Breast Cancer

What are the symptoms of breast cancer?

Breast cancer symptoms may include:

• A lump or thickening in the breast or underarm
• Nipple tenderness or pain in any area of the breast
• Dimpling on the surface of the breast
• Nipple has turned slightly inward or became inverted
• Nipple discharge that starts suddenly or is bloody
• Skin of the nipple or breast area is reddish, flaky or pitted, similar to the texture of an orange peel
• Size or shape of the breast has changed, especially if only on one side

What causes breast cancer?

The risk for breast cancer is due to a combination of factors. Primary factors include being a woman and being over 50 years old, as the risk for breast cancer increases with age. Other factors include:

• Genetic mutations. Women who have inherited mutations to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer.
• Reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
• Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
• Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical ductal hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
• Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
• Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (for instance, treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.

How is breast cancer diagnosed?

Breast Cancer Screening

Breast Self-Examination

• 20 years of age or older - women should perform breast self-examinations to be more aware of how their breasts look and feel. There is no right or wrong way to check your breasts, as long as you learn the entire area of your breast tissue – from your collarbone, under your armpits and your nipples – well enough to notice any changes. The best time to perform a breast self-exam is after your menstrual cycle ends each month, when your breasts are least likely to be swollen. If you no longer have your menstrual cycle, choose a day that’s easy to remember for your self-exam. You may also view How to Do Breast Self-Exams.

Regular Clinical Breast Examinations by a Doctor

• 20 to 39 years of age - a clinical breast exam should be part of your regular women's physical and performed every three years.
• 40 years of age or older - a clinical breast exam should be part of your regular women's physical and performed every year.

Routine Mammograms

• 20 to 39 years of age - if you are at high risk for breast cancer, ask your doctor if you should begin having mammograms or other screenings sooner.
• 40 years of age or older - annual mammogram. If you are at high risk for breast cancer, ask your doctor which screening tests are right for you.

Breast Cancer Biopsy

Determining the grade, stage, and spread of breast cancer is done through a biopsy. A breast biopsy might be recommended if you have a suspicious area in your breast, such as a breast lump or other signs and symptoms of breast cancer. It can also be used to investigate unusual findings on a mammogram, ultrasound, or other breast exam.

During a biopsy, a sample of tissue is removed through a minimally invasive procedure. There are several breast biopsy procedures that can be used to obtain a tissue sample from the breast. Your doctor may recommend a particular procedure based on the size, location, and other characteristics of the suspicious area in your breast. For many biopsies, you'll get an injection to numb the area of the breast to be biopsied.

At the time of the breast biopsy procedures noted below (except for surgical biopsy), a tiny stainless steel or titanium marker may be placed in the breast at the biopsy site. This is done so that if the biopsy shows cancer cells or precancerous cells, your doctor or surgeon can locate the biopsy area to remove more breast tissue during a surgical biopsy. These markers cause no pain or disfigurement and don't interfere when going through metal detectors.

After your breast biopsy, the tissue sample is sent to a lab where pathologists examine the sample. The pathologist prepares a pathology report that is sent to your doctor, who will share the results with you. The pathology report includes details about the size and consistency of the tissue samples and the location of the biopsy site. The report describes whether cancer, noncancerous changes or precancerous cells were present. If the pathology report says that breast cancer is present, it will include information about the cancer itself, such as what type of breast cancer you have and additional information, such as whether the cancer is hormone receptor positive or negative. You and your doctor will then develop a treatment plan that best suits your needs.