The information contained in this brochure
regarding recommendations for the early detection, diagnosis and treatment of
breast disease and breast cancer is only for the purpose of assisting you, the
patient, in understanding the medical information and advice offered by your
physician. This brochure cannot serve as a substitute for the sound
professional advice of your physician. The availability of this brochure or the
information contained within is not intended to alter, in any way, the existing
physician-patient relationship, nor the existing professional obligations of
your physician in the delivery of medical services to you, the
As a woman, you know what it is to be busy. A
routine visit to your health care provider can be the last thing you want to
do. However, it is important that you make time for mammograms and breast
examinations. Do it for yourself...do it for those who depend on you. Early
diagnosis of breast cancer could save your life.
Breast cancer strikes thousands of women each
year. Early detection of breast cancer is maximized through a combined approach
of routine mammograms, annual clinical breast examinations by a doctor or a
nurse and monthly breast self-examinations.
Screening and Early
It is important to take an active part in the
early detection of breast cancer. Talk with your doctor about symptoms to watch
for and an appropriate schedule of checkups. There are three important ways to
detect breast cancer:
Mammogram (X-ray of the
Clinical breast exam (breast exam by a doctor or nurse)
A mammogram is a special kind of X-ray that
uses very low levels of radiation. Mammography performed in women with no
symptoms of breast cancer is usually called screening. Mammography is the most
accurate method available to detect breast cancer in its earliest stage.
However, no diagnostic tool is 100 percent effective. In many cases (but not
all), mammograms can show breast tumors before they cause symptoms or can be
felt. Even though your mammogram may be normal, you should not ignore changes
in your breasts. The American Cancer Society recommends a mammogram each year
if you are 40 years of age or older.
Mammography should be done only by specially
trained medical staff using approved machines designed just for taking X-rays
of the breast. The Mammography Quality Standards Act is a federal law requiring
all mammography facilities to be certified. You can talk to your doctor, the
American Cancer Society at 1-800-227-2345, or the Cancer Information Service at
1-800-422-6237 for help in finding a certified mammography facility.
Clinical Breast Exam
For women of all ages, a breast exam by a
doctor or nurse (called a clinical breast exam) is usually part of a regular
medical checkup. During a clinical breast exam, your doctor will carefully feel
your breasts and under your arms to check for lumps and other unusual
You also should examine your breasts once a
month. Its important to remember that every womans breasts are
different. Your breasts may undergo changes because of aging, your menstrual
cycle, pregnancy, menopause, or taking birth control pills or other hormones.
It is normal for the breasts to feel a little lumpy and uneven. Also, it is
common for a womans breasts to be swollen and tender right before or
during her menstrual period. You should contact your doctor about any unusual
changes in your breasts. When breast cancer first develops, there may be no
symptoms at all. But as the cancer grows, it can cause changes that women
should watch for:
A lump or thickening in or
near the breast or in the underarm area;
A change in the size or shape of the breast;
A discharge from the nipple; or
A change in the color or feel of the skin of the breast, areola or nipple
(dimpled, puckered or scaly).
See your doctor if you notice any of these changes. Most often, they are not
cancer, but only a doctor can tell for sure. If you do not have a doctor, call
your medical society or one of the numbers provided on the back of this
brochure. Staff members will try to help find a doctor or breast cancer clinic
close to where you live.
The Y-ME National Breast Cancer Organization
recommends performing a breast self examination (BSE) seven to 10 days after
the first day of your period, when your breasts are least tender. If you no
longer menstruate, choose the same day each month to do a BSE.
Monthly Breast Self-Exam
Hands at side. Compare for symmetry. Look for changes in:
Hands over head.
Check front and side view for:
Hands on hips, press down, bend forward.
Lie down with a towel under right shoulder; raise right arm above the head.
Examine area from:
underarm to lower bra line
across to breast bone
up to collar bone
back to armpit
Use the pads of the three middle fingers of the left hand. Hold hand in bowed
position. Move fingers in dime-sized circles.
Use three levels of pressure:
Examine entire area using vertical strip pattern.
Be sure to examine both breasts
in the same way.
If there are any lumps,
knots or changes,
tell your doctor right away.
An abnormal area on a mammogram, a lump or
other changes in the breast can be caused by cancer or by other, less serious
problems. To find out the cause of any of these signs or symptoms, a
womans doctor does a careful physical exam and asks about her personal
and family medical history. In addition to checking general signs of health,
the doctor may do one or more of the breast exams described below.
Palpation means carefully feeling the lump and the tissue around it. The doctor
can tell a lot about a lump its size, texture and whether it moves
easily. Benign lumps often feel different from cancerous ones.
X-rays of the breast can give the doctor important information about a breast
lump. If an area on the mammogram looks suspicious or is not clear, additional
X-rays may be needed.
Using high-frequency sound waves, ultrasonography can often show whether a lump
is solid or filled with fluid. This exam may be used along with mammography.
Based on these exams, the doctor may decide
that no further tests are needed and no treatment is necessary. In such cases,
the doctor may need to check the woman regularly to watch for any changes.
Often, however, the doctor must remove fluid or
tissue from the breast to make a diagnosis.
Aspiration or needle
The doctor uses a needle to remove fluid or a small amount of tissue from a
breast lump. This procedure may show whether a lump is a fluid-filled cyst (not
cancer) or a solid mass (which may or may not be cancer). Using special
techniques, tissue can be removed with a needle from an area that is suspicious
on a mammogram but cannot be felt.
The surgeon cuts out part or all of a lump or suspicious area. A pathologist
examines the tissue under a microscope to check for cancer cells.
When Cancer is Found
When cancer is present, the pathologist can
tell what kind of cancer it is (whether it began in a duct or a lobule) and
whether it is invasive (has invaded nearby tissues in the breast).
This booklet is written especially for you if
you have been diagnosed with breast cancer. You probably have many questions
and concerns. You may be feeling confused, worried or anxious. It may be hard
for you to concentrate or to make decisions. These reactions are normal.
The information in this booklet should help you
understand your diagnosis and the treatments that are available. It is very
important that you become a partner with your doctor in deciding what treatment
is best for you.
Who Gets Breast Cancer?
Breast cancer is one of the most frequently
diagnosed cancers in women in the United States today. Every woman has some
chance of developing breast cancer during her lifetime. Since age is a major
risk factor, as women get older, their chances of getting breast cancer
increase. Even though breast cancer is more common in older women, it also
occurs in younger women and even in a small number of men.
While we dont yet know what causes breast
cancer, we do know that
1. Breast cancer is not caused by
stress or by an injury to the breast.
2. Most women who develop breast cancer do not have any known risk factors or a
history of the disease in their families.
3. You should not feel guilty. You havent done anything wrong in your
life that caused breast cancer.
4. You cannot catch breast cancer from other women who have the
disease. It is not contagious.
Remember, you dont have to face breast
cancer alone; there are knowledgeable and caring people who can help
Breast cancer is a complex disease. All cases
are not the same. Once breast cancer has been found, more tests will be done to
find out the specific pattern (description) of your disease. This important
step is called staging. Knowing the exact stage of your disease will help your
doctor plan your treatment. Your doctor will want to know
The size of the tumor and
exactly where it is in your breast.
If the cancer has spread within your breast.
If cancer is present in your lymph nodes under your arm.
If cancer is present in other parts of your body.
Specific Stages of Breast
Very early breast cancer.
This type of cancer has not spread within or outside the breast. It is
sometimes called DCIS, LCIS, or breast cancer in situ or noninvasive cancer.
The cancer is no larger than about 1 inch in size and has not spread outside
The doctor may find any of the following:
The cancer is no larger than
1 inch, but has spread to the lymph nodes under the arm.
The cancer is between 1 inch and 2 inches; it may or may not have spread
to the lymph nodes under the arm.
The cancer is larger than 2 inches, but has not spread to the lymph nodes
under the arm.
This stage is divided into stages IIIA and IIIB:
IIIA The doctor may find either of the following:
The cancer is smaller than 2 inches and has spread to the lymph nodes
under the arm. The cancer also is spreading further to other lymph nodes.
The cancer is larger than 2 inches and has spread to the lymph nodes
under the arm.
Stage IIIB The doctor may find either of the
The cancer has spread to tissues near the breast (skin, chest wall,
including the ribs and the muscles in the chest).
The cancer has spread to lymph nodes inside the chest wall along the
The cancer has spread to other parts of the body, most often the bones, lungs,
liver or brain.
Or, the tumor has spread locally to the skin and lymph nodes inside the neck,
near the collarbone.
Inflammatory breast cancer is a rare, but very
serious, Breast aggressive type of cancer. The breast may look red and Cancer
feel warm. You may see ridges, welts or hives on your breast; or the skin may
look wrinkled. It is sometimes misdiagnosed as a simple infection.
Recurrent disease means that the cancer has
come back Breast (recurred) after it has been treated. It may come back in
Cancer the breast, in the soft tissues of the chest (the chest wall) or in
another part of the body.
Prognosis (Chance of
Once your doctor has determined your specific
type and stage of breast cancer, you can begin to plan for your treatment and
recovery. Your chance of recovery will depend on many factors:
The type and stage of your
cancer (what kind of cancer, the size of the tumor and whether it is only in
your breast or has spread to.any lymph nodes or to other parts of your body)
How fast the cancer is growing. Special lab tests on the tissue can
measure how fast the cancer cells are dividing and how different they are
compared to normal breast cells.
How much the breast cancer cells depend on female hormones (estrogen and
progesterone) for growth, which can be measured by hormone receptor tests.
Patients whose tumors are found to be dependent on hormones (described as
estrogen-positive or progesterone-positive) can be treated by hormonal therapy
to prevent further growth or recurrence of breast cancer.
Your age and menopausal status (whether or not you still have monthly
Your general state of health
Today, most women with breast cancer are
diagnosed at an early stage and they benefit from newer, more effective
treatments. There are treatments available for patients at all stages of breast
cancer. Often, more than one type of treatment is needed.
Surgery is taking out the cancer in an
operation. Surgery has an important role in the treatment of patients with
breast cancer. Most women can choose between breast conserving surgery
(lumpectomy with radiation therapy) or removal of the breast (mastectomy).
Clinical trials have proven that both options provide the same long-term
survival rates for most types of early breast cancer. However, neither option
guarantees that cancer will not recur. Whichever choice you make, you will need
close medical follow-up for the rest of your life.
The surgeon removes the breast cancer and some normal tissue around it (in
order to get clear margins). This procedure usually results in removing all the
cancer, while leaving you with a breast that looks much the same as it did
before surgery. Usually, the surgeon also takes out some of the lymph nodes
under the arm to find.out if the cancer has spread. Women who have lumpectomies
almost always have radiation therapy as well. Radiation therapy is used to
destroy any cancer cells that may not have been removed by surgery.
Partial or segmental
Depending on the size and location of the cancer, this surgery can conserve
much of the breast. The surgeon removes the cancer, some of the breast tissue,
the lining over the chest muscles below the tumor and usually some of the lymph
nodes under the arm. In most cases, radiation therapy follows.
Total (or simple)
The surgeon removes the entire breast. Some lymph nodes under the arm may be
Modified radical mastectomy.
The surgeon removes the breast, some of the lymph nodes under the arm, the
lining over the chest muscles and, sometimes, part of the chest wall muscles.
The surgeon removes the breast, chest muscles, and all the lymph nodes under
the arm. This was the standard operation for many years, but it is used now
only when a tumor has spread to the chest muscles.
As with any kind of surgery, these procedures pose certain risks, including
infection, poor wound healing, bleeding or a reaction to the anesthesia used in
surgery. Fluid may collect under the skin, or tingling, numbness, stiffness,
weakness or swelling of the arm (see discussion of lymphedema below) may occur.
Physical therapy and exercise can help to restore arm movement and strength.
Removal of lymph nodes.
Whether you have a lumpectomy or mastectomy, your surgeon will probably remove
some of the lymph nodes under your arm. This procedure is usually done at the
same time as the breast surgery to check if the cancer has spread outside the
breast. Clear lymph nodes are reported as negative nodes. If cancer is found,
you have positive nodes. Your doctor will talk with you about any additional
treatments needed to destroy and control cancer cells.
The lymph nodes under your arm drain lymph
fluid from your chest and arm. Both surgery and radiation therapy can change
the normal drainage pattern, resulting in a swelling of the arm called
lymphedema. The problem can develop right after surgery or months to years
later. Treatment of lymphedema depends on how serious the problem is. Options
include an elastic sleeve, an arm pump, arm massage or bandaging the arm.
Exercise and diet also are important. If you have this problem, talk with your
doctor and see a physical therapist as soon as possible. Many hospitals and
breast clinics offer help with lymphedema. There is no cure for this condition,
so you should do what you can to prevent it.
Some surgical procedures are followed by
radiation therapy. During radiation therapy, high-energy X-rays are used to
destroy cancer cells that still may be present in the affected breast or in
nearby lymph nodes. Radiation therapy is sometimes used to shrink tumors before
surgery. Doctors sometimes use radiation therapy along with chemotherapy,
before or instead of surgery, to destroy cancer cells and to shrink
Some women may feel more tired than usual; skin problems such as itchiness,
redness, soreness, peeling, darkening or shininess of the skin may occur; or
there may be decreased sensation in the breast. Radiation to the breast does
not cause hair loss, vomiting or diarrhea.
Long-term changes may include changes in the
shape and color of the treated breast or a feeling of heaviness in the breast.
Once a breast has been irradiated, it cannot be irradiated again. Any local
recurrence or new tumor would have to be treated by mastectomy.
Research suggests that, even if a lump is
small, cancer cells may have spread outside the breast. Doctors can use
chemotherapy drugs to destroy cancer cells. Some chemotherapy drugs work better
when combined with other chemotherapy drugs than when used alone. Chemotherapy
drugs travel throughout the body to slow the growth of cancer cells or kill
them. Often, the drugs are injected into the bloodstream through an intravenous
(IV) needle that is inserted into a vein. Some drugs are given as pills.
Treatment can be as short as a few months or as long as two years. Chemotherapy
affects all fast-growing cells throughout the body. Therefore, in addition to
killing cancer cells, it also kills fast-growing normal cells. This is what may
cause side effects such as hair loss, mouth sores and fatigue. Today, because
of what has been learned in research studies, doctors are able to control,
lessen or avoid many side effects of chemotherapy.
Chemotherapy can cause short-term and long-term side effects that are different
for each patient, depending on the drugs used.
The most common short-term side effects that
may appear during chemotherapy include loss of appetite, nausea, vomiting,
diarrhea, constipation, fatigue, infections, bleeding, weight change, mouth
sores and throat soreness. Some of these problems may continue for some time
after chemotherapy ends. There are drugs that may help with these side effects.
Some drugs cause short-term hair loss. Hair will grow back either during
treatment or after treatment is completed. Before you start chemotherapy, you
may want to have your hair cut short, or buy a wig, hat or scarves that you can
wear while going through treatment.
Serious long-term side effects may include
weakening of your heart, damage to your ovaries, infertility, early menopause
or second cancers such as leukemia (cancer of the blood). These side effects
may not appear until some time after chemotherapy is completed.
In breast cancer treatment clinical trials,
researchers at the National Cancer Institute and other health institutions are
testing high-dose chemotherapy to find out if it is better than standard
chemotherapy. They are trying to learn if higher doses of drugs can prevent or
delay the spread or return of breast cancer better than standard doses of
drugs, and which type of treatment helps patients to live longer.
Patients who receive high-dose chemotherapy are
at great risk of suffering life-threatening side effects because the treatment
damages bone marrow and they no longer are able to produce needed blood cells.
To help repair the damage done by high doses of drugs, the treatment includes
peripheral blood stem cell transplantation and/or bone marrow
Peripheral Blood Stem Cell Transplantation
Peripheral blood stem cell transplantation
involves the removal of a certain type of blood cell, called a stem cell, from
a patients blood. Stem cells are immature cells from which all blood
cells develop as they are needed. Stem cells are able to divide and form more
stem cells (copies of themselves) or they can become fully mature red blood
cells (erythrocytes), platelets and white blood cells (leukocytes).
The removed stem cells are frozen and stored
while the patient is treated with high-dose chemotherapy. After chemotherapy
ends and the drugs are gone from the body, the stem cells are returned to the
patient through a vein. The healthy stem cells can then begin to grow and
produce all types of blood cells the patient needs to survive.
Bone Marrow Transplantation
Bone marrow is the sponge-like material found
inside bones that produces blood cells. Autologous bone marrow transplantation
is used in breast cancer treatment. In this procedure, some of a patients
own healthy bone marrow is removed with a needle before treatment begins. The
bone marrow is then frozen and stored while the patient is treated with
high-dose chemotherapy. Several days after the treatment ends and the drugs are
gone from the body, the healthy bone marrow is given back to the patient
through a vein. The healthy bone marrow can then begin to produce blood cells
that the patient needs to survive. Peripheral blood stem cells and bone marrow
transplantation may be used together as part of high-dose chemotherapy.
There are major risks involved with high-dose chemotherapy. Talk with your
doctor about possible complications and severe side effects, and whether this
would be an appropriate treatment for your type and stage of breast
Hormonal therapy is used to prevent the growth,
spread or recurrence of breast cancer. If lab tests show that your tumor
depended on your natural hormones to grow, it will be described as
estrogen-positive or progesterone-positive in the lab report. This means that
any remaining cancer cells may continue to grow when these hormones are present
in your body. Hormonal therapy can block your bodys natural hormones from
reaching any remaining cancer cells.
Research has proven that hormonal therapy can
extend the lifespan of a breast cancer patient who has cancer cells that depend
on hormones to grow. Tamoxifen has been used for nearly 20 years to treat
patients with advanced stage breast cancer. Now it is being used also as
additional treatment for early stage disease after breast cancer is removed by
surgery. Clinical trials show that taking tamoxifen as part of the treatment
for breast cancer helps to reduce the chances of recurrence in the treated
breast and of new cancer developing in the other breast.
Side effects could include hot flashes, nausea, vaginal spotting (small amounts
of blood) or increased fertility in younger women. Less common side effects
include depression; vaginal itching, bleeding or discharge; loss of appetite;
eye problems; headache; and weight gain.
Your own immune system is your bodys
natural defense against diseases, including cancer. Your immune system also
defends your body against infections and other side effects of cancer
treatment. A strong immune system detects the difference between healthy cells
and cancer cells, and it can get rid of those that become cancer. The immune
system can be strengthened and improved by new biological therapies. These
treatments are designed to repair, stimulate or increase your bodys
natural ability to fight infections and cancer.
Medical researchers are looking at many types
of biological therapies that use and boost the substances produced naturally by
the bodys own cells. They also are creating new substances that can
imitate or help the bodys natural immune system to work against infection
and disease. These are being used in clinical trials with chemotherapy and
Biological therapies may produce side effects such as rashes or swellings at
the site where shots are given; flu-like symptoms, including fever, chills and
fatigue; digestive tract problems; or allergic reactions.
Your doctor may suggest that you consider
taking part in a breast cancer treatment clinical trial. A clinical trial is a
research study where patients help scientists find new, improved treatments.
You may want to ask your doctor if you should consider joining such a research
Its important to make this decision
before you start treatment because you may not be eligible if you have had
certain treatment already. Every successful treatment used today started as a
clinical trial, and the patients who participated were the first to benefit
from improved therapy.
Research studies for breast cancer treatments
take place in many hospitals and cancer centers across the country. In these
clinical trials, doctors use the newest treatments to care for cancer patients.
Each carefully planned study is designed to answer certain questions and to
find out specific information about how well a new drug or treatment method
As time goes on, new and better ways to help
cancer patients are being developed. It takes time, often several years, for
clinical trials to prove the true value and effectiveness of a new treatment.
All clinical-study patients receive the best care possible, and their reactions
to the treatment are watched very closely. If the treatment does not seem to be
helping, a doctor can take a patient out of a study. Also, a patient may choose
to leave at any time. If a patient leaves a research study for any reason,
standard care and treatment are still available.
If you are thinking about joining a breast
cancer treatment clinical trial, your doctor can give you information that will
help you decide if the choice is right for you. You should consider carefully
what is involved and all possible benefits and risks of the treatment that is
Options After Treatment
Wearing an artificial breast form may be an
option after mastectomy. Some women wait several months to have reconstruction
and decide to wear a breast prosthesis until they have surgery.
This surgery to rebuild a breasts shape is often an option after
mastectomy. Some health insurance plans pay for all or part of the cost of
breast reconstruction and, also, for surgery to the other breast so that both
breasts are about the same shape and size.
Reconstruction will not give you back your
breast. Although the reconstructed breast will not have natural sensation, the
surgery can give you a result that looks like a breast. If you are thinking
about reconstruction, you should talk with a plastic surgeon before your
mastectomy. Ask your surgeon for a referral to a plastic surgeon with
experience in breast reconstruction. Some women begin reconstruction at the
same time the mastectomy is done; others wait several months or even years.
A plastic surgeon is able to form a breast mound by using an implant or by
using tissues from another part of your body. Breast implants are silicone sacs
filled with saline (salt water) or silicone gel. The sacs are placed under your
skin behind your chest muscle. Your body type, age and cancer treatment will
determine which type of reconstruction will give you the best result.
Saline-filled breast implants are available for
anyone who wants them. Some scientists are concerned about possible short-term
and long-term health problems associated with silicone gel-filled implants. The
U.S. Food and Drug Administration (FDA) has decided that breast implants filled
with silicone gel may be used only in an FDA-approved clinical trial. Your
surgeon can determine if you are eligible and can make arrangements for you to
join the study.
As with any surgery, reconstruction or implants may cause some pain, swelling,
bruising and tenderness. These problems should disappear as you recover. Scars
will fade over time. You should let your doctor know immediately about any
fever, infection or bleeding.
Implant side effects that could appear later
include rupture, leakage, deflation or shifting of the implant, or interference
with mammography readings. Breast implants age over time and may need to be
Reconstruction With Tissue
A flap (section) of skin, muscle and fat can be
moved from another part of the body to the chest where it is formed to create a
breast shape. This tissue can be taken from the lower abdomen, back, or
Choose a plastic surgeon who has been trained
in this procedure and has performed it successfully on many women. Of course,
you will need to have regularly scheduled follow-up care and mammograms.
Tissue flap reconstruction is a major operation, resulting in large surgical
wounds. If there is a poor blood supply to the flap tissue, part or all of the
tissue in the breast area may not survive the transplant. Infection and poor
wound healing are possible problems.
Drugs or gases given before and during surgery so the patient wont feel
pain. The patient may be awake or asleep.
Breast cancer in situ
Very early or noninvasive abnormal cells that are confined to the ducts or
lobules in the breast. Also known as DCIS or LCIS.
An area of normal tissue that surrounds cancerous tissue, as seen during
examination under a microscope.
A small channel in the breast through which milk passes from the lobes to the
Red blood cells that carry oxygen from the lungs to cells in all parts of the
body and carry carbon dioxide from the cells back to the lungs.
A female hormone; one of the hormones that can help some breast cancer tumors
Chemical substances in the body that affect the function of organs and
Hormone receptor tests
Lab tests that determine if a breast cancer depends on female hormones
(estrogen and progesterone) for growth.
A silicone gel-filled or saline-filled sac inserted under the chest muscle to
restore breast shape.
Injection into a vein.
Located at the end of a breast duct, the part of the breast where milk is made.
Each breast contains 15 to 20 sections, called lobes, each with many smaller
White blood cells that defend the body against infections and other
Swelling in the arm caused by fluid that can build up when underarm lymph nodes
are removed during breast cancer surgery or damaged by radiation.
The time of life when a woman stops having monthly menstrual periods.
The hormone changes that lead up to a womans having a period. For most
women, one cycle takes 28 days.
A doctor who examines tissues and cells under a microscope to determine if they
are normal or abnormal.
The part of a blood cell that helps prevent bleeding by causing blood clots to
form at the site of an injury.
A female hormone; one of the hormones that can help some breast cancers
Stage, or staging
Classification of breast cancer according to its size and extent of
Usual, common, customary.
Illinois Department of Public
Health Office of Womens Health
217-524-6088 TTY (hearing impaired use only)
Cancer Information Service
800-422-6237 TTY (hearing impaired use only)
Y-ME National Breast Cancer
American Cancer Society
Susan G. Komen Breast Cancer
Questions about women's health can be directed
Women's Health Line
TTY (hearing impaired use only)800-547-0466