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Mary's doctor calls to give her the results of her mammogram.
The doctor says, "It's not normal and I think we need to biopsy the
area in question." Mary's first thought is, "Could this be breast
cancer?" When she asks, the doctor explains that a biopsy (taking out
and testing tissue from the suspicious area of the breast) is the way
to find out.
Another woman, Peg, just found a lump in her breast. She knows
that the lump wasn't there last month. Her first thought: "I probably
should see the doctor about this, but I'm sure it isn't cancer."
Women react in different ways when they learn that something
may be wrong with their breasts. Whatever their feelings and thoughts,
at some point most women will want more information about what is
happening.
Women who have had breast lumps, suspicious mammograms, and
breast biopsies helped write this document. They have gone through
something much like what you may be going through now.
Here we will share the basics of benign (non-cancerous) breast
conditions, diagnostic tests (such as different types of biopsies), and
breast cancer. You will also learn more about coping with your concerns
and fears, and where to find emotional support. The information you get
here should not take the place of talking with your doctor or nurse.
And, there are many details that we cannot cover here. So in each
section, we've added a list of questions that you might want to discuss
with your doctor and nurse.
We will explain many medical terms that you may hear during
testing and diagnosis. As you learn these terms, you will better
understand what is being said to you. Knowing what these terms mean can
help you as you talk with your health care team. We also have a Breast Cancer Dictionary
that many women and their doctors find very helpful. Call us at
1-800-ACS (227) 2345 for a free copy.
Benign breast conditions: Not all lumps are
cancer
If you find changes or something unusual in one of your
breasts, it is important to see a doctor or nurse as soon as possible.
But keep in mind that most breast changes are not cancer. Just because
your doctor wants you to have a biopsy does not mean you have breast
cancer: 4 of every 5 biopsy results are not cancer. But the only way to
know for sure is to take out and test tissue from the suspicious area
of the breast.
Benign (be-nine)
or non-cancerous breast conditions are very common and they are never
life threatening. The 2 main types are fibrocystic changes and benign
breast tumors.
Fibrocystic changes
Fibrocystic changes are benign changes in the breast tissue
that happen in about half of all women at some time in their lives.
This change often happens just before a menstrual period is about to
begin. Although this used to be called fibrocystic disease, it is not a
disease at all. These changes can cause cysts (fluid-filled sacs) and
areas of lumpiness, thickening, or tenderness; nipple discharge; or
pain in the breast. If they are painful, cysts can be treated by taking
out the fluid with a needle and syringe, but they may fill up again
later.
- A cyst cannot be diagnosed by physical exam alone, nor can
it be diagnosed by a mammogram alone. To be sure that a lump (mass) is
really a cyst, the doctor can do either a breast ultrasound or take the
fluid out of the cyst with a thin, hollow needle.
- A cyst is filled with fluid. If a mass has any solid parts,
it is no longer a simple cyst and you may need to have more imaging
tests. Some masses can be watched with mammograms, while others may
need a biopsy. The size, shape, and edges (margins) of the mass help
the doctor figure out whether cancer may be present.
Lumps and areas of thickening caused by fibrocystic changes
are almost always harmless. If fibrocystic changes are uncomfortable or
painful, doctors may suggest that you avoid caffeine or reduce your
salt intake. In severe cases, doctors can prescribe medicines that may
help reduce or relieve your symptoms.
Benign breast tumors
Benign breast tumors are non-cancerous areas where breast
cells have grown abnormally and rapidly, often forming a lump. Unlike
cysts, which are filled with fluid, tumors are solid. Benign breast
tumors are sometimes uncomfortable, but they are not dangerous and do
not spread outside the breast to other organs. Still, some benign
breast conditions, such as papillomas and atypical hyperplasia, are
important to know about because women with these conditions have a
higher risk of developing breast cancer. For more information see our
document, Non-Cancerous Breast Conditions.
A biopsy is the only way to find out if a tumor is benign or
cancerous. (See the section "Types
of biopsy procedures" for more information.) In a biopsy,
part of the lump or suspicious area is removed and looked at under a
microscope.
If a benign tumor is large, it may change the breast's size
and shape. Depending on the size and number of benign tumors, doctors
may recommend that it be removed by surgery (excision).
If the benign tumor is growing into the tissue of the milk
ducts, it may cause an abnormal discharge from the nipple. In some
cases, this can be treated by surgery to remove the tumor.
Other benign breast conditions
Mastitis
Mastitis is a breast infection that most often affects women
who are breast-feeding. The breast may become red, warm, or painful.
Mastitis is treated with antibiotics. But if the mastitis does not get
better when you take antibiotics, it is important that you let the
doctor know right away. Some breast cancers can look like infections.
Fat necrosis
Fat necrosis sometimes happens when an injury to the breast
heals and leaves scar tissue that can feel like a lump. A biopsy can
tell if it is cancer or not. Sometimes when the breast is injured, an
oil cyst (fluid-filled area) forms instead of scar tissue during
healing. Oil cysts can be diagnosed and treated by taking out
(aspirating) the fluid.
Duct ectasia
Duct ectasia is common and most often affects women in their
40s and 50s. Its symptoms are usually a green, black, thick, or sticky
discharge from the nipple, and tenderness or redness of the nipple and
area around the nipple. Duct ectasia can also cause a hard lump, which
is usually biopsied to be sure it is not cancer. Redness that does not
improve may need to be biopsied to be sure it is not cancer.
Diagnostic tests for breast conditions
The 2 main tests used to diagnose breast conditions are
mammograms and ultrasound. Magnetic resonance imaging (MRI) is also
being used more as a diagnostic tool as centers become experienced in
using it.
More details on these tests and other imaging test used to
diagnose breast changes can be found in another one of our documents, Mammograms and Other Breast
Imaging Procedures.
Diagnostic mammogram
If a woman has noticed breast changes or symptoms, or if a
routine screening mammogram has found a suspicious-looking area, she
may need to get a diagnostic mammogram. During diagnostic mammograms,
more x-rays are taken of the breast and extra pictures are focused on
the suspicious area. (See Appendix A
for more information on breast cancer.)
For a mammogram, the breast is pressed between 2 plates to
flatten and spread the tissue. This may be uncomfortable, but it is
needed to get a good, readable picture. The pressure only lasts a few
seconds. The entire procedure for a mammogram takes about 20 minutes.
Mammograms are usually a black and white picture of the breast tissue
on a large sheet of film that is read, or interpreted, by a radiologist (a
doctor specially trained to read these kinds of tests).
A digital mammogram produces a computer image that can be
stored in a computer system and read on a computer screen. The image
can be looked at from different angles, and the radiologist can enlarge
and zoom in to look at any suspicious areas.
But mammograms cannot prove that an abnormal area is cancer.
The tissue must be taken out and looked at under a microscope. Cancer
cannot be diagnosed without a biopsy.
You should also know that a mammogram is not perfect at
finding breast cancer. If you have a breast lump, you should have it
checked by your doctor and talk about having a biopsy, even if your
mammogram is normal.
Breast ultrasound
Breast ultrasound uses sound waves to make a computer picture
of the inside of the breast. This test is sometimes used to target a
certain area of concern that is found on the mammogram or physical
exam. Ultrasound is useful for looking at some breast changes, such as
those that can be felt but not seen on a mammogram. It also helps tell
the difference between cysts and solid masses. Sometimes it can show a
tumor is benign, in that it can often show if a lump is really a cyst
(fluid-filled). If this is the case your doctor may not have to put a
needle into it to draw out fluid.
Ultrasound is also known as sonography. It uses high-frequency
sound waves to outline a part of the body. The sound waves are
transmitted into the area of the body being studied and echoed back.
These echoes are picked up by the ultrasound probe. A computer changes
the sound waves into a picture that is displayed on a screen. You are
not exposed to radiation during this test.
Magnetic resonance imaging
Magnetic resonance imaging (MRI) is sometimes used after
breast cancer has been found. An MRI can show if your lymph nodes are
enlarged, which may be a sign that they contain cancer. This can be a
clue to the cancer's stage even before surgery. MRI is sometimes used
to look for more breast tumors that did not show up on the mammograms.
It is also used to help guide the biopsy needle for tumors that can't
be seen on mammograms. This is known as MRI-guided biopsy.
Ductogram
Ductograms are sometimes used to find the cause of nipple
discharge. A ductogram is also called a galactogram. In
this test, a small amount is placed into the nipple through a tiny
plastic tube. The dye can be seen on an x-ray, which can then show if
there is a mass inside the duct.
Biopsy
While imaging tests like the mammogram and breast ultrasound
can find a suspicious area, they cannot tell whether the area is
cancer. A biopsy is the only way to tell for sure if a change is a
benign breast condition or cancer.
A biopsy involves removing some cells from the suspicious area
to look at under a microscope. A biopsy can be done using a needle or
with surgery to remove part or all of the tumor. The type of biopsy
depends on the size and location of the lump or area that has changed.
If your doctor thinks you don't need a biopsy, but you feel
there's something wrong with your breasts, follow your instincts. Don't
be afraid to talk to your doctor about this or go to another doctor for
a second opinion.
Second opinions
Before you have a biopsy, you may want to get a second
opinion. This way, another expert from another hospital or mammogram
center will look at your mammogram. You can ask your doctor to set this
up for you, or you can have the films sent to an expert you have
chosen. If you have had digital mammography, the images can be sent
electronically, but you may still need to send your older films for
comparison.
Your doctor's office staff can help you figure out what you
need to do and how to do it. They should send any previous mammograms
and your most recent mammogram to a center that specializes in
mammograms and the diagnosis of breast cancer. Or, if the facility will
make copies, you can take them for a second opinion yourself. Be sure
to find out ahead of time if the second facility or doctor accepts
copies; some facilities read only original x-rays. You should also find
out if your health insurance will cover a second opinion. If not, you
will want know what your costs will be.
It takes great skill and experience to accurately read a
mammogram, either from film or electronic records. You want to be sure
that yours is being read by an expert.
Types
of biopsy procedures
Each type of biopsy has pros and cons. The choice of which
type to use depends on your situation. Some of the things your doctor
will consider include how suspicious the tumor looks, how large it is,
where it is in the breast, how many tumors are present, other medical
problems you may have, and your personal preferences. You might want to
talk to your doctor about the pros and cons of different biopsy types.
Fine needle aspiration biopsy
In fine needle aspiration biopsy (FNAB), the doctor (a
pathologist, radiologist, or surgeon) uses a very thin needle attached
to a syringe to withdraw (aspirate) a small amount of tissue from a
suspicious area. This tissue is then looked at under a microscope. The
needle used for FNAB is thinner than the ones used for blood tests.
If the area to be biopsied can be felt, the needle can be
guided into the area of the breast change while the doctor is feeling
(palpating) it. If the lump can't be felt easily, the doctor might use
ultrasound to watch the needle on a screen as it moves toward and into
the mass. Or the doctor may use a method called stereotactic needle biopsy
to guide the needle. For stereotactic needle biopsy, computers map the
exact location of the mass using mammograms taken from 2 angles. This
helps the doctor guide the needle to the right spot.
The doctor may or may not use a numbing medicine (local anesthetic).
Because such a thin needle is used for the biopsy, getting the
anesthetic may hurt more than the biopsy itself.
Once the needle is in place, fluid is drawn out. If the fluid
is clear, the lump is most likely a benign cyst. Bloody or cloudy fluid
can mean either a benign cyst or, very rarely, a cancer. If the lump is
solid, small pieces of tissue are drawn out. A pathologist (a doctor
who is expert in diagnosing disease from tissue samples) will look at
the biopsy tissue or fluid under a microscope to find out if it is
cancer.
A fine needle aspiration biopsy can sometimes miss a cancer if
the needle does not get a tissue sample from the area of cancer cells.
If it does not give a clear diagnosis, or your doctor is still
suspicious, a second biopsy or a different type of biopsy should be
done.
If you are still having menstrual periods (that is, if you are
premenopausal), you most likely know that breast lumpiness can come and
go each month with your menstrual cycle. But if you have a lump that
doesn't go away, the doctor may want to do a FNAB to see if it is a
cyst (a fluid-filled sac) or a solid growth (mass or tumor). If an
aspiration is done and the lump goes away after it is drained, it
usually means it was a cyst, not cancer. Again, most breast lumps are
not cancer.
Core needle biopsy
A core needle biopsy (CNB) is much like an FNAB. A slightly
larger, hollow needle is used to withdraw small cylinders (or cores) of
tissue from the abnormal area in the breast. CNB is most often done
with local anesthesia (you are awake but your breast is numbed) in the
doctor's office. The needle is put in 3 to 6 times to get the samples,
or cores. This is more invasive and takes longer than an FNAB, but it
is more likely to give a definite result because more tissue is taken
to be looked at. CNB can cause some bruising, but usually does not
leave scars inside or outside the breast.
The doctor doing the FNAB or CNB usually guides the needle
into the abnormal area while feeling (palpating) the lump. If the
abnormal area is too small to be felt, a radiologist or other doctor
may use needle placement, a stereotactic instrument, or ultrasound to
guide the needle to the target area.
Stereotactic core needle biopsy
A stereotactic core needle biopsy uses x-ray equipment and a
computer to analyze the pictures (x-ray views). The computer then
pinpoints exactly where in the abnormal area to place the needle tip.
This type is often used to biopsy microcalcifications (calcium
deposits).
Larger core biopsies
Large core biopsies that use stereotactic methods can be done
to remove even more tissue than a core biopsy.
Vacuum-assisted core biopsy
The Mammotome® is one type of
vacuum-assisted core biopsy (VACB). For this procedure the skin is
numbed and a small cut (about ¼ inch) is made. A hollow
probe is put into the incision and then into the abnormal area of
breast tissue. A cylinder of tissue is then suctioned in through a hole
in the side of the probe, and a rotating knife within the probe cuts
the tissue sample from the rest of the breast.
There are 2 other types of vacuum-assisted core biopsy
systems:
- ATEC
- MIBB (short for minimally invasive breast biopsy)
Both of these methods also allow tissue to be removed through
a single small opening. And both methods are able to remove more tissue
than a standard core biopsy. No stitches are needed and there is very
little scarring. Vacuum-assisted core biopsies are done in outpatient
settings.
Rotating circular "cookie-cutter" knife
The ABBI method (short for Advanced Breast Biopsy Instrument)
uses a probe with a rotating circular knife and thin wire to remove a
larger cylinder of abnormal tissue. ABBI is used with x-ray guidance
(stereotactic imaging), and can sometimes be used to remove an entire
mass. It is slightly less invasive than a surgical biopsy. A few
stitches may be needed afterward.
Magnetic resonance imaging (MRI) guidance
In some centers, the biopsy is guided by an MRI, which uses
computer analysis to find the tumor, plot its coordinates, and help aim
the needle or biopsy device into the tumor. This is helpful for women
with a suspicious area that can only be seen by MRI. One of the
vacuum-assisted core biopsy systems, the ATEC, is designed so that it
can be used with an MRI.
Ultrasound-guided biopsy
Ultrasound-guided biopsy uses an instrument that sends out
sound waves and a computer to make pictures of the breast abnormality.
A doctor can use this test to guide a needle into very small tumors or
cysts.
Surgical (excisional) biopsy
A surgical biopsy is used to remove all or part of the lump so
it can be looked at under the microscope. An excisional biopsy
removes the entire mass or abnormal area, as well as a surrounding
margin of normal-looking breast tissue. In rare cases, this type of
biopsy can be done in the doctor's office, but it is more often done in
the hospital's outpatient department under a local anesthesia (where
you are awake, but your breast is numb). You may also be given medicine
to make you drowsy.
During an excisional breast biopsy the surgeon may use a
procedure called wire localization if there is a small lump that is
hard to find by touch or if an area looks suspicious on the x-ray but
cannot be felt. After the area is numbed with local anesthetic, a thin,
hollow needle is put into the breast and x-ray views are used to guide
the needle to the suspicious area. A thin wire is put in through the
center of the needle. A small hook at the end of the wire keeps it in
place. The hollow needle is then removed, and the surgeon uses the wire
to guide him to the abnormal area to be removed.
If a benign condition is diagnosed, no other treatment is
needed. If the diagnosis is cancer, there is time for you to learn
about the disease and talk about treatment options with your cancer
care team, friends, and family. There is no need to rush into
treatment. You may want to get a second opinion before deciding on what
treatment is best for you.
Questions to ask before having a biopsy
Here are some questions you might want to ask your doctor
before having a biopsy done:
- What type of biopsy do you recommend? Why?
- How does the size of my breast affect the procedure?
- Where will you do the biopsy?
- What exactly will you do?
- How long will it take?
- Will I be awake or asleep during the biopsy?
- Can I drive home afterward or will I need someone to drive
me?
- If you are using a wire to help find the abnormal area
(localize), will you check its placement by ultrasound or with a
mammogram?
- Can you draw pictures showing me the size of the incision
and the size of the tissue you will remove?
- Will there be a hole there? Will it show afterward?
- Where will the scar be? What will it look like?
- How soon will I know the results?
- Should I call you or will you call me with the results?
- Will you or someone else explain the biopsy results to me?
- When can I take off the bandage?
- When can I take a shower?
- Will there be stitches? Will they dissolve or do I need to
come back to the office and have them removed?
- Will there be bruising or changes in color of the skin?
- Will there be a scar?
- When can I go back to work? Will I be tired?
- Will my activities be limited? Can I lift things? Care for
my children?
Your breast biopsy results
Right after the tissue sample is removed, it is sent to the
lab, where a pathologist looks at it. (A pathologist is a medical
doctor who is specially trained to look at cells under a microscope and
identify diseases.)
If your biopsy result is negative
If your biopsy result comes back negative (benign), this means
that no cancer was found. If you have any questions or if for any
reason you feel unsure about the results of the biopsy, you may wish to
get a second opinion or pathology review, where another doctor looks at
your biopsy tissue. Once you feel comfortable that you do not have
cancer, be sure to:
- have regular mammograms (See Appendix
B for our guidelines for finding breast cancer early)
- continue seeing your health care professional for routine
breast exams
- be aware of any changes in your breasts, and report changes
to your doctor right away
- talk with your doctor about your risk of breast cancer
A mammogram may show a lump or other change that can't be felt
on a physical exam. Physical exams may find a lump or skin change that
a mammogram can't see. If you should ever notice a change in your
breasts yourself, let your doctor know right away. Breast changes do
not always mean that breast cancer is present. (See Appendix B for more information
on finding cancer early.)
If the biopsy shows breast cancer
If the biopsy shows that the lump is cancer, the results will
show some important things about the cancer.
Is it in situ or invasive?
The biopsy report may say that the cancer is in situ. This means
that the cancer started in a milk gland (lobule) or duct (tube that
carries milk from the lobule to the nipple) and has not spread to the
nearby breast tissue or to other organs in the body.
Invasive
or infiltrating cancer means that the tumor started in a lobule or a
duct and has spread into nearby breast tissue. This type may spread to
the lymph nodes or to other parts of the body through the lymph system
and bloodstream.
How fast is it likely to grow and spread?
Pathologists use the microscope to see how the cells look and
are arranged to figure out the cancer's grade. The grade
tells how slowly or quickly the cancer is likely to grow and spread.
Pathologists also use measures called ploidy, cell proliferation rate,
Ki-67 tests,
and HER2/neu
tests to give the medical team a better idea of how quickly or slowly
the cancer is likely to grow and spread. These tests help your doctor
to choose the best treatment.
Will it respond to hormone therapy?
Estrogen and progesterone receptors recognize and respond to
the female hormones estrogen and progesterone. Some breast cancers have
these receptors (receptor-positive),
and others do not (receptor-negative).
Finding out if a cancer has these receptors will help your doctor
decide how likely it is to respond to hormone therapy.
Questions to ask about your biopsy results
After your biopsy results are back it is important to know if
the results are final, definite results, or if another biopsy is
needed. Here are some questions to ask if they are final results:
If it is not cancer...
- Do I need any follow-up?
- When should I have my next screening mammogram?
If it is cancer...
- Is the cancer in situ or invasive?
- If the cancer is in situ, is it a type of cancer that can
become invasive?
- Does the cancer seem to be growing and/or spreading slowly
or quickly?
- Will the cancer respond to hormone therapy?
- What types of tests will you recommend to figure out the
stage of the cancer?
- When will I need to start treatment?
More information on breast cancer and its treatment can be
found in our document, Breast Cancer.
Does a biopsy or surgery cause cancer to
spread?
In nearly all cases, surgery does not cause cancer to spread.
There are some important exceptions, such as tumors in the eyes or
testicles. Doctors who are experienced in taking biopsies of cancers
and treating them with surgery know how to avoid the danger in these
situations.
The chances of a needle biopsy causing a cancer to spread are
very low. In the past, larger needles were used for biopsies, and the
chance of spread was higher.
One common myth about cancer is that it will spread if it is
exposed to air during surgery. Some people may believe this because
they often feel worse after the operation than they did before. It is
normal to feel this way when you start to recover from any surgery. And
sometimes, no one knows that the cancer has spread until it is seen
during surgery. Because of this, some people may link surgery with
widespread cancer. But cancer does not spread because it has been
exposed to air. If you put off or refuse surgery because of this myth,
you may be harming yourself by passing up effective treatment.
Biopsy and surgery: Two-step or one-step?
If your biopsy results show cancer and you need to have more
surgery to remove it, the surgery is almost always done later, after
the biopsy. This is called a two-step procedure. But sometimes a
one-step procedure can be done in which the biopsy and surgery are done
during the same operation. If you have a one-step procedure, you will
want to know all of your treatment options beforehand because you must
make important choices before the one-step procedure begins.
The two-step procedure
For many years, a one-step procedure was the only choice.
Today, most women and their health care team prefer to schedule further
surgery, if needed, after the biopsy. Many studies have shown that the
emotional burden of breast cancer is easier to bear if the biopsy and
treatment are done at different times.
In the two-step approach, the biopsy is most often done on an
outpatient basis. Local anesthesia is used (the breast is numbed), so
you stay awake. Many women choose local anesthesia plus a sedative (medicine
to make you sleepy) given through a vein. The sedative helps make you
feel sleepy and calms any nervous or anxious feelings you may have
during the procedure. The biopsy can take about an hour. You can go
home an hour or so later, when the sedative wears off.
With the two-step procedure, if the diagnosis is breast
cancer, you usually don't have to decide on treatment right away. With
most breast cancers, there is no harm to your health in waiting a few
weeks. This gives you time to talk about your treatment options with
your doctors, family, and friends, and then decide what's best for you.
(More information on treatment options is available by calling us or
visiting our Web site; see "Additional
resources," below.)
Waiting for the results
Learning that you might have breast cancer can be very
difficult. If you have a biopsy and have to wait for the results, the
waiting can be a frightening time during which many women go through
some strong emotions, including disbelief, anxiety, fear, anger, and
sadness. It is important to know that it is normal for you to have
these feelings. You will need coping strategies to help you find
healthy ways to deal with the physical and emotional challenges you are
facing.
Remember, too, that what works for you may be different from
what works for others. Some women find comfort in talking with other
people about their breast condition, while others may wish to keep it
very private. While some women want to be very involved in their
testing decisions, others may wish to place their trust almost entirely
in their health care team. The ways in which this event will affect
your lifestyle and your body are unique, and the ways you cope will
also be unique.
You are not alone: Getting emotional support
You may find resources and support -- including your own inner
strengths -- that you did not know existed.
If you are married or in a committed relationship, what you
are going through will affect that relationship. Waiting for your
biopsy test results is a family challenge, as well as a personal one.
Other women who have been through a breast biopsy now can be
your strongest allies. Talking with them can be very helpful and
reassuring. You can reach out – or simply listen –
to others who understand your feelings and concerns.
If you learn that your diagnosis is breast cancer, you may
find it helpful to talk with someone who has already been through
breast cancer. Our Reach to Recovery Program, available in most
communities, is one of many programs that may help you. Reach to
Recovery can put you in touch with a woman who has been diagnosed with
and treated for breast cancer.
To talk with or receive a visit from a Reach to Recovery
volunteer, call your local American Cancer Society office or
1-800-ACS-2345 (1-800-227-2345). Also, the "Additional resources"
section at the end of this document has more information on Reach to
Recovery and other resources available to you and your family.
Other coping strategies
Here are some other coping strategies you may want to try:
Try to learn as much about breast cancer
and your treatment as you can
Some women find that learning as much as they can gives them a
sense of control over what happens. If you want more information about
breast health or breast cancer, please contact us. (See "Additional resources.")
Express your feelings
Most women find that expressing their feelings can help them
maintain a positive attitude. You might choose to talk with trusted
friends or relatives, keep a private journal, or even dance, sing,
paint, or draw to express yourself
Take care of yourself
Take time to do something you enjoy every day. Have your
favorite meal, take a bubble bath, go for a walk, meditate, listen to
your favorite music, read a good book, or watch a funny movie.
Exercise
If you feel up to it, and your doctor agrees that you're
ready, start a mild exercise program, maybe one that involves walking,
yoga, swimming, or stretching. Exercise can help you feel more in
control of your body.
Reach out to others
Making new friends, whether on your own or through support
groups, can help you remember that you are not alone. It also gives you
more people with whom to share your fears, hopes, and personal
accomplishments. It makes the waiting not so lonely. Talk to a Reach to
Recovery volunteer. Interact with one or more support groups in your
community. See Appendix D
for more ways to meet other people dealing with cancer.
Additional
resources
More information from your American Cancer
Society
We have selected some related information that may also be
helpful to you. These materials may be ordered from our toll-free
number, 1-800-ACS-2345 (1-800-227-2345).
- After Diagnosis: A Guide for Patients and Families (also
available in Spanish)
- Breast Cancer Early Detection Guidelines: Fact Sheet
- Breast Cancer Early Detection Guidelines: Frequently Asked
Questions
National organizations and Web sites*
Along with the American Cancer Society, other sources of
patient information and support include:
American College of Radiology
A professional society
that focuses on the practice of radiology, safety, and quality
standards.
Toll-free number: 1-800-227-5463
Web site: www.acr.org
National Breast Cancer Coalition
An organization that
advocates for public policy related to breast cancer issues.
Toll-free number: 1-800-622-2838
Web site: www.stopbreastcancer.org
National Cancer Institute
Toll-free information
line for questions about cancer.
Toll-free number: 1-800-4-CANCER (1-800-422-6237)
Web site: www.cancer.gov
Susan G. Komen for The Cure
An international
not-for-profit organization dedicated to eradicating breast cancer as a
life-threatening disease by advancing research, education, screening,
and treatment.
Toll-free number: 1-877-GO KOMEN (1-877-465-6636)
Web site: www.komen.org
Breast Cancer Network of Strength (formerly Y-Me National
Breast Cancer Organization)
Support and counseling
for women with breast cancer (24-hour hotline).
Toll-free number: 1-877-221-2141 (English); 1-800 986-9505 (Spanish)
Web site: www.networkofstrength.org
*Inclusion on
this list does not imply endorsement by the American Cancer Society.
No matter who you are, we can help. Contact us anytime, day or
night, for cancer-related information and support. Call us at 1-800-ACS-2345 (1-800-227-2345) or
visit www.cancer.org.
APPENDIX
A: WHAT IS BREAST CANCER?
Breast cancer is the development of abnormal cells in the
breast. These cells are very different from normal, healthy cells.
These cells begin to grow out of control and make more cells that grow
into tumors, or growths, and can spread to other parts of the body.
Breast cancer develops over time, starting with one tiny,
abnormal cell. In most cases this takes a long time, but sometimes the
type of cancer is very aggressive and the tumor grows and spreads
quickly.
Likelihood of having breast cancer
Breast cancer is the most common cancer that women may have to
face in their lifetime (other than skin cancer). It can develop at any
age, but it is much more likely after age 40. And the chance increases
as women get older. Some women – because of certain factors
– may have a greater chance of developing breast cancer than
other women.
These factors include:
- a personal history of breast cancer
- inherited changes (or mutations) in breast cancer-related
genes (called BRCA1 and BRCA2 genes)
- previous radiation treatments to the chest area
- 2 or more close relatives with breast or ovarian cancer
- a relative (mother, sister, grandmother, or aunt) on either
side of the family with breast cancer before age 50
- male relatives with breast cancer
Women who have some of these factors should talk with their
doctors about whether they should have an MRI along with their
mammograms and clinical breast exams each year. For more information,
see our document, Breast Cancer: Early Detection.
Some factors may increase the chance of having breast cancer
by only a small amount, such as:
- beginning your menstrual periods at an early age (also
called early menarche)
- going through menopause at a late age
- having no children
- having your first pregnancy after age 30
- gaining weight as an adult
- excessive use of alcohol
But most breast cancers occur in women who have none of these
risk factors, other than getting older. This means it's important that
all women try to find breast cancer early through routine screening
mammograms, regular clinical breast examinations, and watching for any
breast changes.
Rumors about breast cancer risk factors
People with fears about breast cancer sometimes start
unfounded rumors about what causes breast cancer. These rumors can be
hurtful and frightening to others.
For example, some Internet rumors say that antiperspirants and
underwire bras can increase a woman's risk of developing breast cancer.
There is no experimental or clinical evidence to support either of
these claims. Antiperspirants do not contain cancer-causing substances
and do not block such substances from getting out of the body. We also
know that injuries to the breast do not cause cancer, and that breast
cancer is not something a woman gets or catches, like the flu.
If you hear claims about new causes of breast cancer, talk to
your doctor before changing your lifestyle or personal habits. The
American Cancer Society also has up-to-date information on cancer
research and recent findings. This information is available if you call
1-800-ACS-2345 (1-800-227-2345) or visit www.cancer.org.
APPENDIX
B: GUIDELINES FOR EARLY DETECTION OF BREAST CANCER
Breast cancer is most treatable when it is found early. There
is no way to predict who will develop breast cancer and who will not.
For these reasons, routine early detection tests (checking for breast
cancer when there are no symptoms present) are recommended. The
following are the guidelines published by the American Cancer Society
to ensure early detection of breast cancer:
- All women age 40 and older should have a mammogram every
year for as long as they are in good health.
- Women age 40 and older should have a clinical breast exam
(breast exam by a health professional) every year. This exam should be
done close to or preferably before the mammogram.
- Women ages 20 to 39 should have a clinical breast exam
every 3 years.
- Women should report any breast changes to their health
professional right away.
- Breast self-exam (BSE) is an option for women starting in
their 20s. Women should be told about the benefits and limitations of
BSE.
- Some women - because of their family history, a genetic
tendency, or certain other factors -- should be screened with MRI in
addition to mammograms. (The number of women who fall into this
category is small: less than 2% of all the women in the United States.)
Talk with your doctor about your history and whether you should have
additional tests at an earlier age.
For more information on screening, please see our document, Breast Cancer: Early Detection.
Breast changes
Early breast cancer is most often – but not always
– painless. In its very early stages, it is too small to find
by palpating (touching) the breast. This means that there may not be
any symptoms present. At this stage of breast cancer growth, a
screening mammogram can detect the changes before symptoms appear. As
the tumor grows larger, it can feel like a lump or thickness.
Breast cancer can develop anywhere in the breast. Some signs
to watch for are:
- a lump or thickening of tissue anywhere in the breast
- skin dimpling or puckering of the breast
- a nipple that is pushed in (inverted) and hasn't always
been that way
- discharge from the nipples that comes out by itself and is
not clear in color, staining your clothing or sheets
- any change in the shape, texture (raised, thickened skin,
for example), or color of the skin
These are all changes that you may be able to see or feel
yourself. Having these changes, though, does not mean you have breast
cancer. They can appear for other reasons. Always tell your doctor or
nurse right away about any changes you find. If you are interested in
examining your own breasts, ask your doctor or nurse to show you how to
do breast self-exam (BSE).
Any suspicious changes in the breast tissue may also be seen
or felt by a health professional during a clinical breast exam (CBE). A
CBE is simply a check-up in which the doctor or nurse touches and
gently presses the breast tissue in a circular or vertical pattern, to
find any lumps, thickenings, or other abnormalities. The examiner may
also look at the shape of your breasts while you are sitting up to
check for abnormal contours. He or she might ask you to move your arms
into positions that make the breast easier to examine. Some may squeeze
the nipples gently to check for discharge.
While breast exams are very important, breast cancers often
develop without any signs or symptoms. That's why mammograms are also
important.
APPENDIX C: MAMMOGRAMS: FINDING HIDDEN
BREAST CANCER
One of the best ways a woman age 40 or older can defend
herself against breast cancer is to have yearly screening mammograms.
What is a mammogram?
A mammogram is a special type of x-ray that shows an image (a
kind of picture) of the inside of the breast. Mammograms use radiation,
but the amount is very low and is not harmful.
Mammograms can be done in a radiology facility, a hospital or
clinic, or a doctor's office. There are 2 kinds of mammograms:
screening mammograms and diagnostic mammograms.
A screening
mammogram is an x-ray of the breast of a woman who has no
breast symptoms or problems (asymptomatic). Women over 40 should get
screening mammograms every year to look for changes in their breast
tissue. Because most breast cancers do not cause symptoms, a screening
mammogram may be the best way for most women to find cancers in their
early, most treatable stage.
A diagnostic
mammogram is used to find breast disease in women who have
symptoms or areas of change on their screening mammogram. Diagnostic
mammograms help the doctor learn more about breast masses or the cause
of other breast symptoms.
Mammograms are usually not very useful for women younger than
40. This is because breast tissue in most younger women is too dense to
give a good, clear x-ray image. Women who have a family history of
breast cancer, a genetic tendency, or certain other factors may need to
start testing before age 40 and be screened with an MRI along with the
mammogram, Talk with your doctor about your history and the screening
tests and schedule that is best for you.
Mammogram results
When doctors look at mammogram results, they compare the
x-rays from previous mammograms and look for differences between the
breast images. Sometimes the x-ray will show tiny bits of calcium in
the breast called microcalcifications.
Most microcalcifications are harmless, but in some cases, they can be a
sign of cancer or a pre-cancerous condition. The doctor looks at the
shape and arrangement of the microcalcifications to decide if a biopsy
is needed. Sometimes, the doctor may see an area of the breast that
looks a little different but not enough so to report the mammogram as
abnormal. When this happens the doctor may ask that the mammogram be
repeated in about 6 months.
The mammogram may also detect the presence of a mass, or
suspicious-looking area of tissue. Masses are not a sure sign of
cancer. The doctor will look at the size, shape, and margins (edges) of
the mass to figure out the likelihood of cancer. More testing may be
needed to find out if it is cancer.
While mammograms are the best way for most women to check for
cancer in its early stages, a mammogram alone cannot prove that a
suspicious area is cancer. If cancer is suspected, more testing will be
needed.
Remember:
- Only 2 to 4 mammograms out of every 1,000 lead to a
diagnosis of cancer.
- About 10% of women will need to have more mammograms after
the first one is taken. Don't be alarmed if this happens to you.
Sometimes this happens if there is a technical problem with the x-ray
film, or if the film was hard to read.
- Only 8% to 10% of these women who need repeat mammograms
will need a biopsy, and 80% of those biopsies will not be cancer.
- Breast cancer can be curable, especially if it's caught
early enough.
APPENDIX
D: AMERICAN CANCER SOCIETY SUPPORT SERVICES FOR PEOPLE FACING CANCER
The following programs are provided free of charge by the
American Cancer Society. Please call the local Society office listed in
your telephone book or 1-800-ACS-2345 (1-800-227-2345) for more
information.
Reach to Recovery
®: Breast cancer survivors provide
one-on-one support and information to help individuals cope with breast
cancer. Specially trained survivors serve as volunteers, responding in
person or by phone to the concerns of people facing breast cancer
diagnosis, treatment, recurrence, or recovery.
I Can Cope®:
Adult cancer patients and their loved ones learn about the cancer
experience while building their knowledge and coping skills. In these
educational classes, health care professionals provide information,
encouragement, and practical tips in a supportive environment.
Look Good...Feel
Better®: Through this free
service, women getting cancer treatment learn tips to restore their
self-image and cope with side effects that change the way they look.
Certified beauty professionals provide tips on makeup, skin cancer,
nail care, and head coverings. This program is a collaboration of the
American Cancer Society with the Personal Care Products Council and the
National Cosmetology Association.
"tlc"™:
A magazine and catalog in one, "tlc" supports women dealing with hair
loss and other physical effects of treatment. This magalog offers a
wide variety of affordable products, such as wigs, hats, and
prostheses, through the privacy and convenience of mail order.
Group support
programs: Group support programs for cancer patients
and/or their families may be available in your community. These may
include groups specifically related to breast cancer. Groups meet on a
regular basis and provide an opportunity to share experiences,
concerns, and coping strategies with other people in similar
situations. Your local American Cancer Society can tell you what group
support programs are available in your area.
Cancer Survivors
NetworkSM (CSN): Created by and for people personally
touched by cancer, this "virtual" community is a free, Web-based peer
support service available around the clock. It is a welcoming, safe
place for people to find hope and inspiration from others who have
"been there." Services include radio talk show conversations and
interviews, individual stories, personal Web pages, discussion boards,
chat rooms, an Expressions Gallery, private and secure CSN email, and
more. Available on the Internet at: www.acscsn.org.
References
Carney PA, Miglioretti DL, Yankaskas BC, et al. Individual and
combined effects of age, breast density, and hormone replacement
therapy use on the accuracy of screening mammography. Ann Intern Med
2003; 138:168-175.
Kerlikowske K, Carney PA, Geller B, et al. Performance of
screening mammography among women with and without a first-degree
relative with breast cancer. Ann
Intern Med 2000; 133:855-863.
Kerlikowske K, Smith-Bindman R, Abraham LA, et al. Breast
cancer yield for screening mammographic examinations with
recommendation for short-interval follow-up. Radiology 2005;
234:684-692.
Saslow D, Boetes C, Burke W, et al. American Cancer Society
Guidelines for Breast Screening with MRI as an Adjunct to Mammography. CA Cancer J Clin
2007; 57:75-89
Last Medical Review: 08/18/2008
Last Revised: 08/18/2008
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