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This topic is for women who have been diagnosed with breast cancer for the first time. If you are looking for information on breast cancer that has spread or come back after treatment, see the topic Breast Cancer, Metastatic or Recurrent.
For male breast cancer, see the topic Breast Cancer in Men.
Breast cancer occurs when abnormal cells grow out of control in one or both breasts. They can invade nearby tissues and form a mass, called a malignant tumour. The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body.
Breast cancer that begins in the ducts of the breast is called ductal carcinoma. It is the most common type of breast cancer. When breast cancer begins in the lobes of the breast, it is called lobular carcinoma. Sometimes breast cancer is a mix of both types.
If abnormal cells are found only in the lining of a duct or lobe of the breast, they are said to be non-invasive, or "in situ" (say "in-SY-too"). These abnormal cells are called ductal carcinoma in situ or lobular carcinoma in situ.
There are also some less common types of breast cancer, such as inflammatory breast cancer and male breast cancer.
Doctors don't know exactly what causes breast cancer. But some things are known to increase the chance that you will get it. These are called risk factors. Risk factors that you cannot change include getting older and having changes to certain genes. Risk factors you may be able to change include using certain types of hormone therapy after menopause, being overweight, and not getting enough physical activity.
But many women who have risk factors don't get breast cancer. And many women who get breast cancer don't have any known risk factors other than being female and getting older.
Breast cancer can cause:
See your doctor right away if you notice any of these changes.
During a regular physical examination, your doctor can check your breasts to look for lumps or changes. Depending on your age and risk factors, the doctor may advise you to have a mammogram, which is an X-ray of the breast. A mammogram can often find a lump that is too small to be felt. Sometimes a woman finds a lump during a breast self-examination.
If you or your doctor finds a lump or another change, the doctor will want to take a sample of the cells in your breast (biopsy). The results of the biopsy help your doctor know if you have cancer and what type of cancer it is.
You may have other tests to find out the stage of the cancer. The stage is a way for doctors to describe how far the cancer has spread. Your treatment choices will be based partly on the type and stage of cancer.
You and your doctor will decide which mix of treatments is right for you based on many things. These include facts about your cancer as well as your family history, other health problems, and your feelings about keeping your breast.
Breast cancer is usually treated with surgery, radiation therapy, chemotherapy, hormone therapy, or targeted therapy.
In some cases, you may need to decide whether to have surgery to remove just the cancer (breast-conserving surgery, or lumpectomy) or surgery that removes the entire breast (mastectomy).
Treatments can cause side effects. Your doctor can let you know what problems to expect and help you find ways to manage them.
When you find out that you have cancer, you may feel many emotions and may need some help coping. Talking with other women who are going through the same thing may help. Your doctor or your local branch of the Canadian Cancer Society can help you find a support group.
At this time, there is no sure way to prevent breast cancer.
Some risk factors, such as your age and being female, cannot be controlled. But you may be able to do things to stay as healthy as you can, such as having a healthy diet and being active. Knowing your risk of getting breast cancer also can help you choose what steps to take.
Talk to your doctor about your risk. Find out when to start having mammograms and how often you need one. If your doctor confirms that you have a high or very high risk, ask about ways to reduce your risk, such as getting extra screening, taking medicine, or having surgery.
If you have a strong family history of breast cancer, ask your doctor about genetic testing. The test can check for gene changes that increase your risk for getting breast cancer and ovarian cancer.
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The exact cause of breast cancer is not known. A woman's age and health history play a part. The chances that you will get breast cancer increase as you age. In Canada, 1 woman out of 9 will be diagnosed with breast cancer at some point in her life.footnote 1
The first sign of breast cancer is often a painless lump. But early breast cancer is often found on a mammogram before a lump can be felt.
Other symptoms of breast cancer may not appear until the cancer is more advanced. These include:
Symptoms such as changes in the skin of the breast or the nipple may be a sign of inflammatory breast cancer. For more information, see the topic Inflammatory Breast Cancer.
Breast cancer occurs when cells in the breast grow abnormally. As the breast cancer grows, it can spread to nearby tissues and lymph nodes. Advanced breast cancer can affect the bones, liver, and brain.
Your doctor will find out more about your breast cancer when the cancer cells are examined under the microscope. Tests for hormone receptors and gene changes are usually done after surgery. For the tests, your doctor uses tissue taken from your breast.
Your doctor will also stage the cancer to see how far it has spread within the breast, to nearby tissues, and to other organs. Your doctor will find the stage by using tests, such as chest X-rays or CT scans. The stage of your cancer will help guide your treatment options.
Although the exact cause of breast cancer is not known, most experts agree that several things can increase your risk of breast cancer.
For more information about your personal risk level, go to www.cancer.gov/bcrisktool.
Call your doctor if you have:
Your family doctor, general practitioner, or gynecologist can perform a breast examination.
Mammograms are usually read by radiologists.
You may be referred to a general surgeon, a breast surgeon, or a radiologist if further evaluation of a breast problem is needed.
Breast cancer is treated by surgeons, medical oncologists, and radiation oncologists.
You may have a screening test to look for breast cancer. (Screening tests help your doctor look for a certain disease before any symptoms appear.) The earlier breast cancer is found, the more easily and successfully it can be treated.
The type and frequency of breast cancer screening that is best for you changes as you age. The most common ways to find breast cancer early include:
If your doctor thinks that you have breast cancer, you may have other tests, including:
If your doctor thinks that breast cancer may have spread to other organs in your body (metastasized), he or she may order additional testing, including a bone scan or CT scans.
If you have had breast cancer in one breast, you have an increased risk for developing breast cancer again. Breast cancer can come back in the same breast, on the chest wall, in your other breast, or somewhere else in your body. You can expect to have:
If you find any unusual changes in the treated area or in your other breast, or if you have swollen lymph glands or bone pain, call your doctor to discuss these changes. For more information, see the topic Breast Cancer, Metastatic or Recurrent.
It is important to know what your breasts normally look and feel like. When you know what is normal for you, you are better able to notice changes. Tell your doctor right away if you notice any changes in your breasts.
When making decisions about treatment, you and your doctor will consider many things, such as your age and health, the type of breast cancer you have, and how likely it is to spread.
In some cases, chemotherapy or hormone therapy is used before surgery to shrink the breast cancer. This may mean that less breast tissue has to be removed during surgery.
Depending on the tumour's size and whether cancer has spread to your lymph nodes, you may have several treatment options. Hormone therapy, chemotherapy, or a combination of the two treatments may be used after surgery to destroy any remaining cancer cells. This also lowers the chances that the cancer will come back. Your doctor may suggest gene tests to find out if chemotherapy will help.
For women with DCIS (ductal carcinoma in situ), surgery is the standard treatment. But researchers are trying to find out which women might be good candidates for active surveillance. These women might be able to safely avoid or delay surgery.
Treatments can have side effects, such as nausea and vomiting and hair loss. For more information on how to manage side effects, see Home Treatment.
You can find more information about breast cancer online.
When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.
If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment centre may offer psychological or financial services. And a local chapter of the Canadian Cancer Society can help you find a support group.
Having cancer can change your life in many ways. For support in managing these changes, see the topic Getting Support When You Have Cancer.
Your feelings about your body may change after treatment for breast cancer. Managing body image issues may involve talking openly about your concerns with your partner and discussing your feelings with your doctor. Your doctor may be able to refer you to groups that can offer support and information.
Sexual problems can be caused by the physical or emotional effects of cancer or its treatment. Some women may feel less sexual pleasure or lose their desire to be intimate. For more information, see the topic Sexual Problems in Women.
After the initial treatment for breast cancer, you may see your family doctor, medical oncologist, radiation oncologist, or surgeon at regularly scheduled intervals, depending on your individual situation. Your checkups will happen less often as time goes by.
As part of your follow-up, you may have regular physical examinations and mammograms.
It's also important to do regular self-examinations. That way, if the cancer does come back, you have a better chance of finding it early enough for successful treatment. Early signs of recurrence may appear in the incision area itself, the opposite breast, under your arm, or in the area above the collarbone.
If new problems develop, you may have additional tests, such as blood tests, bone scans, chest X-rays, CT scans, or MRI tests.
If your breast cancer tested positive for estrogen and progesterone receptors, your doctor may prescribe medicines that can lower your risk of the cancer coming back. For more information, see Medications.
For information about the treatment of metastatic or recurrent breast cancer, see the topic Breast Cancer, Metastatic or Recurrent.
You cannot control some things that put you at risk for breast cancer, such as your age and being female. But you can make personal choices that lower your risk of breast cancer.
If you are concerned about your risk for breast cancer, talk with your doctor. He or she can help you understand your risk if you have a strong family history of breast cancer. Based on your risk, your doctor will recommend a screening schedule for you.
Your doctor may talk with you about genetic testing, the risks and benefits of taking hormone therapy, or even surgery if your risk is very high.
For more information, see:
The side effects of breast cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects, such as medicines to control and prevent nausea and vomiting.
Other problems that can be treated at home include:
Medicines are used to treat breast cancer and also to help relieve side effects of treatment.
A combination of medicines is typically used to treat breast cancer. The number of cycles of treatment will depend on the medicines that are used and how the medicines are given. Chemotherapy often uses several medicines together. They may include medicines like capecitabine, doxorubicin, and gemcitabine.
The side effects of chemotherapy depend mainly on the medicines you receive. As with other types of treatment, side effects vary from person to person. Your doctor may also prescribe medicines to control and prevent nausea and vomiting.
Medicines used for hormone therapy stop or slow the growth of hormone-sensitive cancer cells. These medicines include:
Hormone-blocking treatments may cause fewer side effects than chemotherapy. If you are deciding what type of medicine to use, weigh the benefits and risks of these medicines for your type of cancer.
Targeted therapies use medicines or substances that go directly to the cancer cells and don't harm normal cells. They include monoclonal antibodies, tyrosine kinase inhibitors, and PARP inhibitors.
The side effects of targeted therapies will depend on the type of medicine that is given. They include nausea, vomiting, and diarrhea. Some medicines can also cause side effects that are more serious.
Most people with breast cancer have surgery to remove the cancer. You may have breast-conserving surgery or surgery to remove the entire breast. Some of the lymph nodes under the arm may also be removed to check for cancer cells.
The kind of surgery you have may depend on the size and location of your cancer and your personal preferences.
Talk to your doctor about what your breast might look like after the surgery.
Mastectomy procedures include:
After mastectomy, a new breast can be reconstructed. Your surgeon will rebuild the shape of your breast using artificial implants or tissue from other parts of your body.
If you want breast reconstruction, talk to your doctor before your surgery is planned. You may be able to have breast reconstruction immediately following your mastectomy.
Radiation treatment is the use of high-energy X-rays to destroy cancer cells and shrink tumours. It lowers the risk of your cancer coming back in the breast or chest wall. Radiation therapy is used after breast-conserving surgery and sometimes after mastectomy, depending on how advanced the breast cancer is at the time of surgery.
The way radiation therapy is given will depend on the type and stage of your cancer.
The most common way to give radiation treatment is called external beam radiation. This method of treatment exposes the skin on the chest and under the arm to a carefully focused beam of radiation.
Sometimes tiny radioactive pellets are placed in or near the tumour site. This is called brachytherapy, internal radiation, or interstitial radiation. One example is accelerated partial breast irradiation (APBI).
Radiation may also be given in a single treatment, such as during surgery when a woman is having a lumpectomy.
Radiation treatment can cause many side effects. Your breast may swell and feel heavy. Fatigue is common. For information about managing side effects, see Home Treatment.
You may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who want to help with breast cancer research and those who are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of Canada, the United States, and in some other countries for all stages of breast cancer.
Check with your doctor to see whether clinical trials are available in your area and whether you might be eligible.
People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the complementary therapies that may be helpful include:
These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.
Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such therapies. They are not meant to take the place of standard medical treatment.
CitationsCanadian Cancer Society (2013). Breast cancer statistics. Available online: http://www.cancer.ca/en/cancer-information/cancer-type/breast/statistics/?region=on.National Cancer Institute (2012). Breast cancer risk in American women. National Cancer Institute Fact Sheet. Available online: http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer.Dizon DS, et al. (2009). Breast cancer. In RR Barakat et al., eds., Principles and Practice of Gynecologic Oncology, 5th ed., pp. 897–945. Philadelphia: Lippincott Williams and Wilkins.Other Works ConsultedNational Cancer Institute (2012). Male Breast Cancer Treatment PDQ—Patient Version. Available online: http://nci.nih.gov/cancertopics/pdq/treatment/malebreast/Patient.National Cancer Institute (2013). Male Breast Cancer Treatment PDQ—Health Professional Version. Available online: http://nci.nih.gov/cancertopics/pdq/treatment/malebreast/HealthProfessional.National Comprehensive Cancer Network (2012). Breast cancer risk reduction. NCCN Clinical Practice Guidelines in Oncology, version 1.2012. Available online: http://www.nccn.org/professionals/physician_gls/pdf/breast_risk.pdf.National Comprehensive Cancer Network (2012). Breast cancer screening and diagnosis. NCCN Clinical Practice Guidelines in Oncology, version 1.2012. Available online: http://www.nccn.org/professionals/physician_gls/pdf/breast-screening.pdf.National Comprehensive Cancer Network (2013). Breast cancer. NCCN Clinical Practice Guidelines in Oncology, version 1.2013. Available online: http://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.U.S. Preventive Services Task Force (2009). Screening for breast cancer. Available online: http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm.
Current as ofDecember 19, 2018
Author: Healthwise StaffMedical Review: Sarah Marshall MD - Family MedicineAnne C. Poinier MD - Internal MedicineE. Gregory Thompson MD - Internal MedicineAdam Husney MD - Family MedicineKathleen Romito MD - Family MedicineElizabeth T. Russo MD - Internal MedicineDouglas A. Stewart MD - Medical Oncology
Current as of: December 19, 2018
Author: Healthwise Staff
Medical Review:Sarah Marshall MD - Family Medicine & Anne C. Poinier MD - Internal Medicine & E. Gregory Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & Elizabeth T. Russo MD - Internal Medicine & Douglas A. Stewart MD - Medical Oncology
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