What is Breast Cancer?

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Breast cancer is the most common cancer in women. It is estimated that about one in eight women in the U.S. will develop breast cancer.^[1] Breast cancer is most common in women over 50 years of age, though it can occur in younger women and, rarely, in men.

Although there may be no symptoms in the early stages, some people may have a painless lump in the breast, skin changes on the breast, or discharge from the nipple.

Testing people with no symptoms, known as screening, is important to diagnose breast cancer in the early stages. Breast cancer that is discovered early has a good chance of recovery and cure.

If diagnosed early, surgery to remove the tissue affected by breast cancer in its entirety, along with local radiation therapy, may cure a person of this condition. If diagnosed at a later stage, when the breast cancer has spread, treatments that affect the whole body, such as chemotherapy, are often necessary.

Always seek medical attention if breast cancer is suspected. However, there are less serious causes for changes in the breast that are more common, such as fibrocystic breasts.

Types of breast cancer

There are many types of breast cancer. Sometimes, one breast tumor can be a combination of two or several different types. Breast cancer types include the following:^[2][3]

In-situ breast cancer

The female breast is made up of sections called lobes. Each of these is made up of many smaller lobules, which produce milk in nursing women. Lobes and lobules are connected by milk ducts, which act as tubes to carry the milk to the nipple. These breast structures are generally where breast cancer begins to form. In its earliest stage, it is known as in-situ breast cancer.

Ductal carcinoma in situ (DCIS)

DCIS is considered by some doctors to be an early form of breast cancer and by others to be a precancerous condition, which may develop into cancer. In DCIS, there are cancerous cells inside the walls of the breast’s milk ducts, but they have not grown through the walls of the ducts.

DCIS is highly curable through surgery to remove the affected area and prevent the possibility of these cells from spreading to surrounding breast tissue. Sometimes, radiation therapy is necessary after surgery. Chemotherapy is not necessary for women with DCIS.

Lobular carcinoma in situ (LCIS)

LCIS is not actually considered to be cancerous. In LCIS, cells that are like cancer cells are growing in the lobules of the breast, but they have not grown through the walls of the lobules.

LCIS does not require treatment, but women with LCIS may be recommended for more regular screenings, as they are considered to be at higher risk of developing breast cancer.

Invasive breast cancer

Invasive breast cancer of no special type (NST), previously known as invasive ductal breast cancer, not otherwise specified (NOS), is the most common type of breast cancer, making up about 8 out of 10 invasive breast cancers, i.e. cancers that have spread beyond the initial layer of tissue where they developed and are growing into surrounding, healthy tissues.

Invasive lobular cancer is another type of invasive breast cancer, which starts in the milk-producing glands.

Inflammatory breast cancer

This type of breast cancer is caused by cancer cells blocking lymph vessels in the skin. The lymph vessels are part of the immune system. They normally drain excess tissue fluid away from the body tissues and organs. The lymph vessels can’t do this job properly if they are blocked. Instead, they cause symptoms of inflammation, such as swelling and redness. Inflammatory breast cancer is uncommon, accounting for 1 to 5 percent of all breast cancers.

Triple negative breast cancer

Breast cancer cells often have receptors that hormones or other proteins can attach to and stimulate cancer to grow. Receptor cells can be used to treat many breast cancers by blocking the hormones or proteins from attaching to the receptors. Triple-negative breast cancer does not have the following key receptors:^[4]

• Estrogen
• Progesterone
• HER2 protein

This means that hormone treatment and the targeted cancer drug trastuzumab do not work on triple-negative cancers. Instead, the main treatments for triple-negative breast cancer are surgery, radiation therapy, and chemotherapy.

Triple-negative breast cancer is usually diagnosed using a sample of cancer to test the cells for these receptors, after a biopsy or after surgery to remove cancer.

Good to know: Triple-negative cancer is an uncommon type of breast cancer; about 15 out of every 100 breast cancers are triple-negative. Basal-like breast cancer, a rare type of breast cancer in which the cells resemble the basal cells that line the breast ducts, is normally triple negative.

HER2 breast cancer

HER2-positive breast cancer has receptors for HER2 proteins.

These cancers tend to grow faster and may have a worse prognosis. They are often successfully treated, however, with targeted therapies aimed at the HER2 protein, such as trastuzumab.

Paget disease of the nipple

Also known as Paget disease of the breast, Paget’s disease of the nipple is a rare type of breast cancer.

It starts in the breast ducts before spreading to the skin of the nipple and then the areola – the dark line circling the nipple. It usually affects only one nipple and can look very similar to eczema, with crusted, scaly, and red skin, sometimes itching or burning. Blood or yellow fluid may be coming out of the nipple. The nipple may also look flat or inverted.

Paget disease usually develops from ductal carcinoma in situ (DCIS) or infiltrating ductal carcinoma.^[5]

Breast cancer symptoms

Early signs of breast cancer include a painless lump or mass in the breast. However, many people with early breast cancer will have no symptoms at all.

The most common symptoms of breast cancer include:^[6][7]

• A painless lump or mass in the breast: This may not be seen, but might be felt.
• Change in breast size or shape: For example, one breast might become larger or lower than the other.
• Changes in skin texture: This could be thickening, puckering or dimpling of the skin of the breast.
• Change in breast color: The breast might look red or inflamed.
• Change in nipple shape: The nipple of the affected breast might become inverted when it normally points out.
• Rash or crusting over the nipple: This also may affect the surrounding area.
• Nipple discharge: Discharge from one nipple, especially if it’s bloodstained
• Pain in a breast or armpit that is there all or almost all of the time
• Lumps or swellings in the armpit or around the collarbone

Good to know: Most breast lumps are not cancerous; 80 percent of those tested with a biopsy are not found to be cancerous.^[8] However, it is important to see a doctor as soon as possible if a person suspects they may have breast cancer. For a free symptom assessment, try the Adoctor conditions and symptoms.

Causes

Breast cancer occurs when abnormal cells develop in the breast tissue and grow quickly and uncontrollably. These cells destroy and replace the normal breast tissue and may spread through the body.

Risk factors

Risk factors for breast cancer include:^[9][10]

• Gender: Being female
• Age: Being older than 50
• Family history: Having a close relative who has either breast, uterine or ovarian cancer
• Genetic inheritance: particularly the BRCA-1 and BRCA-2 genes
• A previous diagnosis of breast cancer
• Being overweight: Fat cells produce estrogen
• Excessive alcohol consumption: Research shows that drinking alcoholic beverages increases the risk of hormone-receptor-positive breast cancer, as it can increase levels of estrogen and other hormones associated with hormone-receptor-positive breast cancer. Alcohol also may increase breast cancer risk by damaging DNA in cells
• Using tobacco products: This is linked to a higher risk of breast cancer in younger, premenopausal women. There may also be a link in postmenopausal women between very heavy second-hand smoke exposure and breast cancer risk
• Not being physically active: Exercise consumes and controls blood sugar and limits blood levels of insulin growth factor, a hormone that can affect how blood cells grow and behave
• Not having children: Women who have not had a full-term pregnancy or have their first child after age 30 may have a higher risk of breast cancer compared with those women who have given birth before the age of 30
• Not breastfeeding: Breastfeeding can lower the risk, especially if done for longer than one year
• Hormone replacement therapy (HRT): Some types of HRT use after menopause, though not all, may result in an increased risk

Diagnosis of breast cancer

Diagnosis is usually made during breast cancer screening. Screening is important because it allows breast cancer to be detected and treated at an early stage. The earlier the cancer is found, the better the chances of surviving it. Breast cancer screening is normally done by mammogram, a type of X-Ray scan.^[11]

In order to rule out a cancer diagnosis, a test, known as a biopsy may be carried out that removes tissue or sometimes fluid from an area suspected to be cancerous. A local anesthetic may be administered, depending on the type of biopsy used.

If you are worried that you may be experiencing symptoms of breast cancer, Please check with your doctor Find my Doctor to find out more.

Mammogram

A mammogram is an X-ray of the breasts that looks for changes that may be signs of breast cancer, such as small white spots called calcifications and lumps or tumors.

A mammogram is the best breast cancer screening test, though it is possible to have a mammogram give an incorrect result, miss the presence of cancer or show cancer-like structures which are in fact benign.^[12]

Women under the age of 40 do not often have a mammogram. This is because it is difficult to obtain a clear picture of younger women’s breasts, which are denser, using a mammogram.

Ultrasound

Ultrasound may be used to look at breast changes that cannot be seen on a mammogram, such as if a woman has very dense breasts or as a follow-up test if a mammogram shows a breast lump.

Biopsy

A biopsy is a test that removes tissue or sometimes fluid from a part of the body. Cells are then examined under a microscope and further tested to check for the presence of breast cancer.

Good to know: About 80 percent of women who have breast biopsies do not have breast cancer.

There are three types of biopsy that may be used to test for breast cancer:^[2][13]

Fine needle aspiration

If the lump is easily accessible or is likely to be filled with fluid, a doctor may perform a fine needle aspiration (FNA), in which fluid is drawn through a needle. The lump should collapse once the fluid inside has been drawn. If the lump persists, the cells in the sample may be examined.

Core needle biopsy

This involves using a larger needle through which a small amount of tissue can be removed. A local anesthetic will be used.

Surgical biopsy

A surgical biopsy is done with local anesthesia and, usually, sedation. This involves the removal of all or part of an abnormal lump.

Breast cancer stages

Once breast cancer is diagnosed, doctors will try to find out whether it has spread and, if so, how far, in a process known as staging.

The staging system most often used for breast cancer is the American Joint Committee on Cancer (AJCC) TNM system, based on tumor size, number, and location of lymph nodes^[14] with cancer.

Cancer may then be given a number stage from 1 to 4, often followed by subdivisions of a, b or c. The lower the number, the less cancer has spread. A general overview of the stages is as follows:^[15][16]

Stage 0 breast cancer is the earliest stage, also known as carcinoma in situ. This stage is used to describe breast cancer that is within the breast ducts or milk glands and has not spread. It is usually curable by surgery to remove the affected area.

Stage 1 breast cancer is invasive, meaning it has invaded other surrounding tissues and may involve N1mic, which means that there is micrometastasis, i.e. tiny amounts of cancer cells, in nearby lymph nodes in tiny amounts.

Stage 2 breast cancer means the tumor has grown to somewhere between the size of a walnut and a lime, spread to nearby lymph nodes, or both.

**Stage 3 breast cancer has not spread to bones or organs but is considered advanced and harder to treat. It may have spread to a significant number of lymph nodes or grown into the chest wall or skin around the breast.

Stage 4 breast cancer has spread to distant sites, most commonly the bones, lungs, liver, and brain, in what is known as metastasis.

Other factors may also affect what stage is given to a case of breast cancer, including:^[15][16]

• Tumor grade: How abnormal the cancer cells look under the microscope
• Estrogen and progesterone receptor status: Whether the cancer cells have receptors for these hormones
• HER2 status: Whether the cancer cells are overproducing the HER2 protein
• Oncotype DX score: If the cancer is estrogen-receptor-positive, HER2-negative and there is no cancer in the lymph nodes

Treatment of breast cancer

The extent of the treatment required for breast cancer depends on the extent to which it has spread and the exact type of cancer. It may be possible to remove the entirety of the affected area(s) with surgery and localized radiotherapy. However, breast cancer that has spread to multiple sites within the body may require a combined approach.

Treatment options for breast cancer will depend on the overall health of the affected person, their specific medical circumstances, and how far cancer has spread.

Surgery

There are many different types of surgery for breast cancer. What a doctor recommends will depend on the state of cancer and the affected person’s wishes and feelings. Types of breast cancer surgery may include:^[17]

• Breast conserving surgery, which removes only the area of the cancer
• Mastectomy – surgery to remove the whole breast
• Breast reconstruction
• Removing the lymph nodes

Radiation

Also known as radiotherapy, radiation therapy uses X-rays to destroy cancer cells. Side effects of radiation for breast cancer are normally relatively easy to tolerate and are mostly limited to the treated area in the form of rashes and other skin irritation.^[18] A doctor will be able to advise on how best to manage the side effects, should they occur.

Chemotherapy

The general aims of chemotherapy treatment for breast cancer are to destroy any cancer cells and increase the likelihood of recovery.

Chemotherapy can sometimes have unpleasant side effects, such as hair loss, nausea, and vomiting, fatigue, and pain. A doctor will be able to advise on how best to manage the side effects, should they occur.

Read more about Chemotherapy Side Effects ».

Hormone therapy

Some breast cancers, known as receptor-positive cancers, are stimulated by estrogen or progesterone, hormones produced in the body that help cancer to grow.

Hormone therapy, also known as endocrine therapy, is a treatment that blocks hormones in the body from acting on breast cancer cells or lowers the levels present.^[19]

Hormone therapy can sometimes have side effects, such as hot flushes, reduced libido, and mood changes. A doctor will be able to advise on how best to manage the side effects.

Immunotherapy

Immunotherapy aims to activate a person’s immune system to recognize and kill their tumors.

Some are now approved for the treatment of certain HER2 breast cancers, while others are being studied further.^[20]

Prevention

The causes of breast cancer are not fully understood, so it’s not known if it can be prevented. However, there are some general preventive measures that may be taken and some treatments available to reduce the risk in women who have a higher risk of developing the condition.

General preventive measures

General measures that may help prevent breast cancer include:^[21][22]

Regular exercise and a healthy, balanced diet: Maintaining a healthy weight can help prevent many forms of cancer, including breast cancer.

Breastfeeding: This has been found to lower the risk of developing breast cancer. It may be because women don’t ovulate as regularly when they’re breastfeeding, so their estrogen levels remain more stable.

Preventative treatments

Women who are at high risk of breast cancer, as determined by factors such as age, family medical history, and genetic testing, may be offered medical treatments to prevent breast cancer.

The two main treatments that may help prevent breast cancer are:^[21][23]

Mastectomy

This can be used to treat breast cancer, prevent a recurrence, and reduce the chance of developing the condition for women at high risk.

This surgery can reduce the risk of breast cancer by up to 90 percent. However, like all operations, there’s a risk of complications, and some women experience significant effects on their body image and sexual relationships.

Surgical breast reconstruction is also available. In some cases, a nipple-sparing mastectomy may be available.

Medication

Hormonal medications are available to reduce a person’s risk of developing breast cancer.

However, these medications may cause side effects such as hot flushes, nausea, and tiredness and have a small risk of more serious problems, such as osteoporosis, blood clots, or womb cancer.

Prognosis

Prognosis is estimated by looking at what happened over many years to large groups of people diagnosed with the same stage of cancer, known as survival rates.

Survival rates show what percentage of people live for a certain length of time after being diagnosed with cancer.

Survival rates are generally sorted into 5-year and 10-year time brackets. Because the statistic is based on people diagnosed over five years ago, the outlook may be better for those diagnosed today, since there are continuing improvements in treatment.

Survival rates include people who are free of disease or who experience few symptoms, as well as those who are still being treated for cancer, those who will survive for many more years and those who will not live much longer than the time bracket given.

Five-year survival rates for people with breast cancer in the U.S. are currently as follows:^[24]

• Localized breast cancer: About 62 percent of breast cancers are found when they are localized, meaning they have not spread beyond the breast. The five-year survival rate is about 99 percent.
• Locally advanced breast cancer: If the cancer has spread to nearby lymph nodes, this is known as locally advanced cancer. The five-year survival rate is about 85 percent.
• Metastatic cancer: If the cancer has spread further to other parts of the body, it is known as metastatic cancer. The five-year survival rate is about 27 percent.

The overall five-year survival rate for breast cancer is about 90 percent.

Good to know: Survival rates do not predict what will happen to someone. Treatment and responses to treatment vary greatly.

FAQs

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1. American Cancer Society. “How Common Is Breast Cancer?” 4 January 2018. Accessed 30 August 2018. ↩

2. UpToDate. “Breast cancer guide to diagnosis and treatment.” 1 June 2017. Accessed 24 October 2018. ↩ ↩

3. American Cancer Society. “Types of Breast Cancer.” 25 September 2017. Accessed 24 October 2018. ↩

4. CDC. “Triple-Negative Breast Cancer.”(https://www.cdc.gov/cancer/breast/triple-negative.htm) 25 June 2018. Accessed 24 October 2018. ↩

5. American Cancer Society. “Paget Disease of the Nipple | Nipple Cancer.” 25 September 2017. Accessed 11 February 2019. ↩

6. Breast Cancer Now. “Breast Cancer Symptoms and Signs.” Accessed 30 August 2018. ↩

7. Breast Cancer Care. “Signs and symptoms of breast cancer.” Accessed 30 August 2018. ↩

8. Cancer Center. “Different Kinds of Breast Lumps.”. Accessed 6 September 2018. ↩

9. Breastcancer.org. “Breast Cancer Risk Factors.”. Accessed 24 October 2018. ↩

10. UpToDate. “Factors that modify breast cancer risk in women.” 15 January 2018. Accessed 24 October 2018. ↩

11. NHS. “Breast cancer screening.” Accessed 24 October 2018. ↩

12. UpToDate. “Patient education: Breast cancer screening (Beyond the Basics).” 23 February 2017. Accessed 24 October 2018. ↩

13. Cancer Research UK. “Needle biopsy | Diagnosing breast cancer.” 19 October 2017. Accessed 24 October 2018. ↩

14. Lymph nodes filter and break down bacteria or other harmful cells in the body. When they have cancerous cells, this is a sign that the cancer has spread to the lymphatic system, a part of the immune system, from where it may be carried to other parts of the body and may form new tumors. ↩

15. Breastcancer.org. “Breast Cancer Stages: 0 Through IV.” 16 October 2018. Accessed 25 October 2018. ↩ ↩

16. Susan G. Komen®. “Stages of Breast Cancer – Stages of Condition.” Accessed 25 October 2018. ↩ ↩

17. Cancer Research UK. “Types of breast cancer surgery.” Accessed 25 October 2018. ↩

18. Breastcancer.org. “Radiation Therapy for Breast Cancer.” 16 October 2018. Accessed 25 October 2018. ↩

19. NHS. “Breast cancer in women – Treatment.” Accessed 1 November 2018. ↩

20. Breastcancer.org. “What Is Immunotherapy?” 10 July 2018. Accessed 1 November 2018. ↩

21. NHS. “Breast cancer in women – Prevention .” Accessed 1 November 2018. ↩ ↩

22. National Cancer Institute. “Breast Cancer Prevention (PDQ®)—Patient Version.” 19 October 2018. Accessed 1 November 2018. ↩

23. UpToDate. “Medications for the prevention of breast cancer.” 30 August 2017. Accessed 1 November 2018. ↩

24. Cancer.Net. “Breast Cancer: Statistics.” Accessed 25 October 2018. ↩

25. ACOG. “Induced Abortion and Breast Cancer Risk.” Accessed 31 August 2018. ↩

26. NHS. “Abortion and breast cancer controversy.” 8 October 2007. Accessed 31 August 2018. ↩

27. Sharecare. “Is there a cure for breast cancer? | Breast Cancer Treatment.” Accessed 31 August 2018. ↩

28. NIH. “Breast cancer – Genetics Home Reference.” Accessed 31 August 2018. ↩

29. Breast Cancer Care. “Bras after surgery for breast cancer.”. Accessed 31 August 2018. ↩

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## ⁤What‌ is Breast ⁤Cancer?



**Definition:**



Breast cancer is a malignant tumor that ​originates in the cells of the breast. It occurs when‍ breast cells undergo uncontrolled growth and​ division, forming a mass or lump within the breast tissue.



**Types:**



There are several ⁤types of breast cancer, including:



* **Invasive ductal carcinoma (IDC):** The most common type,⁤ originating in the ducts that carry milk from the breast.

* **Invasive lobular carcinoma (ILC):** Originating in the lobules (milk-producing glands).

* **Ductal carcinoma in situ (DCIS):** Non-invasive cancer confined to the milk ducts.

* **Lobular carcinoma in situ (LCIS):** Non-invasive cancer confined to the lobules.

* **Inflammatory breast cancer (IBC):** A rare and aggressive subtype that causes⁤ the breast to become swollen, red, and​ inflamed.



**Risk Factors:**



* Age (risk increases with age)

* Family history of breast cancer

* Gene mutations (e.g., BRCA1, BRCA2)

* Obesity

* Dense breasts

*‌ Early menstruation

* Late menopause

* Never having breastfed

* Alcohol consumption

* Hormone replacement therapy



**Symptoms:**



* Lump or thickening in the breast or underarm

* Change in the size or shape of the breast

* Nipple retraction or discharge (not⁢ breast​ milk)

* Redness ⁤or swelling of⁢ the breast

* ‌Dimpling‍ or puckering of the breast skin



**Diagnosis:**



* Clinical breast exam

* Mammogram ⁣(X-ray of the breast)

* Ultrasonography ⁢(sound waves to create images of the breast)

* Biopsy (removal of a small tissue sample for testing)



**Treatment:**



Breast cancer treatment options‌ can include:



* **Surgery:** Lumpectomy (removal of the lump) or mastectomy (removal of the entire breast)

* **Radiation therapy:** Using high-energy rays to destroy cancer cells

* **Chemotherapy:** Using drugs to kill cancer cells

* **Hormone therapy:** Blocking hormones that fuel cancer growth

* **Targeted therapy:** Using ‍drugs ⁢that target specific molecules ‍involved in cancer growth

* **Immunotherapy:**‍ Boosting​ the body’s immune response to ⁢fight cancer



**Prevention:**



* Maintain​ a healthy weight

* Exercise⁢ regularly

* ⁢Reduce alcohol consumption

* Consider genetic testing for hereditary ‌risk

* Breastfeed, if possible

*⁢ Get regular mammograms



**Importance of Early Detection:**



Early detection through regular screenings (mammograms) is crucial for improving breast cancer outcomes.⁢ When diagnosed and treated early, the chances of successful treatment and⁢ survival are significantly higher.