Breast Cancer Sourcebook, 6th Ed.

By Omnigraphics

Provides information about breast cancer and its causes, risk factors, diagnosis and treatment. Covers the types of breast cancer, including ductal carcinoma in situ, lobular carcinoma in situ, invasive carcinoma and inflammatory breast cancer. Information on treatment complications, preventive therapies and tips on living with cancer are also included, along with a glossary of related terms.

• Language: English
• Publisher: Omnigraphics
• Release date: Mar 1, 2019
• ISBN: 9780780816886

Book preview

Preface

About This Book

Breast cancer is one of the most commonly diagnosed cancers in women, and it is estimated that approximately 12.4 percent of women in the United States will be diagnosed with breast cancer at some point during their lifetime. Although breast cancer still claims the lives of nearly 41,000 women annually, there has been progress in the battle against it. Thanks to treatment advances, earlier detection, screening techniques, and increased awareness of symptoms, the number of deaths attributable to breast cancer each year has declined since 1990. Furthermore, according to a recent National Cancer Institute (NCI) report, in 2015, there were more than 3.4 million breast-cancer survivors living in the United States.

Breast Cancer Sourcebook, Sixth Edition provides updated information about breast cancer and its causes, risk factors, diagnosis, and treatment. Readers will learn about the types of breast cancer, including ductal carcinoma in situ, lobular carcinoma in situ, invasive carcinoma, and inflammatory breast cancer, as well as common breast-cancer treatment complications such as pain, fatigue, lymphedema, hair loss, and sexuality and fertility issues. Information on preventive therapies, nutrition and exercise recommendations, and tips on living with breast cancer are also included, along with a glossary of related terms and a directory of organizations that offer additional information to breast-cancer patients and their families.

How to Use This Book

This book is divided into parts and chapters. Parts focus on broad areas of interest. Chapters are devoted to single topics within a part.

Part I: Introduction to Breast Cancer identifies the parts of the breasts and lymphatic system, discusses common changes in the breast that pose no threat to health, and offers general information about breast cancer in women and men. It also offers statistical information on the prevalence of breast cancer in the United States.

Part II: Types of Breast Cancer identifies the most common types of breast cancer, including ductal carcinoma in situ (DCIS), lobular carcinoma in situ (LCIS), invasive carcinoma of the breast, inflammatory breast cancer, Paget disease of the nipple, triple-negative breast cancer, and other rare types of breast cancers.

Part III: Risk Factors, Symptoms, and Prevention of Breast Cancer provides information about hereditary and nonhereditary factors that increase the risk of developing breast cancer, including age, family health history, exposure to radiation, alcohol consumption, use of hormone replacement therapy, reproductive risk factors, and obesity. Genetic counseling for breast-cancer risk is discussed, along with information about preventing breast cancer in people who are susceptible.

Part IV: Screening, Diagnosis, and Stages of Breast Cancer identifies tests and procedures used to screen, diagnose, and stage breast cancer, including breast examinations, mammograms, and breast biopsies. It also provides information on how to understand laboratory tests and breast pathology reports.

Part V: Breast-Cancer Treatments discusses how to find a treatment facility or doctor and offers information about considerations to make before undergoing breast-cancer treatment. Surgical treatments for breast cancer, such as mastectomy, lumpectomy, and breast reconstruction, are discussed, and facts about radiation therapy, chemotherapy, hormone therapy, biologic therapies, and complementary and alternative medicine treatments for breast cancer are provided. The part also includes a discussion of the treatment of breast cancer in pregnant women, men, and patients with recurrent breast cancer.

Part VI: Managing Side Effects and Complications of Breast-Cancer Treatment Disorders describes anemia, delirium, fatigue, hot flashes and night sweats, infection, lymphedema, pain, sexual and fertility issues, and hair loss associated with breast-cancer treatment. Information about complementary and alternative therapies that may relieve physical discomfort or emotional anxiety is also provided.

Part VII: Living with Breast Cancer discusses strategies for coping with the difficult emotions produced by a breast-cancer diagnosis and offers information about talking to family members and friends about cancer. In addition, the part identifies nutrition and exercise recommendations after cancer treatment, tips for dealing with cancer in the workplace, information and suggestions for caregivers of breast-cancer patients.

Part VIII: Clinical Trials and Breast-Cancer Research provides information on current clinical trials related to breast cancer and latest breast-cancer researches.

Part IX: Additional Help and Information provides a glossary of important terms related to breast cancer and directory of organizations that offer financial assistance to people with breast cancer and a directory that offers other information about breast cancer.

Bibliographic Note

This volume contains documents and excerpts from publications issued by the following U.S. government agencies: Centers for Disease Control and Prevention (CDC); Centers for Medicare & Medicaid Services (CMS); Genetic and Rare Diseases Information Center (GARD); National Cancer Institute (NCI); National Center for Biotechnology Information (NCBI); National Center for Complementary and Integrative Health (NCCIH); National Human Genome Research Institute (NHGRI); National Institute of Environmental Health Sciences (NIEHS); National Institutes of Health (NIH); NIH Osteoporosis and Related Bone Diseases—National Resource Center (NIH ORBD—NRC); Office on Women’s Health (OWH); U.S. Department of Labor (DOL); U.S. Department of Veterans Affairs (VA); and U.S. Food and Drug Administration (FDA).

It may also contain original material produced by Omnigraphics and reviewed by medical consultants.

About the Health Reference Series

The Health Reference Series is designed to provide basic medical information for patients, families, caregivers, and the general public. Each volume takes a particular topic and provides comprehensive coverage. This is especially important for people who may be dealing with a newly diagnosed disease or a chronic disorder in themselves or in a family member. People looking for preventive guidance, information about disease warning signs, medical statistics, and risk factors for health problems will also find answers to their questions in the Health Reference Series. The Series, however, is not intended to serve as a tool for diagnosing illness, in prescribing treatments, or as a substitute for the physician/patient relationship. All people concerned about medical symptoms or the possibility of disease are encouraged to seek professional care from an appropriate healthcare provider.

A Note about Spelling and Style

Health Reference Series editors use Stedman’s Medical Dictionary as an authority for questions related to the spelling of medical terms and the Chicago Manual of Style for questions related to grammatical structures, punctuation, and other editorial concerns. Consistent adherence is not always possible, however, because the individual volumes within the Series include many documents from a wide variety of different producers, and the editor’s primary goal is to present material from each source as accurately as is possible. This sometimes means that information in different chapters or sections may follow other guidelines and alternate spelling authorities. For example, occasionally a copyright holder may require that eponymous terms be shown in possessive forms (Crohn’s disease vs. Crohn disease) or that British spelling norms be retained (leukaemia vs. leukemia).

Medical Review

Omnigraphics contracts with a team of qualified, senior medical professionals who serve as medical consultants for the Health Reference Series. As necessary, medical consultants review reprinted and originally written material for currency and accuracy. Citations including the phrase Reviewed (month, year) indicate material reviewed by this team. Medical consultation services are provided to the Health Reference Series editors by:

Dr. Vijayalakshmi, MBBS, DGO, MD

Dr. Senthil Selvan, MBBS, DCH, MD

Dr. K. Sivanandham, MBBS, DCH, MS (Research), PhD

Our Advisory Board

We would like to thank the following board members for providing initial guidance on the development of this series:

Dr. Lynda Baker, Associate Professor of Library and Information Science, Wayne State University, Detroit, MI

Nancy Bulgarelli, William Beaumont Hospital Library, Royal Oak, MI

Karen Imarisio, Bloomfield Township Public Library, Bloomfield Township, MI

Karen Morgan, Mardigian Library, University of Michigan-Dearborn, Dearborn, MI

Rosemary Orlando, St. Clair Shores Public Library, St. Clair Shores, MI

Health Reference Series Update Policy

The inaugural book in the Health Reference Series was the first edition of Cancer Sourcebook published in 1989. Since then, the Series has been enthusiastically received by librarians and in the medical community. In order to maintain the standard of providing high-quality health information for the layperson the editorial staff at Omnigraphics felt it was necessary to implement a policy of updating volumes when warranted.

Medical researchers have been making tremendous strides, and it is the purpose of the Health Reference Series to stay current with the most recent advances. Each decision to update a volume is made on an individual basis. Some of the considerations include how much new information is available and the feedback we receive from people who use the books. If there is a topic you would like to see added to the update list, or an area of medical concern you feel has not been adequately addressed, please write to:

Managing Editor

Health Reference Series

Omnigraphics

615 Griswold, Ste. 901

Detroit, MI 48226

Part One

Introduction to Breast Cancer

Chapter 1

Breast and Lymphatic System Basics

Breast Anatomy

The breasts of an adult woman are milk-producing, tear-shaped glands. They are supported by and attached to the front of the chest wall on either side of the breast bone or sternum by ligaments. They rest on the major chest muscle, the pectoralis major.

The breast has no muscle tissue. A layer of fat surrounds the glands and extends throughout the breast.

The breast is responsive to a complex interplay of hormones that cause the tissue to develop, enlarge and produce milk. The three major hormones affecting the breast are estrogen, progesterone, and prolactin, which cause glandular tissue in the breast and the uterus to change during the menstrual cycle.

Each breast contains 15 to 20 lobes arranged in a circular fashion. The fat (subcutaneous adipose tissue) that covers the lobes gives the breast its size and shape. Each lobe is comprised of many lobules, at the end of which are tiny bulb-like glands, or sacs, where milk is produced in response to hormonal signals.

Ducts connect the lobes, lobules, and glands in nursing mothers. These ducts deliver milk to openings in the nipple. The areola is the darker-pigmented area around the nipple.

Figure 1.1. Anatomy of Breast

Mammary Glands*

Functionally, the mammary glands produce milk; structurally, they are modified-sweat glands. Mammary glands, which are located in the breast overlying the pectoralis major muscles, are present in both sexes, but usually are functional only in the female.

Externally, each breast has a raised nipple, which is surrounded by a circular pigmented area called the areola. The nipples are sensitive to touch, due to the fact that they contain smooth muscle that contracts and causes them to become erect in response to stimulation.

Internally, the adult-female breast contains 15 to 20 lobes of glandular tissue that radiate around the nipple. The lobes are separated by connective tissue and adipose. The connective tissue helps support the breast. Some bands of connective tissue, called suspensory (Cooper’s) ligaments, extend through the breast from the skin to the underlying muscles. The amount and distribution of the adipose tissue determine the size and shape of the breast. Each lobe consists of lobules that contain the glandular units. A lactiferous duct collects the milk from the lobules within each lobe and carries it to the nipple. Just before the nipple, the lactiferous duct enlarges to form a lactiferous sinus (ampulla), which serves as a reservoir for milk. After the sinus, the duct again narrows and each duct opens independently on the surface of the nipple.

Mammary-gland function is regulated by hormones. At puberty, increasing levels of estrogen stimulate the development of glandular tissue in the female breast. Estrogen also causes the breast to increase in size through the accumulation of adipose tissue. Progesterone stimulates the development of the duct system. During pregnancy, these hormones enhance the further development of the mammary glands. Prolactin from the anterior pituitary stimulates the production of milk within the glandular tissue, and oxytocin causes the ejection of milk from the glands.

Regional Lymph Nodes

Blood and lymph vessels form a network throughout each breast. Breast tissue is drained by lymphatic vessels that lead to axillary nodes (which lie in the axilla) and internal mammary nodes (which lie along each side of the breast bone). When breast cancer spreads, it is frequently to these nodes.

Figure 1.2. Regional Lymph Nodes

This chapter includes text excerpted from Breast Anatomy, Surveillance, Epidemiology and End Results Program (SEER), National Cancer Institute (NCI), March 1, 2003. Reviewed February 2019.

Chapter 2

Understanding Breast Changes

Chapter Contents

Section 2.1—Noncancerous Breast Changes

Section 2.2—Breast Changes That May Become Cancer

Section 2.1

Noncancerous Breast Changes

This section contains text excerpted from the following sources: Text in this section begins with excerpts from Breast Changes and Conditions, National Cancer Institute (NCI), October 23, 2018; Text under the heading Details That You Should Share with Your Healthcare Provider is excerpted from Understanding Breast Changes, National Cancer Institute (NCI), February 2014. Reviewed February 2019.

Some breast changes can be felt by a woman or her healthcare provider, but most can be detected only during an imaging procedure such as a mammogram, magnetic resonance imaging (MRI), or ultrasound. Whether a breast change was found by your doctor or you noticed a change, it’s important to follow up with your doctor to have the change checked and properly diagnosed.

Breast Changes of Concern

Check with your healthcare provider if your breast looks or feels different, or if you notice one of these symptoms:

Lump or firm feeling in your breast or under your arm. Lumps come in different shapes and sizes. Normal breast tissue can sometimes feel lumpy. Doing breast self-exams can help you learn how your breasts normally feel and make it easier to notice and find any changes, but they are not a substitute for mammograms.

Nipple changes or discharge. Nipple discharge may be different colors or textures. It can be caused by birth control pills, some medicines, and infections. But because it can also be a sign of cancer, it should always be checked.

Skin that is itchy, red, scaled, dimpled, or puckered

Breast Changes during Your Lifetime That Are Not Cancer

Most women have changes in the breasts at different times during their lifetime.

Before or during your menstrual periods, your breasts may feel swollen, tender, or painful. You may also feel one or more lumps during this time because of extra fluid in your breasts. Your healthcare provider may have you come back for a return visit at a different time in your menstrual cycle to see if the lump has changed.

During pregnancy, your breasts may feel lumpy. This is usually because the glands that produce milk are increasing in number and getting larger. While breastfeeding, you may get a condition called mastitis. This happens when a milk duct becomes blocked. Mastitis causes the breast to look red and feel lumpy, warm, and tender. It may be caused by an infection and it is often treated with antibiotics. Sometimes the duct may need to be drained.

As you approach menopause, your hormone levels change. This can make your breasts feel tender, even when you are not having your menstrual period. Your breasts may also feel lumpier than they did before.

If you are taking hormones (such as menopausal hormone therapy (MHT), birth control pills, or injections) your breasts may become denser. This can make a mammogram harder to interpret. Be sure to let your healthcare provider know if you are taking hormones.

After menopause, your hormone levels drop. You may stop having any lumps, pain, or nipple discharge that you used to have.

Details That You Should Share with Your Healthcare Provider

It can help to prepare before you meet with your healthcare provider. Use the list below. Write down the breast changes you notice, as well as your personal medical history and your family medical history before your visit.

Tell your healthcare provider about breast changes or problems:

The breast changes or problems that you have noticed.

What the breast change looks or feels like? For example: Is the lump hard or soft? Does your breast feel tender or swollen? How big is the lump? What color is the nipple discharge? and so on.

The place of breast change. For example: What part of the breast feels different? Do both breasts feel different or only one breast?

When did you first notice the breast change?

Since then, this is the change you have noticed. For example: Has it stayed the same or gotten worse?

Share your personal medical history:

The breast problems you had in the past

The breast exams and tests that you have had

The date of your last mammogram

The date on which your last menstrual period began

The list of medicines or herbs that you take

Your present status such as whether you have breast implants, or in case you are pregnant or breastfeeding, or if you have had this type of cancer before

Share your family medical history:

Details of breast problems or diseases that your family members had

Details of the family members who had breast cancer and the age when they were diagnosed with breast cancer

Section 2.2

Breast Changes That May Become Cancer

This section includes text excerpted from Understanding Breast Changes, National Cancer Institute (NCI), February 2014. Reviewed February 2019.

Ductal carcinoma in situ (DCIS): DCIS is a condition in which abnormal cells are found in the lining of a breast duct. These cells have not spread outside the duct to the breast tissue. This is why it is called "in situ, which is a Latin term that means in place." You may also hear DCIS called Stage 0 breast carcinoma in situ or noninvasive cancer.

Since it’s not possible to determine which cases of DCIS will become invasive breast cancer, it’s important to get treatment for DCIS. Talk with a doctor who specializes in breast health to learn more. Treatment for DCIS is based on how much of the breast is affected, where DCIS is in the breast, and its grade. Most women with DCIS are cured with proper treatment.

Treatment choices for DCIS include:

Lumpectomy. This is a type of breast-conserving surgery or breast-sparing surgery. It is usually followed by radiation therapy.

Mastectomy. This type of surgery is used to remove the breast or as much of the breast tissue as possible.

Tamoxifen. This drug may also be taken to lower the chance that DCIS will come back, or to prevent invasive breast cancer.

Clinical trials. Talk with your healthcare provider about whether a clinical trial is a good choice for you.

Breast Cancer

Breast cancer is a disease in which cancer cells form in the tissues of the breast. Breast-cancer cells:

Grow and divide without control

Invade nearby breast tissue

May form a mass called a tumor

May metastasize, or spread, to the lymph nodes or other parts of the body

After breast cancer has been diagnosed, tests are done to find out the extent, or stage, of cancer. The stage is based on the size of the tumor and whether cancer has spread. Treatment depends on the stage of cancer.

Getting the Support You Need

It can be upsetting to notice a breast change, to get an abnormal test result, or to learn about a new condition or disease. But knowledge is power and we hope that this sourcebook answers some of your questions and calms some of your fears as you talk with your healthcare provider and get the follow-up care you need.

Many women choose to get extra help and support for themselves. It may help to think about people who have been there for you during challenging times in the past.

Ask friends or loved ones for support. Take someone with you while you are learning about your testing and treatment choices.

Ask your healthcare provider to:

Explain medical terms that are new or confusing

Share with you how other people have handled the types of feelings that you are having

Tell you about specialists that you can talk to learn more

Table 2.1. Breast Conditions and Follow-Up Care

Chapter 3

What You Need to Know about Breast Cancer

Cancer is a disease in which cells in the body grow out of control. Except for skin cancer, breast cancer is the most common cancer in women in the United States. Deaths from breast cancer have declined over time, but remains the second leading cause of cancer death among women overall and the leading cause of cancer death among Hispanic women.

Each year in the United States, about 237,000 cases of breast cancer are diagnosed in women and about 2,100 in men. About 41,000 women and 450 men in the United States die each year from breast cancer. Over the last decade, the risk of getting breast cancer has not changed for women overall, but the risk has increased for black women and Asian and Pacific Islander women. Black women have a higher risk of death from breast cancer than white women.

The risk of getting breast cancer goes up with age. In the United States, the average age when women are diagnosed with breast cancer is 61. Men who get breast cancer are diagnosed usually between 60- and 70-years old.

What Is Breast Cancer?

Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.

Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.

Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

Kinds of Breast Cancer

The most common kinds of breast cancer are:

Invasive ductal carcinoma (IDC). The cancer cells grow outside the ducts into other parts of the breast tissue. Invasive-cancer cells can also spread, or metastasize, to other parts of the body.

Invasive lobular carcinoma (ILC). Cancer cells spread from the lobules to the breast tissues that are close by. These invasive-cancer cells can also spread to other parts of the body.

There are several other less common kinds of breast cancer, such as Paget disease, external medullary, mucinous, and inflammatory breast cancer (IBC).

Ductal carcinoma in situ (DCIS) is a breast disease that may lead to breast cancer. The cancer cells are only in the lining of the ducts and have not spread to other tissues in the breast.

What Are the Symptoms of Breast Cancer?

Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.

Some warning signs of breast cancer include:

New lump in the breast or underarm (armpit)

Thickening or swelling of part of the breast

Irritation or dimpling of breast skin

Redness or flaky skin in the nipple area or the breast

Pulling in of the nipple or pain in the nipple area

Nipple discharge other than breast milk, including blood

Any change in the size or the shape of the breast

Pain in any area of the breast

Keep in mind that these symptoms can happen with other conditions that are not cancer.

If you have any signs or symptoms that worry you, be sure to see your doctor right away.

What Is a Normal Breast?

No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age.

What Do Lumps in Your Breast Mean?

Many conditions can cause lumps in the breast, including cancer. But most breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts.

Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, tender, and sore.

Cysts are small fluid-filled sacs that can develop in the breast.

What Are the Risk Factors for Breast Cancer?

Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.

Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast-cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.

Risk Factors You Cannot Change

Some of the risk factors you can change. Such as:

Getting older. The risk of breast cancer increases with age; most breast cancers are diagnosed after age 50.

Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.

Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.

Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.

Personal history of breast cancer or certain noncancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some noncancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.

Family history of breast cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who has had breast cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.

Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (such as for treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.

Women who took the drug diethylstilbestrol (DES), which was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.

Risk Factors You Can Change

The risk factors that you can change include:

Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.

Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.

Taking hormones. Some forms of hormone replacement therapy (HRT) (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (OC) (birth control pills) also have been found to raise breast-cancer risk.

Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast-cancer risk.

Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.

Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer, and changes in other hormones due to night shift working also may increase breast-cancer risk.

Who Is at High Risk for Breast Cancer?

If you have a strong family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, you may have a high risk of getting breast cancer. You may also have a high risk of ovarian cancer. Talk to your doctor about ways of reducing your risk, including any physical and emotional side effects:

Medicines that block or decrease estrogen in your body

Surgery to reduce your risk of breast cancer

Mastectomy (removal of breast tissue)

Salpingo-oophorectomy (removal of the ovaries and fallopian tubes)

It is important that you know your family history and talks to your doctor about how you can lower your risk.

What Can I Do to Reduce My Risk of Breast Cancer?

Many factors can influence your breast-cancer risk, and most women who develop breast cancer do not have any known risk factors or a history of the disease in their families. However, you can help lower your risk of breast cancer in the following ways—

Keep a healthy weight.

Exercise regularly (at least four hours a week).

Get enough sleep.

Don’t drink alcohol, or limit alcoholic drinks to no more than one per day.

Avoid exposure to chemicals that can cause cancer (carcinogens).

Try to reduce your exposure to radiation during medical tests like mammograms, X-rays, CT scans, and PET scans.

If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and find out if it is right for you.

Breastfeed your babies, if possible.

Although breast-cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast-cancer screening tests are right for you, and when you should have them.

If you have a family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, you may have a higher breast-cancer risk. Talk to your doctor about these ways of reducing your risk—

Antiestrogens or other medicines that block or decrease estrogen in your body.

Surgery to reduce your risk of breast cancer—

Prophylactic (preventive) mastectomy (removal of breast tissue).

Prophylactic (preventive) salpingo-oophorectomy (removal of the ovaries and fallopian tubes).

It is important that you know your family history and talk to your doctor about screening and other ways you can lower your risk.

What Screening Tests Are There?

Breast-cancer screening means checking a woman’s breasts for cancer before there are signs or symptoms of the disease. Three main tests are used to screen the breasts for cancer. Talk to your doctor about which tests are right for you, and when you should have them.

Mammogram

A mammogram is an X-ray of the breast. Mammograms are the best way to find breast cancer early when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. The United States Preventive Services Task Force recommends that if you are 50 to 74 years old, be sure to have a screening mammogram every two years. If you are 40 to 49 years old, talk to your doctor about when to start and how often to get a screening mammogram.

Clinical Breast Exam

A clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.

Breast Self-Exam

A breast self-exam is when you check your own breasts for lumps, changes in size or shape of the breast, or any other changes in the breasts or underarm (armpit).

Which Tests to Choose

Having a clinical breast exam or a breast self-exam have not been found to decrease the risk of dying from breast cancer. At this time, the best way to find breast cancer is with a mammogram. If you choose to have clinical breast exams and to perform breast self-exams, be sure you also get mammograms regularly.

Where Can I Go to Get Screened?

Most likely, you can get screened for breast cancer at a clinic, hospital, or doctor’s office. If you want to be screened for breast cancer, call your doctor’s office. They can help you schedule an appointment. Most health insurance companies pay for the cost of breast-cancer screening tests.

What Is a Mammogram and When Should I Get One?

A mammogram is an X-ray picture of the breast. Doctors use a mammogram to look for early signs of breast cancer.

Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt. When their breast cancer is found early, many women go on to live long and healthy lives.

When Should I Get a Mammogram?

The United States Preventive Services Task Force recommends that women should have mammograms every two years from age 50 to 74 years. Talk to your health professional if you have any symptoms or changes in your breast, or if breast cancer runs in your family. He or she may recommend that you have mammograms before age 50 or more often than usual.

How Is a Mammogram Done?

You will stand in front of a special X-ray machine. A technologist will place your breast on a clear plastic plate. Another plate will firmly press your breast from above. The plates will flatten the breast, holding it still while the X-ray is being taken. You will feel some pressure. The other breast will be X-rayed in the same way. The steps are then repeated to make a side view of each breast. You will then wait while the technologist checks the four X-rays to make sure the pictures do not need to be re-done. Keep in mind that the technologist cannot tell you the results of your mammogram.

What Does Having a Mammogram Feel Like?

Having a mammogram is uncomfortable for most women. Some women find it painful. A mammogram takes only a few moments, though, and the discomfort is over soon. What you feel depends on the skill of the technologist, the size of your breasts, and how much they need to be pressed. Your breasts may be more sensitive if you are about to get or have your period. A doctor with special training, called a radiologist, will read the mammogram. He or she will look at the X-ray for early signs of breast cancer or other problems.

When Will I Get the Results of My Mammogram?

You will usually get the results within a few weeks, although it depends on the facility. A radiologist reads your mammogram and then reports the results to you or your doctor. If there is a concern, you will hear from the mammography facility earlier. Contact your health professional or the mammography facility if you do not receive a report of your results within 30 days.

What Happens If My Mammogram Is Normal?

Continue to get regular mammograms. Mammograms work best when they can be compared with previous ones. This allows your doctor to compare them to look for changes in your breasts.

What Happens If My Mammogram Is Abnormal?

If it is abnormal, do not panic. An abnormal mammogram does not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. You may also be referred to a breast specialist or a surgeon. It does not necessarily mean you have cancer or need surgery. These doctors are experts in diagnosing breast problems.

Tips for Getting a Mammogram

Try not to have your mammogram the week before you get your period or during your period. Your breasts may be tender or swollen then.

On the day of your mammogram, don’t wear deodorant, perfume, or powder. These products can show up as white spots on the X-ray.

Some women prefer to wear a top with a skirt or pants, instead of a dress. You will need to undress from your waist up for the mammogram.

How Is Breast Cancer Diagnosed?

Doctors often use additional tests to find or diagnose breast cancer.

Breast ultrasound. A machine uses sound waves to make detailed pictures, called sonograms, of areas inside the breast.

Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.

Magnetic resonance imaging (MRI). A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.

Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy).

Staging

If breast cancer is diagnosed, other tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. Whether the cancer is only in the breast, is found in lymph nodes under your arm, or has spread outside the breast determines your stage of breast cancer. The type and stage of breast cancer tell doctors what kind of treatment you need.

How Is Breast Cancer Treated?

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