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Breast cancer

Cancer - breast; Carcinoma - ductal; Carcinoma - lobular; DCIS; LCIS; HER2-positive breast cancer; ER-positive breast cancer; Ductal carcinoma in situ; Lobular carcinoma in situ

Breast cancer is cancer that starts in the tissues of the breast. There are two main types of breast cancer:

In rare cases, other kinds of breast cancer can start in other areas of the breast.

Images

Female Breast
Needle biopsy of the breast
Open biopsy of the breast
Breast self-exam
Breast self-exam
Breast self-exam
Lumpectomy
Sentinel node biopsy

Presentation

Breast lump removal - series - Normal anatomy
Mastectomy - series - Normal anatomy

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Causes

Breast cancer risk factors are things that increase the chance that you could develop breast cancer:

Some women are at higher risk for breast cancer because of certain genetic changes or variants that may be passed down from their parents.

Breast implants, using antiperspirants, and wearing underwire bras do not increase the risk for breast cancer. There is also no evidence of a direct link between breast cancer and pesticides.

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:

In men, breast cancer symptoms include breast lump and breast pain and tenderness.

Symptoms of advanced breast cancer may include:

Exams and Tests

The provider will ask about your symptoms and risk factors. Then they will perform a physical exam. The exam includes both breasts, armpits, and the neck and chest area.

Women are encouraged to perform breast self-exams each month. However, the effectiveness of self-exams for detecting breast cancer is debatable.

Tests used to diagnose and monitor people with a breast lump or breast cancer may include:

If your provider 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.

Treatment

Treatment is based on many factors, including:

Cancer treatments may include:

Cancer treatment can be local or systemic:

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 (recurring). 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.

After treatment, some women continue to take medicines for some time, often several years. All women continue to have mammograms 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.

Support Groups

You can ease the stress of illness by joining a cancer support group. Sharing with others who have common experiences and problems can help you not feel alone.

Outlook (Prognosis)

New, improved treatments are helping people with breast cancer live longer. Even with treatment, breast cancer can spread to other parts of the body. Sometimes, breast cancer returns, even after the entire tumor has been removed and nearby lymph nodes are found to be cancer-free.

Some women who have had breast cancer develop a new breast cancer that is not related to the original tumor.

How well you do after being treated for breast cancer depends on many things. The more advanced your cancer, the poorer the outcome. Other factors that determine the risk for recurrence and the likelihood of successful treatment include:

After considering all of the above, your provider can discuss your risk of having a recurrence of breast cancer.

Possible Complications

You may experience side effects or complications from cancer treatment. These may include temporary pain or swelling of the breast and surrounding area. Ask your provider about the possible side effects from treatment.

When to Contact a Medical Professional

Contact your provider if:

After being treated for breast cancer, call your provider if you develop symptoms such as:

Prevention

Talk to your provider about how often you should have a mammogram or other tests to screen for breast cancer. Early breast cancers found by a mammogram have a good chance of being cured.

Tamoxifen is approved for breast cancer prevention in women age 35 and older who are at high risk. Discuss this with your provider.

Women at very high risk for breast cancer may consider preventive (prophylactic) mastectomy. This is surgery to remove the breasts before breast cancer is diagnosed. Possible candidates include:

Many risk factors, such as your genes and family history, cannot be controlled. But making healthy lifestyle changes may reduce your overall chance of getting cancer. This includes:

Related Information

Chemotherapy - what to ask your doctor
Radiation therapy - questions to ask your doctor
Mastectomy - discharge
Mastectomy and breast reconstruction - what to ask your doctor
Lymphedema - self-care
Breast external beam radiation - discharge

References

Harnden K, Mauro L, Pennisi A. Breast cancer. In: Ginsburg GS, Willard HF, Strickler JH, McKinney MS, eds. Genomic and Precision Medicine: Oncology. 3rd ed. Philadelphia, PA: Elsevier; 2022:chap 9.

Makhoul I. Therapeutic strategies for breast cancer. In: Bland KI, Copeland EM, Klimberg VS, Gradishar WJ, eds. The Breast: Comprehensive Management of Benign and Malignant Diseases. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 24.

National Cancer Institute website. Breast cancer treatment (adult) (PDQ) - health professional version. www.cancer.gov/types/breast/hp/breast-treatment-pdq. Updated March 10, 2023. Accessed March 13, 2023.

National Comprehensive Cancer Network website. NCCN clinical practice guidelines in oncology (NCCN guidelines): Breast cancer. Version 3.2022. www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Updated March 23, 2023. Accessed June 5, 2023.

Siu AL; US Preventive Services Task Force. Screening for breast cancer: US Preventive Services Task Force recommendation statement. Ann Intern Med. 2016;164(4):279-296. PMID: 26757170 pubmed.ncbi.nlm.nih.gov/26757170/.

US Preventive Services Task Force, Owens DK, Davidson KW, et al. Risk assessment, genetic counseling, and genetic testing for BRCA-related cancer: US Preventive Services Task Force Recommendation Statement [published correction appears in JAMA. 2019;322(18):1830]. JAMA. 2019;322(7):652-665. PMID: 31429903 pubmed.ncbi.nlm.nih.gov/31429903/.

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Review Date: 2/2/2023  

Reviewed By: Mark Levin, MD, Hematologist and Oncologist, Monsey, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team. Editorial update 06/05/2023.

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