With the right moves: a monthly self examination, an annual check-up by the physician and periodic mammograms you can conquer it.


Like other cancers, breast cancer arises from the abnormal growth of cells, which may progress into a malignancy. No one knows precisely what causes the disease. Surprisingly, about 4 out of 5 women diagnosed with breast cancer have no family history of the illness and many have no known risk factors. Still, women with certain characteristics are more prone to developing breast cancer.


Researchers have linked a number of factors to a higher risk of breast cancer. Yet most women who are diagnosed have none of them. What does that mean for you? It means you should be vigilant about getting mammograms done, regardless of whether you have known risk factors. Step up the vigilance as you get older, since the risk of breast cancer rises with age and is greatest after age 60.


* Belonging to a family with a strong history of breast cancer. The more first-degree relatives, mother, sister or daughter, who has had the disease, particularly before age 50, the more you should watch out.

* Having an inherited mutation in the genes that normally regulates cell growth. BRCA1 and BRCA2 gene mutations increase your lifetime risk to between 40 and 80%.

Understanding cancer
* Beginning menstruation before the age of 12 or reaching menopause after the age of 55, which increase a woman? Exposure to estrogen.

* Hormone replacement therapy (especially the estrogen-progesterone combination) after menopause may put women at greater risk.

* First pregnancy after age 35.


Changes in your lifestyle can reduce risks. Studies blame obesity and physical inactivity. Weight gain in midlife significantly increases the risk of breast cancer. Maintain a healthy body weight (BMI less than 25) throughout your life.

* Minimize/avoid alcohol. It is the best established dietary risk factor for breast cancer.

* Consume fruits and vegetables, as much as you can.

* Exercise regularly. Studies have shown that habitual exercise provides powerful protection.

* Cut out high glycemic-index (GI) foods like white flour, white rice, potatoes, sugar and products containing them. These foods trigger hormonal changes that promote cellular growth in breast tissue.

* Lifetime exposure to estrogen plays a fundamental role in the development of breast cancer. Minimize exposure to pharmacologic estrogen. Do not take prescription estrogen unless unavoidable.

What to watch out for?


A woman's breasts undergo regular changes in size or texture during the menstrual cycle. It is important to become familiar with what's normal for you. This will spare you undue alarm and help you identify any change that may be suspicious. In the early stages, breast cancer usually doesn’t cause pain. In fact, when breast cancer first develops, there may be no symptom at all. As the cancer grows, it may cause changes that should be evident.


* A lump or thickening in or near the breast or in the underarm.

* A change in the size, shape or feel of the breast.

* Nipple discharge or tenderness, or an inverted nipple.

* Ridges or pitting of the breast, making the skin look like the skin of an orange.

* A change in the look or feel of the breast, areola or nipple such as warmth, swelling, redness or scaliness.


Besides the monthly self-exam, screening tests women typically undergo on a routine basis are mammography and clinical breast examination, in which a healthcare provider systematically palpates the breasts to detect changes or irregularities.


* Women over 40 should have an annual mammogram and clinical breast examination for early detection and treatment of breast cancer

* Women with early stage breast cancer have survival rates close to 100%

* 80% of breast cancers occur in women with no risk factors

* Less than 5% of breast cancer cases are inherited

Besides being a screening tool, mammography is used to further examine a lump or area of new concern. The technique uses low-dose X-rays to produce photographic images of breast tissue or mammograms. This method has proved to be the most effective means of detecting cancers early and is credited with a 20 to 30% reduction in the death rate from breast cancer.

An ultrasound may be used as a complementary study to diagnostic mammography to evaluate a suspicious mass. Once a lump or lesion is confirmed through breast imaging and/or a clinical breast exam, women typically undergo a biopsy, in which tissue is obtained for analysis. This analysis will tell your doctor whether the sampled cells are cancerous or benign.

Women newly diagnosed with cancer and with a family history of the disease should consider meeting a genetic counselor or geneticist to discuss obtaining a blood test to determine whether they carry the BRCA 1 or 2 gene mutation. If you are considering testing, discuss the risks, benefits, and possible psychological impacts before a final decision. Knowing that you have the altered gene may increase self-monitoring and help you guide family members, but it doesn’t tell you whether you will indeed develop breast or ovarian cancer. Some women with a mutation choose to have their breasts removed prophylactic ally. Other options include close surveillance or reducing risk by taking tamoxifen.

Treatment by stage
Lesions are almost always treated successfully. Most women with pre-cancerous lobular carcinoma don’t undergo surgery, but tamoxifen or a similar hormonal treatment, known to reduce the likelihood of future cancers, may be prescribed.

Your doctor understands better
Stage I: In early-stage invasive cancer, breast-conserving surgery such as lumpectomy, followed by radiation is done. Chemotherapy is often given prior to radiation.
Stage II: When a tumor is fairly large or a small tumor is accompanied by lymph-node involvement, lumpectomy with subsequent radiation may be appropriate, as may be simple mastectomy. Chemotherapy and hormonal treatment are also commonly prescribed.
Stage III: Often requires more extensive surgery and more aggressive ‘adjuvant therapies’, as the cancer has spread from the breast into the nearby lymph nodes or chest wall.
Stage IV: Cancers have metastasized to the lungs, liver, bones, or brain. Treatment of these advanced cancers is tough. The emphasis is on chemotherapy, and hormonal medication to slow the disease’s progression.


When the tumor alone is excised, the procedure is called lumpectomy. In other cases, the whole breast can be removed (mastectomy). Surgical removal of at least some of the lymph nodes from the underarm is also done to determine whether the cancer has spread to the nodes. In addition, some women choose to have reconstructive surgery to create a new breast form after mastectomy.


The standard method, known as external beam, delivers high-energy X-rays, gamma rays or particle beams to the site of the cancer. This painless procedure is generally given daily for five to seven weeks. The type of beam used depends on how large an area has to be radiated and how deep the treatment must penetrate.
Radiation therapy can produce side effects that build up over time. They include fatigue, skin irritation and darkening or shrinking of the breast. Less common side effects: rib fractures, lung inflammation and damage to the nerves and heart. Very rarely, radiation may foster an additional tumor.


Often used after surgery to kill cancer cells that may have spread outside the breast. The drug may be administered intravenously, in pill form, or using both. May also be recommended before surgery if the breast tumor is large (diameter greater than 5 cm), if the tumor is attached to the chest wall muscles, or if the patient has rapidly spreading inflammatory breast cancer. If the cancer responds well to chemotherapy before surgery, more of the breast may be conserved.

The patient receives chemicals that move through the bloodstream to all parts of the body, where they can destroy cells that have spread from the primary tumor. The course of this periodic treatment usually takes several months.

There are a large number of different chemotherapy drugs, and newer ones are under development. Sometimes, oncologists choose to give chemotherapy through a combination of drugs or ‘cocktails’ to subject cancer cells to a battery of attacks.

Though chemotherapy drugs target cancer cells, they can be toxic to normal cells. They harm cells that are rapidly dividing, damaging the cells of hair follicles, blood, the immune system, and the lining of the digestive tract, among others. Side effects vary in kind and severity. Depending on the drugs used, they can cause hair loss, nausea, vomiting, diarrhea, mouth sores, fatigue and a suppressed immune system.

The female hormones estrogen and progesterone play a role in the growth of breast cells. To make use of these hormones, breast cells normally have special receptors that permit the hormones to connect to the cells. Breast cancer cells that also have such receptors are known as hormone-receptor positive. This therapy is aimed at reducing the hormones available to the cancer cells and may cause them to cease growing or die.

Tamoxifen is the most widely used hormonal treatment for breast cancer in both pre-menopausal and postmenopausal women. It blocks the ability of the hormones to attach to cancer cell receptors. Patients take a pill once a day for at least 5 years after their surgery. Side effects include night sweats and hot flashes, nausea, menstrual irregularity, vaginal discharge, and a dry, itchy vagina. It can also increase the risk of strokes, pulmonary embolism or a blood clot in the lung, and cancers of the uterus.


The patient may need to adjust to effects which can be temporary— hair loss during chemotherapy—or permanent, such as the loss of a breast. This adjustment may include using a prosthesis to replace a missing breast; taking medication (hormonal treatments that have side effects); dealing with fears of a recurrence as well as changes in the emotional landscape surrounding physical intimacy and sexuality. Patients should opt for a lifestyle that cuts down risks of recurrence.


Most critical - The exact schedule will depend on individual circumstances. Routine care should involve visiting the doctor every 3 to 6 months for a physical examination and clinical breast exam, if the patient had a lumpectomy plus radiation, or an evaluation of the chest wall and unaffected breast (in case of mastectomy).

Regardless of the type of treatment, this schedule should continue for at least 5 years and yearly thereafter. Monthly breast self-examination is often suggested. Any change in breast tissue or nearby sites, as well as signs or symptoms that may suggest a recurrence should be reported immediately. Signs include new, persistent pain in the bones, chest, or abdomen; weight loss, and shortness of breath. If the patient is taking tamoxifen and have not had a hysterectomy, she will need a yearly pap test and pelvic examination because of the small risk of uterine cancer associated with this drug. If she has new symptoms, her doctor will recommend the necessary tests to determine whether they are associated with a metastatic recurrence.


Many women fear that the physical changes caused by breast surgery, not to mention the toll taken by chemotherapy and radiation, will have an impact on their intimate relationship with their partner. It’s best for both partners to communicate their needs and their fears. During the months of chemotherapy, intimacy is possible, but at times a patient may be too physically exhausted to think about sex.


Tamoxifen is usually prescribed for 5 years following cancer treatment. This drug blocks the ability of estrogen to attach to cells and promote their growth. It reduces the risk that women who have had a ‘receptor positive’ breast cancer—meaning their cancer cells have hormone receptors—will experience a recurrence of the original cancer or a new cancer.

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