Breast Cancer:Screening and Testing

There's a whole world of testing that goes along with taking care of your breasts. No matter where you are on the line between healthy breasts and breast cancer, tests can be nerve-wracking. But they're an indispensable part of:

• finding breast cancer early, when it's most treatable
• helping your treatment team design the treatment that's right for you
• determining the effectiveness of your continuing care

There are two different stages of testing. Screening tests (such as an annual mammogram) look for signs of disease in women without symptoms; they should be part of every healthy woman's routine. Diagnostic tests (such as magnetic resonance imaging [MRI], blood tests, or bone scans) become part of the picture when breast cancer is suspected or has been diagnosed. Find out more about options for testing.

In this section you'll learn more about mammograms, ultrasound, MRI, PET scans, and more. You'll also see images of what these tests look like.

The medical experts for Screening and Testing are:

• Susan Orel, M.D., professor of radiology, the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
• Emily Conant, M.D., chief of breast imaging, the University of Pennsylvania Medical Center, Philadelphia, Pennsylvania
• Marisa Weiss, M.D. breast radiation oncologist, Thomas Jefferson University Health System, Philadelphia, Pennsylvania

These experts are members of the Breastcancer.org Professional Advisory Board, including more than 70 medical experts in breast cancer-related fields.

Recurrent and Metastatic Breast Cancer

We know you really don't want to be here, reading about breast cancer recurrence or metastasis. If you've had breast cancer, the possibility of recurrence and spread (metastasis) of breast cancer stays with you. You may be here because you fear this possibility. Or you may be here because it's already happened.

Keep in mind that a recurrence of breast cancer or metastatic (advanced) disease is NOT hopeless. Many women continue to live long, productive lives with breast cancer in this stage. It is also likely that your experience with treatment this time will be somewhat different from last time. There are so many options for your care and so many ways to chart your progress as you move through diagnosis, treatment, and beyond.

Because there are so many options, this is a long section. You may want to read just a few pages at a time. You might find it very difficult to concentrate, think straight, and remember what you've read. That's natural when you're anxious, uncertain, overwhelmed. We'll do our best to help you find what you're looking for.

If you're already feeling stuck in the fear and you need to deal with that first, here are a few places to try right away:

• Read about coping with fear of recurrence.
• Visit the discussion boards and chat rooms, where other women who've been there are ready to reach out and help you get through the whole experience.

In this section, we'll give you the support, information, and practical tips you need to deal with breast cancer that has come back or spread. In the following pages, you can learn about:

Inflammatory Breast Cancer

Inflammatory breast cancer is a relatively rare but very serious, aggressive type of breast cancer. According to the National Cancer Institute (NCI), 1% to 5% of breast cancer cases in the United States are inflammatory breast cancer.

The symptoms of inflammatory breast cancer can include:

• Redness of the breast. The most distinguishing feature of inflammatory breast cancer is redness involving part of or the whole breast. Sometimes the redness comes and goes.
• Swelling of the breast. Part of or all of the breast may be swollen, enlarged, and hard.
• Warmth. The breast may feel warm.
• Orange-peel appearance. In some people, the breast can swell and start to look like the peel of a navel orange (this is called "peau d'orange").
• Other skin changes. The skin of the breast might look pink or bruised, or you may have what looks like ridges, welts, or hives on your breast.
• Swelling of lymph nodes. The lymph nodes under the arm or above the collarbone may be swollen.
• Flattening or inversion of the nipple. The nipple may go flat or turn inward.

About 50% of women with inflammatory breast cancer have a lump or a mass in their breast, but it may be difficult to feel since the breast is often bigger and harder than normal.

Inflammatory breast cancer is usually categorized as stage IIIB breast cancer because of the possible involvement of the skin, chest wall, or lymph nodes along the breast bone inside the chest wall. If the cancer has spread to other organs, such as the bones, lungs, liver, brain, or to the lymph nodes in the neck, it is categorized as stage IV.

Antiperspirants Do NOT Cause Breast Cancer

Background

The following e-mail about antiperspirants and breast cancer has made the rounds on the Internet, and many of you sent it to us for comment. The e-mail, which claims that "The leading cause of breast cancer is the use of antiperspirants," has alarmed countless women around the world—unnecessarily.

The false claims

What? Yes, ANTIPERSPIRANT. Most of the products out there are an antiperspirant/deodorant combination, so go home and check your labels. Deodorant is fine, antiperspirant is not. Here's why:

The human body has a few areas that it uses to purge toxins: behind the knees, behind the ears, groin area, and armpits. The toxins are purged in the form of perspiration.

Antiperspirant, as the name clearly indicates, prevents you from perspiring, thereby inhibiting the body from purging toxins from below the armpits. These toxins do not just magically disappear. Instead, the body deposits them in the lymph nodes below the arms since it cannot sweat them out. This causes a high concentration of toxins and leads to cell mutations: a.k.a. CANCER. Nearly all breast cancer tumors occur in the upper outside quadrant of the breast area. This is precisely where the lymph nodes are located.

Additionally, men are less likely to develop breast cancer prompted by antiperspirant usage (though they are not completely exempt) because most of the antiperspirant product is caught in their hair and is not directly applied to the skin. Women who apply antiperspirant right after shaving increase the risk further because shaving causes almost imperceptible nicks in the skin that give the chemicals entrance into the body from the armpit area.

New information about antiperspirants and breast cancer

Intriguing as it is to consider whether antiperspirants and breast cancer are linked—after all, the armpit and the breast ARE next-door neighbors, and the start of antiperspirant use DID precede the subsequent rise in breast cancer incidence—there are no studies that prove any connection. While we'd all like to identify THE single cause of breast cancer so that we could all avoid getting the disease, antiperspirants are simply not a cause of breast cancer.

Here are some reasons why the myth about antiperspirants doesn't make sense:

• There are plenty of other areas where you can still sweat: your scalp, your face, the front of your neck and down along the cleavage, down your back, in your groin area, and behind the knees (think about your all-over sweat "sprinkler system" during a hot flash!).
• Why would antiperspirants affect only breast cancer risk? It doesn't increase the risk of skin cancer in the armpit, even though antiperspirant concentration is highest there. If antiperspirant is absorbed through the skin and stored in the armpit lymph nodes, then why isn't there a higher rate of lymph node cancer?
• Even if the antiperspirant were concentrated in the armpit lymph nodes, the lymphatic fluid would not drain away to the breast. The direction of lymphatic fluid flow starts in the breast, and drains out through the armpit lymph nodes, toward the neck, and back into circulation. Additionally, there are one-way valves along the lymphatic drainage channels that keep the fluid moving in one direction (AWAY from the breast, not TO the breast).
• It's not true that "nearly all breast cancers" occur in the upper outer aspect of the breast, the part closest to the armpit. Rather, 40–50% of all breast cancers occur in that region, in part because more breast tissue naturally "lives" in this area, compared to the three other quadrants of the breast: upper inner, lower outer, and lower inner.

Why is this important?

Don't assume that what you read is necessarily true. You have to be a careful reader as you plow through the enormous amount of information out there. Whenever you read something that makes a big scary claim or concerns you, analyze it critically, and ask your trusted healthcare professional for his or her perspective. You can also express your concern to us at Breastcancer.org and we can offer you our opinion.

Myths About Breast Cancer

What is your risk of breast cancer? Which breast cancer treatment is right for you? What about antiperspirants and breast cancer?

What you don't know CAN hurt you. Misinformation can keep you from recognizing and minimizing your own risk of breast cancer or getting the very best possible care. Arm yourself with the facts.

Here are ten common myths about breast cancer, followed by myths about specific types of breast cancer treatment.

1. Breast cancer only affects older women.
   No. While it's true that the risk of breast cancer increases as we grow older, breast cancer can occur at any age. From birth to age 39, one woman in 231 will get breast cancer (<0.5%>Assuming you live to age 90, the risk of getting breast cancer over the course of an entire lifetime is one in 7, with an overall lifetime risk of 14.3%.
2. If you have a risk factor for breast cancer, you're likely to get the disease.
   No. Getting breast cancer is not a certainty, even if you have one of the stronger risk factors, like a breast cancer gene abnormality. Of women with a BRCA1 or BRCA2 inherited genetic abnormality, 40–80% will develop breast cancer over their lifetime; 20–60% won't. All other risk factors are associated with a much lower probability of being diagnosed with breast cancer.
3. If breast cancer doesn't run in your family, you won't get it.
   No. Every woman has some risk of breast cancer. About 80% of women who get breast cancer have no known family history of the disease. Increasing age – just the wear and tear of living – is the biggest single risk factor for breast cancer. For those women who do have a family history of breast cancer, your risk may be elevated a little, a lot, or not at all. If you are concerned, discuss your family history with your physician or a genetic counselor. You may be worrying needlessly.
4. Only your mother's family history of breast cancer can affect your risk.
   No. A history of breast cancer in your mother's OR your father's family will influence your risk equally. That's because half of your genes come from your mother, half from your father. But a man with a breast cancer gene abnormality is less likely to develop breast cancer than a woman with a similar gene. So, if you want to learn more about your father's family history, you have to look mainly at the women on your father's side, not just the men.
5. Using antiperspirants causes breast cancer.
   No. There is no evidence that the active ingredient in antiperspirants, or reducing perspiration from the underarm area, influences breast cancer risk. The supposed link between breast cancer and antiperspirants is based on misinformation about anatomy and a misunderstanding of breast cancer.
   More on antiperspirants and breast cancer
6. Birth control pills cause breast cancer.
   No. Modern day birth control pills contain a low dose of the hormones estrogen and progesterone. Many research studies show no association between birth control pills and an increased risk of breast cancer. However, one study that combined the results of many different studies did show an association between birth control pills and a very small increase in risk. The study also showed that this slight increase in risk decreased over time. So after 10 years, birth control pills were not associated with an increase in risk. Birth control pills also have benefits:
   • decreasing ovarian and endometrial cancer risk
   • relieving menstrual disorders, pelvic inflammatory disease, and ovarian, and cysts
   • improving bone mineral density
   As with any medicine, you have to weigh the risks and benefits and decide what is best for YOU.
7. Eating high-fat foods causes breast cancer.
   No. Several large studies have not been able to demonstrate a clear connection between eating high-fat foods and a higher risk of breast cancer. Ongoing studies are attempting to clarify this issue further. We can say that avoidance of high-fat foods is a healthy choice for other reasons: to lower the "bad" cholesterol (low-density lipoproteins), increase the "good" cholesterol (high-density lipoproteins); to make more room your diet for healthier foods, and to help you control your weight. Excess body weight, IS a risk factor for breast cancer, because the extra fat increases the production of estrogen outside the ovaries and adds to the overall level of estrogen in the body. If you are already overweight, or have a tendency to gain weight easily, avoiding high-fat foods is a good idea.
8. A monthly breast self-exam is the best way to diagnose breast cancer.
   No. Digital mammography or high quality film-screen mammography is the most reliable way to find breast cancer as early as possible, when it is most curable. By the time a breast cancer can be felt, it is usually bigger than the average size of a cancer first found on mammography. Breast examination by you or your healthcare provider is still very important. About 25% of breast cancers are found only on breast examination (not on the mammogram), about 35% are found on mammography alone, and 40% are found by both physical exam and mammography. Keep both bases covered.
9. I'm at high risk for breast cancer and there's nothing I can do about it.
   No. There are several effective ways to reduce—but not eliminate—the risk of breast cancer in women at high risk. Options include lifestyle changes (minimize alcohol consumption, stop smoking, exercise regularly), medication (tamoxifen, also called Nolvadex); and in cases of very high risk, surgery may be offered (prophylactic mastectomies, and for some women, prophylactic ovary removal). Be sure that you have consulted with a physician or genetic counselor before you make assumptions about your level of risk.
10. A breast cancer diagnosis is an automatic death sentence.
    No. Fully 80% of women diagnosed with breast cancer have no signs of metastases (no cancer has spread beyond the breast and nearby lymph nodes). Furthermore, 80% of these women live at least five years, most longer, and many live much longer. Even women with signs of cancer metastases can live a long time. Plus promising treatment breakthroughs are becoming available each day.

Breast Cellular Changes

Breast cellular changes may be associated with an increased risk of breast cancer. These are found when a breast biopsy (tissue sample) is taken and the breast cells are examined under a microscope. Two cellular changes associated with breast cancer risk are:

• atypical ductal hyperplasia—an overactive growth of cells lining the breast ducts
• lobular carcinoma in situ—an uncontrolled growth of lobular cells, the cells that make breast milk

Who Gets Breast Cancer?

Breast cancer is the most common cancer to affect women. In 2007, it is estimated that there will be about 178,480 new cases of invasive breast cancer diagnosed in the United States, along with 62,030 new cases of non-invasive breast cancer.

Every woman is at SOME risk for breast cancer—this is merely the "risk" of living as a woman. But there are many risk factors that can make one woman's picture differ substantially from another's. When you understand your own particular risk profile, you are in a better position to manage it and don't have to fear the unknown.

The medical experts for Who Gets Breast Cancer? are:

• Carol Cherry, R.N., O.C.N., oncology nurse, Fox Chase Cancer Center, Pennsylvania
• Marisa C. Weiss, M.D., breast radiation oncologist, Thomas Jefferson University Health System, Philadelphia, Pennsylvania