

Treatment for breast cancer is based on the type and stage of the cancer and other things, such as your overall health. The main treatment is surgery to remove the cancer. Other treatment options may include radiation therapy, chemotherapy, endocrine therapy, or targeted therapy.

External beam radiation works well to destroy cancer cells, but it can also harm normal cells. This can lead to side effects.

The most common short-term side effects of radiation therapy for breast cancer are:

• Feeling very tired (fatigue).
• Skin changes in the treated area. The skin may be red, dry, and sore. Toward the end of treatment, the skin may become moist and "weepy."
• Swelling in the treated breast.

Most short-term side effects will go away within a few weeks after you finish treatment. But it may take longer to get your energy back.

Some side effects may occur months or years after radiation therapy. These long-term side effects may include:

• Changes in skin texture where you had radiation.
• Numbness in your arm from nerve damage.
• Swelling in the arm (lymphedema) if lymph nodes in the armpit were treated.
• In rare cases, heart or lung problems.
• Very rarely, a second cancer.

Experts know that people who are BRCA-positive are more likely to get breast cancer and ovarian cancer. If you are BRCA-positive, you can take steps to reduce your risk of these cancers.

To help those with BRCA changes, experts did a study of women with BRCA changes to predict how much breast and ovarian cancer risk could be reduced by certain methods. These methods include:

• Having the breasts removed (mastectomy).
• Having the ovaries removed (oophorectomy).
• Having a mammogram and breast MRI every year starting at age 25. These screening tests don't prevent breast cancer. But they can find cancer early, when a cure is most likely.

The results of the study are shown in the tables below.

The study also looked at having the surgeries at different ages. For example, you can see what difference it might make if you keep your breasts and ovaries until you're past your childbearing years. These results are one piece of information you can use as you explore how to lower your cancer risk.

Surgery and screening tests are not your only options. You can also talk to your doctor about medicines, such as tamoxifen. Or you may choose to have no treatment or extra screening.

Women with BRCA1 changes

According to the study, here's how the different prevention methods affect the life spans of those with BRCA1 changes.

Women with BRCA2 changes

According to the study, here's how the different prevention methods affect the life spans of those with BRCA2 changes.

Deciding about your options

Take some time to think about your options. A genetic counselor can help you understand how the prevention options affect your cancer risk. Discuss them with your family and close friends. Then you can reach a decision that feels right for you.

If breast cancer spreads, it often goes to the lymph nodes first. Lymph node surgery is done to find out if cancer has spread to the lymph nodes.

The types of lymph node surgery for breast cancer are:

Sentinel node biopsy.

The doctor removes the first lymph nodes that cancer may have spread to (sentinel nodes). If cancer is found in only one or two nodes, you may not need to have more lymph nodes removed.

Axillary node dissection.

If enough cancer cells are found in the sentinel lymph nodes, the doctor will usually remove most of the lymph nodes in the armpit area (axillary nodes).

You may have lymph node surgery at the same time as a mastectomy or breast-conserving surgery. People with very early breast cancer, such as ductal carcinoma in situ, may not need lymph node testing.

Some types of endocrine therapy for breast cancer include:

Selective estrogen receptor modulators (SERMs).

Examples are raloxifene and tamoxifen.

Antiestrogen medicines.

An example is fulvestrant.

Aromatase inhibitors.

Examples are anastrozole and letrozole.

LH-RH agonists.

Examples are goserelin and leuprolide.

Breast cancer is treated by surgeons, medical oncologists, and radiation oncologists.

Different health professionals can perform a breast exam to check for lumps or changes. They include:

• Family medicine doctors.
• General practitioners.
• Gynecologists.
• Internists.
• General surgeons or surgeons who specialize in diseases of the breast.
• Nurse practitioners.
• Physician assistants.

You may see a general surgeon, a breast surgeon, or a radiologist if more evaluation of a breast problem is needed.

• Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. You may get medicine for nausea and vomiting if you have these side effects.
• Follow your doctor's instructions to relieve pain. Pain from cancer and surgery can almost always be controlled. Use pain medicine when you first notice pain, before it becomes severe.
• Eat healthy food. If you do not feel like eating, try to eat food that has protein and extra calories to keep up your strength and prevent weight loss. Drink liquid meal replacements for extra calories and protein. Try to eat your main meal early.
• Get some physical activity every day, but do not get too tired. Keep doing the hobbies you enjoy as your energy allows.
• Do not smoke. Smoking can make your cancer worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
• Take steps to control your stress and workload. Learn relaxation techniques.
  • Share your feelings. Stress and tension affect our emotions. By expressing your feelings to others, you may be able to understand and cope with them.
  • Consider joining a support group. Talking about a problem with your spouse, a good friend, or other people with similar problems is a good way to reduce tension and stress.
  • Express yourself through art. Try writing, crafts, dance, or art to relieve stress. Some dance, writing, or art groups may be available just for people who have cancer.
  • Be kind to your body and mind. Getting enough sleep, eating a healthy diet, and taking time to do things you enjoy can contribute to an overall feeling of balance in your life and can help reduce stress.
  • Get help if you need it. Discuss your concerns with your doctor or counselor.
• If you are vomiting or have diarrhea:
  • Drink plenty of fluids to prevent dehydration. Choose water and other clear liquids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
  • When you are able to eat, try clear soups, mild foods, and liquids until all symptoms are gone for 12 to 48 hours. Other good choices include dry toast, crackers, cooked cereal, and gelatin dessert, such as Jell-O.
• If you have not already done so, prepare a list of advance directives. Advance directives are instructions to your doctor and family members about what kind of care you want if you become unable to speak or express yourself.

Possible problems from mastectomy or breast-conserving surgery include breast pain or numbness, buildup of blood or clear fluid in the wound, and the general risks of surgery. These include infection, bleeding, and reactions to the anesthesia. If lymph nodes under the arm were removed, swelling of the arm (lymphedema) may occur.

Physical changes from breast cancer treatment may affect how you feel about your body or your desire to be intimate. Try to talk openly with your partner, if you have one. Or talk to your doctor or nurse. They may be able to help or may refer you to counseling or a support group.

BRCA1 and BRCA2 are genes that normally help control cell growth. But an inherited change, called a mutation, in one of these genes makes you much more likely to get breast, ovarian, and some other cancers. BRCA (say "BRAH-kuh") stands for "BReast CAncer."

BRCA gene changes aren't common. Your doctor may talk to you about testing based on your family medical history or your personal medical history. Your doctor may ask you questions, such as if you have family members who had breast or ovarian cancer, if you were diagnosed with breast cancer before age 50, or if you have an Ashkenazi Jewish heritage.

If you are concerned that you may have a BRCA gene change, talk with your doctor.

In the table below, the figures are only rough estimates from research studies of females. These numbers may not apply to you, but they can give you an idea of how high your risk may be.

Pictures may help you get a better idea of how much a BRCA gene change increases your risk for breast cancer and ovarian cancer.

Genetic testing can show if you have gene changes that increase your risk for breast cancer and ovarian cancer. Before you have genetic testing, you may want to see a genetic counselor. Counseling will help you decide about genetic testing. Both testing and counseling are often covered by insurance. But check with your insurance company to find out for sure.

Breast cancer is the growth of abnormal cells in one or both breasts. Cancer cells can spread to nearby tissues and form a mass, called a tumor. The cells can spread to the lymph nodes and other parts of the body.

Doctors don't know exactly what causes breast cancer. But some things are known to increase the chance that you will get it, such as your age and health history.