Breast cancer treatment

• History will be of a lump or thickening in the breast or armpit, a change in the size or shape of the breast, dimpling or puckering of the skin of the breast, a discharge from the nipple, especially if it is bloody, or changes in the color or feel of the skin of the breast or nipple.
• Physical exam of the breast is done to confirm any of the above findings. The armpits are examined for any evidence of breast mass or enlarged lymph nodes; the neck is also examined for enlarged lymph nodes. A nipple discharge might be produced by gently squeezing the nipples. In early cases, physical examination of the breasts may be negative.
• Tests: Women with any suspicious breast changes may be referred for more detailed examination by mammography or ultrasound. Mammography can focus on an area of change and help decide if there is suspicion of cancer, and if further evaluation is necessary. Ultrasound can help discriminate between a solid and a fluid-filled lump, with solid lesions more likely to require surgical evaluation and possible biopsy. Biopsies can be either an open, surgical biopsy, which removes the entire lump, or a needle biopsy in which samples of cells are removed from the lesion. In both cases, the biopsy sample is examined microscopically to determine if breast cancer cells are present.

Three screening methods are currently recommended to women eighteen years and older to detect breast cancer in its earliest, most treatable stage. Specifically, monthly self-exams and annual breast exams are recommended for women 18 to 40 years of age. Women aged 40 to 49 are encouraged to continue these exams and to begin having mammograms every year to two years; annual mammography is recommended for women 50 years and older, combined with monthly self exams and annual exams by a health care professional.

No symptoms in early stages, but pre-symptom stages may be detected by mammogram.

• Swelling or lump in the breast.
• Vague discomfort in the breast without true pain.
• Retraction of the nipple.
• Distorted breast contour.
• Dimpled or pitted skin in the breast.
• Enlarged nodes under the arm (late stages).
• Bloody discharge from the nipple (rare).

Unknown.

• Women over 50.
• Women who have not had children or who conceived in the late fertile years.
• Family history of breast cancer (especially mother or sister).
• Previous benign tumors of the breast (fibrocystic disease).
• Early menstruation; late menopause; first pregnancy after age 30.
• Previous breast cancer in one breast.
• Radiation exposure.
• Patients with endometrial or ovarian cancer.
• Studies of estrogen replacement therapy are inconsistent and not conclusive regarding their role in increasing breast cancer risk.

• Monthly self-examination of breasts for signs of cancer.
• Obtain professional examinations regularly.
• Obtain a baseline mammogram between ages 35 to 40. Have mammograms every 1 to 2 years to age 49 and annually after 50.
• Eat a well-balanced diet that is low in fat. (Studies are inconclusive about a high-fat diet and breast cancer risks in humans).
• If you are pregnant, consider breast-feeding your baby. Women who have breast-fed have a lower incidence of breast cancer.
• A drug, such as tamoxifen, may be prescribed for women at high risk for breast cancer.

Breast cancer is curable if diagnosed and treated early. The 10-year survival rate is related to the clinical stage of the disease at diagnosis.

• Spread to vital organs if not treated early.
• Adverse reactions to anticancer drugs and radiation.
• Postsurgical complications (wound infection, limited shoulder motion).

• You or a family member discovers a lump or other change in the breast.
• The following occur after treatment or surgery:
  • Nausea or vomiting, fever, swelling in the arm.
  • Pain that is not controlled by medication.
• New, unexplained symptoms develop. Drugs used in treatment may produce side effects.