Information on Breast Cancer

Breast Cancer

What Is Breast Cancer

Breast cancer is a malignant tumor, or cancer, that begins in the cells of the breast. Breast cancer can affect both men and women, but it is about 100 times more common in women

The first sign of breast cancer is often a lump in your breast or abnormal mammogram. Breast cancer staged range from and early, curable disease to metastatic breast cancer—which means that the cancer has spread beyond the breast into other parts of the body.

There are two main types of breast cancer:

Ductal carcinoma begins in the breast ducts, behind the nipples. Ductal carcinoma affects 7 to 8 out of every 10 women with breast cancer and 9 out of 10 men with breast cancer.

Lobular carcinoma starts in the lobules, where the mammary glands are found. It affects 1 out of 10 women with breast cancer and 1 out of 50 men with breast cancer.

The remaining 1 in 5 women and 2 in 25 men with breast cancer may suffer from a combination of both types, or from a less common type, such as inflammatory breast cancer or Paget’s disease of the nipple.

What Causes Breast Cancer

Risk Factors For Breast Cancer

Diagnosing Breast Cancer

Symptoms of Breast Cancer

Doctors recommend that you be aware of your breasts and watch for any changes, but since In its early stages, breast cancer usually has no symptoms, it’s important to know what to be on the lookout for in case something develops.As a general rule of thumb, be on the lookout for an area that is distinctly different from any other area on either breast in feel, texture, bumpiness, or other change from your norm. Causes for concern include:

A lump or thickening in your breast that persists after your menstrual cycle. Often—this is one of the first symptoms or signs of breast cancer. Lumps associated with breast cancer are usually painless, though some may cause a prickly or tingly sensation. While examining your breasts to understand how they change throughout the month is useful, lumps are usually visible on a mammogram long before they can be seen or felt.

Swelling or lump in the armpit.

Pain or tenderness in the breast. Although lumps are usually painless, chronic pain or tenderness can be a sign of breast cancer.

A noticeable flattening or indentation on the breast, which may indicate a tumor that cannot be seen or felt.

Changes to the size or shape of your breast. Any change in the size, contour, texture, or temperature of the breast. A reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.

A change in your nipple, such as peeling, flaking, turning inward, a dimpling, itching, a burning sensation, A scaly rash of the nipple is symptomatic of Paget’s disease, a rarer form of breast cancer, and may indicate possible underlying breast cancer.

Unusual nipple discharge that may be clear, bloody, or another color. It’s usually caused by benign conditions but could be due to cancer in some cases.

Dimpling or a round, marble-like area under the skin of the breast.

Early breast cancer usually does not cause physical pain, and symptoms may not initially be noticeable. As the cancer grows, it can cause changes that include:

A lump or thickening in or near the breast or in the underarm area
A change in the shape or size of the breast
Nipple discharge or tenderness
Inverted nipple
Ridges or pitting of the breast (resembling the skin of an orange)
A change in the way the skin of the breast, nipple, or areola (dark area surrounding the nipple), looks or feels (for example, warm, swollen, red, or scaly)
A sore or ulcer on the breast that does not heal

If you notice any of the above symptoms, contact your doctor immediately for an examination. These symptoms are often associated with breast cancer that has progressed from its earliest stages. Mammography can often detect a breast cancer before it is large enough to produce any of these symptoms. For this reason, regular mammograms are recommended, making it more likely that breast cancer will be detected at its earliest and most curable stages.

Prognosis

Living With Breast Cancer

Screening

Breast cancer screening saves lives—possibly thousands of lives each year—by helping women get treatment early, when the disease is least dangerous. The earlier breast cancer is detected, the better the prognosis in most cases. The best approach to screening for you depends on personal risk factors such as your age and your family history of breast cancer. For most women, the American Cancer Society recommends:

Women with an average risk of breast cancer should undergo regular screening mammography starting at age 45 years.
Women aged 45 to 54 years should be screened annually.
Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually.
Women should have the opportunity to begin annual screening between the ages of 40 and 44 years.
Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer.

The ACS does not recommend clinical breast examination for breast cancer screening among average-risk women at any age.

If you are at high risk for breast cancer, an MRI may also be recommended every year. Talk to your doctor about your risk factors and the best approach for you. If you have a family history of breast cancer, genetic testing can tell you if you have genes that increase your risk.

This is a quick overview of the diagnostic tests used to detect breast cancer:

Breast Self Exam. Self exams are a proactive way to understand your breasts so that you can notice when something changes—and are done at the same time every month. Most lumps are not cancerous, but if you feel one, it’s a good idea to go see your doctor as soon as possible.

Clinical Breast Exam. A clinical breast exam is done by your doctor or other health care professional, and is a regular part of a check up.

Mammogram. A mammogram is a special type of x-ray that looks for changes in breast tissue and abnormal growths. It is the most important tool in detecting breast cancer, though it is not perfect. Most abnormal mammograms are not breast cancer—though an abnormal result does warrant further testing. There has been some controversy about the rate of false positives on mammograms, and the sometimes invasive testing that results to rule out breast cancer.

Breast Ultrasound or Sonogram. Healthcare professionals may use ultrasound images to check whether a breast lump is a solid mass (which may indicate cancer or another condition, like fibroids) or cyst—a fluid-filled sac that is not cancerous.

MRI of breast. An MRI (magnetic resonance imaging) is another diagnostic tool used to detect breast cancer.

Breast Biopsy. During a biopsy, cells are removed from a suspicious lump or mass to ascertain whether they are cancerous. Biopsies are often done after a person has received an abnormal mammogram result.

Needle Biopsy. This is a minimally invasive breast biopsy that uses a needle and not surgery to obtain cell samples for testing.

Sentinel Node Biopsy. With this type of biopsy, physicians check lymph nodes in your underarm to see if cancer has spread into the lymphatic system—a sign of metastasis.

Ductal Lavage. This test checks cells from the milk ducts for precancerous cells.

Prevention

Although certain genetic factors may not be preventable, there are other precautions you can take to decrease your risk of developing Breast Cancer. If you have a strong family history of breast cancer, Talk to your doctor about whether you should be tested for the breast and Ovarian Cancer gene mutation (BRCA1 and BRCA2). Women who carry this gene are at very high risk for developing breast and ovarian cancers and should be followed closely.

General precautions you can take to reduce your risk of developing breast cancer include:

Talk to Your Doctor About Screenings

Talk to your doctor about the best screening schedule for you. Breast cancer screenings include:

Breast self-exam (BSE)-This a step-by-step examination of your breasts that you do yourself. BSE is done on a regular schedule, usually once a month. Doing BSE has benefits and risks. There is a lack of evidence that this exam can reduce your risk of death from breast cancer. Organizations differ in their recommendations for this screening:
- American Cancer Society (ACS)-optional for women aged 20 and older
- American Congress of Obstetricians and Gynecologists (ACOG)-does recommend BSE
- United States Preventive Services Task Force (USPSTF)-does not recommend BSE
Clinical breast exam-This involves your doctor carefully feeling your breasts and under your arms to check for lumps or other unusual changes. Recommendations for this screening also differ:
- ACS-women aged 20-39 should have the exam every three years, and every year for women aged 40 and older
- ACOG-every year
- USPSTF- no recommendations for this exam
Mammogram-This is a special x-ray of the breast that may be able to find tumors that are too small for you or your doctor to feel. If you have no symptoms and are not at a high risk for breast cancer, the recommendations for this screening include:
- ACS-women aged 40 and older should have the test done annually
- ACOG-women aged 40-49 should have the test every 1-2 years, and every year for women aged 50-74 years
- USPSTF-screening for women younger than 50 years based on individuals informed decision, and every two years for women aged 50-74

If you have a very strong family history of breast cancer and also have the breast and ovarian cancer gene mutation (BRCA1, BRCA2), you may want to talk to your doctor about the possibility of having a mastectomy before cancer deveops.

Limit Exposure to Estrogen When Possible

High levels of estrogen have been linked to the development of breast cancer. For older women, the greatest exposure to estrogen is via postmenopausal hormone replacement. Therefore, you should have a frank conversation with your doctor as to the risks and benefits of estrogen replacement relative to breast cancer.

Other lifestyle factors may also increase your exposure to estrogen. If possible, try to limit these factors:

Overweight after the age of Menopause
Alcohol consumption
Physical inactivity

Estrogen-Blocking Drugs

There are two FDA-approved medicines to prevent invasive breast cancer in high-risk, postmenopausal women. tamoxifen and raloxifene work by blocking estrogen from binding to “estrogen-sensitive” cells, which prevents the cells from growing and dividing. These medicines do however increase your chances of having blood clots and Stroke.

Maintain a Healthy Weight

Being overweight-particularly after menopause-may increase your chance of developing breast cancer. This is due to the fact that after menopause, most of the estrogen in a woman’s body comes from her fat tissue. The more fat on the body, the higher the degree of estrogen.

Limit Alcohol Consumption

Studies have shown that women who drink 2-4 alcoholic drinks daily have a 40% greater risk of developing breast cancer than nondrinkers. This may be due to the fact that alcohol may alter the way a woman’s body metabolizes estrogen and may cause blood estrogen levels to rise, increasing the risk of breast cancer onset.

Do Not Smoke

Tobacco Use Disorder greatly increases your risk of several cancers, including breast cancer.

Exercise

Exercise helps maintain weight and modulates high levels of estrogen. It is also believed that low to moderate levels of exercise may enhance the immune system, which ultimately may slow the growth rate or kill cancer cells. Overall, exercise has many benefits and is recommended for overall health and reducing the risk of breast cancer.

Medication And Treatment

With advancements in research and treatment technologies, the options for breast cancer treatment are as varied as ever. Choosing the right treatment plan involves a careful consideration of the following:

Stage of the breast cancer
Type of breast cancer
Medical history
Personal wants and needs

Because each case of breast cancer is unique, treatment plans can vary greatly from patient to patient. Patients should carefully consider the risks and benefits of each treatment method before choosing a plan. Breast cancer can be treated either locally or systemically.

Local therapy involves the targeted treatment of a specific cancerous site, such as breast tumors or cancerous lymph nodes. Types of local therapy include:

Surgery
Radiation therapy

Systemic (adjuvant) therapy is aimed at the entire body. This type of treatment is useful in eliminating cancer cells that have spread to other areas of the body from the site of the initial tumor. Systemic therapy is also called adjuvant therapy, because it is often used in combination with local therapy. Types of systemic therapy include:

Chemotherapy
Hormone therapy
Targeted therapy

Treatment By Stage

The stage of the breast cancer is one of the most important factors to take into consideration when choosing the proper treatment plan. Treatment for breast cancer is as follows

STAGE 0 (Ductal Carcinoma in Situ, DCIS)

In ductal carcinoma in situ (DCIS), the presence of abnormal cells is limited to the milk ducts and has not yet spread to other areas of the body. This is the earliest and most commonly diagnosed stage of non-invasive breast cancer. Treatment for DCIS typically includes:

Surgery to remove the abnormal tissue. This may be done either as a lumpectomy (removal of part of the breast) or mastectomy (removal of entire breast), though the lumpectomy is the most commonly performed surgery for DCIS patients.
Radiation therapy is most often given in combination with a lumpectomy or mastectomy in order to ensure the death of cancerous cells that may remain in the body after surgery.
Hormone therapy is sometimes given after surgery/radiation treatment to prevent the cancer from recurring and/or progressing. The Susan G. Komen Foundation reports that women who have been treated with lumpectomy and radiation therapy for estrogen receptor-positive (ER+) DCIS may benefit from a five year course of hormone therapy with tamoxifen.

STAGE I & II (Early Breast Cancer)

Stage I breast cancer is characterized by the presence of tumors no larger than 2 centimeters in diameter. In stage IIA breast cancer, tumors are no larger than 2 centimeters in diameter but cancerous growth has been detected in the lymph nodes. Tumors larger than 2 cm but smaller than 5 cm with no evidence of cancerous growth in the lymph nodes are characterized as stage IIB. Treatment for early breast cancer may include:

Surgery to remove either the entire breast (mastectomy) or part of the breast (lumpectomy). These procedures may or may not include the removal of the lymph nodes. Ideal candidates for lumpectomies have not received previous radiation treatment to the cancerous area, have two or less tumors with definable boundaries in a location that will not significantly disfigure the breast, and have no previous health conditions that might complicate surgery. Patients with a family history of breast cancer or those with more than two tumors may be more suited for a mastectomy.
Radiation therapy is often given in combination with surgical procedures to prevent cancer progression and eliminate any remaining cancerous cells. The type and dose of the radiation treatment given largely depends on the location and size of the tumor.
Chemotherapy. Chemotherapy involves the systemic delivery of anti-cancer drugs through the blood stream. Chemotherapy is usually only prescribed in cases tumors are larger than 2 cm in diameter or in especially high-risk cases.
Targeted therapy. HER2 inhibitors may be helpful in the treatment of stage I and II breast cancers that test positive for the presence of a certain growth factor known as HER2. Frequently prescribed HER2 inhibitors include trastuzumab and pertuzumab.
Hormone therapy can be used to treat cases of breast cancer that test positive for specific hormone receptors. Hormone therapy is recommended for patients with breast tumors larger than 3 centimeters or with lymph node tumors larger than 2 centimeters. It may also be recommended for high-risk cases with smaller breast tumors (1.9-2.9 centimeters)

Stage III (Advanced Breast Cancer)

In stage IIIA breast cancer, breast tumors are larger than 5 centimeters in diameter and cancerous growth has been detected in the lymph nodes. Tumors in this stage have not reached the breast skin or chest wall. In stage IIIB breast cancer, tumors have spread to involve the breast skin and/or chest wall. In stage IIIC breast cancer, the cancer has spread deep into the lymph nodes and throughout the breast.

Because stage III breast cancers are more severe than DCIS or stages I & II, the treatment is often more aggressive. Treatment for stage III breast cancers includes:

Chemotherapy. For stage III breast cancers, chemotherapy is often given as neoadjuvant therapy, meaning it is given before surgical intervention in order to shrink tumors and slow the growth of cancerous cells.
Surgery. If cancer responds well to neoadjuvant treatment, it may still be possible to conduct a partial mastectomy at this stage. Full mastectomies are most often the chosen surgical method for late stage III cases and those cases that do not respond to neoadjuvant therapy. In stage III cancers, surgical procedures will most likely involve the removal of lymph nodes.
Radiation therapy may be used after a mastectomy, lumpectomy, or round of chemotherapy. For stage IIIA cancers, radiation is given to the whole breast and possibly nearby lymph nodes. For stages IIIB & IIIC, radiation is given to the breast, chest wall, and lymph nodes.
Hormone therapy may be prescribed to slow the growth of cancerous cells in patients that have received chemotherapy, radiation, or surgical treatments. Premenopausal women most commonly prescribed a 5-year treatment with tamoxifen, which blocks the production of estrogen. Post-menopausal women may consider tamoxifen or an aromatase inhibitor, which lowers the bodily level of estrogen.

Stage IV (Metastatic Breast Cancer)

Stage IV breast cancers have spread beyond the local area of the breast to different parts of the body such as the bones, liver, lungs, or brain. Cancerous sites in a stage IV breast cancer patient that are not in the local area of the breast are known as metasteses.

Since most cases of stage IV breast cases are widespread, surgical options are less likely to be considered given that they may not eliminate the majority of the cancer cells and may put further stress on a patient. Treatment for stage IV cancers is mainly focused on the systemic slow of cancer growth. These include:

Hormone therapy including antiestrogens, which stop the production of estrogen, aromatase inhibitors, which lower the level of estrogen in the body but do not stop its production, and other hormones such as megestrol acetate and fluoxymesterone. Hormone therapy may be accompanied by the removal of the ovaries (oophorectomy), radiation therapy directed at the ovaries, or ovarian suppression using lutenizing hormone-releasing hormone in order to slow the rate of estrogen production by the ovaries.
Chemotherapy using one of four types of chemotherapy agents: alkylating agents, anthracyclines, antimetabolites, and microtubule inhibitors.
Targeted therapy, which work to stop particular cellular functions that lead to the reproduction of cancer cells. Targeted therapy drugs used to treat stage IV breast cancers include:
- Trastuzumab
- Pertuzumab
- Ado-trastuzumab emtansine
- Lapatinib
- Bevacizumab
- Everolimus

Since the task of completely eliminating or curing stage IV breast cancer can be a daunting one, many patients and doctors choose a palliative approach to treatment. In palliative treatment, doctors and patients focus on physical and emotional comfort during treatment rather than aggressive elimination of the disease. This can help a patient relieve stress, anxiety, and pain while they live with their disease.

Palliative care for stage IV breast cancer may include:

Prescription or over the counter pain medications
Chemotherapy or targeted therapies to slow overall cancer growth and prolong life expectancy
Working with a social worker to help a patient adjust to changes advanced stage breast cancer brings to daily life
Alternative treatments such as acupuncture and massage
Joining a support group online or in your community
Psychological therapy sessions
Working with a dietitian or nutritionist to outline a diet and exercise plan
Meditation, prayer, or spiritual counseling

For more information on palliative care, visit the thirdAGE palliative care condition center.

Surgery

Many patients with breast cancer will need surgery either to remove a cancerous tumor from the breast (breast-conserving surgery) or to remove the entire breast (mastectomy).

Breast-Conserving Surgery. In breast-conserving surgery, a cancerous tumor or small portion of the breast is removed while preserving the rest of the breast tissue. Breast-conserving surgery can also be called a lumpectomy, partial mastectomy, or quadrantectomy. Because these procedures do not involve the full removal of the breast, radiation treatment and/or chemotherapy is often given after the surgery to ensure the death of as many cancerous cells as possible. This mode of treatment works best for those with stage I or II cancer, when it is not yet widespread. If the surgeon is unable to remove all of the cancerous tissue with a lumpectomy/partial mastectomy, he or she may recommend a full mastectomy for the patient.

Depending on the size and location of the tumor, there may still be significant deformation of the breast. Reconstructive surgical options are available to help restore the breast to its original form.

Mastectomy. In a mastectomy, the entire breast (and possibly surrounding tissues) is removed. There are several different types of mastectomies:

Simple/total mastectomy, in which the entire breast and nipple are removed. This may be a single mastectomy (one breast is removed) or a double mastectomy (both are removed).
Skin-sparing mastectomy, in which the entire breast is removed but the breast skin (minus the nipple and areola) is left intact.
Nipple-sparing mastectomy, in which the entire breast is removed but the breast skin and nipple is left intact. This is a good option for those who have early stage cancers or those whose cancer is at the periphery of the breast.
Modified radical mastectomy, in which the entire breast is removed in addition to the axilliary lymph nodes and muscles of the chest wall that underlay the breast.

Reconstructive Surgery

If surgery has caused significant changes to the appearance of the breast, a woman may opt for reconstructive surgery to help restore the breast to a more normal appearance. Reconstructive surgeries can either be immediate (done in the same procedure as the mastectomy) or delayed (done during a later surgery). To determine which reconstructive and surgical options are best for you, consult with your doctor.

Radiation Therapy

Radiation therapy bombards the site of the cancer with high energy particles that kill the cancerous cells. There are two major types of radiation therapy:

External beam radiation. In this form of radiation therapy, a machine is used to direct radiation beams at specific points on the body. This may include the breast, lymph nodes, or other parts of the body where the cancer has spread. This type of radiation therapy is most often given five days a week for five to six weeks.

Brachytherapy. In this form of radiation therapy, radiation energy is delivered by radioactive pellets that are left inside the breast or affected area. Brachytherapy may be administered by itself or in combination with other types of surgical and radiation therapies. Types of brachytherapy include:

Insterstitial brachytherapy, in which catheters (hollow tubes) are inserted into the breast and then filled with radioactive pellets throughout the course of several days.
Intracavitary brachytherapy, in which a device is placed in a space in the breast created by breast conserving surgery, and then radioactive pellets are inserted and removed from the device over the course of several days. This method is typically done twice a day for five days.

Chemotherapy

Chemotherapy is a form of cancer treatment in which drugs are administered orally (by mouth) or intravenously (by injection) in order to kill cancer cells throughout the body. Because of its harsh side effects, chemo is given in cycles with a recovery period in between each round. Chemotherapy can be given before surgery (neoadjuvant chemotherapy), after surgery (adjuvant chemotherapy), or in cases where breast cancer has spread to many other parts of the body.

According to the American Cancer Society, the following are among the most commonly prescribed chemotherapy drugs:

Anthracyclines (doxorubicin, epirubicin)
Taxanes (paclitaxel, docetaxel)
Fluorouracil
Cyclophosphamide
Platinum agents (cisplatin, carboplatin)
Trastuzumab (best for HER2 positive cancers)
Pertuzumab (best for HER2 positive cancers)
Vinorelbine
Gemcitabine
Mitoxantrone
Ixabepilone
Eribulin

Hormone Therapy

Estrogen can promote the growth of certain breast cancers if the cells have receptors for the either the estrogen or progesterone hormones. Cancers that do have estrogen/progesterone receptors (known as ER-positive cancers) may respond positively to drugs that block the reception of this hormone.

Drugs that help block the reception of these hormones include:

Estrogen blockers (Tamoxifen, Toremifene, Fulvestrant) which block estrogen reception in breast cancer cells
Aromatase inhibitors (letrozole, anastrozole, exemstance) which block the production of estrogen in post-menopausal women by inhibiting the functioning of the aromatase enzyme.

There are also drugs that can be given in conjunction with hormone-blocking drugs in order to make hormone therapy more effective. These include:

Palbociclib, which helps to slow cancer growth through the inhibition of the CDK4 and CDK6 proteins in the cell.
Everolimus, which works by blocking the mTOR protein which promotes cell divison.

Targeted Therapy

Targeted therapies work on specific genetic mutations that have been shown to influence the development of breast cancer. An example of a targeted therapy would be the use of drugs that target the HER2/neu protein, which promotes growth within cancerous cells. HER2/neu targeting drugs include trastuzumab, pertuzumab, ado-trastuzumab emtansine, and lapatinib.

Because of their specific nature, targeted therapies are only suitable for certain cases of breast cancer. Ask your doctor about whether or not there is a suitable targeted therapy for you.

Pain Management

Treatments for breast cancer may cause considerable pain in some patients. There are many different ways to deal with breast cancer treatment-related pain, including:

Acetaminophen, available either in prescription or over-the-counter strength
Non-steroidal anti-inflammatory drugs (NSAIDs), also available in either prescription or over-the-counter strength
Opioids. Opioid pain-relievers are prescription only and can be much more powerful than acetaminophen or NSAID pain relievers. Popularly prescribed opioids include oxycodone, morphine, hydrocodone, and fentanyl. Opioids are addictive and may cause dependency following treatment. Possible side effects of opioids include nausea, constipation, drowsiness, and fatigue.
COX-2s. This class of drugs is among the more controversial options for pain management due to recent studies suggesting the link between COX-2s and increased risk of heart attack and stroke. Ask your doctor if COX-2s are right for you.
Alternative and complimentary therapies including:
- Acupuncture
- Yoga
- Hypnosis
- Guided imagery
- Meditation
- Tai Chi
- Massage
- Chiropractic therapy
- Medical marijuana
- Prayer/Spiritual therapy
- Local or online support groups

Remission and Reccurence

Remission is the disappearance of the signs and symptoms of cancer. Remission may last anywhere from several weeks to several years, or in the best cases, a lifetime. Often, only some cancer symptoms disappear. This is known as a partial remission. Even though there is a chance cancer may never come back one in remission, it is said to be in remission rather than “cured” because doctors cannot guarantee that it will not recur at a later point. Whether or not you experience remission depends on how your body responds to treatment. In addition to the breast cancer treatments that help a patient achieve remission, there are several things your doctor may recommend to help prevent recurrence:

Hormone therapy, to lessen the presence of hormones that could potentially trigger the growth of cancerous cells.
Maintain a balanced diet and regular exercise to help the body keep in its best physical condition.
Return to the doctor for regular checkups. All breast cancer patients should visit their doctor as frequently as he or she recommends, in order to check for signs of recurrence. If the cancer does reappear, it is important to catch it early. Women undergoing hormone therapy should also schedule regular visits to the gynecologist as hormone therapy increases the risk of cervical cancer.

Recurrence is when cancer signs and symptoms reappear after a period of remission. About 20% of breast cancer patients will experience a recurrence within 10 years of initial treatment. The likelihood of recurrence depends on the type of cancer and the body’s response to treatment. The risk of recurrence increases with higher stages of breast cancer. According to the American Cancer Society, a recent study found that the five year recurrence rate for stage I breast cancer is 7% while the rate for stage II is 11% and 13% for stage III. In that same study, the overall recurrence rates for patients who underwent adjuvant therapy were 11% at 5 years after treatment and 20% at 10 years. Treatment for recurring cancers will most likely differ than the initial treatment, given the changes that occur in the body after the first round of treatment.

Clinical Trials

Breast cancer research is ongoing, and many new drugs and treatment technologies are being developed each year. Before a treatment is FDA approved, it must undergo a series of supervised and controlled tests known as clinical trials. Often, researchers draw on the public for eligible participants in the trials. New treatment methods offer an exciting promise for recovery, but they can also have potentially lethal side effects, especially while still in the clinical trial phase. Speak to your doctor before entering into any clinical trial for breast cancer treatment.

For more information on how to find clinical trials, visit www.BreastCancerTrials.org

Complementary and Alternative Treatment

There are many complimentary techniques that can help manage treatment side effects, reduce overall pain, and help to increase general wellness throughout breast cancer treatment. These include:

Acupuncture. Acupuncture is a form of traditional Chinese medicine in which small needles are inserted at points around the body to restore the flow of bodily energy. It has been proven to reduce overall stress, stimulate the immune system, and reduce bodily inflammation. Acupuncture can be used as either a complimentary therapy (i.e., to reduce side effects of chemotherapy) or as an alternative therapy (to boost the immune system to fight off cancer cells).
Herbal therapies. Because the risk of breast cancer increases with overall body inflammation, the use of anti-inflammatory herbs may help to decrease the risk of developing breast cancer. Anti-inflammatory herbs include:

Turmeric
Green Tea
Echinacea
Goldenseal
Pau D’Arco
Wheatgrass
Berberis family
Huang Qi

Clinical research on the effectiveness of herbal therapies is limited as it is still ongoing. However, many of these herbs have been used in other medicine forms (such as traditional Chinese medicine and ayurvedic medicine) as anti-inflammatory medicines for centuries.

Mind/body techniques, which help to strengthen the mind and body connection in order to reduce anxiety, stress, and improve overall health. These include:

Yoga. Yoga can help to relieve physical symptoms of pain as well as emotional stress and anxiety. Studies have shown that women who do a regular practice of yoga (30-60 minutes, 3-4 times per week) while undergoing treatment for breast cancer experience less fatigue, reduced insomnia, and better overall quality of life than patients who do not practice yoga.
Hypnosis. Hypnotherapy has been shown to reduce pain, nausea, and fatigue in cancer patients.
Guided imagery. In guided imagery, therapists work with patients to create a positive mental picture of their self and disease. Studies have proven this method of alternative treatment to be very effective. In a 2012 study on guided imagery in radiation therapy patients, 86% of the patients described the therapy as helpful and 100% reported that they would recommend the therapy to others.
Meditation. A 2008 study of mindful meditation in cancer patients found that meditation helps to improve the patients’ overall quality of life, decreases the level of stress, and decreases the frequency of physical symptoms.
Tai Chi. Tai Chi is a form of moving meditation in which the body gains strength and balance. Tai chi helps to lower anxiety and lessen stress.

Massage. Massage has been proven to reduce anxiety, pain, and fatigue as well as increase immune function in cancer patients. According to the Pacific College of Oriental Medicine, a 2003 study of 230 cancer patients found that patients who received one 45-minute massage each week for a month felt less pain and took eight fewer doses of pain medication than those who did not receive massages. Massage therapy has also been shown to increase the body’s NK cell level (which are crucial in fighting off cancerous growth) as well as inhibit inflammatory stress hormones such as cortisol. There are many different types of massage that may be beneficial for breast cancer patients. To find a licensed therapeutic masseuse, visit The American Massage Therapy Association.

Chiropractic therapy. Chiropractic therapy focuses on the alignment of the body’s skeletal system in order to promote overall wellness and reduce pain.

Prayer/spiritual therapy. According to the National Cancer Institute, a study of 418 cancer patients found that a higher level of meaning and peace led to a decline in depression and psychological distress. The effects of prayer as a successful complementary treatment is still a topic of debate. While some believe that the power of others praying can produce extraordinary results, a 2006 study published by the American Heart Journal found a slight negative correlation between prayer and recovery. Patients that knew they were receiving prayer experienced a slightly higher rate of complication than those that did not know they were receiving prayer.

Support Groups. Local or online support groups can significantly bolster a patient’s confidence and feeling of security. Studies have long shown that support groups help to decreased stress, anxiety depression, and treatment complications. To find a support group in your area, visit your local hospital or The American Cancer Society.

Care Guide

Questions For Your Doctor

Questions For A Doctor

You have a unique medical history. Therefore, it is essential to talk with your doctor about your personal risk factors and/or experience with breast cancer. By talking openly and regularly with your doctor, you can take an active role in your care.

General Tips for Gathering Information

Here are some tips that will make it easier for you to talk to your doctor:

Bring someone else with you. It helps to have another person hear what is said and think of questions to ask.
Write out your questions ahead of time, so you don’t forget them.
Write down the answers you get, and make sure you understand what you are hearing. Ask for clarification, if necessary.
Don’t be afraid to ask your questions or ask where you can find more information about what you are discussing. You have a right to know.
Ask your doctor if it is acceptable to audio tape the interview session so that you can listen again to the interview and discussion when you are at home. Most qualified doctors will welcome the opportunity to have the session taped.

Specific Questions to Ask Your doctor

About Breast Cancer

What kind of breast cancer do I have?
How will you determine whether the disease has spread?
What lab tests were done on the tumor tissue, and what did they show?
How will these results affect my treatment decision?

About Your Risk of Developing Breast Cancer

Based on my medical and family history, and symptoms, am I at an increased risk for developing breast cancer? Remember, breast cancer very often occurs in patients with no distinct risk factors.
Are other members in my family at an increased risk for developing breast cancer?
What can we do to manage that risk? Is prophylactic mastectomy appropriate considering my risk profile?

About Treatment Options

If you have been diagnosed with breast cancer, you should first try to get at least one other opinion from another doctor. If both you and your doctor agree with the diagnosis, you may want to get specific information about the surgery, chemotherapy, hormonal therapy, and the radiation therapy. No one doctor will likely answer all of your questions about all of these therapies, but he should be able to give you some general pointers. Additionally, you should get very specific information from the individual specialist.

Surgery

What kinds of surgery should I consider? Is breast-sparing surgery an option for me?
What are the risks of surgery?
Do I need to have my lymph nodes removed? If so, how many?
- If my lymph nodes are removed, what can I do to prevent lymphedema?
Where will the scars be? What will they look like?
If I decide to have breast reconstruction, how and when can that be done? Can you suggest a plastic surgeon?

Chemotherapy

Will I need chemotherapy?
What drugs will I be taking?
What side effects should I expect?
What are the risks?
When will my treatments begin and end?
Are there certain foods to avoid (ie, fresh fruits and vegetables)?
Do I need to avoid my grandchildren if they get sick?

Radiation

Will I need radiation treatment? If so, will it be external or internal?
How long will the radiation treatments last?
How often will I have them?
What side effects should I expect?
What are the risks of radiation therapy?
Are there certain activities (eg, smoking) or certain herbs adn supplements that I should avoid during my radiation? If so, why?

About Lifestyle Changes

How will I feel after the operation? How will my daily activity be affected?
Will I have to do special exercises?
How long will it take for me to resume my normal activities?
Will I need a special diet?
Are there any alternative or complementary therapies I should consider?

About Outlook

What are the chances that the breast tumor will recur?
Can you recommend a support group or a counselor for me and my family?
What is my prognosis?
How will I feel during therapy?
What physiological changes should I expect? How will they affect my fertility and my sexual life?
Are there any clinical trials that are being conducted that may be of interest to me?

Breast Cancer

What Is Breast Cancer

What Causes Breast Cancer

Risk Factors For Breast Cancer

Diagnosing Breast Cancer

Symptoms of Breast Cancer

Prognosis

Living With Breast Cancer

Screening

Prevention

Medication And Treatment

Treatment By Stage

Surgery

Radiation Therapy

Chemotherapy

Hormone Therapy

Targeted Therapy

Pain Management

Remission and Reccurence

Clinical Trials

Complementary and Alternative Treatment

Care Guide

Questions For Your Doctor

Questions For A Doctor

Resources

Featured Slideshow

Featured Video

Health Recipes

Featured Blogs

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