Breast cancer today is not what it was 20 years ago. Survival rates are climbing thanks to greater awareness, more early detection, and advances in treatment. For roughly 200,000 Americans who are diagnosed with breast cancer each year, there are plenty of reasons to be hopeful.
Breast Cancer Symptoms
There are often no symptoms, but sometimes you may notice something you want to get checked out by a doctor. Those include:
A painless lump in the breast
Changes in breast size, shape, contour, or the skin of the breast
Swelling in the armpit
Nipple changes or discharge
Breast pain can also be a symptom of cancer, but this isn’t common.
Signs of Inflammatory Breast Cancer
This is a rare, fast-growing type of cancer that often causes no distinct lump. Instead, breast skin may become thick and red and may look pitted, like an orange peel. The area may also feel warm or tender and have small bumps that look like a rash.
The earlier breast cancer is found, the easier it is to treat. And mammograms can spot tumors before they are large enough to feel. The American Cancer Society recommends yearly mammograms beginning at age 40 for women at average risk. The U.S. Preventive Services Task Force recommends a mammogram every 2 years from ages 50 to 74. It also notes that before age 50, each woman should check with her doctor to find out which screening schedule is right for her.
Ultrasound and MRI
Besides a mammogram, your doctor may order additional imaging with breast ultrasound. It can find cysts, fluid-filled sacs that are not cancer. An MRI may be recommended along with a mammogram for certain women who have a higher risk of breast cancer.
It was once widely recommended that women check their own breasts once a month. But studies suggest these breast self-exams play a very small role in finding cancer. The current thinking is that it’s more important to know your breasts and be aware of any changes, rather than checking them on a regular schedule. If you want to do breast self-exams, go over the technique with your doctor.
What If You Find a Lump?
First, don't panic. Most lumps often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But you should let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it's found, the better. And if it's not, testing can give you peace of mind.
The only sure way to tell whether a lump is cancer is to do a biopsy. To do this, the doctor will take a tissue sample, sometimes through a small needle. Sometimes surgery is done to take part of the lump or the whole thing for testing. The results will show whether the lump is cancer, and if so, what type. There are several forms of breast cancer. Treatments are carefully matched to the type of cancer.
Hormone-Sensitive Breast Cancer
Some types of breast cancer are fueled by the hormones estrogen and progesterone. A biopsy can show if a tumor has receptors for estrogen (ER-positive) or progesterone (PR-positive) or both. About 2 out of 3 breast cancers are hormone-sensitive. There are several medicines that can stop hormones from causing the cancer to grow.
The image shows a molecular model of an estrogen receptor.
HER2-Positive Breast Cancer
In about 20% of women with breast cancer, breast cancer cells have too many receptors for a protein called HER2. This type of cancer is known as HER2-positive. It tends to spread faster than other forms of breast cancer. It's important to figure out if a tumor is this type because there are special treatments for it.
A HER2-positive breast cancer cell is illustrated here. Growth signals that are not normal are shown in green.
Breast Cancer Stages
Once you know it is cancer, the next step is to figure out how big the tumor is and how far the cancer has spread. This is called staging. Doctors use stages 0 to IV to describe whether cancer is just in the breast, has gotten into nearby lymph nodes, or has spread to other organs. Knowing the stage and type of breast cancer will help your health care team make a treatment plan.
Survival odds are strongly tied to how early it is found. According to the American Cancer Society, 100% of women with stage I breast cancer live at least 5 years, and many women in this group remain cancer-free for good. The more advanced the cancer, the lower this percentage. By stage IV, the 5-year survival rate drops to 22%. But these rates can improve as better treatments are found.
Breast Cancer Surgery
There are many types of surgery. For a lumpectomy or breast-conserving surgery, the surgeon takes out the area just around the lump. Mastectomy means removing the entire breast. It's best to discuss the pros and cons of different surgeries with your doctor before you decide what's right for you.
This uses high-energy rays to kill cancer cells. It may be used after surgery to wipe out any cancer cells that are left. It can also be used with chemotherapy to treat cancer that has spread to other parts of the body. Side effects can include fatigue and swelling or a sunburn-like feeling where you were treated.
For this, drugs are used to kill cancer cells anywhere in the body. Many are given by IV. Some are taken by mouth or in a shot. Chemotherapy may be done after surgery to lower the odds of the cancer coming back. With advanced breast cancer, chemo can help control the cancer's growth. Side effects may include hair loss, nausea, fatigue, and a higher risk of infections.
Hormone Therapy for Breast Cancer
This is for women with ER-positive or PR-positive breast cancer. These are cancers that grow faster in response to the hormones estrogen or progesterone. This treatment can block this effect. It is most often used after breast cancer surgery to help keep the cancer from coming back. It may also be used to lower the chance of cancer in women who are at high risk.
Targeted Drugs for Breast Cancer
These are newer drugs that target specific parts within cancer cells. For example, women with HER2-positive breast cancer have too much of a protein called HER2. Targeted drugs can stop it from promoting cancer cell growth. These drugs are often used in combination with chemo. They tend to have milder side effects.
Life After Diagnosis
There's no doubt that cancer is a life-changing experience. The treatments can wear you out. It can be hard to manage daily tasks or social outings. To ward off feelings of isolation, it's crucial to reach out to friends and family for support. They may be able to go with you to treatments, help out with chores, or just remind you that you’re not alone. Many people choose to join a support group, either near them or online.
Many women who have a breast removed choose to undergo reconstructive surgery. This replaces the skin, nipple, and breast tissue that are lost during a mastectomy. It can be done with a breast implant or with tissue from somewhere else in your body, such as the tummy. Some women choose to do this at the same time as their mastectomy. But you can also do it months or years later.
An alternative to breast reconstruction is to be fitted for a breast form. This is a breast-shaped prosthesis that fits inside your bra. This can give you a balanced look when you are dressed -- without undergoing additional surgery. Like reconstructive surgery, these are often covered by insurance.
Breast Cancer: Why Me?
The most obvious risk factor for breast cancer is being a woman. Men get the disease, too, but it is about 100 times more common in women. You’re also more at risk if you’re over age 55 or have a close relative who has had the disease. But keep in mind that up to 80% of women with breast cancer have no family history of the illness.
Breast Cancer Genes
Some women have a very high risk of breast cancer. That’s because they inherited changes in certain genes. The ones most commonly tied to breast cancer are known as BRCA1 and BRCA2. Women with mutations in these genes have up to an 80% chance of getting breast cancer at some point in life. Other genes may be linked to breast cancer risk, too.
Risk Factors in Your Control
Among survivors, good lifestyle choices may be helpful. Recent studies suggest that physical activity may help lower the risk of a recurrence, and it's a proven mood-booster. If you’re overweight, don’t get enough exercise, and drink more than one alcoholic beverage per day, it can raise the risk of developing breast cancer. Birth control pills and some forms of postmenopausal hormone therapy can also boost your risk. But the risk seems to go back to normal after these medications are stopped.
Breast Cancer Research
Doctors continue to search for treatments that work better and are easier to undergo. Funding for this research comes from many sources, including advocacy groups throughout the country. Many of the 2.5 million breast cancer survivors and their families choose to participate in walk-a-thons and other fundraising events. This links each individual fight against cancer into a common effort for progress.
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