breast cancer detection, symptoms, diagnosis, and treatment

Breast cancer is the most common form of cancer among American women, and almost everyone knows at least one person who has been treated for it.

More than 180,000 women are diagnosed with breast cancer each year. The Breast Cancer Guide is for helping patients with breast cancer and their families and friends better understand this disease. We hope others will read it as well to learn more about breast cancer.

This website discusses screening and early detection, symptoms, diagnosis, treatment, and rehabilitation. It also has information to help patients cope with breast cancer.

Research has led to progress against breast cancer — better treatments, a lower chance of death from the disease, and improved quality of life. Through research, knowledge about breast cancer keeps increasing. Scientists are learning more about what causes breast cancer and are exploring new ways to prevent, detect, diagnose, and treat this disease.

Understanding Breast Cancer

Understanding Breast Cancer

Cancer is a group of many related diseases that begin in cells, the body’s basic unit of life. To understand cancer, it is helpful to know what happens when normal cells become cancerous.

The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes, however, cells keep dividing when new cells are not needed. These extra cells form a mass of tissue, called a growth or tumor. Tumors can be benign or malignant.

  • Benign tumors are not cancer. They can usually be removed, and in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body. Most important, benign breast tumors are not a threat to life.
  • Malignant tumors are cancer. Cells in these tumors are abnormal. They divide without control or order, and they can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or the lymphatic system. That is how cancer spreads from the original (primary) cancer site to form new tumors in other organs. The spread of cancer is called metastasis.

When cancer arises in breast tissue and spreads (metastasizes) outside the breast, cancer cells are often found in the lymph nodes under the arm (axillary lymph nodes). If the cancer has reached these nodes, it means that cancer cells may have spread to other parts of the body — other lymph nodes and other organs, such as the bones, liver, or lungs. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the brain, the cancer cells in the brain are actually breast cancer cells. The disease is called metastatic breast cancer. (It is not brain cancer.) Doctors sometimes call this “distant” disease.

Breast Cancer Risk Factors

Breast Cancer Risk Factors

The exact causes of breast cancer are not known. However, studies show that the risk of breast cancer increases as a woman gets older. This disease is very uncommon in women under the age of 35. Most breast cancers occur in women over the age of 50, and the risk is especially high for women over age 60. Also, breast cancer occurs more often in white women than African American or Asian women.

Research has shown that the following conditions increase a woman’s chances of getting breast cancer:

  • Personal history of breast cancer – Women who have had breast cancer face an increased risk of getting breast cancer in their other breast.
  • Family history – A woman’s risk for developing breast cancer increases if her mother, sister, or daughter had breast cancer, especially at a young age.
  • Certain breast changes – Having a diagnosis of atypical hyperplasia or lobular carcinoma in situ (LCIS) may increase a woman’s risk for developing cancer.
  • Genetic alterations – Changes in certain genes increase the risk of breast cancer. In families in which many women have had the disease, gene testing can sometimes show the presence of specific genetic changes that increase the risk of breast cancer. Doctors may suggest ways to try to delay or prevent breast cancer, or to improve the detection of this disease in women who have these changes in their genes.

Other factors associated with an increased risk for breast cancer include:

  • Estrogen – Evidence suggests that the longer a woman is exposed to estrogen (estrogen made by the body, taken as a drug, or delivered by a patch), the more likely she is to develop breast cancer. For example, the risk is somewhat increased among women who began menstruation at an early age (before age 12), experienced menopause late (after age 55), never had children, or took hormone replacement therapy for long periods of time. Each of these factors increases the amount of time a woman’s body is exposed to estrogen.
  • Late childbearing – Women who have their first child late (after about age 30) have a greater chance of developing breast cancer than women who have a child at a younger age.
  • Breast density – Breasts that have a high proportion of lobular and ductal tissue appear dense on mammograms. Breast cancers nearly always develop in lobular or ductal tissue (not fatty tissue). That’s why cancer is more likely to occur in breasts that have a lot of lobular and ductal tissue (that is, dense tissue) than in breasts with a lot of fatty tissue. In addition, when breasts are dense, it is more difficult for doctors to see abnormal areas on a mammogram.
  • Radiation therapy – Women whose breasts were exposed to radiation during radiation therapy before age 30, especially those who were treated with radiation for Hodgkin’s disease, are at an increased risk for developing breast cancer. Studies show that the younger a woman was when she received her treatment, the higher her risk for developing breast cancer later in life.
  • Alcohol – Some studies suggest a slightly higher risk of breast cancer among women who drink alcohol.

Most women who develop breast cancer have none of the risk factors listed above, other than the risk that comes with growing older. Scientists are conducting research into the causes of breast cancer to learn more about risk factors and ways of preventing this disease.

Detecting Breast Cancer

Women should talk with their doctor about factors that can increase their chance of getting breast cancer. Women of any age who are at higher risk for developing this disease should ask their doctor when to start and how often to be checked for breast cancer. Breast cancer screening has been shown to decrease the risk of dying from breast cancer.

Women can take an active part in the early detection of breast cancer by having regularly scheduled screening mammograms and clinical breast exams (breast exams performed by health professionals). Some women also perform breast self-exams.

A screening mammogram is the best tool available for finding breast cancer early, before symptoms appear. A mammogram is a special kind of x-ray. Screening mammograms are used to look for breast changes in women who have no signs of breast cancer.

Mammograms can often detect a breast lump before it can be felt. Also, a mammogram can show small deposits of calcium in the breast. Although most calcium deposits are benign, a cluster of very tiny specks of calcium (called microcalcifications) may be an early sign of cancer.

If an area of the breast looks suspicious on the screening mammogram, additional (diagnostic) mammograms may be needed. Depending on the results, the doctor may advise the woman to have a biopsy.

Although mammograms are the best way to find breast abnormalities early, they do have some limitations. A mammogram may miss some cancers that are present (false negative) or may find things that turn out not to be cancer (false positive). And detecting a tumor early does not guarantee that a woman’s life will be saved. Some fast-growing breast cancers may already have spread to other parts of the body before being detected.

Nevertheless, studies show that mammograms reduce the risk of dying from breast cancer. Most doctors recommend that women in their forties and older have mammograms regularly, every 1 to 2 years.

Some women perform monthly breast self-exams to check for any changes in their breasts. When doing a breast self-exam, it’s important to remember that each woman’s breasts are different, and that changes can occur because of aging, the menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for the breasts to feel a little lumpy and uneven. Also, it is common for a woman’s breasts to be swollen and tender right before or during her menstrual period. Women in their forties and older should be aware that a monthly breast self-exam is not a substitute for regularly scheduled screening mammograms and clinical breast exams by a health professional.

Recognizing Symptoms

Early breast cancer usually does not cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for:

  • A lump or thickening in or near the breast or in the underarm area;
    A change in the size or shape of the breast;
  • Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast;
  • Ridges or pitting of the breast (the skin looks like the skin of an orange); or
  • A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly).

A woman should see her doctor about any symptoms like these. Most often, they are not cancer, but it’s important to check with the doctor so that any problems can be diagnosed and treated as early as possible.

Benign Breast Conditions

Benign Breast Conditions
Most common breast conditions. Mastalgia. Nipple discharge. Benign breast masses. Sensitive topic for women! Fears and concerns re: breast cancer first and foremost.

Common benign breast changes fall into several broad categories. These include generalized breast changes, solitary lumps, nipple discharge, and infection and/or inflammation.

Generalized Breast Changes

Generalized breast lumpiness is known by several names, including fibrocystic disease changes and benign breast disease. Such lumpiness, which is sometimes described as “ropy” or “granular,” can often be felt in the area around the nipple and areola and in the upper-outer part of the breast. Such lumpiness may become more obvious as a woman approaches middle age and the milk-producing glandular tissue of her breasts increasingly gives way to soft, fatty tissue. Unless she is taking replacement hormones, this type of lumpiness generally disappears for good after menopause.

The menstrual cycle also brings cyclic breast changes. Many women experience swelling, tenderness, and pain before and sometimes during their periods. At the same time, one or more lumps or a feeling of increased lumpiness may develop because of extra fluid collecting in the breast tissue. These lumps normally go away by the end of the period.

During pregnancy, the milk-producing glands become swollen and the breasts may feel lumpier than usual. Although very uncommon, breast cancer has been diagnosed during pregnancy. If you have any questions about how your breasts feel or look, talk to your doctor.

Solitary Lumps

Benign breast conditions also include several types of distinct, solitary lumps. Such lumps, which can appear at any time, may be large or small, soft or rubbery, fluid-filled or solid.

Cysts are fluid-filled sacs. They occur most often in women ages 35 to 50, and they often enlarge and become tender and painful just before the menstrual period. They are usually found in both breasts. Some cysts are so small they cannot be felt; rarely, cysts may be several inches across. Cysts are usually treated by observation or by fine needle aspiration. They show up clearly on ultrasound.

Fibroadenomas are solid and round benign tumors that are made up of both structural (fibro) and glandular (adenoma) tissues. Usually, these lumps are painless and found by the woman herself. They feel rubbery and can easily be moved around. Fibroadenomas are the most common type of tumors in women in their late teens and early twenties, and they occur twice as often in African-American women as in other American women.

Fat necrosis is the name given to painless, round, and firm lumps formed by damaged and disintegrating fatty tissues. This condition typically occurs in obese women with very large breasts. It often develops in response to a bruise or blow to the breast, even though the woman may not remember the specific injury. Sometimes the skin around the lumps looks red or bruised. Fat necrosis can easily be mistaken for cancer, so such lumps are removed in a surgical biopsy.

Sclerosing adenosis is a benign condition involving the excessive growth of tissues in the breast’s lobules. It frequently causes breast pain. Usually the changes are microscopic, but adenosis can produce lumps, and it can show up on a mammogram, often as calcifications. Short of biopsy, adenosis can be difficult to distinguish from cancer. The usual approach is surgical biopsy, which furnishes both diagnosis and treatment.

Nipple Discharge

Breast Cancer - Nipple Discharge

Nipple discharge accompanies some benign breast conditions. Since the breast is a gland, secretions from the nipple of a mature woman are not unusual, nor even necessarily a sign of disease. For example, small amounts of discharge commonly occur in women taking birth control pills or certain other medications, including sedatives and tranquilizers. If the discharge is being caused by a disease, the disease is more likely to be benign than cancerous.

When Cancer Is Found

The most common type of breast cancer is ductal carcinoma. It begins in the lining of the ducts. Another type, called lobular carcinoma, arises in the lobules. When cancer is found, the pathologist can tell what kind of cancer it is (whether it began in a duct or a lobule) and whether it is invasive (has invaded nearby tissues in the breast).

Special lab tests of the tissue help the doctor learn more about the cancer. For example, hormone receptor tests can help determine whether hormones help the cancer to grow. If test results show that hormones do affect the cancer’s growth (a positive test result), the cancer is likely to respond to hormonal therapy. This therapy deprives the cancer cells of estrogen. More information about hormonal therapy can be found in the “Planning Treatment” section.

Other tests are sometimes done to help the doctor predict whether the cancer is likely to progress. For example, the doctor may order x-rays and lab tests. Sometimes a sample of breast tissue is checked for a gene that is associated with a higher risk that the breast cancer will come back. The doctor may also order special exams of the bones, liver, or lungs because breast cancer may spread to these areas.

If the diagnosis is breast cancer, a woman may want to ask these questions:

  • What kind of breast cancer do I have?
  • What did the hormone receptor test show? What other lab tests were done on the tumor tissue, and what did they show?
  • How will you determine whether the disease has spread?
  • How will this information help in deciding what type of treatment or further tests will be best for me?

Breast Cancer Treatment Options

Breast Cancer Treatment Options

Women with breast cancer now have many treatment options. Many women want to learn all they can about the disease and their treatment choices so that they can take an active part in decisions about their medical care. They are likely to have many questions and concerns about their treatment options.

The doctor is the best person to answer questions about treatment for a particular patient: what her treatment choices are and how successful her treatment is expected to be. Most patients also want to know how they will look after treatment and whether they will have to change their normal activities. A woman should not feel that she needs to ask all her questions or understand all the answers at once. She will have many chances to ask the doctor to explain things that are not clear and to ask for more information.

A woman’s treatment options depend on a number of factors. These factors include her age and menopausal status; her general health; the size and location of the tumor and the stage of the cancer; the results of lab tests; and the size of her breast. Certain features of the tumor cells (such as whether they depend on hormones to grow) are also considered. In most cases, the most important factor is the stage of the disease. The stage is based on the size of the tumor and whether the cancer has spread. The following are brief descriptions of the stages of breast cancer and the treatments most often used for each stage. (Other treatments may sometimes be appropriate.)

  • Stage 0 is sometimes called noninvasive carcinoma or carcinoma in situ.
    1. Lobular carcinoma in situ (LCIS) refers to abnormal cells in the lining of a lobule. These abnormal cells seldom become invasive cancer. However, their presence is a sign that a woman has an increased risk of developing breast cancer. This risk of cancer is increased for both breasts. Some women with LCIS may take a drug called tamoxifen, which can reduce the risk of developing breast cancer. Others may take part in studies of other promising new preventive treatments. Some women may choose not to have treatment, but to return to the doctor regularly for checkups. And, occasionally, women with LCIS may decide to have surgery to remove both breasts to try to prevent cancer from developing. (In most cases, removal of underarm lymph nodes is not necessary.)
    2. Ductal carcinoma in situ (DCIS) refers to abnormal cells in the lining of a duct. DCIS is also called intraductal carcinoma. The abnormal cells have not spread beyond the duct to invade the surrounding breast tissue. However, women with DCIS are at an increased risk of getting invasive breast cancer. Some women with DCIS have breast-sparing surgery followed by radiation therapy. Or they may choose to have a mastectomy, with or without breast reconstruction (plastic surgery) to rebuild the breast. Underarm lymph nodes are not usually removed. Also, women with DCIS may want to talk with their doctor about tamoxifen to reduce the risk of developing invasive breast cancer.
  • Stage I and stage II are early stages of breast cancer in which the cancer has spread beyond the lobe or duct and invaded nearby tissue. Stage I means that the tumor is no more than about an inch across and cancer cells have not spread beyond the breast. Stage II means one of the following: the tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm; or the tumor is between 1 and 2 inches (with or without spread to the lymph nodes under the arm); or the tumor is larger than 2 inches but has not spread to the lymph nodes under the arm.

    Women with early stage breast cancer may have breast-sparing surgery followed by radiation therapy to the breast, or they may have a mastectomy, with or without breast reconstruction to rebuild the breast. These approaches are equally effective in treating early stage breast cancer. (Sometimes radiation therapy is also given after mastectomy.)

    The choice of breast-sparing surgery or mastectomy depends mostly on the size and location of the tumor, the size of the woman’s breast, certain features of the cancer, and how the woman feels about preserving her breast. With either approach, lymph nodes under the arm usually are removed.

    Many women with stage I and most with stage II breast cancer have chemotherapy and/or hormonal therapy after primary treatment with surgery or surgery and radiation therapy. This added treatment is called adjuvant therapy. If the systemic therapy is given to shrink the tumor before surgery, this is called neoadjuvant therapy. Systemic treatment is given to try to destroy any remaining cancer cells and prevent the cancer from recurring, or coming back, in the breast or elsewhere.

  • Stage III is also called locally advanced cancer. In this stage, the tumor in the breast is large (more than 2 inches across) and the cancer has spread to the underarm lymph nodes; or the cancer is extensive in the underarm lymph nodes; or the cancer has spread to lymph nodes near the breastbone or to other tissues near the breast.
    Inflammatory breast cancer is a type of locally advanced breast cancer. In this type of cancer the breast looks red and swollen (or inflamed) because cancer cells block the lymph vessels in the skin of the breast.
    Patients with stage III breast cancer usually have both local treatment to remove or destroy the cancer in the breast and systemic treatment to stop the disease from spreading. The local treatment may be surgery and/or radiation therapy to the breast and underarm. The systemic treatment may be chemotherapy, hormonal therapy, or both. Systemic therapy may be given before local therapy to shrink the tumor or afterward to prevent the disease from recurring in the breast or elsewhere.
  • Stage IV is metastatic cancer. The cancer has spread beyond the breast and underarm lymph nodes to other parts of the body.

    Women who have stage IV breast cancer receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. They may have surgery or radiation therapy to control the cancer in the breast. Radiation may also be useful to control tumors in other parts of the body.
  • Recurrent cancer means the disease has come back in spite of the initial treatment. Even when a tumor in the breast seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment.

    Most recurrences appear within the first 2 or 3 years after treatment, but breast cancer can recur many years later.

    Cancer that returns only in the area of the surgery is called a local recurrence. If the disease returns in another part of the body, the distant recurrence is called metastatic breast cancer. The patient may have one type of treatment or a combination of treatments for recurrent cancer.

Breast Reconstruction

Breast Reconstruction

After a mastectomy, some women decide to wear a breast form (prosthesis). Others prefer to have breast reconstruction, either at the same time as the mastectomy or later on. Each option has its pros and cons, and what is right for one woman may not be right for another. What is important is that nearly every woman treated for breast cancer has choices. It is best to consult with a plastic surgeon before the mastectomy, even if reconstruction will be considered later on.

Various procedures are used to reconstruct the breast. Some use implants (either saline or silicone); others use tissue moved from another part of the woman’s body. The safety of silicone breast implants has been under review by the Food and Drug Administration (FDA) for several years. Women interested in having silicone implants should talk with their doctor about the FDA’s findings and the availability of silicone implants. Which type of reconstruction is best depends on a woman’s age, body type, and the type of surgery she had. A woman should ask the plastic surgeon to explain the risks and benefits of each type of reconstruction.

Rehabilitation

Rehabilitation is a very important part of breast cancer treatment. The health care team makes every effort to help women return to their normal activities as soon as possible. Recovery will be different for each woman, depending on the extent of the disease, the type of treatment, and other factors.

Exercising the arm and shoulder after surgery can help a woman regain motion and strength in these areas. It can also reduce pain and stiffness in her neck and back. Carefully planned exercises should be started as soon as the doctor says the woman is ready, often within a day or so after surgery. Exercising begins slowly and gently and can even be done in bed. Gradually, exercising can be more active, and regular exercise becomes part of a woman’s normal routine. (Women who have a mastectomy and immediate breast reconstruction need special exercises, which the doctor or nurse will explain.)

Often, lymphedema after surgery can be prevented or reduced with certain exercises and by resting with the arm propped up on a pillow. If lymphedema occurs, the doctor may suggest exercises and other ways to deal with this problem. For example, some women with lymphedema wear an elastic sleeve or use an elastic cuff to improve lymph circulation. The doctor also may suggest other approaches, such as medication, manual lymph drainage (massage), or use of a machine that gently compresses the arm. The woman may be referred to a physical therapist or another specialist.

Breast Cancer Prevention

Breast Cancer Prevention
Breast Cancer Prevention

Scientists are trying to learn more about factors that increase the risk of developing this disease. For example, they are looking at whether the risk of breast cancer might be affected by environmental factors. So far, scientists do not have enough information to know whether any factors in the environment increase the risk of this disease.

Some aspects of a woman’s lifestyle may affect her chances of developing breast cancer. For example, recent studies suggest that regular exercise may decrease the risk in younger women. Also, some evidence suggests a link between diet and breast cancer. Ongoing studies are looking at ways to prevent breast cancer through changes in diet or with dietary supplements. However, it is not yet known whether specific dietary changes will actually prevent breast cancer. These are active areas of research.

Scientists are trying to learn whether having a miscarriage or an abortion increases the risk of breast cancer. Thus far, studies have produced conflicting results, and this question is still unresolved.

Research has led to the identification of changes (mutations) in certain genes that increase the risk of developing breast cancer. Women with a strong family history of breast cancer may choose to have a blood test to see if they have inherited a change in the BRCA1 or BRCA2 gene. Women who are concerned about an inherited risk for breast cancer should talk to their doctor. The doctor may suggest seeing a health professional trained in genetics. Genetic counseling can help a woman decide whether testing would be appropriate for her. Also, counseling before and after testing helps women understand and deal with the possible results of a genetic test. Counseling can also help with concerns about employment or about health, life, and disability insurance.

Glossary of Terms

Abscess: A pocket of pus that forms as the body’s defenses attempt to wall off infection-causing germs.

Areola: The colored tissue that encircles the nipple.

Aspiration: Removal of fluid from a cyst or cells from a lump, using a needle and syringe.

Benign: Not cancerous; cannot invade neighboring tissues or spread to other parts of the body.

Biopsy: The removal of a sample of tissue or cells for examination under a microscope for purposes of diagnosis.

Breast density: Glandular tissue in the breast common in younger women, making it difficult for mammography to detect breast cancer.

Breast implants: Silicone rubber sacs, which are filled with silicone gel or sterile saline, used for breast reconstruction after mastectomy.

Calcifications: Small deposits of calcium in tissue, which can be seen on mammograms.

Cancer: A general name for more than 100 diseases in which abnormal cells grow out of control. Cancer cells can invade and destroy healthy tissues, and they can spread through the bloodstream and the lymphatic system to other parts of the body.

Carcinoma: Cancer that begins in tissues lining or covering the surfaces (epithelial tissues) of organs, glands, or other body structures. Most cancers are carcinomas.

Carcinoma in situ: Cancer that is confined to the cells where it began, and has not spread into surrounding tissues.

Chemoprevention: The use of drugs or vitamins to prevent cancer in people who have precancerous conditions or a high risk of cancer, or to prevent the recurrence of cancer in people who have already been treated for it.

Clinical breast exam: A physical examination by a doctor or nurse of the breast, underarm, and collarbone area, first on one side, then on the other.

Cyclic breast changes: Normal tissue changes that occur in response to the changing levels of female hormones during the menstrual cycle. Cyclic breast changes can produce swelling, tenderness, and pain.

Cyst: Fluid-filled sac. Breast cysts are benign.

Ducts: Channels that carry body fluids. Breast ducts transport milk from the breast’s lobules out to the nipple.

Ductal carcinoma in situ (DCIS): Cancer that is confined to the ducts of the breast tissue.

False negative (mammograms): Breast x-rays that miss cancer when it is present.

False positive (mammograms): Breast x-rays that indicate breast cancer is present when the disease is truly absent.

Fat necrosis: Lumps of fatty material that form in response to a bruise or blow to the breast.

Fibrocystic disease: See Generalized breast lumpiness.

Fine needle aspiration: The use of a slender needle to remove fluid from a cyst or clusters of cells from a solid lump.

Frozen section: A sliver of frozen biopsy tissue. A frozen section provides a quick preliminary diagnosis but is not 100 percent reliable.

Generalized breast lumpiness: Breast irregularities and lumpiness, commonplace and noncancerous. Sometimes called “fibrocystic disease” or “benign breast disease.”

Genetic change: An alteration in a segment of DNA, which can disturb a gene’s behavior and sometimes leads to disease.

Higher risk (for breast cancer): A measure of the chances of getting breast cancer when factor(s) known to be associated with the disease are present.

Hormone replacement therapy: Hormone-containing medications taken to offset the symptoms and other effects of the hormone loss that accompanies menopause.

Hormones: Chemicals produced by various glands in the body, which produce specific effects on specific target organs and tissues.

Hyperplasia: Excessive growth of cells. Several types of benign breast conditions involve hyperplasia.

Infection: Invasion of body tissues by microorganisms such as bacteria and viruses.

Infiltrating cancer: Cancer that has spread to nearby tissue, lymph nodes under the arm, or other parts of the body. (Same as invasive cancer.)

Inflammation: The body’s protective response to injury (including infection). Inflammation is marked by heat, redness, swelling, pain, and loss of function.

Intraductal papilloma: A small wartlike growth that projects into a breast duct.

Invasive cancer: Cancer that has spread to nearby tissue, lymph nodes under the arm, or other parts of the body. (Same as infiltrating cancer.)

Laser beam scanning: a technology being studied in research for breast cancer detection that shines a laser beam through the breast and records the image produced, using a special camera.

Lobes, lobules, bulbs: Milk-producing tissues of the breast. Each of the breast’s 15 to 20 lobes branches into smaller lobules, and each lobule ends in scores of tiny bulbs. Milk originates in the bulbs and is carried by ducts to the nipple.

Localization biopsy: The use of mammography to locate tissue containing an abnormality that can be detected only on mammograms, so it can be removed for microscopic examination.

Lumpectomy: Surgery to remove only the cancerous breast lump; usually followed by radiation therapy.

Lymphatic system: The tissues and organs that produce, store, and transport cells that fight infection and disease.

Magnetic resonance imaging (MRI): A technique that uses a powerful magnet linked to a computer to create detailed pictures of areas inside the body.

Malignancy: State of being cancerous. Malignant tumors can invade surrounding tissues and spread to other parts of the body.

Mammary duct ectasia: A benign breast condition in which ducts beneath the nipple become dilated and sometimes inflamed, and which can cause pain and nipple discharge.

Mammogram: An x-ray of the breast.

Mammography: The examination of breast tissue using x-rays.

Mastectomy: Surgery to remove the breast (or as much of the breast as possible).

Mastitis: Infection of the breast. Mastitis is most often seen in nursing mothers.

Menopause: The time when a woman’s monthly menstrual periods cease. Menopause is sometimes called the “change of life.”

Menstrual cycle: The monthly cycle of discharge, during a woman’s reproductive years, of blood and tissues from the uterus.

Mutation: A change in the number, arrangement, or molecular sequence of a gene.

Nipple discharge: Fluid coming from the nipple.

Nonpalpable cancer: Cancer in breast tissue that can be seen on mammograms but that cannot be felt.

One-step procedure: Biopsy and surgical treatment combined into a single operation.

Palpation: Use of the fingers to press body surfaces, so as to feel tissues and organs underneath. Palpating the breast for lumps is a crucial part of a physical breast examination.

Permanent section: Biopsy tissue specially prepared and mounted on slides so that it can be examined under a microscope by a pathologist.

Phytochemicals: Naturally occurring chemicals found in plants that may be important nutrients for reducing a person’s cancer risk.

Rad: A unit of measure for radiation. It stands for radiation absorbed dose.

Radiation: Energy carried by waves or by streams of particles. Various forms of radiation can be used in low doses to diagnose disease and in high doses to treat disease.

Risk: A measure of the likelihood of some uncertain or random event with negative consequences for human life or health.

Risk factors (for cancer): Conditions or agents that increase a person’s chances of getting cancer. Risk factors do not necessarily cause cancer; rather, they are indicators, statistically associated with an increase in likelihood.

Sclerosing adenosis: A benign breast disease that involves the excessive growth of tissues in the breast’s lobules.

Sonogram: The image produced by ultrasound.

Tamoxifen: A hormonally related drug that has been used to treat breast cancer and is being tested as a possible preventive strategy.

Tumor: An abnormal growth of tissue. Tumors may be either benign or cancerous.

Tumor markers: Proteins (either amounts or unique variants) made by altered genes in cancer cells that are involved in the progression of the disease.

Two-step procedure: Biopsy and treatment done in two stages, usually a week or two apart.

Ultrasound: The use of sound waves to produce images of body tissues.

X-ray: A high-energy form of radiation. X-rays form an image of body structures by traveling through the body and striking a sheet of film. Breast x-rays are called mammograms.

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