Dr Rosita Rivai: 2016

Breast Cancer Today

Breast cancer isn’t what it was 20 years ago. Survival rates are climbing, thanks to greater awareness, more early detection, and advances in treatment. For roughly 200,000 Americans who are diagnosed with breast cancer each year, there are plenty of reasons to be hopeful.

Breast Cancer Symptoms

Breast cancer often has no symptoms, but you may notice something you want the doctor to check. Keep an eye out for:

A painless lump in the breast
Changes in breast size or shape
Swelling in the armpit
Nipple changes or discharge

Breast pain can also be a symptom of cancer, but this isn’t common.

Signs of Inflammatory Breast Cancer

This rare, fast-growing type rarely causes a distinct lump. Instead, breast skin can become thick, red, and look pitted, like an orange peel. The area might also feel warm or tender and have small bumps that look like a rash.

Mammograms

The earlier you find the disease, the easier it is to treat. Mammograms, an X-ray of the breast, can show tumors before they get large enough to feel. The American Cancer Society says women with an average risk level should get a yearly mammogram beginning at age 45. Continue them as long as you’re in good health. The U.S. Preventive Services Task Force says until you’re 50 you should talk to your doctor about your need for testing. After that, get a mammogram every 2 years from age 50 to 74. You don’t have to stop at 75; the group just doesn’t assess the pros and cons. You can work it out with your doctor.

Ultrasound and MRI

Your doctor may order an extra test that takes pictures of the inside of your body. A breast ultrasound can help find cysts, fluid-filled sacs that aren’t cancer. You might get an MRI along with a mammogram as part of your routine testing if you have a higher risk of breast cancer.

Self-Exams

For years, doctors told women to check their own breasts once a month. But studies suggest these exams play a very small role in finding cancer compared to other testing methods. The current thinking is that it’s more important to know your breasts and be aware of any changes, rather than checking them on a regular schedule. If you want to do a self-exam, go over the technique with your doctor.

What If You Find a Lump?

First, don’t panic. Eighty percent of breast lumps aren’t cancerous. They often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it’s found, the better. And if it isn’t, testing can give you peace of mind.

Breast Biopsy

The only sure way to know a lump is cancer is to do a biopsy. This means removing a sample of the lump so it can be examined in the lab. Your doctor may be able to do this with a small needle. But you might need surgery to take part of or the entire lump for testing. The results will show whether it’s cancer, and if so, what type. There are several forms of breast cancer, and treatments are carefully matched to each type.

Hormone-Sensitive Breast Cancer

Some types of breast cancer are fueled by the hormones estrogen or progesterone. Your doctor will call these receptors -- they’re proteins that pick up signals from the hormone that tell cells to grow. A biopsy can show if a tumor has receptors for estrogen (it’s ER-positive) and progesterone (it’s PR-positive). About 2 out of 3 breast cancers are hormone sensitive. There are several medications that keep the hormones from causing further cancer growth.

The image shows a molecular model of an estrogen receptor.

HER2-Positive Breast Cancer

In about 20% of patients, breast cancer cells have too much of a protein called HER2/neu. This type is known as HER2-positive, and it tends to spread faster than other forms It’s important to know whether a tumor is HER2-positive, because there are special treatments for this type of cancer.

A HER2-positive cell is illustrated here. Growth signals that are not normal are shown in green.

Breast Cancer Stages

If breast cancer is the diagnosis, the next step is to figure out how big the tumor is and how much of your body it affects. This process is called staging. Doctors use stages 0-IV to describe whether cancer is only in the breast, or if it has moved into nearby lymph nodes or spread to other organs, like the lungs. Knowing the stage and type of breast cancer will help your health care team create a treatment plan.

Survival Rates

The odds of beating breast cancer are strongly tied to how early you find it. The American Cancer Society says 100% of women with stage I breast cancer live at least 5 years, and many women in this group remain cancer-free for good. The more advanced the cancer, the lower this figure becomes. By Stage IV, the 5-year survival rate drops to 22%. But these rates will rise as more effective treatments are found.

Breast Cancer Surgery

There are many types of breast cancer surgery, from taking out the area around the lump (lumpectomy or breast-conserving surgery) to removing the entire breast (mastectomy.) Talk about the pros and cons of each with your doctor to decide what’s right for you.

Radiation Therapy

This treatment kills cancer cells with high-energy rays. It may be used after breast cancer surgery to wipe out any cancer cells that remain near the tumor site. It might be paired with chemotherapy to treat cancer that has spread to other body parts. Side effects include fatigue and swelling or a sunburn-like feeling where you were treated.

Chemotherapy

This treatment uses drugs to kill cancer cells anywhere in the body. They’re often given by IV, but they can be taken by mouth or a shot. You might have it before surgery to shrink a large tumor or after to lower the odds of your cancer coming back. In women with advanced breast cancer, chemo can help control the cancer’s growth. Side effects may include hair loss, nausea, fatigue, and a higher risk of infection.

Hormone Therapy

This is for women with ER-positive or PR-positive breast cancer. These cancers grow faster in response to the hormones estrogen or progesterone. Hormone therapy can block this effect. It might be used after surgery to help keep the cancer from coming back. Doctors sometimes give it to women with high risk factors to reduce the chances of getting breast cancer.

Targeted Treatments

These newer drugs pinpoint specific things inside cancer cells. For example, women with HER2-positive breast cancer have too much of a protein called HER2. Targeted therapies can stop this protein from making cancer cells grow. These drugs are often used along with chemo because they tend to have milder side effects.

Life After Diagnosis

There’s no doubt that cancer is a life-changing experience. The treatments can wear you out. You may have trouble managing daily chores, work, or social outings. This can make you feel isolated. It’s crucial to reach out to friends and family for support. They may be able to go with you to treatments, help out with chores, or just remind you that you aren't alone. Many people choose to join a support group, either near them or online.

Breast Reconstruction

Many women who have a breast removed choose to get reconstructive surgery. This replaces the skin, nipple, and breast tissue that are lost during a mastectomy. It can be done with a breast implant or with tissue from somewhere else in your body, like your tummy. Some women start the process right after their mastectomy. But you can also get it months or years later.

Breast Forms

Instead of reconstruction, you can be fitted for a breast form. This is a breast-shaped prosthesis that fits inside your bra. Wearing one allows you to have a balanced look when you’re dressed. Like the surgery, breast forms are often covered by insurance.

Breast Cancer: Why Me?

The most obvious risk factor for breast cancer is being a woman. Men get the disease, too, but it’s about 100 times more common in women. Other things that make it more likely include being over age 55 or having a close relative who had the disease. Still, up to 80% of women with breast cancer have no family history of the illness.

Breast Cancer Genes

Some women have a high risk of breast cancer because they got changes, or mutations, in certain genes at birth. The genes most often involved in breast cancer are known as BRCA1 and BRCA2. Women with mutations in these genes have a higher chance of getting breast cancer at some point in life than those who don’t. Other genes may be linked to breast cancer risk as well.

Reducing Your Risks for Breast Cancer

Women who breast feed their children for the normal length of time (6 months exclusively and up to 2 years or beyond partially) can reduce their risk of breast cancer by 25%. You can also reduce your risk by maintaining a low BMI and by getting exercise. You should also cut back on the amount of alcohol you drink. Birth control pills and some forms of hormone therapy after menopause can boost the odds. But the risk seems to go back to normal after you stop these medications. Good lifestyle choices can help survivors, too. Research says physical activity can lower the chances your cancer will return. And it's a proven mood-booster, too.

Breast Cancer Research

Doctors continue to search for treatments that work better and are easier to undergo. Funding for this research comes from many sources, including advocacy groups throughout the country. Many of the 2.5 million breast cancer survivors and their families choose to participate in walk-a-thons and other fundraising events. This links each individual fight against cancer into a common effort for progress.

Reviewed by Jennifer Robinson, MD on November 10, 2015

Sources:

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REFERENCES:

American Cancer Society: “After the Tests: Staging.”

American Cancer Society: “American Cancer Society Guidelines for the Early Detection of Cancer.”

American Cancer Society: “Breast awareness and self-exam.”

American Cancer Society: "Breast Cancer Facts & Figures 2013-2014."

American Cancer Society: “Breast cancer risk factors you cannot change.”

American Cancer Society: “Breast cancer survival rates by stage.”

American Cancer Society: “Breast Cancer Symptoms: What You Need to Know.

American Cancer Society: “Breast Reconstruction After Mastectomy.”

American Cancer Society: “How Is Breast Cancer Treated?”

American Cancer Society: “How Is Breast Cancer Found?”

American Cancer Society: “How Many Women Get Breast Cancer?”

American Cancer Society: "Lifestyle Changes to Consider During and After Treatment."

American Cancer Society: “Moving On After Treatment.”

American Cancer Society: “What Causes Breast Cancer?”

American Cancer Society: “What’s New in Breast Cancer Research.”

BreastCancer.org: “Symptoms of Breast Cancer.”

Breastcancer.org: “Understanding Hormone Receptors and What They Do.”

Inflammatory Breast Cancer Research Foundation: “Symptoms.”

Dr. Susan Love Research Foundation: “Breast Cancer Detection.”

Mayo Clinic: “Breast lump: Early evaluation is essential.”

U.S. Preventive Services Task Force: “Breast Cancer Screening.”

This tool does not provide medical advice. See additional information:

Slideshow Link: http://www.webmd.com/breast-cancer/ss/slideshow-breast-cancer-overview?ecd=wnl_day_032916&ctr=wnl-day-032916_nsl-ld-stry&mb=U%2ff3CUlLUpcddpusWolIKOHnVev1imbCGCdD%40ep%401jQ%3d

What Is It?

Polycystic ovary syndrome is a hormonal disorder that affects millions of women. Sometimes it's called Stein-Leventhal syndrome.

All bodies need both "male" and "female" hormones to work right, but a woman with PCOS has too much of the male kind. This creates problems with your ovaries: You might have irregular periods or no periods, and you could get cysts in a "string of pearls" pattern. PCOS is also a common cause of infertility.

The condition can't be cured, but it can be treated.

Other Symptoms

You'll tend to gain weight, especially around the waist, and have a hard time losing it. You'll often grow extra hair or have thinning hair. You may get acne or dark patches of skin. Pelvic pain and depression are also possible symptoms.

Causes

Doctors don't know exactly why you get it, but some researchers think high levels of insulin are at the root of the illness. If you're overweight, your chances of developing it are greater.

Your genes play a role, too. If your mother or sister has PCOS, you're more likely to have it. Most women are diagnosed in their 20s or 30s. But even girls as young as 11, who haven't gotten their period yet, can have it.

Diagnosis

PCOS symptoms affect as many as 5 million women. To be diagnosed, you'll have at least two of these: infrequent and irregular periods, a high level of specific hormones, and more than 12 cysts. Find a doctor who specializes in it. They'll ask you about your family, check your body and your ovaries, and take a blood sample. They'll probably rule out other issues, such as a thyroid problem, first.

Treatment

You can take medicine to help relieve symptoms. Your doctor may give you birth control pills to regulate your period or another hormone occasionally to start your period. Metformin, a diabetes medicine, may lower your "male" hormone levels. So does the drug spironolactone (Aldactone). You can also try medicated creams and laser treatments to get rid of extra hair.

Natural Treatments

Weight loss is one of the best things you can do: It makes your periods more normal, and it can also lessen hair growth and depression. Eating well is a big part of that. Also pay attention to how foods affect your blood sugar and insulin, like you would for diabetes. Exercise, the kind that gets your heart pumping, as well as lifting weights to keep your muscles strong, will help control your weight, your stress, and your feelings. If you smoke, quit.

Infertility Treatment

In a very small study of women with this condition, most of them who dropped more than 5% of their weight either got pregnant or had more regular periods. The most common drug used for infertility caused by PCOS, clomiphene, triggers the release of mature eggs. Your doctor may suggest other drugs, too, or in vitro fertilization.

Pregnancy

Your doctor will want to watch you for signs of gestational diabetes, high blood pressure, and early labor and delivery. New research suggests that the diabetes drug metformin will help prevent pregnancy-related issues.

Babies who are born to moms with PCOS may spend more time in intensive care.

Related Health Risks

When you have PCOS, you need to see your doctor regularly for checkups. You're more likely to have trouble from:

High cholesterol, which may lead to heart disease, including high blood pressure and heart attack
Insulin resistance, metabolic syndrome, and type 2 diabetes
Obesity
Sleep apnea
Mood disorders, like depression and bipolar disorder
Endometrial cancer, especially when you're older

Reviewed by Traci C. Johnson, MD, FACOG on October 27, 2015

Sources:

IMAGES PROVIDED BY:

3) Jose Luis Pelaez, Inc/Getty

4) Angello Deco/Thinkstock

5) Fuse/Thinkstock

7) Sneksy/Thinkstock

8) Kiyoshi Takahase Segundo/Thinkstock

9) Pojoslaw/Thinkstock

10) Digital Skillet/Getty

SOURCES:

PCOS Foundation: "What Is PCOS?" "Types of Medical Treatment," "How Do I Know If I Have PCOS?" "Types of Doctors that Treat PCOS."

Eunice Kennedy Shriver National Institute of Child Health and Human Development: "What is PCOS?" "How do health care providers diagnose PCOS?" "Treatments to Relieve Symptoms of PCOS," "Treatments for Infertility Resulting from PCOS."

Office on Women's Health: "Polycystic ovary syndrome (PCOS) fact sheet."

University of Chicago Medicine: "Polycystic Ovary Syndrome: Treatment Options," "PCOS Health Risks."

UpToDate: "Patient information: Polycystic ovary syndrome (PCOS) (Beyond the Basics)."

This tool does not provide medical advice. See additional information: