Breast Cancer: Overview

Do I Need Screening?

A mammogram is the primary test doctors use to screen for breast cancer. Yet medical organizations like the U.S. Preventive Services Task Force and the American Cancer Society don’t agree on what age to start testing, when to stop testing, and how often to screen. That disagreement can be confusing for women who are trying to figure out when they should get screened.

Confused as to when and how often to get mammograms? Dr. Connie Lehman explains when you need to have this test.

The doctors SurvivorNet asked recommend that women make their decision based on personal factors, after having a careful conversation with their doctor. Women with risk factors like dense breasts or a personal or family history of breast cancer may benefit from having annual mammograms.

If you notice any changes in your breasts, such as new lumps or nipple changes, ask your doctor about getting a mammogram or other screening tests. Remember that you’re the best expert on your own health and what’s normal, or not, for your body.

Though breast cancer is far less common in men than in women, it does sometimes affect men, and it needs to be treated as quickly as possible. Men should be aware of the same warning signs as women, such as new lumps in their breast tissue and changes to their nipples, and report them to their doctor.

What Are the Symptoms of Breast Cancer?

It’s always a good idea to be familiar with your own breasts, so you can learn what’s normal for you, and how to spot any changes worth mentioning to your doctor. For this reason, SurvivorNet’s experts recommend that you do regular breast self-exams.

Dr. Comen shares how self-exams can help you learn what’s normal and what’s not for your breasts.

You don’t need to have an MD after your name to know whether a lump is new, or your breast is changing in appearance. Your goal in performing self-exams is to see whether anything about your breasts is different than usual.

Look for changes like:

• A new breast lump
• New swelling in one breast
• Changes in the nipple (such as puckering)
• Redness or flaking in the breast or nipple
• Discharge (including blood) from the nipple
• Pain in the breast

Bring symptoms like these to your doctor’s attention.

Getting a Diagnosis

Your mammogram or self-exam results may lead your doctor to recommend further testing with a diagnostic mammogram, ultrasound, or magnetic resonance imaging (MRI). If these tests suggest changes that might be cancer, you’ll need a biopsy–a test in which your doctor removes a small sample of tissue and has it checked for cancer in a lab. Only a biopsy can confirm or rule out whether you have breast cancer.

A breast biopsy is less scary when you know what to expect.

Although it can be frightening to go through breast cancer testing, SurvivorNet’s doctors advise that you try not to get ahead of yourself. It’s very possible for a biopsy to find that a lump is benign (not cancer).

If you do receive a breast cancer diagnosis, you’ll get a lot more information along with it, such as the type and stage of the disease. The stage means how far in your body the cancer has spread.

Though most breast cancers are not linked to inherited genetic mutations, knowing whether you have a mutation could affect the type of treatment you get. Therefore, it’s recommended that all women who are diagnosed with breast cancer be given genetic testing.

Do you need genetic testing? The answer, according to Dr. Ophira Ginsburg, Director of the High-Risk Cancer Program at NYU Langone’s Perlmutter Cancer Center, depends on your family history of cancer.

Based on your test results, preferences, and personal circumstances (such as your age), you and your doctor will make decisions about how to proceed with treatment.

There are different types of breast cancer, and determining what type you have will help your doctor choose the best treatment option for you.

The links below will take you to simple guides SurvivorNet created to explain treatment options for different types of breast cancer.

• Living With ‘HER2-Low’ Breast Cancer
• Living With HER2-Positive Breast Cancer
• Living With Metastatic Breast Cancer
• Living With HER2-Positive Metastatic Breast Cancer
• Living With HR-Positive Metastatic Breast Cancer

Evaluating Your Treatment Options

Your doctor has many ways to treat breast cancer, including:

• Surgery
• Chemotherapy
• Radiation
• Hormone therapy
• Targeted therapy
• Immunotherapy

SurvivorNet expert, oncologist Dr. Ann Partridge discusses the challenges of diagnosing and treating treating aggressive breast cancers in young women.

Surgery

Most women with breast cancer will have surgery at some point in their treatment. Depending on how far your cancer has spread and your personal preferences, you and your doctor may decide to:

• Remove just the cancer and an area of healthy tissue around it (lumpectomy)
• Remove one breast (mastectomy)
• Remove both breasts (double mastectomy)

Having a breast removed can be an emotional experience. Plastic surgeon Dr. Andrea Pusic offers advice on regaining your sense of self after surgery.

Removing your breasts can have a dramatic effect on your self-esteem, which is why some women who opt for a mastectomy then choose breast reconstruction surgery. This is a highly personal choice, and there is no “right” answer as to whether or not to reconstruct.

Chemotherapy

Chemotherapy uses strong drugs to kill cancer all over the body. You may get this treatment to shrink a tumor before surgery, afterward to get rid of any remaining cancer cells, or on its own if you can’t have surgery.

Whether or not to have chemotherapy can also be a choice, depending on a woman’s age, type of cancer, and stage.

Radiation Therapy

Radiation, the use of high-energy rays to destroy cancer cells, is also used after surgery to lower the chance that the cancer will come back after treatment. Many women undergo radiation as part of their treatment, especially if they opt for a lumpectomy instead of a mastectomy.

Hormone Therapy

The hormones estrogen and progesterone help some breast cancers grow. Doctors refer to these types of cancers as hormone-receptor-positive breast cancers. Receptors are proteins on the surface of breast cells that receive messages from estrogen, progesterone, or both, telling them to grow. Treatments that block these hormones may help stop the tumor.

Testing the tumor sample from a biopsy helps to determine whether hormone therapies such as tamoxifen (Nolvadex) or anastrozole (Arimidex) might work against the cancer. Women with breast cancer that is fueled by estrogen may take one of these drugs as part of their treatment.

Immunotherapy and Targeted Therapy

Immunotherapy and targeted therapies are newer forms of treatment. Immunotherapy boosts your body’s own immune response to help it stop the cancer.

As their name suggests, targeted therapies target certain substances that help the cancer grow. For example, drugs like trastuzumab (Herceptin) and pertuzumab (Perjeta) treat breast cancers that have too much of a protein called HER2 on their surface.

Treating Late-Stage Breast Cancer

Stage IV, or metastatic breast cancer, is the hardest type of cancer to treat. Metastatic means the cancer has spread beyond the breast to other parts of the body.

Though it can be scary to find that you have a late-stage cancer, new treatments have improved the outlook for stage IV cancer, according to the leading medical experts SurvivorNet consulted. These new treatments are increasing the lifespan of women with metastatic disease.

Dr. Comen overviews the many options for treating advanced breast cancer.

For women with HER2-positive breast cancer, meaning they have high levels of a protein called HER2 on the surface of their cancer cells, targeted treatments are available. The drugs trastuzumab (Herceptin) and pertuzumab (Perjeta) have transformed the outlook for some women with late-stage breast cancers. These therapies, which are often combined with chemo, are very effective at controlling breast cancer once it has spread.

Another big advancement has come in the treatment of triple-negative breast cancer. This has historically been one of the most aggressive and hardest to treat forms of the disease, because it lacks any of the main drivers of breast cancer, the estrogen receptor, the progesterone receptor, and the HER2 receptor, and it doesn’t respond to treatments that target these receptors.

Now, in addition to chemotherapy, immunotherapy has been approved to treat triple-negative breast cancer. In studies, this new therapy has been shown to extend the lives of women with this type of cancer.

How immunotherapy could dramatically improve outcomes for some women with breast cancer, explains Dr. Sylvia Adams of NYU Langone Cancer.

For postmenopausal women with hormone-receptor-positive and HER2-negative breast cancers, a newer class of drugs called CDK4/6 inhibitors are available. These drugs have been shown to improve survival in some women with metastatic cancer.

Medical oncologist Dr. Erica Mayer explains how CDK4/6 inhibitors treat hormone-receptor-positive breast cancers.

Although a breast cancer diagnosis is never easy, some women describe it as a wake-up call that actually helped them improve their lives, by allowing them to focus on what matters most and practice better self-care. Taking good care of yourself by exercising, eating right, and limiting alcohol intake will help to ensure that you stay healthy and cancer-free once your treatment ends.