Breast Cancer Clear & Simple

All Your Questions Answered

American Cancer Society

Contents

Finding Out You Have Breast Cancer

What now?

You may be in shock. You may feel angry, worried, overwhelmed, hopeless, or scared. In fact, you may not know what to do. That's okay. It's normal to be upset and confused. No one wants to hear that she has breast cancer.

Don't rush.

You may feel like your cancer must be treated right now, even if you aren't sure how. But it is important to learn as much as you can about your breast cancer before making decisions about treatment. Take a few days or weeks to talk with your doctor about your options. That way, you can be sure you're making the best choices for you and your health.

What will happen to me?

Will I be okay?

Each person's cancer is different.

Most women with breast cancer are treated and recover. In fact, more than 3.5 million women in the United States have had breast cancer and are alive today.

You may already know family members and friends who have had breast cancer, were treated, and went on with their lives. These examples are proof that for most women, there is life after breast cancer.

Experts are working all the time on better ways to find and treat breast cancer.

Will I lose my breast?

Most women do not lose a breast.

Doctors can often remove the cancer without removing the whole breast. They take out the cancerous lump and some of the breast tissue around the cancer. This is called lumpectomy, or breast-conserving surgery.

What if I need to have my breast removed?

Some women do need to have their whole breast removed to get all the cancer.

Removing one breast is called a mastectomy. Removing both breasts is called a double mastectomy.

It is very upsetting to lose one or both of your breasts. You will need information and support to help you cope with your loss.

Read more about lumpectomy and mastectomy on pages 40–54.

Will I be in pain?

Having cancer does not mean you have to be in pain.

If you have pain from cancer or cancer treatment, there are many ways you can feel better. You don't have to suffer through any pain you feel. Medicines and some ways of relaxing can help. Here are some suggestions:

• Remember that controlling your cancer pain is part of your cancer treatment.

• Talk with your doctors about any pain you feel. The more doctors know about your pain, the better job they can do to relieve it. Don't be afraid to talk about your pain.

• Ask for help to treat your pain. Getting relief from your pain can help you deal with your cancer. Being free of pain will help you stay strong so you can get through your cancer treatment.

• Don't feel you have to choose between getting treated for cancer and getting treated for pain. Doctors can help you with your pain while treating your cancer.

My friend had breast cancer. Will my experience be the same as hers?

Each woman with breast cancer is different.

What happens to one woman with breast cancer won't happen to all women with breast cancer. Here are a few reasons why:

• Breast cancer affects people in different ways. Not everyone with one type of cancer has the same experience.

• There are different kinds of breast cancer. They affect the body in different ways.

Doctors don't treat every breast cancer the same way. They think about your breast cancer and your health. Then they make a treatment plan for your cancer.

My loved one had another kind of cancer. Should I expect my experience to be the same as hers?

Not all cancers are the same.

You've probably known someone who has had cancer. Just because something happened to that person does not mean it will happen to you. There are several reasons for this:

• Some types of cancer can be treated more easily than other types.

• Some types of cancer and cancer treatments make people sicker than others.

• Some cancers are found when they are small and easier to treat. Others are found later, after they have been growing for a while, and are harder to treat.

• People often have other illnesses that affect how they respond to the cancer treatment.

What Is Breast Cancer?

Breast cancer is a complex disease. There are different types of breast cancer. Each type is different and needs specific treatments.

This drawing of normal breast tissue shows the 3 main components of the female breast: (1) lobules, the glands that produce milk; (2) ducts, the passages that carry the milk from the lobules to the nipple; and (3) stroma, the fatty and connective tissues surrounding the ducts and lobules.

Most types of breast cancer begin in the cells that line the ducts. This is called ductal cancer. Some types begin in the cells that line the lobules. This is called lobular cancer. Only a small number of breast cancers start in the cells of the stroma of the breast.

How cancer starts

All living things, from plants to people, are made up of tiny cells. The healthy cells in your body grow, form new cells, and die when they're supposed to.

But cancer cells are not normal and don't follow the patterns they should. They don't die like other cells. They keep growing and making new cells. In the most common types of breast cancer, these cells grow out of control and form a lump called a tumor. If the cancer is around long enough, it can spread to other parts of the body.

More facts about breast cancer

• When doctors find breast cancer before it grows into a large tumor or spreads, they can treat it more easily.

• There are different types of breast cancer, and not every breast cancer grows the same way. So doctors don't treat every breast cancer the same way.

• Breast cancer happens mostly in women, but men can get breast cancer, too.

For information about different types of breast cancer, call the American Cancer Society at 800-227-2345, or go to cancer.org.

Why me?

Is it my fault I have breast cancer?

No. It's not your fault.

Many women want to know why they got breast cancer. Some women think they did something to cause their cancer. They may think they got breast cancer as a punishment for something they did or didn't do. Or they may think if they had done something differently, they wouldn't have gotten breast cancer. These reactions to a diagnosis are understandable, but don't blame yourself. You did not cause your breast cancer.

We don't know what makes most breast cancers start to grow. We do know that some things in a woman's life affect her chances of getting breast cancer. This is called her breast cancer risk. But even when certain factors are thought to raise a woman's chance of getting breast cancer, there's no way to know if they actually contribute to her getting it.

For more information about breast cancer risk, see pages 155–160.

If I don't feel sick, do I really have cancer?

Cancer doesn't always make you feel sick.

Some women say they can't believe they have cancer because they feel fine. It can be hard to accept that you have breast cancer when you don't feel sick. Other women may not feel quite right for a while before doctors find their breast cancer.

Cancer can grow silently for a long time before it causes problems or pain. That's why getting checked regularly for cancer is so important. The earlier cancer is found and treated, the better your chances for a long life after treatment.

How serious is my cancer?

How do the doctors know how serious my cancer is?

They first study a sample of your breast tissue.

Doctors study the breast tissue sample that was taken out during the biopsy and write a pathology report. It explains the type of breast cancer you have. It also says whether your tumor is likely to grow quickly or slowly.

Doctors use the report as a guide to help them plan how to treat your cancer. If you have surgery, the pathology report from surgery will be more detailed than the initial report.

What does "cancer grade" mean?

"Cancer grade" refers to how likely it is that your cancer will grow and spread quickly.

When doctors talk about "cancer grade," it is one way of talking about how serious your cancer is.

To decide the grade of your cancer, doctors look at your cancer cells under a microscope. They give your cancer a grade from 1 to 3. Cancer grades are described as follows:

• grade 1, or low grade;

• grade 2, or intermediate grade; and

• grade 3, or high grade.

A doctor will assign a grade to the cancer based on how closely the biopsy sample resembles normal breast tissue. Under a microscope, grade 1 cancer cells will look the most like healthy, normal cells. They are less likely to grow and spread quickly. Cancer cells that are grade 3 will look the most different from normal cells. They are more serious and could grow more quickly.

What does "cancer stage" mean?

"Cancer stage" tells you how much cancer there is and if the cancer has spread.

The cancer stage helps your doctor determine your treatment options and figure out what is likely to happen with your cancer.

To decide the stage of your cancer, your doctor will use the results of the physical exam and biopsy, along with results from surgery, if applicable. Other tests that might be used include a chest x-ray, mammograms of both breasts, bone scans, computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and positron emission tomography (PET) scans. (Most women won't need all of these tests.)

In cancer staging, a system of letters and numbers is used to describe the following:

• the size of your breast tumor;

• whether your cancer has grown into nearby structures (like the skin);

• whether your cancer has reached nearby lymph nodes; and

• whether your cancer has spread to other parts of your body.

See pages 161–164 for more information about cancer staging.

The doctor says my breast cancer has spread. What does that mean?

It's possible for cancer to spread to another part of the body.

Sometimes cancer cells break away from a tumor and spread to other parts of the body through the bloodstream or lymph vessels. The cancer cells can settle in other places in the body and form new tumors. When cancer cells spread to another place in the body, it is called metastasis.

Even when cancer has spread to a new place in the body, the cancer is still named after the part of the body where it started. If breast cancer spreads to the lungs, for example, it is still called breast cancer. Breast cancer is most likely to spread to the bones. Other common sites are the liver, lungs, and brain. Breast cancer can also spread to other parts of the body.

Do my doctors know how well I will respond to treatment?

Your doctors can predict how likely you are to respond to treatment, but no one can be sure.

Your doctors study what has happened to other women who had breast cancer with the same stage and grade as yours, and they consider the hormone receptor and HER2 status of your breast cancer. They look at how well treatment worked for those women to better predict how well you might do with treatment.

Testing for hormone receptors in the breast tissue is an important part of evaluating breast cancer status. At the time of biopsy or surgery, the breast cancer cells are tested to see if estrogen or progesterone receptors are present. Breast cancer cells that have one or both of these receptors are considered hormone-receptor positive. About 2 of 3 breast cancers are hormone-receptor positive. These cancers tend to grow more slowly and are much more likely to respond to hormone therapy than cancers that lack these receptors.

Invasive breast cancers, or those that have spread beyond the top layer of cells in the milk ducts or lobules, should also be tested for HER2, a growth-promoting protein. Tumors containing high levels of HER2 are referred to as HER2-positive tumors. About 1 in 5 breast cancers has too much of this protein. These cancers tend to grow and spread more quickly than others. However, these cancers are also more likely to respond to drugs that target the HER2 protein.

What is meant by the word "prognosis"?

This term means what will probably happen with your cancer.

Prognosis is your outlook after your diagnosis. This includes the time during cancer treatment and afterwards. It relates to your chances of recovering from cancer and having a recurrence.

But you are not a number on a chart. You are a person. Your body will react to cancer and treatment in its own way. Just because something happened to other women with breast cancer like yours does not mean it will happen to you. And cancer treatment is getting better all the time, so numbers and charts don't always reflect the many resources that are helping women right now.

Why doesn't the doctor use the word "cure"?

Even after treatment, it's hard to know if every cancer cell is gone forever.

Most doctors use the word "remission" instead of "cure." If they say "Your cancer is in remission," this means that tests done after your treatment don't show any cancer. This is a wonderful moment for many women!

A few cancer cells might still be hidden somewhere in the body, though, and start growing later. That's why doctors don't like to use the word "cure." They can't guarantee that the cancer is completely gone, even if it's very likely that it is.

Many women recover completely from breast cancer and have no sign of any cancer in their bodies. Other women who still have evidence of cancer are able to keep it under control and live long lives.

Do I need a second opinion?

Consider getting a second opinion. It can be important to know what another doctor says about your breast cancer.

You may want to get a second opinion about your diagnosis. That is, you may want to talk with other doctors about your diagnosis and the treatment plan your first doctor suggested. This way, you can feel more confident that the first doctor had the best plan, and it will help ensure that you understand all of your treatment options.

Your insurance provider might pay for a second opinion if you request it. Some insurance plans might even require that you get one. Talk with someone from your insurance company to find out what costs will be covered before you go to another doctor.

After talking with different doctors, think about what you have learned. Talk it over with friends and family members. Then choose the best treatment plan for you. Once you make that decision, it's time to start your breast cancer treatment.

Won't the first doctor be mad if I want to talk to someone else?

Most doctors will understand why you want a second opinion.

Women with breast cancer frequently seek a second opinion on their diagnosis and treatment. Wanting a second opinion doesn't mean you believe that the first doctor gave you poor treatment or advice, or that you don't trust the doctor. It means you want to explore all your options and make certain you have the right treatment plan. And getting another opinion may be required by your insurance company.

Many doctors will encourage you to talk with another doctor about your biopsy, your cancer diagnosis, and what is likely to happen. They know that your health and life are at stake. If your doctor gets mad or refuses to suggest another doctor, then you need to think about whether he or she is the right doctor for you.

Questions

to ask the doctor who told you about your cancer

1. What is my breast cancer grade?

2. What could this cancer grade mean for my health and my life?

3. What is the stage of my breast cancer?

4. How does my cancer stage affect which cancer treatments I should have?

5. How does my cancer stage affect my prognosis?

6. Was my breast cancer found to be hormone-receptor positive? If so, how will this impact my treatment?

7. Was my breast cancer found to be HER2 positive? If so, how will this affect my treatment?

8. Could you explain the different parts of my pathology report to me?

9. I'd like a second opinion. How do I get one?

10. Can you recommend a doctor to give me a second opinion?

11. How do I get my biopsy samples to that doctor?

12. What other tests do you think I will need?

Treating Your Breast Cancer

Who will help with my cancer treatment?

Can I choose my doctor?

You will likely be able to choose who will be in charge of your cancer treatment, although your choices might be limited based on your insurance coverage.

Talk with your primary care doctor about finding an oncologist. An oncologist is a doctor who specializes in treating people with cancer. You will want to find an oncologist who has treated a lot of women with breast cancer.

Most hospitals have several doctors who treat breast cancer. They may be experts in cancer, surgery, or radiation treatment. Your oncologist will likely oversee all your treatment.

You may have to pay more if you choose a doctor who is outside your insurance provider's network. Ask your insurance provider so you will know what will be covered.