Breast Cancer

What causes breast cancer?
Breast cancer is believed to be caused by the interplay between genetic and environmental factors. While we know several risk factors for breast cancer – such as family history, alcohol use and reproductive factors – the ultimate cause of most breast cancer is not known.

If I have a family history of breast cancer, am I at higher risk for getting it myself?
Yes, if your grandmother, mother, sister or daughter has been diagnosed with breast cancer, you are at higher risk for developing the disease. We recommend a baseline mammogram at age 40, or 10 years before the age your first-degree relative(s) were diagnosed. A family history of ovarian cancer may also increase your risk for breast cancer in some circumstances. You can also consider having genetic counseling and testing through the Cancer Risk Assessment and Prevention Program at Women & Infants. Our counselors can more accurately estimate your risk and help you decide what to do with the information.

What are the signs of breast cancer?
Breast cancer is not usually something you can see, although the most common outward signs are a lump or a dimple in the breast or a rash. Breasts can also swell and the lymph nodes in the underarm can swell or get red. If you notice some of these signs, you should see your doctor immediately. Most of the time, however, breast cancer is discovered through a regular appointment with your doctor or on a screening mammogram.

How often should I see my doctor for a regular check-up?
You should have an annual exam. If you have unusual symptoms or there are changes in your breasts before your next exam, you should see your doctor.

How often should I have a mammogram?
Women & Infants follows the recommendations of the American Cancer Society, which state that women over the age of 40 should have annual mammograms. If you have a family history of breast cancer, your physician may suggest you have mammograms earlier than age 40.

Are mammograms painful?
The mammogram machines - including the new digital breast tomosynthesis three-dimensional mammogram machines at Women & Infants - must compress the breast tissue to get accurate images. This can sometimes be uncomfortable for a few minutes. We suggest that you not schedule your mammogram close to the time you have your period so your breasts are less tender.

Are breast self-exams effective?
Breast self exams may be effective for the right patient. However, the value has been hard to measure in studies. If you choose to perform a monthly self breast exam, look for changes in the breast tissue, including lumps, dimpling or discharge from the nipple. If you discover something, you need to call your physician immediately. Know that your breasts will change during your menstrual cycle. Most lumps you may find, however, are benign or non-cancerous.

Am I at higher risk for breast cancer if I got my period at a young age?
Yes, women whose menstrual cycles began before the age of 12 – as well as women with no children or who had their first child after the age of 30 – are at a higher risk for developing breast cancer.

Does birth control affect my risk of breast cancer?
While birth control regimens have been associated with breast cancer risk in the past, it is not thought that contemporary low dose birth control contributes significantly to a woman's risk of breast cancer.

Does smoking or drinking alcohol affect my breast cancer risk?
We have no evidence at this point that smoking increases a woman's risk of breast cancer, although we recommend that you quit because we know it causes other health risks. Drinking one or two alcoholic drinks a day does, however, slightly increase your risk of breast cancer. The more alcohol you drink, the higher the risk.

Can a healthy diet and exercise reduce my risk of breast cancer?
Yes, women who exercise at least 30 minutes three times a week have a lower rate of breast cancer, and women who maintain a low-fat diet have a reduced incidence of breast cancer.

Can non-cancerous cysts become cancer?
Many women develop cysts in their breasts and they are rarely cancer. If you feel a lump in your breast, you need to contact your doctor to find out what it is. If you've had cysts in the past, you cannot always assume a new lump is a cyst. If the lump does not go away or gets bigger, it's important to have it checked. The doctor will most likely send you for an ultrasound to see if it is a cyst. The doctor may also put a needle into the lump to see if it's a cyst. In a simple cyst, the needle will drain fluid. If the lump is made up of breast cells, the doctor can take a tissue sample for the pathologist to check.

Are there any studies going on that I can join?
Women & Infants' Breast Health Center participates in many research studies. You can find a complete list and information about signing up on the website at womenandinfants.org/womenscancer.

What are the side effects of chemotherapy and how can I manage them?
Different people experience different side effects from chemotherapy. They can include: nausea, vomiting, hair loss, fatigue, anemia, mouth sores, taste and smell changes, infection, diarrhea, early onset menopause, infertility, fluid retention, rashes, and numbness and aching of the joints, hands and feet. There are medications to help you cope with some of the side effects. In addition, we offer an Integrative Care Program that can offer some relief through therapies like massage, reiki, acupuncture and yoga. We also offer support groups where people share their own remedies and suggestions.

Should I choose a mastectomy or lumpectomy to remove my breast cancer?
Both procedures give women the same chance of survival if radiation is combined with the lumpectomy. Studies over the past 20 years show that mastectomy does not give a better chance of survival than lumpectomy. A lumpectomy will preserve the overall appearance of the breast. Radiation needs to start several weeks after a woman has healed from the lumpectomy and lasts for about six weeks.

Women & Infants has surgeons trained in oncoplastic surgery, which combines plastic surgery techniques with cancer removal to ensure that your breast will be attractive after a lumpectomy. When mastectomy is required, immediate reconstruction is usually an option. Different types of reconstruction offered by dedicated plastic surgeons at Women and Infants include both implant and tissue-based procedures. Lumpectomy and mastectomy are usually paired with surgery to evaluate the possibility that the cancer spread to the small glands called lymph nodes in the underarm. This technique is called a sentinel node biopsy and refers to removal of the first or "gatekeeper" lymph node in the underarm. Knowing the status of the cancer is important for your doctors to decide if you need other treatments such as chemotherapy.

When my doctor talks about "margins" with my breast cancer, what does that mean?
When you have a surgery to remove a cancerous lump in your breast, the surgeon will also take tissue around the tumor. The margin is the space between the tumor and the tissue around it that the doctor removed. The pathologist will check the tissue and describe it as either positive margins, which is when the tissue around the tumor has cancer in it; negative margins, when there are no cancer cells found in the tissue around the tumor; or close margins, which is between positive and negative. Knowing the margins helps your doctors decide on the right treatment for you.

If I need help finding support services during treatment, who do I turn to?
Women & Infants offers the services of a breast patient navigator who can help connect you with the services you need as you're going through treatment. This can include a support group, counseling, financial assistance, transportation to treatment, or other community services.

What if I become depressed?
Your doctor can refer you for a consultation to a psychiatrist from Butler Hospital who is on hand weekly at the Breast Health Center. He can evaluate your situation and help you connect with whatever long-term services you may need.

How long before I can say I'm cancer free?
You are cancer free once your cancer is removed. The added treatments of chemotherapy and radiation reduce the risk of the cancer coming back. Breast cancer can recur at any time, but the more time that passes, the lower your risk of it coming back.