As a woman, you know what it is to be busy. A routine visit to your health care provider can be the last thing you want to do. However, it is important that you make time for mammograms and breast examinations. Do it for yourself…do it for those who depend on you? Early diagnosis of breast cancer could save your life.
Breast cancer strikes thousands of women each year. Early detection of breast cancer is maximised through a combined approach of routine mammograms, annual clinical breast examinations by a doctor or a nurse and monthly breast self-examinations.
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Screening and Early Detection
It is important to take an active part in the early detection of breast cancer. Talk with your doctor about symptoms to watch for and an appropriate schedule of checkups. There are three important ways to detect breast cancer:
•Mammogram (X-ray of the breast)
•Clinical breast exam (breast exam by a doctor or nurse)
A mammogram is a special kind of X-ray that uses very low levels of radiation. Mammography performed in women with no symptoms of breast cancer is usually called screening. Mammography is the most accurate method available to detect breast cancer in its earliest stage. However, no diagnostic tool is 100 percent effective. In many cases (but not all), mammograms can show breast tumors before they cause symptoms or can be felt. Even though your mammogram may be normal, you should not ignore changes in your breasts. The American Cancer Society recommends a mammogram each year if you are 40 years of age or older.
A woman’s breast is made up of milk glands and milk ducts, surrounded by fatty tissue and connective supports. Uncontrolled growth of cells in any of these breast tissues can cause breast cancer.
Breast cancer is the most common cancer among women.. Chances of developing breast cancer rise dramatically as women age. At age 30, the chances of getting the disease are 1 in 209; at age 50, the risk of developing breast cancer goes up to 1 in 42; and over the age of 70, it becomes 1 in 25.
Breast cancer is rare in men, accounting for less than 1% of all cases. Breast cancer is the second most common cause of death from cancer in women.
Clinical Breast Exam
For women of all ages, a breast exam by a doctor or nurse (called a clinical breast exam) is usually part of a regular medical checkup. During a clinical breast exam, your doctor will carefully feel your breasts and under your arms to check for lumps and other unusual changes.
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You also should examine your breasts once a month. It’s important to remember that every woman’s breasts are different. Your breasts may undergo changes because of ageing, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for the breasts to feel a little lumpy and uneven. Also, it is common for a woman’s breasts to be swollen and tender right before or during her menstrual period. You should contact your doctor about any unusual changes in your breasts. When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for:
•A lump or thickening in or near the breast or in the underarm area;
•A change in the size or shape of the breast;
•A discharge from the nipple; or
•A change in the color or feel of the skin of the breast, areola or nipple (dimpled, puckered or scaly).
See your doctor if you notice any of these changes. Most often, they are not cancer, but only a doctor can tell for sure. If you do not have a doctor, call your medical society or one of the numbers provided on the back of this brochure. Staff members will try to help find a doctor or breast cancer clinic close to where you live.
The Y-ME National Breast Cancer Organisation recommends performing a breast self examination (BSE) seven to 10 days after the first day of your period, when your breasts are least tender. If you no longer menstruate, choose the same day each month to do a BSE.
When Cancer is found
When cancer is present, the pathologist can tell what kind of cancer it is (whether it began in a duct or a lobule) and whether it is invasive (has invaded nearby tissues in the breast).
This booklet is written especially for you if you have been diagnosed with breast cancer. You probably have many questions and concerns. You may be feeling confused, worried or anxious. It may be hard for you to concentrate or to make decisions. These reactions are normal.
The information in this booklet should help you understand your diagnosis and the treatments that are available. It is very important that you become a partner with your doctor in deciding what treatment is best for you.
Who Gets Breast Cancer?
Breast cancer is one of the most frequently diagnosed cancers in women in the United States today. Every woman has some chance of developing breast cancer during her lifetime. Since age is a major risk factor, as women get older, their chances of getting breast cancer increase. Even though breast cancer is more common in older women, it also occurs in younger women and even in a small number of men.
While we don’t yet know what causes breast cancer, we do know that–
1. Breast cancer is not caused by stress or by an injury to the breast.
2. Most women who develop breast cancer do not have any known risk factors or a history of the disease in their families.
3. You should not feel guilty. You haven’t done anything wrong in your life that caused breast cancer.
4. You cannot “catch” breast cancer from other women who have the disease. It is not contagious.
Remember, you don’t have to face breast cancer alone; there are knowledgeable and caring people who can help you.
The body’s cells reproduce themselves throughout your lifetime, as tissues wear out and their cells are replaced in a controlled manner. Breast cancer – like all cancers – occurs when that control is lost and cells begin to divide at an unusually high rate.
No single trigger or cause has been identified for breast cancer. Certain risk factors exist, though, that increase a woman’s chance of developing it:
Age – it’s more common in women over 50
Family history – if a woman’s mother or sister had the disease before menopause, this is occasionally associated with one of two genes linked to breast cancer
Previous breast cancer
Family history of ovarian cancer
Age of pregnancy – women who haven’t had children, or whose first child was born after age 30
Age of menstruation – starting periods at a young age (under 12 years old)
Entering menopause later (over age 55) increases breast cancer risks
Recent research suggests that women who start smoking regularly within 5 years of the onset of their menstrual periods are 70% more likely to develop breast cancer before the age of 50 than non-smokers
Having dense breast tissue
Radiation treatment to the chest, especially before 30 years of age
Alcohol consumption contributes to the risk of breast cancer
Hormone replacement therapy (HRT; estrogen plus progesterone) increases the risk of breast cancer slightly after 5 years of therapy
Oral contraceptives increase risks slightly, if used over many years
Obesity with excess caloric and fat intake
The increased risks of getting breast cancer associated with the above factors are often statistically quite small. In fact, for most women, the only risk factor they have is being over 50 years of age. Any concerns should be discussed with your doctor.
Symptoms and Complications
9 out of 10 times, women are the first to notice a lump or mass in their breast. It usually isn’t painful, but can cause an unusual sensation in the area where the lump is.
When a tumor grows, the size or shape of the breast may change. As well, the nipple might draw in, or some of the skin will pull in, causing what looks like a dimple to appear. Other symptoms may include a lump or swelling in the armpit and redness or swelling of the breast.
A breast that develops a red rash should be evaluated for breast cancer even in the absence of a lump.
While these might be signs of breast cancer, they might also indicate another non-cancerous condition. In fact, about 8 out of 10 breast growths are non-cancerous. However, a doctor should be consulted to determine the exact cause of the lump.
The most serious complication of breast cancer is metastasis. That’s when some cells from a tumour break off and move to other areas of the body, either through the blood or the lymphatic vessels – invading the tissue at new, possibly distant sites. When breast cancer cells metastasis, it’s most commonly to the lymph nodes, lungs, liver, bones, brain, and skin. It can take years, even after the breast tumor is diagnosed and treated, before cancer that has spread from the original tumour appears.
Once metastatic tumors are discovered, chances are that the cancer has spread to other locations as well, even if they remain undetected.
Making the Diagnosis
A suspicious lump in your breast should be checked by your doctor. Aside from an extensive physical examination, the doctor will also want to do a mammogram, which is a low-level X-ray that can show abnormal areas in your breast. An ultrasound can sometimes be performed to see if the lump is a fluid-filled cyst or a solid growth. Even if the lump that can be felt is not visible on the mammogram, some sort of biopsy may need to be done.
Using a needle, fluid can be removed from a cyst to check if it contains cancerous cells. A solid lump must be analysed under a microscope. This requires either a needle biopsy, a core biopsy, or a surgical biopsy to be performed.
For a needle biopsy, a fine needle is inserted into the lump and cells are drawn out with the needle. With a core biopsy, a sample of breast cells and tissues is removed for examination. A surgical biopsy is an operation that removes the whole lump and some normal tissue around it. It can be done under a local or general anesthetic.
Cancerous cells can be tested for the presence of estrogen or progesterone receptors. Other tests, including X-rays, bone scans, ultrasounds, CT scans, or an MRI, may be done to see if the cancer has spread to other organs and tissues.
Treatment and Prevention
Early detection of breast cancer minimises the likelihood that the cancer has spread, and it increases the chances of making a complete recovery.
Treatment depends on individual circumstances, such as the rate of growth, how it responds to treatment, and whether or not it has spread. Treatment options for breast cancer include surgery, radiation therapy, chemotherapy, and medication therapy (including hormone and biological therapy).
With surgery, part or all of the breast is removed. Removal of a small part of the breast (only the tumour and some surrounding tissue) is called a lumpectomy, or partial mastectomy if a larger area of the breast is removed. A simple mastectomy involves removing the whole breast, and a radical mastectomy includes the underlying chest muscle and tissue as well. The lymph nodes in the underarms may also be taken out. Breast reconstruction surgery may be an option for many women either at the time of surgery or at a later date.
Chemotherapy is usually given by injection. Chemotherapy interferes with the growth of cancer cells, but it also affects healthy cells. Common side effects of chemotherapy can include nausea, vomiting, hair loss, and infection.
Hormonal therapy (e.g., tamoxifen, or the class of medications known as aromatase inhibitors) also helps stop the growth of cancer cells and may be used for up to 5 years for postmenopausal women who have receptor-positive cancer. Common side effects of hormonal therapy include hot flashes and irregular menstruation.
On rare occasions, systemic therapy is used before surgery. This is called neoadjuvant therapy. This type of treatment is used to improve chances of avoiding a mastectomy in favour of a lumpectomy, or to control a cancer that involves a large portion of the breast.
Radiation therapy is often administered after lumpectomy or partial mastectomy. Radiation kills cancer cells in the breast and sometimes in the armpit and chest wall as well. Side effects of radiation therapy such as skin redness and tiredness are the result of healthy tissue in the area being destroyed, and go away on their own following the completion of therapy.
While successful surgery and radiation therapy rely on exact knowledge of where the tumour is located, systemic therapy does not. Chemotherapy involves taking one or more medications to destroy cancer cells in various parts of the body. Hormone therapy works on cancerous cells that have estrogen receptors, making them susceptible to estrogen-blocking medications.
Biological therapy interferes with the growth of cancer cells and helps the body to kill cancer cells. It is usually used for breast cancer that has too much of a protein called HER2.
For some women with a high risk of breast cancer, research has shown that an anti-estrogen medication may be used to help prevent breast cancer.
Since there are risks associated with any medication, the decision to use preventative therapy should be made after knowing all of the risks and benefits of treatment.
There are also other steps you can take to reduce your risk of breast cancer:
Eat a healthy, low-fat diet with lots of fruits and vegetables
Reduce alcohol intake (risk increases with the amount of alcohol consumed; even 1 to 2 drinks per day can slightly increase your risk)
Consider the risks of taking hormone replacement therapy (especially for more than 5 years).
In addition, women should become familiar with the usual look and feel of their breasts. This will ensure you are aware of any changes in your breasts. Report any changes to your doctor.
From age 40 to 49, you should talk with your doctor about your risk of breast cancer and screening options for you. From age 50 to 74, women of average risk should also have mammograms every 2 years. If you have a higher-than-average risk of breast cancer or are outside of this age range, ask your doctor when you should have a mammogram. These measures help detect any unusual lumps or abnormalities in breast tissue. Early detection can make a big difference in successful treatment.