Frequently Asked Questions about Breast Cancer

Frequently Asked Questions about Breast Cancer

This text has been adapted from the Oncology Interactive Education Series. Click here for a demo of this unique and innovation series.

1. What is breast cancer?
2. Why does breast cancer occur?
3. What are the symptoms of breast cancer?
4. Is mammography used only for screening?
5. What is breast self-examination (BSE)?
6. Can breast cancer be cured?
7. Are there different types of breast cancer?
8. Are my daughters at risk?
9. What do lymph nodes have to do with breast cancer?
10. Where should I go for additional information and reading materials?
11. What should I ask my health care team?

1. What is breast cancer?
Breast cancer is the uncontrolled growth of cells located in the breast. All cancer cells have the ability to spread. If breast cancer is not treated, the cancer cells can invade local tissues and eventually spread to distant organs (metastasize).

2. Why does breast cancer occur?
Cancer is caused by changes or mistakes in our DNA, which is our genetic material. A mistake may be caused by a genetic predisposition or a physical or chemical agent, known as a carcinogen. Environmental and other influences can also affect the DNA. Environmental influences have not been clearly established for breast cancer.

A number of changes must happen to a cell before it becomes cancerous.

Several factors can increase your risk of developing breast cancer. These risk factors include:

• being a woman
• increasing age
• family history

3. What are the symptoms of breast cancer?
In the early stages of breast cancer, there are often no symptoms. Most often, breast cancer is detected when a woman feels a lump in her breast or when an abnormality is detected on a mammogram. About 80% of breast lumps are benign (non-cancerous).

A tumour can grow for many months or even years before symptoms develop. If breast cancer is not detected early, it can spread to other parts of the body. This is called metastasis. If metastasis occurs, other symptoms may develop, such as a persistent pain, a lump felt elsewhere in the body (e.g., the neck) or shortness of breath.

4. Is mammography used only for screening?
Mammography is usually used to screen for breast cancer in women who have no known abnormality in their breasts. It is also used to help diagnose the cause of lumps in the breast. In addition, mammography is often performed to look for evidence of recurrence and new breast cancers in women who have previously been treated for breast cancer.

5. What is breast self-examination (BSE)?
Breast self-examination (BSE) is regular examination of your breasts to check for changes or abnormalities. This is a monthly examination that you can carry out at home. By checking your breasts every month, you will get to know how they look and feel. This will make it easier to tell if something has changed.

The key points to remember with breast self-examination are:

• Check your breasts at the same time every month.
• Do a complete check every time.
• Tell your doctor about any unusual changes.

6. Can breast cancer be cured?
In many cases, breast cancer is caught at a very early stage and never comes back after treatment. When cancer has definitely spread to other parts of the body, there is little chance for cure. However, women whose cancer has spread may live for more than ten years.

7. Are there different types of breast cancer?
The different types of breast cancer are named according to where and how they develop within the breast. About 85% of breast cancers are of the ductal type, meaning that they develop in the milk ducts. About 10% are lobular, meaning they develop in the lobes and lobules. About 5% of breast cancers are inflammatory or other uncommon types.

The vast majority of breast cancers occur in women; less than 1% of all cases occur in men.

8. Are my daughters at risk?
Every woman has a risk of developing breast cancer, and the risk increases as a woman becomes older. Of all cases of breast cancer, 95% are not inherited, and 75% to 80% of women who develop the disease have no identifiable risk factor other than that of being a woman.

Only 5% of breast cancer cases are hereditary. With many types of cancer, certain families are at higher risk than others. This is sometimes because of genetic factors that make members of those families more susceptible to developing cancer. Research has shown that some cases of breast cancer are associated with breast cancer susceptibility genes.

People with a strong family history of breast cancer have a higher risk of developing the disease.

If your family has a strong history of breast cancer, you may want to contact a genetics clinic to speak to a genetic counselor. Depending on your family history, the genetic counselor may recommend that your daughters undergo genetic testing to determine their personal risk levels.

During genetic counseling, the following factors are generally used to determine whether you are at an increased risk:

• number of cases of cancer on each side of your family
• types of cancers
• age at diagnosis
• presence of bilateral disease
• presence of multiple primary cancers
• ethnic background

9. What do lymph nodes have to do with breast cancer?
Lymph nodes are small, bean-shaped structures located at stations along the vessels of the lymphatic system. The lymphatic system is a network of vessels that transports fluids around your body. A major function of this transportation network is to filter foreign substances from the body. Unfortunately, when cancer is present, it may use the lymphatic system to gain access to other parts of the body. Once cancer cells reach the lymph vessels in the breast, the cancer can use this transportation network to spread to nearby lymph nodes in the armpit (axilla) and to more distant parts of the body, such as the bones or lungs. Even when the lymph nodes are not involved by cancer, it is still possible, although less likely, for the cancer to spread (e.g., through the bloodstream).

It is common for breast cancer to spread to the axillary lymph nodes, which are located in the armpit.

The axillary lymph nodes are usually removed as part of breast-conserving surgery in order to allow diagnosis and to decrease the chance of disease recurrence.

10. Where should I go for additional information and reading materials?
The best source of information on breast cancer is your treatment team. Each member of your treatment team has received specific training on the subject of breast cancer and can answer many of your questions.

You may wish to consult additional sources as well. Bookstores, the Internet and the patient library at your local hospital are all good resources.

11. What should I ask my health care team?
You should ask your health care team whatever questions are necessary to make you feel comfortable with what is happening to you during the course of your diagnosis, staging, treatment and follow-up.

Here are some examples of questions you may wish to ask your health care team:

1. How advanced is the cancer?
2. What are my treatment options?
3. Which treatment would you choose if you were in my shoes?
4. Is there anyone else with whom I should speak?
5. Where can I find more information?
6. Where should I be treated?
7. Do I need to decide on a treatment right away?
8. Is recurrence likely?
9. What complementary therapies are available?
10. Am I eligible for any ongoing clinical trials of new therapies?

This text has been adapted from the Oncology Interactive™ Education Series. Each title in this series contains between 15 and 20 hours of interactive, graphically rich and comprehensive content for patients, their families and health care professionals. You can use this series at any one of the Resource Centres at Princess Margaret Hospital, borrow a copy from the PMH Patient and Family Library or purchase your own personal copy from http://www.OncologyInteractive.com