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OVERVIEW

What is breast cancer?

Breast cancer begins in breast tissue.  It usually shows up as a tumor. There are three types of breast tumors.

• Benign (not cancerous). Most of the tumors that develop in breast tissue are benign.
• “In situ.” These tumors are cancerous. The cancer is confined to the breast duct or lobule. This type of breast cancer can almost always be cured with treatment.
• This is the most serious type of breast cancer. It is when the cancerous tumors have spread to other parts of the body.

Breast cancer is the most common cancer among Canadian women (excluding non-melanoma skin cancers).). The good news is that the rate of death from breast cancer has declined over the last few years. This is probably because more tumors have been found early, when treatment can help the most. Regular screening mammograms and breast exams (both self-exams and exams by a healthcare provider) can help find breast cancers early.

Symptoms of breast cancer

Symptoms of breast cancer can include:

• A lump in the breast.
• Change in size or shape of the breast.
• Dimpling or puckering of the skin of the breast.
• Nipple turned inward toward the breast.
• Scaly, red, or swollen skin on the breast, nipple, or areola (dark area of skin around the nipple).
• Discharge from the nipple

CAUSES & RISK FACTORS

What causes breast cancer?

It is not known exactly what causes breast cancer. There are certain risk factors that seem to increase your chance of getting the disease. It’s estimated that about 10% of breast cancer cases are hereditary (run in the family). In many of these cases, you inherited a gene from your parents that has mutated (changed from its normal form). This mutated gene makes it more likely for a person to get breast cancer.

Everyone has two genes called BRCA1 and BRCA2. Normally, these genes help to prevent cancer tumors from growing. But sometimes a person inherits an abnormal (mutated) form of BRCA1 or BRCA2 from their family. This person’s chance of getting breast cancer increases. Mutations in these genes have also been linked to ovarian cancer.

Besides BRCA1 and BRCA2, there are other mutated genes that may make it more likely for a person to get breast cancer. Scientists know about some of these genes, and they are working to identify others.

Breast cancer in 2 or more first-degree relatives is a sign that the mutated form of BRCA1 or BRCA2 might run in your family. First-degree relatives include your parents, siblings and children. Another sign of a risk of inherited breast cancer is a first-degree relative who got breast cancer before the age of 50.

Does everyone who has family members with breast cancer have these mutated genes?

The chances of inheriting breast cancer aren’t high, even if someone in your family has had the disease. Many people have had breast cancer without carrying a mutated form of BRCA1 or BRCA2.  Although anyone with first‑degree relatives who have had breast cancer is at increased risk, most people don’t get the inherited kind of breast cancer.

Discuss with your healthcare provider about your family history. For example, your healthcare provider will want to know how you are related to any family members who have had breast cancer. Your healthcare provider will also want to know how old your relatives were when their breast cancer was diagnosed.

Should I have a test to find out if I carry the breast cancer gene?

The choice is up to you and your healthcare provider. Your healthcare provider can help you decide if a gene test might be useful to you. They can also discuss the pros and cons of taking the test. Talking with a genetic counselor might also be helpful.

Think about how you would feel if the test results show that you carry an abnormal BRCA1 or BRCA2 gene and are at greater risk of getting breast cancer. Some people want to know if they have one of the mutated genes. Knowing, instead of wondering, helps them deal with the risk of breast cancer. It allows them and their healthcare providers to watch more closely for early signs of cancer. But other people would rather not know they have the abnormal gene because it would be too hard to cope with. Discuss with your healthcare provider your feelings. It’s important to note that even if you have a mutated BRCA1 or BRCA2 gene, your chances of developing breast cancer are still very low.

DIAGNOSIS & TESTS

How is breast cancer diagnosed?

If you notice a lump or other change in your breast, contact your healthcare provider right away. They may do a physical exam. They will ask you about your health history and your family’s history of breast cancer. They will carefully feel your breasts and under your arms for lumps.

If they find something abnormal, your healthcare provider may order a mammogram. A mammogram is a special X-ray of your breasts. Your breast will be pressed between two plates. This spreads out your breast so that a better X-ray picture can be taken. The X-ray takes 1 or 2 minutes. The entire process usually takes about 20 minutes.

If the mammogram shows something, your healthcare provider may order more tests.  These include:

• Ultrasound – high-energy sound waves bounce off organs and tissues to create a picture.
• MRI – uses a magnet, radio waves, and a computer to make detailed pictures.
• Bloodwork – blood samples are checked for signs of disease.
• Biopsy – cells or tissues are removed from the breast and looked at under a microscope. This helps find cancer cells. There are different kinds of biopsy that look for breast cancer:
• Excisional – an entire lump of tissue is removed.
• Incisional – part of a lump or a sample of tissue is removed.
• Core – a wide needle removes tissue.
• Fine-needle aspiration (FNA) – a thin needle removes tissue or fluid.

If cancer cells are found in a biopsy, your healthcare provider will do more testing. This will help them find out how quickly the cancer may grow, how likely it will spread, and how certain treatments might work.

Can breast cancer be prevented or avoided?

There are things you can do to reduce your risk of getting breast cancer. Lifestyle changes have been shown to decrease risk, even in high-risk women. These changes include:

• Don’t smoke.
• Limit alcohol.
• Eat a healthy diet.
• Keep a healthy weight.
• Exercise regularly.
• Breastfeed your babies if you can.
• Limit hormone therapy.
• Minimize exposure to radiation in screening tests if not medically necessary.

You can’t always avoid breast cancer, but you can find it early. This increases your chances of a full, speedy recovery.

A mammogram is the most effective way to find breast cancer early, up to 2 years before the lump is even large enough to feel.

Mammograms can be uncomfortable. But they don’t take very long. You may find that planning to have your mammogram shortly after your period makes it less uncomfortable. Your breasts may be less tender at this time.

How often should I get a mammogram?

In Nova Scotia, women between ages 40-49 are recommended to have annual screening mammography. Women in Nova Scotia, aged 50-74, are recommended to have screening mammography at two year intervals. Women 50-74 can also be recommended to return on an annual basis if they:

• have a strong family history of breast cancer (mother, sister, daughter, father, brother, son),
• are currently on HRT or
• the radiologist has recommended returning sooner.

Women over the age of 75 are recommended to continue to have screening mammography if they are in good health.

In Prince Edward Island, women between ages 40-49 are recommended to have annual screening mammography. Women in PEI aged 50-74, are recommended to have screening mammography at two year intervals

In Prince Edward Island, a screening mammogram is available for women aged 40-74 who:

• have never had breast cancer;
• do not have symptoms such as a breast lump, puckered skin, rash or nipple discharge;
• have not had a mammogram in the last 12 months;
• do not have breast implants; or

In PEI, screening is recommended yearly for women 40-74 who have an immediate family member (mother, daughter, sister, father, son, brother) with breast cancer.  Screening is also recommended yearly for women who have had radiation therapy to the chest (prior to age 30) to treat another cancer or condition (e.g., Hodgkin lymphoma) or are known to have a gene mutation (e.g., BRCA1, BRCA2).

If you have risk factors for breast cancer, such as a family history of breast cancer, your healthcare provider may want you to have mammograms more often or start having them sooner.

Breast cancer treatment

There are many treatment options for breast cancer. Your healthcare provider may recommend more than one type of treatment. What is best for one person may not be the best treatment for you. Your healthcare provider will make the decision based on several things, including:

• Your general health.
• The stage of the cancer.
• Whether the tumor has hormone receptors.
• The size of the tumor.
• If you have gone through menopause.

Available treatments include:

• Lumpectomy –The tumor and a small amount of tissue around it is removed during surgery. Surgery is the most common treatment for breast cancer.
• Mastectomy – If the cancer is widespread in the breast, all of the breast tissue is removed. This is called a mastectomy. If the cancer has spread to the underarm lymph nodes, the whole breast and most or all of the lymph nodes are removed. This is called a modified radical mastectomy.
• Radiation therapy –High-energy rays are used to kill cancer cells. It may be used after surgery to destroy any cancer cells that are still there.
• Hormone therapy –Lab tests could show that your breast cancer cells have hormone receptors. If they do, hormone therapy can prevent the cancer cells from using the natural hormones they need to grow.
• Chemotherapy –Powerful drugs are used to kill cancer cells. They are given through an IV (directly into the vein) or in pill form. Chemotherapy can cause unpleasant side effects. These include weakness, tiredness, and hair loss.
• Targeted therapy – Lab tests could show that your breast cancer cells have too much of a protein called HER2. If they do, you can receive targeted therapies. These block the action of the extra HER2 protein and stop growth. They can be given in an IV or as a pill.

Living with breast cancer

Many cases of breast cancer can be cured with treatment. How well you do after treatment depends on many things. This includes how early the cancer was diagnosed. Left untreated, breast cancer can spread to other parts of the body, including internal organs. This could cause serious health problems or be fatal. It is very important to get treatment as soon as possible.

Living with cancer during treatment can be stressful. Treatments can have different side effects on your body. Take good care of yourself. Eat a healthy diet, get plenty of sleep, and try to keep your energy up by staying mildly active.

Many women choose to do nothing and to be proud of their bodies after a mastectomy. Some women may choose to have a breast reconstruction. This is surgery that rebuilds the shape of the breast. If you don’t want more surgery, you have other options. Some women wear a breast form, a device that replaces the breast. They also may wear padding inside their bras.

Even after your cancer is gone, you are at higher risk of cancer returning to your body. You will need to get regular follow-up care and check-ups for years after your treatment.

FOR MORE INFORMATION

Canadian Cancer Society
Toll Free 1-888-939-3333
http://www.cancer.ca