Breast cancer is the most common cancer afflicting women in the United States, regardless of race or ethnicity. The Centers for Disease Control and Prevention reports that 1 in 8 women will be diagnosed with invasive breast cancer in her lifetime. In 2013, more than 40,000 women and 464 men died of the disease. In 2017, more than 250,000 women and over 2,000 men are expected to be diagnosed with the disease.
Signs and Symptoms
Not every case of breast cancer will have signs and symptoms noticeable to the patient straight away. This is why routine screening, i.e. regularly scheduled mammograms, are considered by many doctors to be critical to improving survival rates of the disease. However, some breast cancers do show themselves. If you notice any of the following signs, as outlined by the Memorial Sloan Kettering Cancer Center, see your doctor right away:
- "A lump or thickness in or near the breast or under the arm
- Unexplained swelling or shrinkage of the breast, particularly on one side only
- Dimpling or puckering of the breast
- Nipple discharge (fluid) other than breast milk that occurs without squeezing the nipple
- Breast skin changes, such as redness, flaking, thickening or pitting that looks like the skin of an orange
- A nipple that becomes sunken (inverted), red, thick or scaly"
Risk Factors
There are many factors that contribute to whether you’ll develop breast cancer in your lifetime. The primary risk for any cancer is age – the older you are, the more chances you'll have a cell develop genetic mutations that could eventually grow into cancer. This is true for breast cancer, too, which affects more older women than it does younger women. The National Cancer institute reports that the median age at diagnosis among breast cancer patients is 62 years.
Genetics have also been shown to play a role in whether you’ll develop breast cancer. Genetic mutations on the BRCA1 and BRCA2 gene have gotten a lot of attention over the past 10 years or so as being the primary source of genetically-based cases of breast cancer, but other genetic mutations can also lead to the development of cancer. Certain ethnicities, in particular Ashkenazi Jews, have a higher rate of BRCA1 and BRCA2 gene mutations. A strong family history of breast, ovarian or prostate cancer could also point to a genetic component and may lead you to pursue genetic testing to get a better understanding of your individual risk.
Other individual variations in the amount of estrogen your body produces and the duration of that exposure can factor into whether you develop breast cancer. This is why your doctor will likely ask how old you were when you started menstruating, when you entered menopause, whether you’ve had children and whether you breastfed any children you did have. Taking birth control pills, getting pregnant later in life or not getting pregnant at all may also slightly increase your risk of developing breast cancer. Studies have also shown that exposure to certain chemicals in the environment, a lack of exercise and poor diet can play a role in the development of breast cancer.
Diagnosis
Mammography is the most common tool currently used to diagnose breast cancer. A mammogram is an X-ray of the breasts that creates an image that is then reviewed by a radiologist. This doctor is looking for suspicious lumps or growths that will show up as a whiter spot against a darker background. The Susan G. Komen organization reports that mammography has an 84 percent success rate. Other diagnostic tools include:
- Digital mammography. This is also an X-ray, but the image is rendered digitally rather than on film.
- Digital tomosynthesis. This tool creates a three-dimensional image, allowing the radiologist to look at cross sections of the breast, rather than the entire breast all at once.
- Ultrasound. Ultrasound technology uses sound waves to create images of the breasts and any masses within them without the use of radiation. It’s often used as a follow up to a mammogram with an abnormal finding.
- MRI. Molecular resonance imaging uses magnetic fields and radio waves to create an image of the breast. This is usually used only as a secondary screening tool after something abnormal shows up on a mammogram.
- Molecular breast imaging. MBI uses an injected radioactive isotope to light up cancerous growths on an image created with a molecular camera. It has a higher success rate for finding cancers in women with very dense breasts, but some concerns persist about the amount of radiation the patient's body is exposed to during the procedure.
Each modality has its pros and cons, but the good news is that these days, there are several different ways your doctor can get a picture of what’s going on inside your breasts that may aid in the early diagnosis of breast cancer.
The U.S. Preventive Services Task Force currently recommends that all women age 50 to 74 have a biennial screening mammogram. The American Cancer Society recommends women of average risk start annual screening at age 45. Neither group currently recommends that women conduct monthly breast self-exams, but advocate that women should be aware of their breasts and remain vigilant of any changes.
Stages of Breast Cancer
As with other forms of cancer, the severity and treatment of any individual case of breast cancer is in part dependent on the stage at which it is diagnosed. As a case of cancer progresses, the number of the stage increases, signifying how much it has grown or spread. Later-stage disease often correlates to reduced survival rates.
- Stage 0. Stage 0 refers to noninvasive breast cancers that have not grown beyond the part of the breast in which they started. Also called ductal carcinoma in situ, these abnormal growths are not technically considered cancer and are often referred to as precancers. But they do indicate an increased risk of developing breast cancer, and are typically treated with surgery or radiation. Chemotherapy is not usually part of the treatment protocol, but may be indicated in some instances.
- Stage 1. Stage 1 refers to invasive breast cancer, meaning a cancer that has begun to grow beyond its point of origin, but is still contained within the breast. Stage 1 can be further divided into subcategories A and B based on the size of the tumor and whether cancerous cells have been found in nearby lymph nodes.
- Stage 2. Stage 2 breast cancers are growing but are still contained within the breast and nearby lymph nodes, but tend to be larger than most stage 1 cancers. This stage is also broken into two subcategories, A and B, depending on the size of the tumor and whether cancer cells have spread to lymph nodes.
- Stage 3. Stage 3 is an advanced but treatable form of breast cancer that has spread beyond the immediate region of the tumor. In many cases, the tumor may have invaded nearby lymph nodes and muscles, but hasn't spread to distant organs. This stage is also subdivided into three subcategories – A, B and C – depending on the size of the tumor and the number of lymph nodes it has spread to.
- Stage 4: Stage 4, also called metastatic breast cancer, is the final stage of the disease. Breast cancers that have spread to distant organs – typically the brain, bones, lungs or liver – are described as stage 4. It's fatal, but new therapies are extending life expectancy within this stage, and many patients manage the disease as a chronic condition for months or years.
Types
Most people think of breast cancer as a single disease, but in fact, there are several different types of breast cancer you may end up facing in your lifetime. They can be classified into two broad categories: noninvasive and invasive. For noninvasive cancer, the Cancer Treatment Centers of America website reports that “cancerous cells remain in a particular location of the breast, without spreading to surrounding tissue, lobules or ducts.”
With invasive breast cancers, “cancerous cells break through normal breast tissue barriers and spread to other parts of the body through the bloodstream and lymph nodes,” reports Breastcancer.org, an educational website. Invasive ductal carcinoma, in which cancer cells grow in the milk ducts, is the most common form of breast cancer, according to the American Cancer Society.
Invasive breast cancers are further categorized by the shape and location of the tumor. In addition, the cancer will be classified based on how it is fed by the body, with the majority of breast cancers being considered estrogen receptive (ER) – that is they’re fed by estrogen.
Treatments
Because there are many different types of breast cancer, the approach your doctor takes to treating yours will be highly individualized. Treatments can include:
- Surgery. Your doctor may prescribe a:
- Lumpectomy, in which the cancerous tissue is removed from the breast but most of the breast is left intact.
- A mastectomy, in which the entire breast is removed. The surgeon may also remove some nearby lymph nodes.
- A bilateral mastectomy, in which both breasts are removed, along with nearby lymph nodes.
- Radiation. Radiation therapy uses targeted, high-energy light and X-rays to kill cancer cells where they grow. It’s used in certain breast cancer cases to kill cancer cells, but not all.
- Endocrine therapy. Endocrine therapy is drug-based regimen that suppresses the hormones that feed the cancer. Tamoxifen is one of the most commonly prescribed anti-estrogen drugs and an example of this type of treatment.
- Chemotherapy. Chemotherapy is a drug-based way of killing cancer cells wherever they may be in the body, and it’s notorious for having deleterious side effects, such as hair loss and nausea. Nevertheless, chemotherapy can be a highly effective, systemic way of ridding the body of cancer. It’s sometimes used before surgery to shrink a tumor, or after to kill any cancer cells that may have been left behind
- Immunotherapy. One of the newer forms of treatment is highly targeted immunotherapy. This type of treatment leverages your body’s own ability to fight cancer naturally. It may have fewer side effects for some people, but not everyone responds well to immunotherapy. This highly personalized approach will likely become more popular in the future as medical science learns more about how to use the immune system to fight cancer where it grows.
The type of treatment you’ll receive is based not only on the type of cancer you have, but also on your preferences and what the doctor thinks will work best for your body and your individual situation.
Breast cancer is a complex disease that can have wide-ranging impacts on your health and many different aspects of your life. Available screening, treatments and our understanding of the various diseases that constitute breast cancer continue to evolve. For more information, please read on with our in-depth series that covers many different aspects of this common disease.
Breast Cancer Survival Rates
According to the American Cancer Society's Cancer Facts & Figures 2019 report, an estimated 268,600 new cases of breast cancer are expected to be diagnosed in 2019, and 42,260 people are anticipated to die of the disease. The ACS reports that "the overall 5- and 10-year relative survival rates for women with invasive breast cancer are 90 percent and 83 percent respectively." But within those figures is a lot of variation and detail that's dependent on the individual case, the stage at which it's diagnosed, how it's treated and other comorbidities you may have. You are not a statistic, and each case of cancer is different.
The ACS reports that 62 percent of cases of breast cancer are diagnosed at a localized stage, meaning the disease has not spread beyond the breast. The five-year survival rate for those early-stage breast cancers is 99 percent. Five-year relative survival rates fall as the disease progresses:
- Stage 2: about 93 percent
- Stage 3: about 72 percent
- Stage 4: about 22 percent
Survival rates are also influenced by race. The ACS reports that survival rates have "improved over time for both white and black women, but remain about 10 percent lower (in absolute terms) for black women. Continuing disparities in outcomes for black women are an area of national focus."
Breast Cancer Prevention
Prevention is always the best medicine, but because so many different factors can lead to the development of breast cancer, it's difficult to say exactly which actions will or won't prevent breast cancer. Some risk factors for the disease simply can't be controlled, such as your age and genetic makeup. However, there are several lifestyle factors that have been linked to an increased risk of breast cancer, so avoiding or reducing your exposure to certain items or actions may help prevent the development of breast cancer.
- Control your weight. Dr. Sagar Sardesai, a breast medical oncologist at The Ohio State University Comprehensive Cancer Hospital and Richard J. Solove Research Institute, says "we know that obesity is a known risk factor for breast cancer." This is because most cases of breast cancer are hormonally-driven and fat cells can produce estrogen that can feed the cancer. Therefore, it's important to manage your weight to help prevent developing the disease.
- Eat right. As the saying goes, we are what we eat, and for a long time now, there's been a link drawn between certain dietary habits and a higher risk of developing breast cancer. Dr. Gertraud Maskarinec, a preventive medicine physician and nutritional epidemiologist at the University of Hawaii Cancer Center, says "I would say we don't have much evidence that eating particular foods will help. But eating in a balanced way is the [best] approach. It's not one food that'll particularly save you or not save you, it's the overall state of health." Talk with your doctors about how to eat for your health. Eating right can also help you control your weight.
- Exercise more. As with diet, exercise is an important factor in managing your weight and has been linked with a reduced risk of breast cancer. It's also thought that exercising consistently can reduce the chance of breast cancer returning.
- Get enough sleep. A good night's sleep is important for more than just feeling ready for the day. Studies have shown that chronic sleep deprivation may contribute to an increased risk of cancer because the body can't repair damage to cells without adequate rest. That damage can accumulate over time and lead to the development of cancer.
- Drink less alcohol. The ACS reports that even moderate use of alcohol may increase risk for breast cancer.
- Consider breastfeeding. Breastfeeding has been linked with a reduced risk of developing breast cancer later in life, so feeding your baby may be one way to help prevent the disease.
Corrected on Aug. 16, 2017: A previous version of this story misstated how often women age 50 to 74 should have a biennial screening mammogram.
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