What Doctors Want You to Know About Breast Cancer
A guide to everything you need to know about breast cancer, including symptoms, diagnosis, treatment and prevention.
Breast cancer is a disease that starts when cells in the breast begin to grow out of control. While cancer cells most often form a lump that can sometimes be felt on a self-exam or noticed on a mammogram, some people don’t show obvious signs of the disease. That’s why it’s important to regularly examine your breasts so you can quickly notice any unusual changes.
Breast cancer symptoms
- New lump in the breast or armpit
- Swelling of part or all of the breast
- Dimpling in the skin that might look like an orange peel
- Breast or nipple pain
- Red, dry or flaky skin on the breast or around nipple
- Nipple turning inward
- Any change in the shape or size of the breast
- Nipple discharge (other than breast milk)
- Swollen lymph nodes under the arm or around the collar bone
These symptoms can also be signs of other conditions besides breast cancer. Still, if you find any changes in your breast, it’s important that you see your doctor for an exam and tests.
(Related: Cervical cancers risks every woman needs to know.)
Types of breast cancer
There are many types of breast cancer. They are described as either “invasive” or “noninvasive,” which is also known as “in situ” (a Latin term that basically means “in place”). Invasive cancers—ductal carcinoma and lobular carcinoma—spread from the breast ducts or lobules to other parts of the breasts. Noninvasive or in situ cancer —ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS)—does not spread outside its original location.
Several less common types of breast cancer include: Paget’s disease, inflammatory breast cancer, Phyllodes tumour, and angiosarcoma.
Breast cancer risk factors
Researchers don’t know what causes breast cancer, but certain risk factors make you more likely to develop it, according to the Canadian Cancer Society. Some of them are out of your control—like your age and having a family history of the disease. But some things you can change, like losing weight if you are overweight, limiting alcohol, or quitting smoking.
Risk factors you can’t control
Gender: Most breast cancers occur in women. Based on Canadian Cancer Society statistics, it is estimated that 27,400 women compared to 240 men will be diagnosed with breast cancer in 2020.
Age: Your risk goes up as you get older. Most breast cancers occur in women between 50 and 69 years of age.
Family history: Most women who have breast cancer don’t have a family history of the disease. But if you have a close female relative (mother, sister, or daughter) with cancer, that almost doubles your risk.
Personal history: If you’ve already had breast cancer, you have a higher risk of developing it again.
Genes: Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are more likely to develop breast cancer.
Having dense breasts: Dense breast tissue can make mammograms harder to read. People with dense breasts have a higher risk of developing breast cancer than women with non-dense breast tissue.
Menstrual history: Your odds increase if you started your period before age 11 or you didn’t go through menopause until age 55 or later.
Having certain breast conditions: Some benign conditions such as papillomas (growths that can occur in the milk ducts of the breast) or a radial scar (a type of lesion that can look like breast cancer on a mammogram but is not) may raise your chances of being diagnosed with breast cancer. (Although in some cases they may not be associated with higher risk, so talk to your doctor about your particular condition.)
Risk factors you can control
Drinking alcohol: The risk increases the more you drink.
Being overweight: Older women who are overweight or obese have a higher risk of developing breast cancer.
Not exercising: Exercising helps prevent cancer. In a 2016 meta-analysis of 38 studies, the most active women had up to a 21 percent lower risk of breast cancer than those who were the least active.
Smoking: Breast cancer, like so many diseases, is also linked to smoking.
How breast cancer is diagnosed
If you notice a change in your breast or if something unusual appears on a mammogram, your doctor will do an exam and possibly order some diagnostic tests to better understand what’s causing your symptoms. According to the Canadian Cancer Society, these typically include:
Breast ultrasound: This imaging test uses sound waves to make detailed pictures of areas inside the breast. It can help tell the difference between fluid-filled cysts and solid masses.
Mammogram: This is a detailed X-ray of the breast that looks at lumps or other issues. (Related: 8 reasons to request an earlier mammogram.)
Magnetic resonance imaging (MRI): This body scan uses a magnet linked to a computer to make detailed images of areas inside the breast.
Biopsy: For this test, your doctor removes fluid or tissue from your breast to be examined under a microscope. Sometimes your doctor will use a needle to remove the sample and other times they will make a small cut in your breast to remove samples for testing.
Treatments for breast cancer
If tests show that you have breast cancer, you’ll work with your health care team to find the best treatment plan for you. Surgery is one of the most common treatments for breast cancer, but some women also have additional treatments such as chemotherapy or radiation. Here are some options:
Surgery: Surgery is the most common treatment for breast cancer, according to the Canadian Cancer Society. There are several types:
- Breast-conserving surgery The surgeon removes only the part of the breast that contains the cancer, along with some surrounding tissue. How much they take out depends on things like where and how big the tumour is. Types of this surgery include lumpectomy, quadrantectomy, partial mastectomy, and segmental mastectomy.
- Mastectomy A surgeon removes the entire breast, including sometimes nearby tissue. There are several kinds of mastectomies. Removing both breasts is a double mastectomy.
- Lymph node removal Your doctor might remove lymph nodes if cancer has spread outside the breast.
Radiation therapy: Radiation uses high-energy rays to destroy cancer cells. Traditional radiation uses a machine that transmits radiation from outside your body. With a newer type called brachytherapy, a surgeon places radioactive pellets inside the body that transmit radiation for a while.
Chemotherapy: Cancer-destroying chemotherapy drugs are either injected into your veins via IV or are taken by mouth. It’s often given before or after surgery.
Hormone therapy: Certain cancers grow in response to some hormones. This treatment works by blocking your body’s production of those trigger hormones.
Targeted therapy: These drugs attack specific cancer cells. They usually don’t harm normal cells as much as chemotherapy or radiation.
Immunotherapy: These drugs use your body’s immune system to fight cancer cells.
Clinical trials: Ask your doctor if there is a clinical trial available for breast cancer and whether it would be a good choice for you.
How to prevent breast cancer
There are some risk factors that you can’t avoid. However, there are many lifestyle habits that can help prevent breast cancer: maintain a healthy weight, exercise regularly, quit smoking, and limit or don’t drink alcohol.
Adding certain foods to your diet like olive oil, salmon and nuts may help lower your cancer risk as well.
(Related: Learn more about how your diet can help reduce your risk of developing breast cancer.)
Screenings and self-exams
Doing monthly breast self exams and having regular mammograms can help find cancer at an early stage. Recommendations for how often you should get a mammogram may depend on your age, family history of cancer, and certain risk factors.
- Women 40-49: Mammograms are an option, if your doctor thinks you need it.
- Women 50-74: Get a mammogram every two years.
- Women 75 and older: If you and your doctor think you need it.
Genetic testing for breast cancer risk
If you have a history of breast cancer in your family, your doctor might suggest genetic testing to see if you have a genetic mutation—like the BRCA1 or BRCA2 gene mutation—that would increase your chances of developing the disease.
If you have a concerning mutation, talk to your doctor about preventive options. A prophylactic mastectomy or surgical removal of both breasts has been found to reduce the risk of breast cancer in high-risk women by about 90 percent, according to the National Cancer Institute.