Breast Cancer

What Is Breast Cancer?

Like all forms of cancer, breast cancer is made of unusual cells that grow out of control. Those cells may also travel to places in your body where they aren’t usually found. When that happens, the cancer is called metastatic.

Breast cancer usually begins either in your glands that make milk (called lobular carcinoma), or the ducts that carry it to the nipple (called ductal carcinoma). It can grow larger in your breast and spread to nearby lymph nodes or through your bloodstream to other organs. The cancer may grow and invade tissue around your breast, such as your skin or chest wall.

Different types of breast cancer grow and spread at different rates. Some take years to spread beyond your breast, while others grow and spread quickly.

Who Gets Breast Cancer?

Men can get breast cancer too, but they account for less than 1% of all breast cancer cases. Among women, breast cancer is the most second most common cancer diagnosed, after skin cancer, and the second leading cause of cancer deaths, after lung cancer.

On average, 1 in 8 women will develop breast cancer in their lifetimes. About two-thirds of women with breast cancer are 55 or older. Most of the rest are between 35 and 54.

Fortunately, breast cancer is very treatable if you spot it early. Localized cancer (meaning it hasn’t spread outside your breast) can usually be treated before it spreads.

Once the cancer begins to spread, treatment becomes more complicated. It can often control the disease for years.

Breast Cancer Symptoms

The symptoms of breast cancer include:

• A lump or thickened area in or near your breast or underarm that lasts through your period
• A mass or lump, even if it feels as small as a pea
• A change in your breast’s size, shape, or curve
• Nipple discharge that can be bloody or clear
• Changes in the skin of your breast or your nipple. It could be dimpled, puckered, scaly, or inflamed.
• Red skin on your breast or nipple
• Changes in the shape or position of your nipple
• An area that’s different from any other area on either breast
• A hard, marble-sized spot under your skin

Types of Breast Cancer

Some of the most common types of breast cancer include:

In situ cancers. These types haven't spread past the duct or lobule where they started.

• Ductal carcinoma in situ (DCIS). This is ductal carcinoma in its earliest stage (stage 0). In this case, the disease is still in the milk ducts. But if you don’t treat this type, it can become invasive. It’s often curable.
• Lobular carcinoma in situ (LCIS). This is found only in the lobules, which produce breast milk. It isn't a true cancer, but it means you’re more likely to get breast cancer later. If you have it, get regular breast exams and mammograms.

Invasive cancers. These have spread or invaded the surrounding breast tissue.

Less common types include:

• Inflammatory breast cancer. This rare type is caused by inflammatory cells in lymph vessels in your skin.
• Paget's disease of the nipple. This type affects the areola, the thin skin around your nipple.
• Phyllodes tumors of the breast. These rare tumors grow in a leaflike pattern. They grow quickly but rarely spread outside the breast.
• Metastatic breast cancer. This is cancer that has spread to another body part, like your brain, bones, or lungs.

Breast Cancer Causes and Risk Factors

Experts don’t know what causes breast cancer, but certain things make you more likely to get it. Your age, genetic factors, personal health history, and diet all play a role. Some you can control; others you can’t.

Breast Cancer Risk Factors You Can Control

• You have your first child after age 30.
• You don’t breastfeed.
• You don’t have a full-term pregnancy.

Use hormone replacement therapy that includes both estrogen and progesterone during menopause for more than 5 years. This increase in breast cancer risk returns to normal 5 years after you stop treatment.Use certain birth control methods including birth control pills, shots, implants, IUDS, skin patches, or vaginal rings that contain hormones.

Still, most women who are at high risk for breast cancer don’t get it. On the other hand, 75% of women who develop breast cancer have no known risk factors. Learn more about the risk factors for breast cancer.

Breast Cancer Diagnosis

If you feel a lump or if something shows up on a mammogram, your doctor will begin the breast cancer diagnosis process.

They’ll ask about your personal and family healthy history. Then, they’ll do a breast exam and order tests that include:

Imaging tests. Your doctor will use these to learn more about your breast.

• Ultrasound. This test uses sound waves to make a picture of your breast.
• Mammogram. This detailed X-ray gives doctors a better view of lumps and other problems.
• Magnetic resonance imaging (MRI). This body scan uses a magnet linked to a computer to create detailed images of the insides of your breasts.

• Fine-needle aspiration. This is for easy-to-reach lumps or those that might be filled with fluid.
• Core-needle biopsy. This type uses a bigger needle to remove a piece of tissue.
• Surgical (open) biopsy. A surgeon removes the entire lump along with nearby breast tissue.
Lymph node biopsy. The doctor removes a part of the lymph nodes under your arm to see if the cancer has spread.
• Image-guided biopsy. The doctor uses imaging to guide the needle.

The doctor can test your biopsy sample for:

• Tumor features. Is it invasive or in situ, ductal, or lobular? Has it spread to your lymph nodes? The doctor also measures the margins or edges of the tumor and their distance from the edge of the biopsy tissue, which is which is called margin width.
• Estrogen receptors (ER) and progesterone receptors (PR). This tells the doctor if the hormones estrogen or progesterone make your cancer grow. This affects how likely it is that your cancer will come back and what type of treatment is most likely to prevent that.
• HER2. This test looks for the gene human epidermal growth factor receptor 2. It can help cancer grow more quickly. If your cancer is HER2-positive, targeted therapy could be a treatment option for you.
• Grade. This tells the doctor how different the cancer cells look from healthy cells and whether they seem to be slower-growing or faster- growing.
• Oncotype Dx. This test evaluates 16 cancer-related genes and five reference genes to estimate the risk of the cancer coming back within 10 years of diagnosis.

• Breast Cancer Index. This test can help your doctor decide how you need endocrine therapy.
• MammaPrint. This test uses information from 70 genes to predict the risk of the cancer coming back.
• PAM50 (Prosigna). This test uses information from 50 genes to predict if the cancer will spread.

Find out more on biopsy for breast cancer diagnosis.

You might get blood tests including:

• Complete blood count (CBC). This measures the number of different types of cells, like red and white blood cells, in your blood. It lets your doctor know if your bone marrow is working like it should.
• Blood chemistry. This shows how well your liver and kidneys are working.
• Hepatitis tests. These are sometimes done to check for hepatitis B and hepatitis C. If you have an active hepatitis B infection, you may need medication to fight the virus before you get chemotherapy. Without it, chemo can cause the virus to grow and damage your liver.

Breast Cancer Stages

• Smaller than 2 centimeters across, with underarm lymph node involvement.
• Larger than 2 but less than 5 centimeters across, without lymph node involvement.

• Larger than 5 centimeters across, without underarm lymph node involvement
• Larger than 2 but less than 5 centimeters across, with lymph node involvement.

• A tumor larger than 5 centimeters that has spread to the lymph nodes under the arm or near the breastbone.
• Any size tumor with cancerous lymph nodes that stick to one another or nearby tissue.

Get more information about the stages of breast cancer.

Breast Cancer Treatment

If the tests find breast cancer, you and your doctor will develop a treatment plan to get rid of the cancer, to lower the odds that it will come back, and to reduce the chance of it moving outside your breast. Treatment generally follows within a few weeks after the diagnosis.

Your treatment will depend on the size and location of the tumor, the results of lab tests on the cancer cells, and the stage of the disease. Your doctor usually considers your age and general health as well as your feelings about the treatment options.

Local treatments

These remove, destroy, or control the cancer cells in a specific area, such as your breast. These include:

Surgery

• Lumpectomy
• Quadrantectomy
• Partial mastectomy
• Segmental mastectomy

• Sentinel lymph node biopsy. The doctor removes one or a few lymph nodes where cancer is most likely to spread.
• Axillary lymph node dissection. This involves more nodes, though usually fewer than 20.

Know more about breast cancer surgery options.

Radiation. Whether you get it and what type depends on the type of surgery you had, if your cancer has spread to the lymph nodes or somewhere else in your body, the size of your tumor, and sometimes, your age. You might have one type or a combination:

Hypofractionated radiation therapy. You get larger doses using fewer treatments, typically only 3 weeks.Intraoperative radiation therapy (IORT). In this approach, you get a single large dose of radiation in the operating room right after breast conservation surgery (before the wound is closed).3D-conformal radiotherapy. You get radiation from special machines that can better aim it at the area where the tumor was. You’ll get treatments twice a day for 5 days.

Interstitial brachytherapy. The doctor inserts several small, hollow tubes called catheters into the breast around the area where the cancer was. They stay in place for several days. Doctors put radioactive pellets into them for short periods every day.Intracavitary brachytherapy. This is the most common type of brachytherapy for women with breast cancer. The doctor uses a small catheter to put a device inside your breast. The device is widened and stays in place during the treatment. The other end sticks out of the breast. The doctor uses a tube to put radiation sources (often pellets) into the device. You usually get this twice a day for 5 days as an outpatient. After the last treatment, the doctor collapses and removes the device.

Systemic treatments

They destroy or control cancer cells all over your body. These treatments include:

• Tamoxifen (Nolvadex, Soltamox, Tamoxen)
• Fulvestrant (Faslodex)
• Aromatase inhibitors: Anastrozole (Arimidex)Exemestane (Aromasin)Letrozole (Femara)

• Anastrozole (Arimidex)
• Exemestane (Aromasin)
• Letrozole (Femara)

Get more details on hormone therapy for breast cancer treatment.

• Abemaciclib (Verzenio)
• Everolimus (Afinitor)
• Lapatinib (Tykerb)
• Neratinib (Nerlynx)
• Olaparib (Lynparza)
• Palbociclib (Ibrance)
• Pertuzumab (Perjeta)
• Ribociclib (Kisquali)
• Talazoparib (Talzenna)
• Trastuzumab (Herceptin)
• Trastuzumab emtansine (Kadcyla)

Know more about targeted therapy for breast cancer.

Immunotherapy. Medications such as atezolizumab (Tecentriq) help your immune system fight cancer. Find out the pros and cons of immunotherapy to treat cancer.

Breast Cancer Prevention

These tips may help you prevent breast cancer:

• 40-44: Get an annual mammogram if you and your doctor think you need it.
• 45-54: Get an annual mammogram.
• 55-74: Get a mammogram every 1 or 2 years.
75+: Get a mammogram every year so long as you’re in good health and expected to live 10 years or more.

Management if you’re at high risk

If you have one of the risk factors for breast cancer, talk to your doctor about some things that may help lower your odds. These include:

• Genetic testing to look for a change in your genes that raises your risk
• More frequent doctor visits and screening tests
• Medicines such as raloxifene, tamoxifen, and aromatase inhibitors
• Surgery to remove your breasts or ovaries

Breast Cancer Outlook

Your outlook after breast cancer depends on many things, including your cancer stage when you were diagnosed.

Nearly 100% of women whose cancer is only in their breast live at least 5 years after diagnosis. In women whose cancer has spread to nearby tissue, 91% live at least 5 more years, and 84% live at least 10 more years.

If a woman’s breast cancer has spread to nearby lymph nodes, the 5-year survival rate is 86%. About 27% of women whose cancer has spread farther in their body live at least 5 more years.

Black women’s survival rates are about 9% lower than those of white women.

For men who have breast cancer, the overall 5-year survival rate is 84%. If the tumors are only in their breast, 96% of men live at least 5 more years. The 5- year survival rate is 83% if the cancer has spread to nearby lymph nodes and 22% if it’s spread farther in a man’s body. Get more information on breast cancer survival rates.

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