breast_cancer

Breast cancer is a cancer that starts in breast tissue. It happens when cells in the breast change and grow out of control. The cells usually form a tumor.

Sometimes the cancer does not spread any further. This is called "in situ." If the cancer spreads outside the breast, the cancer is called "invasive." It may just spread to nearby tissues and lymph nodes. Or the cancer may metastasize (spread to other parts of the body) through the lymph system or the blood.

Breast cancer is the second most common type of cancer in women in the United States. Rarely, it can also affect men.

There are different types of breast cancer. The types are based on which breast cells turn into cancer. The types include:

• Ductal carcinoma, which begins in the cells of the ducts. This is the most common type.
• Lobular carcinoma, which begins in the lobules. It is more often found in both breasts than other types of breast cancer.
• Inflammatory breast cancer, in which cancer cells block lymph vessels in the skin of the breast. The breast becomes warm, red, and swollen. This is a rare type.
• Paget's disease of the breast, which is a cancer involving the skin of the nipple. It usually also affects the darker skin around the nipple. It is also rare.

Breast cancer happens when there are changes in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown.

But sometimes these genetic changes are inherited, meaning that you are born with them. Breast cancer that is caused by inherited genetic changes is called hereditary breast cancer.

There are also certain genetic changes that can raise your risk of breast cancer, including changes in the BRCA1 and BRCA2 genes. These two changes also raise your risk of ovarian and other cancers.

Besides genetics, your lifestyle and the environment can affect your risk of breast cancer.

The factors that raise your risk of breast cancer include:

• Older age
• History of breast cancer or benign (noncancer) breast disease
• Inherited risk of breast cancer, including having BRCA1 and BRCA2 gene changes
• Dense breast tissue
• A reproductive history that leads to more exposure to the estrogen hormone, including
  • Menstruating at an early age
  • Being at an older age when you first gave birth or never having given birth
  • Starting menopause at a later age
• Taking hormone therapy for symptoms of menopause
• Radiation therapy to the breast or chest
• Obesity
• Drinking alcohol

The signs and symptoms of breast cancer include:

• A new lump or thickening in or near the breast or in the armpit.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast. It may look like the skin of an orange.
• A nipple turned inward into the breast.
• Nipple discharge other than breast milk. The discharge might happen suddenly, be bloody, or happen in only one breast.
• Scaly, red, or swollen skin in the nipple area or the breast
• Pain in any area of the breast.

Your health care provider may use many tools to diagnose breast cancer and figure out which type you have:

• A physical exam, including a clinical breast exam (CBE). This involves checking for any lumps or anything else that seems unusual with the breasts and armpits.
• A medical history.
• Imaging tests, such as a mammogram, an ultrasound, or an MRI.
• Breast biopsy.
• Blood chemistry tests, which measure different substances in the blood, including electrolytes, fats, proteins, glucose (sugar), and enzymes. Some of the specific blood chemistry tests include a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), and an electrolyte panel.

If these tests show that you have breast cancer, you will have tests that study the cancer cells. These tests help your provider decide which treatment would be best for you. The tests may include:

• Genetic tests for genetic changes such as in the BRCA and TP53 genes.
• HER2 test. HER2 is a protein involved with cell growth. It is on the outside of all breast cells. If your breast cancer cells have more HER2 than normal, they can grow more quickly and spread to other parts of the body.
• An estrogen and progesterone receptor test. This test measures the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly.

Another step is staging the cancer. Staging involves doing tests to find out whether the cancer has spread within the breast or to other parts of the body. The tests may include other diagnostic imaging tests and a sentinel lymph node biopsy. This biopsy is done to see whether the cancer has spread to the lymph nodes.

Treatments for breast cancer include:

• Surgery such as
  • A mastectomy, which removes the whole breast
  • A lumpectomy to remove the cancer and some normal tissue around it, but not the breast itself
• Radiation therapy
• Chemotherapy
• Hormone therapy, which blocks cancer cells from getting the hormones they need to grow
• Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells
• Immunotherapy

You may be able to help prevent breast cancer by making healthy lifestyle changes such as:

• Staying at a healthy weight
• Limiting alcohol use
• Getting enough exercisee
• Limiting your exposure to estrogen by
  • Breastfeeding your babies if you can
  • Limiting hormone therapy

If you are at high risk, your health care provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy (of their healthy breasts) to prevent breast cancer.

It's also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.

NIH: National Cancer Institute

Although breast cancer is much more common in women, men can get it too. It happens most often to men between the ages of 60 and 70.

Breast lumps usually aren't cancer. However, most men with breast cancer have lumps. Other breast symptoms can include:

• Dimpled or puckered skin
• A red, scaly nipple or skin
• Fluid discharge

Risk factors for male breast cancer include exposure to radiation, a family history of breast cancer, and having high estrogen levels, which can happen with diseases like cirrhosis or Klinefelter syndrome.

Treatment for male breast cancer is usually a mastectomy, which is surgery to remove the breast. Other treatments include radiation, chemotherapy and/or hormone therapy.

NIH: National Cancer Institute

A mammogram is an x-ray picture of the breast. Health care providers use mammograms to look for early signs of breast cancer. There are two types of mammograms: screening mammograms and diagnostic mammograms.

A screening mammogram is a mammogram usually done for women who have no signs or symptoms of breast cancer. Regular screening mammograms can help reduce the number of deaths from breast cancer among women ages 40 to 74. This is because they can find breast cancer early and treatment can start earlier, maybe before it has spread.

But screening mammograms can also have risks. They can sometimes find something that looks abnormal but isn't cancer. This leads to further testing and can cause you anxiety. Sometimes mammograms can miss cancer when it is there. It also exposes you to radiation. You should talk to your provider about the benefits and drawbacks of mammograms. Together, you can decide when to start and how often to have a mammogram.

Not much is known about breast cancer risk in transgender people. If you are transgender, talk to your provider about your risk and whether you need screening mammograms.

A diagnostic mammogram is done for people who have a lump or other signs or symptoms of breast cancer. The signs can include breast pain, thickening of the skin of the breast, nipple discharge, or a change in breast size or shape. But these signs can also be caused by a breast condition that is benign (not cancer). A mammogram, along with other tests, can help your provider figure out whether you have cancer.

When you have a mammogram, you stand in front of an x-ray machine. The person who takes the x-rays places your breast between two plastic plates. The plates press your breast and make it flat. This may be uncomfortable, but it helps get a clear picture.

You will get both breasts x-rayed from the front and from the side. Afterwards, a radiologist (a doctor with special training) will read the mammogram. The doctor will look at the x-ray for early signs of breast cancer or other problems. You will usually get the results within a few weeks, although it depends on the clinic or medical office that you went to. If your results are not normal, you should hear back earlier. Contact your provider or the office where you had the mammogram if you do not receive a report of your results within 30 days.

An abnormal (not normal) mammogram does not always mean that there is cancer. You will need to have additional mammograms, tests, or exams before your provider can tell for sure. You may also be referred to a breast specialist or a surgeon. But it does not necessarily mean you have cancer or need surgery. You would see one of these doctors because they are experts in diagnosing breast problems.

A mastectomy is surgery to remove a breast or part of a breast. It is usually done to treat breast cancer. Types of breast surgery include:

• Total (simple) mastectomy - removal of breast tissue and nipple
• Modified radical mastectomy - removal of the breast, most of the lymph nodes under the arm, and often the lining over the chest muscles
• Lumpectomy - surgery to remove the tumor and a small amount of normal tissue around it

Which surgery you have depends on the stage of cancer, size of the tumor, size of the breast, and whether the lymph nodes are involved. Many women have breast reconstruction to rebuild the breast after a mastectomy.

Sometimes mastectomy is done to prevent breast cancer. Only high-risk patients have this type of surgery.

NIH: National Cancer Institute

Tumors during pregnancy are rare, but they can happen. Tumors can be either benign or malignant. Benign tumors aren't cancer. Malignant ones are. The most common cancers in pregnancy are breast cancer, cervical cancer, lymphoma, and melanoma. Cancer itself rarely harms the baby, and some cancer treatments are safe during pregnancy. You and your health care provider will work together to find the best treatment. Your options will depend on how far along the pregnancy is, as well as the type, size, and stage of your cancer.

Another type of tumor that women can get is called a gestational trophoblastic disease (GTD). It happens when a fertilized egg doesn't become a fetus. GTD is not always easy to find. It is usually benign, but some types can be malignant. The most common type of GTD is a molar pregnancy. In its early stages, it may look like a normal pregnancy. You should see your health care provider if you have vaginal bleeding (not menstrual bleeding).

Treatment depends on the type of tumor, whether it has spread to other places, and your overall health.

Your bones are made of living tissue. To keep them strong, your body breaks down old bone and replaces it with new bone. But when more bone is broken down than replaced, you lose bone density, also called bone mass. Bone density is a measure of the amount of calcium and other minerals in bone. Bones containing more minerals are denser. They tend to be stronger and less likely to fracture (break).

Losing bone density can weaken your bones. In some cases, it can lead to osteoporosis. This is a disease which can make your bones more likely to break. Low bone density that is not low enough to be osteoporosis is sometimes called osteopenia.

Your bones become less dense as you age. Other factors can also make you more likely to lose bone mass, such as:

• A family history of osteoporosis or low bone mass
• Not developing good bone mass when you are young
• Having certain medical conditions, such as:
  • Endocrine diseases
  • Certain digestive diseases
  • Rheumatoid arthritis
  • Certain types of cancer
  • HIV
  • Anorexia nervosa, a type of eating disorder
• Taking certain medicines, such as:
  • Corticosteroids
  • Proton pump inhibitors (which treat GERD)
  • Medicines to treat epilepsy
• Smoking tobacco
• Long-term heavy alcohol use
• Physical inactivity or prolonged periods of bedrest

Not everyone who has low bone mass gets osteoporosis, but they are at higher risk for developing it.

A bone density scan is the best way to measure your bone health. It compares your bone density, or mass, to that of a healthy person who is the same age and sex as you are. It can show:

• Whether you have low bone density
• Whether you have osteoporosis, a disease that makes your bones weak
• Your risk for breaking bones
• Whether your osteoporosis treatment is working

To help keep your bones strong and help prevent osteoporosis, the best thing to do is to eat a healthy diet rich in calcium and vitamin D. Getting regular physical activity, limiting alcohol, and not smoking can also help. In some cases, your health care provider may prescribe medicines to prevent osteoporosis.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Cancer begins in your cells, which are the building blocks of your body. Normally, your body forms new cells as you need them, replacing old cells that die. Sometimes this process goes wrong. New cells grow even when you don't need them, and old cells don't die when they should. These extra cells can form a mass called a tumor. Tumors can be benign or malignant. Benign tumors aren't cancer while malignant ones are. Cells from malignant tumors can invade nearby tissues. They can also break away and spread to other parts of the body.

Cancer is not just one disease but many diseases. There are more than 100 different types of cancer. Most cancers are named for where they start. For example, lung cancer starts in the lung, and breast cancer starts in the breast. The spread of cancer from one part of the body to another is called metastasis. Symptoms and treatment depend on the cancer type and how advanced it is. Most treatment plans may include surgery, radiation and/or chemotherapy. Some may involve hormone therapy, immunotherapy or other types of biologic therapy, or stem cell transplantation.

NIH: National Cancer Institute

Cosmetics are products you apply to your body to clean it, make it more attractive, or change the way it looks. They include:

• Hair dyes
• Makeup
• Perfumes
• Skin-care creams

Cosmetics that treat or prevent diseases are also drugs. Products such as dandruff shampoo, fluoride toothpaste, and antiperspirant deodorant are both cosmetics and drugs. A good way to tell if you're buying a cosmetic that is also a drug is to see if the first ingredient listed is an "active ingredient." The active ingredient is the chemical that makes the product effective. The manufacturer must have proof that it's safe for its intended use.

Cosmetics can cause allergic reactions. The first sign is often red and irritated skin. Fragrances and preservatives are the most common causes of skin problems.

To find out all the ingredients in a cosmetic you use, check the container. Manufacturers are required to list them. Labels such as "natural" and "hypoallergenic" have no official meaning. Companies can use them to mean whatever they want.

Food and Drug Administration

Screenings are tests that look for diseases before you have symptoms. Screening tests can find diseases early, when they're easier to treat. You can get some screenings in your doctor's office. Others need special equipment, so you may need to go to a different office or clinic.

Some conditions that doctors commonly screen for include:

• Breast cancer and cervical cancer in women
• Colorectal cancer
• Diabetes
• High blood pressure
• High cholesterol
• Osteoporosis
• Overweight and obesity
• Prostate cancer in men

Which tests you need depends on your age, your sex, your family history, and whether you have risk factors for certain diseases. After a screening test, ask when you will get the results and whom to talk to about them.

Agency for Healthcare Research and Quality

Menopause is the time in a woman's life when her period stops. It is a normal part of aging. In the years before and during menopause, the levels of female hormones can go up and down. This can cause symptoms such as hot flashes, night sweats, pain during sex, and vaginal dryness. For some women, the symptoms are mild, and they go away on their own. Other women take hormone replacement therapy (HRT), also called menopausal hormone therapy, to relieve these symptoms. HRT may also protect against osteoporosis.

HRT is not for everyone. You should not use HRT if you:

• Think that you are pregnant
• Have problems with vaginal bleeding
• Have had certain kinds of cancers
• Have had a stroke or heart attack
• Have had blood clots
• Have liver disease

There are different types of HRT. Some have only one hormone, while others have two. Most are pills that you take every day, but there are also skin patches, vaginal creams, gels, and rings.

Taking HRT has some risks. For some women, hormone therapy may increase their chances of getting blood clots, heart attacks, strokes, breast cancer, and gallbladder disease. Certain types of HRT have a higher risk, and each woman's own risks can vary, depending upon her medical history and lifestyle. You and your health care provider need to discuss the risks and benefits for you. If you do decide to take HRT, it should be the lowest dose that helps and for the shortest time needed. You should check if you still need to take HRT every 3-6 months.

Food and Drug Administration