When Should I See My Doctor
See your doctor or healthcare professional if you notice symptoms of possible breast cancer, such as a lump, pain, itch, nipple discharge or dimpling, or if you have any concerns about your breast cancer risk.
Your doctor or healthcare professional will assess you and work out if you need further tests. If required, they can refer you to a local service and provide necessary follow-up care.
Early Signs Of Breast Cancer
Pinpointing breast cancer in its earliest stages isnt easy because breast cancer signs and symptoms are different for everyone. Sometimes there is a palpable lump or tenderness. Very often, there is neither. Generally, breast cancer shows no symptoms in the early stage.
However, there are certain changes in the breast that may indicate breast cancer in both men and women.
Whether you are a man or a woman, its important to become familiar with your breasts so you can recognize when changes occur and seek timely treatment. Know the facts and understand your risk factors for the disease, such as genetics and family history, by reviewing these frequently asked questions.
Treatment For Inflammatory Breast Cancer
The treatment for inflammatory breast cancer can be slightly different to other types of breast cancer.
Chemotherapy
You usually have chemotherapy as your first treatment. This is called neo adjuvant chemotherapy. It helps to control the cancer cells in the breast and reduces the swelling. It also aims to destroy any cancer cells that might have spread elsewhere in the body.
Surgery
After chemotherapy you have surgery unless there is a reason why this isn’t suitable for you. You are most likely to have your whole breast removed .
Some women might be able to have breast conserving surgery. For this type of surgery, the surgeon removes the area of cancer and a surrounding area of healthy tissue. But for most women, mastectomy is the best option.
The surgeon usually removes the lymph nodes under your armpit.
Radiotherapy
After surgery you have radiotherapy to the remaining breast tissue. This is to help stop the cancer coming back.
Other drug treatment you may have
You have hormone therapy tablets for some years if your breast cancer has hormone receptors. Your doctor might recommend that you also have targeted cancer therapy, such as trastuzumab and pertuzumab, if your cancer has receptors for those drugs.
Breast reconstruction
You may be able to have breast reconstruction after you have finished your treatment . Do ask your surgeon, they can tell you whether this is suitable for you.
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Our Approach To Breast Cancer
UCSF offers the highest quality breast cancer care in a respectful and supportive environment. We focus on effective and less toxic therapies, patient education and research that may lead to even better prevention and treatment strategies. Our team of surgeons, oncologists, radiologists, psychologists and nutritionists work together to heal the whole person, both physically and emotionally.
Prompt Surgery Is Better
Because Im a surgeon Ill take a look at Bleicher et al first. This study looks at two large cancer databases, the Surveillance, Epidemiology, and End Results -Medicarelinked database and the National Cancer Database . The SEER-Medicare cohort included Medicare patients older than 65 years, and the NCDB cohort included patients cared for at Commission on Canceraccredited facilities throughout the United States. Analyses performed assessed overall survival as a function of time between diagnosis and surgery and evaluated five intervals . It also looked at disease-specific survival at 60 day intervals. The patient cohort included women diagnosed with invasive breast cancer that had not metastasized beyond axillary lymph nodes who were treated with surgery first. Patients with inflammatory breast cancer were excluded, which makes sense because inflammatory cancer is generally treated first with chemotherapy. The SEER-Medicare cohort included 94,544 patients 66 years or older diagnosed between 1992 and 2009, while the NCDB cohort included 115,970 patients 18 years or older diagnosed between 2003 and 2005.
The tale is told by this graph, from the SEER-Medicare cohort and the NCDB cohort :
You might wonder why there is less of an effect of treatment delay in stage III disease. So did the authors:
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Factors Associated With More Rapid Spread
Some types of breast cancer, as well as their subtypes, are more likely to spread than other types. For example, ductal carcinoma is more likely to spread than lobular carcinoma, among tumors that are the same size and stage.
Many breast cancers do not spread to lymph nodes until the tumor is at least 2 cm to 3 cm in diameter. Some types may spread very early, even when a tumor is less than 1 cm in size.
Grade Of Breast Cancer
The grade describes the appearance of the cancer cells.
- Low grade the cells, although abnormal, appear to be growing slowly.
- Medium grade the cells look more abnormal than low-grade cells.
- High grade the cells look even more abnormal and are more likely to grow quickly.
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- Breast Cancer Now: Secondary breast cancer
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What Is Usually The First Sign Of Breast Cancer
The common signs of breast cancer include:
- A lump in the breast or in the armpits is often the first sign of breast cancer. This may be felt while in the shower. There may or may not be changes in the structure of the breast. Axillary swelling may indicate that cancer from the breast has traveled to the lymph nodes, and now there may be a lymph node invasion.
Apart from above signs below are few other sign and symptoms:
- Changes in the nipple area, nipple retraction and inverted nipple are common warning signs of breast cancer
- Bleeding from the nipple may be limited and difficult to see, but if an individual notices blood stains on the bra, or if the secretions are unusual, bloody or continuous, they may need urgent medical attention.
- Change in color and/or thickening of skin on the breast that resembles an orange rind is a warning sign of breast cancer. If the breast skin changes color, typically to a pink or reddish hue that covers more than half the breast that may also be a warning sign.
- A non-healing sore anywhere on the breast, including the nipple with or without bleeding may be a warning sign of breast cancer
- Increased warmth in the breast with change in size and appearance of breast is a sign of breast cancer.
N Categories For Breast Cancer
N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are involved.
Lymph node staging for breast cancer is based on how the nodes look under the microscope, and has changed as technology has gotten better. Newer methods have made it possible to find smaller and smaller groups of cancer cells, but experts haven’t been sure how much these tiny deposits of cancer cells influence outlook.
Its not yet clear how much cancer in the lymph node is needed to see a change in outlook or treatment. This is still being studied, but for now, a deposit of cancer cells must contain at least 200 cells or be at least 0.2 mm across for it to change the N stage. An area of cancer spread that is smaller than 0.2 mm doesn’t change the stage, but is recorded with abbreviations that indicate the type of special test used to find the spread.
If the area of cancer spread is at least 0.2 mm , but still not larger than 2 mm, it is called a micrometastasis . Micrometastases are counted only if there aren’t any larger areas of cancer spread. Areas of cancer spread larger than 2 mm are known to influence outlook and do change the N stage. These larger areas are sometimes called macrometastases, but are more often just called metastases.
NX: Nearby lymph nodes cannot be assessed .
N0: Cancer has not spread to nearby lymph nodes.
N1c: Both N1a and N1b apply.
N3: Any of the following:
N3a: either:
N3b: either:
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Does A Benign Breast Condition Mean That I Have A Higher Risk Of Getting Breast Cancer
Benign breast conditions rarely increase your risk of breast cancer. Some women have biopsies that show a condition called hyperplasia . This condition increases your risk only slightly.
When the biopsy shows hyperplasia and abnormal cells, which is a condition called atypical hyperplasia, your risk of breast cancer increases somewhat more. Atypical hyperplasia occurs in about 5% of benign breast biopsies.
Age At First Period Estrogen And Breast Cancer Risk
The increased risk of breast cancer linked to a younger age at first period is likely due, at least in part, to the amount of estrogen a woman is exposed to in her life. A higher lifetime exposure to estrogen is linked to an increased breast cancer risk .
The earlier a woman starts having periods, the longer her breast tissue is exposed to estrogens released during the menstrual cycle. This means a greater lifetime exposure to estrogen.
A woman cant change the age when she started her period, but the age a girl starts her period can be impacted by certain healthy lifestyle factors. For example, girls who are lean and get more exercise tend to start their periods at a later age than other girls.
Its a good idea for all young girls to be physically active and not be overweight. However, its not recommended girls do anything to try to change when they start getting their period.
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Treatment Options For Breast Cancer
According to the American Cancer Society, early-stage breast cancer has a five-year survival rate of about 99 percent.
What Is Stage Iv Breast Cancer
Stage IV is the most advanced stage of breast cancer. It has spread to nearby lymph nodes and to distant parts of the body beyond the breast. This means it possibly involves your organs such as the lungs, liver, or brain or your bones.
Breast cancer may be stage IV when it is first diagnosed, or it can be a recurrence of a previous breast cancer that has spread.
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Side Effects And Complications
All treatments have some side effects that range from mild to severe. Most clear up when treatment ends, but there can be some lasting complications.
Its important to tell your oncologist about all symptoms, even if they seem minor. Your healthcare team will work with you to ease side effects and deal with complications.
How Much Do Anastrozole And Exemestane Lower The Risk Of Breast Cancer
Studies have shown that both anastrozole and exemestane can lower the risk of breast cancer in postmenopausal women who are at increased risk of the disease.
In one large study, taking anastrozole for five years lowered the risk of developing estrogen receptor-positive breast cancer by 53 percent. In another study, taking exemestane for three years lowered the risk of developing estrogen receptor-positive breast cancer by 65 percent.
The most common side effects seen with anastrazole and exemestane are joint pains, decreased bone density, and symptoms of menopause .
Last reviewed by a Cleveland Clinic medical professional on 12/31/2018.
References
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How Quickly Breast Cancer Develops
The actual time it takes for breast cancer to grow from a single cancer cell to a cancerous tumor is unknown. Part of the reason is that estimates based on doubling time assume that the rate stays constant at all times as the tumor grows.
If this were true, cancer with a doubling time of 200 days would take 20 years to develop into a detectable tumor. A doubling time of 100 days would take 10 years to be found on exam. In contrast, a breast tumor with a doubling time of 20 days would take only 2 years to develop.
Most studies have found the average doubling time to be between 50 days and 200 days. This means it’s possible that breast cancers diagnosed now began at least 5 years earlier, but again, this assumes the growth rate is constant. It is not.
About Metastatic Breast Cancer
Cancer begins when healthy cells change and grow out of control, forming a mass or sheet of cells called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.When breast cancer is limited to the breast and/or nearby lymph node regions, it is called early stage or locally advanced. Read about these stages in a different guide on Cancer.Net. When breast cancer spreads to an area farther from where it started to another part of the body, doctors say that the cancer has metastasized. They call the area of spread a metastasis, or use the plural of metastases if the cancer has spread to more than 1 area. The disease is called metastatic breast cancer. Another name for metastatic breast cancer is “stage IV breast cancer if it has already spread beyond the breast and nearby lymph nodes at the time of diagnosis of the original cancer.
Doctors may also call metastatic breast cancer advanced breast cancer. However, this term should not be confused with locally advanced breast cancer, which is breast cancer that has spread to nearby tissues or lymph nodes but not to other parts of the body.
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Can Breast Cancer Be Prevented
You may be able to help prevent breast cancer by making healthy lifestyle changes such as:
- Staying at a healthy weight
- Limiting alcohol use
- Limiting your exposure to estrogen by
- Breastfeeding your babies if you can
- Limiting hormone therapy
If you are at high risk, your health care provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy to prevent breast cancer.
It’s also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.
NIH: National Cancer Institute
What Causes Breast Cancer In Your 20s And 30s
Breast cancer happens when cells in the breast begin to grow and multiply abnormally. Changes in DNA can cause normal breast cells to become abnormal.
The exact reason why normal cells turn into cancerous cells is unclear, but researchers know that hormones, environmental factors, and genetics each play a role.
Roughly 5 to 10 percent of breast cancers are linked to inherited gene mutations. The most well known are breast cancer gene 1 and breast cancer gene 2 .
If you have a family history of breast or ovarian cancer, your doctor may suggest testing your blood for these specific mutations.
In some cases, breast cancer in your 20s and 30s has been found to differ biologically from the cancers found in older women.
For example, younger women are more likely to receive a diagnosis of triple-negative and HER2-positive breast cancers than older women.
more likely in adolescent and young women than in older women who have a diagnosis of early stage breast cancer.
Metastatic breast cancer means that the cancer has advanced to stage 4. It has moved beyond the breast tissue into other areas of the body, such as the bones or the brain.
Survival rates are lower for cancer that has metastasized to other parts of the body.
According to the American Cancer Society, the 5-year survival rate for women with breast cancer that has spread to other parts of the body is 28 percent for all ages.
However, some signs and symptoms of breast cancer may
- changes in the skin
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Breast Cancer Cell Growth
Cancer begins when there are genetic changes, called mutations, in a normal breast cell. These changes happen in genes that control the growth of the cell. These changes may occur over a long period of time, even decades, before a cancer cell forms.
These tumor cells multiply and divide exponentially, meaning that one cell becomes two, two cells become four, and so on. That’s why a tumor size will increase more rapidly, the larger it becomes.
That said, not all cells are dividing at the same time. The cancer’s growth can change at different stages as a tumor forms. Compared with many types of cancer, breast cancer has a “low growth fraction.” This means that the proportion of cancer cells that are in an active cell cycle is low.
Some tumors, such as lymphomas and some leukemias, have much higher growth fractions. They may be active for a much shorter period of time before they are detected, even in children.
How Does Cancer Spread Beyond The Breast
Breast cancer can invade through nearby tissue, or spread through the body via the lymphatic system and blood.
- Tissue: the cancer spreads from the original site and grows into nearby areas .
- Lymphatic system: breast cancer cells break away from the original site and can enter nearby lymph tubes , grow in nearby lymph nodes or travel through lymph vessels to other parts of the body.
- Blood: breast cancer cells break away from the original site and can enter and travel through nearby blood vessels to other parts of the body.
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