Facts About Breast Cancer

Breast cancer is the most common type of cancer in American women, according to the American Cancer Society.

• This year, nearly 213,000 women and 1,700 men will learn they have breast cancer.
• Another 62,000 women will learn they have noninvasive (also called in situ) breast cancer.
• Nearly 41,000 women and 500 men will die from breast cancer this year.
• Breast cancer can often be cured. About 80 percent of all patients with breast cancer are free of the disease 10 years after their diagnosis.

Risk Factors for Breast Cancer

Many women who develop breast cancer do not have known risk factors. Patient qualities that may increase the risk of developing the disease include:

• Age is the biggest risk factor. More than 75 percent of women diagnosed with breast cancer are over age 50.
• Family history of breast cancer in your mother or sister.
• Early onset of periods.
• Having children later in life, or not at all.
• Hormone replacement therapy with estrogen and progesterone.

Being physically active, keeping a healthy weight, breast feeding and limiting alcohol intake may lower your risk for developing breast cancer.

Diagnosing Breast Cancer

Many breast tumors are found by a breast X-ray study called a mammogram. At age 40, women should begin having regular mammograms. If you have a family history of the disease or other risk factors, ask your healthcare provider about earlier screening.

• If you notice a lump in the breast or underarm, have it checked by a doctor. Breast swelling, skin discoloration, dimpling of the skin or nipple discharge should also be checked.
• In addition to a mammogram, your doctor may also recommend ultrasound or MRI scans.
• In some cases, a biopsy to see if you have breast cancer will be done if your mammogram is abnormal or you have a lump. Sometimes a small needle will be used to remove tissue from the lump and look at it under a microscope. Somtimes it is better to have a surgeon remove the entire lump to be sure about the diagnosis.

Treating Breast Cancer

The main treatment for breast cancer is surgery. This is often followed by radiation therapy. Some patients will also need chemotherapy and/or hormone blocking therapy.

• Breast conserving surgery is surgical removal of only the cancerous tissue. This operation is called a lumpectomy and is usually followed by radiation.
• Mastectomy is surgical removal of the breast.
• Both surgeries may be done in combination with tests that check the lymph nodes near the breast for cancer.
• Radiation therapy involves a radiation oncologist delivering radiation to the breast to destroy cancer cells. Radiation therapy works within cancer cells to make them unable to multiply. When these cells die, the body naturally eliminates them. Healthy tissue is able to repair itself in a way cancer cells cannot.
• Chemotherapy is medication prescribed by a medical oncologist to destroy cancer cells that may have traveled elsewhere in the body.
• Hormonal therapy is medication prescribed by a medical oncologist to block the effects of hormones that may be helping your tumor grow.

External Beam Radiation Therapy

Painless radiation treatments are delivered in a series of sessions Monday through Friday, for five to eight weeks. Each treatment lasts less than 30 minutes.

• The usual course of radiation treats only the breast, although you may need to have nearby lymph node areas treated also.
• 3-dimensional conformal radiotherapy (3D-CRT) combines multiple radiation treatment fields to deliver very precise doses of radiation to the breast and spare surrounding normal tissue.

Side effects can include fatigue, skin irritation similar to a moderate sunburn, and mild to moderate breast swelling. These changes are temporary and can be treated by skin creams and/or medications. Tell your radiation oncologist or nurse about any discomfort you may feel.

Accelerated Partial Breast Irradiation

External beam radiation therapy over several weeks is the standard of care. In national clinical trials, doctors are studying if accelerated partial breast irradiation (or APBI) — where radiation is delivered to only part of the breast over four to five days — works as well. These techniques are only available in a few clinics and then only to a select group of patients.

• Breast brachytherapy involves placing flexible plastic tubes called catheters or a balloon into the breast. Twice a day for five days, the catheters or the balloon are connected to a brachytherapy machine, also called a high dose rate afterloader. Your radiation oncologist then directs a special computer to guide a small, radioactive seed into the breast tissue near where the tumor was removed. The radiation is left in place for several minutes. After the end of the five days, the catheters or balloon are removed.
• 3-D conformal partial breast irradiation is where only part of the breast receives external beam radiation.
• Intra-operative radiation therapy (IORT) involves doctors delivering radiation to the breast during surgery.

The long-term results of these techniques are still being studied. Talk with your radiation oncologist for more information.

After Mastectomy Radiation

After a mastectomy, your doctor may suggest radiation therapy for the chest wall and nearby lymph node areas.

• Whether or not radiation therapy should be used after removal of the breast depends on several factors. These factors include the number of lymph nodes involved, tumor size, and whether or not cancer cells were found near the edge of the tissue that was removed.

Many patients who have a mastectomy can safely skip radiation therapy. Ask your doctor for more information.

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Most women receive radiation therapy after breast-sparing surgery. Some women receive radiation therapy after a mastectomy. Treatment depends on the size of the tumor and other factors. The radiation destroys breast cancer cells that may remain in the area.

Some women have radiation therapy before surgery to destroy cancer cells and shrink the tumor. Doctors use this approach when the tumor is large or may be hard to remove. Some women also have chemotherapy or hormone therapy before surgery.

Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:

• External radiation: The radiation comes from a large machine outside the body. Most women go to a hospital or clinic for treatment. Treatments are usually 5 days a week for several weeks.
• Internal radiation (implant radiation): Thin plastic tubes (implants) that hold a radioactive substance are put directly in the breast. The implants stay in place for several days. A woman stays in the hospital while she has implants. Doctors remove the implants before she goes home.

Side effects depend mainly on the dose and type of radiation and the part of your body that is treated.

It is common for the skin in the treated area to become red, dry, tender, and itchy. Your breast may feel heavy and tight. These problems will go away over time. Toward the end of treatment, your skin may become moist and "weepy." Exposing this area to air as much as possible can help the skin heal.

Bras and some other types of clothing may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time. Gentle skin care also is important. You should check with your doctor before using any deodorants, lotions, or creams on the treated area. These effects of radiation therapy on the skin will go away. The area gradually heals once treatment is over. However, there may be a lasting change in the color of your skin.

You are likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

Although the side effects of radiation therapy can be distressing, your doctor can usually relieve them.

Questions to ask your doctor before radiation therapy for breast cancer

• How will radiation be given?
• When will treatment start? When will it end? How often will I have treatments?
• How will I feel during treatment? Will I be able to drive myself to and from treatment?
• How will we know the treatment is working?
• What can I do to take care of myself before, during, and after treatment?
• Will treatment affect my skin?
• How will my chest look afterward?
• Are there any long-term effects?
• What is the chance that the cancer will come back in my breast?
• How often will I need checkups?