Breast cancer, the growth of malignant cells in the breast, is the most common cancer among women. It is rare but does occur in men. Breast cancer usually originates in the milk-carrying ducts, although it may arise in the milk-producing lobules or, more rarely, in the dense connective tissue of the breast. A breast tumor is not in itself life-threatening, but there is a high risk that the cancer will spread to other organs via the lymph nodes or the blood- stream, so early detection is imperative. In 90 percent of cases, only one breast is affected, although those who have had cancer in one breast are at increased risk of eventually developing it in the other. In all cases, early detection and treatment improve the outlook significantly.
Symptoms of Breast Cancer
A lump or swelling, usually painless, anywhere
in the breast or underarm area (but most
commonly in the upper and outer region of
the breast).
Changes in the appearance of the breast’s skin,
including flattening, indentation, dimpling,
creasing, redness, or scaliness.
Changes in the nipple, including indentation,
an itching or burning sensation, or dark or
bloody discharge.
Changes in the size or symmetry of the
breasts.
Discomfort or pain in the breast in advanced
cases.
What Causes Breast Cancer
The precise cause is unknown, but the following factors correlate with a higher incidence of breast cancer:
Age: The risk of breast cancer increases progressively with age. Most often it occurs after age 50.
Family history. Approximately 10 percent of women with breast cancer have a positive family history. Women who have at least 2 first degree relatives with breast cancer that was diagnosed before the age of 50, or ovarian cancer diagnosed at any age, may have inherited one of two breast cancer genes, increasing their risk of both breast and ovarian cancer.
Having had children late in life or not at all. Women who have no children, have their first child in their 30s, or have never breastfed may be more susceptible to breast cancer.
Early onset of menstruation (that is before age 11). * Late menopause (that is not having reached menopause by one's early 50s). * Nonmalignant cysts and tumors in the breasts.
A diet high in animal fat.
Moderate to severe alcohol intake (greater than 3 drinks per day). * Possibly, environmental toxins.
Long-term (greater than 5 years) use of hormone replacement therapy (the combination of estrogen and progestin).
Long-term nocturnal light exposure (such as shift work).
Prevention of Breast Cancer
Mammograms can detect tumors too small to feel. Women over 50 should have annual mammograms, and those between ages 40 and 50 should discuss their individual risk factors with their doctors to determine when to begin mammography. The exam should be performed by a radiologist specializing in mammography or by a mammography center accredited by the American College of Radiology. A list of accredited centers is available from the National Cancer Institute at 1-800-4-CANCER.
Women should have a yearly breast exam performed by a doctor or other trained specialist.
Women should perform monthly breast exams (the best time is two or three days after menstruation ends). Breast tissue is normally somewhat lumpy and uneven, so it is important to become familiar with the normal contour and texture of the breasts. Changes in texture and appearance will then become more easily detectable.
Regular exercise and maintaining weight can decrease risk of postmenopausal breast cancer.
Women who are at increased risk of breast cancer may benefit from chemoprevention, which involves Tamoxifen therapy for 5 years. The decision to undergo chemoprevention should be made after discussing individual risks and benefits with a physician.
Women with a strong family history of breast cancer may consider undergoing genetic testing for one of the breast cancer genes. Women who test positive may undergo increased surveillance for both breast and ovarian cancer or consider preventative removal of their breasts or ovaries.
Women with a strong family history of breast cancer may consider undergoing genetic testing for one of the breast cancer genes. Women who test positive may undergo increased surveillance for both breast and ovarian cancer or consider preventative removal of their breasts or ovaries.
Diagnosis of Breast Cancer
Breast examination or mammography may reveal the presence of a lump in the breast.
A biopsy of the lump is necessary to determine whether cancerous cells are present. Tissue or fluid may be drawn out of the lump with a needle, or a sample of tissue may be removed during minor surgery.
Ultrasound, thermography, or CT (computed tomography) scans may be recommended.
How To Treat Breast Cancer
Surgery is necessary to remove the tumor. The patient will be given the choice of having any necessary surgery performed at the time of the biopsy or in a subsequent operation. Depending upon how far the cancer has spread, surgery may involve removing only the mass or lump (lumpectomy) or the entire breast (mastectomy), either of which may include removal of the neighboring lymph nodes. If a tumor has invaded the muscle tissue under the breast, the removal of the breast and the underlying muscle tissue (radical mastectomy) may be advised.
Radiation therapy may be required after surgery to prevent further spread of the cancer, especially if the lymph nodes were affected.
Chemotherapy may be required before and after surgery to prevent further spread of the cancer. Such treatment generally lasts from six months to a year.
Hormone therapy may be prescribed after surgery for estrogen-receptor-positive tumors.
Reconstructive plastic surgery is available for women who have had part or all of the breast removed. Women may have reconstructive surgery at the same time as surgery to remove the tumor or at a later date.
When To Call A Doctor
Make an appointment with a doctor if you notice a lump anywhere in the breast or under the arm. Most lumps are not cancerous, but a biopsy is necessary to diagnose breast cancer with certainty.
Make an appointment with a doctor if you notice any change in the size, shape, or appearance of the breast or if you experience any discharge from the nipple.
The Johns Hopkins Hospital has been ranked #1 again in the Honor Roll of America's Best Hospitals by U.S. News and World Report for the 18th consecutive year.
Medical Disclaimer: The information on this page is not intended to substitute for the advice of a physician.
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