Breast cancer is when a cancerous tumor occurs inside the breast. Each year more than 185,000 women are diagnosed with breast cancer. Incidence rates rose 21% from 1973 - 1990, but then began to decline. Mortality rates have stayed relatively constant until recently, when annual decreases have been seen. About 43,500 women die from breast cancer annually, making this disease second to lung cancer as the leading cause of death by cancer among women. Women detect 90% of breast cancers themselves, often through breast self-examination (BSE).

According to the National Cancer Institute, breast cancer is often accompanied by the following signs and symptoms:

• A lump or thickening in or near the breast or in the underarm area
• A change in the size or shape of the breast
• Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
• Ridges or pitting of the breast (the skin looks like the skin of an orange)
• A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)

Over the course of a lifetime, 1 in 8 women will be diagnosed with breast cancer.

Risk factors you cannot change include:

• Age and gender -- Your risk of developing breast cancer increases as you get older. The majority of advanced breast cancer cases are found in women over age 50. Women are 100 times more likely to get breast cancer then men.
• Family history of breast cancer -- You may also have a higher risk for breast cancer if you have a close relative who has had breast, uterine, ovarian, or colon cancer. About 20 - 30% of women with breast cancer have a family history of the disease.
• Genes -- Some people have genes that make them more prone to developing breast cancer. The most common gene defects are found in the BRCA1 and BRCA2 genes. These genes normally produce proteins that protect you from cancer. But if a parent passes you a defective gene, you will have a higher risk of developing breast cancer. Women with one of these defects have up to an 80% chance of getting breast cancer sometime during their life.
• Menstrual cycle -- Women who get their periods early (before age 12) or went through menopause late (after age 55) have an increased risk for breast cancer.

Other risk factors include:

• Alcohol use -- Drinking more than 1 glass of alcohol a day may increase your risk for breast cancer.
• Childbirth -- Women who have never had children, or who had them only after age 30, have an increased risk for breast cancer. Being pregnant more than once or becoming pregnant at an early age reduces your risk of breast cancer.
• DES -- Women who took diethylstilbestrol (DES) to prevent miscarriage may have an increased risk of breast cancer after age 40. This drug was given to the women in the 1940s - 1960s.
• Hormone replacement therapy (HRT) -- You have a higher risk for breast cancer if you have received hormone replacement therapy for several years or more. Many women take HRT to reduce the symptoms of menopause.
• Obesity -- Obesity has been linked to breast cancer, although this link is controversial. The theory is that obese women produce more estrogen, which can fuel the development of breast cancer.
• Radiation -- If you received radiation therapy as a child or young adult to treat cancer of the chest area, you have a significantly higher risk for developing breast cancer. The younger you started such radiation and the higher the dose, the higher your risk -- especially if the radiation was given when a female was developing breasts.

Breast implants, using antiperspirants, and wearing underwire bras do not raise your risk for breast cancer. There is no evidence of a direct link between breast cancer and pesticides.

The National Cancer Institute provides an online tool to help you figure out your risk of breast cancer. See: www.cancer.gov/bcrisktool/

People with the following conditions or characteristics are at a higher than average risk for developing breast cancer:

• Women (over 99% of cases)
• Increasing age
• History of cancer in one breast
• History of benign breast disease
• Never giving birth or first pregnancy after age 30
• Family history (first degree relative) of breast cancer (significant for premenopausal women)
• Early onset of menstruation and late menopause
• High doses of ionizing radiation before age 35
• History of cancer of the colon, thyroid, endometrium, or ovary
• Diets high in animal fat, excessive alcohol consumption, and obesity
• Alterations in certain genes
• Breast implants

Despite the relevance of risk factors, 70 - 80% of women with breast cancer have none of the known risk factors.

If you have symptoms associated with breast cancer, see your health care provider immediately. Your health care provider can help make a diagnosis and help you determine which treatment or combination of therapies will work best for you.

Your health care provider will do a breast exam and run some laboratory tests, including a study of breast tissue and genetic testing. Imaging techniques may include mammography, ultrasound, magnetic resonance imaging (MRI), and other methods that help distinguish a cyst from a tumor or make a distinction between cancerous and noncancerous disease. Nuclear imaging techniques like positron emission tomography (PET) and single photon emission tomography (SPECT) may help physicians monitor the growth of tumors. Your doctor may also recommend a surgical biopsy to determine which type of breast cancer you have.

Prevention

Early detection is important. Monthly breast self examination and annual gynecologic exams play a large role in early detection. Some health authorities also recommend mammography every 1 - 2 years for women 40 years of age and older. Regular exercises, maintaining a healthy weight, limiting alcohol intake, and limiting postmenopausal hormone therapy may help prevent breast cancer. Women who breastfed their babies are also at lower risk of developing breast cancer. Some women who are at high risk of developing breast cancer may choose to take preventive drugs, such as tamoxifen and raloxifene.

Treatment Plan

Treatment options depend on the size and location of the tumor, results of lab tests, and the stage, or extent, of the disease, along with the patient's age and menopausal status, general health, and breast size.

Drug Therapies

Your health care provider may prescribe one or more of the following therapies:

• Radiation therapy -- the use of high energy x-rays to kill cancer cells and prevent them from growing
• Chemotherapy -- the use of drugs to kill cancer cells
• Hormonal therapy, which keeps cancer cells from getting the hormones they need to grow
• Antitumor antibiotics
• Antiestrogens, such as tamoxifen, which block estrogen from reaching breast cancer cells, reducing the risk of recurrence
• Monoclonal antibodies to block the protein receptor that is produced in large numbers in women who have breast cancer
• High dose progestogens (steroid hormones)
• Non-steroidal anti-inflammatory drugs (NSAIDs), which may reduce features of breast cancer and play a role in the prevention and treatment of the disease

Surgical and Other Procedures

Surgery is the most common treatment for breast cancer. The choice of surgeries includes the following:

• Mastectomy -- removal of the breast or as much of the breast tissue as possible. This treatment may be followed by breast reconstruction.
• Lumpectomy -- removal of the tumor and a small amount of tissue around it, usually followed by radiation therapy.
• Segmental, or partial, mastectomy -- removal of the tumor and a small amount of tissue around it, as well as the lining of the chest muscles below the tumor and some of the lymph nodes under the arm. It is usually followed by radiation therapy.

Complementary and Alternative Therapies

A comprehensive treatment plan for breast cancer may include a range of complementary and alternative therapies. Many naturally oriented doctors believe that nutritional supplementation and herbal medications are important for cancer patients. Other doctors are concerned that certain supplements may interfere with conventional cancer therapies. It is important that patients educate themselves and inform all of their health care providers about the therapies they are using.

Psychotherapy and support groups may help improve quality of life and survival. Make sure all of your doctors know about every therapy you are using, including any supplements you are taking. Work with specialists, keep all of your doctors informed, and know that new research on the risks and benefits of complementary and alternative therapies in cancer medicine are becoming available all the time.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Try to eliminate suspected food allergens, such as dairy (milk, cheese, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid caffeine and other stimulants, alcohol, and tobacco.
• Exercise, if possible, 5 days a week. Speak to your physician to find a regimen that is right for you.

You may address nutritional deficiencies with the following supplements. Remember to inform all of your health care providers about any natural therapies or supplements you are using.

• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results. Speak to your doctor to determine whether these supplements are appropriate for you.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbsp. of oil 1 - 2 times daily, to help decrease inflammation and help with immunity. Cold water fish, such as salmon or halibut, are good sources. Omega-3 fatty acids can increase the blood thinning effects of certain medications, including Coumadin and aspirin, and may increase the risk of bleeding in general. Speak with your health care provider.
• Melatonin, 2 - 6 mg at bedtime, for immune support and sleep. Higher doses may be needed in breast cancer. Melatonin may interact with a variety of medications, including but not limited to, sedatives, psychiatric medications, blood thinning medications, and blood pressure medications. Ask you health care provider.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should talk to your health care provider before starting treatment.

Homeopathy

An experienced homeopath considers both your symptoms and constitutional type in order to create an individualized treatment regimen. Some of the most common homeopathic remedies that may treat symptoms associated with breast cancer are the following:

• Arsenicum for anxiety and nausea, with restlessness and burning pains
• Ipecac for nausea unrelieved by vomiting
• Nux vomica for sharp abdominal pains with anger and collapse

Acute dose is 3 - 5 pellets of 12X to 30C every 1 - 4 hours until symptoms are relieved.

Acupuncture

While acupuncture is not used as a treatment for cancer itself, evidence suggests it can be a valuable therapy for symptoms associated with cancer and the side effects of chemotherapy. In a study of 104 women with breast cancer and nausea from chemotherapy (all of whom were taking anti nausea medication), women treated with acupuncture had fewer attacks of nausea than women who received the medication alone.

Other studies suggest that acupuncture can help alleviate fatigue and cognitive dysfunction in breast cancer patients undergoing chemotherapy. Acupuncture may also help eliminate pain and hot flashes caused by tamoxifen (a breast cancer medication). One study found that acupuncture markedly improved breathlessness in women with late stages of breast cancer. Acupressure (pressing on rather than needling acupuncture points) has also proved useful in controlling breathlessness and chemotherapy induced nausea and vomiting. Patients can learn this technique to treat themselves.

Some acupuncturists prefer to work with breast cancer patients only after they have completed conventional medical cancer therapy. Others will provide acupuncture and herbal therapy during active chemotherapy or radiation. Acupuncturists treat breast cancer patients based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In many cases of cancer related symptoms, a qi deficiency is usually detected in the spleen or kidney meridians.

Most complications result from surgery, radiation, chemotherapy, or use of the drug tamoxifen, which is effective in preventing recurrence but increases a woman's risk of developing endometrial cancer and blood clots. Other potential complications include:

• Restricted shoulder movement
• Increase in size of operative scar
• Inflammation of connective tissue in the affected arm
• Cancerous tumor of the lymphatic vessels in the affected arm
• Accumulation of fluid in the breast; swelling of tissue in the arm
• Discoloration of the skin from radiation, or a red spot
• Inflammation of the lung from radiation
• Death of the fat cells underlying the breast tissue
• Recurrence of the disease

The prognosis for breast cancer patients depends primarily on the stage, or extent, of the disease at the time of the initial diagnosis. With increased early detection rates and improved treatments, the 5 year survival rate is greater than 85%.

Breast cancer patients should see their health care provider every 3 months for 18 months to 4 years, then every 6 months thereafter.

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