A Woman's Guide to Breast Cancer Treatment

Survivors should immediately report new lumps, changes in breast shape or skin, persistent pain, unexplained weight loss, changes in energy, persistent cough, headaches, or other unusual health changes.

Breast cancer develops when cells in a part of the breast become abnormal and begin to grow and divide out of control. If left untreated, these cells can invade and damage nearby tissue and spread to other parts of the body.

The exact causes of breast cancer are not fully known. Most cases occur in women over 50, and only 20%-30% have a family history. It is not caused by stress, injury, antiperspirants, underwire bras, or caffeine.

Breast cancer is the second most common cancer in women. In California, about 25,000 women are diagnosed annually, and in the US, about 250,000. A woman living to age 80 has a 1 in 8 chance of getting it.

There are two main types: non-invasive (carcinoma in situ, such as DCIS and LCIS) and invasive (such as Invasive Ductal Carcinoma and Invasive Lobular Carcinoma).

Staging describes how much cancer is present and if it has spread. Stages 0-IV guide treatment decisions and help predict how the cancer will respond to therapy.

Additional tests include the hormone receptor test (estrogen/progesterone receptors), HER2 test (for HER2 protein), and gene expression profiling, which help determine the best treatment plan.

The team may include an anesthesiologist, case manager/patient navigator, clinical nurse specialist, lymphedema therapist, oncologist, oncology nurse, pathologist, physical therapist, plastic surgeon, primary care provider, psychologist, radiation oncologist, radiation therapist, radiologist, radiology technologist, social worker, and surgeon.

The main types are surgery, radiation therapy, chemotherapy, hormonal therapy, and targeted therapy. Complementary therapies and participation in clinical trials may also be considered.

Local therapy (surgery, radiation) targets cancer at its site, while systemic therapy (chemotherapy, hormonal, targeted) uses drugs or hormones to affect cancer cells throughout the body.

Breast-conserving surgery (lumpectomy/partial mastectomy) removes the cancer and a small margin of tissue, aiming to save most of the breast. It's suitable for most women with one small area of cancer who can also have radiation therapy.

Mastectomy removes the entire breast and is recommended when cancer is in more than one area, when radiation is not possible or desired, or when the cancer is large relative to breast size.

Lymph node removal helps determine if cancer has spread beyond the breast. This can be done with axillary lymph node dissection (ALND) or sentinel lymph node biopsy (SLNB).

Lymphedema is swelling caused by lymph fluid buildup, sometimes resulting from lymph node removal or radiation. It occurs in 5%-20% of women after ALND and can occur after treatment or many years later.

Common side effects include fatigue, skin changes like redness and swelling, increased sensitivity, and in some cases, lymphedema when underarm nodes are irradiated.

Chemotherapy uses drugs to destroy cancer cells throughout the body. It can be used before surgery (neoadjuvant) to shrink tumors, after surgery (adjuvant) to prevent recurrence, or as a main treatment for advanced cancer.

Common types are tamoxifen (for pre- and postmenopausal women) and aromatase inhibitors (for postmenopausal women). These drugs block or lower hormone levels to slow or stop hormone receptor-positive breast cancer.

Targeted therapy (e.g., trastuzumab/Herceptin, lapatinib) uses drugs to specifically target cancer cells that have too much HER2 protein, often in combination with other treatments.

Clinical trials are research studies testing new treatments. Participation gives access to new therapies and contributes to medical research but may involve unknown risks.

Breast reconstruction recreates the shape of a breast after mastectomy. Options include reconstruction with implants or with your own tissue (e.g., TRAM or LAT flap).

Follow-up care involves regular checkups every 3-6 months for the first 3-5 years, then annually, to monitor for recurrence and manage side effects or late effects of treatment.

Survivors should immediately report new lumps, changes in breast shape or skin, persistent pain, unexplained weight loss, changes in energy, persistent cough, headaches, or other unusual health changes.

Breast cancer develops when cells in a part of the breast become abnormal and begin to grow and divide out of control. If left untreated, these cells can invade and damage nearby tissue and spread to other parts of the body.