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What is Breast Cancer?

Breast cancer is a life-threatening tumor that begins in the breast. If cancer cells invade lymph nodes in the armpit, the disease can spread, or metastasize, to other parts of the body. Breast cancer accounts for nearly 30% of all cancers in women in this country. Each year, more than 175,000 American women are diagnosed with, and 43,300 die from, the disease. Only lung cancer kills more women under age 54. But men are also vulnerable. They account for about 1% of breast cancer cases each year. The single greatest risk factor for breast cancer is being female, and the risk increases with age. While the average 40-year-old woman has a 1 in 217 chance of getting breast cancer, by the time she's 85, it's 1 in 9. Risk is higher among women with a strong family history, but only 10% of those diagnosed have a close relative who has also had breast cancer. So, 90% of breast cancer patients are "the first in their family." Other established risk factors include genetic abnormalities, getting your first period earlier or going through menopause later than usual, and having your first baby after age 30. Long-term estrogen therapy, a high-fat diet, the Epstein-Barr virus, and alcohol use are also associated with breast cancer, but no firm links have been made. On a positive note, exercise has been shown to reduce your risk. The likelihood of recovering from breast cancer depends largely on how early the disease is caught, but also on the particular type of tumor you have. Breast tumors can be invasive (spreading) or "in situ," remaining at the site where they originated. Doctors also characterize breast cancer based on where in the breast tissue the tumor arose ("ductal" means in a milk duct, for example), and by stage, or how far the disease has progressed. All women over 20 should have her breasts examined by a healthcare professional on a regular basis (every 3 years, then annually after age 40), and perform monthly breast self-examinations. The best time to do a breast exam on yourself is one week after your period starts. If you've gone through menopause, simply pick a day and do the exam on that same day each month. By checking your breasts regularly, you can better recognize changes and report them to your doctor right away.


Learning you have breast cancer must be terrifying. Fear of losing your body image, your lifestyle, and even your life is only natural -- but fear itself is your worst enemy. Denying the problem won't make it go away, nor will postponing important treatment decisions. Fear of the unknown just keeps you in the dark about what to expect -- when what you need is to be enlightened about all the recent advances. Fear prevents your body from doing what it was designed so beautifully to do -- to fight cancer. Every day, every one of us successfully fights off cancer cells without even realizing it. But fear or depression can cripple your immune system and prevent it from destroying the cancer cells, and from recovering from surgery or radiation free of infection or other complications. Thanks to new treatments, you need not be afraid. While you may associate breast cancer surgery with radical mastectomy, this disfiguring operation is now rarely done. Most women with early breast cancer can have a lumpectomy, removing only the tumor, followed by radiation and other treatment. Hormonal treatments like Nolvadex or Femara[delete tamoxifen] allow many women to avoid the side effects of chemotherapy. But for those who do need chemotherapy, new drugs dramatically reduce symptoms like nausea and anemia, allowing you to continue most normal activities. Even if you do feel sick for a few days, it's well worth it to get your life back. New drugs like Herceptin and Xeloda target cancer cells, leaving healthy cells alone. Picture yourself as a fighter rather than a victim, and you can win the war against this dreaded enemy. Taking charge of your health by quitting smoking, following a good diet, exercising sensibly, and getting plenty of rest helps mobilize your forces. Prayer or meditation focuses your mind and frees your spirit, allowing your body to fight the cancer. One in nine American women is diagnosed with breast cancer during her lifetime. So don't forget your allies -- get reinforcements through support groups and organizations for the 2 million breast cancer survivors in the U.S. alone. Your odds are better than you think. If breast cancer is caught early, 95% of women live more than 5 years. Take it one day at a time, knowing that every year you outlive breast cancer, the risk of it returning goes down. Five years with no recurrence, and you're 80% home-free.

How Do I Know I Have It?

Early on, when it's most curable, breast cancer has no symptoms at all. You aren't sick and you can't feel the still-tiny lump. This is why it's crucial for all women over age 40 (35 if you're at high risk) to get regular mammograms. Although the X-ray is imperfect -- missing up to 25% of cancers and picking up harmless lumps -- mammography is still the best available tool for identifying tumors before they can be felt. More precise, high-tech breast imaging techniques such as scintimammography and MRI may one day replace standard mammography. Today their availability remains somewhat limited. If your mammogram identifies an abnormality, your doctor will likely do a biopsy -- extracting and analyzing a sample of the suspicious breast tissue -- to determine if it's cancer. Fortunately, 80% of suspicious lumps tested turn out to be harmless. Your best protection is knowing your own body. If you notice any of the following, see your doctor right away. any lump or thickening in your breast or armpit a scaly, thickened, or inward-turning nipple any discharge from your nipple dimpled or reddened skin, or sores, on your breast breast swelling (that's different from your usual monthly changes) strange veins in an irregular pattern on your breast breast pain If testing confirms breast cancer, don't despair. The sooner you find it and treat it, the more likely you'll be cured. Medical advances -- from innovative surgical techniques to the latest cancer-fighting drugs -- have greatly improved your chances of making a complete recovery.


What's the Treatment?

Breast cancer treatments fall into three categories -- surgery, radiation, and chemotherapy. If your cancer is still in an early stage, your doctor will probably perform a lumpectomy to remove the tumor while leaving your breast intact. For more advanced breast cancer, however, a mastectomy may be necessary. The procedure involves the surgical removal of the entire breast, with or without portions of the underlying chest wall and the nearby lymph nodes. Some women who undergo mastectomy choose to have breast reconstruction right away. Ask your doctor if this is an option for you. Depending on the type and stage of cancer, your doctor may also recommend radiation, chemotherapy, hormonal therapy, or a combination of these. Radiation uses X-rays, either as an external beam or as internally planted "seeds," to destroy cancer cells and shrink tumors. Side effects, including fatigue, skin burns, nausea, and permanent firming of the breast tissue, are usually mild, becoming more severe with extended treatment. The goal of chemotherapy -- a fancy term for "drug or chemical therapy" -- is destruction of any cancer cells that may have split off from the original tumor and threaten to take hold elsewhere. The drugs are usually given in combination by intravenous injection, though some now come in pill form. A few more common chemotherapy drugs for breast cancer include fluorouracil or "5-FU," and doxorubicin which is also known as Adriamycin. Paclitaxil or "Taxol" can be effective against advanced breast cancers that have spread to the lymph nodes or other organs. Although it can be a lifesaver, chemotherapy can also be unpleasant. The drugs destroy all rapidly dividing cells, including those lining the gut and the hair follicles, not just cancer cells. You've no doubt heard horror stories of nausea, fatigue, and hair loss, and the prospect of beginning treatment can be daunting. But medical advances have made the experience less traumatic, and many patients are able to stick closely to their normal routine during chemo. Hormonal therapy works best in patients who are postmenopausal and have "estrogen-receptor positive" tumors -- that is, tumors that grow in response to estrogen. Drugs like tamoxifen mimic estrogen but don't induce tumor growth. In effect, they "trick" the tumor and stop the cancer from spreading. Some less-common treatments for breast cancer include removal of the ovaries, therapies that target only the breast cancer without affecting other cells, and bone marrow transplant. You may have to scale back your activities during treatment, but maintaining your daily routine as much as possible can help preserve a sense of normalcy. Eating a healthy diet (several small snacks may be easier on your stomach than three big meals), staying hydrated, learning relaxation techniques such as meditation and yoga, and getting a little bit of exercise can help you feel your best. Last but not least, don't underestimate the value of support groups and counseling. Whether in person or on-line, in a group or one-on-one, sharing your concerns with others who understand what you're going through can make a world of difference before, during, and after breast cancer treatment.