What is breast cancer?

Breast cancer is the development of abnormal cells in the breast. These cells grow and replace normal healthy tissue.

Breast cancer is a treatable disease. Early detection is the key to surviving breast cancer. The cancer usually starts as a small lump. However, with time the lump can grow and spread to nearby areas, such as muscle or skin, as well as the lymph nodes under the arm. Ultimately the tumor can spread to vital organs such as the liver, brain, and lungs.

The incidence of breast cancer among women in the United States appears to be rising. One out of every nine women in this country develops breast cancer. Despite recent progress in early detection, as well as improved treatment, breast cancer is now the third leading cause of death for women in the U.S.

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How does it occur?

The cause of breast cancer is not known. Any woman can have breast cancer. Although it is much less common, men too can have breast cancer. Some women are more likely to develop breast cancer than others. Factors that increase your chance of getting breast cancer include:

• having a mother or sister with breast cancer

• never having children

• having a first child after age 30

• a history of radiation exposure.

There is no definite evidence yet that use of birth control pills for a long period of time causes breast cancer, but this possibility continues to be studied. It also appears that taking estrogen after menopause causes a slight increased risk of breast cancer.

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What are the symptoms?

Most often the first sign of breast cancer is a small lump in the breast. The lump is usually painless. It may grow slowly or quickly.

Other symptoms of breast cancer include:

• color change, dimpling, puckering, or scaling of the skin in one area of the breast

• a change in the size or shape of the breast

• fluid discharge from the nipple

• one or more lumps felt in the armpit.

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How is it diagnosed?

To detect breast cancer at the earliest possible time, you should, from the time you are old enough to have yearly pelvic exams:

• Do a breast self-exam every month.

• Have a breast exam by your health care provider at least once a year.

• Have a baseline mammogram and follow-up mammograms according to the schedule recommended by your health care provider.

Most breast lumps are not cancer. Often they are fluid- filled cysts in the breast tissue that wax and wane with the menstrual cycle. But every lump must be evaluated. The evaluation usually involves:

• an exam by a health care provider

• a mammogram (a special x-ray of the breast)

• either a needle aspiration or a biopsy (these tests should be done even if the lump is not seen on the mammogram).

When you have a needle aspiration, you are first given a local anesthetic to numb the area of your breast that is being tested. Then your health care provider inserts a needle into the breast lump. If fluid is removed, the lump is a fluid-filled cyst and not cancer. Removing the fluid also makes the lump go away.

If fluid cannot be removed from the lump, a breast biopsy may be done. Your health care provider will give you a local anesthetic, make a cut in the breast, and remove the lump. This breast tissue will be examined under a microscope. An estrogen receptor (ER) test can be done on the biopsy sample to see if hormones promote the growth of the cancer. You may also have lymph nodes removed from your armpit (axillary node dissection) to see if the cancer has spread beyond the breast.

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How is it treated?

If a breast lump is cancerous, the decisions for treatment will be made by you, your surgeon, and your oncologist (cancer specialist). These decisions will be based on the type and size of the cancer and whether it has spread to lymph nodes or other parts of your body.

Possible surgical treatments are lumpectomy (removing the cancerous tissue only) or mastectomy (removing the entire breast). Other possible treatments are radiation and chemotherapy. These different treatments may be used singly or in combination.

If you are considering mastectomy, you should discuss the options and timetable for reconstructive surgery with your surgeon.

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How can I take care of myself?

If you have been diagnosed with breast cancer:

• Discuss your cancer and treatment options with your health care provider so you understand them. Do not hesitate to get a second opinion.

• Tell your health care provider if your treatment causes discomfort. Relief may be available.

• Get regular check-ups after your treatment is finished.

• Continue monthly breast exams, even if both your breasts have been surgically removed, to look for recurrence of the cancer.

Many supportive services are available to women with breast cancer. You can find the names of groups and agencies from your health care provider or through the local American Cancer Society office.

Breast cancer survival continues to improve. Most tumors are found by the women who have them. As more women do regular breast self-exams, more cancers are found early. As screening mammography and other technologies improve, more cancers are being detected before we can even feel or suspect their existence. Early detection and treatment of breast cancer greatly increase your chances of survival. To help detect breast cancer early:

• Do a breast self-exam every month.

• Have yearly mammograms from age 50 on.

• Never ignore a lump or a change in the appearance or feel of a breast. Remember that a cancerous tumor is usually not painful.