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The REAL Guide to Breast Cancer

Every woman is at risk for breast cancer and should raise their awareness about the symptoms and treatment of this disease, the most common malignancy affecting women in North America and Europe. Breast cancer is the second leading cause of cancer death in American women behind lung cancer. The lifetime risk of any particular woman getting breast cancer is about 1 in 8 although the lifetime risk of dying from breast cancer is much lower at 1 in 28



What Is Breast Cancer?

Breast cancer is a type of uncontrolled growth of abnormal cells that can develop in one of several different areas of the breast, including the ducts that carry milk to the nipple, the breast's lobules (small sacs that produce milk) and the breast's nonglandular tissue.

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Risk Factors for Breast Cancer

All women are at risk for developing breast cancer. However, there are certain factors that may increase a woman’s chance of getting the disease. These include:

Age
The number one risk factor for developing breast cancer is age. Risk increases as a woman ages. Three out of four breast cancers occur in women over age 50, and the risk is highest for women over age 60.

Race
Breast cancer occurs more often in Caucasian women than African American or Asian women.

Personal history of breast cancer
Women who have had breast cancer face an increased risk of developing breast cancer in the other breast.

Family history of cancer
A woman is at greater risk if her mother, sister or daughter had breast cancer, particularly before menopause. Also, risk is higher if two or more other close relatives, such as aunts or cousins, have a history of breast cancer, especially at a young age. About 5 to 10 percent of women with breast cancer have a hereditary form of the disease.

Certain breast changes
Women with a diagnosis of atypical hyperplasia (noncancerous condition in which cells have abnormal features and are increased in number) or lobular carcinoma in situ (abnormal cells found in the lobules of the breast) or having had two or more breast biopsies for other benign conditions are at increased risk for developing breast cancer.

Childbearing
Women having their first child after age 30 and women having no children have a greater risk than those having a first child at an earlier age.


Increased length of exposure to estrogen influences risk. This includes women who began menstrual periods at an early age, entered menopause at a late age, or women who take hormone replacement therapy for an extended period of time.

Breast density
Cancer is more likely to occur in breasts with greater dense tissue, than in breasts with greater fatty tissue. Also, dense, glandular breasts make identifying abnormalities on a mammogram more difficult.


Women whose breasts were exposed to radiation therapy before age 30, especially those treated with radiation for Hodgkin’s disease, are at increased risk for breast cancer.

Lifestyle factors
Some studies suggest that certain lifestyle behaviors can put women at greater risk for developing breast cancer. These include: alcohol consumption; lack of exercise and weight gain, particularly in postmenopausal women; and working at night under artificial lighting.

Most women who develop breast cancer have none of the risk factors listed above, other than the risk that comes with growing older.

Signs and Symptoms of Breast Cancer

Although widespread use of screening mammography has increased the number of breast cancers found before they cause any symptoms, some breast cancers are not found by mammography, either because the test was not done or because even under ideal conditions mammography cannot find every breast cancer.

The most common sign of breast cancer is a new lump or mass. A mass that is painless, hard, and has irregular edges is more likely to be cancerous, but some rare cancers are tender, soft, and rounded. For this reason, it is important that any new breast mass or lump be checked by a health care provider with experience in diagnosis of breast diseases.

Other signs of breast cancer include a generalized swelling of part of a breast (even if no distinct lump is felt), skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk. Sometimes a breast cancer can spread to underarm lymph nodes that are obviously enlarged, even before the original tumor in the breast tissue is large enough to be felt.

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Diagnosis of Breast Cancer

When a breast lump or abnormal area shows up on a mammogram, additional testing is needed to rule out cancer. In many cases, cancer can be ruled out by additional mammograms but in some instances a biopsy is needed to check the cells. A biopsy is where some of the suspicious cells are removed from the breast and checked under a microscope. Having a biopsy is frightening to most women, but it is important to keep in mind that most women who have them (4 out of 5) do not have cancer.

There are two types of biopsies: needle biopsies and surgical biopsies.

A needle biopsy is where a thin, hollow needle is inserted into the breast and a sample of abnormal tissue or cells is removed. It can be used to test different types of abnormal areas, including those that can be felt (palpable masses) and those that are only visible on a mammogram (nonpalpable lesions).

A surgical biopsy is considered the most accurate way to diagnose breast cancer, but studies have shown that a core needle biopsy is nearly as accurate at detecting breast cancer and it is far less evasive. Because a surgical biopsy is so evasive, it is typically not a woman’s first choice for a diagnosis. A surgical biopsy is where the entire abnormal area, or a large portion if it is too large, is removed and tested for cancer. The two types of surgical biopsies are excisional, where the entire suspicious area plus the surrounding normal tissue is removed and incisional, where only a portion of the lump is removed.



Treatment for Breast Cancer

The mainstay of breast cancer treatment is surgery with adjuvant chemotherapy and/or radiotherapy.

Depending on the staging and type of the tumour, just a lumpectomy (removal of the lump only) may be all that is necessary or removal of larger amounts of breast tissue may be necessary. Surgical removal of the entire breast is called mastectomy.

Standard practice requires that the surgeon must establish that the tissue removed in the operation has margins clear of cancer, indicating that the cancer has been completely excised. If the tissue removed does not have clear margins, then further operations to remove more tissue may be necessary. This may sometimes require removal of part of the pectoralis major muscle which is the main muscle of the anterior chest wall.

During the operation, the lymph nodes in the axilla are also considered for removal. In the past, large axillary operations took out 10-40 nodes to establish whether cancer had spread - this had the unfortunate side effect of frequently causing lymphedema of the arm on the same side as the removal of this many lymph nodes affected lymphatic drainage. More recently the technique of sentinel lymph node dissection has become popular as it requires the removal of far fewer lymph nodes, resulting in fewer side effects.

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Coming to Terms with Breast Cancer

Coming to terms with your breast cancer is a very difficult process. There are steps you can take to make sure your experience is as comfortable as possible:

· Ask a spouse, lover, family member or friend to sit with you during treatments

· Inform your doctor of any physical or emotional changes you experience

· Ask questions, even if you feel silly or embarrassed

· Take a break—give your body time to heal

· Seek different opinions regarding diagnosis and treatment options

· Join a support group

· Remember that though many women are affected by breast cancer, more women are treated and cured every day.

Y! Health Breast Cancer News

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