How Is Breast Cancer Diagnosed?
Treatments for breast cancer work best when you find the disease early. So it’s important to get the right screening test at the right time. If you’re diagnosed with the disease, it helps to learn as much as you can about your treatment options before you choose the one you want.
Breast Self-Exams and Mammograms
Breast self-exams are a cancer screening option for women starting in their 20s. Experts don’t agree on whether every woman needs to do them, so talk to your doctor about the pros and cons of checking your breasts and if it’s a good idea for you to start. If you decide to do them, ask your doctor to show you the right way to do it and what to watch for.
To do a self-exam, you’ll need to look at and feel your breasts. Stand in front of a mirror to look for dimpling or changes in shape or symmetry. The rest of the breast self-exam is easiest in the shower, using soap to smooth your skin. With light pressure, check for lumps near the surface. Use firm pressure to explore deeper tissues. Gently pinch all parts of your nipple and the colored area around it, called the areola. If there is any discharge from your nipple -- especially if it is bloody -- see your doctor.
It may be better to do a self-exam 3 to 5 days after your period ends. Premenstrual changes can make your breast tissue feel thicker in some places, but it goes away after your period is over.
Any time you find a new or unusual lump in your breast, have your doctor check it.
Mammograms are the most effective way to detect breast cancer.They can find lumps up to 2 years before you or a doctor can feel them by hand. But medical experts don’t agree on how often women need them. The American Cancer Society recommends that women have one every year starting at age 45. But the U.S. Preventive Services Task Force says women should have mammograms every 2 years between the ages of 50 and 74. The group says that there is not enough research to know whether screening after age 74 is a good idea. The decision about when to have a mammogram is personal. If you're over 40, talk to you doctor about when you should begin.
If you do find a lump during a self-exam or your doctor sees one on a mammogram, remember that most lumps aren’t cancer. But it’s still important for your doctor to test it. There are a few different tests she might use. Imaging tests such as digital mammography, 3-D mammography, and ultrasound can help her see if the lump has the physical features of a tumor. The only way to confirm that it’s cancer is to take some of the cells from the lump and look at them under a microscope. Your doctor can do this with a biopsy that uses a very thin needle.
What Are the Treatments for Breast Cancer?
If you have breast cancer, the earlier you can get treatment, the better. But before you decide what to do, research your options. Ask questions of your doctor, other specialists, and people who’ve had breast cancer. Find a doctor you trust, and don't feel you have to rush to make a choice. A brief delay between diagnosis and treatment won’t make your therapy less effective.
The treatment options for breast cancer depend on the size of your tumor and how far it has spread in your body, your age, and how healthy you are.
Surgery for Breast Cancer
The standard surgery for breast cancer used to be the removal of the entire breast and lymph nodes nearby, called a modified radical mastectomy. But today, many women who find breast cancer before it has spread can remove just the lump. This operation, called a lumpectomy, has proven to work just as well as a mastectomy, and the physical changes it causes are much less drastic. After this type of surgery, most women also get radiation therapy, chemotherapy, or hormone therapy.
For breast cancer that has spread in the body and for disease that has come back after treatment, surgery usually isn’t the main treatment option.
Chemotherapy for Breast Cancer
This treatment uses powerful drugs to kill cancer cells. Your doctor might recommend it after you have surgery to kill any remaining cancer that the operation left behind. It helps reduce the chance that breast cancer will come back.
If your tumor is large, you might get chemotherapy before surgery to shrink it so it’s easier to remove.
Chemotherapy or hormone therapy are the main treatments for women whose cancer has spread to parts of the body outside of the breast and lymph nodes.
Radiation Therapy for Breast Cancer
In this treatment, high-energy waves destroy cancer cells. Doctors usually give radiation therapy after a lumpectomy and sometimes after a mastectomy to reduce the risk of cancer coming back in the same breast. The treatments generally start a few weeks after the surgery so the area has some time to heal. They can last for several days or a few weeks. If your doctor recommends chemotherapy along with radiation therapy, you’ll have the chemo first.
The type of radiation that most people know about is called external beam radiation. A machine focuses a beam of radiation on the tumor. It's the most common type of radiation therapy for breast cancer.
The other type is called brachytherapy. It delivers radiation to the cancer through radioactive seeds or pellets -- as small as grains of rice -- that doctors place inside the breast near the cancer. You can get brachytherapy by itself or with external beam radiation. Tumor size, location, and other things determine if this type of radiation is right for you.
Reconstructive Breast Surgery
After a mastectomy, reconstructive plastic surgery can replace breast tissue that doctors had to remove along with the cancer, including skin and the nipple.
The goal of reconstruction is to give the two breasts the same size and shape again. You might get breast implants, or doctors can move tissue from other parts of your body to your breast. Doctors can do it at the same time as the operation to remove the cancer or after you’re finished with chemotherapy or radiation.
Hormone Therapy for Breast Cancer
When your doctor diagnoses you with breast cancer, she’ll see if lab tests show that your tumor depends on your natural hormones, estrogen or progesterone, to grow. If they do, she’ll call your disease estrogen-receptor-positive or progesterone-receptor-positive breast cancer.
Hormone therapy, also called endocrine therapy, blocks your body's natural hormones from reaching the cancer cells that use them. There are a few types. You can take drugs to block the effects of estrogen, have surgery to remove your ovaries (which make estrogen), or take medicine or have radiation to make the ovaries stop making the hormone.
The estrogen-blocking drug tamoxifen (Nolvadex, Soltamox) is one of the most common hormone therapy drugs. Studies show that it lowers the chance that some early-stage cancers will come back and prevents cancer in the opposite breast. Tamoxifen works by blocking estrogen from attaching to cancer cells, which keeps them from growing.
Tamoxifen works for women before and after menopause. Most people take it for 5-10 years. While you take it, you should have a pelvic exam once a year, and let your doctor know if you have any unusual pain or bleeding.
Other types of hormone therapy keep the body from changing testosterone into estrogen. These drugs are called aromatase inhibitors. Examples are anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). They only work in postmenopausal women, but they work better than tamoxifen. Most people take them for 5-10 years.
For premenopausal women, doctors sometimes can treat breast cancer by making the ovaries stop working. The treatment, called ovarian ablation, means removing the ovaries with surgery, treating them with radiation, or blocking the hormone that makes them work with a group of drugs known as LHRH or GnRH agonists. Most of the time, doctors use this treatment for cancer that has spread beyond the breast.
Targeted Therapy for Breast Cancer
Targeted therapy is another way to fight cancer. About 25% of women with breast cancer have too much of a protein known as HER2, which makes the cancer spread more quickly. Several targeted therapies fight HER2-positive breast cancer. Options include ado-trastuzumab emtansine (Kadcyla), lapatinib (Tykerb), pertuzumab (Perjeta), and trastuzumab (Herceptin). You can take them along with other medicines. For HER2-negative breast cancers, everolimus (Afinitor), palbociclib (Ibrance), or ribociclib (Kisqali) can treat women with advanced, hormone-receptor-positive breast cancer.
After breast cancer surgery, a regular routine of simple exercises can ease muscle stiffness and help you move your body normally again. If you’ve had radiation, avoid wearing a tight-fitting bra or clothes that may irritate your skin around the treatment area. Keep your skin clean and wear loose clothing, and use only the skin lotions, creams, and deodorants that your doctor recommends.