What is breast cancer?
Breast cancer is the uncontrolled, abnormal growth of cells in the breast. Abnormal cell mutations develop into malignant tumors, which can invade nearby healthy breast tissue over time. Usually, breast cancer begins in the cells of the milk-producing glands (lobules) or the passages that drain milk (ducts). If not treated, the cancer can progress and spread to the lymph nodes under the arm and eventually may invade other parts of the body by way of the lymphatic system.
Breast cancer is caused by a mistake in your genetic makeup, which usually occurs as a result of natural "wear and tear" and the normal aging process. In some instances, only about 5-10 percent of the time, breast cancer is caused by a genetic abnormality inherited from your parents.
It is important to remember that breast cancer is more than one disease. There are various types of genetic differences within a tumor. If it is determined that you have breast cancer, it is extremely important to take the time up front to secure a comprehensive diagnosis because the unique biology of your tumor will shape your treatment decisions.
Types of Breast Cancer
Based on where your cancer begins and how it spreads, your cancer will be characterized according to different types and stages. Although there are many types of breast cancer, below is a breakdown of some of the common types:
- DCIS – Ductal Carcinoma In Situ – DCIS is the most common type of non-invasive breast cancer that starts in the milk ducts and has not yet spread into any normal tissue (Stage 0)
- LCIS – Lobular Carcinoma In Situ – LCIS is an area in the milk-producing glands (lobules) of abnormal cell growth that indicates a person has a higher risk of invasive breast cancer in the future (Stage 0)
- IDC – Invasive Ductal Carcinoma – IDC accounts for 80 percent of breast cancers and refers to cancer that started in the milk duct and invaded nearby breast tissue (Stages I-IV)
- Recurrent and Metastatic Breast Cancer – Recurrent and metastatic refers to breast cancer that has returned after temporarily successful treatment or cancer that has spread beyond the breast and into other parts of the body
How are you diagnosed?
There are a number of tests that a doctor may use to determine whether a patient has developed breast cancer:
- Screening tests, such as annual mammograms, are usually given to people who are not suspected of having breast cancer in order to detect the cancer early and begin treatment as soon as possible.
- Diagnostic tests, such as biopsies, are usually given to people who are experiencing symptoms or people who received unusual screening test results.
Defining your healthcare team
Your healthcare team is there to be your advocate and answer any questions you may have. Breast cancer is best treated by a team of healthcare professionals, each with their own specialty and specific role in your treatment process. Below is a list of some of the medical professionals you may encounter during your treatment.
- Primary care physician – Often serves as your first point of contact for medical issues and continues to track your overall health throughout your treatment
- Oncologist – Oversees your healthcare team during diagnosis and treatment, and manages your potential chemotherapy, hormonal therapy and/or targeted treatment regimens
- Radiologist – Identifies and monitors your cancer through medical imaging
- Pathologist – Studies cells to determine the specifics of your cancer stage and grade
- Surgeon – Performs necessary operations related to your cancer
- Reconstructive plastic surgeon – Rebuilds breast after surgeries like a mastectomy (often called breast reconstruction surgery)
- Radiation oncologist – Specializes in treating your cancer through radiation
- Physician assistant – With physician supervision, supports your basic care as well as performs more comprehensive medical duties and procedures
- Nurse practitioner/Nurse – Provides personalized care and quality of life education during your treatment
- Psychiatrist/Psychologist – Can help you navigate your emotional issues and personal challenges during your diagnosis and treatment
Remember, YOU are one of the most important members of your healthcare team, so start out by getting to know these people and understand their important role in your care and treatment. Ask questions to ensure you're comfortable with the treatment options proposed by your healthcare team.
Treatment and side effects
After a breast cancer diagnosis, you and your doctors will put together a treatment plan specific to your situation, based on your pathology report. Your treatment plan will be made up of one or more specific treatments that are intended to target the cancer cells in different ways and reduce the risk of future breast cancer recurrence. Based on the type and stage of your cancer, your plan may include a combination of surgery, chemotherapy, radiation, hormonal therapy and targeted therapies. Your physician will recommend a follow-up regimen including exams and tests to watch for recurrence.
- Surgery – Surgery, often the first option for treatment, involves the removal of tumors, breast tissue and/or lymph nodes from the body. A lumpectomy involves the removal of the tumor and a small amount of surrounding tissue. A mastectomy is the removal of all breast tissue. As a part of surgery, patients will consider breast reconstruction surgery to rebuild the removed tissue.
- Genomic Diagnostic Tests – genomic diagnostic tests provide personalized information about your tumor to help guide your treatment plan. For example, Oncotype DX®1 is a diagnostic test that predicts the likelihood of a patient's breast cancer recurring (coming back) over a 10 year period. This test also predicts whether a patient is likely to benefit from adding chemotherapy to hormonal treatment.
- Chemotherapy – Chemotherapy is a systemic therapy that uses medicine to destroy cancer cells throughout the body. In this process, a combination of medicines will be used to destroy rapidly dividing cells in your body, including both cancer cells and healthy cells. While all patients experience different symptoms, some may experience uncomfortable side effects as a result of the medicines targeting otherwise healthy cells.
- Radiation therapy – Radiation therapy is the use of a high-energy beam to damage any cancer cells that may remain following surgery. Patients who undergo radiation may experience skin irritation, chest pain, armpit discomfort and fatigue.
- Hormonal therapy (anti-estrogen therapy) – Hormonal therapy medicines work against hormone-receptor-positive (ER/PR+) breast cancer by blocking the effects of estrogen on cancerous cells and by lowering the overall amount of estrogen in your body. There are three types of hormonal therapy medicines, so it is important to weigh the possible side effects and the benefits of each medicine.
- Targeted therapies – Targeted cancer therapies focus on blocking specific cancer cell characteristics, like blocking the growth of new blood vessels or certain proteins, or blocking the ability to receive chemical signals telling the cancer to grow. Targeted treatments, such as Herceptin, Tykerb and Avastin, are less likely to harm healthy cells in the body because they are focused on characteristics specific to cancer cells.
Building your treatment plan
Empowering yourself with information and discussing your treatment regimen with your healthcare team can be very beneficial for you as you tackle this disease. No two diagnoses and treatment regimens for breast cancer look exactly the same, which is why learning all you can about your options and talking to your health care team are critical. To gather personalized information about your type of cancer, please take a few minutes to complete the My Breast Cancer Coach questionnaire. You'll receive a customized report to help you better understand your cancer, and can use the report to discuss next steps with your doctor.