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Breast cancer usually starts with a cancerous, or malignant, tumor located in the breast tissue. Most breast cancers are located in the area around the nipple. For women, breast cancer is the most common cancer and the second leading cause of cancer deaths, following only lung cancer. Although men can get breast cancer, it’s rare (only one half of 1 percent of all breast cancers are in men). Breast cancer is curable if caught early–and is usually treated through some combination of surgery, radiation, chemotherapy, and other medications.

Are you worried about the possibility of breast cancer in your future, or in the future of someone you love? Here are the top ten things you can do to ensure a breast cancer-free future for yourself and your loved ones.

Detection:

1. Get regular mammograms. It sounds obvious, but you’d be surprised how many women don’t. Last week an Australian study found that women who get regular mammograms had a 4 percent risk of dying of breast cancer; women who weren’t screened had a 56 percent mortality rate. Ready to make that appointment?

2. Find out whether you or women close to you have dense breasts. What does this mean? It means the breast cells grow and multiply more rapidly, raising your risk. Plus dense breasts make it harder for a mammogram to “see” through the tissue and detect a tumor. While dense breast tissue is more common in younger women who haven’t yet had children, it’s also hereditary and can affect any woman. I have a dear 43-year-old friend whose breast tumor failed to show up on three years’ worth of mammograms before her doctor finally ordered an MRI. How to find out? Schedule a breast exam and ask your doctor. Also talk to the radiologist who’s administering your mammogram.

3. Ask your doctor to recommend other tests. Surprise: Mammograms are only 16 to 40 percent accurate, studies show. Meanwhile, ultrasounds and MRIs can detect breast tumors that may not show up on mammograms. MRIs, the gold standard, are 70 to 100 percent accurate. This fall Dartmouth University published a study showing that MRIs found tumors in 20 percent of patients who’d already “passed” a mammogram or ultrasound. If you have any reason for concern, ask your doctor to refer you for an ultrasound, MRI, or both.

Prevention:

4. Know your BMI–and lower it if necessary. Studies show that women whose body mass index (BMI) is at the lower end of the scale for their height lower their risk of breast cancer. Even more important, though, is getting rid of belly fat, which acts like a “hormone pump” releasing estrogen into the bloodstream as well as raising levels of other hormones.

5. Get 30 minutes a day of exercise. We all know this is one of the best ways to keep our weight down, but research also shows that activity itself helps prevent cancer by keeping hormone levels healthy. This is important for preventing hormone-fueled breast cancer.

6. Limit alcohol to one drink a day–or save it for special occasions. More than one drink a day is associated with a significant increase in breast cancer risk, and teetotalers have the lowest risk of all. It seems that alcohol boosts the effect of other toxins, such as nicotine from smoking, and can directly damage DNA, leading to cancer.

7. Eat those fruits and veggies. For more information, check out these 10 foods known to prevent cancer.

8. Quit smoking. Sorry, I know you don’t want to hear it. But there are great new helpful tools to make it easier to quit–and doing so will reduce your risk of not only breast cancer, but lung, colon, and throat cancer too.

9. Skip the supplemental soy. Soy contains chemicals called isoflavones, which–when concentrated–act like estrogen in your body, so they can stimulate estrogen-sensitive breast cancer. But it’s soy supplements that are the concern; eating tofu or drinking soy milk is fine unless you’re at specific risk of estrogen-sensitive cancer. Overall, women who eat a diet high in soy have a lower breast cancer risk.

10. Don’t take hormones, or limit how long you take them. There’s still plenty of controversy, but most experts agree that long-term use of estrogen and progesterone combination hormone therapy boosts your breast cancer risk. If you or someone you care for is really desperate, ask your doctor to prescribe the lowest possible dose, and plan to use it as a six month respite, and then reevaluate. Five years is considered the maximum time a woman should be on hormones.

More sientific approch

Breast Cancer: What is Breast Cancer?

Affiliation: National Cancer Institute Last Modified: November 1, 2001

Description

Note: Separate PDQ summaries on Screening for Breast Cancer; Prevention of Breast Cancer; and Male Breast Cancer Treatment are also available.

What is breast cancer?

Breast cancer, a common cancer in women, is a disease in which cancer(malignant) cells are found in the tissues of the breast. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. The lobes and lobules are connected by thin tubes called ducts. The most common type of breast cancer is ductal cancer. It is found in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular cancer. Lobular cancer is more often found in both breasts than other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer. In this disease, the breast is warm, red, and swollen.

Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer cases. The genes in cells carry the hereditary information that is received from a person's parents. Several genes have been found to be defective in some breast cancer patients. Relatives of breast cancer patients who carry these defective genes may be more likely to develop breast or ovarian cancer. Some defective genes are more common in certain ethnic groups. Tests are being developed to determine who has the genetic defect long before any cancer appears. (Refer to the PDQ summaries on Screening for Breast Cancer and Prevention of Breast Cancer for more information.)

Hormonal contraceptives may be another factor to consider. Research findings suggest a link between contraceptive use and a slightly increased risk of developing breast cancer.

A doctor should be seen if changes in the breasts are noticed. The doctor may suggest that you have a mammogram. A mammogram is a special x-ray of the breast that may find tumors that are too small to feel. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy. Sometimes the biopsy is done by inserting a needle into the breast and drawing out some of the tissue. If the biopsy shows that there is cancer, it is important that certain tests (called estrogen and progesterone receptor tests) be done on the cancer cells.

Estrogen and progesterone receptor tests may tell whether hormones affect the way the cancer grows. They may also give information about the chances of the tumor coming back (recurring). The results help a doctor decide whether to use hormone therapy to stop the cancer from growing. Tissue from the tumor needs to be taken to the laboratory for estrogen and progesterone tests at the time of biopsy because it may be hard to get enough cancer cells later, although newer techniques can be used on tissue that is not fresh.

The chance of recovery (prognosis) and choice of treatment depend on the stage of the cancer (whether it is just in the breast or has spread to other places in the body), the type of breast cancer, certain characteristics of the cancer cells, and whether the cancer is found in the other breast. A woman's age,weight, menopausal status (whether or not a woman is still having menstrual periods), and general health can also affect the prognosis and choice of treatment.

If a patient is going to have a mastectomy, breast reconstruction (making a new breast mound) may be considered. It may be done at the time of the mastectomy or at some future time. The breast may be made with the patient's own(non-breast) tissue or by using implants. Different types of implants can be used. The Food and Drug Administration (FDA) has announced that breast implants filled with silicone gel may only be used in clinical trials. Saline-filled breast implants, which contain saltwater rather than silicone gel, may also be used. Before the decision to get an implant is made, patients can call the FDA's Center for Devices and Radiologic Health at 1-888-INFO-FDA(1-888-463- 6332) to obtain additional information. Additional questions can then be discussed with a doctor.

Stage explanation

Stages of breast cancer Once breast cancer has been found, more tests will be done to find out if the cancer has spread from the breast to other parts of the body. This is called staging. To plan treatment, a doctor needs to know the stage of the disease. The following stages are used for breast cancer.

Stage 0 Ductal carcinoma in situ (DCIS; also known as intraductal carcinoma) is a very early breast cancer that may develop into an invasive (cancer that has spread from the duct into surrounding tissues) type of breast cancer.

Lobular carcinoma in situ (LCIS) is not cancer, but rather a marker that identifies a woman at increased risk to develop invasive (cancer that has spread into surrounding tissues) breast cancer later in life.

Stage I The cancer is no larger than 2 centimeters (about 1 inch) and has not spread outside the breast.

Stage II Stage II is divided into stages IIA and IIB.

Stage IIA is defined by either of the following:

The cancer is no larger than 2 centimeters but has spread to the lymph nodes under the arm (the axillary lymph nodes).

The cancer is between 2 and 5 centimeters (from 1 to 2 inches), but has not spread to the lymph nodes under the arm.

Stage IIB is defined by either of the following:

The cancer is between 2 and 5 centimeters (from 1 to 2 inches), and has spread to the lymph nodes under the arm.

The cancer is larger than 5 centimeters (larger than 2 inches), but has not spread to the lymph nodes under the arm.

Stage III Stage III is divided into stages IIIA and IIIB.

Stage IIIA is defined by either of the following:

The cancer is smaller than 5 centimeters and has spread to the lymph nodes under the arm, and the lymph nodes are attached to each other or to other structures.

The cancer is larger than 5 centimeters and has spread to the lymph nodes under the arm.

Stage IIIB is defined by either of the following:

The cancer has spread to tissues near the breast (skin or chest wall, including the ribs and the muscles in the chest).

The cancer has spread to lymph nodes inside the chest wall along the breast bone.

Stage IV The cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain. Or, tumor has spread locally to the skin and lymph nodes inside the neck, near the collarbone.

Inflammatory breast cancer Inflammatory breast cancer is a special class of breast cancer that is rare. The breast looks as if it is inflamed because of its red appearance and warmth.

The skin may show signs of ridges and wheals or it may have a pitted appearance. Inflammatory breast cancer tends to spread quickly.

Recurrent Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the breast, in the soft tissues of the chest (the chest wall), or in another part of the body.

Treatment option overview

How breast cancer is treated

There are treatments for all patients with breast cancer. Four types of treatment are used: -

• surgery (taking out the cancer in an operation) -
• radiation therapy (using high-dose x-rays to kill cancer cells) -
• chemotherapy (using drugs to kill cancer cells) - hormone therapy (using drugs that change the way hormones work or taking out organs that make hormones, such as the ovaries)

Biological therapy (using the body's immune system to fight cancer), bone marrow transplantation, and peripheral blood stem cell transplantation are being tested in clinical trials.

Most patients with breast cancer have surgery to remove the cancer from the breast. Usually, some of the lymph nodes under the arm are also taken out and looked at under a microscope to see if there are any cancer cells.

Different types of operations used:

Surgery to conserve the breast:

Lumpectomy (sometimes called excisional biopsy or wide excision) is the removal of the lump in the breast and some of the tissue around it. It is usually followed by radiation therapy to the part of the breast that remains. Most doctors also take out some of the lymph nodes under the arm.

Partial or segmental mastectomy is the removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor. Usually some of the lymph nodes under the arm are taken out. In most cases, radiation therapy follows.

Other types of surgery:

Total or simple mastectomy is the removal of the whole breast. Sometimes lymph nodes under the arm are also taken out.

Modified radical mastectomy is the removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles. This is the most common operation for breast cancer.

Radical mastectomy (also called the Halsted radical mastectomy) is the removal of the breast, chest muscles, and all of the lymph nodes under the arm. For many years, this was the operation most used, but it is used now only when the tumor has spread to the chest muscles.

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation(radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the breast area.

If tests show that the breast cancer cells have estrogen receptors and progesterone receptors, hormone therapy may be given. Hormone therapy is used to change the way hormones in the body help cancers grow. This may be done by using drugs that change the way hormones work or by surgery to take out organs that make hormones, such as the ovaries. Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer. Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of getting cancer of the uterus. A doctor should be seen for a pelvic examination every year. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

Even if the doctor removes all the cancer that can be seen at the time of the operation, the patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Therapy given after an operation when there are no cancer cells that can be seen is called adjuvant therapy.

Biological therapy tries to get the body to fight cancer. It uses materials made by the body or made in a laboratory to boost, direct, or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. This treatment is currently only being given in clinical trials.

Bone marrow transplantation is a type of treatment that is being studied in clinical trials. Sometimes breast cancer becomes resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy the bone marrow, marrow is taken from the bones before treatment. The marrow is then frozen and the patient is given high-dose chemotherapy with or without radiation therapy to treat the cancer. The marrow that was taken out is then thawed and given back to the patient through a needle inserted into a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow that is given is taken from another person, the transplant is called an allogeneic transplant.

Another type of autologous transplant is called a peripheral blood stem cell transplant. The patient's blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop) and then returns the blood back to the patient. This procedure is called leukapheresis and usually takes 3 or 4 hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted back to the patient. This procedure may be done alone or with an autologous bone marrow transplant.

A greater chance for recovery occurs if the doctor chooses a hospital that does more than five bone marrow transplantations per year.

Treatment by stage

Treatment of breast cancer depends on the type and stage of the disease, and the patient's age, menopausal status, and overall health.

Standard treatment may be considered because of its effectiveness in patients in past studies, or participation in a clinical trial may be considered. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are ongoing in most parts of the country for all stages of breast cancer. To learn more about clinical trials,call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

Ductal carcinoma in situ

If the patient has ductal carcinoma in situ (DCIS), treatment may be one of the following:

1. Breast-conserving surgery with radiation therapy, with or without hormone therapy.
2. Surgery to remove the whole breast (total mastectomy), with or without hormone therapy.
3. Clinical trials comparing breast-conserving surgery and hormone therapy with or without radiation therapy.

Lobular carcinoma in situ

If the patient has lobular carcinoma in situ (LCIS), treatment may be one of the following:

1. Biopsy to diagnose the LCIS followed by regular examinations and regular mammograms to find any changes as early as possible.
2. Hormone therapy to reduce the risk of developing breast cancer.
3. Clinical trials including a large clinical trial (Study of Tamoxifen and Raloxifene--STAR trial)comparing 2 types of hormone therapy to lower the risk of developing breast cancer and to compare the side effects of treatment. The Cancer Information Service can be called for more information (1-800-4-CANCER).
4. Surgery to remove all of both breasts (total bilateral mastectomy). This treatment choice is sometimes used in women who have a high risk of getting breast cancer. Most surgeons believe that this is a more aggressive treatment than is needed.

Stage I, ii, and iiia breast cancer

Primary treatment may be one of the following: If the cancer is confined to the breast and lymph nodes under the arm:

1. Breast-conserving surgery to remove only the cancer and some surrounding breast tissue (lumpectomy) followed by radiation therapy. Some of the lymph nodes under the arm are also removed.
2. Surgery to remove the whole breast and the lining over the chest muscles (modified radical mastectomy), as well as some of the lymph nodes under the arm with or without breast reconstruction surgery.
3. A clinical trial evaluating limited lymph node removal (sentinel lymph node biopsy).

Adjuvant therapy (given in addition to the treatments listed above) may include:

1. Radiation therapy to the lymph nodes under the arm following a modified radical mastectomy.
2. Systemic chemotherapy with or without hormone therapy.

Stage IIIB, iv, recurrent, and metastatic breast cancer

Treatment for breast cancer that comes back (recurs) to the breast or chest wall may include:

1. Surgery (radical or modified radical mastectomy) and/or radiation therapy.
2. Systemic chemotherapy or hormone therapy.

Treatment for Stage IIIB cancer or inflammatory breast cancer may include one or more of the following:

1. Systemic chemotherapy.
2. Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy) with lymph node removal followed by radiation therapy. Additional systemic therapy (chemotherapy and/or hormone therapy) may be given).
3. Clinical trials testing new chemotherapy drugs, new drug combinations, and new ways of giving treatment.

Treatment for Stage IV cancer or metastatic breast cancer may include one or more of the following:

1. Hormone therapy and/or chemotherapy with or without trastruzumab (Herceptin).
2. Radiation therapy and/or surgery to relieve the pain caused by the cancer.
3. Clinical trials testing new chemotherapy and/or hormone therapy. Clinical trials are also studying new combinations of trastruzumab (Herceptin) with chemotherapy drugs.
4. Clinical trials evaluating other approaches, including high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.