Breast Cancer; Key Q&A.

Why is it important to find a lump or other breast abnormality early?

If detected early, breast cancer can often be treated effectively with surgery that preserves the breast, followed by radiation therapy. This local therapy is often accompanied by systemic chemotherapy and/or hormonal therapy. Five-year survival after treatment for --stage 0 and stage 1 breast cancers is close to 100 percent.

I'm only 25--do I need to worry about breast cancer?

Although it is rare, breast cancer can occur in women under 30. Make an effort to find out if breast cancer has occurred in any of your relatives. If so, speak to your health care professional about a plan of action. A typical plan includes periodic breast self-examinations, an examination by a health care professional at least every three years, and regular mammograms and MRIs beginning at age 30. Breast cancer incidence increases with age, rising sharply after age 40. About 80 percent of invasive breast cancer occurs in women over age 50.

A friend told me her routine mammogram was "abnormal." What does this mean, and what should a woman do if she receives this type of report?

Along with the increased use of mammography comes a greater chance that a woman will have a result that needs more study. Any mammogram with an abnormal report is cause for additional testing to determine the nature of the abnormality. It may not necessarily be cancer, but only more testing will tell you this for sure. Additional testing can involve more mammograms and possibly a biopsy of the abnormality.

My doctor said my mammogram was suspicious--what does that mean?

Mammograms that are labeled "suspicious" or "abnormal" means there are signs that are strongly suggestive of a cancer, such as an irregular mass, contraction of the tissue around it, groups of small calcifications, underarm lymph node involvement or thickening of the skin.

What could it be if it is not breast cancer?

A frequent type of abnormality appears as calcifications, which are seen as white specks grouped in clusters or in strings on the films from your mammogram. Calcifications themselves are not cancer but may be present in the midst of a cancer. Clustered small calcifications alone are associated with about a 25 percent risk of cancer. The way these calcifications are positioned within the breast and their number and shape can provide a radiologist with a suggestion of whether these should be left alone or further examined for invasive or preinvasive disease. If your mammogram reveals a mass, one that is star-shaped or irregularly bordered is more suspicious than a round or smooth-edged mass, which is more likely to be a fluid-filled cyst.

My doctor ordered a second mammogram, and it's still not clear. What next?

After re-imaging or a follow-up mammogram, if unresolved concerns persist, the next step is to learn more about the area in question. If a cyst is suspected, a sonogram (ultrasound) can often determine if a mass is a cyst that can be drained or is solid and requires a biopsy. Many biopsy options exist today, including image-guided core needle procedures that remove small quantities of tissue from the area in question and can be completed in a doctor's office.

How do I know if I'm at high risk of getting breast cancer?

A woman is considered at higher risk for breast cancer if she has a mother, sister or daughter who has been diagnosed with breast cancer. About five to 10 percent of all breast cancer patients are believed to carry a mutation in the BRCA1 or BRCA2 gene. A carrier of BRCA1/2 may have as high as an 80 percent lifetime chance of developing breast cancer and a 60 percent risk of developing ovarian cancer.

I have atypical hyperplasia. What does that mean?

This type of noncancerous breast disease is characterized by a growth of abnormal cells within the breast ducts. Premenopausal women with a biopsy-confirmed diagnosis of atypical hyperplasia are at increased risk for later developing invasive breast cancer.

I have large breasts and I've been having a strange pain in one of them. Am I at risk of having breast cancer?

There is no known correlation between breast size and cancer. Also, breast pain is very commonly due to noncancerous conditions and is not usually the first symptom of breast cancer. However, you should contact your health care professional about any unusual symptoms that persist.

I want to have breast reconstruction, but what about the horror stories about silicone implants?

There are various alternatives, including saline implants or using tissue from your abdomen or from other areas of the body to reconstruct a breast. Depending on your situation, you may even be able to have breast reconstruction at the time of mastectomy. But you would likely have to return to surgery if you wanted a nipple and areola added. Nowadays, however, you can have breast reconstruction as an outpatient, depending on your health and stage of cancer.

References

Genomic Health, Inc. 2008. "What is Oncotype DX?" Available at http://www.genomichealth.com Accessed April 2008.

"What is breast cancer?" The American Cancer Society. September 2007. http://www.cancer.org. Accessed March 2008.

"How many women get breast cancer?" The American Cancer Society. September 26, 2007. http://www.cancer.org. Accessed March 2008.

"How is breast cancer staged?" The American Cancer Society. September 2007. http://www.cancer.org. Accessed March 2008.

"Abortion, miscarriage, and breast cancer risk." The National Cancer Institute. http://www.cancer.gov. Accessed March 2008.

Ries LAG, Harkins D, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2003. Bethesda, MD: National Cancer Institute; 2006.

Vogel VG. Management of the high-risk patient. Surg Clin North Am. 2003;83(4):733-751.

"ACS Advises MRIs for Some at High Risk of Breast Cancer." The American Cancer Society. March 28, 2007. Accessed March 28, 2007.

"FDA approves Tykerb for advanced breast cancer patients." The U.S. Food and Drug Administration. 2007. http://www.fda.gov

San Antonio Breast Cancer Symposium, Dec. 14-17, 2006. Donald Berry, PhD, department of biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston. Peter Ravdin, MD, PhD, department of biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston. Eric Winer, MD, Dana-Farber Cancer Institute, Boston.

"Detailed Guide: Breast Cancer--What are the Key Statistics for Breast Cancer?" American Cancer Society copyright 2007. http://www.cancer.org. Accessed February 2007.

"Breast self-exams: One way to detect breast cancer." Mayo Clinic. July 1, 2005. http://www.mayoclinic.com. Accessed September 15, 2005.

"Mammograms." Womenshealth.gov. National Women's Health Information Center. US Department of Health and Human Services. Office on Women's Health. March 2002. http://www.4women.gov. Accessed September 15, 2005.

"Sentinel Node Biopsy." National Cancer Institute. http://www.nci.nih.gov.

U. Veronesi, et al. "Sentinel Node Biopsy May Be as Good as Regular Lymph Node Biopsy," New England Journal of Medicine, August 7, 2003; last updated Sept. 2003.http://www.breastcancer.org. Accessed March 2004

"Prophylactic Mastectomy." Last updated February 2004. http://www.breastcancer.org. Accessed March 2004

"Bone Marrow Or Stem Cell Transplant Helps Reduce Breast Cancer Relapses," 1999. American Society of Clinical Oncology Conference, Atlanta, Georgia.

"Breast Cancer." CancerNet. National Cancer Institute. National Institutes of Health. http://www.cancer.gov. Accessed November 2003.

Canadian Medical Association Journal 2001;164:1837-1846,1851-1852.

"20-Year Follow-up of a Trial Comparing Total Mastectomy with Lumpectomy" New England Journal of Medicine, This Week in the Journal. October 2002. http://content.nejm.org. Accessed November 2002.

"The Facts for Life." The Komen Foundation. http://www.komen.org. Accessed November 2003.

"Updated Breast Cancer Screening Guidelines Released" American Cancer Society, May 15, 2003. http://www.cancer.org. Accessed November 2003.

Breast Cancer: Detailed Guide. American Cancer Society. 2003. http://www.cancer.org. Accessed May 2003.

"Cancer Facts and Figures 2003" American Cancer Society. http://www.cancer.org. Accessed May 2003.

King MC, et al. "Breast and Ovarian Cancer Risks Due to Inherited Mutations in BRCA1 and BRCA2." Science. 2003;302(5645):643-646. http://www.sciencemag.org. Accessed November 2003.

Gross PE, et al. "A Randomized Trial of Letrozole in Postmenopausal Women after Five Years of Tamoxifen Therapy for Early-Stage Breast Cancer" New England Journal of Medicine. 2003;340:1793-1802. http://content.nejm.org. Accessed November 2003.

"Summary from the General and Plastic Surgery Devices Panel Meeting--October 14 and 15, 2003." US Food and Drug Aministration. Center for Devices and Radiological Health. October 2003. http://www.fda.gov. Accessed November 2003.

Coombes R, Hall E, Gibson L, et al. A randomized trial of exemestane after two to three years of tamoxifen therapy in postmenopausal women with primary breast cancer. N Engl J Med. 2004;350:1081-1092.

Howell A, Cuzick J, Baum M, et al. ATAC Trialists' Group. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet. 2005;365(9453):60-2.

"General information about breast cancer." The National Cancer Institute. June 22, 2005. http://www.cancer.gov. Accessed January 2006.

Piccart-Gebhart MJ, Procter M, Leyland-Jones B et al. Trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer. N Engl J Med. 2005;353(16):1659-72.

Romond E. H., Perez E. A., Bryant J, et al. Trastuzumab plus Adjuvant Chemotherapy for Operable HER2-Positive Breast Cancer. N Engl J Med 2005; 353:1673-1684, Oct 20, 2005

"Study of Tamoxifen and Raloxifine (STAR) Trial." The National Cancer Institute. Updated 4/26/06. http://www.cancer.gov. Accessed April 26, 2006.

"What are the risk factors for breast cancer?" American Cancer Society. September 2006. http://www.cancer.org. Accessed February 2007.

"What is breast cancer?" American Cancer Society. September 2006. http://www.cancer.org. Accessed February 2007.

Keywords: breast cancer, abnormal mammogram, suspicious mammogram, calcifications, biopsy, breast reconstruction