Twelve percent of women will develop invasive breast cancer in their lifetime. Each year in the United States, about 233,000 women are diagnosed with invasive breast cancer. Although breast cancer in men is rare, about 2,000 American men are diagnosed each year with invasive breast cancer.
There are 2 main types of breast cancer:
- Ductal carcinoma starts in the tubes (ducts) that carry milk from the breast to the nipple. Most breast cancers are of this type.
- Lobular carcinoma starts in the parts of the breast, called lobules, which produce milk.
In rare cases, breast cancer can start in other areas of the breast.
Breast Cancer Risk Factors
There are many different risk factors for breast cancer including:
Age. Most cases of breast cancer occur in women older than age 60. According to the American Cancer Society, about 1 in 8 cases of invasive breast cancer are found in women younger than age 45, while 2 in 3 cases of invasive breast cancer are found in women ages 55 and older.
Race and Ethnicity. Breast cancer is slightly more common among white woman than African-American, Asian, Latina, or Native American women. However, African-American women tend to have more aggressive types of breast cancer tumors and are more likely to die from breast cancer than women of other races.
Breast cancer is also more prevalent among Jewish women of Eastern European (Ashkenazi) descent.
Family and Personal History. Women who have a family history of breast cancer are at increased risk for developing breast cancer themselves. Having a first-degree relative (mother, sister, or daughter) who has been diagnosed with breast cancer doubles the risk for developing breast cancer.
Women who have had ovarian cancer are at increased risk for developing breast cancer. A personal history of breast cancer increases the risk of developing a new cancer in the same or other breast.
Genetic Factors. 5 to 10% of breast cancer cases are due to inherited genetic mutations.
Breast Cancer Symptoms
Early breast cancer often does not cause symptoms. This is why regular breast exams and mammograms are important, so cancers that don't have symptoms may be found earlier.
As the cancer grows, symptoms may include:
- Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt.
- Change in the size, shape, or feel of the breast or nipple. For example, you may have redness, dimpling, or puckering that looks like the skin of an orange.
- Fluid from the nipple. Fluid may be bloody, clear to yellow, green, or look like pus.
In men, breast cancer symptoms include breast lump and breast pain and tenderness.
Symptoms of advanced breast cancer may include:
- Bone pain
- Breast pain or discomfort
- Skin ulcers
- Swelling of the lymph nodes in the armpit (next to the breast with cancer)
- Weight loss
Breast Cancer Diagnosis
Women should keep aware of how their breasts look and feel. If you notice changes that persist, discuss your concerns with your physician. Some of these symptoms may be caused by conditions that are not cancer.
Women are encouraged to perform breast self-exams monthly. If you feel a lump or questionable mass during a self-exam, schedule an appointment with your doctor. During a physical exam, your physician will check both your breasts, armpits and your neck and chest area.
Tests used to diagnose and monitor people with breast cancer may include:
- Breast MRI to help better identify the breast lump or evaluate an abnormal change on a mammogram
- Breast ultrasound to show whether the lump is solid or fluid-filled
- Breast biopsy, using methods such as needle aspiration, ultrasound-guided, stereotactic, or open
- CT scan to check if the cancer has spread outside the breast
- Mammography to screen for breast cancer or help identify the breast lump
- PET scan to check if the cancer has spread
- Sentinel lymph node biopsy to check if the cancer has spread to the lymph nodes
If your doctor learns that you do have breast cancer, more tests will be done. This is called staging, which checks if the cancer has spread. Staging helps guide treatment and follow-up. It also gives you an idea of what to expect in the future.
Breast cancer stages range from 0 to IV. The higher the stage, the more advanced the cancer.
While most women with an abnormal mammogram do not have cancer receiving a definitive breast cancer diagnosis is the only way to alleviate concerns. For those who do have cancer, it is important to evaluate breast cancer treatment options and determine a course of action as quickly as possible.
Cancer Treatment at the Breast Care Center
Research demonstrates that in medicine, multidisciplinary care - the care of a patient by multiple specialists - is the most effective breast cancer treatment course. The Breast Care Center at the Wake Forest Baptist Comprehensive Cancer Center consolidates the services of a multidisciplinary team in a central location, giving patients access to multiple breast cancer specialists during a single visit.
Each patient is different, and we provide individualized treatment plans based on your clinical, imaging and laboratory findings, as well as your own unique lifestyle and preferences. Treatment is based on many factors, including:
- Type of breast cancer
- Stage of the cancer (staging is a tool your providers use to find out how advanced the cancer is)
- Whether the cancer is sensitive to certain hormones
- Whether the cancer overproduces (overexpresses) the HER2/neu protein
Cancer treatments may include:
- Hormone therapy.
- Chemotherapy, which uses medicines to kill cancer cells.
- Radiation therapy, which is used to destroy cancerous tissue.
- Surgery to remove cancerous tissue: A lumpectomy removes the breast lump. Mastectomy removes all or part of the breast and possibly nearby structures. Nearby lymph nodes may also be removed during surgery.
- Targeted therapy uses medicine to attack the gene changes in cancer cells. Hormone therapy is an example of targeted therapy. It blocks certain hormones that fuel cancer growth.
Cancer treatment can be local or systemic:
- Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment. They are most effective when the cancer has not spread outside the breast.
- Systemic treatments affect the entire body. Chemotherapy and hormonal therapy are types of systemic treatment.
Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning. For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.
- Stage 0 and ductal carcinoma: Lumpectomy plus radiation or mastectomy is the standard treatment.
- Stage I and II: Lumpectomy plus radiation or mastectomy with lymph node removal is the standard treatment. Chemotherapy, hormonal therapy, and other targeted therapy may also be used after surgery.
- Stage III: Treatment involves surgery, possibly followed by chemotherapy, hormone therapy, and other targeted therapy.
- Stage IV: Treatment may involve surgery, radiation, chemotherapy, hormone therapy, other targeted therapy, or a combination of these treatments.
After treatment, some women continue to take medicines for a time. All women continue to have blood tests, mammograms, and other tests after treatment to monitor for the return of cancer or development of another breast cancer.
Women who have had a mastectomy may have reconstructive breast surgery. This will be done either at the time of mastectomy or later.
Known as compassionate and caring specialists, our team works together to give each patient the right combination of advanced treatment, access to the right resources and above all, hope.