Introduction

Breast cancer is a malignant tumor (a collection of cancer cells) arising from the cells of the breast. Although breast cancer predominantly occurs in women it can also affect men.

What are the risk factors

Some of the breast cancer risk factors can be modified (such as alcohol use) while others cannot be influenced (such as age). It is important to discuss these risks with your health care professional any time new therapies are started (for example, postmenopausal hormone therapy). The following are risk factors for breast cancer:

Age: The chances of breast cancer increase as you get older. Family history: The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative with the disease (sister, mother, or daughter) doubles a woman's risk. Personal history: Having been diagnosed with breast cancer in one breast increases the risk of cancer in the other breast or the chance of an additional cancer in the original breast. Women diagnosed with certain benign breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is abnormal proliferation of breast cells but no cancer has developed. Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk. Breast tissue: Women with dense breast tissue (as documented bymammogram) have a higher risk of breast cancer. Race: White women have a higher risk of developing breast cancer, but African-American women tend to have more aggressive tumors when they do develop breast cancer. Exposure to previous chest radiation or use of diethylstilbestrol increases the risk of breast cancer. Having no children or the first child after age 30 increases the risk of breast cancer. Breastfeeding for 1 to 2 years might slightly lower the risk of breast cancer. Being overweight or obese increases the risk of breast cancer. Use of oral contraceptives in the last 10 years increases the risk of breast cancer. Using combined hormone therapy after menopause increases the risk of breast cancer.

Alcohol use increases the risk of breast cancer, and this seems to be proportional to the amount of alcohol used. Exercise seems to lower the risk of breast cancer.

How is breast cancer diagnosed?

Although breast cancer can be diagnosed by the above signs and symptoms, the use of screening mammography has made it possible to detect many of the cancers early before they cause any symptoms. The American Cancer Society has the following recommendations for breast cancer screenings: Women age 40 and older should have a screening mammogram every year and should continue to do so as long as they are in good health.
Mammograms are a very good screening tool for breast cancer. As in any test, mammograms have limitations and will miss some cancers. The results of your mammogram, breast exam, and family history should be discussed with your health care professional.

Women should have a clinical breast exam (CBE) as part of regular health exams by a health care professional about every 3 years for women in their 20s and 30s and every year for women 40 years of age and over.
CBE are an important tool to detect changes in your breasts and also trigger a discussion with your health care professional about early cancer detection and risk factors.

Breast self-exam (BSE) is an option for women starting in their 20s. Women should report any breast changes to their health care professional. If a woman wishes to do BSE, the technique should be reviewed with her health care professional. The goal is to feel comfortable with the way the woman's breasts feel and look and, therefore, detect changes. Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderate risk (15% to 20%) should talk to their doctor about the benefits and limitations of adding MRI screening to their yearly mammogram.

Stages of breast cancer

Stage Definition

Stage 0

Cancer cells remain inside the breast duct, without invasion into normal adjacent breast tissue.

Stage IA

The tumor measures up to 2 cm AND the cancer has not spread outside the breast; no lymph nodes are involved

Stage IB

There is no tumor in the breast; instead, small groups of cancer cells -- larger than 0.2 millimeter but not larger than 2 millimeters are found in the lymph nodes OR there is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells larger than 0.2 millimeter but not larger than 2 millimeters in the lymph nodes.

Stage IIA

No tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm) OR the tumor measures 2 centimeters or smaller and has spread to the axillary lymph nodes OR the tumor is larger than 2 but no larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB

The tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes OR the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage IIIA

No tumor is found in the breast. Cancer is found in axillary lymph nodes that are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone OR the tumor is any size. Cancer has spread to the axillary lymph nodes, which are sticking together or to other structures, or cancer may be found in lymph nodes near the breastbone.

Stage IIIB

The tumor may be any size and has spread to the chest wall and/or skin of the breast AND may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone. Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC

There may either be no sign of cancer in the breast or a tumor may be any size and may have spread to the chest wall and/or the skin of the breast AND the cancer has spread to lymph nodes either above or below the collarbone AND the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.

Stage IV

The cancer has spread or metastasized to other parts of the body.