Breast cancer occurs when cells in the breast grow out of control and form a tumor. Breast cancer almost always occurs in women, but occasionally is diagnosed in men.
Overview and Symptoms
Breast Cancer Symptoms
Breast cancer is usually discovered as a lump in the breast, although a lump in the breast can be caused by other benign breast conditions. Benign breast disease is much more common than breast cancer, but both cancerous and benign conditions may involve these symptoms:
- breast lumps and thickenings
- breast pain
- breast infections
- nipple discharge
- abnormal mammograms
Breast Cancer Diagnosis
Breast cancer diagnosis usually begins with imaging tests, such as mammogram, breast ultrasound, and/or MRI scans. If an abnormal breast lump or change is discovered, the affected breast tissue will be removed for biopsy. A biopsy is the only way to confirm for certain if it’s cancer.
Breast Cancer Risk Factors
We do not know why some people develop breast cancer. However, studies have found risk factors for the disease, including:
- Being a woman
- Having a strong family history in a first-degree relative (mother, sister, daughter)
- Inherited genetic mutation for breast cancer
- Early menarche (onset of menstruation)
- Late menopause (end of menstruation)
- Nulliparity (never giving birth)
- Giving birth for the first time over the age of 30
- Previous atypical breast biopsies, such as LCIS – lobular carcinoma in situ (LCIS) – or atypical hyperplasia. With LCIS, atypical (or abnormal) cells are present in the breast's milk-producing glands. These cells are a marker for breast cancer risk. Atypical hyperplasia is marked by abnormal cells in the milk ducts.
- Personal history of breast cancer – If you have had cancer in one breast, you have an increased risk of developing breast cancer in your other breast
- Radiation exposure – you received radiation therapy to your chest before you were 30 years old, you may be at increased risk of breast cancer later in life.
- Being overweight
- Alcohol use – the more alcohol you drink, the greater your risk of breast cancer
Every breast cancer is different and each case requires its own approach. Breast cancer can be treated with:
- Surgery, to remove tumors
- Radiation therapy, using high doses of radiation to kill cancer cells
- Chemotherapy and/or endocrine therapy, using drugs to target cancer cells
Many treatment plans involve a combination of these therapies. Appropriate and thorough treatment for breast cancer at an early stage reduces the risk of recurrence.
Your dedicated care team will advise you about options for local (focused on the breast) or systemic (addressing the entire body) treatment, based on several factors, including:
- the size of your tumor
- the tumor's pathological features
- the number of lymph nodes that may be involved
- your overall health
Breast Cancer Surgery
Surgery is the most common treatment for breast cancer. You and your surgeon will need to decide which operation may be best for you based on your overall health and your type of breast cancer.
If you have been diagnosed with cancer at an early stage, or if the cancer is in only one part of the breast and small enough, lumpectomy may be an option. Surgeons at BIDMC were early leaders in developing lumpectomy — removing the tumor and a small margin of surrounding tissue instead of removing the whole breast (mastectomy). Lumpectomy is a way to “conserve" the breasts, is highly effective and safe for many women.
Mastectomy is the surgical removal of the entire breast. Depending on the type of cancer, your specialists may offer the option of mastectomy. Our breast surgeons offer skin-sparing and nipple-sparing mastectomy options. These procedures help improve cosmetic appearance when breast reconstruction is chosen as a subsequent surgery. If you have a mastectomy, please review the Women's Health and Cancer Rights Act of 1998. It informs you about the obligations on the part of your insurance company.
Hidden Scar Surgery
Hidden scar surgery is a special breast cancer surgery technique that minimizes noticeable scarring. Although some situations do not allow for this type of breast cancer surgery, data has shown that women whose surgeries are performed with these techniques are at no greater risk of cancer recurrence.
For a lumpectomy, the hidden scar technique involves placing the incision underneath the breast line, around the areola, or in the fold of the armpit, depending on the location of the tumor.
When skin-sparing or nipple-sparing mastectomy followed by breast reconstruction surgery is performed, the breast surgeon makes the incision around the areola or under the breast. This preserves the skin and does not create a typical large scar across the chest.
Choosing No Reconstruction
After breast surgery, some women choose not to have reconstruction, due to a variety of reasons. Many women and doctors call this “going flat.” The decision about whether or not to have reconstruction is a personal one. There is no “right way” to approach mastectomy and reconstructive surgery (or lack of it). There is only the way that is best for you and your healing. At BIDMC, our physicians are here to support you no matter what your decision. We will discuss with you the pros and cons of all of our options so that you can make the decision that is best for you.
Recovery After Surgery
Your hospital stay will depend on whether you are having a lumpectomy or mastectomy. Recovery varies from woman to woman. Your care team will provide you detailed instructions on post-surgery dos and don'ts when you are discharged from BIDMC.