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Breast cancer


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

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
  • 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 of advanced breast cancer may include:

  • Bone pain
  • Breast pain or discomfort
  • Skin ulcers
  • Swelling of in the armpit (next to the breast with cancer)
  • Weight loss
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. 

Expectations (prognosis):

New, improved treatments are helping persons with breast cancer live longer. Even with treatment, though, 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.

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 used to determine the risk of recurrence and the likelihood of successful treatment include:

  • Location of the tumor and how far it has spread
  • Whether the tumor is hormone receptor-positive or -negative
  • Tumor markers, such as HER2
  • Gene expression
  • Tumor size and shape
  • Rate of cell division or how quickly the tumor is growing

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

Complications:

You may experience side effects or complications from cancer treatment. For example, radiation therapy may cause temporary swelling of the breast (lymphedema), and aches and pains around the area.

Lymphedema may start 6-8 weeks after surgery or after radiation treatment for cancer. It can also start slowly after cancer treatment is over. You may not notice symptoms until 18-24 months after treatment. Sometimes it can take years to develop.

Ask your doctor about the side effects you may have during treatment.

Calling your health care provider:

Contact your health care provider if:

  • You have a breast or armpit lump
  • You have nipple discharge

Call your health care provider if you develop symptoms after being treated for breast cancer:

  • Nipple discharge
  • Rash on the breast
  • New lumps in the breast
  • Swelling in the area
  • Pain, especially chest pain, abdominal pain, or bone pain
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 of breast cancer may consider preventive (prophylactic) mastectomy. This is surgery to remove the breasts before breast cancer is ever diagnosed. Possible candidates include:

  • 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)

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. But making healthy lifestyle changes may reduce your overall chance of getting cancer. This includes eating health foods:

  • Choose foods and portion sizes that promote a healthy weight
  • Choose whole grains instead of refined grain products
  • Eat more fruits and vegetables each day
  • Limit processed and red meat in the diet
  • Limit alcohol consumption to one drink per day (women at high risk of breast cancer should not drinking alcohol at all)
References:

Chalasani P, Downey L, Stopeck AT. Caring for the breast cancer survivor: a guide for primary care physicians. Am J Med. 2010;123(6):489-95.

Chlebowski RT, Anderson GL, Gass M, et al. Estrogen plus progestin and breast cancer incidence and mortality in postmenopausal women. JAMA. 2010;304(15):1684-92.

Chlebowski RT, Kuller LH, Prentice RL, Stefanick ML, Manson JE, Gass M, et al. Breast cancer after use of estrogen plus progestin in postmenopausal women. N Engl J Med. 2009 Feb 5;360(6):573-87.

Cuzick J, DeCensi A, Arun B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011;12(5):496-503.

Giuliano AE, Hunt KK, Ballman KV, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinel node metastasis: a randomized clinical trial. JAMA. 2011;305(6):569-75.

Goss PE, Ingle JN, Alés-Martínez JE, et al. Exemestane for breast-cancer prevention in postmenopausal women. N Engl J Med. 2011;364(25):2381-91.

Katz VL,Dotters D. Breast diseases: diagnosis and treatment of benign and malignantdisease.In: Lentz GM, Lobo RA,Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 15.

LaCroix AZ, Chlebowski RT, Manson JE, et al. Health outcomes after stopping conjugated equine estrogens among postmenopausal women with prior hysterectomy: a randomized controlled trial. JAMA. 2011 Apr 6;305(13):1305-14.

National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Breast cancer. Version3.2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed November 16, 2012.

Warner E. Clinical practice. Breast-cancer screening. N Engl J Med. 2011 Sep 15;365(11):1025-32.


Review Date: 11/17/2012
Reviewed By: Yi-Bin Chen, MD, Leukemia/Bone Marrow Transplant Program, Massachusetts General Hospital. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, Stephanie Slon, and Nissi Wang.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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