Breast Cancer – Diagnosis and Treatment
Diagnosis
Physical Check of the Breasts
A healthcare provider examines and feels the breasts, collarbones, and armpits. They look for lumps, skin changes, or unusual appearances.
During this check, they note nipple changes and new skin textures. Swelling or lumps under the arms can show if lymph nodes are involved.
Breast X-ray (Mammogram)
A mammogram takes detailed X-ray pictures of the breast’s inside structure. Doctors usually use this test first to find breast cancer, especially in women without symptoms.
If the first images show something unusual, doctors perform a more focused mammogram for a closer look. They may check both breasts during this process.
Types of Mammograms:
- Screening Mammogram: For people without symptoms
- Diagnostic Mammogram: For those with possible signs or abnormal screening results
Modern mammograms, including 3D versions, help spot ductal carcinoma in situ (DCIS) and small tumors in dense breast tissue.
Sound Wave Imaging (Breast Ultrasound)
An ultrasound uses sound waves to create images inside the breast. It helps doctors tell if a suspicious area is a solid lump or a fluid-filled cyst.
These scans do not use radiation and are painless. Ultrasound also guides needle biopsies and checks lymph nodes near the breast or in the armpit.
Magnetic Imaging of the Breast (Breast MRI)
A breast MRI uses magnetic fields and radio waves to make clear images of breast tissue. Before the scan, doctors usually inject a dye into a vein to highlight areas of concern.
Doctors often use MRI when they need more details before surgery or if a person has a high risk of breast cancer, such as those with BRCA1 or BRCA2 mutations. MRI also checks both breasts for cancer or measures the size of a known tumor.
MRI works well in dense breast tissue and can find invasive or inflammatory breast cancer.
Taking a Tissue Sample for Analysis
Doctors perform a biopsy by removing a small piece of tissue or cells from the breast, usually with a needle. Imaging tools like X-rays, ultrasound, or MRI help guide the needle to the right spot.
Sometimes, doctors leave a tiny metal marker where they took the sample to track the area for future tests or surgery. A lab examines the sample to determine what the cells show.
Lab Testing on Removed Breast Cells
After a biopsy, laboratory staff check the cells under a microscope. Tests reveal if the cells are cancerous, how fast they might grow, and what type they are.
The lab checks for hormone receptors like estrogen and progesterone on the cancer cells. Some tests also look for certain proteins, such as HER2.
These results help doctors identify the cancer type and choose the best treatment plan. Genetic tests may be done if there is a family history of cancer or other risk factors, including changes in the BRCA1 or BRCA2 genes.
Figuring Out the Extent of the Cancer (Staging)
After finding breast cancer, doctors use other tests to see how far it has spread. The stage shows if cancer is only in the breast, has reached the lymph nodes, or has spread to other body parts.
Breast Cancer Stages:
| Stage | Description |
|---|---|
| 0 | Cancer in ducts (DCIS), has not spread |
| 1 | Small tumor, limited to breast |
| 2 | Larger tumor and/or spread to nearby nodes |
| 3 | More lymph node involvement or larger tumor |
| 4 | Cancer spread to distant organs (metastatic) |
Treatment
Surgical Procedures for Breast Cancer
Surgery is a main way doctors treat breast cancer. Most people have an operation to remove the tumor and sometimes nearby tissue.
Types of breast surgery include:
| Surgery Type | Description |
|---|---|
| Lumpectomy | Removes the tumor and some healthy tissue nearby, keeping most of the breast. This is also called breast-conserving surgery. Often, radiation therapy follows. |
| Mastectomy | Removes all of the breast tissue, including the nipple, ducts, and some skin. Some people can have skin-sparing and nipple-sparing options. |
| Sentinel Node biopsy | Removes just a few lymph nodes near the breast to check for cancer spread. If these are clear, doctors may not remove more nodes. |
| Axillary Lymph Node Removal | Removes several lymph nodes in the armpit if doctors find cancer. This can cause arm swelling (lymphedema). |
| Preventive Mastectomy | Removes both breasts to lower cancer risk, often in those with a high genetic risk or strong family history. |
People can also discuss breast reconstruction with their care team. Surgeons can use implants or the person’s own tissue for reconstruction.
Common risks of breast surgery:
- Pain
- Bleeding
- Infection
- Arm swelling (after lymph node removal)
Surgeons, plastic surgeons, and sometimes a radiation oncologist or medical oncologist help plan these treatments.
Radiation Treatment for Breast Cancer
Doctors use radiation therapy to destroy cancer cells with strong energy beams. The most common type is external beam radiation, where a machine sends radiation to the breast from outside the body.
Brachytherapy is less common and delivers radiation from inside the body. Doctors usually give radiation after breast-conserving surgery to kill any remaining cancer cells and reduce the risk of cancer returning.
Types of Radiation:
- Whole-Breast Irradiation: Treats the whole breast.
- Partial Breast Irradiation: Focuses on the area around the tumor. Accelerated partial breast irradiation uses higher doses over a shorter time.
Possible Side Effects:
- Tiredness
- Redness and irritation of the skin, like a sunburn
- Swelling or firmness in the breast
- Rare risks: heart or lung damage, or a new cancer in the treated area
Radiation oncologists manage this treatment and adjust it as needed.
Medicines to Kill Cancer (Chemotherapy)
Doctors use chemotherapy to kill cancer cells with drugs. These medicines travel throughout the body and are often given through a vein, but sometimes as pills.
Doctors may use chemotherapy after surgery to kill leftover cancer cells. They may also use it before surgery to shrink the tumor, making it easier to remove.
For advanced cancer, chemotherapy can slow cancer growth and help control symptoms.
Side effects can include:
- Tiredness
- Hair loss
- Nausea or vomiting
- Higher risk of infection
- Early menopause
- Rare: nerve damage or risk of secondary cancers
Doctors plan the number of chemotherapy cycles based on the cancer stage and the person’s health. Medical oncologists oversee these treatments.
Medicine to Block Hormones (Hormone Treatment)
Some breast cancers need estrogen or progesterone to grow. Doctors call these hormone receptor-positive cancers.
Hormone therapy blocks these hormones or lowers their levels, making it harder for cancer to grow.
Types of Hormone Therapy:
- Selective Estrogen Receptor Modulators (SERMs): Block hormones from attaching to breast cancer cells.
- Aromatase Inhibitors: Lower how much estrogen the body makes after menopause.
- Ovarian Suppression: Uses medicines or surgery to stop the ovaries from making estrogen.
Doctors use hormone therapy after surgery to lower the risk of cancer coming back or for advanced breast cancer to help control it.
Side Effects:
- Hot flashes
- Night sweats
- Vaginal dryness
- Bone thinning (osteoporosis)
- Risk of blood clots
Doctors also call this treatment endocrine therapy. Medical oncologists choose the best hormone therapy options.
Cancer Treatments That Target Specific Changes (Targeted Therapy)
Targeted therapy uses drugs that focus on certain molecules or genetic changes in cancer cells. These medicines mostly work on cancer cells and try to leave normal cells alone.
Doctors may use targeted therapy if tests show certain features, such as HER2-positive breast cancer.
Types of Targeted Therapy:
- Medicines that block the HER2 protein (for HER2-positive cancers)
- Medicines aimed at the PI3K or CDK4/6 proteins for certain advanced cancers
Side Effects:
- Diarrhea
- Heart problems (with some medicines)
- Skin rashes
- Fatigue
Doctors may combine targeted therapy with other treatments, such as hormone therapy or chemotherapy.
Boosting the Immune Response to Cancer (Immunotherapy)
Immunotherapy helps the immune system attack cancer cells. Doctors often use it for certain advanced or triple-negative breast cancers.
How It Works:
- Drugs called immune checkpoint inhibitors help the immune system recognize and destroy cancer.
Doctors may use immunotherapy when cancer no longer responds to standard treatments. They often combine it with chemotherapy.
Possible Side Effects:
- Skin changes
- Tiredness
- Changes in bowel habits
- Rarely, damage to other organs
Doctors use tumor testing to decide if immunotherapy is right for a patient.
Care That Improves Comfort (Palliative Care)
Palliative care aims to improve quality of life, not cure the cancer. It is available to everyone at any stage, but is especially important for advanced cancer.
This care may include:
- Managing pain with medicines
- Treating symptoms like trouble breathing, fatigue, or nausea
- Helping with side effects of treatment
- Support for healthcare decisions
- Emotional, mental, and spiritual support
A team of doctors, nurses, social workers, and counselors provides palliative care. People can receive this care while getting other cancer treatments. The goal is to keep people as comfortable and active as possible.
Approaches Beyond Standard Treatment
Ways to Manage Ongoing Tiredness
Many people feel tired during or after treatment for breast cancer. This tiredness can last a long time. Some individuals try non-traditional methods to boost their energy.
Below are some ideas to manage tiredness, along with regular medical care:
| Technique | Description |
|---|---|
| Sharing Feelings | Journaling, talking to a counselor, or joining a support group can help process emotions. |
| Mild Physical Activity | Gentle movements like walking, yoga, tai chi, or swimming can help you feel better. Start slowly and increase activity as you are able, with your healthcare provider’s approval. |
| Stress Relief | Managing stress is important. You can try muscle relaxation, visualization, or spending time with supportive friends and family. |
Talk with your healthcare team before trying these options. They can help you decide what is safe and suitable for your situation.
Coping and Support
Understanding Your Breast Cancer for Informed Choices
Learning about your breast cancer diagnosis can help you feel more in control. Ask your care team questions about the type, stage, and features of your cancer.
Write down important information and ask for reliable resources. Some people prefer not to know every detail, so let your health team know how much information you want.
| What to Ask | Why It Matters |
|---|---|
| Type and Stage | Impacts treatment choices. |
| Hormone Status | Guides medication use. |
| Treatment Options | Prepares you for next steps. |
Connecting with Others Who Have Faced Breast Cancer
Talking with people who have had a similar diagnosis can offer comfort. You can find support groups through local cancer organizations or online communities.
Participants share experiences, tips, and hope. Hearing survivor stories can help you feel less alone.
Sharing Your Feelings With Someone You Trust
Talking about your feelings with someone you trust can be helpful. Friends, family, clergy, or counselors can listen and support you.
Your cancer care team can refer you to professionals who work with people affected by cancer. Everyone handles emotions differently, so find someone who feels right for you.
Relying on Loved Ones for Practical and Emotional Help
Friends and family can provide both practical and emotional support. They may cook meals or spend time with you.
Plan ahead for the help you need, so it is easier for others to assist. Staying connected with loved ones can make daily challenges feel less overwhelming.
Getting Ready for Your Visit
Steps to Take Before Your Appointment
Being organized before your healthcare visit can help you feel more in control. Here are some steps to help you prepare:
- List all symptoms. Write down any health changes or symptoms, even those that may not seem related to breast health.
- Track important personal details. Record recent life changes or sources of stress that might affect your health.
- Document your family’s cancer history. Make a list of family members who have had cancer, their relationship to you, the type of cancer, their age at diagnosis, and if they survived.
| Family Member | Relationship | Cancer Type | Age at Diagnosis | Outcome |
| Example: Ann | Mother | Breast Cancer | 47 | Survived |
- Prepare a current medication list: Include prescriptions, over-the-counter medicines, vitamins, and supplements.
- Keep medical records organized: Gather all test results, procedures, and notes related to your diagnosis. Store them in a binder or folder to bring to every appointment.
- Bring a friend or relative: Someone else can help you remember information and provide support.
- Write down any questions: Take notes on everything you want to discuss
Tip: A notebook or note-taking app can help you keep track of details easily.
Key Topics to Discuss With Your Healthcare Provider
Bring a list of questions to your visit to make sure you get the answers you need. Here are some questions to consider:
- What type of breast cancer do I have?
- Has the cancer spread, and if so, how far?
- Can you help me understand my pathology report? May I have a copy?
- Do I need more tests before deciding on treatment?
- What treatment choices are available?
- What are the possible benefits and risks of these treatments?
- Will the treatments affect menopause?
- How might treatment impact my daily life, like work or family time?
- Is there a treatment you recommend over others? Why?
- How soon do I need to decide on treatment?
- What is the cost of treatments? Will insurance help cover tests and procedures?
- Can I get more information on my diagnosis, such as brochures or trustworthy websites?
| Question | Priority Level |
| What treatment options are available? | High |
| What are the side effects? | High |
| Will I be able to keep working during treatment? | Medium |
| Should I get a second opinion? | Medium |
| Will my insurance cover recommended treatments? | High |
- Are clinical trials or new treatments an option for me?
- Would you suggest something different if I were a family member?
- What might happen if I choose not to have treatment?
Start with your most important questions in case time is limited during your appointment.
What Your Doctor Might Ask or Share
Healthcare providers will want detailed information about your health history and current symptoms.
They may ask questions like:
- When did you first notice the symptoms?
- How often do the symptoms occur, and how severe are they?
- Have you tried anything that improved the symptoms?
- Are there things that seem to make symptoms worse?
Doctors may explain which type of specialist will help with your care, such as:
- Breast specialists or surgeons
- Radiologists for extra imaging
- Oncologists and radiation oncologists for treatment
- Genetic counselors if you have a family history
- Plastic surgeons if surgery is needed
Doctors may give you printed materials or suggest trusted health sites for more information. It is normal to feel nervous or have concerns. Bringing information and preparing for your appointment can help things go more smoothly.
