Overview

What is breast cancer? An expert explains

Learn more from breast surgeon Judy C. Boughey, M.D.

I'm Dr. Judy Boughey, a breast surgeon at Mayo Clinic. In this video, we'll cover the basics of breast cancer. What is it? Who gets it? The symptoms, diagnosis, and treatment. Whether you're looking for answers for yourself or someone you love. We're here to give you the best information available.

Breast cancer is a relatively common type of cancer. In fact, it is the most common cancer worldwide and the most common cancer diagnosed in the US. Currently nearly 4 million women in the US alone are diagnosed with breast cancer. However, this doesn't make a diagnosis easier, but it does mean a great deal of research and effort is being put towards ending it and it's working. Survival rates continue to go up as treatments get better and more tailor made to each patient.

Just like any cancer, breast cancer results from DNA mutations that instruct your cells to grow out of control. In this case, it targets cells in the breast tissue, and there's no single thing that causes these DNA mutations. There are a wide set of risk factors. But having more of these risk factors, can increase your chances of developing breast cancer. More than anything, your risk is increased by being female. That doesn't mean men don't get it. Actually, men account for about 1 percent of all cases. Another factor is age. The older you get, the more likely a breast cancer diagnosis becomes. A history of breast cancer increases your risk too, that includes your own personal history if you've had it before and your family history. If breast cancer is common in your family tree, you are likely at increased risk of developing it. Scientists have identified several genes that if inherited, are more likely to cause breast cancer. There are many, but the most common and well studied are, BRCA1 and BRCA2. While they don't make breast cancer a certainty, your chances of developing it, are much higher with these particular mutations. Beyond that, radiation exposure at any point in your life increases your risk of breast cancer. As does having children at what is scientifically considered an older age. Starting menopause at an older age and taking post-menopausal hormones.

There are things that can decrease your risk. Self breast awareness is one. Make note of any changes you notice in your breasts. Women aged 40 and older should get yearly mammograms. Early detection is really your best defense based on your other personal risk factors, you may want to consult with your doctor about starting at even a younger age. Limit alcohol, while not drinking lowers your risk the most. Drinking in moderation lowers your risk too. Stay physically active and try to maintain a healthy weight. You can talk to your doctor if you struggle with this. In some cases, post-menopausal hormones are necessary and can't be avoided. But be aware that they do seem to play a role in breast cancer risk. If you give birth, breastfeeding may reduce your chances of developing breast cancer in the future.

Things to keep an eye out for that might be signs, include lumps or thickening in your breast, changes in the size or shape of your breast, changes in your breast skin, or a new inversion of your nipple. Peeling, scaling or flaking of the areola and redness or pitting of the skin of your breast that looks like an orange. Most importantly, because these things may or may not be cancer, be sure to check with your doctor if you notice any of these signs.

If you suspect you might have breast cancer. How do you find out? Doctors use physical exams, mammograms, ultrasounds, MRIs, and needle biopsies to determine if cancer is present. If that's the case, you and your doctor will need to discuss treatment options.

Like any other cancer, Breast cancer requires a smart and strategic approach. Your treatment plan depends on what you're up against, maybe the size and the stage of the cancer. What type is it? Is it sensitive to hormones? Many questions have to be answered before you and your care team can put a plan together. Surgery is not always the first step. Frequently medical therapy, such as endocrine therapy or chemotherapy will be recommended first to decrease the size of the tumor in the breast, or decrease the disease and the lymph nodes, and importantly to evaluate the response of the cancer to the treatment. As this can be critical information to guide further treatment after surgery. But surgery is often indicated as part of the treatment, and that can mean just removing the breast lump, or sometimes removing the entire breast, or both breasts. It usually involves removal of some lymph nodes from under your armpit on that side. Whether or not you've got any treatment before surgery, you may need treatment after surgery. This could involve radiation and medical therapies such as endocrine therapy and chemotherapy. If the disease has spread beyond the breast and lymph nodes, surgery is usually not recommended and medical therapy is the main course of treatment. Radiation uses beams of energy to target and kill cancer cells and prevent cancer recurrence in that area. Chemotherapy uses powerful drugs to kill the cancers. Some cancers are sensitive to hormones and can be treated with a different set of drugs. Hormone therapy has its own set of side effects, but your doctor will be able to guide you through best options for your specific cancer type. Then there's immunotherapy. Cancer cells blind your body's natural defense systems. Immunotherapy pulls off those blinders, so your body's natural defenses can do their job and zero in on that target. All of these treatments have side effects going through these measures that will ultimately heal you can be really hard. But there are ways to deal with that too. Pain management and other palliative care can help you deal with all these necessary but difficult processes.

This can all feel overwhelming. A breast cancer diagnosis is a complicated and scary topic. Keep your friends and family close. Rely on them for practical and emotional support. Find someone to talk with, maybe a friend, relative, clergy member, or medical social worker. A support group can be really helpful to connect with others who have been down this road before. The outlook on breast cancer has improved immensely. Research and scientific advancement have made this disease a very treatable one. With new and constantly improving therapies and expert care, there is plenty of hope. If you'd like to learn even more about breast cancer, watch our other related videos or visit mayoclinic.org. We wish you well.

Breast cancer is cancer that forms in the cells of the breasts.

After skin cancer, breast cancer is the most common cancer diagnosed in women in the United States. Breast cancer can occur in both men and women, but it's far more common in women.

Substantial support for breast cancer awareness and research funding has helped created advances in the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased, and the number of deaths associated with this disease is steadily declining, largely due to factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease.

Breast cancer care at Mayo Clinic

Types

Symptoms

Signs and symptoms of breast cancer may include:

  • A breast lump or thickening that feels different from the surrounding tissue
  • Change in the size, shape or appearance of a breast
  • Changes to the skin over the breast, such as dimpling
  • A newly inverted nipple
  • Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
  • Redness or pitting of the skin over your breast, like the skin of an orange

When to see a doctor

If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor for prompt evaluation.

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Causes

Doctors know that breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.

Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.

Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

Inherited breast cancer

Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family.

A number of inherited mutated genes that can increase the likelihood of breast cancer have been identified. The most well-known are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which significantly increase the risk of both breast and ovarian cancer.

If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific mutations in BRCA or other genes that are being passed through your family.

Consider asking your doctor for a referral to a genetic counselor, who can review your family health history. A genetic counselor can also discuss the benefits, risks and limitations of genetic testing to assist you with shared decision-making.

Risk factors

A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But having one or even several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women.

Factors that are associated with an increased risk of breast cancer include:

  • Being female. Women are much more likely than men are to develop breast cancer.
  • Increasing age. Your risk of breast cancer increases as you age.
  • A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.
  • A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
  • A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
  • Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don't make cancer inevitable.
  • Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
  • Obesity. Being obese increases your risk of breast cancer.
  • Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
  • Beginning menopause at an older age. If you began menopause at an older age, you're more likely to develop breast cancer.
  • Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
  • Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.
  • Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
  • Drinking alcohol. Drinking alcohol increases the risk of breast cancer.

Prevention

Breast cancer risk reduction for women with an average risk

Making changes in your daily life may help reduce your risk of breast cancer. Try to:

  • Ask your doctor about breast cancer screening. Discuss with your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms.

    Talk to your doctor about the benefits and risks of screening. Together, you can decide what breast cancer screening strategies are right for you.

  • Become familiar with your breasts through breast self-exam for breast awareness. Women may choose to become familiar with their breasts by occasionally inspecting their breasts during a breast self-exam for breast awareness. If there is a new change, lumps or other unusual signs in your breasts, talk to your doctor promptly.

    Breast awareness can't prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.

  • Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day, if you choose to drink.
  • Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven't been active lately, ask your doctor whether it's OK and start slowly.
  • Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy.

    Some women experience bothersome signs and symptoms during menopause and, for these women, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms.

    To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.

  • Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask your doctor about healthy strategies to accomplish this. Reduce the number of calories you eat each day and slowly increase the amount of exercise.
  • Choose a healthy diet. Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer. The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts. People who follow the Mediterranean diet choose healthy fats, such as olive oil, over butter and fish instead of red meat.

Breast cancer risk reduction for women with a high risk

If your doctor has assessed your family history and determined that you have other factors, such as a precancerous breast condition, that increase your risk of breast cancer, you may discuss options to reduce your risk, such as:

  • Preventive medications (chemoprevention). Estrogen-blocking medications, such as selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast cancer in women with a high risk of the disease.

    These medications carry a risk of side effects, so doctors reserve these medications for women who have a very high risk of breast cancer. Discuss the benefits and risks with your doctor.

  • Preventive surgery. Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed (prophylactic mastectomy). They may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer.

Breast cancer care at Mayo Clinic

Oct. 16, 2021
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