Breast Cancer
Know More: Breast Cancer
Trustworthy information, straight from the source. Education is the first step in an empowering healthcare plan. Learn more about breast cancer from prevention to diagnosis and treatment.
Condition Overview
Breast anatomy
The breast is made up of different types of tissues. There are fatty and connective tissues, and suspended within these tissues are lobules and ducts. The lobules produce milk, and the ducts carry the milk out of the body through the nipple. Surrounding the tissues are a network of blood vessels and lymph vessels. Blood provides nourishment to cells, and lymphatic system drains waist products.
Breast cancer
Breast cancer develops in the breast tissue, most commonly in the lobules, or ducts of the breast. Breast cancer begins when a normal healthy cell mutates or changes into an abnormal (atypical) cell. These abnormal cells mutate into a cancer cell. Cancer cells continue to grow and divide, forming a mass called a tumor.
Breast cancer can be noninvasive, or invasive. Noninvasive means that the breast cancer has not spread beyond tissue of origin. Invasive breast cancer spreads outside tissue of origin, into the surrounding tissues.
Factors That May Increase Risk for Breast Cancer
- Female (less common in males)
- Increasing age
- Inherited gene mutation
- Family history of breast cancer
- Previous breast cancer
- Dense breast tissue
- First monthly period before age 12 or continuing after age 55
- Having certain benign breast conditions
- Overweight or obese
- Lack of physical activity
- Drinking alcohol
- Smoking cigarettes
- Not having children or first child after the age of 30
- Hormonal birth control
- Estrogen therapy
- Not breastfeeding
- Large amounts of high-fat foods
- Previous radiation exposure to the chest, such as from cancer treatment
Although there are common factors that may increase risk to females, there are some unique factors that increase risk of breast cancer for males including those with Klinefelter syndrome and testicular conditions (such as a testicle that did not descend or surgical removal of one or both testicles) or having mumps as an adult.
Breast cancer starts in the tissue or ducts of the breast. Breast cancer cells may spread to other parts of the body, such as the liver, lung, and brain. You may feel uncomfortable about talking to your healthcare provider if you notice changes or problems in your breasts, but it is important to have changes and problems checked.
Transgender men who have not undergone bilateral mastectomy, or who have only undergone breast reduction, should undergo screening according to current guidelines for cisgender women. Those guidelines recommend mammography screening every 1–2 years beginning at age 40 years. Screening should continue until at least age 75 years.
Length of Exposure to Estradiol and Testosterone
There is conflicting evidence about what impact exogenous testosterone has on your risk for breast cancer. The need for breast cancer screening is based upon the amount of breast tissue you have and your lifetime exposure to higher estrogen levels. Limited retrospective data has not demonstrated increased risk for breast cancer among transgender men taking testosterone.
Modality of Screening Post-Top Surgery
Since most or nearly all breast tissue may have been removed, mammography for the evaluation of a palpable lesion may not be technically feasible, and alternatives such as ultrasound or MRI may be necessary. Any approach to screening in this group should occur in the context of shared decision-making between patients and providers regarding the potential harms, benefits, and unknowns of these approaches.
Special Considerations
Most people in this group will have some breast tissue remaining, and therefore it is important to be aware breast cancer risk is not zero in this population. The timing and approach to breast cancer screening in this group who have had chest surgery is currently not established, and similar to cisgender men with significant family history or BRCA gene mutation, screening via MRI or ultrasound may be appropriate.
Breast cancer starts in the tissue or ducts of the breast. Breast cancer cells may spread to other parts of the body, such as the liver, lung, and brain. You may feel uncomfortable about talking to your healthcare provider if you notice changes or problems in your breasts, but it is important to have changes and problems checked.
Length of Exposure to Feminizing Hormones
It is recommended that screening not commence in transgender women until after a minimum of 5 years of feminizing hormone use, regardless of age. Note that transgender women over age 40 do not meet screening criteria until they have at least 5-10 years of feminizing hormone use.
In transgender women, factors that may contribute to a reduced risk of breast cancer include potentially less lifetime overall or cyclical exposure to estrogen and in some cases the absence of or minimal exposure to progesterone.
Special Considerations
Transgender women with a family history suggestive of (or known) a BRCA mutation should be referred for genetic counseling. No data exists to guide the use of estrogens in transgender women found to have a BRCA mutation.
There is no evidence of an increase in breast cancer due to implants, but implants may impair mammogram accuracy.
Symptoms
Breast cancer often does not cause pain, but symptoms may include:
- Swelling or a lump in your breast or armpit
- Bleeding or clear discharge from your nipple
- Skin that is dimpled like an orange peel
- Nipple that looks like it has been pushed in
- Sudden red skin on your breast
- Swollen lymph nodes under your arm
- Aching or soreness of your breast
Diagnosis: Imaging / Biopsy / Staging
Diagnosing breast cancer includes a physical exam, imaging, and biopsy. Breast cancer is often detected as a change seen on your screening mammogram. Breast cancer may also be detected during a clinical exam by your healthcare provider, or during a self-exam. In either case, additional imaging would be recommended. If imaging shows any abnormal features, a biopsy (tissue sample) would be recommended.
Imaging
- Mammogram: This is an x-ray of the breast. Screening mammograms are recommended yearly, starting at age 40, and often detect breast cancers early. Diagnostic mammogram is done to take a closer look at a specific area of concern.
- Ultrasound: Uses sound waves to detect cysts and masses within the breast tissue.
- Magnetic resonance imaging (MRI): Uses magnetic field and computer-generated radio waves to create images of the breasts and surrounding tissue. May be done with a contrast dye called gadolinium – unless contraindicated.
Biopsy
Biopsy is the only way to tell if you have breast cancer. A biopsy is a procedure in which a doctor removes a small amount of tissue. The biopsy may be done with guidance of imaging (ultrasound, stereotactic/mammogram, or MRI), or surgically in an outpatient setting. The tissue is tested for cancer, type of cancer, and presence of certain proteins on the cancer.
Additional imaging
Additional imaging, such as CT scan, bone scan, or PET scan may be recommended by your provider to look for cancer spread.
Staging
Breast cancer staging is used to define the extent of breast cancer and helps guide treatment decision making.
Treatment
How is breast cancer treated?
Breast cancer is treated locally and systemically and tailored to each patient based on diagnosis, and extent of cancer.
Local treatment consists of treating the involved breast tissue with surgery and often radiation therapy.
Surgery includes removal of the cancer and often sentinel lymph node biopsy. Surgery options to remove the tumor include:
- Lumpectomy: Removes the cancer plus a plus a healthy rim of tissue to obtain negative margins, plus radiation therapy.
- Mastectomy: Removal of all the breast tissue.
- Breast reconstruction: An option to reconstruct the breast
Survival rates are the same for people who have lumpectomy plus radiation, versus mastectomy. The goal is to remove the cancer and have a good cosmetic outcome.
Radiation generally occurs after surgery. Radiation uses high energy x-ray beams to target the remaining tissue and helps reduce the risk of local breast cancer recurrence. Radiation typically consists of 4-6 weeks of daily treatment.
Systemic treatment is used to treat the entire body and is tailored to each person. Examples of these treatments include chemotherapy, targeted therapy, immunotherapy, and endocrine therapy. These treatments can include oral drugs, intravenous drugs, or a combination of these.
Who are the primary members of the care team?
- Breast navigator: The breast navigator provides resource throughout your cancer treatment, assists in helping you understand test results, treatment plans, and assists with care coordination.
- General surgeon: The general surgeon performs the surgery to remove the breast cancer.
- Medical oncologist: The medical oncologist prescribes medications aimed to treat your breast cancer.
- Radiation oncologist: The radiation oncologist uses ionizing radiation to treat breast cancer.
- Plastic surgeon: The plastic surgeon performs breast reconstruction after cancer is removed, to improve cosmetic outcomes.
- Genetic counselor: The genetic counselor assists you in making informed decisions regarding inherited mutations, that may increase your risks for certain cancers (i.e., breast, ovarian, etc.).
- Physician nurse coordinator: PNCs work directly with providers in patient care, including immediate patient needs and symptom management.
- Chemotherapy nurse: The chemotherapy nurse supports patients during their chemotherapy treatments.
How to care for myself during and after breast cancer treatment?
- Do monthly breast self-exams. Check your breasts for lumps and other changes every month. Contact your oncologist if you notice any breast changes. Ask for more information about how to do breast self-exams.
- Have mammograms as directed.
- Eat a variety of healthy foods. Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. Ask if you need to be on a special diet.
- Drink liquids as directed. Ask how much liquid to drink each day and which liquids are best for you. Drink extra liquids to prevent dehydration. You will also need to replace fluid if you are vomiting or have diarrhea from cancer treatments.
- Exercise as directed. Ask your oncologist about the best exercise plan for you. Exercise may help to decrease the side effects of treatment, such as nausea, vomiting and weakness. It may also help improve your mood. Stop exercising if you feel pain in your chest, have trouble breathing or feel dizzy. Do not exercise if you have a fever or if you had anticancer medicines through an IV in the last 24 hours.
- Do not smoke. Nicotine can damage blood vessels and make it more difficult to manage your breast cancer. Smoking also increases your risk for new or returning cancer and delays healing after treatment. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine. Ask your healthcare provider for information if you currently smoke and need help quitting.
- Do not drink or limit alcohol intake. Your oncologist may tell you to limit or not drink alcohol. Alcohol contributes to an increased risk of breast cancer recurrence. Limit alcohol to less than 4 drinks a week. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
Contact the North Memorial Health Cancer Center
Whether you’re a provider looking to refer a patient or someone with a recent diagnosis, we are here for you. Contact us at 763-581-2800 to connect with our team.