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Q: Who is most likely to get breast cancer?
A: Breast cancer occurs most often in women over 40 and the risk increases with age. There are many things that may increase a woman's risk of breast cancer. Some of these are things that cannot be controlled, and others are lifestyle choices that can be controlled. Some things may cause large increases in risk and some may result in small increases in risk.
Risk factors that cannot be controlled include having a breast cancer gene and having a long, uninterrupted menstrual history. Families who have a breast cancer gene tend to have several members with breast cancer and it is often diagnosed before menopause. These families may also have cancers of the endometrium, ovary, or colon. A long, uninterrupted menstrual history includes menstruation that begins at an early age, menopause starting at a late age, not having children, or first pregnancy at late age.
Controlling modifiable risk factors include reducing or eliminating the use of postmenopausal estrogen, decreasing alcohol use to no more than one drink a day, addressing postmenopausal obesity, and stopping smoking. The role of diet as a breast cancer risk factor is unclear at this time. Lifestyle risk factors may be of the most importance to women already at high risk due to family history and breast cancer gene presence.
Q: Can breast cancer be prevented?
A: There is no sure way to prevent breast cancer. All women can consider the lifestyle risk factors as they make their choices. The answers are not all in on this subject and women need to stay informed as new research is published. For women who are at higher-than-average risk, tamoxifen and raloxifene have been approved in the United States to reduce their risk of developing breast cancer. These hormonal treatments have side effects and risks, so the decision to use one of them for prevention should be made in careful consultation with a breast cancer specialist. For women at extremely high risk of breast cancer, preventive mastectomy (surgery to remove the breasts) may be considered. While many breast cancers cannot be prevented, early detection and prompt treatment can save lives when breast cancer occurs.
Q: Is breast cancer inherited?
A: All cancers involve changes in a person's genes. Usually, several changes are required before a cancer develops. If a person inherits a genetic mutation (change or defect), from a parent, that person has a higher risk for developing cancer. It is currently believed that less than 10 percent of breast cancers involve an inherited genetic mutation. Most happen because of genetic mutations that occur during the person's lifetime. If a woman's mother, grandmother, aunts, or sisters developed breast cancer before menopause, she may have a greater chance of getting breast cancer than a woman with no family history. The same gene may increase risk for ovarian, prostate, and pancreatic cancers. Genetic testing may help determine if a woman has inherited a breast cancer gene.
Q: How often should I have a mammogram?
A: Experts have different recommendations for mammography. Currently, the U.S. Preventive Services Task Force recommends screening every two years for women ages 50 to 74. The American Cancer Society (ACS) recommends yearly screening for all women ages 40 and older. Women should talk with their doctors about their personal risk factors before making a decision about when to start getting mammograms or how often they should get them.
Q: Does it hurt to have a mammogram?
A: A mammogram may be slightly uncomfortable, but it shouldn't hurt. In order to get a clear picture, the breast is compressed between two flat plates. It lasts only a few seconds. It is a good idea to schedule a mammogram after your menstrual period when your breasts are less likely to be tender.
Q: Does breastfeeding either cause or prevent breast cancer?
A: Some studies have found that breastfeeding may reduce the risk of breast cancer. The benefit appears to be related to how long the woman breastfeeds. Studies that show a benefit tend to be those in societies where a woman may have several children, breastfeed each for two years, with a total breastfeeding time approaching ten years. Studies that compare women who didn't breastfeed at all, to those who did for a few months, generally do not show a breast cancer reduction.
Q: Can injuries to the breast cause breast cancer?
A: Injuries to the breasts do not cause breast cancer to develop. Often injuries lead to the discovery of a tumor because it causes women to pay more attention to their breasts, but bumps and bruises do not cause tumors to appear.
Q: What is preventive mastectomy?
A: Preventive or prophylactic mastectomy is the removal of one or both breasts to reduce the risk of getting breast cancer. Some women who have a very high risk of breast cancer choose this option. Prophylactic mastectomy has been shown to reduce the risk of breast cancer by 90 percent in very high-risk women. However, some women who have had this surgery have regretted it afterward. This irreversible decision should be made carefully, following extensive consultation with a breast cancer expert and genetic counselor about risk, benefits, and other alternatives.
Women who consider prophylactic mastectomy are often also advised about prophylactic oophorectomy--removal of the ovaries. This is considered because women with genes for breast cancer risk may also be at high risk for ovarian cancer. Removing the ovaries in premenopausal women may decrease breast cancer risk, as well.
Q: Can breast cancer be cured?
A: Most women diagnosed with breast cancer in the early stages are alive after five years. Many women with breast cancer will be successfully treated and never experience breast cancer again. However, all women who have had breast cancer are at risk for recurrence or for a second primary breast cancer and thus regular checkups and mammograms are essential. At this time, there is no cure for women whose breast cancer has spread to other parts of the body. Still, many of these women can live for many years, undergoing treatment for breast cancer as a chronic illness.
Q: Can my doctor tell if I have cancer without doing a biopsy?
A: A biopsy is the only way to be sure if a breast change or lump is cancerous or not. By feeling the lump, it is possible for the doctor to determine if the lump is suspicious, but not if it is cancer.
Q: Is a mastectomy safer than a lumpectomy and radiation?
A: The National Cancer Institute found that a lumpectomy (breast-conserving surgery) followed by radiation was as effective as a mastectomy in saving women's lives from breast cancer. The risk of local recurrence is still higher with lumpectomy, but if cancer recurs in the breast after a lumpectomy and radiation, mastectomy can still be done and can be just as effective.
Q: If I have chemotherapy, will I still be able to have children?
A: Almost half of women under 35 years of age remain fertile after chemotherapy and can have safe and successful pregnancies. Women over 35 years old are less likely to retain their fertility after treatment.
Q: Why is chemotherapy such a long treatment?
A: Cancer cells divide quickly but they also take "rests" between divisions, just like normal cells do. During these resting periods, the cancer cells are relatively safe from chemotherapy drugs, which only attack tumor cells that are growing or dividing. Chemotherapy is administered over a period of months to reduce the chance that resting cells will be left behind and cause a recurrence.
Q: Where is the best place for me to receive treatment?
A: There are many factors to consider in deciding where to receive treatment. Ideally, a woman with breast cancer is treated by a team of doctors that specialize in breast cancer treatment. That team is supported by other health care professionals, such as oncology nurses, social workers, physical therapists, nutritionists, and others who collaborate to meet the needs of the patient. This helps to ensure that all options are considered and the best treatment plan for that woman is developed and provided.
Often, these resources may not be available close to the woman's home. In that case, decisions must be made that balance the health care needs with other parts of the woman's life. If possible, she should consider going to a multidisciplinary breast program at a major cancer center if she has a new breast cancer diagnosis by biopsy or a very strongly suspicious mammogram. Once a team of breast cancer specialists reviews her situation, surgery and treatment recommendations are made. The patient can then look into options closer to her home for radiation therapy and/or chemotherapy, if needed.
If the patient lives near a comprehensive or clinical cancer center that has been designated by the National Cancer Institute, she should definitely consider getting treatment, or at least a second opinion, there. These centers are involved in the latest research and their doctors can advise her about the newest and best treatments available.
Q: How does diet affect breast cancer?
A: Studies indicate that diet may be a factor in breast cancer, but the results are mixed. While the evidence of total fat intake impacting cancer outcome is not clear, we do know that diets high in fats tend to be high in calories. This may result in obesity, which is linked with increased cancer risk, increased risk of recurrence, and reduced chance of survival for many cancer sites, according to the ACS.
Maintaining a healthy weight is a recommendation of the American Institute for Cancer Research (AICR). The AICR also recommends that consumers limit consumption of red meats (such as beef, pork, and lamb) and avoid processed meats, like bacon.
Q: Do men ever get breast cancer?
A: According to the ACS, in 2012 over 2,200 men were diagnosed with breast cancer. Little is known about this rare cancer, but the risk factors seem to be the same as female breast cancer.
Q: How will breast cancer affect my sexuality?
A: Breast cancer can affect your sexuality in many ways. Local treatments for breast cancer--surgery and radiation therapy--may affect the appearance and sensations in the breast. You may feel uncomfortable being touched and your partner may feel uncomfortable touching you. Communicating with your partner about any concerns can help alleviate fears.
Both radiation therapy and chemotherapy may rob you of the energy you need for your daily activities, leaving little energy for sex. If you were premenopausal at diagnosis, chemotherapy may send you abruptly into menopause. If you had to stop hormone replacement therapy abruptly at diagnosis, you may experience vaginal dryness. Sex may not seem like a high priority during treatment. However, intimacy, in its many different forms, can help both you and your partner through these difficult times. It will help if you can talk with your partner about your needs and feelings during treatment. That will help to keep the communication paths open as you work together to resume and rebuild your sexual relationship when you are feeling better.
You should not hesitate to discuss sexuality issues with your doctor or nurse.
Q: What role does estrogen replacement therapy play in breast cancer?
A: The results of the Women's Health Initiative have provided helpful information in understanding the impact of hormone replacement therapy in breast cancer. The researchers said the risks of taking hormones, such as premarin and provera, outweighed the benefits. After the women had been on hormone replacement therapy for an average of just over five years, they had an increased risk of breast cancer, as well as stroke, heart attack, and blood clots. They had a decreased risk of colorectal cancer and hip fracture. Each woman should work with her health care provider to evaluate her individual risk factors in making decisions about hormone replacement therapy. If hormone therapy is used, it is usually best to use it at the lowest dose needed to control symptoms and for as short a time as possible.
Q: If I have breast cancer, do I have a higher chance of getting other cancers?
A: Women who have breast cancer are at higher risk to get cancer of the endometrium, ovary, and colon. They also have a higher chance of developing breast cancer in the other breast.
Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors conduct clinical trials to learn about how well new treatments work and what their side effects are. If they look promising, they are then compared to the current treatment to see if they work better or have fewer side effects. People who participate in these studies may benefit from access to new treatments before the FDA approves them. Participants also help further our understanding of cancer and help future cancer patients.
Q: Should everyone get a second opinion?
A: Many people with cancer get a second opinion from another doctor. There are many reasons to get a second opinion, including if the person is not comfortable with the treatment decision, if the type of cancer is rare, if there are different ways to treat the cancer, or if the person is not able to see a cancer expert.
Q: How can someone get a second opinion?
A: There are many ways to get a second opinion:
Ask a primary care provider. He or she may be able to recommend a specialist, such as a surgeon, medical oncologist, or radiation oncologist. Sometimes these doctors work together at cancer centers or programs.
Call the National Cancer Institute's Cancer Information Service. The number is 800-4-CANCER (800-422-6237). They have information about treatment facilities, including cancer centers and other programs supported by the National Cancer Institute.
Seek other options. Patients can get names of doctors from their local medical society, a nearby hospital, a medical school, or local cancer advocacy groups, as well as from other people who have had that type of cancer.
Bayhealth is Southern Delaware’s healthcare leader with hospitals in Dover and in Milford. Bayhealth provides a wide range of medical services, including cardiovascular, cancer, orthopaedics and rehabilitation, pediatrics, respiratory care, sleep care, surgical weight loss and women’s services.