Over a quarter million people are diagnosed with breast cancer in the United States each year. Learn more about the various types and treatment options.
Cancer is a disease that is
characterized by abnormal cell growth. These cancer cells can form tumors and
spread to surrounding tissue. When this process originates in the breast, it’s
known as breast cancer.
n the United States, breast cancer is the second most common
cancer in women, following skin cancer. Although it’s much less common, men can
develop breast cancer too. Over 260,000 women and 2,400 men are diagnosed with
breast cancer each year.
Most breast cancers begin in the
tube-shaped ducts of the breast. In female breasts, these ducts connect the
milk-producing glands (called lobules) to the nipples; male breasts have these
ducts and a few glands too—though they usually don’t produce milk. Less
often, breast cancers may originate in the lobules and more rarely, in the
breast’s fatty and fibrous connective tissue.
If the cancer spreads to other
tissues and organs in the body, it’s called metastatic breast cancer.
Due to early screening and
diagnosis, along with better treatments for breast cancer, female deaths from
breast cancer have declined by over 40% between 1989 and 2019.
From 2015 to 2019, the U.S. Cancer
Statistics reports that the death rate is about 20 out of every 100,000 women
with breast cancer.
It’s important to learn about the
risk factors and prevention for breast cancer and what you can expect from
diagnosis and treatments.
Types
There are several types of breast
cancer, categorized by where the cancer starts and where it has spread. Some
common breast cancers are:
- Ductal carcinoma in situ (DCIS): This is an
early-stage cancer in the ducts of the breast. It is non-invasive, meaning
it hasn’t spread to other parts of the body. It has a high survival rate
of 95% from 10 years of diagnosis.9
- Invasive ductal carcinoma (IDC): Also
called infiltrating ductal carcinoma, this is the most common type of
breast cancer.10 It begins in
the lining of the duct and spreads to other breast tissue. As an invasive
cancer, it can spread to other parts of the body through your bloodstream
or lymphatic system (part of your immune system).
- Invasive lobular carcinoma (ILC): This is an
invasive cancer that begins in the lobules and spreads to surrounding
tissue.
Some breast cancers are rare. Inflammatory breast cancer (IBC), for
example, is an uncommon-but-aggressive form. It tends to occur in women younger
than 40.
A doctor can classify breast
cancers by their stage, based on:
- Tumor size and location
- Number and location of affected lymph nodes
(organs that help your body fight infection)
- Metastasis (the spread of cancer cells to
other tissues and/or organs)
- Tumor grade (how fast a tumor grows, based
on how abnormal the cells are)
- Estrogen receptor and progesterone receptor
status (whether cancer cells produce these hormone-specific proteins)
- HER2 (human epidermal growth factor
receptor 2) status, a protein that speeds up breast cancer growth
Based on the type of cancer, an
oncologist (a doctor specializing in cancer diagnosis and treatment) can
determine a suitable treatment plan.
For male breast cancer, it may be
difficult to detect in the breast tissue alone. A healthcare provider may also
take scans of other parts of the body, like the chest and abdomen to determine
the cancer stage.
Symptoms
Breast cancer symptoms vary, and
many people have no symptoms at all, especially early on. That's why regular
screening mammograms are so important. Mammograms are a type of X-ray that may detect
small tumors before you can feel them.
Still, mammography isn't
foolproof; you should also become familiar with your breasts, so you know what
is and isn’t normal for you.
Pay attention to any breast
changes you experience, including these possible warning signs:
- A new lump in the breast or armpit
- Changes in the size or shape of the breast
(swelling, thickening, or shrinkage)
- Skin dimpling or pitting (like an orange
peel)
- Red, dry, flaking, or thickened nipple or
breast skin
- Breast or nipple pain
- A nipple that turns inward or has a sore
- Milky or bloody discharge from the nipple
- Swollen lymph nodes under the armpit or
around the collarbone
Causes
Breast cancer begins when mutated
cells in the breast divide and grow without restraint. These abnormal cells
form a mass of tissue called a tumor. There are a variety of reasons as to why
this may occur. For some people, you may have inherited gene mutations (passed
down through families) that can harm your cells’ ability to fix DNA mutations.
More often, your cells can become cancerous even if you don’t have a genetic
risk for breast cancer—perhaps due to certain lifestyle or environmental
factors.
Risk Factors
Though breast cancer is most
common in people assigned female at birth, several factors may raise your risk
of breast cancer, regardless of your sex. These include:
- Being age 50 or older
- Being overweight or obese, especially when
also at an older age
- Inheriting certain genes (such as BRCA1 and BRCA2)
- A family history of breast cancer
- Having a benign breast condition
- Having radiation therapy in the chest area
- Undergoing hormone therapy containing
estrogen (such as for menopausal symptoms)
- Long-term alcohol consumption
- Long-term physical inactivity
However, there are differences
between female and male breast cancer.21
Specific risk factors that have
been linked to female breast cancer include:
- Dense breast tissue
- An early first period (before age 12)
- Going through menopause after age 55
- A family history of ovarian cancer (in a
first-degree relative)
- Being exposed to the drug DES
(diethylstilbestrol, a synthetic estrogen)
- Higher bone density
- Not having children
- Not breastfeeding
- Giving birth for the first time at age 35
or older
- Naturally having high estrogen levels
- Taking combined oral contraceptives with
estrogen and progestin (though this risk is reversible with
discontinuation)
In general, male breast cancer is
understudied compared to female breast cancer. But some factors that may raise the
risk of male breast cancer include:
- Klinefelter syndrome, a rare condition of
having XXY chromosomes (an extra X chromosome)
- Changes to testicles (like injury,
inflammation, swelling, or surgical removal)
- Liver disease
Having any of these risk factors
does not necessarily mean that you will get breast cancer. Talk to your
healthcare provider about keeping up with routine screenings and what you can
do to reduce your risk.
Diagnosis
Doctors may use different tests
and procedures to diagnose breast cancer. As of May 2023, the U.S. Preventative Services Task Force (USPSTF) recommends that
cisgender women and people assigned female at birth get mammograms every two
years beginning at age 40.
Common diagnostics include:
- Standard physical exam: A healthcare
provider will ask you about any recent health changes and your
medical history.
- Blood tests: This helps evaluate
how certain organs and tissues are functioning based on substances in your
blood sample.
- Breast exam: A healthcare provider checks
for lumps or other changes in your breasts.
- Mammogram: This is an X-ray of your breasts to
check for potential signs of cancer. It’s the most common diagnostic tool
used to check for breast cancer.
- Ultrasound: This visualizes tumors to help
determine whether they are cancerous or benign.
- Magnetic resonance imaging (MRI): This is an
imaging technique that can generate images of your organs and tissues. It
is usually only done for women at high risk of breast cancer.
- Biopsy: This is a lab test where a sample of
your breast tissue is removed and the cells are examined.
Once a diagnosis is confirmed, a
healthcare provider will conduct additional tests and procedures to locate
where the cancer has spread, determine the stage of the disease, and identify
features of your particular cancer that may help guide treatment. These may
include:
- Additional imaging tests
- Bone scan
- Lab testing to measure estrogen and
progesterone receptors in cancerous tissue
- Lab testing to examine amount of HER2 gene
and HER2 protein in cancerous tissue
- Multigene testing to identify gene
mutations linked to a higher breast cancer risk (BRCA1, BRCA2, PALB2)
Treatment
Breast cancer treatment differs by the
type of cancer; its size, stage, and sensitivity to hormones; a person's age
and health; and other factors. If you have breast cancer, you may receive one
or more of the following therapies, depending on your condition:
Surgery: You might
have breast-conserving surgery (such as lumpectomy), which removes cancerous
breast tissue and some surrounding healthy tissue, but not the whole breast.
Or, you might have a mastectomy—a surgery that removes the breast with cancer
and, if necessary, the lymph nodes near the armpit.
Radiation
therapy: This uses radiation to stop cancer growth at specific areas of
the body. It can be used after a surgery or if the cancer has spread beyond the
breast (metastasized). Options include external beam radiation therapy and
brachytherapy.
Chemotherapy:
Typically, this uses an intravenous (IV) therapy to deliver chemo drugs through
your bloodstream to help stop cancer growth. It can be administered before or
after surgery, or as the main treatment—usually for metastatic cancer.
Hormone
therapy: If the cancer cells have estrogen or progesterone receptors,
they can grow faster with those hormones present. Therefore, taking an
anti-hormone drug can either lower the amount of estrogen or progesterone in
your body or block them from cancer cells.
Targeted
therapy: These drugs target features of cancer cells, which then blocks
their growth. Trastuzumab is one that targets HER2-positive breast cancers.
Immunotherapy: This
treatment helps your immune system attack cancer cells. You might take a
substance that your body produces naturally (but needs more of) or a drug
designed to aid your immune response.
Talk to your healthcare provider
about possible side effects of treatments. Besides these options, you could
also participate in a clinical trial for new breast cancer treatment
candidates—in which researchers are testing whether they work and how safe they
are to use.
Prevention
There's no sure way to prevent
breast cancer. But there is a lot you can do to lower your risk:
- Maintain a healthy weight: This can reduce
your risk of cancer and includes regular exercise, getting enough sleep,
and limiting your daily stress. Also,
eating a healthy diet, such as a Mediterranean diet that’s rich in fruits
and vegetables and limits red and processed meat, may lower your risk.
- Exercise regularly: Being
physically active can lower your risk of breast cancer. You'll want to aim
for a minimum of 150 minutes of moderate activity (like brisk walking) or
75 minutes of vigorous exercise (like jogging) each week.
- Limit your alcohol intake: The American
Cancer Society recommends limiting daily alcohol intake to 1 drink for
women and 2 drinks for men, or avoiding alcohol entirely.
- Consider non-hormonal options to treat menopause
symptoms: Using
hormone therapy after menopause may increase your risk of developing
breast cancer. Instead, your healthcare
provider may recommend other treatments for menopausal hot flashes and
stress.
- Consider breastfeeding: Choosing to
breastfeed after giving birth can lower estrogen levels in your breasts,
which may decrease your risk of breast cancer.
- Consider the risks of taking the
pill: Taking combined oral contraceptives may raise the risk of
female breast cancer, though research is limited. Talk with your healthcare
provider about whether you should take the pill or try other birth control
options.
Preventive Tests
Locating changes in the breasts
and understanding your genetic risk for breast cancer can help you be vigilant
about reducing your risk and help detect cancer early.
Genetic
Testing
If you have a personal or family
history of breast cancer, talk to your healthcare provider about whether you
should get genetic testing. This involves a lab test on a DNA sample—such as
from your saliva or blood. It can check whether you have any specific gene mutations
that have been linked to an increased risk for breast cancer.
BRCA gene mutations are known to
be more common in certain people. If you are of Ashkenazi Jewish, West African,
Dutch, Belgian, Icelandic, or Swiss ancestry—especially if you also have a
family history of breast cancer—you may be more likely to have one or more BRCA
gene mutations.
Breast
Cancer Screenings
The
thought of getting a screening often starts with a question of when. It’ll
depend on your individual risk for breast cancer.
Some risk factors carry more
weight than others. Factors such as genetic, hereditary, or personal medical
history of breast cancer, or a history of chest radiation (before age 30)
indicate that you have a higher risk of developing breast cancer.
If you are at higher risk for
breast cancer, experts recommend starting routine screenings at an earlier age.
This might begin around age 35 for men or age 30 for women.
The CDC provides information on
resources for low-cost screenings for people who are
eligible.
Breast
Exams
Regular breast exams can help you
understand what’s normal for your breasts and what isn’t. Your healthcare
provider may conduct a clinical breast exam during your annual physical. They
can teach you how to do this exam on your own time (known as a breast
self-exam). You can also refer to tutorials from official medical associations.
Though there hasn’t been enough
research to suggest that a breast exam can change your risk for breast cancer,
it’s an extra precaution you can take for early detection, especially if you’re
at high risk for breast cancer. However, it’s not recommended to rely on breast
exams alone for cancer detection. Even if you do breast exams, experts
recommend continuing with standard screening methods, like mammograms.
Other
Options for People Who Are High Risk
If you are at higher risk for
female breast cancer, such as having a BRCA gene mutation, there are additional
preventive measures you can take—even when you don’t have cancer.
You could ask your healthcare
provider about taking antiestrogens, which prevent cells from making or using
estrogen. Another option is having preventive surgery
to help lower your risk. This could be a surgery to remove your breast tissue
(bilateral risk-reducing mastectomy) or to remove your ovaries and fallopian
tubes (prophylactic salpingo-oophorectomy).
A Quick Review
Breast cancer is cancer that
originates in breast tissue. There are several types of breast cancer that vary
by severity and spread, though common symptoms include an abnormal growth on
the breast or other breast changes, like nipple inversion. A healthcare
provider can provide a diagnosis and determine the type, stage, and status of
breast cancer. Several treatment options are available, such as radiation
therapy, surgery, chemotherapy, and more.
Some people may have a higher
risk, such as those with a genetic predisposition or family history of breast
cancer. Early screening and preventive tests are available to help determine
your risk for breast cancer, as well as procedures to prevent local breast
cancer from spreading—particularly if you have a high genetic risk.
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