What is Breast Cancer?
Breast cancer is a malignant (cancer) tumor that starts from cells of the breast. It is found mostly in women, but men can get breast cancer, too. Here we will only talk about breast cancer in women.
Parts of the normal breast
To understand breast cancer, it helps to know something about the normal structure or parts of the breasts, as shown in the picture below.
A woman's breast is made up of glands that make breast milk (called lobules), ducts (small tubes that carry milk from the lobules to the nipple), fatty and connective tissue, blood vessels, and lymph (pronounced limf) vessels. Most breast cancers begin in the cells that line the ducts (ductal cancer), some begin in the lobules (lobular cancer), and a small number start in other tissues.
The lymph system
The lymph system is one of the main ways in which breast cancers can spread. Lymph nodes are small, bean-shaped groups of immune system cells (cells that fight infections) that are connected by lymphatic vessels. Lymphatic vessels are like small veins, except that they carry a clear fluid called lymph (instead of blood) away from the breast. Breast cancer cells can enter lymphatic vessels and begin to grow in lymph nodes.
Most lymph vessels of the breast lead to lymph nodes under the arm. These are called axillary nodes. If breast cancer cells reach the underarm lymph nodes and keep on growing, they cause the nodes to swell. The doctor needs to know whether cancer cells have spread to lymph nodes because if they have, there is a higher chance that the cells have also gotten into the bloodstream and spread to other places in the body. The more lymph nodes that have cancer in them, the more likely it is that the cancer will be found in other organs, too. This could affect the treatment plan.
Breast lumps that are not cancer
Causes of Breast swelling:
The following medical conditions are some of the possible causes of Breast swelling. There are likely to be other possible causes, so ask your doctor about your symptoms.
 
* Puberty - causes breast size increase.
* Menstrual cycle - may change breast size during the cycle.
* Contraceptive pill - may cause slight breast size increase.
* Hormone replacement therapy - may cause slight breast size increase.
* Mastitis
* Gynecomastia
* Breast abscess
* Sexual arousal - causes breasts to swell
* Lymphatic obstruction - may cause one swollen breast
* Pregnancy
* Newborn infant breast swelling - some newborns get temporary breast swelling from maternal hormones.
Most breast lumps are benign. This means they are not cancer. Benign breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening. But some benign breast lumps can increase a woman's risk of getting breast cancer.
Most lumps are caused by fibrocystic changes. Cysts are fluid-filled sacs. Fibrosis is the formation of scar-like tissue. These changes can cause breast swelling and pain. They often happen just before a woman's period is about to start. The breasts may feel lumpy, and sometimes there is a clear or slightly cloudy nipple discharge.
Self-Examination
Age Breast Self-Examination
20-40 Once a month, seven to ten days after your period starts.
40-50 Once a month, seven to ten days after your period starts.
50+ Postmenopausal women: the same day each month
Age Professional or Clinical Examination
20-40 Every one to three years
40-50 Every year
50+ Every yearAge
Mammography
35-40 Baseline mammogram
40-50 Every 1-2 years
50+ Every year
Breast cancer terms
It can be hard to understand some of the words your doctor uses to talk about breast cancer. Here are some of the key words you might hear:
Carcinoma: This is a term used to describe a cancer that begins in the lining layer of organs such as the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas).
Adenocarcinoma: An adenocarcinoma is a type of cancer that starts in gland tissue (tissue that makes and secretes a substance). The ducts and lobules of the breast are gland tissues because they make breast milk, so cancers starting in these areas are often called adenocarcinomas.
Carcinoma in situ: This term is used for the early stage of cancer, when it is still only in the layer of cells where it began. In breast cancer, in situ means that the cancer cells are only in the ducts (ductal carcinoma in situ) or lobules (lobular carcinoma in situ). They have not spread into deeper tissues in the breast or to other organs in the body. They are sometimes called non-invasive or pre-invasive breast cancers.
Invasive (infiltrating) carcinoma: An invasive cancer is one that has already grown beyond the layer of cells where it started (unlike carcinoma in situ). Most breast cancers are invasive carcinomas -- either invasive ductal carcinoma or invasive lobular carcinoma.
Sarcoma: Sarcomas are cancers that start from connective tissues such as muscle tissue, fat tissue or blood vessels. Sarcomas of the breast are rare.
Types of breast cancers
There are many types of breast cancer, but some of them are very rare. Sometimes a breast tumor can be a mix of these types or a mixture of invasive and in situ cancer.
Ductal carcinoma in situ (DCIS): This is the most common type of non-invasive breast cancer. DCIS means that the cancer is only in the ducts. It has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. Often the best way to find DCIS early is with a mammogram. If there are areas of dead or dying cancer cells (called tumor necrosis) within the biopsy sample (when tissue is taken out to be looked at in the lab), the tumor is likely to grow and spread quickly (be more aggressive).
Lobular carcinoma in situ (LCIS): This begins in the milk-making glands (lobules) but does not go through the wall of the lobules. It is not a true cancer, but having LCIS increases a woman's risk of getting cancer later. For this reason, it's important that women with LCIS make sure they have regular mammograms and doctor visits.
Invasive (or infiltrating) ductal carcinoma (IDC): This is the most common breast cancer. It starts in a milk passage (a duct), breaks through the wall of the duct, and invades the tissue of the breast. From there it may be able to spread (metastasize) to other parts of the body. It accounts for about 8 out of 10 invasive breast cancers.
Invasive (infiltrating) lobular carcinoma (ILC): This cancer starts in the milk glands (the lobules). It can spread (metastasize) to other parts of the body. About 1 out of 10 invasive breast cancers are of this type.
Inflammatory breast cancer (IBC): This uncommon type of invasive breast cancer accounts for about 1% to 3% of all breast cancers. Usually there is no single lump or tumor. Instead, IBC makes the skin of the breast look red and feel warm. It also makes the skin look thick and pitted, something like an orange peel. The breast may get bigger, hard, tender, or itchy.
In its early stages, inflammatory breast cancer is often mistaken for infection. Because there is no defined lump, it may not show up on a mammogram, which may make it even harder to catch it early. It usually has a higher chance of spreading and a worse outlook than invasive ductal or lobular cancer.
How Many Women Get Breast Cancer?
* 192,370 new cases of invasive breast cancer
* 40,170 deaths from breast cancer
Breast cancer is the most common cancer among women in the United States, other than skin cancer. It is the second leading cause of cancer death in women, after lung cancer.
The chance of a woman having invasive breast cancer some time during her life is a little less 1 in 8. The chance of dying from breast cancer is about 1 in 35. Breast cancer death rates have been going down. This is probably the result of finding the cancer earlier and better treatment. Right now there are more than 2½ million breast cancer survivors in the United States.
What Causes Breast Cancer?
Certain changes in DNA can cause normal breast cells to become cancer. DNA is the chemical in each of our cells that makes up our genes -- the instructions for how our cells work. Some inherited DNA changes (mutations) can increase the risk for developing cancer and cause the cancers that run in some families. For instance, BRCA1 and BRCA2 are tumor suppressor genes -- they keep cancer tumors from forming. When they are changed (mutated), they no longer cause cells to die at the right time, and cancer is more likely to develop.
But most breast cancer DNA changes happen in single breast cells during a woman's life rather than having been inherited. So far, the causes of most of the DNA mutations that could lead to breast cancer are not known.
Risk factors
While we do not yet know exactly what causes breast cancer, we do know that certain risk factors are linked to the disease. A risk factor is something that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, such as smoking, drinking, and diet are linked to things a person does. Others, like a person's age, race, or family history, can't be changed.
But risk factors don't tell us everything. Having a risk factor, or even several, doesn't mean that a woman will get breast cancer. Some women who have one or more risk factors never get the disease. And most women who do get breast cancer don't have any risk factors. Some risk factors have a greater impact than others, and your risk for breast cancer can change over time, due to factors such as aging or lifestyle.
Although many risk factors may increase your chance of having breast cancer, it is not yet known just how some of these risk factors cause cells to become cancer. Hormones seem to play a role in many cases of breast cancer, but just how this happens is not fully understood.
Risk factors you cannot change
Gender: Being a woman is the main risk for breast cancer. While men also get the disease, it is about 100 times more common in women than in men.
Age: The chance of getting breast cancer goes up as a woman gets older. About 2 out of 3 women with invasive breast cancer are 55 or older when the cancer is found.
Genetic risk factors: About 5% to 10% of breast cancers are thought to be linked to inherited changes (mutations) in certain genes. The most common gene changes are those of the BRCA1 and BRCA2 genes. Women with these gene changes have up to an 80% chance of getting breast cancer during their lifetimes. Other gene changes may raise breast cancer risk, too.
Family history: Breast cancer risk is higher among women whose close blood relatives have this disease. The relatives can be from either the mother's or father's side of the family. Having a mother, sister, or daughter with breast cancer about doubles a woman's risk. (It's important to note that 70% to 80% of women who get breast cancer do not have a family history of this disease.)
Personal history of breast cancer: A woman with cancer in one breast has a greater chance of getting a new cancer in the other breast or in another part of the same breast. This is different from a return of the first cancer (called recurrence).
Race: White women are slightly more likely to get breast cancer than African-American women. But African American women are more likely to die of breast cancer. At least part of the reason seems to be because African-American women have faster growing tumors, but we don't know why this is the case. Asian, Hispanic, and Native-American women have a lower risk of getting and dying from breast cancer.
Dense breast tissue: Dense breast tissue means there is more gland tissue and less fatty tissue. Women with denser breast tissue have a higher risk of breast cancer. Dense breast tissue can also make it harder for doctors to spot problems on mammograms.
Certain benign (not cancer) breast problems: Women who have certain benign breast changes may have an increased risk of breast cancer. Some of these are more closely linked to breast cancer risk than others. For more details about these, see our document, Non-cancerous Breast Conditions.
Lobular carcinoma in situ: Women with lobular carcinoma in situ (LCIS) have a 7 to 11 times greater risk of developing cancer in either breast.
Menstrual periods: Women who began having periods early (before age 12) or who went through the change of life (menopause) after the age of 55 have a slightly increased risk of breast cancer. They have had more menstrual periods and as a result have been exposed to more of the hormones estrogen and progesterone.
Earlier breast radiation: Women who have had radiation treatment to the chest area (as treatment for another cancer) earlier in life have a greatly increased risk of breast cancer. The risk varies with the patient's age when they had radiation. The risk from chest radiation is highest if the radiation were given during the teens, when the breasts were still developing. Radiation treatment after age 40 does not seem to increase breast cancer risk.
Treatment with DES: In the past, some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of losing the baby (miscarriage). Recent studies have shown that these women (and their daughters who were exposed to DES while in the womb), have a slightly increased risk of getting breast cancer. For more information on DES see our document, DES Exposure: Questions and Answers.
Breast cancer risk and lifestyle choices
Not having children or having them later in life: Women who have not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant many times and at an early age reduces breast cancer risk. Being pregnant lowers a woman's total number of lifetime menstrual cycles, which may be the reason for this effect.
Recent use of birth control pills: Studies have found that women who are using birth control pills have a slightly greater risk of breast cancer than women who have never used them. This risk seems to go back to normal over time once the pills are stopped. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk. It's a good idea to talk to your doctor about the risks and benefits of birth control pills.
Using post-menopausal hormone therapy (PHT): Post-menopausal hormone therapy (also known as hormone replacement therapy or HRT), has been used for many years to help relieve symptoms of menopause and to help prevent thinning of the bones (osteoporosis).
There are 2 main types of PHT. For women who still have a womb (uterus), doctors most often prescribe estrogen and progesterone (known as combined PHT). Estrogen alone can increase the risk of cancer of the uterus, so progesterone is added to help prevent this. For women who no longer have a uterus (those who've had a hysterectomy), estrogen alone can be prescribed. This is known as estrogen replacement therapy (ERT).
* Combined PHT: Use of combined PHT increases the risk of getting breast cancer. It may also increase the chances of dying from breast cancer. Breast cancer may also be found at a more advanced stage. Five years after stopping PHT, the breast cancer risk seems to drop back to normal.
* ERT: The use of estrogen alone does not seem to increase the risk of developing breast cancer very much, if at all. But when used long-term (for more than 10 years), some studies have found that ERT increases the risk of ovarian and breast cancer.
At this time, there seem to be few strong reasons to use PHT, other than for short-term relief of menopausal symptoms. Because there are other factors to think about, you should talk with your doctor about the pros and cons of using PHT. If a woman and her doctor decide to try PHT for symptoms of menopause, it is usually best to use it at the lowest dose that works for her and for as short a time as possible.
Not breast-feeding: Some studies have shown that breast-feeding slightly lowers breast cancer risk, especially if the breast-feeding lasts 1½ to 2 years. This could be because breast-feeding lowers a woman's total number of menstrual periods, as does pregnancy
Alcohol: Use of alcohol is clearly linked to an increased risk of getting breast cancer. Women who have one drink a day have a very small increased risk. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who drink no alcohol. The American Cancer Society suggests limiting the amount you drink to one drink a day.
Being overweight or obese: Being overweight or obese is linked to a higher risk of breast cancer, especially for women after change of life or if the weight gain took place during adulthood. Also, the risk seems to be higher if the extra fat is around the waist. But the link between weight and breast cancer risk is complex. And studies of fat in the diet as it relates to breast cancer risk have often given conflicting results. The American Cancer Society recommends you stay at a healthy weight throughout your life and avoid gaining too much weight.
Lack of exercise: Studies show that exercise reduces breast cancer risk. The only question is how much exercise is needed. One study found that as little as 1 hour and 15 minutes to 2½ hours of brisk walking per week reduced the risk by 18%. Walking 10 hours a week reduced the risk a little more. The American Cancer Society suggests that you exercise for 45 to 60 minutes 5 or more days a week.
Uncertain risk factors
High fat diets: Studies of fat in the diet have not clearly shown that this is a breast cancer risk factor. Most studies found that breast cancer is less common in countries where the typical diet is low in fat. On the other hand, many studies of women in the United States have not found breast cancer risk to be linked to how much fat they ate. Researchers are still not sure how to explain this difference. More research is needed to better understand the effect of the types of fat eaten and body weight on breast cancer risk.
The American Cancer Society recommends eating a healthy diet that includes 5 or more servings of vegetables and fruits each day, choosing whole grains over processed (refined) grains, and limiting the amount of processed and red meats.
Antiperspirants and bras: Internet e-mail rumors have suggested that underarm antiperspirants can cause breast cancer. There is very little evidence to support this idea. Also, there is no evidence to support the idea that bras cause breast cancer.
Abortions: Several studies show that induced abortions do not increase the risk of breast cancer. Also, there is no evidence to show a direct link between miscarriages and breast cancer. For more detailed information, see our document, Is Having an Abortion Linked to Breast Cancer?
Breast implants: Silicone breast implants can cause scar tissue to form in the breast. But studies have found that this does not increase breast cancer risk. If you have breast implants, you might need special x-ray pictures during mammograms.
Pollution: A lot of research is being done to learn how the environment might affect breast cancer risk. At this time, research does not show a clear link between breast cancer risk and environmental pollutants.
Tobacco Smoke: Most studies have found no link between active cigarette smoking and breast cancer. An issue that continues to be a focus of research is whether secondhand smoke (smoke from another person's cigarette) may increase the risk of breast cancer. But the evidence about secondhand smoke and breast cancer risk in human studies is not clear. In any case, a possible link to breast cancer is yet another reason to avoid being around secondhand smoke.
Night Work: A few studies have suggested that women who work at night (nurses on the night shift, for instance) have a higher risk of breast cancer. This is a fairly recent finding, and more studies are being done to look at this.
Survival Rates for Breast Cancer
Some people with cancer may want to know the survival rates for their type of cancer.Others may not find the numbers helpful, or may even not want to know them. Whether or not you want to read about survival rates is up to you.
The 5-year survival rate refers to the percentage of patients who live at least 5 years after their cancer is found. Of course, many people live much longer than 5 years. Five-year relative survival rates leave out patients dying of other diseases. This means that anyone who died of another cause, such as heart disease, is not counted.
These numbers are based on women treated a number of years ago. Because we now find more cancers early and use newer, better treatments, the survival rates are getting better all the time.
Stage 5-year Relative Survival Rate
0 100%
I 100%
II 86%
III 57%
IV 20%
While these numbers provide an overall picture, keep in mind that every woman is unique and the statistics can't predict exactly what will happen in your case. Talk with your cancer care team if you have questions about your own chances of a cure or how long you might survive your cancer. They know your situation best.
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