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Indeed it was.
Notes from a breast cancer patient.
From the American Cancer Society
There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.
Lowering your risk: You can lower your risk of breast cancer by changing those risk factors that can be changed. If you limit alcohol use, exercise regularly, and keep a healthy weight, you are decreasing your risk of getting breast cancer. Women who choose to breast-feed for at least several months may also reduce their breast cancer risk.
Not using post-menopausal hormone therapy (PHT) if you don't need it can also help you avoid raising your risk.
Finding breast cancer early: It is also important for women to follow the American Cancer Society's guidelines for finding breast cancer early. (See the section, "How is breast cancer found?")
For women who are or may be at increased risk
If you have a higher risk for breast cancer there may be some things you can do to reduce your chances of getting breast cancer. Before deciding which, if any, of these may be right for you, talk with your doctor.
Genetic testing: There are tests that can tell if a woman has certain changed (mutated) genes linked to breast cancer. With this information, women can then take steps to reduce their risk. Recently the U.S. Preventive Services Task Force made recommendations for genetic testing. They suggest that only women with a strong family history be evaluated for genetic testing for BRCA mutations. This group is only about 2% of adult women in the United States.
If you are thinking about genetic testing, you should talk to a genetic counselor, nurse, or doctor qualified to explain the results of these tests. It is very important that you know what genetic testing can and can't tell you, and to carefully weigh the benefits and risks of testing before these tests are done. Testing is expensive and may not be covered by some health insurance plans. For more information, see our document, Genetic Testing: What You Need to Know.
Breast cancer chemoprevention: Chemoprevention is the use of drugs to reduce the risk of cancer. Many drugs have been studied for use in lowering breast cancer risk. The drug tamoxifen has already been used for many years as a treatment for some types of breast cancer. Studies have shown that women at high risk for breast cancer are less likely to get the disease if they take tamoxifen. Another drug, raloxifene, has been approved to help reduce breast cancer risk in women past menopause who are at high risk for breast cancer. Other drugs are also being studied.
Preventive surgery for women with very high breast cancer risk: For the few women who have a very high risk for breast cancer, preventive surgery such as bilateral (double) mastectomy may be an option.
Preventive (prophylactic) double (bilateral) mastectomy: For some who are at very high risk for breast cancer, this surgery (a double mastectomy) may be an option. In this operation both breasts are removed before there is any known breast cancer. While this operation removes nearly all of the breast tissue, a small amount remains. So although this operation greatly reduces the risk of breast cancer, the disease can still start in the breast tissue that remains after surgery. To date, this has been a rare problem.
The reasons for thinking about this type of surgery need to be very strong. There is no way to know ahead of time whether this surgery will benefit a particular woman. A second opinion is strongly recommended before making a decision to have this type of surgery.
Preventive ovary removal (prophylactic oophorectomy): Women with a certain gene change (BRCA mutation) who have their ovaries removed may reduce their risk of breast cancer by half or more. This is because taking out the ovaries removes the main sources of estrogen in the body.
Although this document is not about ovarian cancer, it is important that women with this gene change also know that they also have a high risk of getting ovarian cancer. Most doctors recommend that these women have their ovaries removed after they are done having children.
Stages of Breast Cancer. Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive, whether lymph nodes are involved, and whether the cancer has spread beyond the breast.
The purpose of the staging system is to help organize the different factors and some of the personality features of the cancer into categories, in order to:
Stage 0 is used to describe non-invasive breast cancers, such as DCIS and LCIS. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.
Stage I describes invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which:
Stage II is divided into subcategories known as IIA and IIB.
Stage IIA describes invasive breast cancer in which:
Stage IIB describes invasive breast cancer in which:
Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.
Stage IIIA describes invasive breast cancer in which either:
Stage IIIB describes invasive breast cancer in which:
Stage IIIC describes invasive breast cancer in which:
Stage IV describes invasive breast cancer in which:
"Metastatic at presentation" means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.
You may also hear terms such as "early" or "earlier" stage, "later," or "advanced" stage breast cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:
Doctors use a staging system to determine how far a cancer has spread. The most common system is the TNM staging system. You may hear the cancer described by three characteristics:
The T (size) category describes the original (primary) tumor:
The N (node involvement) category describes whether or not the cancer has reached nearby lymph nodes:
The M (metastasis) category tells whether there are distant metastases (whether the cancer has spread to other parts of body):
Once the pathologist knows your T, N, and M characteristics, they are combined in a process called stage grouping, and an overall stage is assigned.
For example, a T1, N0, M0 breast cancer would mean that the primary breast tumor:
This cancer would be grouped as a stage I cancer.
“Chemo brain” or “chemo fog” are terms used for thinking and memory difficulty that some associate with chemotherapy treatment. While some research suggests a link between chemotherapy and problems with thinking and memory, findings are not yet consistent and more studies need to be done. What we do know is that for many breast cancer patients, “chemo brain” is a very real issue. You may not remember where you put your keys or why you went to the store, or you may simply not be able to think of the right word. Join us to find out how other aspects of treatment can affect your cognitive abilities, learn ways to improve your mental skills, get the latest research on chemo brain, and more. | |
Join us tomorrow night between 7:00 p.m. and 8:30 p.m (EDT)* for this month's Ask-the-Expert Online Conference: Managing Chemo Brain. Christina Meyers, Ph.D., A.B.P.P. and George Sledge, M.D. will answer your questions about how long memory issues can last, what you can do to keep your brain active including tips to sharpen your memory, and more. | |
Christina Meyers, Ph.D., A.B.P.P. is a board certified neuropsychologist. She created the Neuropsychology Service in the newly formed Department of Neuro-Oncology at M.D. Anderson Cancer Center in 1984. | |
George Sledge, M.D. is the Ballvé-Lantero Professor of Oncology at Indiana University at Indianapolis, where he co-directs Indiana University Simon Cancer Center's Breast Cancer Program. | |
If you'd like to ask a question for our MANAGING CHEMO BRAIN conference, but will not be able to join the conference tomorrow night, you can submit your question now. | |
We'll answer as many questions as we can during the conference. A conference transcript will be posted at Breastcancer.org by October 22, 2008. | |
To join the conference, visit Breastcancer.org any time between 7:00 p.m. and 8:30 p.m. EDT* tomorrow night and click on the "Join Conference" button. It’s easy to participate; no special software is required. The live conference will appear in text on your screen. | |
Visit the Ask-the-Expert Online Conference page for more details. |
Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.
Your doctor may suggest the following screening tests for breast cancer:
You should ask your doctor about when to start and how often to check for breast cancer.
To find breast cancer early, NCI recommends that:
Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.
If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present. (The "Diagnosis" section has more information on biopsy.)
Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:
Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.
During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.
Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.
Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.
A thorough clinical breast exam may take about 10 minutes.
You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.
You should contact your health care provider if you notice any unusual changes in your breasts.
Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.
You may want to ask the doctor the following questions about screening:
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No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.
Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.
Studies have found the following risk factors for breast cancer:
Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.
Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.
But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.
If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.
Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.
Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.
Tumors can be benign or malignant:
When breast cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs, and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.
The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.
The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful substances.
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These pictures show the parts of the breast and the lymph nodes and lymph vessels near the breast. |
Manage Your Anxiety
Getting tests done and waiting for their results can create a lot of anxiety. Here are some suggestions to help you manage your anxiety:
- Get to know the people on your medical team and make every effort to meet them in person. You'll find out who is the best communicator, who can answer which questions, who is available to help you when you need it most.
- Find a doctor who communicates with you who invites your questions and takes your concerns seriously, who gives you as much or as little information as you feel comfortable with.
- Make plans with your doctor about how to receive test results in a prompt way. Try to schedule important tests early in the beginning of the week, so you don't have to wait over a long weekend, when lab work may slow down or doctors aren't communicating with each other.
In this section you'll find the web version of the breastcancer.org booklet: Your Guide to the Breast Cancer Pathology Report.
Waiting is so hard! But just one test can lead to several different reports. Some tests take longer than others. Not all tests are done by the same lab. Most information comes within one to two weeks after surgery, and you will usually have all the results within a few weeks. Your doctor can let you know when the results come in. If you don't hear from your doctor, give her or him a call.
Be sure that you have all the test information you need before you make a final decision about your treatment. Also, don't focus too much on any one piece of information by itself. Try to look at the whole picture as you think about your options.
Different labs and hospitals may use different words to describe the same thing. If there are words in your pathology report that are not explained in this booklet, don't be afraid to ask your doctor what they mean.
The pathology report will help your doctor decide the stage of your breast cancer. It could be:
Staging is based on the size of the tumor, whether lymph nodes are involved, and whether the cancer has spread beyond the breast. Your doctors use all parts of the pathology report as well as the breast cancer stage to shape your treatment plan.
First, check the top of the report for your name, the date you had your operation, and the type of operation you had. Make sure they are right for you.