- The Breasts
- Benign Breast Lumps
- Breast Cancer
- Risk Factors for Breast Cancer
- Early Detection
- Orthodox Treatment
- Side Effects of Orthodox Treatment
Each breast has 15 to 20 overlapping sections called lobes.
Within each lobe are many smaller lobules, which end in dozens
of tiny bulbs that can produce milk. The lobes, lobules, and
bulbs are all linked by thin tubes called ducts. These ducts
lead to the nipple in the center of a dark area of skin called
the areola. Fat fills the spaces around the lobules and ducts.
There are no muscles in the breast, but muscles lie under
each breast and cover the ribs.
Each breast also contains blood vessels and vessels that carry
colorless fluid called lymph. The lymph vessels lead to small
bean-shaped organs called lymph nodes. Clusters of lymph nodes
are found near the breast in the axilla (under the arm), above
the collarbone, and in the chest. Lymph nodes are also found
in many other parts of the body.
Benign Breast Lumps
Any noticeable change, thickening or localized swelling
in your breast that was not there before may be a lump. Eighty-five
percent of all breast lumps found are benign. Some common
benign breast problems that appear as lumps are:
Cystic Disease (fibrocystic breast
disease) is the most common cause of breast lumps in women.
These lumps or cysts are fluid-filled sacs that enlarge and
become tender and painful before the menstrual cycle. This
condition is responsible for at least half of all breast biopsies
performed. It tends to involve both breasts. These lumps are
movable, and if large may feel round and firm. Cystic disease
usually disappears after menopause.
Lipomas develop as single, painless
lumps. They can vary in size. Lipomas consist of fatty tissue
and are commonly found elsewhere in the body.
Fibroadenomas, single solid tumors,
appear most often in young women. These breast lumps are firm,
rubbery, movable, often oval-shaped, and usually painless.
Papillomas are small, wart-like
growths in the lining of a mammary duct near the nipple. These
can produce a bloody discharge of the nipple.
There are other, not as common benign breast lumps caused
by a variety of breast problems such as sclerosing adenosis,
The most common type of breast cancer begins in the lining
of the ducts and is called ductal carcinoma. Another type,
called lobular carcinoma, arises in the lobules.
When breast cancer spreads 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 may
mean that cancer cells have spread to other parts of the body--other
lymph nodes and other organs, such as the bones, liver, or
lungs--via the lymphatic system or the bloodstream.
Cancer that spreads is the same disease and has the same name
as the original (primary) cancer. When breast cancer spreads,
it is called metastatic breast cancer, even though the secondary
tumor is in another organ. Doctors sometimes call this "distant"
Risk Factors for Breast Cancer
The risk of breast cancer increases gradually as a woman
gets older. This disease is uncommon in women under the age
of 35. All women age 40 and older are at risk for breast cancer.
However, most breast cancers occur in women over the age of
50, and the risk is especially high for women over age 60.
Research has shown that the following conditions place a woman
at increased risk for breast cancer:
Personal history of breast cancer.
Women who have had breast cancer face an increased risk of
getting breast cancer again.
Genetic alterations. Changes in
certain genes (BRCA1, BRCA2, and others) make women more susceptible
to breast cancer.
Family history. A woman's risk
for developing breast cancer increases if her mother, sister,
daughter, or two or more other close relatives, such as cousins,
have a history of breast cancer, especially at a young age.
Certain breast changes. Having
a diagnosis of atypical hyperplasia or lobular carcinoma in
situ (LCIS) or having had two or more breast biopsies for
other benign conditions may increase a woman's risk for developing
Other factors associated with an
increased risk for breast cancer include:
1. Breast density. Women age 45 and older whose mammograms
show at least 75 percent dense tissue are at increased risk.
2. Radiation therapy. Women whose breasts were exposed to
radiation during their childhood, especially those who were
treated with radiation for Hodgkin's disease, are at an increased
risk for developing breast cancer throughout their lives.
3. Late childbearing. Women who had their first child after
the age of 30 have a greater chance of developing breast cancer
than women who had their children at a younger age.
In most cases, doctors cannot explain why a woman develops
breast cancer. Studies show that most women who develop breast
cancer have none of the risk factors listed above, other than
the risk that comes with growing older. Also, most women with
known risk factors do not get breast cancer. Scientists are
conducting research into the causes of breast cancer to learn
more about risk factors and ways of preventing this disease.
When breast cancer is found and treated early, the chances
for survival are better. Women can take an active part in
the early detection of breast cancer by having regular screening
mammograms and clinical breast exams (breast exams performed
by health professionals). Some women also perform breast self-exams.
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
A change in the size or shape of the breast;
Nipple discharge or tenderness, or the nipple pulled back
(inversion) 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.
In addition to checking general signs of health, a woman's
doctor may do one or more of the breast exams described on
the following page.
Palpation. The doctor can tell
a lot about a lump (its size, its texture, and whether it
moves easily) by palpation, carefully feeling the lump and
the tissue around it. Benign lumps often feel different from
Mammography. X-rays of the breast
can give the doctor important information about a breast lump.
If an area on the mammogram looks suspicious or is not clear,
additional mammograms may be needed.
Ultrasonography. Using high-frequency
sound waves, ultrasonography can often show whether a lump
is solid or filled with fluid. This exam may be used along
Fine needle aspiration. A thin
needle is used to remove fluid from a breast lump. This procedure
may show whether a lump is a fluid-filled cyst (not cancer)
or a solid mass (which may or may not be cancer). Clear fluid
removed from a cyst may not need to be checked by a lab.
Needle biopsy. Using special techniques,
tissue can be removed with a needle from an area that is suspicious
on a mammogram but cannot be felt. Tissue removed in a needle
biopsy goes to a lab to be checked by a pathologist for cancer
Surgical biopsy. The surgeon cuts
out part or all of a lump or suspicious area. A pathologist
examines the tissue under a microscope to check for cancer
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
Special lab tests of the tissue
help the doctor learn more about the cancer. For example,
hormone receptor tests (estrogen and progesterone receptor
tests) can help predict whether the cancer is sensitive to
The treatment options for each woman depend on the size and
location of the tumor in her breast, the results of lab tests
(including hormone receptor tests), and the stage (or extent)
of the disease.
Methods of Treatment
Methods of treatment for breast cancer are local or systemic.
Local treatments are used to remove, destroy, or control the
cancer cells in a specific area. Surgery and radiation therapy
are local treatments. Systemic treatments are used to destroy
or control cancer cells throughout the body. Chemotherapy
and hormonal therapy are systemic treatments. A patient may
have just one form of treatment or a combination. Different
forms of treatment may be given at the same time or one after
Surgery is the most common treatment
for breast cancer. Several types of surgery may be used. An
operation to remove the breast (or as much of the breast as
possible) is a mastectomy. Breast reconstruction is often
an option at the same time as the mastectomy, or later on.
An operation to remove the cancer but not the breast is called
breast-sparing surgery or breast-conserving surgery. Lumpectomy
and segmental mastectomy (also called partial mastectomy)
are types of breast-sparing surgery. They usually are followed
by radiation therapy to destroy any cancer cells that may
remain in the area.
In lumpectomy, the surgeon removes the breast cancer and
some normal tissue around it. Often, some of the lymph nodes
under the arm are removed.
In segmental mastectomy, the surgeon removes the cancer and
a larger area of normal breast tissue around it. Occasionally,
some of the lining over the chest muscles below the tumor
is removed as well. Some of the lymph nodes under the arm
may also be removed.
In total (simple) mastectomy, the surgeon removes the whole
breast. Some of the lymph nodes under the arm may also be
In modified radical mastectomy, the surgeon removes the whole
breast, most of the lymph nodes under the arm, and often the
lining over the chest muscles. The smaller of the two chest
muscles is also taken out to help in removing the lymph nodes.
In radical mastectomy (also called Halsted radical mastectomy),
the surgeon removes the breast, the chest muscles, all of
the lymph nodes under the arm, and some additional fat and
skin. Breast reconstruction (surgery to rebuild a breast's
shape) is often an option after mastectomy.
Radiation therapy (also called
radiotherapy) is the use of high-energy rays to kill cancer
cells and stop them from growing. The rays may come from radioactive
material outside the body and be directed at the breast by
a machine (external radiation). The radiation can also come
from radioactive material placed directly in the breast in
thin plastic tubes (implant radiation). Some women receive
both kinds of radiation therapy.
Radiation therapy, alone or with chemotherapy or hormone therapy,
is sometimes used before surgery to destroy cancer cells and
shrink tumors. This approach is most often used in cases in
which the breast tumor is large or not easily removed by surgery.
Chemotherapy is the use of drugs
to kill cancer cells. Chemotherapy for breast cancer is usually
a combination of drugs. The drugs may be given by mouth or
by injection. Either way, chemotherapy is a systemic therapy
because the drugs enter the bloodstream and travel throughout
Chemotherapy is given in cycles: a treatment period followed
by a recovery period, then another treatment, and so on. Most
patients have chemotherapy in an outpatient part of the hospital,
at the doctor's office, or at home. Depending on which drugs
are given and the woman's general health, however, she may
need to stay in the hospital during her treatment.
Hormonal therapy is used to keep
cancer cells from getting the hormones they need to grow.
This treatment may include the use of drugs that change the
way hormones work or surgery to remove the ovaries, which
make female hormones. Like chemotherapy, hormonal therapy
is a systemic treatment; it can affect cancer cells throughout
Treatment decisions are complex. They are often affected
by the judgment of the doctor, by the desires of the patient
and, the most important, the stage of the disease. The stage
is based on the size of the tumor and whether the cancer has
Side Effects of Orthodox Treatment
It is hard to limit the effects of cancer treatment so that
only cancer cells are removed or destroyed. Because healthy
cells and tissues may also be damaged, treatment often causes
unwanted side effects.
The side effects of cancer treatment are different for each
person, and they may even be different from one treatment
to the next.
Surgery causes short-term pain and tenderness in the area
of the operation, so women may need to talk with their doctor
about which method of pain control would be appropriate. Any
kind of surgery also carries a risk of infection, poor wound
healing, bleeding, or a reaction to the anesthesia used in
surgery. Removal of a breast can cause a woman's weight to
shift and be out of balance--especially if she has large breasts.
This imbalance can cause discomfort in a woman's neck and
back. Also, the skin in the breast area may be tight, and
the muscles of the arm and shoulder may feel stiff. After
a mastectomy, some women have some permanent loss of strength
in these muscles.
Because nerves may be injured or cut during surgery, a woman
may have numbness and tingling in the chest, underarm, shoulder,
and arm. These feelings usually go away within a few weeks
or months, but some women may have permanent numbness.
Removing the lymph nodes under the arm slows the flow of lymph.
In some women, this fluid builds up in the arm and hand and
causes swelling (lymphedema). Women need to protect the arm
and hand on the treated side from injury, even long after
The radiation may cause side effects that involve the heart,
lungs, and ribs. One of the common side effects is fatigue,
especially in the later weeks of treatment and for sometime
afterward. It is also common for the skin in the treated area
to become red, dry, tender, and itchy. Toward the end of treatment,
the skin may become moist and "weepy." Exposing
this area to air as much as possible will help the skin heal.
Because bras and some types of clothing may rub the skin and
cause irritation, patients may want to wear loose-fitting
cotton clothes. These effects of radiation therapy on the
skin are temporary, and the area gradually heals once treatment
is over. However, there may be a permanent change in the color
of the skin.
For most women, the breast will look and feel about the same
after radiation therapy. Occasionally, the treated breast
may be firmer. Also, it may be larger (due to fluid buildup)
or smaller (because of tissue changes) than it was before.
For some women, the breast skin is more sensitive after radiation
treatment; for others, it is less sensitive.
The side effects of chemotherapy depend mainly on the drugs
the patient receives. As with other types of treatment, side
effects vary from person to person. In general, anticancer
drugs affect rapidly dividing cells. These include blood cells,
which fight infection, cause the blood to clot, and carry
oxygen to all parts of the body. When blood cells are affected
by anticancer drugs, patients are more likely to get infections,
bruise or bleed easily, and may have less energy during treatment
and for some time afterward. Cells in hair follicles and cells
that line the digestive tract also divide rapidly. As a result
of chemotherapy, patients may lose their hair and may have
other side effects, such as loss of appetite, nausea, vomiting,
diarrhea, or mouth sores. There are cases in which the heart
is weakened, and second cancers such as leukemia (cancer of
the blood cells) have occurred. Also, some anticancer drugs
can damage the ovaries. If the ovaries fail to produce hormones,
the woman may have symptoms of menopause, such as hot flashes
and vaginal dryness. Her periods may become irregular or may
stop, and she may not be able to become pregnant. However,
some women may still be able to get pregnant during treatment.
Because the effects of chemotherapy on an unborn child are
not known, it is important for a woman to talk to her doctor
about birth control before treatment begins. After treatment,
some women regain their ability to become pregnant, but in
women over the age of 35 or 40, infertility is likely to be
Hormonal therapy can cause a number of side effects. They
depend largely on the specific drug or type of treatment,
and they vary from patient to patient. Tamoxifen is the most
common hormonal treatment. This drug blocks the body's use
of estrogen but does not stop estrogen production. Tamoxifen
may cause hot flashes, vaginal discharge or irritation, and
irregular periods. Any unusual bleeding should be reported
to the doctor. Younger women taking tamoxifen may become pregnant
more easily and should discuss birth control methods with
Serious side effects of tamoxifen are rare, but this drug
can cause blood clots in the veins, especially in the legs.
In a very small number of women, tamoxifen has caused cancer
of the lining of the uterus. The doctor may do a pelvic exam,
as well as biopsies or other tests of the lining of the uterus,
to monitor for this condition. (This does not apply to women
who have had a hysterectomy, surgery to remove the uterus.)
Young women whose ovaries are removed to deprive the cancer
cells of estrogen experience menopause immediately. The side
effects they have are likely to be more severe than the effects
of natural menopause.