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Genes carry the information that determines which characteristics or features are passed on to you from your parents. These characteristics include eye color, blood type, and risks of getting certain diseases. Everyone inherits two sets of genes – one set of genes from your mother and one set of genes from your father, for a total of 20,000 and 25,000 genes. Most genes are the same in everyone, but less than 1% are slightly different between people. When there is a permanent change in the DNA sequence that makes up a gene, this is called a gene mutation. Only some gene mutations affect health and development.
Genetics is the study of genes or parts of genes that have a known function. Genetics looks at how characteristics are passed on from one generation to the next, and it can help you and your family learn about how conditions such as breast cancer is inherited, what screening and testing options are available, and what treatments are available.
Genetic testing is a type of medical test that examines your DNA to reveal changes in your genes that may cause illness or disease such as breast cancer. There are over 1,000 genetic tests in use, and more are being developed. Genetic testing is voluntary, and the results are confidential, like the rest of your medical record. The cost of testing ranges from $300 to $5000 depending on the complexity of the test. In many cases, health insurance plans will cover the costs of genetic testing when it is recommended by your doctor. The Affordable Care Act requires insurance plans that began on or after August 1, 2012 to cover genetic testing costs when the test is recommended by a provider. Further, if you have a BRCA1/2 gene mutation, the Affordable Care Act requires coverage of counseling to help you decide if taking medications to lower breast cancer risk is right for you. Health insurance providers have different policies about which tests are covered, so be sure to contact your insurance company beforehand to ask about coverage. You may also choose to pay out-of-pocket for the test if you are worried that the results of a genetic test can affect your insurance coverage. In this case, find out more about your state’s privacy protection laws before asking your insurance company to cover the costs.
Typically, to perform the genetic test, a sample of your blood, saliva or other tissue is sent to a testing facility. Within a few weeks, the results are generally ready and provided in writing to your doctor or genetic counselor, or sometimes directly to you. After you receive your results, it is important that you speak with the your genetic counselor or healthcare professional to interpret the results and discuss health management options.
The results of genetic tests are not always straightforward, which often makes them challenging to interpret and explain. Therefore, it is important for patients and their families to ask questions about the potential meaning of genetic test results both before and after the test is performed. When interpreting test results, healthcare professionals consider a person’s medical history, family history, and the type of genetic test that was done. There are three types of results:
- A positive test result means that the laboratory found a change in a particular gene, chromosome, or protein of interest. Depending on the purpose of the test, this result may confirm a diagnosis, indicate that a person is a carrier of a particular genetic mutation, identify an increased risk of developing a disease (such as cancer) in the future, or suggest a need for further testing. Because family members have some genetic material in common, a positive test result may also have implications for certain blood relatives of the person undergoing testing. It is important to note that a positive result of a predictive or presymptomatic genetic test usually cannot establish the exact risk of developing a disorder. Also, health professionals typically cannot use a positive test result to predict the course or severity of a condition.
- A negative test result means that the laboratory did not find a change in the gene, chromosome, or protein under consideration. This result can indicate that a person is not affected by a particular disorder, is not a carrier of a specific genetic mutation, or does not have an increased risk of developing a certain disease. It is possible, however, that the test missed a disease-causing genetic alteration because many tests cannot detect all genetic changes that can cause a particular disorder. Further testing may be required to confirm a negative result.
- An uninformative, indeterminate, inconclusive, or ambiguous test result are as follows: uninformative test results sometimes occur because everyone has common, natural variations in their DNA that do not affect health. If a genetic test finds a change in DNA that has not been associated with a disorder in other people, it can be difficult to tell whether it is a natural variation or a disease-causing mutation. An uninformative result cannot confirm or rule out a specific diagnosis, and it cannot indicate whether a person has an increased risk of developing a disorder. In some cases, testing other affected and unaffected family members can help clarify this type of result.
Benefits of Genetic Testing
Genetic test results can provide a sense of relief from uncertainty and help you make informed decisions about managing your health care. For example, a negative result can eliminate the need for unnecessary checkups and screening tests in some cases. A positive result can direct you toward available prevention, monitoring, and treatment options. Some test results can also help you make decisions about having children.
Potential Risks of Genetic Testing
The physical risks associated with most genetic tests are minimal, particularly if the test requires only a blood sample or cheek swab.
Emotional and social consequences of the test results are more common risks associated with genetic testing. When you receive your genetic test results and you are positive for a particular genetic mutation, you may feel angry, depressed, anxious, or guilty. These results may create a lot of emotions within a family because the results can reveal information about other family members in addition to the person who is tested. You may also worry that your genetic test results may cause you to experience genetic discrimination in employment or insurance.
Limitations of Genetic Testing
Generally, the genetic test cannot determine if you will show symptoms of a mutation, how severe the symptoms will be, or whether symptoms will progress over time. Another limitation of genetic testing is that there may not be a treatment strategy for that genetic disorder.
Fear of discrimination is a common concern among people considering genetic testing. Genetic discrimination is how you would describe being treated differently by your employer or insurance company because you have a gene mutation that causes or increases the risk of an inherited disorder. A federal law called the Genetic Information Nondiscrimination Act (GINA) is designed to protect people from this form of discrimination. GINA has two parts:
- Title I prohibits genetic discrimination in health insurance. This makes it illegal for health insurance providers to use or require genetic information to make decisions about your insurance eligibility or coverage. This part of the law went into effect on May 21, 2009.
- Title II prohibits genetic discrimination in employment. This makes it illegal for employers to use your genetic information when making decisions about hiring, promotion, and several other terms of employment. This part of the law went into effect on November 21, 2009.
GINA and other laws do not protect people from genetic discrimination in all circumstances. For example, GINA does not apply when an employer has fewer than 15 employees. It does not cover people in the U.S. military or those receiving health benefits through the Veterans Health Administration or Indian Health Service. GINA also does not protect against genetic discrimination in forms of insurance other than health insurance, such as life, disability, or long-term care insurance.
Hereditary Breast Cancer
Hereditary breast cancer is a type of breast cancer that may be caused by a change in certain genes that you inherited from your mother or father. These changes in the genes may prevent the genes from doing their job correctly. In turn, cells may divide and change more quickly, which can lead to cancer. Approximately 5%-10% of breast cancers are hereditary, which means that the cancer runs in the family.
Breast Cancers with BRCA Gene Mutations
The normal BReast CAncer (BRCA) genes, BRCA1 and BRCA2, help to repair damaged DNA so that cells can continue to grow and function normally. Changes in the BRCA1 and BRCA2 genes increase the risk of breast cancer, and common mutants include BRCA1 185delAG, BRCA1 5382insC and BRCA 617delT. Here is some additional information about breast cancer with BRCA1/2 gene mutation:
- Among Ashkenazi Jewish people, approximately 1 in 40 have BRCA1/2 gene mutation.
- Compared to breast cancers without a BRCA1 genemutation or BRCA2 genemutation, breast cancers that are associated with a BRCA1 gene mutation or BRCA2 genemutation tend to be more common in younger women and tend to occur in both breasts.
- BRCA1/2 gene mutation may increase the risk of a second primary breast cancer, which means a second breast tumor that is unrelated to the first tumor. The second tumor typically occurs in the opposite breast, not the same breast. Women with BRCA1/2 gene mutation have a 10-30% chance of developing breast cancer in the opposite breast 10 years after diagnosis of the breast cancer. By comparison, women without BRCA1/2 gene mutations have 5-10% of developing breast cancer in the opposite breast 10 years after diagnosis of the breast cancer.
- Mutations in BRCA1 gene and BRCA2 gene account for about 10% of all breast cancers, and this is considered to be rare. If you have a BRCA1 genemutation or BRCA2 gene mutation or both, you may have approximately 40%-70% chance of being diagnosed with breast cancer. Therefore, not every woman who has a BRCA1 or BRCA2 gene mutation will get breast cancer. About 50 out of 100 women with a BRCA1 or BRCA2 gene mutation will get breast cancer by the time they turn 70 years old, compared to only 7 out of 100 women in the general United States population. Looking at each gene separately, those with mutations in BRCA1 gene have 55-65% chance of developing breast cancer by age 70; those with mutations in BRCA2 gene have 45% chance of developing breast cancer by age 70.
- Mutations in BRCA1 gene and BRCA2 gene account for about 75-80% of hereditary l breast cancers.
- Women with BRCA1 gene mutation have an increased risk of developing triple negative breast cancer. This type of breast cancer is estrogen receptor-negative, progesterone receptor-negative and HER2-negative.
- Women with BRCA2 gene mutation are more likely to have estrogen receptor-positive breast cancer.
Genetic Testing for BRCA Gene Mutations:
To determine if genetic testing may be right be you, the best way to get started is to learn more about your family history on both your mother’s and your father’s side. An abnormal gene that increases breast cancer risk, such as BRCA1 or BRCA2 gene mutations, is more likely to run in your family if:
- Three or more women in your family have had breast and/or ovarian cancer, particularly if breast cancer is diagnosed at a younger age than this cancer typically develops (before age 50).
- A close relative has had cancer involving both breasts.
- There is both breast and ovarian cancer in your family.
- Men in your family have had breast cancer.
- There is breast cancer in your family and either male relatives on the same side of the family have had prostate cancer at a young age, or male or female relatives on the same side of the family have had other types of cancer, including but not limited to melanoma, pancreatic, stomach, uterine, thyroid, colon, and/or sarcoma.
- Your family is of Ashkenazi (Eastern European) Jewish descent.
To determine if you have BRCA gene mutations, your doctor or a genetic counselor may order testing for mutations in the genes individually or as part of a larger panel such as BRCA1, BRCA2, ATM, CDH1, CHEK2, PALB2, PTEN and TP53.
BRACAnalysis CDx® as Genetic Test for BRCA Gene Mutations
Myriad’s BRACAnalysis CDx® is a genetic test that is approved by the FDA for detecting mutations in the BRCA1 and BRCA2 genes, which in turn determines if you are eligible for treatment with Poly (ADP-ribose) polymerase (PARP) inhibitors. This test can only be ordered by a qualified healthcare professional such as your doctor. To perform the test, a small amount of blood is drawn from you. Results usually take less than two weeks and are sent to either the ordering healthcare provider or a designated “mail to” provider identified on the request form. The price of BRACAnalysis CDx testing is not made public. However, Myriad has published that the testing is covered by 97% of private insurance companies. Further, the average patient pays a coinsurance of less than $54, and 75% of patients pay $0.
If you are found to have an abnormal BRCA gene, you may proceed by testing the relative most closely related to you. If that next relative does not have it, you could not have passed it on to children. For example:
- If your mother’s sister has an abnormal BRCA gene, the next person to be tested would be your mother. If your mother’s test is negative (no gene abnormality present), then you do not need to be tested, because she could not have passed the mutation on to you. If your mother’s test is positive, you might then decide to be tested. If your mother is no longer living, then you might go ahead with testing on the basis of your aunt’s test result.
- If you test positive for an abnormal BRCA gene, the next people to be tested would be your siblings and/or your adult children. If any of them test positive, then they could have passed the mutation on to their own children. If they test negative, then they could not have passed on the mutation.
PARP proteins normally help repair damaged DNA inside cells. PARP inhibitor drugs work by blocking the PARP proteins from working properly, which means that the cells are unable to repair damaged DNA. This in turn often leads to the death of the cancer cells. PARP inhibitors specifically target cancer cells, so that healthy cells are unaffected and the risk of difficult side-effects is reduced. PARP inhibitors were first developed as a cancer treatment following research done in 2015 by a group of scientists in London. They were the first group to show that cancer cells with BRCA1/BRAC2 gene mutations were very sensitive to treatment with this class of drugs.
PARP Inhibitors and Immunotherapy
Some tumors have defective DNA repair system, which turns on the body’s alarm to send in immune cells because these tumor cells are seen as “foreign”. To counteract this, some tumors avoid attack by the immune system by producing an increased amount of programmed cell death-1 with ligand (PD-L1), which is a molecule that disables the immune system’s ability to launch an attack against cancer. This way, the tumor cell is able to hide from the immune system, making immunotherapy ineffective at killing the cancer cells. An example of an immunotherapy drug is Tecentriq (atezolizumab), which is a PD-L1 inhibitor. In March 2019, it was approved by the FDA to be used in combination with chemotherapy for the treatment of triple-negative, metastatic breast cancer in patients whose tumors express the PD-L1 protein.
Researchers have observed that combined treatment with a PARP inhibitor and a PD-L1 inhibitor is more effective at killing cancer cells than treatment with only immunotherapy. One theory is that the PARP inhibitor makes the tumor cell unable to repair the damaged DNA, and when the tumor cell produces increased amount of PD-L1 to avoid being attacked by immune cells, the PD-L1 inhibitor is able to easily target the cancer cells, which leads to death of the cancer cells.
PARP Inhibitors as Treatment for Breast Cancer with BRCA Gene Mutations
Breast cancers with BRCA gene mutations can be treated with PARP inhibitors. PARP inhibitors work by blocking the PARP proteins, which normally help repair damaged DNA inside cells. Cancer cells with a mutated BRCA gene already have trouble repairing damaged DNA, and these tumor cells tend to have very active PARP. The higher level of PARP activity in tumor cells compared to healthy cells makes it easy for the PARP inhibitor to target the tumor cells. Blocking the PARP proteins often leads to the death of the cancer cells.
- Lynparza (olaparib) is a PARP inhibitor that is used to treat patients who have been previously treated with chemotherapy and have an inherited BRCA gene mutation and have HER2-negative metastatic breast cancer.
- Talzenna (talazoparib) is a PARP inhibitor that is used to treat patients who have an inherited BRCA gene mutation and have HER2-negative locally advanced or metastatic breast cancer.
- Education & Advocacy: Tigerlily Foundation provides education, advocacy, empowerment and support for young women under age 45, before, during and after breast cancer. See more information on our website (https://www.tigerlilyfoundation.org) or call 888-580-6253.
- Financial Assistance: Myriad recognizes that you and your families use genetic test results to make lifesaving medical decisions. Therefore, they promise to provide affordable access to testing, a lifetime commitment to accurate results and comprehensive support for all appropriate patients and their families. If you encounter any financial hardship associated with your bill or insurance, Myriad will work directly with you to resolve the matter: 844-MYRIAD9 (844-697-4239) or email@example.com.
For qualified underinsured patients in the U.S., Myriad offers financial assistance to reduce out-of-pocket costs depending on your household income level. Examples of patients who are considered underinsured include:
- Those with a high deductible or out-of-pocket expenses
- Those with a restrictive medical policy
To be eligible, patients must have private insurance, meet the medical criteria for testing (see the link below), and meet low-income requirements (household incomes up to 400% of the Federal poverty level).
For qualified patients in the U.S. who do not have medical health insurance, Myriad offers financial assistance to reduce out-of-pocket costs depending on your household income level. To be eligible, patients must meet the medical criteria for testing, and meet low-income requirements (household incomes up to 400% of the Federal poverty level). Due to regulatory limitations, patients who are recipients of government-funded programs (e.g., Medicaid, Medicare, Medicare-Advantage, and Tricare) are not eligible to apply for Myriad’s Financial Assistance Program.
- Genetic Counseling: Genetic counselors are specially trained health professionals who help families learn about and cope with genetic conditions. If you are considering testing, a genetic counselor would discuss risks, benefits, and limitations and provide balanced information for you to make an informed decision about whether to proceed with testing. There are many issues to consider including psychological impact, family issues, and privacy. Genetic counseling can be helpful in addressing these issues. Genetic counselors support families and individuals in making decisions about genetic testing and in adjusting to test results. For more information on genetic counseling, visit the National Cancer Institute’s website (https://www.cancer.gov/about-cancer/causes-prevention/genetics/genetic-testing-fact-sheet) or call 1-800-4-CANCER. To find a genetic counselor, you may visit the National Society of Genetic Counselor’s website (https://www.nsgc.org/).
- Support Groups: If you have BRCA1/2 gene mutations or other gene mutation that increase your risk for breast cancer, you may benefit from joining a support group. There are also support groups for people with BRCA1/2 gene mutations who do not have cancer, and support groups for people with BRCA1/2 gene mutations who have cancer.
Definition of Genomics:
Genomics is the study of all of your genes, including how the genes interact with each other and with your environment. With breast cancer, genomics can be used to increase our understanding of this complex disease. For example, the behavior of the breast tumor is affected by activity and interaction of genes in the tumor. Thus, how likely it is that the tumor grows and spreads, how aggressive the tumor is, or how likely it is that the tumor will respond to particular treatment are all dependent on genomics of the tumor.
Genomics versus Genetics:
Genomics and genetics both play a role in health and disease, and both deal with the approximately 20,000 genes in the human body. Genomics is the study of the genome, which is all of your genes. Genetics is the study of specific and limited number of genes or parts of genes that have a known function. Changes in a specific gene may increase your risk for breast cancer, such as BRCA1 gene mutations.
Therefore, while genomics and genetics are both focused on your genes, genomics is a study of all of the genes and genetics is the study of single genes. Another difference is that genetics looks at how characteristics such as eye color are passed on through DNA from one generation to another generation, while genomics is focused on identifying variations on the DNA that affect health, disease or drug response. The genetics field has been around since the 1860s whereas the genomics field is much newer, with the Human Genome Project being launched in 1990.
Definition of Personalized Medicine
Personalized medicine or precision medicine is treatment that is tailored to an individual patient, so that the patient is treated in the most effective manner. In order words, the treatment plan will target your specific breast cancer or the pathways that your tumor cells use to grow and survive. To accomplish this, the medical team considers the genes or other markers on the cancer cells, your genes, your lifestyle factors, and the molecular characteristics of your disease. Testing for personalized medicine may focus on:
- Drug-Gene Interactions: Since your genes may influence the way your body processes medications used to treat breast cancer, your doctor may use your genetic information to determine which medications and dosages are most appropriate for you. The field of drug-gene interactions is called pharmacogenomics.
- Tumor Sequencing: If your cancer continue to progress despite treatment, your doctor may recommend testing the genetic makeup of your cancer cells. This test, called tumor sequencing, is used to identify changes or alterations in the cancer so that your doctor can choose the best treatment for your specific type of tumor.
- Genetic Testing: Mutations in some genes are associated with an increased risk of developing breast cancer compared with the general population. One example is the BRCA genes. Since BRCA gene mutations are inherited, genetic testing for these types of inherited gene mutations is offered to people with a strong family history of the disease.
How is treatment personalized?
To personalize your treatment for breast cancer, several factors are taken into consideration:
- Size of the tumor – T0 means that no tumor can be found, Tis means carcinoma in situ, T1 means that the tumor is 2 cm or smaller, T2 means that the tumor is larger than 2cm but smaller than 5 cm, T3 means that the tumor is larger than 5cm, and T4 means that the tumor can be any size but has spread beyond the breast tissue.
- Type of tumor – the two breast cancer types are non-invasive and invasive. Ductal carcinoma in situ (DCIS) is a non-invasive type of breast cancer, which means that the tumor cells are contained within the milk ducts of the breast. Invasive breast cancer has spread beyond the breast, possibly to the lymph nodes and/or other parts of the body.
- Grade of the tumor – there are 3 grades. Grade 1 refers to well-differentiated cancer cells, which look slightly different from normal cells and grow in slow, well-organized patterns. Grade 2 refers to moderately differentiated cancer cells that do not look like normal cells and grow and divide faster than normal. Grade 3 refers to poorly differentiated cancer cells that look very different from normal cells and grow quickly in disorganized, irregular patterns.
- Hormone receptor status of the tumor – if the tumor is positive for hormone receptors such as estrogen receptor and progesterone receptor (ie., the tumor is estrogen receptor-positive and/or progesterone receptor-positive), hormone therapy might be suitable. On the other hand, if the tumor is negative for estrogen receptor and/or progesterone receptor, hormone therapy might not be suitable.
- HER2 receptor status of the tumor – if the tumor is positive for HER2 receptor (ie., the tumor is HER2-positive), anti-HER2 drugs may be suitable. On the other hand, if the tumor is HER2-negative, anti-HER2 drugs might not be suitable.
- Menopausal status – if you have not entered into menopause, you may be eligible to take tamoxifen, however if you are post-menopausal, you can take either tamoxifen or an aromatase inhibitor.
- Lifestyle factors – we are increasing our knowledge about this.
- Genes – we are also increasing our understanding on how your genes affect breast cancer, and to identify genes that might predict your response to a specific therapy. For example, PARP inhibitors can be more effective for treating metastatic breast cancer if the woman has a BRCA1 or BRCA2 gene mutation compared to women without these mutations.
Importance of personalized medicine for treating Breast Cancer
Breast cancer is a complex disease. It can develop, progress and respond to treatment very differently among patients. Personalized medicine for treating breast cancer provides the most effective treatment as it is tailored to an individual, based on their specific tumor characteristics. This way, the best results are achieved while avoiding unnecessary treatment, risks and side effects.
Factors that Can Increase Your Chances of Getting Breast Cancer
Factors and characteristics that increase your chances of getting breast cancer are called risk factors. The main risk factors of breast cancer are being a woman (breast cancer is rare in men) and getting older (breast cancer is generally found in women who are 50 years old or older), but younger women can and do g. It is important that you understand that having risk factors does not mean that you will get breast cancer. Also, it is important that you know that you may get breast cancer even without any risk factors that they know of. This is why you need to be your best advocate for your health and stay informed about what the risk factors of breast cancer are and how you can lower your risk.
Genetic risk factors associated with Breast Cancer
About 5% -10% of breast cancer cases are associated with abnormalities in genes, which can be passed on from parent to child. Some examples of genes that may become abnormal and lead to breast cancer are:
- BRCA1 and BRCA2 genes: BRCA gene means BReast CAncer gene. The normal BRCA1 and BRCA2 genes help to repair damaged DNA so that cells can continue to grow and function normally. Mutations in BRCA1 and BRCA2 account for about 10% of all breast cancers, and this is considered to be rare. If you have a BRCA1 mutation or BRCA2 mutation or both, you may have approximately 40%-70% chance of being diagnosed with breast cancer. Compared to breast cancers without a BRCA1 mutation or BRCA2 mutation, breast cancers that are associated with a BRCA1 mutation or BRCA2 mutation tend to be more common in younger women and tend to occur in both breasts.
- ATM gene: The ATM gene normally helps cells repair damaged DNA. Though rare, mutations in the ATM gene have been linked to breast cancer.
- TP53 gene: The TP53 gene normally instructs cells how to make a protein called p53 that helps stop the growth of abnormal cells. Though rare, mutations of the TP53 gene lead to an increased risk of breast cancer.
- CHEK2 gene: The CHEK2 gene normally helps cells with DNA repair. A CHEK2 mutation can increase your breast cancer risk.
- PTEN gene: The PTEN gene normally helps cells grow properly. Though rare, mutations in the PTEN gene can increase your risk of developing breast cancer.
- CDH1 gene: The CDH1 gene makes a protein that helps cells bind together. Though rare, a woman with a mutated CDH1 gene has a 39% to 52% lifetime risk of developing breast cancer.
- STK11 gene: The SK11 gene normally helps cells grow properly. Though rare, mutations in the SK11 gene may lead to increased risk of developing breast cancer.
- PALB2 gene: The PALB2 gene normally makes a protein that interacts with the protein made by the BRCA2 gene to ensure that damaged DNA is repaired. Women with a PALB2 mutation may have a 33% to 53% lifetime risk of developing breast cancer.
Personal risk factors associated with Breast Cancer
- Gender: Women are at higher risk of being diagnosed with breast cancer than men. Approximately 12% of women get breast cancer and 0.1% of men get breast cancer.
- Aging: Your risk of developing breast cancer increases as you become older. For women who are diagnosed with breast cancer, 77% are over age 50 and 1% are in their 20s.
- Family history of breast cancer: Breast cancer risk is higher among women who have relatives with this disease. This includes your mother, sister, aunt and others.
- Personal history of breast cancer: If you have had cancer before, you have an increased risk of developing a new cancer in another part of the same breast or in the other breast.
- Race and Ethnicity: Breast cancer is more common in African-American women under 45 years of age. However, above 45 years old, white women are slightly more likely to develop breast cancer than African-American women.
- Dense Breast: With dense breasts, it is difficult to see abnormalities in the breast tissues. Thus, if you have dense breast and develop breast cancer, it may take longer to detect the breast cancer.
- Menstruation before age 12: If you start your period before age 12, your risk of breast cancer may be higher. This may be because you have been exposed to hormones for longer.
- Late or no pregnancy: If you have your first pregnancy after age 30 or if you have never had a full-term pregnancy, you may be at increased risk of developing breast cancer.
- Menopause after age 55: If you do not experience menopause until after age 55, you are exposed to hormones longer. This could increase your risk for breast cancer.
- Oral Contraceptives: Some forms of oral contraceptives (birth control pills) raise breast cancer risk.
- Combination Hormone Therapy: When estrogen and progestin are taken together for more than five years to replace missing estrogen and progesterone in menopause, your risk of breast cancer increases.
- Radiation Therapy: If you have had radiation therapy to the chest or breasts before age 30, you have a higher risk of developing breast cancer.
- Diethylstilbestrol (DES): Women who took DES while pregnant to prevent miscarriage have an increased risk for developing cancer.
- Lifestyle-related factors: Breast cancer risk can be higher if you are overweight or obese, if you are physically inactive, if you drink alcohol, and/or if you smoke.
High-risk individuals for Breast Cancer
Some women have a higher chance of being diagnosed with breast cancer. The factors that increase your chances of having breast cancer include having a personal history of breast cancer. If you have had cancer before, you have an increased risk of developing a new cancer in another part of the same breast or in the other breast. In addition, if you have relatives (e, g., your mother, sister, daughter) who have been diagnosed with breast cancer, you have an increased risk of developing breast cancer. A history of breast cancer in your family may be linked to having an abnormal gene that is passed on over time. For example, mutations in genes such as BRAC1, BRAC2 and PTEN are linked to breast cancer, and these mutations can be passed on from parent to child.
Breast Cancer Screening
For women with a personal history of breast cancer, or a family history of breast cancer and/or a family history of abnormal breast-cancer related genes, you should speak with your health care provider to discuss breast cancer screening guidelines. The doctor will discuss which screening option may be right for you, whether you need to be screened earlier or more frequently than other women. Some screening options include:
- Genetic Testing: There are genetic tests available to determine if you have mutations in genes that are associated with increased risk of developing breast cancer. Your doctor or a genetic counselor may order testing for mutations in the following genes individually or as part of a larger panel such as BRCA1, BRCA2, ATM, CDH1, CHEK2, PALB2, PTEN, TP53. Typically, to perform the genetic test, a sample of your blood or saliva is sent to a testing facility. The results are generally ready within two to four weeks. After you receive your results, it is important that speak with the your genetic counselor or healthcare professional to interpret the results and discuss health management options. The cost of testing ranges from $300 to $5000 depending on the complexity of the test. Some insurance covers the cost of genetic testing.
- Screening Frequency: A screening plan for a woman at high risk of developing breast cancer may include:
- breast ultrasound
- monthly breast self-exam
- yearly breast exam by your doctor
- yearly mammogram starting at age 30 or younger
- yearly MRI scan every year starting at age 30 or younger
Women with an abnormal breast cancer gene have a much higher risk of developing breast cancer in between yearly screenings. For example, women with an abnormal BRCA1 or BRCA2 gene are recommended to have a mammogram and an MRI scan each year, about 6 months apart (for example, a mammogram in January and an MRI in July).
Profiling of Breast Tumor
Like every cell in your body, the cells in a breast tumor have genes that reveal the molecular characteristics of the tumor. This information helps to determine your prognosis and guides treatment decisions. A complete profiling of your breast cancer may include tumor size tumor type, tumor grade, the hormone status of your tumor, the HER2 receptor status of the tumor, and gene mutations.
Determining Hormone Status:
Estrogen and progesterone are a type of protein called hormones that give “fuel” to breast tumor growth. Breast cancers that have high levels of estrogen are called estrogen receptor-positive (ER-positive or ER+). Similarly, breast cancers that have high levels of progesterone are called progesterone receptor-positive (PR-positive or PR+). If the breast cancer has both hormone receptors, it is called ER/PR-positive or ER+/PR+). Your medical team can determine your hormone status as follows:
- Immunohistochemistry (IHC) test detects the presence of estrogen and progesterone receptors in the cancer cells. This test is done on a biopsy of your tumor.
Determining HER2 Status:
Human epidermal growth factor receptor 2 (HER2) is a type of protein that is on breast cells. Normally, HER2 receptors help control how breast cell grows, divides, and repairs itself. But in about 25% of breast cancers, the HER2 gene doesn’t work correctly and makes too many copies of itself (known as HER2 gene amplification). This in turn leads to overproduction of the HER2 receptors, which makes breast cells grow and divide in an uncontrolled way. Breast cancers that have high levels of HER2 receptors are HER2-positive. Your medical team can determine your hormone status as follows:
- Immunohistochemistry (IHC) test detects the number of HER2 protein receptors in the cancer cells. The results of the IHC test can be: 0 (negative), 1+ (also negative), 2+ (borderline), or 3+ (positive, HER2 protein overexpression).
- Fluorescence in situ hybridization (FISH) test detects the number of HER2 genes in the cancer cells. The results of the FISH test can be positive (HER2 gene amplification) or negative (no HER2 gene amplification).
- SPoT-Light HER2 CISH test (Subtraction Probe Technology Chromogenic In Situ Hybridization) finds out if there are too many copies of the HER2 gene in the cancer cells. The results of the SPoT-Light test can be positive (HER2 gene amplification) or negative (no HER2 gene amplification).
- Inform HER2 Dual ISH (Inform Dual In Situ Hybridization) test finds out if there are too many copies of the HER2 gene in the cancer cells. The results of the Inform HER2 Dual ISH test can be positive (HER2 gene amplification) or negative (no HER2 gene amplification).
Determining Genetic Makeup: The genes in breast tumor cells reveal the molecular characteristics of the tumor. This information helps to determine your prognosis and guides treatment decisions. Your medical team can determine the genetic makeup of your tumor using these four tests as follows:
- BRACAnalysis CDx test identifies mutations in the BRCA1 gene or BRCA2 gene.
- Breast Cancer Index test examines a group of 11 genes in the tumor cells. It is used to determine treatment decisions for breast cancers that are ER-positive, HER2-negative, and lymph node-negative.
- Oncotype DX® test is used to determine the benefit of using chemotherapy in addition to hormone therapy to treat estrogen receptor positive (ER-positive) breast cancers. Oncotype DX is the most commonly used tumor profiling test in the U.S. and it is the only tests that is used in breast cancer staging. Along with other factors, the results of the Oncotype DX test help predict the chance of metastasis for early breast cancers that are ER-positive, HER2 negative, and lymph node negative. Oncotype DX may also be used for some postmenopausal women with invasive breast cancers that are ER-positive, HER2-negative and lymph node-negative when chemotherapy is being considered. If Oncotype DX testing is right for you, your oncologist will review your test results with you and discuss how the Oncotype DX score may guide your treatment plan. Additional details about Oncotype DX are below:
- Tumor testing: Oncotype DX tests a sample of the tumor (removed during a biopsy or surgery) for the activity of a group of 21 genes.
- Tumor staging: Oncotype DX is part of breast cancer staging for some estrogen receptor-positive, lymph node-negative tumors.
- Oncotype DX scores: If your Oncotype DX score is high, this means that you have a fairly high risk of metastasis. Your doctor may recommend a more aggressive treatment plan that includes both hormone therapy and chemotherapy. If your Oncotype DX score is low, this means that you have a low risk of metastasis. Your doctor may recommend the use of hormone therapy alone.
- Study results: The National Cancer Institute is using OncotypeDX in a clinical trial called TAILORx to study recently diagnosed patients with hormone receptor-positive, HER2-negative breast cancer that has not spread to the lymph nodes. Recent findings from the TAILORx study show, for some women over 50 with an Oncotype DX score showing an intermediate risk of metastasis, treatment with hormone therapy alone may be as effective as treatment with hormone therapy and chemotherapy. For some women 50 and younger with an Oncotype DX score showing an intermediate risk of metastasis, TAILORx showed there may be a benefit of including both hormone therapy and chemotherapy in the treatment plan. The Oncotype DX test can also be used for invasive breast cancer has been modified to help predict the chance that ductal carcinoma in situ (DCIS) will return as DCIS or invasive breast cancer by testing a sample of the DCIS tumor for the activity of the group of genes in the test. This test may help identify which cases of DCIS would benefit most from radiation therapy after lumpectomy (and which women might be treated with lumpectomy alone). This test needs further study and is not yet part of standard practice.
- MammaPrint test is used to determine the benefit of using chemotherapy in addition to hormone therapy to treat estrogen receptor positive (ER-positive) breast cancers. It is typically used in breast cancers that have all four of these characteristics: stage I or II, ER-positive, HER2-negative and lymph node-negative or lymph node-positive with 1-3 positive nodes.
o Tumor testing: MammaPrint tests a sample of the tumor (removed during a biopsy or surgery) for the activity of a group of 70 genes.
o MammaPrint scores: If the score indicates a fairly high risk of metastasis, your doctor will likely recommend a more aggressive treatment plan that includes both hormone therapy and chemotherapy. If the score indicates a low risk of metastasis, your doctor may recommend treatment with only hormone treatment.
- PAM50 (Prosigna®) test, Prediction Analysis of Microarray 50, is used to determine the benefit of using chemotherapy in addition to hormone therapy for some estrogen receptor-positive and HER2-negative breast cancers. Along with other factors, the results of the PAM50 (Prosigna) test help predict the chance of metastasis (when cancer spreads to other organs) and determine the molecular subtype of breast cancer. PAM50 helps predict the chance of metastasis for postmenopausal women with breast cancers that are all of the following: Stage I or II, ER-positive, HER2-negative and lymph node-negative.
- Tumor profiling: PAM50 tests a sample of the tumor (removed during a biopsy or surgery) for activity of a group of 50 genes.
- PAM50 scores: If the PAM50 test shows the breast cancer has a fairly high risk of metastasis (the PAM50 score is high), a more aggressive treatment, your doctor may recommend both hormone therapy and chemotherapy. If the test shows a low risk of metastasis (the PAM50 score is low), the use of hormone therapy alone may be considered. In this way, PAM50 may help some people avoid chemotherapy and its side effects.
- Recent findings: Some findings show PAM50 may help identify which ER-positive breast cancers may benefit from hormone therapy beyond 5 years. However, PAM50 is not recommended for use in guiding extended hormone therapy use at this time.
Targeted drug therapies for Breast Cancer
Targeted therapy drugs for breast cancer are designed to attack certain cancer cells or certain cellular pathways that cancer cells use to grow and survive. There are several targeted therapies for breast cancer, based on whether they are hormone receptor-positive or HER2-positive. Targeted therapies are also developed for treatment of breast cancer at early stage and at metastatic stage.
About HER2-positive breast cancers. A number of treatments have been developed to target HER2-positive breast cancers. These include:
- Trastuzumab (Herceptin): It may be used alone, but it may also be given along with chemo. Trastuzumab can be used to treat both early- and late-stage breast cancer. For early breast cancer, this drug is usually given for a total of 6 months to a year. For advanced breast cancer, treatment is often given for as long as the drug is helpful.
- Pertuzumab (Perjeta): This drug can be given with trastuzumab and chemo, either before surgery to treat early-stage breast cancer, or to treat advanced breast cancer.
- Ado-trastuzumab emtansine (Kadcyla, also known as TDM-1): This drug is used by itself to treat advanced breast cancer in women who have already been treated with trastuzumab and chemo.
- Lapatinib (Tykerb): Lapatinib is used to treat advanced breast cancer, and might be used along with certain chemotherapy drugs, trastuzumab, or hormone therapy drugs.
- Neratinib (Nerlynx): Neratinib is used to treat early-stage breast cancer after a woman has completed one year of trastuzumab and is usually given for one year. Some clinical trials show that it may also be effective in advanced breast cancer, as well.
About Hormone receptor-positive breast cancers. Treatments that target hormone receptor-positive breast cancers include Everolimus (Afinitor) and CDK4/6 inhibitors.
- Everolimus (Afinitor) has been approved for women who have advanced hormone receptor-positive, HER2-negative breast cancer and have gone through menopause. Everolimus is used along with the aromatase inhibitor exemestane (Aromasin) for women whose cancers have grown while being treated with either letrozole or anastrozole (or if the cancer started growing shortly after treatment with these drugs was stopped).
- CDK4/6 inhibitors are drugs that block proteins in the cell called cyclin-dependent kinases (CDKs), particularly CDK4 and CDK6. Blocking these proteins in hormone receptor-positive breast cancer cells helps stop the cells from dividing. This can slow cancer growth. These drugs are approved for women with advanced hormone receptor-positive, HER2-negative breast cancer. Some examples include: CDK4/6 inhibitors that Palbociclib (Ibrance),ribociclib (Kisqali), and abemaciclib (Verzenio). Additional details about these drugs are as follows:
- Palbociclib or abemaciclib can be given with fulvestrant to women who are premenopausal (still having regular periods) or are almost in menopause (perimenopausal). These women, however, must also be on medications, such as luteinizing hormone-releasing (LHRH) analogs that stop the ovaries from making estrogen.
- Ribociclib can be given with an aromatase inhibitor (such as letrozole) to women who have not gone through menopause. As with palbociclib or abemaciclib, these women must also be using medicines that suppress the ovaries.
- Abemaciclib can be used by itself in women who have previously been treated with hormone therapy and chemotherapy.
About Breast cancers with BRCA gene mutations. Treatments that target breast cancers with BRCA gene mutations are PARP inhibitors. PARP proteins normally help repair damaged DNA inside cells. The BRCA genes (BRCA1 and BRCA2) also help repair DNA (in a slightly different way), but mutations in one of those genes can stop this from happening. PARP inhibitors work by blocking the PARP proteins. Because tumor cells with a mutated BRCA gene already have trouble repairing damaged DNA, blocking the PARP proteins often leads to the death of these cells.
- Olaparib (Lynparza) and talazoparib (Talzenna) can be used to treat metastatic, HER2-negative breast cancer in women with a BRCAmutation who have already gotten chemotherapy. Olaparib can also be used in women who have already received hormone therapy if the cancer is hormone receptor-positive.
The Oncotype Dx Test
The Oncotype DX Test is a genomic test that evaluates specific genes in your breast tumor to provide information that your doctor can use to develop a personalized treatment plan for you. If you have early-stage invasive breast cancer, Oncotype DX test predicts the likelihood that you may benefit from chemotherapy, and the likelihood of your cancer returning. If you have ductal carcinoma in situ (DCIS), the Oncotype DX test predicts the likelihood of your cancer returning in the same breast. The Oncotype DX test is a product of Genomic Health.
Is Oncotype DX for you?
You may be a candidate for the Oncotype DX test if:
- you have recently been diagnosed with stage I breast cancer or stage II invasive breast cancer
- the cancer is estrogen-receptor-positive
- there is no cancer in your lymph nodes (lymph-node-negative breast cancer)
- you and your doctor are making decisions about chemotherapy
Questions to Ask Your Doctor About Oncotype DX
The Oncotype DX test must be ordered by your doctor or a licensed healthcare provider. You and your doctor will decide if the Oncotype DX test is right for you. Some questions that you may want to ask your doctor include:
- What stage is my breast cancer?
- What are the chances of my cancer coming back after surgery?
- Is my breast cancer hormone receptor-positive (ER+ or PR+)?
- What are my treatment options? What do you suggest for me and why?
- What are the benefits of each treatment option? What are the drawbacks/side effects of each one?
- How long do side effects of each treatment option last? Do side effects go away once treatment is complete?
- Is it OK to wait a few weeks to consider my treatment plan options before I have to make a decision about treatment?
- Am I a candidate for the Oncotype DX test?
- If I am a candidate for the Oncotype DX test, how could we use the test results to develop my treatment plan?
- How can I get a copy of my pathology report and my Oncotype DX test results (if I’m eligible for the test)?
Take the Oncotype DX Eligibility Quiz
- Are you a newly diagnosed breast cancer patient or caregiver trying to determine what treatment plan is right for you or a loved one?
- What stage is your breast cancer?
- Stage 0 DCIS (non-invasive breast cancer).
- Stage I.
- Stage II.
- Stage IIIa.
- Stage IIIb or above.
- I am not sure.
- Has your breast cancer been diagnosed as estrogen receptor positive (ER+)?
- I am not sure.
- Does your breast cancer have lymph node involvement?
- One to three lymph nodes are positive.
- More than 3 lymph nodes are positive.
- I am not sure.
Genomic Health has several free guides for Oncotype DX. For DCIS Breast Cancer, see Doctor Discussion Guide for DCIS Breast Cancer, DCIS Breast Cancer Patient Guide, and Patient Guide to DCIS Surgery. For Invasive Breast Cancer, see Doctor Discussion Guide for Invasive Breast Cancer, Invasive Breast Cancer Patient Guide, Patient Guide to Early-Stage Invasive Breast Cancer Surgery and Treatment and Invasive Breast Cancer Patient Guide (Spanish). For general knowledge, see Recently Diagnosed – Inform Yourself.
Mobile Breast Cancer Apps are convenient tools for guiding breast cancer patients, survivors and caregivers. Some examples are:
- My Cancer Coach: Includes calendar, note-taking, audio-recording. It has a list of questions to ask your doctor. My Cancer Coach is available for iPhone and Android.
- NCCN Reimbursement Resource: Provides access to payment assistance and reimbursement programs for covering cancer-related charges. NCCN Reimbursement is available for iPhone and Android.
- Caring Bridge: Connects you with the support of family and friends. Caring Coach is available for iPhone and Android.
- Pills on the Go: Provides reminder to take your medications. Pills on the Go is available for Android.
- CareZone: Helps to manage daily appointments, medications, school practices and contacts. CareZone is available for iPhone and Android.
- Breast Check Reminder: Provides reminder to perform monthly breast self-exam. Breast Check is available for iPhone and Android.
- Breast Self-Exam: Helps you track changes that you detect when you are conducting your monthly breast self-exam. Breast Check is available for Android.
- Breast Cancer Ribbons: Provides a variety of positive wallpapers and messages to help you stay strong and inspired during your breast cancer journey. Breast Cancer Ribbon is available for iPhone.
Genomic Health has a library of videos and websites that provide additional information about breast cancer and treatments. This library also provides guidance for personalizing your breast cancer treatment with Oncotype DX. There are videos about DCIS Breast Cancer, Invasive Breast Cancer and Oncotype DX score, results. There are links to Advocacy, Education and Support, Clinical Trials, Answers from Breast Cancer Experts, Advanced Breast Cancer Information and Breast Cancer Blogs.
Biomarker: A biomarker or molecular marker is a biological molecule found in blood, other body fluids or tissues.
Biopsy: Biopsy is the examination of tissue removed from a living body. For example, a biopsy of breast cancer is taken to examine the characteristics of the tumor.
Clinical trial: A clinical trial is a type of medical research study that determines whether an intervention – a new drug, medical device or diagnostic tool – is safe and/or effective.
Companion Diagnostic: A companion diagnostic is a test or measurement that can be used to determine the efficacy and/or safety of a specific drug for a targeted patient group or patient sub-groups.
DNA: Deoxyribonucleic acid or DNA is a cellular component that contains the instructions for most forms of life.
Epigenomics: Epigenomics takes into account how factors, such as the environment, can result in changes in gene expression.
Gene Mutation: This is permanent change in the DNA sequence that makes up a gene. Gene mutations may be inherited from a parent or acquired during a person’s lifetime.
Gene testing: Genetic testing is performed with a laboratory test to identify genetic changes associated with a disease.
Genetic Counseling: A healthcare professional with specialized knowledge of genetics meets with an individual or family to determine if a condition in the family is genetic and estimate the chances that another relative may be affected. Genetic counseling may also involve performing and interpreting genetic tests that estimate disease risk, as well as conveying information so as to help address concerns of the individual or family and provide psychological counseling to help them adapt to the condition or risk.
Genetic Marker: A genetic marker is an alternation in DNA that may indicate an increased risk of developing breast cancer.
Genome: The genome is the complete genetic material of an organism.
Genomic Sequencing: Genomic Sequencing is a method to determine the entire genetic makeup of a single cell or of an entire organism. This method can help determine changes in DNA that may lead to the development of breast cancer.
Genomics: Genomics is the study of the genome – structure, function, evolution and mapping.
GINA: The Genetic Information Nondiscrimination Act or GINA is a federal legislation that prohibits discrimination against individuals on the basis of their genetic profiles in regard to health insurance and employment. The law was passed in 2008.
Personalized medicine: This refers to treatment that is tailored to an individual patient, so that the patient is treated in the most effective manner. Diagnostic tools are used to identify specific biological markers to help determine which medical treatments and procedures will be best for the patient.
Pharmacogenomics: Pharmacogenomics is the field that examines how your genes influence the way your body processes medications used to treat breast cancer.
Proteomics: Proteomics is the analysis of protein structure and function.
Risk factors: A risk factor is a characteristic or exposure of an individual that increases their likelihood of developing breast cancer.
Targeted therapy: Targeted therapy is drugs for breast cancer that are designed to attack certain cancer cells or certain cellular pathways that cancer cells use to grow and survive.
Tumor sequencing: Doctors can sequence the DNA from your cancer cells to identify which mutations are responsible for causing breast cancer.
Your Healthcare Provider and You
Having the right healthcare provider and a strong relationship with that individual is one of the most important relationships you’ll make during your lifetime. Selecting a healthcare provider in your teens when you begin your annual visits and building a connection of open communication and trust, can be the foundation for how you build your healthcare team – whether you’re healthy or have been diagnosed with breast cancer. The right doctor will listen to you, teach you how to be your best advocate, and advocate for you, if and when needed. The right provider also will have a network of other specialists he/she trusts, if you need specialized care.
- Selecting: When choosing a doctor, such as a general practitioner, OB/GYN, surgeon, radiation oncologist or a medical oncologist, you may combine information from the sources mentioned below to help you make an informed decision. A good starting point is directories from hospitals and health insurance plans. These directories often list doctors by medical specialty and gender, and may include personal biographies details such as education, training, certification and personal interests. To find the best doctor for you, you may also consider referrals from a trusted source such as your primary care provider, family members, friends or other breast cancer survivors. A good provider is board certified, which means that the doctor has the training and knowledge to practice a medical specialty and have passed a certification exam. The American Board of Medical Specialties (ABMS) oversees the certification of specialists and has an online directory. In addition to being board certified, a doctor’s malpractice records a good indication of the quality of care that they provide. In general, little or no malpractice payouts are a good indication that they offer the best quality care possible. However, doctors may be sued for malpractice when, in fact, they did nothing wrong. State medical boards often have malpractice records available to the public.
Your doctor should be someone you feel comfortable with on a personal level and someone who you can talk to openly. A doctor should be open to you getting more than one or two opinions before selecting the one that is best for you. This is a good way to learn about their abilities and to see whether or not you have a personal connection with the healthcare provider. Here are some questions that may help you interview a doctor:
- How long have you been practicing?
- Are you open to questions or other opinions?
- Are you comfortable with me sharing my opinion and having a conversation about what we both think is right for me?
- Do you only see people diagnosed with breast cancer?
- How many people with breast cancer do you see (or operate on) in a year?
- What breast cancer treatment guidelines do you follow?
- What is your area(s) of special interest or research?
- Which hospitals are you affiliated with?
- Are you board-certified in the area of specialization?
- Have you completed any fellowships completed in cancer care (surgery, radiation therapy, medical oncology)?
- Building and Sustaining the Relationship: Finding a doctor with whom you feel comfortable and can talk openly is one of the best ways to feel good about your breast cancer treatment decisions. During your initial visits with your doctor, it may be a good idea to bring a friend or loved one with you who can help ask questions and discuss the answers later as you may feel overwhelmed by all of the new information.
After additional visits with your doctor, you should continue to feel even more comfortable talking with your doctor. Whether you continue to go alone or with someone, it is always a good idea to prepare a list of questions ahead of time for your doctor. This can help you remember everything you want to ask and keep the discussion focused on the issues that are most important to you. In keeping abreast of new and available treatment, be sure to ask your doctor whether they take part in clinical trials. A doctor who participates in clinical trials is likely to know about new therapies and may be more open to future medical treatments, which could make a big difference in managing your breast cancer.
In general, the best relationship you can have with your doctor is one where you are open and do not feel shy about speaking frankly. Be sure to update your doctor about how you are feeling and about your full family history of breast and other cancers. This information helps your doctor understand your risk of breast cancer and your risk of breast cancer returning.
- Talking with your Provider: An open line of communication between you and your doctor can make a big difference in both quality of life and a sense of empowerment over the care received. Being your own advocate will help you better understand your treatment. It will also help you be actively involved in your care. Keeping the lines of communication open reduces the chances for misunderstandings between you and your doctor. Here are a few tips:
- Ask questions. Ask questions about anything that you do not understand, and do not be afraid to ask the question again if you don’t understand the answer.
- Take notes. Make notes about what you discuss so that you can refer to them as needed.
- Ask for what you need. It is almost always better to ask a question as soon as you think about it rather than put it off for a later date.
- Speak up if you feel there may be a misunderstanding.Most misunderstandings are much easier to resolve right away. If you find it difficult to speak up, ask a friend to speak for you. Do not let miscommunication linger and become an even greater issue.
- Be patient.During your appointments, bring something to read or keep you busy while you are in the waiting room. This will make the time flow more easily and reduce your irritation. Having a physician who is there for you when you need it and who takes the time to answer all of your questions means that they are likely to get backed up at times.
To clarify details about coordinating your care generally or in an emergency, here are some questions to ask your doctor:
- Who should I call if I have any symptoms on weekends or after hours?
- If I need emergency care, where should an ambulance take me?
- What symptoms might suggest an emergency?
- What types of emergencies may occur with cancer like mine?
- Who should I call if I have any side effects?
- Who is ultimately in charge of my care?
- When should I call the clinical trial investigator and when should I call another member of my healthcare team?
Basically, you should feel as if your physician is competent, professional and that he/she really cares about you. Start building this relationship as a healthy young woman; and know that it will benefit you throughout your life journey.
Having Breast Cancer and Managing Mental Health: It is important to be cognizant of mental health after diagnosis and during treatment. While it is important to try to stay positive, sometimes the “over-pinking” of breast cancer or the fact that everyone is cheering you on towards health and may be solely focused on keeping you positive can tend to negate feelings that some wome have – feelings of sadness. It is important to recognize that each woman’s journey is different and that being diagnosed with breast cancer can affect your mental health and that of your loved ones. From anxiety and worry about the future, to the stress of treatment, and fear of recurrence, many breast cancer patients and survivors develop anxiety or depression; and symptoms of post-traumatic stress disorder (PTSD). These symptoms can be short- or long-term. Some women can begin to see the impact on their mental health at the onset of their breast cancer diagnosis. Other women may have pre-existing mental health conditions, which can make it harder for them to cope after a breast cancer diagnosis. Some women who undergo surgery for their breast cancer can experience depression and sadness as a result of substantial change in appearance through mastectomy. Mastectomies can decrease women’s body confidence, impact their relationships to their sexuality, and have a negative effect on overall mental health. In addition, weight loss or weight gain as a result of breast cancer treatment can also alter how a woman feels about herself, which could impact mental health as well. Also, women who are metastatic can have more acute anxiety and/or depression.
Managing mental health can make it challenging to do things that benefit your health, such as eating healthy foods, exercising, connecting with friends and family, and complying with medical treatment. However, the good news is that breast cancer and its emotional impact such as feelings of depression can lift over time, and the level of anxiety is likely to decrease. However, it is important to note that if you feel anxious or depressed, ask your healthcare team for a referral to a mental health provider. Taking care of your mental health should be a priority.
Staying as active as you can and focusing on healthy, eating including lots of fruits and vegetables can help you feel better and more relaxed. Also, reaching out to supportive intimate partners and family members, friends, or a faith-based group can increase breast cancer survivors’ overall mental well-being. Talk to a therapist, who can listen objectively and help you cope. In addition, you may consider a combination of group therapy, which allows women to share emotional support, and individual therapy, which helps women learn problem-solving skills and alter patterns of thinking. You should always communicate your moods and emotions with your doctor and healthcare team as they can connect you with the appropriate help. If all else fails, your doctor may recommend taking anti-depressant medications. There are a variety of effective medications available that you might be prescribed to address any underlying chemical components of your anxiety or depression.
Below is a list of additional resources that provide information about diagnosis/treatment, complementary and alternative medicine, clinical trials, financial assistance, transportation and other resources.
- BREASTCANCER.ORG (610-642-6550)
- Living Beyond Breast Cancer (855-807-6386)
- Triple Negative Breast Cancer Foundation (877-880-8622)
- Talk to Someone: Triple Negative Breast Cancer
- National Breast Cancer Foundation, Inc.
- Susan G. Komen (877-465-6636)
- Tigerlily Foundation’s Funds for Families Covid-19 Relief Program
- Cancer Care (800-813-4673)
- Cancer Financial Assistance Coalition (CFAC)
- Cancer.Net (571-483-1780 and 888-651-3038)
- Patient Advocate
PALS (Patient Airlift Services) arranges FREE air transportation for those in need of medical diagnosis, treatment and follow up. Utilizing Volunteer Pilots and their personal aircrafts there is no cap to the amount of flights someone takes from Maine down to North Carolina and out to Ohio. PALS also partners with some commercial airlines to assist those that need it within the contingent United States.
To qualify, PALS asks that individuals have a financial need and be able to get in and out of a small 4-6 passenger air craft.
To make a request, call our Toll Free number 1-888-818-1231.
For more information: www.PALSflight.org
Partner Resources and Events
WHAT IS BREAST CANCER?
Understanding what is breast cancer is the first step to understanding your diagnosis and your way forward. Essentially, breast cancer occurs when breast cells grow uncontrollably. There are specific genes that keep cells healthy and also regulate the growth of cells. If these genes are changed abnormally, or mutated, cancer can result. Certain mutations can alter the growth processes in the cells, stopping the ability of a cell to grow and divide at a regular rate, allowing the cells to multiply rapidly, creating a tumor.
There are two different types of tumors; a benign tumor is not cancerous, while a malignant tumor is cancerous. Malignant tumors are cancerous and can spread throughout the body. Unlike malignant tumors, benign tumors are not cancerous, do not grow rapidly or spread to other parts of the body, and the cells appear almost normal.
Specifically, breast cancer is defined as a malignant tumor that began growing in cells in your breast. Cancer usually originates in either the lobules, where milk is produced, or in the ducts, where the milk flows from the lobules to the nipple. Cancer can also start in the fatty and fibrous connective tissues, also known as the stromal tissues.
Cancer can spread to other parts of the breast, and can sometimes spread to the lymph nodes. Once the cancer is in the lymph nodes, it may or may not have spread to other parts of the body. Breast cancer stages describe the size and growth of a malignant tumor.
Also, breast cancer that is caused by a genetic mutation only accounts for 5-10% of all cancers. About 85-90% of cancers are caused by both aging and life in general. Eating well, exercising and not smoking are proactive ways for you to keep healthy and minimize your risk in being diagnosed with cancer.
A common statistic that you may have heard is that 1 in 8 women will be diagnosed with breast cancer. This can be a frightening statistic. However, understanding the background of this statistic makes it a little less scary. Essentially, 1 in 8 means 12 out of 100 women will be diagnosed with cancer, or 12% of women. Yet this statistic fails to include that this diagnosis is over a woman’s lifetime, which, on average, is 80 years in the U.S. So, to accurately restate this statistic, it is that 1 in 8 women who reach the age of 80 are likely to be diagnosed with cancer. So for each decade that you live, your risk is lower than 12% for most women.
Another way to look at this seemingly scary statistic is the optimistic way—you have a 7 in 8 chance of not getting cancer, or an 87.5% chance of being cancer-free throughout your life. Clearly, some women have higher risk factors than others, like a family member having cancer, or other risk factors.
A person’s chance of developing a certain disease over a certain time period. The absolute risk of a disease is estimated by looking at a large group of people similar in some way (in terms of age, for example) and counting the number of people in this group who develop the disease over the specified time period. For example, if we followed 100,000 women between the ages of 30 and 34 for one year, about 25 would develop breast cancer. This means the one-year absolute risk of breast cancer for a 30- to 34-year-old woman is 25 per 100,000 women (1 per 4,000 women).
Use of very thin needles inserted at precise points on the body that may help control pain and other side effects of treatment or breast cancer itself. It is a type of integrative or complementary therapy.
Adjuvant (Systemic) Therapy
Treatment given in addition to surgery and radiation to treat breast cancer that may have spread to other parts of the body. It may include chemotherapy, targeted therapy and/or hormone therapy.
Advocacy (see Breast Cancer Advocacy)
Any therapy used instead of standard medical treatments such as surgery, chemotherapy and hormone therapy. Alternative therapies are different from integrative and complementary therapies, which are used in addition to standard treatments. Alternative therapies have not been shown to be effective in treating breast cancer, so it is not safe to use them.
The absence or stopping of menstrual periods.
Loss of feeling or sensation that keeps a person from feeling pain during surgery or other medical procedures. Local or regional anesthesia may be used for a specific part of the body, such as the breast, by injection of a drug into that area. General anesthesia numbs the entire body and puts a person to sleep with drugs that are injected into a vein or inhaled.
Aneuploid (DNA Ploidy)
The presence of an abnormal number of chromosomes in cancer cells.
The growth of new blood vessels that cells need to grow.
A protein made by white blood cells that is part of the body’s immune system. Each antibody binds to a certain antigen (foreign substance, such as bacteria) and helps the body fight the antigen.
A drug containing an antibody that is specially made to target certain cancer cells. See Antibody.
An agent that counteracts carcinogens (cancer causing agents).
A medicine that prevents or relieves nausea and vomiting.
A substance that causes the body to make an immune response. This immune response often involves making antibodies.
A substance that protects the body from damage by oxidizing agents. Oxidizing agents are always present in the body and are often beneficial. However, when large amounts of oxidants are present in cells, they can cause damage, especially to DNA. This can lead to abnormal cell growth. Antioxidants include beta-carotene and vitamins A, C and E.
A normal cell process in which a genetically programmed series of events leads to the death of a cell. Cancer cells may block apoptosis.
The darkly shaded circle of skin surrounding the nipple.
Hormone therapy drugs that lower estrogen levels in the body by blocking aromatase, an enzyme that converts other hormones into estrogen. Aromatase inhibitors are used to treat postmenopausal women with hormone-receptor positive breast cancer.
To remove fluid and a small number of cells.
Atrophic Vaginitis (see Vaginal Atrophy)
A benign (not cancer) breast condition where breast cells are growing rapidly (proliferating). The proliferating cells look abnormal under a microscope. Although atypical hyperplasia is not breast cancer, it increases the risk of breast cancer.
A blood donation or tissue graft from a person’s own body rather than from a donor. For example, autologous breast reconstruction techniques use skin and tissue flaps (grafts) from a person’s own body.
The underarm area.
Axillary Dissection (Axillary Sampling)
Surgical procedure to remove some or all of the lymph nodes from the underarm area so that the nodes can be examined under a microscope to check whether or not cancer cells are present.
Axillary Lymph Nodes
The lymph nodes in the underarm area.
An integrative or complementary medical system from India that involves diet, exercise, meditation and massage. Ayurveda means “life-knowledge.”
Not cancerous. Does not invade nearby tissue or spread to other parts of the body.
Benign Breast Conditions (Benign Breast Disease)
Noncancerous conditions of the breast that can result in lumps or other abnormalities. Examples include cysts and fibroadenomas.
Benign Phyllodes Tumor
A rare benign (not cancer) breast condition similar to a fibroadenoma. A lump may be felt, but is usually painless.
Bilateral Prophylactic Mastectomy
Surgery where both breasts are removed to prevent breast cancer from developing.
Biobank (Tissue Repository)
A large collection of tissue samples and medical data that is used for research studies.
Bioimpedance (Bioelectrical Impedance Analysis)
A method of measuring the amount of fluid in body tissues.
A therapy that targets something specific to the biology of the cancer cell, as opposed to chemotherapy, which attacks all rapidly dividing cells. Often used to describe therapies that use the immune system to fight cancer (immunotherapy). Trastuzumab (Herceptin) is an example of a biological or targeted therapy agent.
A substance found in blood, other body fluids or tissues that can be measured and is a sign of disease or another process in the body (normal or abnormal). It also may be used to see how well the body responds to a treatment for a disease.
Removal of tissue to be tested for cancer cells.
Drugs used to strengthen bones and decrease the rate of bone fractures and pain due to breast cancer metastases to the bone.
Body Mass Index (BMI)
A measure used to estimate body fat. BMI takes into account a person’s height and weight. Calculate your BMI.
A test done to check for signs of cancer in the bones. A small amount of radioactive material is injected into the bloodstream. It collects in the bones, especially abnormal areas, and is detected by a scanner. Bone scans can show cancer as well as benign bone diseases (like arthritis).
Additional dose of radiation to the part of the breast that had the tumor.
BRCA1/BRCA2 Genes (BReast CAncer genes)
Genes that help limit cell growth. A mutation (change) in one of these genes increases a person’s risk of breast, ovarian and certain other cancers.
A procedure that uses targeted radiation therapy from inside the tumor bed.
An uncontrolled growth of abnormal breast cells.
Breast Cancer Advocacy
Influencing targeted audiences to promote the support of breast cancer issues.
Breast Cancer Survivor (see Survivor)
Breast Conserving Surgery (see Lumpectomy)
A measure used to describe the relative amounts of fat and tissue in the breasts as seen on a mammogram.
Breast-Specific Gamma Imaging (see Nuclear Medicine Imaging of the Breast)
Breast Imaging Reporting and Data System (BI-RADS®)
A system developed by the American College of Radiology to provide a standard way to describe the findings on a mammogram.
Surgery to restore the look and feel of the breast after mastectomy.
Breast Self-Examination (BSE)
A method that may help women become familiar with the normal look and feel of their breasts. BSE is not recommended as a breast cancer screening tool because it has not been shown to decrease breast cancer death.
Breast Tomosynthesis (3D Digital Mammography, Digital Tomosynthesis)
A tool that uses a digital mammography machine to take multiple two dimensional (2D) X-ray images of the breast. Computer software combines the multiple 2D images into a three dimensional image. Breast tomosynthesis is not a standard breast cancer screening tool at this time.
Loss of appetite and weight.
Deposits of calcium in the breast that appear as bright, white spots on a mammogram. Most calcifications are not cancer. However, tight clusters or lines of tiny calcifications (called microcalcifications) can be a sign of breast cancer.
General name for over 100 diseases with uncontrolled cell growth.
Cancer Staging (see Staging)
Carcinoma in Situ(in Situ Carcinoma)
Condition where abnormal cells are found in the milk ducts or lobules of the breast, but not in the surrounding breast tissue. In situ means “in place.” See ductal carcinoma in situ and lobular carcinoma in situ.
An observational study that looks at two groups–one with people who already have the outcome of interest (cases), and one with people who do not (controls). For example, the cases may be women with breast cancer and the controls may be cancer-free women. The two groups are then compared to see if any characteristic was more common in the past history of one group compared to the other.
A health care provider’s observations of a group of patients who are given a certain type of treatment.
A small tube used to deliver fluids to (or remove them from) the body.
One centigray describes the amount of radiation absorbed by the body and is equivalent to 1 RAD (radiation absorbed dose).
A drug or combination of drugs used to lower the risk of breast cancer in cancer-free women at higher risk.
A drug or combination of drugs that kills cancer cells in various ways.
Clinical Breast Examination (CBE)
A physical exam done by a health care provider to check the look and feel of the breasts and underarm for any changes or abnormalities (such as lumps).
Research studies that test the benefits of possible new ways to detect, diagnose, treat or prevent disease. People volunteer to take part in these studies.
Mental processes related to understanding, such as reasoning and problem-solving.
A study that follows a large group of people (a cohort) over time.
Co-Insurance (see Co-Payment)
Complementary Therapies (Integrative Therapies)
Therapies (such as acupuncture or massage) used in addition to standard medical treatments. Complementary therapies are not used to treat cancer, but they may help improve quality of life and relieve some side effects of treatment or the cancer itself. When complementary therapies are combined with standard medical care, they are often called integrative therapies.
Computerized Axial Tomography (CAT) Scan (see CT Scan)
95% Confidence Interval (95% CI)
A statistical concept that shows there is a 95 percent probability the ‘true’ measure is found within a range of measures computed from a single study. For example, if the 95% confidence interval for a survival rate is 75 to 90 percent, there is a 95 percent chance the true survival rate falls between 75 and 90 percent.
In an insurance plan, the portion of medical costs a person must pay (the portion not covered by his/her insurance policy).
Core Needle Biopsy
A needle biopsy that uses a hollow needle to remove samples of tissue from an abnormal area in the breast.
A person who lends support to someone diagnosed with breast cancer, from the time of diagnosis through treatment and beyond. Co-survivors may include family members, spouses or partners, friends, health care providers and colleagues.
CT Scan (Computerized Tomography Scan, Computerized Axial Tomography (CAT) Scan)
A series of pictures created by a computer linked to an X-ray machine. The scan gives detailed internal images of the body.
The sum of a person’s chances of developing a disease (like breast cancer) over the course of a lifetime (usually defined as birth up to age 85). For example, the cumulative (lifetime) risk of breast cancer for women is about 1 in 8 (or about 12 percent). This means for every 8 women, one will be diagnosed with breast cancer during her lifetime (up to age 85).
A fluid-filled sac.
A pathologist who specializes in looking at individual cells. A cytopathologist is needed to interpret the results of fine needle aspiration.
Toxic, or deadly, to cells (cell killing). Often used to describe chemotherapy.
Deductible (Insurance Deductible)
The pre-set amount of medical costs a person must pay before insurance payments begin.
All of the known tumor is removed and no follow-up surgery is needed.
A rare benign (not cancer) breast condition that consists of small hard masses in the breast. It occurs most often in women with insulin-dependent (type 1) diabetes.
Identification of a disease from its signs and symptoms.
A mammogram used to check symptoms of breast cancer (such as a lump) or an abnormal finding noted on a screening mammogram or clinical breast exam. It involves two or more X-ray views of the breast.
Diagnostic Radiologist (Radiologist)
A health care provider who specializes in the diagnosis of diseases using X-rays.
Diploid (DNA Ploidy)
The presence of a normal number of chromosomes in cancer cells.
Disease-Free Survival Rate
Percent of people alive and without disease at a certain time (often five years or 10 years) after treatment. Those who die from causes other than the disease under study are not included in this measure.
Distant Recurrence (see Metastases)
DNA (Deoxyribonucleic Acid)
The information contained in a gene.
Chemotherapy given over a shorter (more condensed) time period compared to standard therapy. The frequency of treatment sessions is increased, so the length of the treatment period is shortened.
Lowering the stage of a cancer from its original stage (or the stage it was thought to be). Down-staging occurs most often after a good response to neoadjuvant therapy. Neoadjuvant therapy is chemotherapy or hormone therapy used as a first treatment (before surgery) for some large or advanced breast cancers. Neoadjuvant therapy can shrink a tumor such that it lowers the stage of the breast cancer and a lumpectomy, instead of a mastectomy, can be done.
Duct (Milk Duct, Mammary Duct)
A canal that carries milk from the lobules to a nipple opening during breastfeeding (see figure).
Ductal Carcinoma in Situ (DCIS, Intraductal Carcinoma)
A non-invasive breast cancer that begins in the milk ducts of the breast, but has not invaded nearby breast tissue. Also called stage 0 or pre-invasive breast carcinoma.
Ductal Papilloma (see Intraductal Papilloma)
Early Breast Cancer
Cancer that is contained in the breast or has only spread to lymph nodes in the underarm area. This term often describes stage I and stage II breast cancer.
Excess fluid in body tissues that causes swelling.
Endocrine Manipulation (see Hormone Therapy)
Cancer of the endometrium (the lining of the uterus).
A protein that speeds up biologic reactions in the body.
The study of the causes and prevention of disease.
The most biologically active, naturally occurring estrogen in women.
A female hormone produced by the ovaries and adrenal glands that is important to reproduction. Some cancers need estrogen to grow.
Specific proteins in cells that estrogen hormones attach to. A high number of estrogen receptors on a breast cancer cell often means the cancer cell needs estrogen to grow.
The cause(s) of a disease.
Surgical procedure that removes the entire abnormal area (plus some surrounding normal tissue) from the breast.
External Beam Radiation Therapy (see Radiation Therapy)
A test result that incorrectly reports a person is disease-free when she/he actually has the disease.
A test result that incorrectly reports a person has a disease when she/he does not have the disease.
Family History (Family Medical History)
A record of the current and past health conditions of a person’s biological (blood-related) family members that may help show a pattern of certain diseases within a family.
A benign (not cancer) breast change in which the breast responds to trauma with a firm, irregular mass, often years after the event. The mass is the result of fatty tissue dying, after either surgery or blunt trauma to the breast. This breast change does not increase risk of breast cancer.
A benign (not cancer) fibrous tumor that may occur at any age, but is more common in young adulthood.
Fibrocystic Condition (Fibrocystic Changes)
A general term used to describe a benign (not cancer) breast condition that may cause painful cysts or lumpy breasts.
Fine Needle Aspiration (FNA, Fine Needle Biopsy)
A biopsy procedure that uses a thin, hollow needle to remove a sample of cells from the abnormal area of the breast.
First-Degree Relative (Immediate Family Member)
A person’s mother, father, sister, brother or child.
The initial (first) therapy used in a person’s cancer treatment.
A laboratory test done on tumor tissue to measure the growth rate of the cancer cells and to check if the cells have too much DNA.
Fluorescence In Situ Hybridization (FISH)
A laboratory test done on breast tumor tissue to find out the number of copies of the HER2/neu gene contained in the cancer cells.
Process where a portion of tissue from a surgical biopsy is frozen so a thin slice can be studied to check for cancer. Frozen section results are only preliminary and always need to be confirmed by other methods.
Gail Model (Breast Cancer Risk Assessment Tool)
A tool that uses personal and family history to estimate a woman’s risk of invasive breast cancer.
A milk-filled cyst.
The part of a cell that contains DNA. The DNA information in a person’s genes is inherited from both sides of a person’s family.
Process in which a gene gets turned on in a cell to make RNA and proteins.
Gene Expression Profiling (see Tumor Profiling)
Any change in the DNA (the information contained in a gene) of a cell. Gene mutations can be harmful, beneficial or have no effect.
Gene Variant of Uncertain Significance
A gene mutation not currently known to increase breast cancer risk.
General Practitioner (Internist, Physician)
The personal or family physician who may first find a suspicious area in the breast through a clinical breast exam or mammogram.
The chemical name of a drug, not the brand name. The chemical formulations of a generic drug and the brand name drug are the same.
Related to genes. The information in a person’s genes can be passed on (inherited) from either parent.
Genetic Susceptibility (Genetic Predisposition)
An increased likelihood or chance of developing a disease due to specific changes in a person’s genes passed on from either parent.
Analyzing DNA to look for a gene mutation that may show an increased risk for developing a specific disease.
The total genetic information of an organism.
The study of genes and their functions.
Glandular Tissue (in the breast)
The tissue in the breast that includes the milk ducts and lobules.
Grade (see Tumor Grade)
Guaranteed Renewable Insurance
A health insurance policy that requires the insurance company to renew your policy for a certain amount of time, even if your health condition changes.
H&E (Hematoxylin and Eosin) Staining
A laboratory test that gives color to cells so cell structures can be identified.
HER2/neu (Human Epidermal Growth Factor Receptor 2, erbB2)
A protein involved in cell growth and survival that appears on the surface of some breast cancer cells. HER2/neu-negative breast cancers have little or no HER2/neu protein. HER2/neu-positive breast cancers have a lot of HER2/neu protein. HER2/neu-positive tumors can be treated with the targeted therapy drug trastuzumab (Herceptin).
Herceptin (see Trastuzumab)
Hereditary (see Genetic)
Homeopathy (Homeopathic Medicine)
A medical system based on a belief that “like cures like.” Natural substances are specially prepared in small amounts to restore health. These substances cause symptoms similar to the condition they are meant to treat in healthy people. There are limited data on the safety of these substances.
Chemicals made by certain glands and tissues in the body, often in response to signals from the pituitary gland or the adrenal gland. Hormones have specific effects on specific target organs and tissues. Examples include estrogen and progesterone. Hormones can also be made in a laboratory.
Specific proteins on cells that hormones attach to. A high number of hormone receptors on a breast cancer cell often means the cancer cell needs the hormone to grow.
Hormone Receptor Status
Shows whether or not a breast cancer needs hormones to grow. A hormone receptor-positive (estrogen and/or progesterone receptor-positive) cancer needs hormones to grow. A hormone receptor-negative (estrogen and/or progesterone receptor-negative) cancer does not need hormones to grow. See Hormone Receptor.
Hormone Replacement Therapy (see Menopausal Hormone Therapy)
Hormone Therapy (Endocrine Therapy, Endocrine Manipulation)
Treatment that works by keeping cancer cells with hormone receptors from getting the hormones they need to grow.
A philosophy of care focusing on improving quality of life and easing pain and other symptoms at the end stage of a terminal illness. Hospice care also provides support services to patients and their families.
Hyperplasia (Usual and Atypical Hyperplasia)
A benign (not cancer) breast condition where breast cells are growing rapidly (proliferating). Although hyperplasia is not breast cancer, it increases the risk of breast cancer. In usual hyperplasia, the proliferating cells look normal under a microscope. In atypical hyperplasia, the proliferating cells look abnormal.
Immediate Family Member (First-Degree Relative)
A person’s mother, father, sister, brother or child.
Therapies that use the immune system to fight cancer. These therapies target something specific to the biology of the cancer cell, as opposed to chemotherapy, which attacks all rapidly dividing cells. See Biological Therapy.
A laboratory test done on tumor tissue to detect the amount of HER2/neu protein on the surface of the cancer cells.
Implant (Breast Implant)
An “envelope” containing silicone, saline or both, that is used to restore the breast form after a mastectomy (or for other cosmetic reasons).
In Situ Carcinoma (see Carcinoma in Situ)
The health care providers and medical centers (hospitals and other treatment centers) that are part of a particular group health plan or health maintenance organization (HMO).
The number of new cases of a disease that develop in a specific time period.
Surgical biopsy that removes only part of the tumor.
A prepayment insurance plan that gives services or a cash payment for medical care needed in times of illness or disability.
Induction Chemotherapy (see Neoadjuvant Chemotherapy)
Inflammatory Breast Cancer (IBC)
A rare and aggressive form of invasive breast cancer. Its main symptoms are swelling (inflammation) and redness of the breast. The skin on the breast may look dimpled, like the skin of an orange, and may be warm to the touch.
The process through which a person learns about the possible benefits and side effects of a treatment plan and then accepts or declines the treatment. The person is usually asked to sign a consent form, but may stop the treatment at any time and get other medical care.
Infraclavicular Lymph Nodes
The lymph nodes below the clavicle (collarbone). See Lymph Nodes.
Insurance Payment Cap
A maximum amount an insurance company will pay out in a given time period.
Insurance Premium (Premium)
The cost of insurance coverage for a certain period of time.
Integrative Therapies (see Complementary Therapies)
Within the milk duct. Intraductal can describe a benign (not cancerous) or malignant (cancerous) process.
An excess of cells growing within the milk ducts of the breast.
Intraductal Papilloma (Ductal Papilloma)
Small, benign (not cancer) growths that begin in the ducts of the breast and usually cannot be felt. Symptoms include a bloody or clear nipple discharge.
Intravenous or IV
Being within or entering the body through the veins.
Invasive Breast Cancer
Cancer that has spread from the original location (milk ducts or lobules) into the surrounding breast tissue and possibly into the lymph nodes and other parts of the body. Invasive ductal cancer begins in the milk ducts. Invasive lobular cancer begins in the lobules of the breast.
Investigational New Drug (New Experimental Treatment)
A chemical or biological drug that has been approved for use by researchers in studies, but is not yet available outside of a clinical trial.
A common way to measure proliferation rate. The more cells the Ki-67 antibody attaches to on a tissue sample, the more likely the tumor cells are to grow and divide rapidly.
The process of producing milk and breastfeeding a child.
Large Veins (Deep Veins)
The large veins deep inside the legs that carry blood from the legs back to the heart.
Late-Stage Cancer (see Metastatic Breast Cancer)
Area of abnormal tissue.
The chance of developing a disease (like breast cancer) over the course of a lifetime (usually defined as birth up to age 85). For example, the lifetime risk of breast cancer for women is 1 in 8 (or about 12 percent). This means for every 8 women, one will be diagnosed with breast cancer during her lifetime (up to age 85).
The device used during radiation therapy to direct X-rays into the body.
An image of the liver that can show the presence or absence of a tumor.
Lobular Carcinoma in Situ (LCIS, Lobular Neoplasia in Situ)
A condition where abnormal cells grow in the lobules of the breast. LCIS increases the risk of breast cancer.
Lobular Neoplasia in Situ (see Lobular Carcinoma in Situ)
Ball-shaped sacs in the breast that produce milk.
Anesthesia that only numbs the tissue in a certain area. See Anesthesia.
Treatment that focuses on getting rid of the cancer from a certain (local) area. In breast cancer, the local area includes the breast, the chest wall and lymph nodes in the underarm area (axillary nodes). Local treatment for breast cancer includes surgery with or without radiation therapy.
Localized Breast Cancer
Cancer that is contained in the breast and has not spread to nearby tissue, lymph nodes or other organs.
Locally Advanced Breast Cancer (Stage III Breast Cancer)
Cancer that has spread beyond the breast to the skin or chest wall, but not to distant organs like the lungs or liver. It also refers to a tumor that is larger than five centimeters (about two inches) in size.
Local Recurrence (Recurrence)
The return of cancer to the same breast or to the same side chest wall.
Any mass in the breast or elsewhere in the body.
Lumpectomy (Breast Conserving Surgery)
Surgery that removes only part of the breast—the part containing and closely surrounding the tumor.
Lymph Nodes (Lymph Glands)
Small groups of immune cells that act as filters for the lymphatic system. Clusters of lymph nodes are found in the underarms, groin, neck, chest and abdomen.
Lymph Node Status
Shows whether or not cancer has spread to the lymph nodes. Lymph node-positive means that cancer has spread to the lymph nodes. Lymph node-negative means that cancer has not spread to the lymph nodes. See Lymph Nodes.
The network of lymph nodes and vessels in the body.
Swelling due to poor draining of lymph fluid that can occur after surgery to remove lymph nodes or after radiation therapy to the area. Most often occurs in the upper limbs (arm, hands or fingers), but can occur in other parts of the body.
Macrobiotics (Macrobiotic Diet)
Integrative or complementary dietary therapy that includes a mostly vegetarian, organic food diet with certain methods of food preparation.
Magnetic Resonance Imaging (see MRI)
Mammary Duct (see Duct)
Mammary Duct Ectasia
A benign (not cancer) breast condition resulting from inflammation (swelling) and enlargement of the ducts behind the nipple. Often there are no symptoms, but calcifications seen on a mammogram may point to its presence. No treatment is needed if the woman is not having symptoms (burning, pain or itching in the nipple area).
The breast glands that produce milk.
An X-ray image of the breast.
The rim of normal tissue surrounding a tumor that has been surgically removed. A margin is clean (also known as uninvolved, negative or clear) if there is only normal tissue (and no cancer cells) at the edges. Clean margins show the entire tumor was removed. With involved (also known as positive) margins, normal tissue does not completely surround the tumor. This means the entire tumor was not removed and more surgery is needed to get clean margins.
Surgical removal of the breast. The exact procedure depends on the diagnosis. See Total Mastectomy and Modified Radical Mastectomy.
An inflammation (swelling) of the breast usually occurring during breastfeeding. Symptoms include pain, nipple discharge, fever, redness and hardness over an area of the breast.
The average of a group of numbers.
Mean Survival Time
The average time from the start of treatment (or diagnosis) that people in a study stay alive.
The middle value (50th percentile) of a group of numbers.
A physician specializing in the treatment of cancer using chemotherapy, hormone therapy and targeted therapy.
Hormone made by the pineal gland in the brain. It is an important part of the body’s internal timing system.
The first menstrual period.
Menopausal Hormone Therapy (Postmenopausal Hormone Use, Hormone Replacement Therapy)
The use of hormone pills containing estrogen (with or without progestin) to ease symptoms of menopause.
The ending of the normal menstrual cycle in women. It occurs most often in the late forties or early fifties.
A method for taking the results reported in a group of studies and averaging them to come up with a single, summary result.
The chemical process whereby drugs and food are broken down by the body.
Spread of cancer to other organs through the lymphatic and/or circulatory system.
Small, clustered deposits of calcium in the breast that may be seen on a mammogram. These may or may not be related to breast cancer.
Surgery that involves connecting small blood vessels.
Modified Radical Mastectomy
Surgical removal of the breast, the lining of the chest muscles and some of the lymph nodes in the underarm area. Used to treat early and locally advanced breast cancer.
Molecular Breast Imaging (see Nuclear Medicine Imaging of the Breast)
Immune proteins that can locate and bind to cancer cells. They can be used alone or they can be used to deliver drugs, toxins or radioactive material directly to tumor cells. Trastuzumab (Herceptin) is an example of a monoclonal antibody used to treat breast cancer.
Number of deaths in a given group of people over a certain period of time.
MRI (Magnetic Resonance Imaging)
An imaging technique that uses a magnet linked to a computer to make detailed pictures of organs or soft tissues in the body.
mTOR (Mammalian Target of Rapamycin) Inhibitors
A class of targeted therapy drugs that may increase the benefit of hormone therapy. Everolimus (Afinitor) is an example of an mTOR inhibitor.
Multifocal Tumors (Multicentric Tumors)
One or more tumors that develop from the original breast tumor.
Use of two or more treatment methods (such as surgery, radiation therapy, chemotherapy, hormone therapy and targeted therapy) in combination or one after the other to get the best results.
Mutation (Gene Mutation)
Any change in the DNA (the information contained in a gene) of a cell. Gene mutations can be harmful, beneficial or have no effect.
Naturopathy (Naturopathic Medicine)
A medical system based on a belief in using natural elements to maintain health and to help the body heal itself. It includes therapies such as nutrition and massage.
Needle Localization (see Wire Localization)
Neoadjuvant Chemotherapy (Induction Chemotherapy, Primary Chemotherapy, Preoperative Chemotherapy)
Chemotherapy used as a first treatment. Often used for large or locally-advanced cancers to shrink tumors before surgery.
Neoadjuvant Hormone Therapy
Hormone therapy used as a first treatment. Often used for large or locally-advanced cancers to shrink tumors before surgery.
Neoadjuvant Therapy (Preoperative Therapy)
Chemotherapy or hormone therapy used as a first treatment. Often used for large or locally-advanced cancers to shrink tumors before surgery.
Excess number of cells in a mass that can be either benign (not cancerous) or malignant (cancerous).
Nested Case-Control Study
A case-control study done within a prospective cohort study. The major advantage of a nested case-control study over a regular case-control study is the exposure of interest (for example, diet or alcohol use) is measured before any of the participants have disease, making it less subject to bias.
A breast reconstruction procedure that removes the tumor and margins as well as the fat and other tissue in the breast, but leaves the nipple and areola intact.
Node-Negative (Lymph Node-Negative)
Cancer that has not spread to the lymph nodes. See Lymph Node Status.
Node-Positive (Lymph Node-Positive)
Cancer that has spread to the lymph nodes. See Lymph Node Status.
1. In treatment, describes a procedure that does not penetrate the skin (or any body opening) with a needle or other instrument.
2. In breast cancer pathology, describes a cancer that has not spread beyond the ducts or lobules where it began (see Carcinoma in Situ).
Describes a breast lump or abnormal area that cannot be felt but can be seen on an imaging test (such as a mammogram).
Cells that are cancer-free.
Nuclear Medicine Imaging of the Breast (Molecular Breast Imaging)
A technique under study for use in the early detection of breast cancer. Nuclear medicine imaging uses short-term radioactive agents given through an IV. Cancer cells absorb these agents and can be imaged with a special camera. Nuclear medicine imaging is not a standard breast cancer screening tool. Breast-specific gamma imaging and scintimammography are types of nuclear medicine imaging.
The part a cell that contains the genetic material DNA. Nuclei is the plural of nucleus.
A research study where participants live their daily lives as usual and report their activities to researchers.
A measure reported in case-control studies that describes the increase (or decrease) in disease risk related to a risk factor. An odds ratio is interpreted in the same way as a relative risk, though it is calculated differently.
The physician in charge of planning and overseeing cancer treatment.
Surgical removal of the ovaries.
A drug that contains opium or a substance made from opium and is used to treat pain.
A drug that does not contain opium or any substances made from opium, but is used to treat pain.
A condition marked by a loss of bone mass and density that causes bones to become fragile.
Any health care provider or medical center (hospital or other treatment center) that is not part of a particular group health plan or health maintenance organization (HMO).
Diagnosis that occurs when a mammogram finds ductal carcinoma in situ (DCIS) or a small, invasive breast cancer that would have never caused symptoms or problems if left untreated. These breast cancers may never grow or a person may die from another cause before the breast cancer becames a problem.
Treatment for ductal carcinoma in situ (DCIS) or a small, invasive breast cancer that would have never caused symptoms or problems if left untreated.
Overall Survival (Overall Survival Rate, Survival)
The percentage of people alive for a certain period of time after diagnosis with a disease (such as breast cancer) or treatment for a disease.
Paget Disease of the Breast (Paget Disease of the Nipple)
A rare cancer in the skin of the nipple or in the skin closely surrounding the nipple that is usually, but not always, found with an underlying breast cancer (ductal in situ carcinoma or invasive breast cancer). In these cases, the tumor grows from underneath the nipple and breaks out onto the surface of the nipple.
Palliative Therapy (Palliative Care, Palliation)
Care focused on relieving or preventing symptoms (like pain) rather than treating disease.
Describes a breast lump or abnormal area that can be felt during a clinical breast exam.
To examine, using the hands and fingers.
PARP (poly(ADP-ribose) polymerase) Inhibitors
A class of targeted therapy drugs that block an enzyme involved in DNA repair (called PARP enzyme).
Partial Mastectomy (see Lumpectomy)
A measure describing how much of the tumor is left in the breast and lymph nodes after neoadjuvant (before surgery) therapy. The pathologic response gives some information about prognosis. A complete pathologic response means there is no invasive cancer in the tissue removed during breast surgery.
The physician who uses a microscope to study the breast tissue and lymph nodes removed during biopsy or surgery and determines whether or not the cells contain cancer.
The time in a woman’s life prior to menopause when menstrual periods become irregular and some menopausal symptoms may begin.
Peripherally Inserted Central Catheter (PICC)
A small tube used to deliver medicine to the body through a vein. Instead of being reinserted for each use, a PICC is left in place to allow access for a long period of time (weeks to months).
A method used in diagnosis. Thin slices of tissue are processed and put on a slide so that a pathologist can study them under a microscope. These sections are of better quality than frozen sections.
A device that uses infrared light beams to measure limb volume.
Using information about a person’s genes, the tumor’s genes, molecular characteristics of the tumor and the environment to prevent, diagnose and treat disease (such as the use of targeted therapies).This may also be known as precision medicine.
PET (Positron Emission Tomography)
A procedure where a short-term radioactive sugar is given through an IV so that a scanner can show which parts of the body are consuming more sugar. Cancer cells tend to consume more sugar than normal cells do. PET is sometimes used as part of breast cancer diagnosis or treatment, but is not used for breast cancer screening.
The study of the way genes affect a person’s response to drugs to help predict which drugs may offer him/her the most benefit.
A characteristic in a person that results from the interaction between his/her genes and his/her environment.
A rare sarcoma (cancer of the soft tissue) in the breast.
A part of the brain that controls growth and other glands in the body, such as the ovaries.
An inactive medicine sometime used to have a comparison to a new drug in a clinical study. May be called a “sugar pill.”
A method for collecting the individual data from a group of studies, combining them into one large set of data and then analyzing the data as if they came from one big study.
Positron Emission Tomography (see PET)
Postmenopausal Hormone Use (see Menopausal Hormone Therapy)
Using information about a person’s genes, the tumor’s genes, molecular characteristics of the tumor and the environment to prevent, diagnose and treat disease (such as the use of targeted therapies ). This may also be known as personalized medicine.
Factors (such as hormone receptor status) that help guide treatment for a specific cancer case.
To make more at risk for a disease.
Women who have regular menstrual periods.
Premium (Insurance Premium)
The cost of insurance coverage for a certain period of time.
Preoperative Chemotherapy (see Neoadjuvant Chemotherapy)
The proportion (percentage) of people in a population who have a certain disease, behavior or characteristic at a defined point in time.
Steps taken to lower the risk of a disease.
Primary Chemotherapy (see Neoadjuvant Chemotherapy)
The original cancer.
A hormone made by the body that is important in menstrual cycles and pregnancy. May be made in a laboratory (called progestin) and used in birth control pills, menopausal hormone therapy and other types of hormone treatment.
Specific proteins on cells that progesterone hormones attach to. A high number of progesterone receptors on a breast cancer cell often means the cancer cell needs progesterone to grow.
Any substance (laboratory-made or natural) that has some or all of the effects of progesterone in the body.
The expected or probable outcome or course of a disease (the chance of recovery).
Factors (such as tumor type, size and grade) that help determine prognosis.
The growth or spread of cancer, with or without treatment.
The length of time a person lives with cancer (such as metastatic breast cancer) before the cancer grows or spreads.
Rapidly growing and increasing in number.
Preventive surgery where one or both breasts are removed in order to prevent breast cancer. When both breasts are removed, the procedure is called bilateral prophylactic mastectomy.
An observational study that follows people forward in time. See Cohort Study.
Prosthetic (Breast Prosthetic, Prosthesis)
An artificial breast form that can be worn under clothing after a mastectomy.
An outline or plan for the use of an experimental drug, treatment or procedure in cancer therapy or diagnosis.
Removal of a small circle of skin (with a special instrument called a punch or trephine) to be tested for cancer cells.
Surgery where one quadrant or 25 percent of the breast is removed. See Lumpectomy.
Quality of Care
Measures of how well breast cancer is treated and how well a person is cared for during and after treatment.
Quality of Life
A measure of a person’s well-being and his/her overall enjoyment of life.
Categories of an exposure (like body weight or exercise) based on four equal parts of the total number of people in the study.
Categories of an exposure (like body weight or exercise) based on equal parts of the total number of people in the study. When the total number of people is divided into thirds, the categories are called tertiles. When the total number of people is divided into quarters, the categories are called quartiles.
RAD (dose of radiation)
Short for “radiation absorbed dose.” This term describes the amount of radiation absorbed by the tissues. One RAD is equal to one centigray. See Centigray.
Radial Scars (Complex Sclerosing Lesions)
A benign (not cancer) breast condition with a core of connective tissue fibers. Ducts and lobules grow out from this core.
A physician specializing in the treatment of cancer using targeted, high energy X-rays.
Radiation Therapy (Radiotherapy)
Treatment given by a radiation oncologist that uses targeted, high energy X-rays to kill cancer cells.
Radical Mastectomy (Halsted Radical)
Surgical removal of the breast, chest muscles and underarm lymph nodes. Used only when the breast tumor has spread to the chest muscles.
Does not allow radiation to pass through. A radio-opaque object will show up on an X-ray.
A physician who reads and interprets X-rays, mammograms and other scans related to diagnosis or follow-up. Radiologists also perform needle biopsy and wire localization procedures.
Radiotherapy (see Radiation Therapy)
A drug first used to treat osteoporosis and now also used to lower the risk of breast cancer in postmenopausal women at high risk.
Randomized Controlled Trials
Studies where researchers change some participants’ behavior or provide a certain therapy to see how it affects health. Participants are randomly assigned (as if by coin toss) to either an intervention group (such as one getting a new drug) or a control group (such as one getting standard treatment).
Reconstruction (see Breast Reconstruction)
Return of cancer. Local recurrence is the return of cancer to the same breast or the same side chest wall. Distant recurrence is the return of cancer that has spread to other parts of the body, such as the lungs, liver, bones or brain. See Metastases.
A treatment plan.
Regional Lymph Nodes
In breast cancer, the axillary (in the underarm area) lymph nodes, infraclavicular (under the collarbone) lymph nodes, supraclavicular (above the collarbone) lymph nodes and internal mammary nodes. See Lymph Nodes.
The shrinking of a tumor.
A measure used to describe the increase (or decrease) in risk related to a specific risk factor. A relative risk is the ratio of two absolute risks: the numerator is the absolute risk among those with the risk factor and the denominator is the absolute risk among those without the risk factor. A relative risk that is greater than one shows a factor increases risk. A relative risk that is less than one shows a factor decreases risk. And, a relative risk of one shows the factor neither increases nor decreases risk (this means the factor is not likely related to risk of the disease).
Relative Survival (Relative Survival Rate)
A measure used to compare the survival of people who have a certain disease with those who do not at a given time after diagnosis or treatment. The relative survival rate shows whether the disease shortens life. If relative survival is 100 percent at five years after treatment, there is no difference in survival between those who have the disease and those who do not five years after treatment.
A study where both the exposure (such as alcohol use) and the outcome (such as breast cancer) occur before the start of the study.
Risk (of disease)
Probability (chance) of disease developing in a person during a specified time period.
The relationship between the possible (or expected) side effects and benefits of a treatment or procedure.
Any factor—from a lifestyle choice (such as diet) to genetics to an environmental exposure (such as radiation)—that increases or decreases a person’s risk of developing a certain disease.
RNA (Ribonucleic Acid)
A molecule made by cells containing genetic information that has been copied from DNA. RNA performs functions related to making proteins.
A saltwater solution similar to that found in IV fluids. Saline can be used to fill a breast implant.
The use of a cap filled with a chilled substance during chemotherapy. Scalp cooling is under study as a technique for reducing hair loss due to chemotherapy.
The different combinations and timing for chemotherapy and other drugs.
Small, benign (not cancer) breast lumps caused by enlarged lobules. The lumps may be felt and may be painful.
Scintimammography (see Nuclear Medicine Imaging of the Breast)
A test or procedure used to find cancer or a benign (not cancer) condition in a person who does not have any known problems or symptoms.
A test used to find early signs of breast cancer in a woman who does not have any known breast problems or symptoms.
Second Primary Tumor
A second breast cancer that develops in a different location from the first. This is different from a local recurrence, which is the return of the first breast cancer.
In a summary research table, the specific standards (such as study design and number of participants) a study has to meet to be included.
Selective Estrogen Receptor Modulator (SERM)
A drug that can either block the effects of estrogen or behave like estrogen, depending on the part of the body being treated. Tamoxifen and raloxifene are SERMs.
The proportion (or percentage) of people who truly have the condition of interest who test positive for that condition.
Sentinel Node Biopsy
The surgical removal and testing of the sentinel node(s) (first axillary node(s) in the underarm area filtering lymph fluid from the tumor site) to see if the node(s) contains cancer cells.
Medical-grade, solid form of silicone used for breast implants. Silicone implants can mimic the feel of a natural breast better than saline implants.
Simple Mastectomy (see Total Mastectomy)
A procedure that surgically removes the breast, but keeps intact as much of the skin that surrounds the breast as possible. This skin can then be used in breast reconstruction to cover a tissue flap or an implant instead of having to use skin from other parts of the body.
Sonogram (see Ultrasound)
The proportion (or percentage) of people who truly do not have the condition of interest who test negative for the condition.
Stage of Cancer (Cancer Stage)
A way to indicate the extent of the cancer within the body. The most widely used staging method for breast cancer is the TNM system, which uses Tumor size, lymph Node status and the absence or presence of Metastases to classify breast cancers.
Staging (Cancer Staging)
Doing tests to learn the extent of the cancer within the body (the cancer’s stage 0 to IV). Knowing a cancer’s stage helps determine what treatment is needed and how effective this treatment may be in getting rid of the disease and prolonging life.
Standard Treatment (Standard of Care)
The usual treatment of a disease or condition currently in widespread use and considered to be of proven effectiveness on the basis of scientific evidence and past experience.
Describes whether or not the result of a study is likely due to chance. A statistically significant result likely shows a true link between a risk factor and breast cancer.
Stereotactic Needle Biopsy
Core needle biopsy done with the use of stereotactic (three-dimensional) mammography guidance.
Three-dimensional mammography used to guide a needle biopsy.
Supraclavicular Lymph Nodes
The lymph nodes above the clavicle (collarbone). See Lymph Nodes.
Physician who performs any surgery, including surgical biopsies and other procedures related to breast cancer.
A physician specializing in the treatment of cancer using surgical procedures.
Survival (see Overall Survival and Relative Survival)
Survivor (Breast Cancer Survivor)
A person living with breast cancer (from the time of diagnosis).
The emotional and physical health, life and care of a breast cancer survivor from the time of diagnosis until the end of life.
Systemic (Adjuvant) Treatment
Treatment given in addition to surgery and radiation to treat breast cancer that may have spread to other parts of the body. It may include chemotherapy, targeted therapy and/or hormone therapy.
A hormone therapy drug (taken in pill form) used to treat early and advanced stage breast cancers that are hormone receptor-positive. These breast cancers need estrogen to grow. Tamoxifen stops or slows the growth of these tumors by blocking estrogen from attaching to hormone receptor in the cancer cells.
Drug therapies designed to attack specific molecular agents or pathways involved in the development of cancer. Trastuzumab (Herceptin) is an example of a targeted therapy used to treat breast cancer.
Categories of an exposure (like body weight or exercise) based on three equal parts of the total number of people in the study.
An integrative or complementary therapy where trained practitioners enter a semi-meditative state and hold their hands just above a person’s body to sense energy imbalances due to illness. Healing energy is then said to transfer to the person.
An imaging technique that uses infrared light to measure temperature differences on the surface of the breast. The U.S. Food and Drug Administration (FDA) and the American College of Radiology do not view thermography as a valuable breast cancer screening method.
A group or layer of cells.
Tomosynthesis (see Breast Tomosynthesis)
Total Mastectomy (Simple Mastectomy)
Surgical removal of the breast but no other tissue or nodes. Used for the treatment of ductal carcinoma in situ and, in some cases, breast cancer recurrence. Also used in prophylactic mastectomy.
A drug that is a specially made antibody that targets cancer cells with a lot of the protein called HER2/neu on their surfaces. When attached to the HER2/neu protein, trastuzumab slows or stops the growth of the cancer cells. Trastuzumab is used to treat HER2/neu-positive breast cancer. Herceptin is the brand name for trastuzumab.
Triple Negative Breast Cancer
A breast cancer that is estrogen receptor-negative, progesterone receptor-negative and HER2/neu-negative. These factors limit treatment choices. Most triple negative tumors are basal-like tumors. These breast cancers tend to be aggressive and are more common in African American women.
An abnormal growth or mass of tissue that may be benign (not cancerous) or malignant (cancerous).
Describes how closely cancer cells look like normal cells. Grade 1 tumors have cells that are slow-growing and look the most like normal cells. Grade 3 tumors have cells that are fast-growing and look very abnormal. Grade 2 tumors fall in between grade 1 and grade 3.
A substance found in blood that may be a sign of metastatic breast cancer. Tumor markers are found in both normal cells and cancer cells, but they are made in larger amounts by cancer cells. A tumor marker may help indicate metastatic breast cancer treatment activity. The term tumor marker may also be used more broadly to refer to characteristics of tumor cells such as hormone receptors.
Tumor Profiling (Gene Expression Profiling)
Tests that give information about thousands of genes in cancer cells. Specific genes (or combinations of genes) may give information useful in prognosis and in making treatment decisions.
Biopsy and further surgical treatment done at two separate times.
A class of drugs that target enzymes important for cell functions (called tyrosine-kinase enzymes). These drugs can block tyrosine-kinase enzymes at many points along the cancer growth pathway.
Diagnostic test that uses sound waves to make images of tissues and organs. Tissues of different densities reflect sound waves differently.
A benign (not cancer) breast condition where breast cells are growing rapidly (proliferating). The proliferating cells look normal under a microscope. Although usual hyperplasia is not breast cancer, it increases the risk of breast cancer.
Vaginal Atrophy (Atrophic Vaginitis)
Wire Localization (Needle Localization)
Insertion of a very thin wire into the breast to highlight the location of an abnormal area so that it can be removed during biopsy or lumpectomy.
Radiation that, at low levels, can be used to make images of the inside of the body. For example, a mammogram is an X-ray image of the breast. At high levels of radiation, X-rays can be used in cancer treatment.
To help researchers find better ways to prevent, detect, treat and cure breast cancer, as well as provide improved quality of care and survivorship outcomes, it’s important to understand research and participate in research initiatives.
Cancer research can help us understand how cancer starts, how it grows and how it spreads (metastasizes). It takes place in the lab where the focus all about how the cells functions in the human body so that we can have a better understanding on the differences between normal, healthy cells and cancer cells. In terms of cancer research, the goal is to find a cure to end cancer once and for all. Research, clinical trials and emerging treatments are particularly important to healthcare providers, as their main objective is to identify, diagnose and treat diseases through medication, procedures, surgery and/or therapy or more specifically to breast cancer – surgery, radiation, chemotherapy, immunotherapy.
However, we all know that each and every body comes in different shapes, ages and sizes and if we only look through a standardized lens, some treatment protocols may be over looked. As we work to find a cure, it is also important to study how to improve patients’ quality of life and their quality of care during and after breast cancer. Survivorship is still an area that can benefit from research and programmatic efforts. While we celebrate being declared cancer-free, it is important to study the lifestyle, psycho-social, family, emotional and mental needs of the patient going forward. Further, those diagnosed with metastatic breast cancer, can’t get busy living unless they have a good quality of life, supported by more navigational tools and support.
A holistic approach to research is important – one that includes the cure and survivorship, so that we marry and balance the knowledge we gain in the lab with lives and stories of real life people who have experienced breast cancer. In this way, we can empower all those affected by this disease, through the entire lifecycle, and bring light to millions of people who hear the words “you have cancer”, so they know they are not alone.
Breast Self Examination
Download our Breast Self Examination Card in English or Spanish to use as reminders or to share with others.