Breast Cancer: Key Q&A

Reviewed By:
Martin E. Liebling, M.D., FACP

When should I have a mammogram?
The American Cancer Society (ACS) recommends that all women age 40 and older have a screening mammogram every year. These mammograms should continue as long as you are in good health.

If you are at high risk for breast cancer, your physician may recommend that you have a mammogram at an earlier age or more frequently.

What other tests should be used for breast cancer detection?
If you are in your 20s or 30s, you should have a clinical breast exam (CBE) by a health professional as part of your regular physical examination. A CBE should be conducted at least every three years. Once you have reached age 40, a CBE should be conducted by a health professional every year.

A breast self-examination (BSE) should be considered by all women in their 20s and above. BSEs are not a substitute for clinical breast examinations or mammograms, but they can help you learn the normal feel of your breasts. In turn, this may help you detect changes and seek immediate attention for them.

What signs might indicate breast cancer?
For many women, the first indication of breast cancer may come from an abnormal mammogram. The early stages of breast cancer may not have any signs or symptoms. For this reason, it is important to follow the recommended screening guidelines. When a tumor grows and breast cancer progresses, you may have a number of symptoms, including a lump or thickening in your breast or underarm, a change in the shape of your breast, or ridges and pitting in your skin. You may notice redness or scaling of the skin or discharge from your nipple as well.

What steps will be taken if I have an abnormal mammogram?
There are several options that may follow an abnormal mammogram. In some cases, your physician may recommend a repeat mammogram in a few months. Or, you may receive another mammogram that takes more specific images of the area of concern. An ultrasound may be used to help determine if the abnormality is solid (possible cancer) or fluid filled (such as a benign cyst). You may be referred to a physician for a needle biopsy if a lump can be felt in addition to the abnormality on the mammogram.

How is breast cancer diagnosed?
A biopsy is the only definitive way to know if you have cancer. It allows your physician to obtain cells from the suspicious tissue for examination under a microscope. There are different types of biopsies, and your doctor can determine the best kind depending on your particular mass.

Breast tissue is removed during the biopsy and is examined by a pathologist to determine if it is cancer. If it is, the pathologist can obtain a great deal of information from the sample, including the type of cancer, the level of abnormality and whether it has spread to surrounding tissues. Additional tests may be performed on the tissue to help plan treatment and gain information for your prognosis.

What are the treatment options?
Your treatment will depend on a number of factors such as the size, location and type of the cancer. The stage of the cancer, your age and general health will also affect your treatment options. Surgical treatment possibilities include lumpectomy and various types of mastectomy. Chemotherapy and radiation therapy may be used before or after surgery depending on your individual case. Depending on certain tumor characteristics, you also may receive hormone therapy or some form of biological therapy. Most patients receive a combination of these treatments.

What are the risk factors?
Many risk factors for breast cancer cannot be controlled. Just being female and over the age of 50 increases your chance of developing breast cancer. A family history of the disease and certain genetic mutations also raise your risk. However, risk factors such as weight, diet and physical activity, can be controlled. Maintaining a healthy weight, eating a balanced diet and exercising can help reduce your risk of breast cancer. In addition, limiting alcohol use and not using tobacco improve your chances of living a life without breast cancer.

Can breast cancer be prevented?
There is no sure way to prevent breast cancer. The most important action you can take is to follow recommended detection guidelines. Receive regular mammograms and clinical breast examinations to increase your odds of detecting cancer at its earliest stage. If you notice any changes in your breast or in your armpits, immediately consult a physician. You may not be able to prevent breast cancer, but you can improve your chance of successful treatment and survival with early detection.

Where can I go for information and support?
There are many organizations that offer information and support for breast cancer patients and their families. Your physicians can refer you to local organizations that provide support and counseling. You can also obtain information from the:

American Cancer Society (ACS)
800-227-2345
http://www.cancer.org

National Cancer Institute (NCI)
800-422-6237
http://www.cancer.gov/

Centers for Disease Control and Prevention (CDC)
800-311-3435
http://www.cdc.gov/cancer/