Frequently Asked Questions (FAQs)

1. My doctor is sending me to a breast surgeon. Does this mean that I have cancer?

Not necessarily. Your physician is concerned about your breast health, or is encountering something outside of his or her “comfort zone.” Or, it could mean simply that your physician feels that you deserve the care of a specialist.

2.  What is breast cancer?

Breast cancer, plainly defined, is breast cells which grow out of control.

Normally, there are genes in every cell of every organ which regulate cell growth, as well as keeping the cells healthy. There are also genes that specifically “tell” cells when they have lived their life and should die. Abnormal changes (aka mutations) in these genes can cause uncontrolled division and growth of the cells.  This leads to a growth or mass.

Not all masses are cancerous. They are called benign when the cells divide rather slowly, or when the mass is not invasive, does not spread to other parts of the body, and the cells look close to the normal appearance. When the mass contains cells that look abnormal, which divide rapidly or invade other tissues, the mass is called malignant, or cancerous.  If these malignant masses are not controlled, the cells can spread to other parts of the body.

In the breast, cancer can occur in one of three places:

  1. The lobules = glands which produce milk
  2. The ducts = the structures which drain milk from the glands to the nipple
  3. The stroma = the fatty/ fibrous connective tissue of the breast (this is not as common)

Breast cancer is always due to a mutation in the cell’s genes. The majority of breast cancer (more than 90%) is due to wear and tear due to aging, smoking, hormones, alcohol, stress, or simply a mistake that the cell made in making new genetic material. The other 5-10% of breast cancers happen as a result of genetic mutations passed down by your mother or father.

3.  What are the stages of breast cancer?

Staging of a cancer takes into account the size of the tumor, whether the tumor is invasive or not, if lymph nodes are involved, and if the cancer has spread (or metastasized) outside of the original organ (the breast, in this case). The stage of a cancer helps your physician to guide your care.

Stage 0:  The cancer cells are still inside the original location, with no invasion.

Stage 1: The cancer is less than or equal to 2 centimeters (cm) and has not gone outside of the breast (the lymph nodes do not have cancer in them).

Stage 2A:  The cancer is 2-5 cm in size and has not spread to the lymph nodes

OR

The cancer is less than or equal to 2 cm, but has spread to the lymph nodes

OR

There is no cancer found in the breast itself, but there are cancer cells found in the lymph nodes.

Stage 2B:  The cancer is 2-5 cm and in the lymph nodes

OR

The cancer is > 5 cm, but is not in the lymph nodes

Stage 3A: Cancer is not found in the breast, but is found in the lymph nodes in the underarm. These nodes are stuck together or to other structures (artery, vein, nerve). Alternately, there is cancer found in the lymph nodes at the sternum (breastbone).

OR

Cancer is any size and has spread to lymph nodes in the underarm, and those nodes are stuck together or to other structures, or cancer is in the lymph nodes near the sternum.

Stage 3B: The cancer is any size and is found to have spread to the skin and/ or the chest wall.  There may be spread to the lymph nodes as in Stage 3A.

Stage 3C: No cancer, or any size cancer, is found in the breast which has spread to the skin and/ or chest wall

AND

There is spread to the lymph nodes around the collarbone

AND

There may be cancer in the underarm lymph nodes or those near the sternum

Stage 4: The cancer has spread to other body parts.  This is called metastasis.

Sometimes it may be difficult to tell a patient what stage of cancer they have on initial assessment. Often, you will be given a clinical stage and later a pathological stage and the two may be different. This happens most often if your physician believes that there has been no spread of cancer outside of the breast and upon surgical evaluation, it is found that the patient has lymph node involvement.

4.  What are breast cancer risks?  Is there anything I can do to decrease my risk?

Simply put, breast cancer risks are those things that can put you at risk of developing breast cancer.

The two biggest factors for developing breast cancer are gender and age. As we age, our risk of developing breast cancer increases.

Breasts are more inclined to cancer than any other organ because of their unique way of development. The breasts begin to develop while a fetus is still in the womb. Adolescence continues breast development, and breasts reach their final size when a woman is in her early twenties.

Some risk factors include:

  • Your genetic makeup–if you have “the breast cancer gene” (BRCA 1 or 2)
  • Personal history of breast cancer
  • Family history of breast cancer. Even if you do not carry the BRCA gene, if a first degree relative has breast cancer, you may be at higher risk.
  • Radiation therapy to the chest, such as mantle radiation for Hodgkin’s lymphoma–specifically between the ages of 10 and 30.
  • Race: Caucasian women are slightly more likely than African American women to develop breast cancer. People of Native Americans, Asians and Hispanic background have a smaller risk of developing breast cancer.
  • Breast findings: if you have developed hyperplasia or atypical cells that were found on biopsy, you may have an increased risk of breast cancer.
  • Estrogen exposure: the start of menstruation before age 12 and menopause after age 55 increases your body’s exposure to estrogen and your risk.
  • Pregnancy and breastfeeding: this again has to do with exposure to estrogen, as these two entities decrease the number of menstrual cycles in one’s lifetime. A woman who has never had a child, or had her first live birth older than age 30 has a higher risk of developing breast cancer. There is supporting information that breastfeeding may decrease risk of breast cancer.
  • Diethylstilbestrol (DES) exposure: Women to whom this was administered (to prevent miscarriage) have a higher risk of breast cancer, as do the daughters of women who took DES while pregnant.

Risk factors that you can change: 

  • Keeping an active lifestyle (at least 3.5 hours of moderate exercise/ week)
  • Keeping BMI (body mass index) to between 18-25
  • Stop smoking
  • Keep alcohol intake to no more than 5 drinks/ week
  • Decrease your estrogen exposure (either by losing weight or by not taking hormone replacement therapy).

5. I have been diagnosed with breast cancer. Will I live to see my kids grow up… my grandchildren… my child’s high school graduation… next week?

Please be aware that, although this is a very general statement, and your individual case will be considered, but breast cancer is currently a very controllable disease. We have come a long way with detection, diagnosis and clearance.  In fact, because of our advances in breast cancer diagnosis and treatment, as well as increased awareness, death rates due to breast cancer have been declining since 1990.

At the same time, we need to understand that breast cancer is the cause of more cancer deaths in women in the U.S. than any other, except lung cancer.

Breast cancer is also the second most diagnosed cancer in women in the United States (skin cancer is first).  The most recent statistics state that 1 in 8 women will develop invasive breast carcinoma in their lifetime–this makes about 12% of women in the United States.

6. I have been diagnosed with breast cancer. Will I need chemotherapy?

When regarding patients for therapy in addition to surgery, we look at the patient (age, risk factors, etc.), as well as the cancer’s biology (aggressivity, size, lymph node spread, etc.). Also, please be aware that medical therapies for breast cancer include pills such as Tamoxifen and Arimidex as well as injectables.

Your breast surgeon and your medical oncologist will be happy to discuss your options with you.

7. I have been diagnosed with breast cancer. Will I need radiation therapy?

This depends on several factors. The type of surgery that you undergo is a big determinant. For example, if you have a partial mastectomy=lumpectomy, you will likely need radiation therapy. However, even patients that undergo mastectomies sometimes will also need radiation therapy.

Your breast surgeon and your radiation oncologist will be happy to discuss this with you.