BREAST CANCER

General Information

DEFINITION--A malignant growth of breast tissue. Breast cancer spreads to nearby lymph glands, lungs, pleura, bone (especially the skull), pelvis and liver. It may affect males (rare).

BODY PARTS INVOLVED--Nipple or tissue of the breast.

SEX OR AGE MOST AFFECTED--Women; males (rare). Breast cancer is rare before age 30; the peak ages are from 45 to 65. The incidence increases after menopause.

SIGNS & SYMPTOMS--

No symptoms in early stages, but pre-symptom stages may be detected by mammogram.

• Swelling or lump in the breast.
• Vague discomfort in the breast without pain.
• Retraction of the nipple.
• Distorted breast contour.
• Dimpled or pitted skin in the breast.
• Enlarged nodes under the arm (late).
• Bloody discharge from the nipple (rare).

CAUSES--Unknown.

RISK INCREASES WITH

• Family history of breast cancer (especially mother or sister).
• Women who have not had children.
• Atypical hyperplasia on previous biopsy.
• Early menstruation (before age 12); late meno-pause (after age 55); first pregnancy after age 30.
• Obesity; alcohol use.
• Current or previous oral contraceptive use.
• Premenopausal or postmenopausal estrogen replacement therapy.

HOW TO PREVENT

• Examine breasts monthly for signs of cancer (see Breast Self-Exam in Appendix).
• Visit your doctor regularly for an examination.
• Obtain a baseline mammogram between ages 35 to 40. Have mammograms every 1 to 2 years to age 49 and annually after 50 or as recommended by your doctor.
• Eat a well-balanced diet that is low in fat.
• If you are pregnant, consider breast-feeding your baby. Women who have breast-fed have a lower incidence of breast cancer.
• The drug, tamoxifen, is undergoing testing as a preventive.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and exam by a doctor.
• Biopsy (See Glossary), x-rays of the breast and bones.
• Laboratory blood studies of hormones.
• After diagnosis, other tests such as ultrasound, bone scan, chest x-ray, liver scan are often performed.

APPROPRIATE HEALTH CARE

• Surgery to remove the lump, or breast, lymph glands, and lymphatic channels and muscles under the breast (sometimes). See Mastectomy in the Surgery section.
• Radiation therapy, hormonal therapy or chemotherapy (sometimes).

POSSIBLE COMPLICATIONS--Spread to vital organs if not treated early, adverse reactions to anticancer drugs and radiation, postsurgical complications (infection, limited shoulder motion).

PROBABLE OUTCOME--Many breast cancers are curable if diagnosed and treated early. The 10-year survival rate is related to the stage of the disease at diagnosis.

How To Treat

GENERAL MEASURES--

• The decision for treatment is very complex, and often confusing. Be sure all options are explained and that the risks and benefits of each are thoroughly understood. It is important for you to be well informed.
• Joining a support group is helpful.
• See Resources for Additional Information.

MEDICATION--Your doctor may prescribe:

• Pain relievers.
• Anticancer drugs, such as fluorouracil, cyclophosphamide, methotrexate, chlorambucil, vincristine, doxorubicin or melphalan.
• Hormones (male and/or female).
• Cortisone drugs.

ACTIVITY--

• No restrictions.
• Exercise for rehabilitation following surgery will depend on how much tissue has been removed and your general physical condition.

DIET--No special diet. Keep fat intake to a minimum.

Call Your Doctor If

• You find a lump or change in a breast.
• The following occurs after surgery: Nausea or vomiting, fever, swelling in the arm. Pain that is not controlled by medication.
• New, unexplained symptoms develop.