Playing An Active Role
You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.
Together, you and your health care provider can choose treatments that fit your values and lifestyle.;
The National Academy of Sciences released the report, Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis in 2013. Susan G. Komen® was one of 13 organizations that sponsored this study.
The report identified key ways to improve quality of care:
Radiation Therapy For Breast Cancer
Radiation therapy uses high-energy rays or particles to destroy cancer cells. It is often used to treat breast cancer. Your healthcare team will consider your personal needs to plan the type and amount of radiation, and when and how it is given. You may also receive other treatments.
Radiation therapy is given for different reasons. You may have radiation therapy to:
- lower the risk of the cancer coming back, or recurring, after surgery
- shrink a tumour before surgery
- treat breast cancer that comes back, or recurs, in the area of a mastectomy
- relieve pain or control the symptoms of advanced breast cancer
Doctors use external beam radiation therapy to treat breast cancer. During external beam radiation therapy, a machine directs radiation through the skin to the tumour and some of the tissue around it.
Some women may not be able to have radiation therapy because they already had radiation therapy to the chest or breast. Doctors may not offer radiation therapy to women with lung problems, damaged heart muscles and certain connective tissue diseases.
Treatment Of Breast Cancer Stages I
The stage of your breast cancer is an important factor in making decisions about your treatment.;
Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of drug therapy. In general, the more the breast cancer has spread, the more treatment you will likely need.;But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:
- If the cancer cells contain hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
- If the cancer cells have large amounts of the HER2 protein
- How fast the cancer is growing
- Your overall health
- If you have gone through menopause or not
Talk with your doctor about how these factors can affect your treatment options.
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How Does The Doctor Know I Have Breast Cancer
A change seen on your mammogram may be the first sign of breast cancer. Or you may have found a lump or other change in your breast.
The doctor will ask you questions about your health and will do a physical exam. A breast exam is done to look for changes in the nipples or the skin of your breasts. The doctor will also check the lymph nodes under your arm and above your collarbone. Swollen or hard lymph nodes might mean breast cancer has spread there.
Mammogram: This is an x-ray of the breast. Mammograms are mostly used to find breast cancer early. But another mammogram might be done to look more closely at the breast problem you might have.
MRI scan: MRIs use radio waves and strong magnets instead of x-rays to make detailed pictures. MRIs can be used to learn more about the size of the cancer and look for other tumors in the breast.
Breast ultrasound: For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture that you can see on a computer screen. Ultrasound can help the doctor see if a lump is a fluid-filled cyst , or if it’s a tumor that could be cancer.
Nipple discharge exam: If you have fluid coming from your nipple, some of it may be sent to a lab. There, it will be checked to see if there are cancer cells in it.
How Fast Can Breast Cancer Spread
Metastasis occurs when breast cancer cells begin to grow in another body part.
It is hard to say exactly how quickly breast cancer can grow, including the timeframe, as the disease affects each person differently.
Cancer occurs due to mutations in human cells. Mutations do not follow normal, predictable patterns of cell division, so it is difficult to predict the progression.
Tumors appear when damaged cells replicate over and over to form a clump of abnormal cells. Breast cancer cells can break off and move through the lymph or blood vessels to other areas of the body.
If breast cancer cells begin to grow in another body part, this is called metastasis. Breast cancer is most likely to metastasize to the lymph nodes, lungs, and bones.
Regardless of the location of the new tumor, doctors still consider it to be breast cancer.
Breast cancer growth and its chances of spreading depend on the following:
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How Are Clinical Trials Helping To Improve Treatments
Scientists continue to conduct clinical trials to develop and test treatments for breast cancer.
These trials may help them develop new treatment options and learn which types of people are most likely to benefit from available treatments. Over time, this might lead to more effective and personalized treatment plans.
One 2018 trial found that chemotherapy doesnt benefit most women with early stage breast cancer that is hormone-positive and HER2-negative. These women may benefit from surgery and hormone therapy instead.
Researchers in many other trials are also trying to determine whether certain combinations of therapies work better in certain types of breast cancer, report the authors of a 2019 review .
Scientists are also studying ways to improve breast cancer screening and diagnosis to detect breast cancer in the earliest stage possible.
For example, the tomosynthesis mammographic imaging screening trial is evaluating the potential benefits of 3-D mammography.
This is a new technology that produces images from different angles around the breast to build a multidimensional picture.
There is no natural cure for breast cancer. Medical treatments are necessary to remove, shrink, or slow the growth of tumors.
That said, you may use certain complementary therapies and lifestyle changes alongside standard medical treatments to help:
- control symptoms of breast cancer
- ease side effects of treatment
- improve quality of life
Testing Genes To See If Your Breast Cancer Is Likely To Come Back
Gene activity tests are also called tumour profiling tests, genetic expression profiling tests or gene assays. They look at groups of cancer genes to find out how active they are.;The activity of particular genes helps doctors work out;whether a cancer is likely to come back
Your doctor may suggest you have a;tumour profiling test when the benefit of having chemotherapy is not clear.;This gives them more detailed information on whether or not you should have chemotherapy to lower the risk of the cancer coming back.;
Some of these tumour profiling tests;are available for breast cancer, depending on your situation. Your doctor can explain;whether this;testing is an option for you. Examples include;EndoPredict , Oncotype DX Breast Recurrence Score, and Prosigna.
Doctors do this test using a sample of the;cancer taken during your surgery. This means that you will not need any extra tests or examinations.
These tests should not be confused with tests that look for an inherited faulty gene that increases a persons risk of getting cancer.
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Myth #1: Metastatic Breast Cancer Is Curable
Whether metastatic breast cancer is someones first diagnosis or a recurrence after treatment for earlier-stage breast cancer, it cant be cured. However, treatments can keep it under control, often for months at a time. People with MBC report fielding questions from family and friends such as, When will you finish your treatments? or Wont you be glad when youre done with all of this? The reality is they will be in treatment for the rest of their lives.
A typical pattern is to take a treatment regimen as long as it keeps the cancer under control and the side effects are tolerable. If it stops working, a patient can switch to another option. There may be periods of time when the cancer is well-controlled and a person can take a break. But people with MBC need to be in treatment for the rest of their lives.
As Breastcancer.org Community member Vlnprh of Wisconsin comments: The vast majority of people have no idea what MBC treatment involves. They somehow think that you will undergo something similar to early-stage patients surgery, radiation, chemo, whatever and then be done. They want to see you as a pink-tutu-wearing cheerleader jumping up and down declaring that you have beaten this disease
Amarantha of France writes: The one I get over and over is, How long will you be on this chemo? I mean doesn’t it end sometime? Yes, it ends when it stops working and then we go on to another treatment lather, rinse, repeat I guess until we run out of options.
How Is Inflammatory Breast Cancer Treated
Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.
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Myth #5: If Youre Diagnosed With Metastatic Breast Cancer You Did Something Wrong Or Didnt Get The Right Treatment The First Time
When some people hear stage IV breast cancer, they assume something must have been missed along the way to let the cancer get that far. There is a misconception that breast cancer always develops in orderly steps from stages I to II, III, and then IV and that theres plenty of time to catch it early. People with MBC can face misguided assumptions that they must have skipped mammograms or self-exams, or they didnt control risk factors such as not exercising enough, watching their weight, or eating healthy. But a person can do everything right and still get MBC. Although regular screenings increase the odds of diagnosing breast cancer at an earlier stage, they cant guarantee it.
Another major misconception: If youre diagnosed with metastatic cancer after being treated for an early-stage breast cancer, you must have chosen the wrong treatment regimen or it wasnt aggressive enough. But between 20% and 30% of people with an earlier-stage breast cancer will eventually go on to develop MBC and theres often no good explanation as to why. And it can happen to anyone. Treatments can reduce the risk of recurrence, but they cant eliminate it.
As Illimae of Houston notes: that a stage IV diagnosis equals negligence on the part of the patient. In my case, it had spread before I ever felt a lump. I felt it Saturday and saw my doc on Monday, I ignored nothing, sometimes it just happens that fast.
Testing For Proteins And Genes
The breast cancer cells will be tested for certain proteins called estrogen and progesterone receptors. If the cancer has these proteins, it’s called a hormone receptor positive breast cancer. The cells are also tested to see if the cancer makes too much of the HER2 protein. If it does, it’s called a HER2-positive cancer. These cancers are sometimes easier to treat. If the cancer doesn’t test positive for any of these proteins, it’s called a triple-negative breast cancer.
The cells might also be tested for certain genes, which can help decide if chemo might be helpful and how likely it is that the cancer will come back. Ask your doctor to explain the tests they plan to do, and what the results might mean.
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How Is Invasive Ductal Carcinoma Diagnosed
Same Day Results
At the Johns Hopkins Breast Center, we know how quickly patients want results from a biopsy or scan if there is a suspicion of breast cancer. We follow strict guidelines for biopsies and pathology reports. Most of our patients will receive the probability of cancer immediately following their biopsy procedure and a pathology confirmation within 24 hours.
Learn more about the steps of diagnosis, including:
- Digital mammography
- Biologic targeted therapy
Does Breast Cancer Affect Women Of All Races Equally
All women, especially as they age, are at some risk for developing breast cancer. The risks for breast cancer in general arent evenly spread among ethnic groups, and the risk varies among ethnic groups for different types of breast cancer. Breast cancer mortality rates in the United States have declined by 40% since 1989, but disparities persist and are widening between non-Hispanic Black women and non-Hispanic white women.
Statistics show that, overall, non-Hispanic white women have a slightly higher chance of developing breast cancer than women of any other race/ethnicity. The incidence rate for non-Hispanic Black women is almost as high.
Non-Hispanic Black women in the U.S. have a 39% higher risk of dying from breast cancer at any age. They are twice as likely to get triple-negative breast cancer as white women. This type of cancer is especially aggressive and difficult to treat. However, it’s really among women with hormone positive disease where Black women have worse clinical outcomes despite comparable systemic therapy. Non-Hispanic Black women are less likely to receive standard treatments. Additionally, there is increasing data on discontinuation of adjuvant hormonal therapy by those who are poor and underinsured.
In women under the age of 45, breast cancer is found more often in non-Hispanic Black women than in non-Hispanic white women.
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What Does It Mean To Have Stage 1 Breast Cancer
In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.
Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.
Stage 1b Breast Cancer Means One Of The Following Descriptions Applies:
Lymph nodes have cancer evidence with small clusters of cells between the approximate size of a pinprick to the approximate width of a grain of rice .
AND EITHER;No actual tumor is found in the breast.
OR;The tumor is smaller than the approximate size of a peanut .
Similar to stage 0, breast cancer at this stage is very treatable and survivable. When breast cancer is detected early, and is in the localized stage , the 5-year relative survival rate is 100%.
Determining Breast Cancer Stage
In breast cancer, stage is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade, and whether certain biomarkers are present.
The TNM system, the grading system, and the biomarker status are combined to find out the breast cancer stage.
Survival For All Stages Of Breast Cancer
Generally for women with breast cancer in England:
- Around 95 out of every 100 women survive their cancer for 1 year or more after diagnosis
- Around 85 out of every 100 women will survive their cancer for 5 years or more after diagnosis
- Around 75 out of every 100 women will survive their cancer for 10 years or more after diagnosis
Cancer survival by stage at diagnosis for England, 2019Office for National Statistics
These statistics are for net;survival. Net survival estimates the number of people who survive;their;cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account that some people would have died from other causes if they had not had cancer.
Will The Nhs Fund An Unlicensed Medicine
It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.
Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.
Page last reviewed: 28 October 2019 Next review due: 28 October 2022
What To Know About Breast Cancer Growth
Breast cancer occurs when normal cells mutate and multiply faster than usual. One cell divides to become two cells, then each of those cells divides to become four cells, and so on. The uncontrolled multiplication of cancer cells creates tumors within the breast tissue.
The speed at which a cancer progresses depends on the growth rate of the cancer cells. It is hard to estimate cancer growth because not all cancer cells multiply and divide at the same speed.
In most cases, breast cancer initially develops in either the milk ducts or the lobules, which are the glands that produce milk, before expanding into the breast tissue.
Breast cancer that develops in ducts or lobules can spread to the connective tissue. From there, it can spread to the surrounding lymph nodes.
Once in the lymph nodes, the cancer cells can enter the lymphatic system or the bloodstream, where they can move to other areas of the body.