This topic is for people
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.
What is breast cancer?
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
tumor. The cancer cells can spread (metastasize) to the
lymph nodes and other parts of the body.
Breast cancer is many women’s worst fear. But experts have made great
progress in treating cancer. If it is found early, breast cancer can often be
cured, and it is not always necessary to remove the breast.
What causes breast cancer?
Doctors do not 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:1
Being a woman.
Getting
older.
Gene changes.
Your race and ethnicity. White
women have a slightly higher risk for getting breast cancer than
African-American women. Asian, Hispanic, and Native American women have even
less risk.
Having a history of radiation treatment to the
chest.
There are also risk
factors that you may be able to change. These are risk factors related to your lifestyle, such as:
Not having children, or not having children until after age 30.
Drinking alcohol
beverages.
But many women who have risk factors do
not get breast cancer. And many women who get breast cancer do not have any
known risk factors other than being female and getting
older.
What are the symptoms?
Breast cancer can
cause:
A change in the way the breast feels. The
most common symptom is a painless lump or thickening in the breast or
underarm.
A change in the way the breast looks. The skin on the
breast may dimple or look like an orange peel. There may be a change in the
size or shape of the breast.
A change in the nipple. It may turn
in. The skin around it may look scaly.
A fluid that
comes out of the nipple.
See your doctor right away if you notice any of these
changes.
Many people think that only
women get breast cancer. But about 1 out of 100 cases of breast cancer occurs
in men. So any man who has a breast lump should be checked.
How is breast cancer diagnosed?
During a regular
physical exam, 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-exam.
If you or
your doctor finds a lump or other change, the doctor will want to take a sample
of the cells in your breast. This is called a
biopsy. Sometimes the doctor will put a needle into
the lump to take out some fluid or tissue (needle biopsy). Or if the
doctor cannot feel the lump, a special type of
X-ray can be used to guide the needle. This is called
stereotactic biopsy. In other cases, a
surgeon may take out the whole lump through a small cut in your breast. 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
the cancer.
How is it treated?
Most people who have breast
cancer have surgery to remove the cancer. The surgeon may also take out some of the
lymph nodes under your arm to find out if the cancer has spread to this area.
After surgery, you may have
radiation therapy to destroy cancer cells. You may
also get
chemotherapy or hormone therapy. These are powerful
medicines that travel through your body to kill cancer cells. You might have
radiation, chemotherapy, or hormone therapy before surgery to help shrink the
cancer.
Depending on the stage of your cancer, you may have a
choice of:
Surgery to remove just the cancer from the
breast (breast-conserving surgery, or lumpectomy). You will need to have
several weeks of radiation after surgery.
Surgery to remove the
breast (mastectomy). If you choose mastectomy, you can have an operation to
make a new breast. This is called breast reconstruction. Sometimes radiation is
not needed after a mastectomy.
In years past, having breast cancer meant
that you would have to have your breast removed. In many cases, this is no
longer true. Studies now show that for early-stage breast cancer,
breast-conserving surgery followed by radiation therapy is as good as
mastectomy.
You and your doctor will decide which mix of
treatments is right for you based on many factors. These include facts about
your cancer as well as your family history, other health problems, and your
feelings about keeping your breast. Learn all you can about breast cancer and
its treatment so you can make the choices that are right for you.
Treatments for breast cancer can cause side effects. Your doctor can let
you know what problems to expect and help you find ways to manage them.
Finding out that you have breast cancer can cause a range of feelings,
from sadness and fear to anger and despair. If your emotions are making it hard
for you to move ahead, be sure to tell your doctor. You may be able to get
counseling or find a support group. Talking with other people who have faced
the same choices can be a big help.
Can breast cancer be prevented?
You cannot
control some things that put you at risk for breast cancer, such as your gender
and age. But you can change others. To stay as healthy as you can:
Eat a healthy diet with lots of fruits,
vegetables, and whole grains.
Make exercise a routine part of your
life.
Stay at a healthy weight. Getting regular exercise and
watching what you eat can help.
If you drink alcohol, limit the amount. After menopause, even
having one drink a day or less may increase the risk for breast cancer.
Still, there is no sure way to prevent breast cancer, so
it is very important to have regular exams and mammograms. Discuss your risk
factors with your doctor to find out how often you should have a mammogram.
If you have a strong family history of breast cancer,
ask your doctor about genetic testing. A blood test can check for changes in
the BRCA genes that may increase your chance of getting breast and
ovarian cancer.
The exact cause of
breast cancer is not known. Female
hormones and increasing age play a part. The chances
that you will develop breast cancer increase as you age. In the United States,
about 1 in every 7 women who live to be
85 will have been diagnosed with breast cancer at some
point in her life.2
Family history also plays a role in the development of
breast cancer. You are more likely to have breast cancer if your mother,
father, or sister has breast cancer. Also, women who carry certain
genes called BRCA1 and BRCA2 are more likely to have
breast and ovarian cancer. If you have a strong family
history of breast or ovarian cancer, you may want to be tested for these genes.
People who inherit specific changes, or mutations, in one or both of these
genes have a much greater risk of developing breast and ovarian
cancer.
Studies show that menopausal women who take
hormone therapy with estrogen and progestin have an
increased risk of breast cancer. Women who take estrogen alone may have a
slightly increased risk.3, 4
Many people believe that only women have breast
cancer. But, although rare, about 1% of all
breast cancer occurs in men. Most men who have breast
cancer are older than 65, but it can appear in younger men. For this reason,
any breast lump in an adult man is considered abnormal.
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:
A thickening in the breast or armpit.
A change in the
size or shape of the breast.
Changes in the skin of the breast,
such as a dimple or skin that looks like an orange peel.
A change
in the nipple, such as scaling of the skin or a nipple that turns
in.
A green or bloody fluid that comes from the
nipple.
A change in the color or feel of the skin around the nipple
(areola).
About 1% of
breast cancer occurs in men. Although most men
diagnosed with breast cancer are older than 65, the disease can appear in
younger men. For this reason, any breast lump in an adult male is considered
abnormal.
Inflammatory breast cancer is a specific type of
breast cancer that involves the skin of the breast. It occurs when breast
cancer cells form "nests" and block the lymphatic drainage from the skin of the
breast. Symptoms include redness, tenderness, and warmth. Thickening of the
skin of the breast (an orange-peel appearance), rapid breast enlargement, and
ridging of the skin of the breast may also be present. Some women may also
develop a lump in the breast. 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.
Fortunately, when found at an early stage, breast cancer is highly curable.
Your doctor will learn more about how your breast cancer may behave when
the cancer cells are examined under the microscope. This is called
classification. It tells your doctor how rapidly the
cancer cells are growing and dividing and where they may have started in the
breast tissue.
Tests for hormone receptors and other tumor markers
are usually done after surgery with tissue from a lumpectomy or
mastectomy. All of this information will help you and your doctor
make decisions about treatment.
The
stage indicates how far the cancer has spread within
the breast, to nearby tissues, and to other organs. Your doctor will determine
the stage of your breast cancer by gathering information from other tests, such
as axillary lymph node surgery, blood tests,
bone scans, ultrasounds, and
X-rays. The stage of your cancer is one of the most
important pieces of information that will help guide your treatment
options.
Although the exact cause of
breast cancer is not known, most experts agree that
there are several factors that increase your risk of breast cancer.
Top risk factors linked to breast cancer
Aging.Your breast
cancer risk increases as you get older. By age group, breast cancer is
diagnosed in:5
4 out of 1,000 women in their
30s.
14 out of 1,000 women in their
40s.
26 out of 1,000 women in their 50s.
37 out of
1,000 women in their 60s.
Being female. Although
breast cancer can occur in men, most breast cancer is found in women.
Conditions that increase the risk of developing breast cancer.
Personal history of breast cancer. Women who have had breast cancer in one breast have an increased
chance of having another breast cancer. The breast cancer can come back in the
same breast, in the opposite breast, or in other areas of the body, such as the
lungs, liver, brain, or bones.
Family history. A woman's risk of breast cancer increases if her mother,
sister, daughter, or two or more other close relatives, such as cousins, have a
history of breast cancer, especially if they were diagnosed with breast cancer
before age 50.
Women who inherit specific changes (genetic mutations) in the
BRCA1 and BRCA2 genes are much more likely to have
breast cancer. They are also more likely to have
colon or
ovarian cancer. But most women who have a family
history of breast cancer do not have changes in BRCA genes.
Mutations in the BRCA1 and BRCA2 genes are more common
in certain ethnic groups, such as Ashkenazi Jews.
Genetic tests are available to determine whether you
have the genetic mutations long before any cancer appears. In families where
many women have had breast or ovarian cancer, genetic testing can show whether
a woman has specific genetic changes known to greatly increase the risk of
breast cancer. Doctors may suggest ways to try to prevent or delay breast
cancer or to improve the detection of breast cancer in women who have the
genetic mutations. For more information, see Breast cancer risk: Should I have a gene test for breast cancer?
Other factors that increase the risk of breast cancer
Race. Breast cancer occurs more frequently in white women than in black, Hispanic, or
Asian women. But black women are more likely to get breast cancer at a younger
age and are also more likely to die of breast cancer.6
Radiation therapy. Women whose breasts
were exposed to significant amounts of radiation at a young age, especially
those who were treated for
Hodgkin's lymphoma, have an increased risk for
developing breast cancer.
Late or no childbearing. Women who had their first child after the age of 30 have a
greater chance of developing breast cancer than women who had their children at
a younger age. Women who never had children have an increased risk for
developing breast cancer.
Not breast-feeding. Women who don't breast-feed have a higher risk of breast
cancer than those who breast-feed. The more months of breast-feeding, the lower
the breast cancer risk.
Hormones. Female
hormones play a part in some types of breast cancer.
The use of estrogen-progestin
hormone therapy after menopause for several years or
more increases your risk of developing breast cancer. But within 5 years after
you stop using combined therapy, your risk returns to normal. Long-term use of estrogen alone may increase your risk for
breast and ovarian cancer. 7
Beginning menstruation before age 12
and beginning
menopause later than age 55 increase a woman's risk of
breast cancer. The years when you have a menstrual cycle are your high-estrogen
years. Experts think that the longer you have higher estrogen, the more risk
you have for breast cancer.8
Having extra
body fat and drinking alcohol both lead to higher levels of estrogen in the
body. Especially after menopause, when your estrogen levels are naturally low,
this raises your breast cancer risk.8
For more information about your personal risk level, go
to www.cancer.gov/bcrisktool.
The most common symptom of
breast cancer is a painless lump. But, early breast
cancer is often found on a
mammogram before a lump can be felt. Other breast
problems that need to be evaluated by a doctor include:
A thickening in the breast or armpit.
A change in the
size or shape of the breast.
Changes in the skin of the breast,
such as a dimple or skin that looks like an orange peel.
A change
in the nipple, such as scaling of the skin, a nipple that turns in, or
discharge or bleeding.
A change in the color or feel of the skin
around the nipple.
Any breast lump in an adult male is considered abnormal
and needs to be evaluated by a doctor.9, 10
Watchful Waiting
If you notice any changes in your breasts, call
your doctor to arrange for an evaluation.
Who To See
Health professionals who can perform a breast exam include
a:
The earlier
breast cancer is found, the more easily and
successfully it can be treated. The most common methods for detecting breast
cancer include:
Mammogram. A
mammogram is an X-ray of the breast. It can often find tumors that are too
small for you or your doctor to feel. Your doctor may suggest that you have a
screening mammogram, especially if you have any
risk factors for breast cancer.
Clinical breast exam (CBE). During a clinical breast exam, your doctor will carefully feel
your breasts and under your arms to check for lumps or other unusual
changes.
Magnetic resonance imaging (MRI) of the breast. MRI is
a test that uses a magnetic field and pulses of radio wave energy to provide
pictures of the inside of the breast. It may be used as a screening
test for women at high risk. It may be more sensitive than a
mammogram for finding breast cancer. But MRI also finds small irregularities
that can lead to further testing but turn out to not be breast cancer.
Talk to your doctor about MRI if you have risk factors
for breast cancer. These can include a positive test for the
BRCA1 or BRCA2 gene or having two or more close family
members who have had breast cancer before age 50. For more information about
your risk level, go to www.cancer.gov/bcrisktool.
An
ultrasound. You may have an ultrasound of the breast
if a lump is found during a clinical breast exam or on a mammogram. Breast
ultrasound is often used to distinguish between solid lumps and fluid-filled
(cystic) lumps.
An
MRI of the breast, which is sometimes used to get more
information about a breast lump or to evaluate problems in women who have
breast implants. MRI of the breast may be most useful for very high-risk women,
such as those who test positive for the BRCA1 or BRCA2 gene or have two or more
close family members who have had breast cancer before age 50. MRI may also be
used to evaluate the opposite breast in women diagnosed with breast
cancer.
A
breast biopsy. If a lump is found in your breast, your
doctor will need to remove a small sample of the lump (biopsy) and look at it
under a microscope to see whether any cancer cells are present. A needle biopsy
is done by inserting a needle into the breast and removing some of the
tissue.
A
lymph node biopsy to see whether breast cancer cells have spread to the
axillary lymph nodes under the arm. The two methods used are:
Surgery to take a sample of just one or
two of the lymph nodes that are most likely to contain cancer cells. This
surgery, called
sentinel node biopsy, is now the standard way of
checking the lymph nodes. Studies have shown that sentinel lymph node biopsy is
as accurate as axillary lymph node dissection for staging breast cancer.
Sentinel lymph node biopsy is less likely than axillary lymph node dissection
to impair arm mobility, cause pain, or result in problems with swelling of the
arm and hand (lymphedema).11, 12
Surgery to remove most of the lymph nodes in the underarm.
This is called an
axillary lymph node biopsy.
Tests for
tumor markers, which are usually done on tissue from a
lumpectomy or a mastectomy. These include:
Estrogen and progesterone receptor status. The hormones estrogen and progesterone stimulate the growth of
normal breast cells, as well as some breast cancers. Hormone receptor status is
an important piece of information that will help you and your doctor plan
treatment.
HER-2 receptor status. HER-2/neu is a
protein that regulates the growth of some breast cancer cells. About 20% of
women with breast cancer have too much (overexpression) of this
growth-promoting protein.13
For post-menopausal women with hormone receptor positive breast cancer, gene tests may be done, such as the ONCOtype DX. These gene tests can find differences in two cancer cells that may look the same under the microscope. Oncotyping is a way to study the genes inside tumor cells. The test shows your chances of the cancer coming back. This can help your doctor tell whether chemotherapy is likely to work for you.
A
chemistry screen, to measure the levels of several
substances (such as those involved in liver functions) in your
blood.
A
chest X-ray, to provide a picture of organs and
structures within your chest, including your heart and lungs, your blood
vessels, and the thin sheet of muscle just below your lungs (diaphragm).
Tests if your doctor suspects that breast cancer has spread
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:
CT scan to
provide detailed pictures of the organs and structures in your chest, abdomen,
and pelvis.
Bone scan to detect cancer that has
spread (metastasized) to the bones.
CT scan or
MRI of the brain to provide detailed pictures of your
brain and to check for cancer that may have spread to your brain.
What to think about
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 (metastatic or recurrent breast cancer). To be sure that the cancer has not returned,
you will have regular checkups that include physical exams and
mammogram.
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.
Early detection
Early detection is an important
factor in the success of breast cancer treatment. The earlier breast cancer is found, the more easily and
successfully it can be treated. The two methods commonly
used for early detection are:
Mammogram. A mammogram is an X-ray of the breast that can often find tumors that are too small for you or your doctor to feel. Experts differ in their recommendations about when or how often women should have mammograms. Some recommend you begin screening at age 40, and some recommend you begin screening at age 50. Your doctor may suggest that you have a screening mammogram at a younger age if you have risk factors for breast cancer.
Clinical breast examination (CBE). During your routine physical exam, your doctor may do a clinical breast exam. During a CBE, your doctor will carefully feel your breasts and under your arms to check for lumps or other unusual changes. Talk to your doctor about whether to have a clinical breast exam.
MRI of the breast may be most useful for very
high-risk women, such as those who test positive for the BRCA1 or BRCA2 gene or
have two or more close family members who have had breast cancer before age 50.
MRI may also be used to evaluate the opposite breast in women diagnosed with
breast cancer.
Breast cancer
is usually treated with surgery, medicine, and radiation therapy. Because of
improved screening methods, diagnosis at an early stage, and improved treatment
techniques, the number of deaths from breast cancer has been steadily declining
over the past few years. Decisions about how to treat breast cancer are based
on a combination of factors that include specific information about the cancer,
your preferences, and your health.
When making decisions about
treatment for your breast cancer, you and your doctor will consider:
The size and location of your breast cancer
(stage).
Whether your breast cancer cells contain high levels of human epidermal
growth factor (HER-2/neu).
Whether your breast cancer has
spread to the
lymph nodes in your underarm area (axilla).
You and your doctor will also consider your personal
preferences and health when developing a treatment plan for you. This will
include:
Your feelings about keeping your
breast.
Your personal and family history of breast
cancer.
Your age and whether you have other serious health
problems.
Most people with breast cancer have surgery to remove the
cancer from the breast. Some of the lymph nodes under the arm are also
usually removed to find out whether the breast cancer has spread to this
area.
Even if your doctor removes all the cancer that can be seen
at the time of your surgery, you may be treated with
radiation therapy.
Chemotherapy or
hormone therapy may also be recommended to make sure
that the breast cancer cells have been destroyed. You may also be given
chemotherapy or hormone therapy to shrink your breast cancer before surgery.
This is called
neoadjuvant therapy.
Surgery to remove the cancer. This may be
done by removing the whole breast (mastectomy) or
just the part of the breast that contains the breast cancer (breast-conserving
surgery, or
lumpectomy). Some of the lymph nodes under the arm
will also be removed using either
axillary lymph node dissection or
sentinel node biopsy.
Radiation therapy, which is the use of high-dose
X-rays to destroy cancer cells and shrink tumors.
Chemotherapy, which is the use of medicine to destroy
cancer cells. Chemotherapy is called a systemic treatment, because the
medicines enter the bloodstream, travel through the body, and can destroy
cancer cells outside the target area.
Treatment with
trastuzumab (Herceptin) if your breast cancer tests positive for
human epidermal growth factor (HER-2/neu). Trastuzumab is a
monoclonal antibody.
If you are older than 70, you may be a good candidate for having limited
treatment and skipping lymph node biopsy or radiation.14 This depends on your health and what type of breast cancer
you have.
Coping with your diagnosis
The diagnosis of
breast cancer is devastating and scary. Most women will experience some denial,
anger, and grief. There is no "normal" or "right" way to react to a diagnosis
of cancer. There are many steps you can take to help with your
emotional reaction to breast cancer. You may find that
talking with family and friends helps you with your emotions. Some women find
that spending time alone is what they need.
If your reaction interferes with your ability to make
decisions about your health, it is important to talk with your doctor. Your
cancer treatment center may offer psychological or financial services. You may
also contact your local chapter of the American Cancer Society to help you find
a support group. Talking with other people who may have had similar feelings
can be very helpful.
Nausea and vomiting
One of the biggest concerns
about treatment for cancer is managing nausea and vomiting from chemotherapy.
Depending on the type of chemotherapy, you may only need
home treatment to reduce mild nausea. But for certain types of chemotherapy,
it's best to take
prescription medicine for nausea and vomiting. In some
cases, it's best to take it before the first dose of chemotherapy. Everyone is
different. Work with your doctor to develop a plan that works for you.
For more ways to help manage side effects caused by breast cancer or
breast cancer treatment, see the Home Treatment section of this topic.
Ongoing treatment
After the initial treatment for
breast cancer, you may see your
family doctor,
general practitioner,
medical oncologist,
radiation oncologist, or
surgeon at regularly scheduled intervals, depending on
your individual situation. The length of time between visits will gradually
lengthen until at 5 years, if no new problems develop, you are seeing your
doctor once each year. As part of your follow-up, you may have:
Physical exams. The frequency of your
physical exams depends on your general health and the type of breast cancer you
have. In general, you will see your doctor every 3 to 6 months for 3 years and
then every 6 months until 5 years have passed since your diagnosis of breast
cancer. You may see your doctor once a year at this point.
Mammograms to screen for breast cancer and investigate
lumps that can be felt during a breast exam.
After treatment for breast cancer, it is important to do
regular self-exams. This may help you detect signs of recurrence. 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 your breast cancer cells
test positive for estrogen and progesterone receptors (ER/PR+), any remaining cancer cells may grow because of estrogen in
your body. Medicine such as an
aromatase inhibitor (such as Arimidex, Aromasin, or
Femara), or
tamoxifen (Nolvadex) may be a good treatment option.
These hormone therapies block estrogen's effect on the cancer cells.
Studies show that
an aromatase inhibitor works even better than tamoxifen in postmenopausal women
who are also estrogen receptor-positive (ER+).15 For
women who have taken tamoxifen for a few years, switching to an aromatase
inhibitor improves their chances of successful treatment.16 Talk with your doctor about the risks and benefits of these
medicines if your breast cancer is ER/PR+.
Even if your doctor removes all the cancer that can be
seen at the time of the operation, you may need additional treatment. Radiation
therapy, chemotherapy, hormone therapy, or a combination of the three therapies
may be used after surgery to try to destroy any cancer cells that may be left
in your body. This is called adjuvant therapy and is used to reduce the chances that your breast
cancer will come back. Talk with your doctor about the risks and benefits of
each type of treatment. Your personal preferences and considerations are
important when choosing a treatment that is right for you.
You may also make decisions about using chemotherapy or
hormone therapy to shrink your breast cancer before surgery (neoadjuvant therapy). Talk with your doctor about the
risks and benefits of each type of treatment.
The likelihood that
your breast cancer will return after treatment depends on a number of factors,
including the size and grade of your breast cancer, whether you had breast
cancer cells in your lymph nodes, and how many lymph nodes were involved with
breast cancer.
For more information about specific breast cancer
treatments, see the topics:
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
at high risk for getting breast cancer, your doctor may also offer you certain
medical treatments that can help prevent breast cancer.
Female hormones
Hormones change the way cells
within the breast grow and divide. The years when you have a
menstrual cycle are your high-estrogen years.
Experts think that the longer you have higher estrogen, the more risk you have
for breast cancer.8 This includes taking hormones
after
menopause.3, 17
The use of
estrogen-progestin
hormone therapy after menopause for several years or
more increases your risk of developing breast cancer. But within 5 years after
you stop using combined therapy, your risk returns to normal. Long-term use of estrogen alone may increase your risk for
breast and ovarian cancer.7
Breast-feed. Breast-feeding may lower
your breast cancer risk. The benefit appears to be greatest in women who
breast-fed for longer than 12 months or who breast-fed several
children.18
Strive for a healthy weight.
Extra fat cells make extra estrogen, which raises your breast cancer
risk.8 Getting regular exercise and watching what you
eat can help.
Having a full-term pregnancy before age 30 also lowers your
breast cancer risk.6
Healthy food and exercise
Eat a healthy diet with plenty of fruits,
vegetables, and whole grains.
Be active. Try to do
at least 2½ hours a week of
moderate exercise. One way to do this is to be active
30 minutes a day, at least 5 days a week.19, 20 Staying active may lower your breast cancer risk.21
Drink no more than one alcoholic drink a
day.8 Using alcohol leads to extra estrogen in the
body, which raises your breast cancer risk.6
If you are at high risk for breast cancer
If you are concerned that you may have an increased risk of
developing breast cancer, talk with your doctor about whether you should take
tamoxifen or raloxifene to lower your risk of breast cancer. It is important to consider
both the benefits and risks of
hormone therapy for breast cancer.
If you have a
strong family history of early breast cancer or breast
and ovarian cancer, talk to your doctor about BRCA testing. For more
information, see:
Surgery to remove the breasts. Some women with a strong family history of breast cancer decide
to have surgery to remove their breasts. This called a preventive or
prophylactic mastectomy. It reduces the risk of developing breast cancer by
approximately 90% in women who have a strong family history of breast cancer. A
cancer risk assessment,
genetic test, and psychological counseling are
recommended for women who may be considering this treatment option.
Surgery to remove the ovaries.Genetic mutations (called BRCA1 or BRCA2 gene changes)
raise the risk of both breast cancer and
ovarian cancer. Hormones made by the ovaries increase
the risk of breast cancer. Removal of the ovaries (prophylactic oophorectomy)
reduces the risk of breast or ovarian cancer in women with a genetic mutation.
Such a decision is best made after a cancer risk assessment,
genetic test, and counseling.
In general, healthy habits such as eating a
balanced diet and getting enough sleep and exercise
can help control your symptoms from
breast cancer treatment.22 Aim
for at least 2½ hours a week of
moderate exercise.20 Even when
you are feeling bad, do everything you can to get regular exercise. It's fine
to be active in blocks of 10 minutes or more throughout your day and week. Try
walking with a friend to help you stick to a routine. Study after study has
shown that getting plenty of exercise:
Improves chances of survival from breast
cancer.23
Helps battle
anemia during radiation or chemotherapy.24
Improves quality of life after breast cancer
treatment.25
During treatment for any stage of breast cancer, you can use home
treatment to help manage the side effects that may occur with cancer treatment.
Home treatment may be all that you need to manage the following common
problems. Be sure to follow any instructions and take any medicines your doctor
has given you to treat these symptoms.
Nausea or vomiting. If
you have problems with nausea and vomiting while you are taking
chemotherapy or receiving
radiation therapy, let your doctor know. Medicines are
available to prevent and treat nausea and vomiting that may be caused by
treatment. It is important to let your doctor know if you have nausea or
vomiting in spite of the use of these medicines.
Home treatment for nausea or vomiting includes watching for and treating
early signs of
dehydration, such as a dry mouth, sticky saliva, and
reduced urine output with dark yellow urine. For more information on how to
deal with these side effects, see:
Diarrhea. Some
chemotherapy medicines can cause diarrhea. Let your doctor know if you have
diarrhea while you are on treatment. (Radiation therapy to the chest should not
cause diarrhea.)
Home treatment for diarrhea includes resting your
stomach and being alert for signs of dehydration. Check with your doctor before
you use any nonprescription medicines for your diarrhea.
Constipation. Pain medicines, chemotherapy, and medicines used
to treat nausea and vomiting related to chemotherapy can sometimes cause
constipation. Let your doctor know if you have problems with constipation after
surgery or while you are on chemotherapy. (Radiation therapy to the chest
should not cause constipation.)
Home treatment for constipation includes regular
exercise along with getting enough fluids and eating a diet that is high in
fruits, vegetables, and fiber. Check with your doctor before you use a laxative
for your constipation.
Fatigue. Breast
cancer and treatment for it can cause fatigue. The stress of being diagnosed
and treated can also make you feel tired. Some fatigue is expected after
surgery and during both chemotherapy and radiation therapy. Fatigue is often
worse at the end of treatment or just after treatment is completed. It is also
common for fatigue to last more than a year after breast cancer
treatment.26Home treatment for fatigue includes making sure you
get extra rest while you are receiving chemotherapy or radiation therapy. Let
your symptoms be your guide, and try to balance exercise with rest. You may be
able to stay with your usual routine and just get some extra sleep. Let your
doctor know if you are having trouble with fatigue.
Other issues that arise may include:
Hair loss from chemotherapy. Hair loss
can be emotionally distressing. Not all chemotherapy medicines cause hair loss,
and some people have only mild thinning that is noticeable only to them. Talk
to your doctor about whether hair loss is an expected side effect with the
medicines you will receive. Other treatments for breast cancer, including
hormone therapy and radiation therapy, do not cause
hair loss.
Lymphedema, which is swelling of the arm. Normally,
lymph nodes filter fluid as it flows through them,
trapping bacteria, viruses, and other foreign substances, which are then
destroyed by white blood cells called lymphocytes. Without normal lymph
drainage, fluid can build up in the affected arm, and lymphedema can develop.
Because lymph nodes are removed from under the arm to help determine the stage
of your breast cancer, you can develop lymphedema. Medicines such as tamoxifen,
radiation therapy, and injury to the lymph nodes can also cause lymphedema. Not
everyone will have a problem with lymphedema. You can reduce your risk of
developing lymphedema by protecting your arm on the side where you had surgery
and letting your doctor know right away if you have swelling or redness in that
arm.
Sleep problems. If you have trouble sleeping,
you may find that having a regular bedtime, getting some exercise during the
day, avoiding caffeine late in the day, and using other
tips to
relieve sleep problems may help you sleep more easily.
Tell your doctor if you have persistent difficulty sleeping.
Pain.
Not all forms of cancer or cancer treatment cause pain. If pain occurs, many
treatments are available to relieve it. Be sure to follow all instructions and
take the medicines your doctor has given you to treat pain. You may use
home treatment for pain to improve your physical and mental well-being. Be
sure to discuss with your doctor any home treatment you use for pain.
Coping with stress
Discovering that you have
breast cancer and then having treatment for it can be very stressful.
You may be able to reduce your stress by
talking about your feelings to others. Stress and tension affect our emotions.
By discussing your feelings with others, you may be able to understand and cope
with them. Learning relaxation techniques may also help you reduce your stress.
Expressing yourself through writing, crafts, dance, or art is a
good tension reliever. Some dance, writing, or art groups that are specifically
for individuals diagnosed with cancer may be available.
Join a support group. Talking about
a problem with your spouse, a good friend, or other people with similar
problems is a valuable way to reduce tension and stress. Social support is very
important both during and after treatment. Talk to your doctor or contact the
American Cancer Society to find out about support groups in your area. If you
have access to the Internet, you may also find an online support group.
Your feelings about your body may change after a diagnosis of
breast cancer and the need for treatment.
Adapting to your body image changes may involve
talking openly about your concerns with your partner and discussing your
feelings with your doctor. Your doctor may also be able to refer you to
organizations that can offer additional support and information.
It is not unusual for people with cancer to become depressed. Talk to your doctor if you feel sad or hopeless every day for more than two weeks. You may have depression, which can be treated.
For more information about how to find support groups and
activities, see the Other Places to Get Help section of this topic.
Complementary therapies, such as
acupuncture,
herbs,
biofeedback,
meditation,
yoga, and
vitamins, are sometimes used along with medical
treatment. Some people feel that they benefit from some of these therapies.
Before you try a complementary therapy, talk with your doctor about the
possible value and potential side effects. Let your doctor know if you are
already using any such therapies.
Complementary therapies are not
meant to take the place of standard medical treatment, but they may improve
your quality of life and help you deal with the stress and side effects of
cancer treatment.
Treatment before surgery for breast cancer (neoadjuvant treatment)
In some cases, chemotherapy or
hormone therapy is used before surgery to shrink the
breast cancer. This is called
neoadjuvant therapy. It may allow you to save your
breast if the cancer is large. Talk with your doctor about the risks and
benefits of neoadjuvant therapy and whether it is an option for you.
Treatment after surgery for breast cancer (adjuvant treatment)
Depending on a variety of factors, such as tumor size, grade, and lymph
node involvement, you may have several treatment options. Hormone therapy,
chemotherapy, or a combination of the two therapies may be used after surgery
to try to destroy any cancer cells that may be left in your body. This is
called adjuvant therapy, and it is used to lower the chances that your breast
cancer will come back. Your doctor may suggest gene tests to find out
if chemotherapy will help you. Talk with your doctor about the risks
and benefits of each type of treatment. Your personal preferences and
considerations are important when choosing a treatment that is right for
you.
Aromatase inhibitors, such as letrozole
(Femara), anastrozole (Arimidex), and exemestane (Aromasin), are medicines that
stop estrogen production in postmenopausal women. Aromatase inhibitors are
used to treat early estrogen receptor-positive (ER+) breast cancer. They are
also used to treat metastatic or recurrent ER+ breast cancer. An aromatase
inhibitor can be used alone or after tamoxifen treatment.
Trastuzumab (Herceptin) is recommended after surgery and
chemotherapy for
HER-2/neu breast cancer. This medicine is a
monoclonal antibody that targets the HER-2
protein. It helps chemotherapy work better.
Chemotherapy. A combination
of medicines is generally 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. Some of the most commonly used combinations
are:
Medicines that may help to prevent breast cancer recurrence
Tamoxifen and raloxifene are medicines that block the effects of estrogen on breast cancer cells and normal breast cells.
Raloxifene works as well as tamoxifen to prevent invasive breast cancer from coming back in postmenopausal women after surgery. Raloxifene is less likely to cause endometrial cancer than tamoxifen, although raloxifene doesn't work as well as tamoxifen to reduce the risk of non-invasive breast cancer.27
What to Think About
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.
Hormone-blocking treatments, such as
tamoxifen or an
aromatase inhibitor, act on cells all over the body
but generally cause fewer side effects than chemotherapy. If you are deciding
what type of medicine to use, weigh the side effects and risks along with the
benefits for your type of cancer.
Side effects can include
hot flashes, vaginal dryness, muscle/body ache, mild
nausea, diarrhea/constipation, weakness, and fatigue.
Increased
risk of
osteoporosis after 5 years of treatment for women who
started out with weak bones (osteopenia)
When taking tamoxifen, you will need a pelvic exam every
year. If you have any vaginal bleeding, other than normal menstrual bleeding,
tell your doctor as soon as possible. This can be a sign of uterine
precancer or cancer.
Neither chemotherapy nor hormone therapy is likely to
cure breast cancer that has spread to another area of the body (metastasized),
but either therapy can reduce symptoms and may prolong life.
Most people with
breast cancer have surgery to remove the cancer. In
most cases, a few of the lymph nodes under the arm are also removed and
examined under the microscope to see whether cancer cells are present. This is
called
sentinel lymph node biopsy. When nearly all lymph
nodes under the arm are removed, it is called
axillary lymph node dissection. You are less likely to
have arm swelling (lymphedema) after
a sentinel node biopsy than an axillary dissection.
Even if your
doctor removes all the cancer that can be seen at the time of your surgery, you
may be given treatment with radiation therapy, chemotherapy, or hormone therapy
after surgery to try to destroy any cancer cells that may be left. This is
called adjuvant therapy.
Breast-conserving surgery (lumpectomy), which is the
removal of the lump in the breast along with some of the tissue around it. This
is sometimes called excisional biopsy or wide excision. It is usually followed
by radiation therapy to the remaining breast tissue.
Partial or segmental mastectomy, which is the removal of the
area of the breast that contains cancer as well as some of the breast tissue
around the tumor and the lining over the chest muscles below the tumor. Some of
the lymph nodes under the arm are also removed and examined under the
microscope (axillary lymph node dissection or sentinel lymph node biopsy). In
most cases, radiation therapy follows.
Total or simple mastectomy, which is the removal of the whole breast.
Modified radical mastectomy, which is the removal of the
breast, some of the lymph nodes under the arm, and sometimes part of the chest
wall muscles.
Skin-sparing mastectomy, which leaves most of the skin that
was over the breast, except for the nipple and the areola. This type of
mastectomy removes about as much breast tissue as a modified radical
mastectomy, but leaves less scar tissue and a reconstructed breast that seems
more natural.
Radical mastectomy (Halsted
radical mastectomy), which is the removal of the breast, chest muscles, and all
of the lymph nodes under the arm (axillary lymph node dissection). For many years, radical
mastectomy was the most common operation for breast cancer.
This surgery is rarely used now because it does not
improve survival or risk for recurrence when compared with other surgical
treatments.
Breast reconstruction
You may wish to talk to your
doctor about
breast reconstruction before you make a decision about
which type of surgery to have for breast cancer. If you choose to have a
mastectomy, a different surgeon with special expertise in reconstructive
surgery may perform this operation at the same time as the mastectomy or after
the mastectomy.
Your choice will depend on the size of the
cancer, the size and shape of your breasts, the size and shape of your body,
how active you are, and other details, such as whether you have chemotherapy or
radiation. If you choose to have a mastectomy, discuss reconstructive surgery
and the use of a breast prosthesis with your doctor. For more information about
reconstructive surgery, see the topic
Cosmetic Surgery and Procedures.
Radiation therapy is the use of high-energy X-rays to destroy cancer cells and
shrink tumors. 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. It may be given 5 days
each week for up to 6 weeks. Sometimes larger doses are given over a shorter
period of time. This is called accelerated breast irradiation.
Radiation therapy also may be combined with other treatments, such as
chemotherapy or
hormone therapy.
The most common way to
give radiation therapy 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. You will not be able to
see the radiation, but your skin will look slightly sunburned in the treated
area (called the radiation field). Small marks are tattooed onto the skin to
help identify the radiation area.
Sometimes tiny radioactive
pellets are placed in or near the tumor site. This is called brachytherapy, internal radiation, or
interstitial radiation. Giving an extra boost of
radiation near where the tumor was removed may help keep the breast cancer from
returning to that area.
Brachytherapy is often used with external
beam radiation.
Side effects
Radiation therapy can cause many
side effects. Your breast may swell and feel heavy.
Fatigue is common, especially toward the end of your treatment and for several
weeks afterward. For some women, fatigue can last a long time after treatment.
Be
patient. It can take time to fully recover. Balancing rest with activity is
important. Try to match your activities to your energy levels. Making
the effort to be physically active can lift your mood and help you feel better.
It can also help with your blood counts and anemia during radiation treatment. It's fine to be
active in blocks of 10 minutes or more throughout your day and week. Walk with
a friend to help you stick to a routine while you get added support.
The skin on your breast and under your arm may become red, dry, tender,
and itchy. Toward the end of treatment, the skin may become moist and "weepy."
These effects are temporary, and the area will gradually heal when treatment is
completed. Expose the area to air as much as possible to help the skin heal.
Some types of clothing may rub the skin and cause irritation, so you may want
to wear loose-fitting cotton clothes. You may feel more comfortable if you do
not wear a bra until your skin heals.
Possible long-term effects
Radiation treatment can cause long-lasting fatigue.
It may also cause a weakness in the ribs, which could possibly lead
to a fracture. In the past, radiation effects on the heart and lungs after
breast cancer treatment was a problem, but modern methods allow better focus of
the radiation. There also is a very rare cancer (angiosarcoma) that can result
from radiation therapy.
Complementary therapy
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:
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.
Complementary
therapies are not meant to take the place of standard medical treatment, but
they may improve your quality of life and help you deal with the stress and
side effects of cancer treatment.
Clinical trials
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 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.
The American Cancer Society (ACS) conducts educational
programs and offers many services to people with cancer and to their families.
Staff at the toll-free numbers have information about services and activities
in local areas and can provide referrals to local ACS divisions.
Breastcancer.org
7 East Lancaster Avenue, 3rd Floor
Ardmore, PA 19003
Web Address:
www.breastcancer.org
Breastcancer.org is a Web site dedicated to helping women
understand breast cancer and make good decisions about their treatment. This
site provides information from medical professionals on all aspects of
breast cancer, from screening and surgery to sex and intimacy. The site also offers links
to chat rooms, discussion boards, and "Ask the Expert" online conferences.
FORCE: Facing Our Risk of Cancer Empowered
16057 Tampa Palms Boulevard West
PMB #373
Tampa FL 33647
United States of America
Phone:
Toll-free: 1-866-288-RISK
Fax:
(954) 827-2200
E-mail:
info@facingourrisk.org
Web Address:
www.facingourrisk.org
FORCE is an organization that provides educational and emotional support for women who are making decisions about surgery to prevent breast or ovarian cancer because they are at high risk. This Web site also has resources for women who have cancer and are concerned about their cancer coming back. There are online resources as well as a helpline, newsletters, and information on local groups and annual conferences.
National Breast Cancer
Coalition
1101 17th Street NW
Suite 1300
Washington, DC 20036
Phone:
1-800-622-2838 or (202) 296-7477
Fax:
(202) 265-6854
E-mail:
info@stopbreastcancer.org
Web Address:
www.stopbreastcancer.org
The National Breast Cancer Coalition (NBCC)
asks the government for increased funding for breast cancer research. The NBCC
also works with researchers to advance the science of breast cancer research,
and to improve access to high-quality health care and breast cancer clinical
trials for women. The NBCC has a sister organization, the National Breast
Cancer Coalition Fund (NBCCF). Together they help women take a leadership role
among government leaders, scientists, and doctors.
National Cancer Institute (NCI)
NCI Publications Office
6116 Executive Boulevard
Suite 3036A
Bethesda, MD 20892-8322
Phone:
1-800-4-CANCER (1-800-422-6237) 9:00 a.m. to 4:30 p.m. EST, Monday through Friday
TDD:
1-800-332-8615
E-mail:
cancergovstaff@mail.nih.gov
Web Address:
www.cancer.gov (or
https://cissecure.nci.nih.gov/livehelp/welcome.asp# for live help
online)
The National Cancer Institute (NCI) is a U.S. government
agency that provides up-to-date information about the prevention, detection,
and treatment of cancer. NCI also offers supportive care to people with cancer
and to their families. NCI information is also available to doctors, nurses,
and other health professionals. NCI provides the latest information about
clinical trials. The Cancer Information Service, a service of NCI, has trained
staff members available to answer questions and send free publications.
Spanish-speaking staff members are also available.
National Lymphedema Network (NLN)
Latham Square, 1611 Telegraph Avenue
Suite 1111
Oakland, CA 94612-2138
Phone:
1-800-541-3259
Fax:
(510) 208-3110
E-mail:
nln@lymphnet.org
Web Address:
www.lymphnet.org
The National Lymphedema Network (NLN) provides education and
guidance to people with lymphedema, health professionals, and the general
public. The NLN provides information on the prevention and management of
primary and secondary lymphedema and supports research to find causes and
treatments for lymphedema.
American Cancer Society (2009). What are the risk
factors for breast cancer? Detailed guide: Breast cancer. Cancer Reference Information. Available online:
http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_breast_cancer_5.asp.
National Comprehensive Cancer Network
(2009). Breast cancer screening and diagnosis. NCCN Clinical Practice Guidelines in Oncology, Version 1. Available online:
http://www.nccn.org/professionals/physician_gls/PDF/breast-screening.pdf.
Beral V; Million Women Study Collaborators (2003).
Breast cancer and hormone-replacement therapy in the Million Women Study.
Lancet, 362(9382): 419–427.
Women's Health Initiative Steering Committee (2004).
Effects of conjugated equine estrogen in postmenopausal women with
hysterectomy. JAMA, 291(14): 1701–1712.
National Cancer Institute (2006). Probability of
breast cancer in American women. National Cancer Institute Fact Sheet. Available online:
http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer.
Willett WC, et al. (2004). Nongenetic factors in the
causation of breast cancer. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 223–276. Philadelphia: Lippincott Williams
and Wilkins.
Beral V, et al. (2007). Ovarian cancer and hormone
replacement therapy in the Million Women Study. Lancet,
369(9574): 1703–1710.
American Cancer Society (2007). Breast Cancer Facts and Figures 2007. Atlanta: American Cancer
Society. Available online:
http://www.cancer.org/docroot/STT/stt_0.asp.
Paley PJ (2001). Screening for the major malignancies
affecting women: Current guidelines. American Journal of Obstetrics and Gynecology, 184(5): 1021–1030.
Gradishar WJ (2004). Male breast cancer. In JR Harris
et al., eds., Diseases of the Breast, 3rd ed., pp.
983–990. Philadelphia: Lippincott Williams and Wilkins.
Veronesi U, et al. (2003). A randomized comparison of
sentinel-node biopsy with routine axillary dissection in breast cancer.
New England Journal of Medicine, 349(6):
546–553.
Mansel RE, et al. (2006). Randomized multicenter
trial of sentinel node biopsy versus standard axillary treatment in operable
breast cancer: The ALMANAC trial. Journal of the National Cancer Institute, 98(9): 599–609.
Wolff AC, et al. (2007). American Society of Clinical Oncology/College of American Pathologists Guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer. Journal of Clinical Oncology, 25(1): 118–145.
Martelli G, et al. (2005). A randomized trial comparing axillary dissection to no axillary dissection in older patients with T1N0 breast cancer: Results after 5 years of follow-up. Annals of Surgery, 242(1): 1–6.
Thurlimann B, et al. (2005). A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. New England Journal of Medicine, 353(26): 2747–2757.
Boccardo F, et al. (2007). Switching to an aromatase
inhibitor provides mortality benefit in early breast carcinoma. Cancer, 109(6): 1060–1067.
Chlebowski T, et al. (2003). Influence of estrogen
plus progestin on breast cancer and mammography in healthy postmenopausal
women: The Women's Health Initiative randomized trial. JAMA, 289(24): 3243–3253.
Beral V, et al. (2002). Breast cancer and breastfeeding: Collaborative reanalysis of individual data from 47 epidemiological studies in 30 countries, including 50,302 women with breast cancer and 96,973 women without disease. Lancet, 360(9328): 187–2218.
Dallal CM, et al. (2007). Long-term recreational
physical activity and risk of invasive and in situ breast cancer.
Archives of Internal Medicine, 167(4):
408–415.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
McTiernan A, et al. (2004). Recreational physical
activity and the risk of breast cancer in postmenopausal women. JAMA, 290(10): 1331–1336.
Burstein HJ (2003). Breast cancer: Supportive measures
and follow-up care. In B Furie et al., eds., Clinical Hematology and Oncology, pp. 763–768. Philadelphia: Churchill
Livingstone.
Holmes MD, et al. (2005). Physical activity and survival after breast cancer diagnosis. JAMA, 293(20): 2479–2486.
Drouin JS, et al. (2006). Random control clinical
trial on the effects of aerobic exercise training on erythocyte levels during
radiation treatment for breast cancer. Cancer, 107(10):
2490–2495.
Ohira T, et al. (2006). Effect of weight training on
quality of life in recent breast cancer survivors: The Weight Training for
Breast Cancer Survivors (STBS) study. Cancer, 106(9):
2076–2083.
Collado-Hidalgo A, et al. (2006). Inflammatory
biomarkers for persistent fatigue in breast cancer survivors. Clinical Cancer Research, 12(9): 2759–2766.
National Comprehensive Cancer Network
(2009). Breast cancer risk reduction. NCCN Clinical Practice Guidelines in Oncology, Version 1. Available online:
http://www.nccn.org/professionals/physician_gls/PDF/breast_risk.pdf.
National Cancer Institute (2008).
Breast Cancer PDQ: Treatment—Health Professional Version. Available online:
http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional.
Other Works Consulted
American Cancer Society (2009). Prevention and Early Detection: American Cancer Society Guidelines for the Early Detection of Cancer. Atlanta: American Cancer Society. Available online: http://www.cancer.org/docroot/PED/content/ped_2_3X_ACS_Cancer_Detection_Guidelines_36.asp.
U.S. Preventive Services Task Force (2009). Screening for breast cancer. Available online: http://www.ahrq.gov/clinic/uspstf/uspsbrca.htm.
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