Breast Cancer Chapter 1

Diagnosing Breast Cancer (VIDEO)

Breast imaging and early detection of breast cancer have advanced immensely over the last 25 years, leading to increased survival rates and improved quality of life for millions of women with breast cancer. This video takes you through the process of screening and diagnosis using various imaging modalities, including mammogram, ultrasound, and MRI.

Medical experts: Dr. Nora Jaskowiak, Dr. Gillian Newstead

Special thanks: University of Chicago Medical Center, Dr. Lina Meinel, the Sorrentino family

Breast Cancer

Worldwide, breast cancer is by far the most common cancer among women. It occurs twice as often as colorectal cancer and cervical cancer and three times as often as lung cancer. About 1.3 million women are diagnosed with breast cancer annually, and about 465,000 will die from it. North America has the highest rate of breast cancer in the world. A woman living in the US has a 1-in-8 chance of having malignant breast cancer at some time during her life (up from 1 in 20 in 1960), and a 1-in-35 chance of dying from it. According to the American Cancer Society, about 182,500 women in the United States will have been diagnosed with invasive breast cancer in 2008... Read more

The Marvel of the Breast

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Breast Function

What Are Breasts?

Breasts are complex, specialized organs whose primary function is to produce milk for the infant and baby. They are made up mainly of fat and breast tissue, intermingled with nerves, blood vessels, lymph vessels and lymph nodes, muscle tissue, and connective tissue.

Breast tissue extends from the breastbone to the underarm, and from below the collarbone to the level of the sixth or seventh rib. Breast tissue is composed of lobules, lobes, and mammary ducts. Fifteen to twenty lobes are arranged beneath the nipple and areola (the shaded area around the nipple), like petals on a flower. Each lobe contains thousands of tiny round sacs called lobules, and lobules hold the bulbs that produce breast milk. A single breast contains up to a million lobules. The lobules are connected to the mammary ducts like bunches of grapes on stems. Mammary ducts are the canals that carry breast milk to the nipple openings. Fat covers the breast tissue and gives the breast its shape.
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Breast Density

Radiologists grade breasts on the basis of how dense they are. Dense breasts have a high proportion of ductal and connective tissue, while less-dense breasts have a higher proportion of fatty tissue. The four commonly used categories are: (1) entirely fat, (2) scattered fibroglandular densities, (3) heterogeneously dense, and (4) extremely dense. Women with dense breasts have a higher risk of developing breast cancer.
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When Things Go Wrong - What Is Cancer?

The process of cell growth in the body is normally an orderly one. Cells grow and divide as necessary to produce more cells as they are needed. Cells that are old or damaged die, and are replaced with new cells.

In cancer, something has gone wrong with this process. The cell's DNA has been damaged. DNA is a substance found in every cell in the body that directs the cell's functioning and reproduction. Cell DNA may be damaged by environmental agents, such as radiation (including excessive sunlight), viruses, chemicals, and tobacco smoke. Cells with damaged DNA may also be inherited from one's parents.

  • Types of Cancer
  • Cancers of the Breast
    • In Situ and Invasive Cancer
    • Types of Breast Cancer
    • Ductal Carcinoma
    • Lobular Carcinoma
    • Inflammatory Carcinoma
    • Medullary Carcinoma
    • Tubular Carcinoma
    • Paget's Disease of the Nipple/Areola
    • Mucinous (Colloid) Carcinoma
  • Risk Factors
    • Risk Factors You Can't Control
    • Risk Factors You Can Control

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Signs & Symptoms

Breast cancer may be without symptoms, even in its advanced stages. If there are symptoms, they can include:

  • Lump in the breast or underarm area. This is the most common symptom, with an incidence of about 65-75%. Most breast cancers are discovered as a lump by the patient during breast self-exam, or during routine physical examination or mammography. Lumps may be benign or due to hormonal changes, but should be investigated, especially if they persist.
  • Change in size or shape of the breast. A change in the size or shape of the mature breast can be caused by the swelling of the ducts or lobes and might be due to monthly hormonal cycles. However, it may also indicate cancer, especially if it is in only one breast.
  • Fluid discharge from the nipple. If fluid is leaking from only one nipple, is a new discharge, or is bloody, then testing should be done to discover the cause…

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Screening for Cancer

  • Breast Cancer Screening
  • Breast Self-Exam (BSE)
  • Clinical Breast Exam (CBE)
  • Mammograms
  • Digital Mammography
  • Computer-Aided Detection (CAD)
  • Breast Calcifications

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Early Detection - Magnetic Resonance Imaging (MRI)

For women with a high risk of developing breast cancer (a genetic mutation or strong family history of breast cancer), a more aggressive schedule of screening may be advisable. High-risk women are more likely to develop breast cancer before the age of 40, when women normally start having screening mammograms. They're also more likely to have fast-growing cancers that can develop between mammograms. Mammograms are less effective in younger women because their breasts tend to be more dense, making mammogram images harder to read. In addition, some types of tumors that high-risk women may develop are less apparent on mammograms… Read more

Diagnosing Breast Cancer

If a woman has symptoms of breast cancer (such as a lump), or if a suspicious area is found in an imaging exam, the next step is to physically examine the breasts by noting any changes in their appearance and palpating the breast and the underarm region. A complete physical exam may be done as well. If symptoms or results of these exams suggest cancer might be present, then further tests will be done. (Note: The following diagnostic procedures are common to the US; procedures may vary in other countries.)

  • Diagnostic Imaging Tests:
    • Mammograms
    • What Abnormalities Can Mammograms Detect?
    • Masses
    • Computer-Aided Detection and Diagnosis (CAD)
    • Angiogenesis and Cancer Imaging
    • Imaging Angiogenesis
    • Magnetic Resonance Imaging (MRI)
    • Ultrasound
    • Ductogram
  • Nonimaging Diagnostic Tests
    • Biopsy
    • Several types of biopsy
  • Grading Breast Cancer
  • Hormone Receptor Status Tests
  • HER2 Testing
  • HER2 Tests

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Becoming Well

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Treatment – Types of Breast Cancer Treatment

There are four standard types of treatment for breast cancer patients: surgery, radiation therapy, chemotherapy, and hormone therapy. While treatment regimens may vary, the important constants are to communicate closely with the care team, understand treatment options, and maintain the treatment regimen. (Note: The following methods of breast cancer treatment are common to the US; different treatment techniques may be used in other countries.)

  • Surgery
  • After the Surgery
  • Side Effects of Surgery
  • Adjuvant Therapy
    • Radiation Therapy
    • External Radiation Therapy
  • Brachytherapy
    • Types of brachytherapy
    • Image-Guided Radiation Therapy (IGRT)
    • Intensity-Modulated Radiation Therapy (IMRT)
    • Side Effects of Radiation Therapy
  • Systemic Breast Cancer Treatment
    • Chemotherapy and Hormone Therapy
    • Chemotherapy
    • Side Effects of Chemotherapy
    • Treatment with Herceptin
    • Hormone Therapy
    • Types of Hormone Therapy
    • Side Effects of Hormone Therapy

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Prevention & Exercise

There is no certain way to prevent breast cancer, but there are ways to lower the risk of getting the disease.

  • Chemoprevention
  • Preventive Surgery
  • Lifestyle Measures
  • Postsurgical Exercise

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Related Health Centers:

Breast Cancer, Cancer Introduction, Colorectal Cancer, Prostate Cancer

The material on this site is for informational purposes only and is not intended as medical advice. It should not be used to diagnose or treat any medical condition. Consult a licensed medical professional for the diagnosis and treatment of all medical conditions and before starting a new diet or exercise program. If you have a medical emergency, call 911 immediately.