Breast cancer

Definition

Breast cancer is cancer that starts in the tissues of the breast. There are two main types of breast cancer:

In rare cases, breast cancer can start in other areas of the breast.

Alternative Names

Cancer - breast; Carcinoma - ductal; Carcinoma - lobular; DCIS; LCIS; HER2-positive breast cancer; ER-positive breast cancer; Ductal carcinoma in situ; Lobular carcinoma in situ

Causes

Breast cancer risk factors are things that increase the chance that you could develop breast cancer:

Breast implants, using antiperspirants, and wearing underwire bras do not increase the risk for breast cancer. There is also no evidence of a direct link between breast cancer and pesticides.

Symptoms

Early breast cancer often does not cause symptoms. This is why regular breast exams and mammograms are important, so cancers that don't have symptoms may be found earlier.

As the cancer grows, symptoms may include:

In men, breast cancer symptoms include breast lump and breast pain and tenderness.

Symptoms of advanced breast cancer may include:

Exams and Tests

The health care provider will ask about your symptoms and risk factors. Then the provider will perform a physical exam. The exam includes both breasts, armpits, and the neck and chest area.

Women are encouraged to perform breast self-exams each month. However, the importance of self-exams for detecting breast cancer is debatable.

Tests used to diagnose and monitor people with breast cancer may include:

If your doctor learns that you do have breast cancer, more tests will be done. This is called staging, which checks if the cancer has spread. Staging helps guide treatment and follow-up. It also gives you an idea of what to expect in the future.

Breast cancer stages range from 0 to IV. The higher the stage, the more advanced the cancer.

Treatment

Treatment is based on many factors, including:

Cancer treatments may include:

Cancer treatment can be local or systemic:

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 (recurring). 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.

After treatment, some women continue to take medicines for a time. All women continue to have blood tests, mammograms, and other tests after treatment to monitor for the return of cancer or development of another breast cancer.

Women who have had a mastectomy may have reconstructive breast surgery. This will be done either at the time of mastectomy or later.

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

New, improved treatments are helping people with breast cancer live longer. Even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns, even after the entire tumor has been removed and nearby lymph nodes are found to be cancer-free.

Some women who have had breast cancer develop a new breast cancer that is not related to the original tumor.

How well you do after being treated for breast cancer depends on many things. The more advanced your cancer, the poorer the outcome. Other factors that determine the risk for recurrence and the likelihood of successful treatment include:

After considering all of the above, your provider can discuss your risk of having a recurrence of breast cancer.

Possible Complications

You may experience side effects or complications from cancer treatment. These may include temporary pain or swelling of the breast and surrounding area. Ask your provider about the possible side effects from treatment.

When to Contact a Medical Professional

Contact your provider if:

After being treated for breast cancer, call your provider if you develop symptoms such as:

Prevention

Talk to your provider about how often you should have a mammogram or other tests to screen for breast cancer. Early breast cancers found by a mammogram have a good chance of being cured.

Tamoxifen is approved for breast cancer prevention in women age 35 and older who are at high risk. Discuss this with your provider.

Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy. This is surgery to remove the breasts before breast cancer is diagnosed. Possible candidates include:

Many risk factors, such as your genes and family history, cannot be controlled. But making healthy lifestyle changes may reduce your overall chance of getting cancer. This includes:

References

Makhoul I. Therapeutic strategies for breast cancer. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 24.

Moyer VA; U.S. Preventive Services Task Force. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer in women: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2014;160(4):271-281. PMID: 24366376 www.ncbi.nlm.nih.gov/pubmed/24366376.

National Cancer Institute website. PDQ breast cancer treatment. Updated October 13, 2017. Accessed November 10, 2017. www.cancer.gov/types/breast/hp/breast-treatment-pdq.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): Breast cancer. Version 2.2017. Accessed November 10, 2017. www.nccn.org/professionals/physician_gls/pdf/breast.pdf.

Siu AL, on behalf of the U.S. Preventive Services Task Force. Screening for Breast Cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2106;164(4):279-296. PMID: 26757170 www.ncbi.nlm.nih.gov/pubmed/26757170.


Review Date: 10/21/2017
Reviewed By: Todd Gersten, MD, Hematology/Oncology, Florida Cancer Specialists & Research Institute, Wellington, FL. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
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