Breast Cancer - Frequently Asked Questions (FAQs)

If you or a loved one has been diagnosed with breast cancer, you will want to know more about this condition.

There is a lot of support and information out there that will help you during this time. Finding answers to your questions means you'll be better equipped to deal with this disease.

Some facts about breast cancer:

• Breast cancer is when cancer cells divide and multiply in milk-producing glands (lobules) or in the ducts that bring milk to the nipple.

• In the US, one in eight women will be diagnosed with breast cancer in their lifetime. 95% of these women are aged 40 and above.

• Men get breast cancer too. During his lifetime, a man's risk is about 0.1%. 

• Deaths from breast cancer are markedly declining due to better awareness, early detection, and better treatment.

• If you are screened regularly, your risk of dying from the disease is 47% lower than women who are not.

• Breast cancer survivors are the largest group of survivors of all cancers.

Which breast cancer stage has the best prognosis?

Cancer is often described in three stages:

Localized: Cancer is only in the breast.

Regional: Cancer has spread to lymph nodes or nearby tissue.

Distant: Cancer is detected in other areas, such as bones or lungs. 

Survival rates measure how many people are still alive five years after first diagnosis, compared to people in the overall population.

If you're told you have a 90% survival rate, it means that you're probably 90% as likely to be alive in five years as someone who doesn't have breast cancer.

The SEER Database monitors cancer statistics. Between 2010 and 2016, SEER figures for women with breast cancer had these five-year relative survival rates:

• Localized—90%

• Regional—86%

• Distant—28%

• All stages combined—90%.

Other considerations when studying relative survival rates

• Year by year, survival rates have been improving¹ (40% fewer deaths in the past 25 years) due to early detection and better treatment.

• Assessment is based on how far the cancer has spread, but other factors that may affect the outcome are age and general health.

• Biopsies of the cancer will be tested for hormone receptors. When estrogen and progesterone hormones attach to the protein receptors, they fuel cancer growth. (These are termed ER-positive and PR-positive breast cancer.) 

• HER2-positive breast cancers show a higher level of a growth-promoting protein called HER2. These cancers grow and spread quickly, but respond well to drugs that control HER2. 

• If you have been diagnosed with triple-negative breast cancer (TNBC), this means tests have shown negative receptors for estrogen and progesterone and low HER2. These cancers spread quickly and do not respond well to treatment. 

• Inflammatory breast cancer (IBC) is rare, affecting 1–5% of people diagnosed with breast cancer in the US. It’s hard to diagnose early and spreads quickly, so it doesn't have a very good prognosis.

It's important to recognize that the way each individual responds to treatment is unique and that the statistics are a general view of the outcome.

Which type of breast cancer is most likely to recur?

There are a number of factors that influence the risk of breast cancer recurring. Some are linked to the type of breast cancer you have. Others relate to the treatment you've had or your age and overall health.

Recurrence is influenced by:

• If the original tumor was large and lymph nodes were also affected, your risk of recurrence is increased.

• If your tumor was removed by surgery, the negative or positive margin will influence the chance of cancer returning.

• Women with ER-positive breast cancer are at higher risk of cancer returning or spreading, even up to 20 years after diagnosis.

• People with inflammatory breast cancer and women with triple-negative breast cancer have a high risk of local recurrence and spread.

• If you had a lumpectomy and did not receive radiation therapy after the surgery, you will be at increased risk of recurrence.

• Similarly, if you have not had endocrine therapy for hormone receptor-positive breast cancer, you will be at increased risk.

• Women who develop breast cancer before the age of 35 are at increased risk of it recurring.

• A high body mass index also increases the risk.

What do breast cancer lumps look and feel like?

Typically, a breast cancer lump will be painless. It will feel hard and irregular around the edges, appear on the top outer side of your breast, and won't move when pushed. It may get larger and will continue to remain during all stages of your menstrual cycle.

A breast cancer lump can also feel soft and malleable. It can be sensitive to touch or even painful, though that is not generally the case. 

Some women will become aware of a change of shape or size of their breasts. They may notice an area of thickened breast tissue or a discharge from the nipple. There may be a rash or dimpling of the skin on the breasts. They may notice a lump in an armpit. 

These lumps and changes to breast tissue are often due to other causes, such as benign cysts, trauma, or bacterial infections.

Learn more about the signs and symptoms of breast cancer, and, if you have any concerns, check with your physician.

What treatments are used for breast cancer?

The most common treatment for breast cancer is surgery.

Radiation therapy is also used; this is energy released in particle or electromagnetic waves that kill cancer cells by damaging their DNA. Radiation can be applied externally or internally (brachytherapy). 

Chemotherapy

Chemotherapy contains a cocktail of drugs that are tailored to treat your specific condition. It's given either before surgery (neoadjuvant) or after (adjuvant).

Neoadjuvant chemotherapy is used to shrink tumors before surgery, and adjuvant chemotherapy is used to make sure any remaining cancer cells are eradicated. 

If you have advanced breast cancer, chemotherapy may be given using just one type of drug, rather than a mixture. This may be more effective at slowing the spread of the disease.

Hormone therapy

Approximately two-thirds of breast cancers are hormone-receptor-positive. Hormone or endocrine therapy can stop estrogen and progesterone from attaching to the protein receptors in the cells. This kind of therapy blocks the body’s ability to make hormones and slows or stops the growth of hormone-sensitive tumors.

SERMs 

Tamoxifen is the most-prescribed selective estrogen receptor modulator (SERM). It blocks estrogen from breast cancer cells, so they don't grow. But it also strengthens growth in other parts of the body, such as the uterus and bones. If you haven't gone through menopause, this may be used.

Tamoxifen is also used to help lower the risk of developing breast cancer if you have a high risk. It's also used to reduce the chance of recurrence.

Another SERM is Toremifene (Fareson). It's generally used for postmenopausal women who have metastatic breast cancer.

SERDs

Selective estrogen receptor degraders (SERDs) block estrogen receptors. They work throughout the body, so they're generally only used in post-menopausal women. If they're used for pre-menopausal women, they're combined with another drug to "turn off" the ovaries.

The SERD Fulvestrant is used to treat advanced breast cancer and is sometimes combined with targeted therapy such as a CD4/6 or P13K inhibitor.

AIs

Aromatase inhibitors (AIs) stop estrogen production. They are used by post-menopausal women and pre-menopausal women, along with a drug to suppress ovarian function. 

AIs used in treating breast cancer are: 

• Letrozole (Femara)

• Anastrozole (Arimidex)

• Exemestane (Aromasin).

AIs are used with Tamoxifen in adjuvant therapy in various combinations. 

LHRH

Luteinizing hormone-releasing hormone (LHRH) analogs stop the ovaries from working, causing temporary menopause.

Goserelin (Zoladex) and Leuprolide (Lupron) are drugs in this category. They're used on their own or with SERMs, SERDs, or AIs.

Other hormone therapy

Male hormones called androgens, a progesterone-type drug called megestrol acetate (Megace), and high doses of estrogen are all hormone therapy treatments that are less likely to be used today.

Targeted therapy

Targeted therapy is a more recent development in treating cancer. The drugs target the changes in cells that are causing cancer. 

For hormone receptor-positive breast cancer: 

• CDK4/6 inhibitors. These drugs stop hormone receptor-positive cells from dividing and slow cancer growth. These drugs are taken with other drugs that inhibit estrogen production and depend on whether you have gone through menopause. 

• mTOR inhibitor. This drug is used to block the mTOR protein, which is a protein that helps cells grow and divide. It may make hormone therapy more effective. It's used by post-menopausal women who have advanced HER2-negative and hormone-receptor-positive cancer.

• PI3K inhibitor. This blocks the PI3K protein in cancer cells. If your breast cancer has a mutated PI3K gene, and you are post-menopausal, you may be treated with this drug.

For women with BRCA gene mutations:

BRCA genes help repair damaged DNA in cells, but if they've mutated due to cancer, then they are ineffective.

PARP inhibitors work to make the cancer cells that contain BRCA genes ineffective. This treatment is used in various ways depending on whether your breast cancer is metastatic and if you’ve already had chemotherapy or hormone therapy. 

For triple-negative breast cancer (TNBC):

If you have TNBC, your cancer doesn’t have estrogen or progesterone receptors, or much HER2 protein.

An antibody-drug conjugate (ADC) is a monoclonal antibody with a chemotherapy drug that brings the chemo directly to affected cells. This may be used in advanced TNBC after other chemotherapy has been tried.

Immunotherapy

Immunotherapy is used to boost the body's ability to identify and fight cancer cells.

The immune system has "checkpoints" to ensure healthy cells are not destroyed by the immune system. Cancer cells can avoid being attacked by the immune system by using checkpoints. The drugs allow immune cells to respond more strongly to cancer cells. 

A PD-1 checkpoint inhibitor, Pembrolizumab (Keytruda), blocks the PD-1 protein, which can boost the immune response and shrink tumors. Another PD-L1 inhibitor is called Atezolixumab (Tecentriq).

What are the side effects of breast cancer treatment?

Along with these various treatment options to combat breast cancer, there’s a wide range of possible side effects. Side effects vary from patient to patient.

You should inquire about the likely side effects of any particular drug or drug combination you are given.

Fertility and early menopause

Treatment with chemotherapy, hormone therapy, and targeted therapy are likely to affect your reproductive system. Some women will experience temporary menopause, and some will go into early and permanent menopause.

If you have concerns about your fertility, it's important to discuss your treatment options with your oncologist.

Immediate side effects from chemotherapy and radiation therapy

Possible side effects that you may experience as you go through a course of chemotherapy or radiotherapy include:

• Nausea

• Loss of appetite

• Fatigue

• Neutropenia—higher risk of infections

• Weight gain

• Lymphedema—if lymph nodes are removed or damaged by radiation, fluid may not drain effectively, causing swelling.

• Alopecia—loss of hair

• Difficulty in concentrating

• Deep vein thrombosis (DVT)

• Depression and/or anxiety

Many of these side effects can be alleviated by medication and other therapies.

Long-term side effects

There may be side effects that continue or appear after the initial phases of treatment. These can include:

• Fatigue

• Osteoporosis—bone density loss

• Muscle or joint pain, or peripheral neuropathy (numbness)

• Infertility, loss of menstruation, and symptoms of early menopause

• Changes to sex life and body image

• Changes to appearance, sensation, and movement around the breast area

• Damage to heart or lungs

• Weight gain

• Diabetes

• Cognitive impairment—difficulty concentrating or remembering

It is important that you talk to your medical team if you have any of these side effects.

What will my breasts look like after treatment/surgery?

You will notice changes whether you have a breast-conserving surgery or a mastectomy (removal of the entire breast).

Breast-conserving surgery can be a lumpectomy, quadrantectomy, partial or segmental mastectomy. Surgery will leave scars, swelling that should reduce over time, and changes to the shape of your breast. 

Radiotherapy can also cause changes to the look of your breasts. Common side effects are:

• Color changes and sensitivity, particularly to sunlight.

• Breast thickening, or hardening and shrinking of the affected breast.

• Dilated blood vessels causing thin red lines.

Reconstruction surgery can restore the shape of the breast after a mastectomy. You can also use a partial breast prothesis (a type of shell worn under clothing) to help your breasts look the same.

Support is available to help you deal with the feelings associated with changes to the look and feel of your breasts after treatment.

Can breast cancer spread?

The term "noninvasive cancer" means the cancer is contained and has not spread from the original site. "Invasive cancer" means that the disease has spread from breast ducts or glands to other parts of the breast. 

All types of breast cancer can spread. The areas breast cancer generally first spreads to are lymph nodes located under your arm, inside your breast, and near the collarbone. 

Breast cancer is considered to have metastasized when it has spread to other parts of the body, usually lungs, bones, brain, and liver.

HER2-positive cancer and triple-negative cancers are aggressive and more likely to metastasize.

Oncologists regularly check for signs that cancer has spread, both during treatment and when you are in remission. 

Can breast implants cause breast cancer?

Breast implants (surgically implanted silicone or saline material to give breasts shape) don't cause breast cancer. They are not a risk factor for developing breast cancer. 

However, research shows a link between breast implants and the development of cancer of the immune system, called anaplastic large cell lymphoma (ALCL). A new term to describe this condition is BIA-ALCL (breast implant-associated anaplastic large cell lymphoma). This is a very rare condition and is associated with textured silicone and saline implants used in cosmetic surgery and breast cancer reconstruction. 

Do men get breast cancer?

Yes, but very infrequently.

About 1% of breast cancers detected in the US are found in men, who are generally aged 60 and above. It has a good prognosis if it's detected at an early stage. 

Risk factors

• Age

• Family history of breast cancer

• Increased estrogen due to

• Hormone therapy to address prostate cancer

• Obesity

• Cirrhosis of the liver

• Testicular disease or surgery 

• Klinefelter's syndrome (when males are born with more than one X chromosome) 

Symptoms

• A painless lump

• Changes to your skin in the area of the breast, such as scaling, redness, or a dimpled or puckered appearance

• Thickening of breast tissue

• Changes to your nipple—discharge, scaling, or redness

• Your nipple begins to invert

How is male breast cancer treated?

Your treatment will be similar to the treatment for women. It may involve surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapy. 

Should I get genetic testing for breast cancer?

Most women who get breast cancer don't have a family history of the disease, but about 5–10% of breast cancer cases² may result from a gene mutation from a parent. 

The most common gene mutations are BRCA1 or BRCA2, which are genes that make proteins to repair DNA. If these cells mutate, they grow abnormally and can lead to breast cancer.

Other gene mutations are less common and less likely to lead to developing breast cancer. However, if you have a blood relative who was diagnosed with breast cancer under the age of 50, this is more likely to be due to a genetic mutation and may increase your breast cancer risk.

When is genetic testing useful?

If you have a mother, sister, or daughter with breast cancer—a "first-degree relative", your risk may be double. If you have two first-degree relatives, your risk may be three times as high. You may be at higher risk if you have a father or brother who has had breast cancer. 

If you are considering a genetic test for breast cancer, you are likely to be offered counseling. This helps you consider the pros and cons of having the test. 

Some of the benefits of having genetic testing are:

• You'll be more aware of the risk you carry. You can examine your breasts frequently, get regular screening, and maintain a healthy lifestyle.

• You may decide on risk-reducing surgery.

The disadvantages of genetic testing include:

• The test may be inconclusive.

• Increased anxiety for yourself and your family if genetic testing results show the faulty BRCA1 or BRCA2 gene is present.

What type of doctor should I see if I think I have breast cancer?

If you suspect you have breast cancer, first see your primary care physician, who will examine you and refer you for further tests if necessary.

If you have breast cancer, you will see different medical professionals at various stages of your treatment:

• Surgery—surgical oncologist or breast surgeon

• Radiation therapy—radiation oncologist

• Chemotherapy—medical oncologist

• Hormone therapy—endocrinologist

• Reconstructive surgery—plastic surgeon

• Immunotherapy—immuno-oncologist.

Should I participate in a clinical trial?

Clinical trials may involve new drugs, a different surgical intervention, or the use of alternative therapy. 

There are three phases of a clinical trial:

• Phase I generally has very few participants. It studies the safety of a new treatment and evaluates different ways of delivering the treatment.

• Phase II trial groups usually involve less than 100 people and commence after Phase I is shown to be safe. It assesses how the treatment affects certain types of cancer or advanced cancer.

• Phase III compares the new treatment with the existing treatment and uses a much wider trial group. If this phase is successful, the treatment may then proceed to FDA approval for general use.

If you want to participate in a clinical trial, you'll first be assessed to see if you're suitable. 

The advantages of taking part in a clinical trial are that you may get a new treatment before it's in general use. The cost of treatment may be less. You will be helping researchers develop better treatments. 

The disadvantages are that you may suffer from potential side effects that have not been previously identified. 

When is Breast Cancer Awareness Month?

Breast Cancer Awareness Month, or "Pink October," aims to:

• Increase awareness of the disease

• Share stories of hope

• Raise funds to support sufferers and breast cancer charities

• Increase uptake of regular screening to increase early detection

Still have questions? Find even more information in our complete guide to breast cancer.