Breast Cancer

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Breast Cancer

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Overview
Breast cancer affects one in eight women during
their lives. Breast cancer kills more women in the
United States than any cancer except lung cancer.
No one knows why some women get breast
cancer, but there are a number of risk factors. Risks
that you cannot change include:

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Overview
**Age**
- the chance of getting breast cancer rises, as a
woman gets older


Overview
**Genes**
- there are two genes, BRCA1 and BRCA2, which
greatly increase the risk. Women who have family
members with breast or ovarian cancer may wish
to be tested.


Overview
**Personal factors**
- beginning periods before age 12 or going
through menopause after age 55
Other risks include being overweight, using
hormone replacement therapy (also called
menopausal hormone therapy), taking birth
control pills, drinking alcohol, not having children
or having your first child after age 35 or having
dense breasts.


Overview
**Personal factors**
Symptoms of breast cancer may include a lump in
the breast, a change in size or shape of the breast
or discharge from a nipple. Breast self-exam and
mammography can help find breast cancer early
when it is most treatable. Treatment may consist
of radiation, lumpectomy, mastectomy,
chemotherapy and hormone therapy.
Men can have breast cancer, too, but the number
of cases is small.


Symptoms
Early breast cancer usually does not cause
symptoms. This is why regular breast exams are
important. As the cancer grows, symptoms may
include:
-- Breast lump or lump in the armpit that is hard,
has uneven edges, and usually does not hurt


Symptoms
-- Change in the size, shape, or feel of the breast or
nipple -- for example, you may have redness,
dimpling, or puckering that looks like the skin of an
orange
-- Fluid coming from the nipple -- may be bloody,
clear to yellow, green, and look like pus
-- Men can get breast cancer, too. Symptoms
include breast lump and breast pain and
tenderness.

Symptoms
Symptoms of advanced breast cancer may include:
-- Bone pain
-- Breast pain or discomfort
-- Skin ulcers
-- Swelling of one arm (next to the breast with
cancer)


Symptoms
-- Weight loss


Diagnosis
The doctor will ask you about your symptoms and
risk factors. Then the doctor will perform a physical
exam, which includes breasts, armpits, and the
neck and chest area.
Tests used to diagnose and monitor patients with
breast cancer may include:


Diagnosis
-- Breast MRI to help better identify the breast
lump or evaluate an abnormal change on a
mammogram
-- Breast ultrasound to show whether the lump is
solid or fluid-filled
-- Breast biopsy, using methods such as needle
aspiration, ultrasound-guided, stereotactic,
or openCT scan to see if the cancer has spread


Diagnosis
-- Mammography to screen for breast cancer or
help identify the breast lump
-- PET scanSentinel lymph node biopsy to see if the
cancer has spread


Diagnosis
If your doctor learns that you do have breast
cancer, more tests will be done to see if the cancer
has spread. This is called staging. Staging helps
guide future treatment and follow-up and gives
you some idea of what to expect in the future.
Breast cancer stages range from 0 to IV. The higher
the staging number, the more advanced the
cancer.


Treatment
Treatment is based on many factors, including:
-- Type and stage of the cancer
-- Whether the cancer is sensitive to certain
hormones


Treatment
-- Whether the cancer overproduces
(overexpresses) a gene called HER2/neu
In general, cancer treatments may include:
-- Chemotherapy medicines to kill cancer cells
-- Radiation therapy to destroy cancerous tissue


Treatment
-- Surgery to remove cancerous tissue --
a lumpectomy removes the breast
lump; mastectomy removes all or part of the
breast and possible nearby structures
-- Hormonal therapy is prescribed to women with
ER-positive breast cancer to block certain
hormones that fuel cancer growth.


Treatment
An example of hormonal therapy is the
drug tamoxifen. This drug blocks the effects
of estrogen, which can help breast cancer cells
survive and grow. Most women with estrogen-
sensitive breast cancer benefit from this drug.


Treatment
Another class of hormonal therapy medicines
called aromatase inhibitors, such
as exemestane (Aromasin), have been shown to
work just as well or even better than tamoxifen in
postmenopausal women with breast cancer.
Aromatase inhibitors blocks estrogen from being
made.


Treatment
Targeted therapy, also called biologic therapy, is a
newer type of cancer treatment. This therapy uses
special anticancer drugs that target certain
changes in a cell that can lead to cancer. One such
drug is trastuzumab (Herceptin). It may be used for
women with HER2-positive breast cancer.
Cancer treatment may be local or systemic.


Treatment
Local treatments involve only the area of disease.
Radiation and surgery are forms of local treatment.
Systemic treatments affect the entire body.
Chemotherapy is a type of systemic treatment.


Treatment
Most women receive a combination of treatments.
For women with stage I, II, or III breast cancer, the
main goal is to treat the cancer and prevent it from
returning (curing). For women with stage IV cancer,
the goal is to improve symptoms and help them
live longer. In most cases, stage IV breast cancer
cannot be cured.
**Stage 0 and DCIS**


Treatment
- Lumpectomy plus radiation or mastectomy is the
standard treatment. There is some controversy on
how best to treat DCIS.
**Stage I and II**
- Lumpectomy plus radiation or mastectomy with
some sort of lymph node removal is the standard
treatment. Hormone therapy, chemotherapy, and
biologic therapy may also be recommended
following surgery.

Treatment
**Stage III**
- Treatment involves surgery, possibly followed by
chemotherapy, hormone therapy, and biologic
therapy.


Treatment
**Stage IV **
- Treatment may involve surgery, radiation,
chemotherapy, hormonal therapy, or a
combination of these treatments.
After treatment, some women will continue to
take medications such as tamoxifen for a period of
time. All women will continue to have blood tests,
mammograms, and other tests after treatment.


Treatment
**Stage IV **
Women who have had a mastectomy may have
reconstructive breast surgery, either at the same
time as the mastectomy or later.


Causes
Cancer begins in cells, the building blocks that
make up tissues. Tissues make up the breasts and
other parts of the body.
Normal cells grow and divide to form new cells as
the body needs them. When normal cells grow old
or get damaged, they die, and new cells take their
place.


Causes
Sometimes, this process goes wrong. New cells
form when the body doesn't need them, and old
or damaged cells don't die as they should. The
buildup of extra cells often forms a mass of tissue
called a lump, growth, or tumor.
Tumors in the breast can be benign (not cancer)
or malignant (cancer). Benign tumors are not as
harmful as malignant tumors:


Causes
**Benign tumors**
:
-- Are rarely a threat to life
-- Can be removed and usually don't grow back
-- Don't invade the tissues around them


Causes
**Benign tumors**
-- Don't spread to other parts of the body
**Malignant tumors**
:
-- May be a threat to life
-- Often can be removed but sometimes grow back


Causes
**Benign tumors**
-- Can invade and damage nearby organs and
tissues (such as the chest wall)
-- Can spread to other parts of the body


Causes
**Benign tumors**
Breast cancer cells can spread by breaking away
from the original tumor. They enter blood vessels
or lymph vessels, which branch into all the tissues
of the body. The cancer cells may be found in
lymph nodes near the breast. The cancer cells may
attach to other tissues and grow to form new
tumors that may damage those tissues.
The spread of cancer is called metastasis.


Causes
**Benign tumors**
Over the course of a lifetime, 1 in 8 women will be
diagnosed with breast cancer.
Risk factors you cannot change include:


Causes
**Age and gender **
- Your risk of developing breast cancer increases as
you get older. Most advanced breast cancer cases
are found in women over age 50. Women are 100
times more likely to get breast cancer than men.


Causes
**Family history of breast cancer**
- You may also have a higher risk for breast cancer
if you have a close relative who has had breast,
uterine, ovarian, or colon cancer. About 20 - 30%
of women with breast cancer have a family history
of the disease.


Causes
**Genes**
- Some people have genes that make them more
likely to develop breast cancer. The most common
gene defects are found in the BRCA1 and BRCA2
genes. These genes normally produce proteins that
protect you from cancer. If a parent passes you a
defective gene, you have an increased risk for
breast cancer. Women with one of these defects
have up to an 80% chance of getting breast cancer
sometime during their life.


Causes
**Menstrual cycle**
- Women who got their periods early (before age
12) or went through menopause late (after age 55)
have an increased risk for breast cancer.
Other risk factors include:


Causes
**Alcohol use**
- Drinking more than 1 - 2 glasses of alcohol a day
may increase your risk for breast cancer.


Causes
**Childbirth**
- Women who have never had children or who had
them only after age 30 have an increased risk for
breast cancer. Being pregnant more than once or
becoming pregnant at an early age reduces your
risk of breast cancer.


Causes
**DES**
- Women who took diethylstilbestrol (DES) to
prevent miscarriage may have an increased risk of
breast cancer after age 40. This drug was given to
the women in the 1940s - 1960s.


Causes
**Hormone replacement therapy (HRT)**
- You have a higher risk for breast cancer if you
have received hormone replacement therapy
with estrogen for several years or more.


Causes
**Obesity**
- Obesity has been linked to breast cancer,
although this link is controversial. The theory is
that obese women produce more estrogen, which
can fuel the development of breast cancer.


Causes
**Radiation**
- If you received radiation therapy as a child or
young adult to treat cancer of the chest area, you
have a much higher risk for developing breast
cancer. The younger you started such radiation and
the higher the dose, the higher your risk --
especially if the radiation was given during breast
development.


Causes
**Radiation**
Breast implants, using antiperspirants, and wearing
underwire bras do not raise your risk for breast
cancer. There is no evidence of a direct link
between breast cancer and pesticides.
The National Cancer Institute provides an online
tool to help you figure out your risk of breast
cancer.


Prevention
Tamoxifen is approved for breast cancer
prevention in women aged 35 and older who are
at high risk. Discuss this with your doctor.
Women at very high risk for breast cancer may
consider preventive (prophylactic) mastectomy.
This is the surgical removal of the breasts before
breast cancer is ever diagnosed. Possible
candidates include:


Prevention
-- Women who have already had one breast
removed due to cancer
-- Women with a strong family history of breast
cancer
-- Women with genes or genetic mutations that
raise their risk of breast cancer (such as BRCA1 or
BRCA2)


Prevention
-- Your doctor may do a total mastectomy to
reduce your risk of breast cancer. This may
reduce, but does not eliminate the risk of breast
cancer.
Many risk factors, such as your genes and family
history, cannot be controlled. However, eating a
healthy diet and making a few lifestyle changes
may reduce your overall chance of getting cancer.


Prevention
There is still little agreement about whether
lifestyle changes can prevent breast cancer. The
best advice is to eat a well-balanced diet and avoid
focusing on one "cancer-fighting" food. The
American Cancer Society's dietary guidelines for
cancer prevention recommend that people:
-- Choose foods and portion sizes that promote a
healthy weight


Prevention
-- Choose whole grains instead of refined grain
products
-- Eat 5 or more servings of fruits and vegetables
each day
-- Limit processed and red meat in the diet


Prevention
-- Limit alcohol consumption to one drink per day
(women who are at high risk for breast cancer
should consider not drinking alcohol at all)


Living and Coping
**Nutrition and Physical Activity**
It's important for you to take very good care of
yourself before, during, and after cancer
treatment. Taking care of yourself includes eating
well and staying as active as you can.


Living and Coping
You need the right amount of calories to maintain
a good weight. You also need enough protein to
keep up your strength. Eating well may help you
feel better and have more energy.


Living and Coping
Sometimes, especially during or soon after
treatment, you may not feel like eating. You may
be uncomfortable or tired. You may find that foods
don't taste as good as they used to. In
addition, the side effects of treatment (such as
poor appetite, nausea, vomiting, or mouth blisters)
can make it hard to eat well. On the other
hand, some women treated for breast cancer may
have a problem with weight gain.Your doctor, a
registered dietitian, or another health care
provider can suggest ways to help

Living and Coping
**Breast Reconstruction**
Some women who plan to have a mastectomy
decide to have breast reconstruction. Other
women prefer to wear a breast form (prosthesis)
inside their bra. Others decide to do nothing after
surgery. All of these options have pros and cons.
What is right for one woman may not be right for
another. What is important is that nearly every
woman treated for breast cancer has choices.


Living and Coping
Breast reconstruction may be done at the same
time as the mastectomy, or later on. If radiation
therapy is part of the treatment plan, some
doctors suggest waiting until after radiation
therapy is complete.
If you are thinking about breast
reconstruction, you should talk to a plastic surgeon
before the mastectomy, even if you plan to have
your reconstruction later on.


Living and Coping
There are many ways for a surgeon to reconstruct
the breast. Some women choose to have breast
implants, which are filled with saline or silicone
gel. You can read about breast implants on the
Food and Drug Administration Web site
at http://www.fda.gov.


Living and Coping
You also may have breast reconstruction with
tissue that the plastic surgeon removes from
another part of your body. Skin, muscle, and fat
can come from your lower abdomen, back, or
buttocks. The surgeon uses this tissue to create a
breast shape.


Living and Coping
The type of reconstruction that is best for you
depends on your age, body type, and the type of
cancer surgery that you had. The plastic surgeon
can explain the risks and benefits of each type of
reconstruction.
**Follow-up Care**


Living and Coping
You'll need regular checkups after treatment for
breast cancer. Checkups help ensure that any
changes in your health are noted and treated if
needed. If you have any health problems between
checkups, you should contact your doctor.
Your doctor will check for return of the cancer.
Also, checkups help detect health problems that
can result from cancer treatment.


Living and Coping
You should report any changes in the treated area
or in your other breast to the doctor right away.
Tell your doctor about any health problems, such
as pain, loss of appetite or weight, changes in
menstrual cycles, unusual vaginal bleeding, or
blurred vision. Also talk to your doctor about
headaches, dizziness, shortness of breath,
coughing or hoarseness, backaches, or digestive
problems that seem unusual or that don't go away.
Such problems may arise months or years after
treatment. They may su

Living and Coping
Checkups usually include an exam of the neck,
underarm, chest, and breast areas. Since a new
breast cancer may develop, you should have
regular mammograms. You probably won't need a
mammogram of a reconstructed breast or if you
had a mastectomy without reconstruction. Your
doctor may order other imaging procedures or lab
tests.


Top Treatment Centers
As ranked by US news 2012 Best Hospitals for
Cancer
University of Texas Anderson Cancer Center –
Houston, Tx
Memorial Sloan-Kettering Cancer Center – New
York, NY


Johns Hopkins Hospital – Baltimore, Md
Mayo Clinic – Rochester, MN
Dana-Farber Brigham & Women’s Cancer
Center – Boston, Ma
Cleveland Clinic – Cleveland, OH


Massachusetts General Hospital – Boston, Ma
University of Washington Medical Center – Seattle,
Wa
Ronald Reagan UCLA Medical Center – Los Angeles,
Ca
Barnes-Jewish Hospital Washington University –
Saint Louis, Mo


Breast Cancer

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