Breast Cancer in Women
- Ductal carcinoma situ—Early stage cancer confined to the ducts. This type has a high cure rate.
- Lobular carcinoma in situ (LCIS)—Most doctors consider the finding of LCIS to be incidental, and it is thought to be a marker for breast cancer risk. Women with LCIS seem to have a 7-10 times increased risk of developing some form of breast cancer (usually infiltrating lobular carcinoma) over the next 20 years.
- Infiltrating ductal carcinoma—A cancer that starts in the ducts of the breast and spreads into surrounding tissues. This is the most common type of breast cancer in women.
- Infiltrating lobular carcinoma—A cancer that starts in the lobules of the breast and spreads into surrounding tissues.
- Medullary, mucinous, and tubular carcinomas—These are three relatively slower-growing types of breast cancer.
- Inflammatory carcinoma—A rare and aggressive form of breast cancer that can be difficult to treat. This cancer invades the lymphatic vessels of the skin and can be very extensive. It is very likely to spread to the local lymph nodes.
- Paget's disease—A very rare cancer of the areola and nipple. Although Paget's does not arise from glandular tissue in the breast, it can be associated with both in situ and infiltrating breast cancers.
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- Personal history of breast cancer
- Family members with breast cancer
- Changes in breast tissue, such as atypical ductal hyperplasia, radial scar formation, and lobular carcinoma in situ (LCIS)
- Genetic mutations, such as BRCA1, BRCA2, and others
- Overweight, particularly after menopause
Increased exposure to estrogen over a lifetime through:
- Early onset of menstruation
- Late onset of menopause
- No childbearing or late childbearing
- Absence of breast-feeding
- Hormone replacement therapy
- Increased breast density—more lobular and ductal tissue and less fatty tissue
- Radiation therapy before the age of 30 years old
- Excessive alcohol use
- One or more lumps in the breast which may or may not be painful
- One or more lumps in lymph nodes near the breast, under your arm, or collarbone which may or may not be painful
- Thickening in or around the breast
- A change in the size or shape of the breast
- Nipple discharge or tenderness, or the nipple inverted into the breast
- Ridges or pitting of the breast skin, like the skin of an orange
- A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)
- Fine-needle aspiration—Removal of fluid and/or cells from a breast lump using a thin needle.
- Needle biopsy—Removal of tissue with a needle from an area that looks unusual on a mammogram but cannot be felt.
- Incisional biopsy—Cutting out a sample of a lump or suspicious area.
- Excisional biopsy—Cutting out all of a lump or suspicious area and an area of healthy tissue around the edges.
- Blood tests—To look for tumor markers or genetic mutations.
- Tissue evaluation—To look for estrogen and progesterone receptors, and the presence of HER2/neu and Oncotype DX. These are used to help plan therapy.
- Lumpectomy—Removal of the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are also removed. This may also be called tylectomy or quadrantectomy.
- Segmentectomy—Removal of the cancer and a larger area of normal breast tissue around it.
- Simple mastectomy—Removal of the breast, or as much of the breast as possible. If the surgeon removes some lymph nodes for biopsy, it is done with a separate incision. This is the most common surgery for breast cancer treatment.
- Skin-sparing mastectomy—The same amount of tissue is removed as with a simple mastectomy, but the skin over the breast is spared. This can be used when immediate breast reconstruction surgery is planned. A variation of this procedure also can spare the nipple and areola. This may not be an option for all women.
- Modified radical mastectomy—Removal of the whole breast, the lymph nodes under the arm and, often, the lining over the chest muscles.
- Radical mastectomy—Removal of the breast, both chest muscles, the lymph nodes under the arm, and some additional fat and skin. This procedure is only considered in rare cases. It is done if the cancer has spread to the chest muscles.
- Sentinel lymph node biopsy—A small amount of blue dye and/or a radioactive tracer is placed in the area where the tumor was located. The lymph nodes that pick up the substance are removed. Those remaining lymph nodes should be removed if any sentinel nodes contain cancer. This method is usually done in women who do not have lymph nodes that can be felt in the armpit.
- Axillary lymph node dissection—Removal of the lymph nodes under the arm. This is done to help determine whether cancer cells have entered the lymphatic system.
- Cryotherapy—Extreme cold is used to freeze and destroy cancer cells. Cryotherapy is considered to be experimental at this time.
- External radiation therapy—Radiation directed at the breast from a source outside the body.
- Internal radiation therapy—Radioactive materials are placed into the breast in or near the cancer cells.
- Microwave thermotherapy—Used to bring cancer cells to a high temperature. This may make them more sensitive to when exposed to traditional radiation therapy treatment. It is early in the research process and may not be available in all areas.
- Biologic therapy—The use of medications or substances made by the body to treat cancer. Biologic response modifier (BRM) therapy is the use of medications to increase or restore the body's natural defenses against cancer.
- Targeted therapy—Treats specific characteristics of cancer cells by altering how the body responds to them. For example, medications can block the growth of new blood vessels or block chemical signals that allow cancer cells to grow and function.
- Hormone blocking therapy—Designed to take advantage of the fact that many breast cancers are estrogen sensitive. Estrogen binds to the estrogen-sensitive cells and stimulates them to grow and divide. Anti-estrogen drugs prevent the binding of estrogen. This stops the cells from growing and prevents or delays breast cancer from returning.
- Age 40-49—Recommendations vary from waiting until age 50 to having the screening every 1-2 years.
- Age 50-74—Ranges from every year to every two years.
Clinical breast exam:
- Age 20-39—Ranges from every year to every three years.
- Age 40 and older—Every year.
- Breast self-exam is optional for those age 20 and older. Talk to your doctor about the risks and benefits.
Canadian Breast Cancer Foundation http://www.cbcf.org
Canadian Cancer Society http://www.cancer.ca
Breast cancer. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003090-pdf.pdf. Accessed December 31, 2013.
Breast cancer. National Cancer Institute website. Available at: http://www.cancer.gov/cancertopics/types/breast. Accessed December 31, 2013.
Breast cancer in women. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated December 16, 2013. Accessed December 31, 2013.
Cryotherapy. Breast Cancer website. Available at: http://www.breastcancer.org/treatment/surgery/cryotherapy. Updated September 17, 2013. Accessed December 31, 2013.
How radiation works. Breast Cancer website. Available at: http://www.breastcancer.org/treatment/radiation/how%5Fworks. Updated November 20, 2012. Accessed December 31, 2013.
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1/19/2010 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Lee C, Dershaw D, Kopans D, et al. Breast cancer screening with imaging: recommendations from the Society of Breast Imaging and the ACR on the use of mammography, breast MRI, breast ultrasound, and other technologies for the detection of clinically occult breast cancer. J Am Coll Radiol. 2010;7(1):18.
1/28/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Lostumbo L, Carbine N, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane Database Syst Rev. 2010;(11):CD002748.
9/26/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Herman A. USPSTF updates to guidelines on using medications to prevent breast cancer. NEJM Journal Watch. 2013 Sept 24. Available at: http://www.jwatch.org/fw107927/2013/09/24/uspstf-updates-guidelines-using-medications-prevent?query=pfw. Published September 24, 2013. Accessed December 31, 2013.
10/1/2013 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Hughes KS, Schnaper LA, Bellon JR, et al. Lumpectomy plus tamoxifen with or without irradiation in women age 70 years or older with early breast cancer: long-term follow-up of CALGB 9343. J Clin Oncol. 2013 Jul 1;31(19):2382-7.
- Reviewer: Michael Woods, MD
- Review Date: 12/2013 -
- Update Date: 12/31/2013 -