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How Do I Know If I Have Breast Cancer?

Breast cancer responds to treatment best when it is detected early. For this reason, you should be sure to have an annual medical checkup, perform monthly breast self-examinations, and get mammograms as recommended by your doctor.

Breast Self-Exam

Starting around age 20, examine your breasts every month so that you are familiar with their structure and can detect any new masses or lumps. Premenstrual changes can cause temporary thickening that disappears after the period, so it is best to check your breasts three to five days after your period ends. If you are no longer menstruating, examine your breasts on the same day of each month. Pick a date that's easy to remember. If a breast self-exam makes you anxious or you have questions about how to perform it, consult your health care provider.

Look for dimpling or changes in shape or symmetry. This may be best done by looking in a mirror. The rest of the breast self-exam is easiest in the shower, using soap to smooth your skin. Using light pressure, you should check for lumps near the surface. Use firm pressure to explore deeper tissues. Squeeze each nipple gently; if there is any discharge — especially if it is bloody — see your doctor.
Any time you find a new or unusual lump in your breast, have your doctor check it to make sure it is not cancerous or precancerous. Most lumps are benign and do not signal cancer. The best test for distinguishing a cyst from a solid tumor is ultrasound; a needle biopsy may also be done. Have your breasts examined by a healthcare provider once every three years starting at age 20, and every year after age 40.

A baseline mammogram — an X-ray of the breast — is recommended for women at age 35 by the American Cancer Society. Most women should also get a mammogram every year beginning at age 40. You should consult your doctor for the best schedule. Breast lumps can be identified on a mammogram up to two years before they can be felt.

Several tests that can help distinguish a benign lump from a malignant tumor. Because malignant and benign lumps tend to have different physical features, imaging tests such as mammography and ultrasonography can often rule out cancer. The only way to confirm cancer is to perform a needle aspiration or a biopsy and to test the tissue sample for cancer cells.

In the event of malignancy, you and your doctor need to know how advanced the cancer is. Various tests are used to check for the presence and likely sites of spread, or metastasis. Cancer cells can be analyzed for the presence or absence of hormone receptors, to find out if the cancer is likely to respond well to hormone therapy, such as tamoxifen. Other tests can help predict the likelihood of metastasis and the potential for recurrence after treatment.

What Are the Treatments?

If you have breast cancer, do what you can as soon as you can to treat it. But before making treatment decisions, research your options. Ask questions of your doctor, other specialists, and people who have had the disease. Find a doctor you trust, and don't rush your decision. A brief delay between diagnosis and treatment will not compromise the effectiveness of treatment.

Surgery

The options for treating breast cancer depend on how advanced the cancer is, how old the woman is, and how healthy she is otherwise. If possible, breast cancer is treated surgically, followed usually by some combination of radiation therapy, chemotherapy, or hormone therapy.

The standard surgery for breast cancer was once modified radical mastectomy — removal of the entire breast and lymph nodes in the breast and under the arm. For many women whose breast cancer is detected early and is still localized, lumpectomy — removal of the cancerous lump and the lymph nodes under the arm — is now the preferred treatment. Followed by appropriate radiation therapy, chemotherapy, and hormone therapy, lumpectomy has proven as effective as mastectomy for early breast cancer and is much less disfiguring.

For breast cancer that has metastasized and for breast cancer that has come back, radiation therapy and chemotherapy are the main treatments. Hormone therapy may also be beneficial for cancers that are hormone-responsive; of the estrogen-suppressing drugs in use, tamoxifen is most widely used. Meanwhile, researchers are exploring treatment of breast cancer with various forms of immunotherapy; by manipulating the body's immune system, they hope to improve its natural resistance to cancer.

Chemotherapy

When breast cancer is limited to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This is done to help reduce the chance of breast cancer coming back.

If the breast tumor is large, chemotherapy is sometimes given before surgery in order to shrink the tumor so it can be removed more easily or so that a lumpectomy can be performed instead of a mastectomy.

Chemotherapy may also be given as the main treatment for women whose cancer has spread to other parts of the body outside of the breast and lymph nodes.

Radiation therapy

Radiation therapy is usually given after a lumpectomy and sometimes after a mastectomy to reduce your risk of cancer coming back in the same breast. The treatments generally start several weeks after the surgery so the area has some time to heal. If your doctor recommends chemotherapy along with radiation therapy, this might be given before you start radiation therapy.

Once radiation treatments start, you can expect to receive small daily doses of radiation over a period of several days to several weeks.

Reconstructive Breast Surgery

Reconstructive plastic surgery for breast cancer is performed to replace skin, breast tissue, and the nipple removed during mastectomy. The amount of missing tissue varies with each mastectomy. Factors contributing to the amount of tissue removed include the width, size, and location of the original tumor, and its proximity to the armpit (called theaxilla), where the lymph glands are removed.

The ultimate goal for reconstruction is to restore symmetry between the two breasts. Reconstructive breast surgery can usually be done at the time of the original surgery for the cancer or later down the road.

Hormone Therapy

If lab tests show that your tumor depended on your natural hormones to grow, it will be called estrogen-receptor-positive or progesterone-receptor-positive. Such tumors are often sensitive to anti-estrogen treatments , called hormonal therapy.

Hormone therapy is used to prevent the growth, spread or recurrence of breast cancer by blocking your body's natural hormones from reaching any remaining cancer cells.

Hormone therapy includes medicines that block the effects of estrogen, or having a procedure that either removes the ovaries or makes them unable to produce hormones.

The estrogen-blocking drug tamoxifen (Nolvadex) is one of the most common hormonal therapy drugs. It has been shown to decrease the chance of recurrence in some early-stage cancers and to prevent the development of cancer in the opposite breast. Tamoxifen works by blocking estrogen from attaching to estrogen receptors on cancer cells. By blocking the estrogen receptors, it is believed that the growth of the cancer cells will be halted.

Tamoxifen is effective in pre- and post-menopausal women.

Newer types of hormone therapy are called aromatase inhibitors — examples are anastrozole and letrozole. They block the production of estrogen in the body, thus lowering the levels of the hormone in the blood. Armatase inhibitors only work in postmenopausal women.

While on hormone therapy, you should continue to have your yearly pelvic exams, and notify your doctor of any unusual bleeding or pain. The typical length of time you will take tamoxifen or other anti-estrogen drugs is about five years.

Sometimes a treatment called ovarian ablation involves is used to treat breast cancer. Ovarian ablation means making the ovaries of premenopausal woman nonfunctional, either by removing them with surgery or by radiation therapy to the ovaries.

At-Home Recovery

After breast surgery, a regular routine of simple exercises will help to restore your mobility and reduce muscle stiffness. To minimize potential discomfort from radiation, avoid wearing a tight-fitting bra or clothes that may irritate the area. Keep you skin clean and well aired, and use only those skin lotions, creams, and deodorants recommended by your doctor.

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