Breast cancer

Alternative names:

carcinoma of the breast

Treatment:

OVERVIEW:
The choice of initial treatment is based upon the extent and aggressiveness of the disease. Currently breast cancer is viewed as a systemic disease that requires both local and systemic treatment.

• Local treatment may include lumpectomy, mastectomy (partial, total, or radical with axillary dissection) and radiation therapy -- all directed at the breast and immediately surrounding tissue.
• Systemic treatment includes chemotherapy and hormonal therapy, which circulate drugs and hormones throughout the entire body in an attempt to eliminate cancer cells that may be present in distant parts of the body.

Most women receive a combination of treatments including surgery, radiation, chemotherapy, and/or hormonal therapy. Current recommendations for potentially curable breast cancer usually suggest that the best primary treatment is partial mastectomy plus axillary dissection and radiation therapy.

MEDICATIONS:
Chemotherapy may be used as additional, systemic treatment in patients with curable breast cancer. Hormonal adjunctive therapy includes the use of antiestrogen drugs (such as tamoxifen), which may be prescribed for individuals found to have estrogen-dependent cancers.

SURGERY:
Lumpectomy (surgical removal of the lump) with radiation may be considered for individuals with stage 1 disease. However, axillary dissection is still recommended with the surgery.

LIFESTYLE CHANGES:

Support groups:

The stress of illness can often be helped by joining a support group where members share common experiences and problems. See cancer - support group.

Expectations (prognosis):

The clinical stage of breast cancer is the best indicator for prognosis (probable outcome). Five-year survival rates for individuals with breast cancer who receive appropriate treatment are approximately:

• 85% for stage 1
• 66% for stage 2
• 41% for stage 3
• 10% for stage 4

When the axillary lymph nodes are involved, the survival rate drops to approximately 40 to 50% at 5 years and probably less than 25% at 10 years.

Complications:

Even with aggressive and appropriate treatments, breast cancer often metastasizes to distant sites such as the lungs, liver, and bones. The local recurrence rate is about 5% after total mastectomy and axillary dissection when the nodes are found not to be involved. The local recurrence rate is 25% in those with similar treatment found to have nodal involvement.

Calling your health care provider:

Call for an appointment with your health care provider if:

• symptoms of breast cancer occur
• if you are a woman, 40 years or older, and have not had a baseline mammogram performed
• if you are a woman, 35 years or older, and have a mother or sister with breast cancer, or a past medical history of prior breast cancer, uterine cancer, endometrial cancer, ovarian cancer, or colon cancer
• if you are a woman, 20 years or older, and are unfamiliar with how to perform a breast self-examination