What Is A Normal Breast?

A breast is made up of three main parts: glands, ducts, and connective tissue. The glands produce milk. The ducts are passages that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) connects and holds everything together.

No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age.

This diagram shows the parts of the breast and the chest wall.

Many conditions can cause lumps in the breast, including cancer. But most breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, tender, and sore. Cysts are small fluid-filled sacs that can develop in the breast.

Tumors and Breast Cancer

Sometimes breast cells become abnormal. These abnormal cells grow, divide, and create new cells that the body does not need and that do not function normally. The extra cells form a mass called a tumor. Some tumors are "benign" or not cancer. These tumors usually stay in one spot in the breast and do not cause big health problems. Other tumors are "malignant" and are cancer. Breast cancer often starts out too small to be felt. As it grows, it can spread throughout the breast or to other parts of the body. This causes serious health problems and can cause death.

Common Kinds of Breast Cancer

There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer. Breast cancer can begin in different parts of the breast, like the ducts or the lobes.

Common kinds of breast cancer:

* Ductal carcinoma. The most common kind of breast cancer. It begins in the cells that line the milk ducts in the breast, also called the lining of the breast ducts.
o Ductal carcinoma in situ (DCIS). The abnormal cancer cells are only in the lining of the milk ducts, and have not spread to other tissues in the breast.
o Invasive ductal carcinoma. The abnormal cancer cells break through the ducts and spread into other parts of the breast tissue. Invasive cancer cells can also spread to other parts of the body.
* Lobular carcinoma. In this kind of breast cancer, the cancer cells begin in the lobes, or lobules, of the breast. Lobules are the glands that make milk.
o Lobular carcinoma in situ (LCIS). The cancer cells are found only in the breast lobules. Lobular carcinoma in situ, or LCIS, does not spread to other tissues very often.
o Invasive lobular carcinoma. Cancer cells spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.

Symptoms

Different people have different warning signs for breast cancer. Some people do not have any signs or symptoms at all. A person may find out they have breast cancer after a routine mammogram.

Some warning signs of breast cancer:

* New lump in the breast or underarm (armpit).
* Thickening or swelling of part of the breast.
* Irritation or dimpling of breast skin.
* Redness or flaky skin in the nipple area or the breast.
* Pulling in of the nipple or pain in the nipple area.
* Nipple discharge other than breast milk, including blood.
* Any change in the size or the shape of the breast.
* Pain in any area of the breast.

Keep in mind that MOST of these warning signs can happen with other conditions that are not cancer so please see your doctor as soon as possible.

Risk Factors

Research has found several risk factors that may increase your chances of getting breast cancer including:

* Getting older.
* Being younger when you first had your menstrual period.
* Starting menopause at a later age.
* Being older at the birth of your first child.
* Never giving birth.
* Not breastfeeding.
* Personal history of breast cancer or some non-cancerous breast diseases.
* Family history of breast cancer (mother, sister, daughter).
* Treatment with radiation therapy to the breast/chest.
* Being overweight (increases risk for breast cancer after menopause).
* Long-term use of hormone replacement therapy (estrogen and progesterone combined).
* Having changes in the breast cancer-related genes BRCA1 or BRCA2.
* Using birth control pills, also called oral contraceptives.
* Drinking alcohol (more than one drink a day).
* Not getting regular exercise.

Having a risk factor does not mean you will get the disease. Most women have some risk factors and most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.

Prevention

Methods to help lower your risk of breast cancer:

* Get screened for breast cancer regularly. By getting the necessary exams, you can increase your chances of finding out early on, if you have breast cancer. For more information about the kinds of tests used to screen for breast cancer, and to learn how you can be screened, see Screening.
* Control your weight and exercise. Make healthy choices in the foods you eat and the kinds of drinks you have each day. Stay active. Learn more about keeping a healthy weight and ways to increase your physical activity.
* Know your family history of breast cancer. If you have a mother, sister, or daughter with breast cancer, ask your doctor what is your risk of getting breast cancer and how you can lower your risk. For more information, visit the Agency for Healthcare Research and Quality for information about medicines to prevent breast cancerExternal Web Site Icon and genetic testing for breast cancer.External Web Site Icon
* Find out the risks and benefits of hormone replacement therapy. Some women use hormone replacement therapy (HRT) to treat the symptoms of menopause. Ask your doctor about the risks and benefits of HRT and find out if hormone replacement therapy is right for you. To learn more about HRT, visit the Agency for Healthcare Research QualityExternal Web Site Icon and the National Cancer Institute (NCI)—Menopausal Hormone Use and Cancer: Questions and Answers.External Web Site Icon
* Limit the amount of alcohol you drink. The Alcohol Chapter of the Dietary Guidelines for Americans 2005 is a good resource.

Detection and Diagnosis

Breast cancer screening means checking a woman's breasts for cancer before there are signs or symptoms of the disease. Three main tests are used to screen the breasts for cancer. Talk to your doctor about which tests are right for you, and when you should have them.

* Mammogram. A mammogram is an X-ray of the breast. Mammograms are the best method to detect breast cancer early when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. If you are age 40 years or older, be sure to have a screening mammogram every one to two years.

* Clinical breast exam. During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.

Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side and then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.

If you have a lump, your health care provider will feel its size, shape, and texture. Your health care provider will also check to see if the lump moves easily. Benign lumps often feel different from cancerous ones. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer, but further tests are needed to diagnose the problem.

* Breast self-exam. A breast self-exam is when you check your own breasts for lumps, changes in size or shape of the breast, or any other changes in the breasts or underarm (armpit).

Here are additional details regarding Mammograms:

Keep in mind that, at this time, the best way to find breast cancer is with a mammogram. If you choose to have clinical breast exams and to perform breast self-exams, be sure you also get regular mammograms.

What is a mammogram?
A mammogram is an X-ray picture of the breast. Doctors use a mammogram to look for early signs of breast cancer.

Why should I get a mammogram?
Regular mammograms are the best tests doctors have to find breast cancer early, sometimes up to three years before it can be felt. When their breast cancer is found early, many women go on to live long and healthy lives.

When should I get a mammogram?
Most women should have their first mammogram at age 40 and then have another mammogram every two years until age 74. Talk to your health professional if you have any symptoms or changes in your breast, or if breast cancer runs in your family. He or she may recommend that you have mammograms before age 40 or more often than usual.

How is a mammogram done?
You will stand in front of a special X-ray machine. A technologist will place your breast on a clear plastic plate. Another plate will firmly press your breast from above. The plates will flatten the breast, holding it still while the X-ray is being taken. You will feel some pressure. The other breast will be X-rayed in the same way. The steps are then repeated to make a side view of each breast. You will then wait while the technologist checks the four X-rays to make sure the pictures do not need to be re-done. Keep in mind that the technologist cannot tell you the results of your mammogram.

What does having a mammogram feel like?
Having a mammogram is uncomfortable for most women. Some women find it painful. A mammogram takes only a few moments, though, and the discomfort is over soon. What you feel depends on the skill of the technologist, the size of your breasts, and how much they need to be pressed. Your breasts may be more sensitive if you are about to get or have your period.

When will I get the results of my mammogram?
You will usually get the results within a few weeks, although it depends on the facility. A radiologist reads your mammogram and then reports the results to you or your doctor. If there is a concern, you will hear from the mammography facility earlier. Contact your health professional or the mammography facility if you do not receive a report of your results within 30 days.

Tips for getting a mammogram:

* Try not to have your mammogram the week before you get your period or during your period. Your breasts may be tender or swollen then.
* On the day of your mammogram, don't wear deodorant, perfume, or powder. These products can show up as white spots on the X-ray.
* Some women prefer to wear a top with a skirt or pants, instead of a dress. You will need to undress from your waist up for the mammogram.

What happens if my mammogram is normal?
Continue to get regular mammograms. Mammograms work best when they can be compared with previous ones. This allows your doctor to compare them to look for changes in your breasts.

What happens if my mammogram is abnormal?
If it is abnormal, do not panic. An abnormal mammogram does not always mean that there is cancer. But you will need to have additional mammograms, tests, or exams before the doctor can tell for sure. You may also be referred to a breast specialist or a surgeon. It does not necessarily mean you have cancer or need surgery. These doctors are experts in diagnosing breast problems.

* Ultrasound: A woman with a lump or other breast change may have an ultrasound test. An ultrasound device sends out sound waves that people can't hear. The sound waves bounce off breast tissues. A computer uses the echoes to create a picture. The picture may show whether a lump is solid, filled with fluid (a cyst), or a mixture of both. Cysts usually are not cancer. But a solid lump may be cancer.

* MRI: MRI uses a powerful magnet linked to a computer. It makes detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue.

Biopsy: A biopsy is the removal of tissue to look for cancer cells. A biopsy is the only way to tell for sure if cancer is present.

You may need to have a biopsy if an abnormal area is found. An abnormal area may be felt during a clinical breast exam but not seen on a mammogram. Or an abnormal area could be seen on a mammogram but not be felt during a clinical breast exam. In this case, doctors can use imaging procedures (such as a mammogram, an ultrasound, or MRI) to help see the area and remove tissue.

Your doctor may refer you to a surgeon or breast disease specialist for a biopsy. The surgeon or doctor will remove fluid or tissue from your breast in one of several ways:

* Fine-needle aspiration biopsy: Your doctor uses a thin needle to remove cells or fluid from a breast lump.
* Core biopsy: Your doctor uses a wide needle to remove a sample of breast tissue.
* Skin biopsy: If there are skin changes on your breast, your doctor may take a small sample of skin.
* Surgical biopsy: Your surgeon removes a sample of tissue.
      o An incisional biopsy takes a part of the lump or abnormal area.
      o An excisional biopsy takes the entire lump or abnormal area.

A pathologist will check the tissue or fluid removed from your breast for cancer cells. If cancer cells are found, the pathologist can tell what kind of cancer it is. The most common type of breast cancer is ductal carcinoma. It begins in the cells that line the breast ducts. Lobular carcinoma is another type. It begins in the lobules of the breast.

If you are diagnosed with breast cancer, your doctor may order special lab tests on the breast tissue that was removed:

* Hormone receptor tests: Some breast tumors need hormones to grow. These tumors have receptors for the hormones estrogen, progesterone, or both. If the hormone receptor tests show that the breast tumor has these receptors, then hormone therapy is most often recommended as a treatment option.
* HER2/neu test: HER2/neu protein is found on some types of cancer cells. This test shows whether the tissue either has too much HER2/neu protein or too many copies of its gene. If the breast tumor has too much HER2/neu, then targeted therapy may be a treatment option. See the Targeted Therapy section.

It may take several weeks to get the results of these tests. The test results help your doctor decide which cancer treatments may be options for you.

Staging

After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.

The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The three ways that cancer spreads in the body are:

* Through tissue. Cancer invades the surrounding normal tissue.
* Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body.
* Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body.

When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

The following stages are used for breast cancer:

Stage 0 (carcinoma in situ)

There are 2 types of breast carcinoma in situ:

* Ductal carcinoma in situ (DCIS) is a noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive.
* Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.

Tumor size compared to everyday objects; shows various measurements of a tumor compared to a pea, peanut, walnut, and lime

Tumor size compared to everyday objects; shows various measurements of a tumor compared to a pea, peanut, walnut, and lime

Pea, peanut, walnut, and lime show tumor sizes.

Stage I:

Cancer has formed. The tumor is 2 centimeters or smaller and has not spread outside the breast.

In stage IIA:

* no tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or
* the tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
* the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.

Stage IIB

The tumor is either:

* larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
* larger than 5 centimeters but has not spread to the axillary lymph nodes.

Stage IIIA:

* no tumor is found in the breast. Cancer is found in axillary lymph nodes that are attached to each other or to other structures, or cancer may be found in lymph nodes near the breastbone; or
* the tumor is 2 centimeters or smaller. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
* the tumor is larger than 2 centimeters but not larger than 5 centimeters. Cancer has spread to axillary lymph nodes that are attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone; or
* the tumor is larger than 5 centimeters. Cancer has spread to axillary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.

Stage IIIB:

The tumor may be any size and cancer:

* has spread to the chest wall and/or the skin of the breast; and
* may have spread to auxiliary lymph nodes that may be attached to each other or to other structures, or cancer may have spread to lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast is inflammatory breast cancer. See the section on Inflammatory Breast Cancer for more information.

Stage IIIC

There may be no sign of cancer in the breast or the tumor may be any size and may have spread to the chest wall and/or the skin of the breast.

* has spread to lymph nodes above or below the collarbone; and
* may have spread to auxiliary lymph nodes or to lymph nodes near the breastbone.

Cancer that has spread to the skin of the breast is inflammatory breast cancer.

Stage IIIC breast cancer is divided into operable and inoperable stage IIIC.

In operable stage IIIC, the cancer:

* is found in ten or more auxiliary lymph nodes; or
* is found in lymph nodes below the collarbone; or
* is found in auxiliary lymph nodes and in lymph nodes near the breastbone.

In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone.

Stage IV

In stage IV, the cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.

Treatment
Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. Treatments include surgery, chemotherapy, hormonal therapy, biologic therapy, and radiation. People with breast cancer often get more than one kind of treatment.

* Surgery. An operation where doctors cut out and remove cancer tissue.
* Chemotherapy. Using special medicines, or drugs to shrink or kill the cancer. The drugs can be pills you take or medicines given through an intravenous (IV) tube, or, sometimes, both.
* Hormonal therapy. Some cancers need certain hormones to grow. Hormonal treatment is used to block cancer cells from getting the hormones they need to grow.
* Biological therapy. This treatment works with your body's immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments. Biological therapy is different from chemotherapy, which attacks cancer cells directly.
* Radiation. The use of high-energy rays (similar to X-rays) to kill the cancer cells. The rays are aimed at the part of the body where the cancer is located.

It is common for doctors from different specialties to work together in treating breast cancer. Surgeons are doctors that perform operations.

Medical oncologists are doctors that treat cancers with medicines.

Radiation oncologists are doctors that treat cancers with radiation.

Clinical Trials

If you have breast cancer, you may consider taking part in a clinical trial. Clinical trials are research studies that help find new treatment options. Visit the National Cancer Institute (NCI) and National Institutes of Health (NIH) sites listed below for more information about finding clinical trials.

Complementary and Alternative Medicine

Complementary medicine is a group of medicines and practices that may be used in addition to the standard treatments for cancer. Alternative medicine means practices or medicines that are used instead of the usual, or standard, ways of treating cancer. Examples of complementary and alternative medicine are meditation, yoga, and dietary supplements like vitamins and herbs.

Complementary and alternative medicine does not treat breast cancer, but may help lessen the side effects of the cancer treatments or of the cancer symptoms. It is important to note that many forms of complementary and alternative medicines have not been scientifically tested and may not be safe. Talk to your doctor before you start any kind of complementary or alternative medicine.

The information provided on this website is for informational purposes only and is NOT intended to diagnose nor treat any disease.  The best option for any patient is to speak with their medical professional that can access the symptoms and provide medical treatment.