Breast Cancer

About Breast Cancer

In this section, you or a loved one can find out more about medical treatments for breast cancer. We also provide practical advice about breast cancer and offer tips on how to tap into your support network. Read on and you’ll find answers to some of your questions as well as links to resources with more information. Being informed is an important first step towards becoming an active decision-maker in your care plan.

What is breast cancer?

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One in four (26%) of cancers diagnosed in Canadian women is breast cancer making it the most common cancer diagnosed among women in Canada.

Breast cancer is a cancer that originates in the cells of the breast. Before going into detail about this particular type of cancer, it’s important to understand the basics:

  • Cell – the body is made of up millions of cells. Each cell contains genes that are basically a set of instructions that tell the cell how to grow, work, reproduce and die. 
  • Cancer – is a disease that affects the set of instructions in certain cells; as a result the instructions can be changed and the cells become cancer cells. Cancer cells may grow too much, form lumps or malignant tumours, and potentially spread to other parts of the body.

People often consider breast cancer to be only one cancer.  Actually, it is a group of different cancers that affect the breast. Knowing about the type of breast cancer you have can help you understand what is happening in your body and how the treatment options prescribed by your doctor work.

 

The most common type of breast cancer is called ductal carcinoma because it starts in the cells of the milk ducts (or tubes) that carry milk from the glands to the nipple. Another common type of breast cancer starts in the group of glands that make milk (lobules) and is called lobular carcinoma

 

The breast

Less common types of breast cancer include inflammatory breast cancer, Paget’s disease of the nipple and triple negative and basal-like breast cancers. 

Finding out you have breast cancer can leave you feeling devastated and overwhelmed, so it's crucial to reach out for help and information from people who are close to you and to your healthcare team. Along with obtaining the best possible medical support and treatment, it is important to make your emotional and physical wellbeing a priority, to ask for help and support when you need it, and to nurture relationships with compassionate people who enrich your life. You don't have to do it alone — there are many ways to manage your daily life with your healthcare team, family and friends, as you will see in the following sections.

Risk factors for breast cancer

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Most breast cancers occur in women, with less than 1% of the breast cancers occurring in men. The main reason is that female hormones, especially estrogen, encourage the growth of some breast cancers. 

Some of the factors that increase the risk of someone developing breast cancer include: 

  • Family history of breast and other cancers 
    • Family history means having one or more close blood relatives who had breast cancer
    • Ashkenazi Jewish ancestry
      • BRCA gene mutations are more common in Ashkenazi women
  • BRCA gene mutations
    • BRCA genes control how breast cancer behaves. There are 2 BRCA genes (BRCA1 and BRCA2). Mutations (abnormal changes) in these genes are rare and typically are inherited. Having mutations in one or both BRCA genes greatly increases the likelihood of developing breast cancer 
  • Dense breasts
  • Rare genetic conditions
  • Reproductive history
    • Early start of first menstruations, late menopause, late pregnancy, or no pregnancies increase the risk of developing breast cancer 
  • Exposure to ionizing radiation
  • Long-term (more than 5 years) use of hormone replacement therapy
  • Use of certain types of oral contraceptives for more than 10 years
  • Accumulation of abnormal cells in the breast (also called atypical hyperplasia)
  • Excessive use of alcohol
  • Being obese
  • Personal history of breast cancer
    • Women who have had breast cancer are at higher risk of developing breast cancer again.

In order to prescribe treatment, doctors need to know the extent or “stage” of cancer in the body.  For breast cancer, the most common staging system is the “TNM” system. 

TNM stands for tumour, nodes and metastasis. These are measured as follows: 

  • Tumour: The size of the main tumour
  • Nodes: The number and location of any cancerous lymph nodes 
  • Metastasis: Determination as to whether or not the cancer has spread (metastasized) to other parts of the body

In breast cancer, there are five main stages: 0, I, II, III and IV. Generally, the possible outcome of the disease (prognosis) for the patient is better at lower stages. Very generally, the stages are: 

  • Stage 0: the cancer is only in the ducts, lobule or nipple and has not spread to nearby breast tissue and is at an early stage
  • Stage I: the tumour is less than 2 cm in diameter; the cancer has not spread to the lymph nodes or other parts of the body 
  • Stage II: A tumour larger than 2 cm but not more than 5 cm. Cancer may or may not have spread to the lymph nodes.
  • Stage III: A tumour of any size. Cancer has not spread to other parts of the body but is in the lymph nodes 
  • Stage IV: Cancer has spread to other parts of the body

Many of the tests used to diagnose cancer are also used to determine the cancer stage. 

 

Diagnostic tests Staging and other tests

Breast cancer: factors influencing disease outcomes

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How breast cancer affects a patient can vary depending on a number of factors, including:

  • Medical history (medical background which includes previous or existing conditions and past or present treatments)
  • Type of breast cancer
  • Characteristics (including size, status, age, grade and stage) of the cancer
  • Results from hormone receptor testing. Possible results are:
  • Results of HER2 status testing (HER2 is a gene that can help tumours grow). Possible results are:
    • HER2 positive — HER2 genes are overly active (overexpression of the gene)
    • HER2 negative — HER2 genes have a normal level of activity
  • Cancer treatment chosen
  • Response to primary treatment

A doctor familiar with these factors can better predict a patient’s disease outcomes over time (prognosis). 

You may have come across survival statistics regarding breast cancer. Keep in mind that survival statistics are general estimates and must be interpreted carefully. These statistics are based on the experience of groups of people and; therefore, cannot be used to predict an individual’s specific chances of survival. Generally, the earlier breast cancer is diagnosed and treated, the more likely the patient will survive. 

Your doctor can explain the statistics for breast cancer and what they may mean for you.

Signs and symptoms of breast cancer

The most common symptoms of breast cancer include:

  • A lump in the breast – the most common first sign
  • A lump in the armpit
  • Changes in breast shape or size
  • Breast skin changes
    • The skin of the breast may become dimpled or puckered; this is sometimes called orange peel skin, or peau d’orange.
    • Redness, swelling and increased warmth (signs that look like an infection) or itching of the breast or nipple may be signs of inflammatory breast cancer
  • Nipple changes
    • Newly inverted nipple
    • Discharge from nipples
    • Crusting, ulcers or scaling on the nipple
  • Changes in lymph nodes
    • Feeling for any lumps or other abnormalities

Are there other associated symptoms?

As the breast cancer gets larger or spreads to other organs, other symptoms may occur: 

  • Bone pain
  • Nausea
  • Loss of appetite
  • Weight loss
  • Jaundice
  • Buildup of fluid around the lungs
    • Shortness of breath
    • Cough
  • Headache
  • Double vision
  • Muscle weakness

Support means everything

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When you have cancer, you may need different types of support at different times. 

Although you may find it hard to ask for help, the fact is that having help often makes it easier to cope with cancer. Keep in mind that your family and friends, even co-workers, may really want to help but they aren’t sure what to do. Knowing that you need something done (for example walking your dog) allows your loved ones to feel useful. Keep in mind that receiving and giving help are both gifts. 

Other sources of support are people who have gone through what you’re going through. These people understand how you feel, they can tell you what to expect, how they coped, and give you hope for the future. You can get in touch with people in your situation through organized support programs. If you’re interested in an organized support program ask your doctor or other member of your healthcare team for more information. Contacting the Canadian Cancer Society , the Canadian Breast Cancer Foundation or, in Quebec, the Quebec Breast Cancer Foundation/Fondation du cancer du sein du Québec are all options. 

Your healthcare team is also a key source of support for you. Although the people on your team are all professionals, they are also human beings so it’s important to build a good relationship with them with open honest communication. 

Family and friends want to be there for you. Some people know what to do and say without you saying anything. Others want to help but aren’t sure how. In these cases, you can take the first step by starting the conversation and tell the other person exactly what you need help with. You shouldn't assume that the other person will know how to help. In other cases, someone may say, “Let me know if I can do anything.” You can answer by saying specifically what you need help with. 

Here are some tips and helpful insights we’ve learned from patients:

  • Ask those closest to you to learn about your condition. This will help them understand your symptoms better and how you feel about them. It may give them new ideas about how to make things easier for you in your day-to-day life. This awareness alone will make you all more comfortable dealing with breast cancer. Mutual understanding often arises from education – friends and relatives can read this or other Web sites, look up reliable sources of information in libraries, or go with you to some of your appointments. Contacting the Canadian Cancer Society, the Canadian Breast Cancer Foundation or, in Quebec, the Quebec Breast Cancer Foundation/Fondation du cancer du sein du Québec are all options. 
  • Let them know you need their support. This could be just their listening when you need to talk – even about things not directly related to your breast cancer. Nourish your important personal relationships – share how you are feeling physically and emotionally. There will be times when you experience more pain and limitations, and are frustrated. 
  • Always be open and honest about your needs. It’s best to give others a very clear idea of how they can help you. Here are some examples of what you may ask of your friends and family: 
    • Help with housework such as cooking, cleaning, shopping and yard work 
    • Water your house plants and garden 
    • Mow the lawn 
    • Bring in your mail 
    • Take care of your pets 
    • Drive you to your medical appointments or treatments 
    • Drive a child to or from school or other activities 
    • Pick up a prescription at the pharmacy 
    • Look up information about your condition or other topics 
    • Be the contact person who keeps others updated on your condition

People with cancer can experience a range of emotions. Although some of these feelings are difficult to deal with, there are positive feelings as well. Some cancer patients find that they begin to appreciate life in a new way. 

Breast cancer is different for every patient, with treatment tailored to each individual case. The key is to closely follow your health care team’s instructions for the steps and medications to take. Be persistent in following your treatment. Keep notes and communicate regularly with your doctor about the effects of your treatment. If you feel there’s a problem with your treatment, or are experiencing any side effects, talk to your doctor right away about these concerns. Don’t hold back from asking questions. Be pro-active and involved in the decision-making about your health. 

Here are some tips on how to get the most out of your appointment with people on your healthcare team: 

  • Be open and honest about how you’re feeling 
  • If you want a loved one to talk with your healthcare team either with you or on your behalf, it helps to choose one person to play this role. This will help avoid having many people asking your healthcare team the same questions 
  • Write down any questions you have and bring the list with you 
  • Take notes 
  • Ask who you should call if something happens between scheduled appointments 
  • Try not to become hostile or angry during your appointment, this can affect how your healthcare team communicates with you

Lifestyle options

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For most people, regardless of having cancer or not, exercise, healthy eating and good sleep habits are recommended. A healthy lifestyle can lead to enhanced quality of life for most people. 

Talk to your doctor before making any lifestyle changes. 

Physical activity can play an important role in your recovery from breast cancer.

Benefits of exercise after breast cancer treatment can include:

  • Increased energy level
  • Less fatigue, anxiety and depression
  • Reduction of stress
  • Improvement in cardiovascular fitness
  • Better self-esteem
  • Improved quality of life

Even though adding regular exercise to your life may be challenging, it’s important to remember that exercise can also help maintain your endurance as well as strength and flexibility. Make sure to discuss any plans for new physical activities with your healthcare team.If you experience any health problems while exercising, be sure to seek medical attention.

 

Planning your exercise program

Here are some general pointers to consider when planning an exercise program: 

  • For most people, 30–60 minutes of physical activity 3 to 5 days of the week is recommended to maintain health. Talk to you doctor about goals appropriate for you.
  • Be sure to start slowly. Over time, you may be able to build up the level of effort or intensity of activity. 

For general information about exercise, you can go to the Public Health Agency of Canada Physical Activity’s webpage 

For patients who have recently had surgery or radiation therapy for breast cancer, here are some general tips for exercising: 

  • Wear comfortable, loose clothing 
  • Try doing exercises when muscles are warm and relaxed, such as after a shower
  • Take slow, deep breaths while you exercise
  • Do the exercises until you feel a gentle stretch, but not pain
  • Make sure to start exercises slowly and gently
  • Do not over-exercise; pain and swelling are often signs of over-exercise
  • Gradually increase your pace and level of physical activity. 
  • It’s important to report unexplained pain or swelling to your doctor or physiotherapist.

 

Rehabilitation exercises after breast cancer treatment

Surgery and/or radiation therapy can affect a patient’s arm and shoulder on the treated side of the body. Doing exercises after breast cancer treatment can help patients regain movement and mobility in the arm and shoulder. 

Exercising the affected arm and shoulder after breast cancer surgery can help your recovery in many ways: 

  • Improve your muscle tone
  • Help you regain the ability to do daily activities
  • Diminish side effects of surgery, such as pain, joint stiffness and swelling
  • Help improve your overall well-being

 

Managing fatigue

Patients may describe fatigue as feeling tired, weak, worn-out, heavy, slow, or no energy. 

Cancer-related fatigue may not be completely relieved by sleep and rest. This type of fatigue generally diminishes after cancer treatment ends but patients may continue to experience it months and even years later. 

Here are some approaches to coping with fatigue. Make sure to discuss any changes to your lifestyle with your doctor:  

  • Exercise can help patients with cancer feel better and have more energy. Refer to our section on exercise
  • A schedule of activity, rest and proper sleep time. Changes in daily routine makes the body use more energy so keeping to a regular schedule can improve sleep and increase day-time energy levels
  • Talk to a counselor about how you feel. Bottled up feelings and emotions can make fatigue worse 

Eating right during and after cancer treatment can be a challenge. Some patients lose weight while others gain weight. 

Medications used to treat cancer may change your sense of taste and or cause nausea. These side effects may lead to weight loss. However, in general, women who receive chemotherapy for breast cancer are more likely to experience weight gain.

Patients can consult Canada’s Food guide for help in making healthy food choices after having received treatment for breast cancer

A dietician can also help you make a meal plan that fits with your health needs and food preferences.

 

Supplements

Dietary supplements including vitamin, mineral or herbal supplements cannot take the place of healthy well-balanced eating. In some cases, however your doctor or dietician will recommend supplements if you are deficient in a certain nutrient. 

It is important to note that taking vitamins or other supplements at a higher than recommended amount may do more harm than good and could even be dangerous. If you are thinking of taking a supplement, talk to your doctor first. 

Both prior to and after your cancer treatment, you’ll likely experience many different emotions. These can include shock, anxiety, anger as well as concern regarding how your cancer is affecting your loved ones. 

Patients may experience different emotions depending on the type or stage of treatment.Dealing with these varying emotions can be a challenge.

Getting support from other people can help you manage your emotional health. Family, friends, religious or spiritual groups, cancer support groups, on-line support forums and counselors are all options. Which people or group(s) are best suited to you is a personal decision. Your level of comfort with the support setting is very important. If you prefer talking with one person at a time, a counselor or trusted friend might be the best choice. If you prefer talking with other cancer patients who are experiencing the same thing you are experiencing, then a peer-support group run by a local clinic or local branch of the Canadian Cancer Society (see the community services locator for your province) may be the best option for you.

 

Counseling for self-esteem and body image

Following breast cancer treatment, some women may feel less feminine because of a lost breast, scars, lost hair, or weight change. 

If this happens, it’s important to give yourself time to adjust. Ask your doctor about patient support programs appropriate for you. You may want to consider talking to your healthcare team about a referral to a counselor or support services in your area.

Complimentary therapy options for cancer

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During your interactions with family and friends, and perhaps support groups, you may hear about various complementary and alternative therapies for cancer. These therapies, used for cancer in general, may include vitamins, herbs, special diets, and acupuncture among other things. 

If you are considering any complimentary or alternative therapies, talk to your doctor first. The decision to use a complementary or alternative therapy is a personal choice; however, it’s important that your doctor knows about these therapies because they could have some effects on the treatment prescribed by your doctor(s)

Examples of complementary and alternative therapies

Here are some examples of complementary therapies:

Medical treatments

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Your healthcare team will discuss your treatment options with you. These options may include: surgery, chemotherapy, hormonal therapy, biological therapy, radiation therapy and palliative care. 

Your healthcare team will consider a number of factors when deciding on a treatment for breast cancer including:

Depending on the stage of your cancer and the treatment option(s) prescribed, you may have one or more of the following specialists on you healthcare team:

  • Surgical oncologist (surgeon who specialises in the treatment of cancer)
  • Radiation oncologist 
  • Medical oncologist

Other healthcare professionals may also be involved, such as nurses and social workers.

Surgery is used to remove or repair body tissues in people with many different types of cancer including breast cancer.It’s the oldest cancer treatment and more than half of people with cancer will have some type of surgery. Complications from surgery may occur and vary based on the extent of the surgery as well as the patient’s health prior to surgery. It is very important to report any side effects of surgery to your health care team.

Surgery can also be used to reduce the risk of developing specific types of cancer or to relieve cancer symptoms. 

The types of surgery for breast cancer include:

  • Breast-conserving surgery (BCS) – involves removal of the tumour and some of the healthy tissue around it
  • Mastectomy – removal of the entire affected breast
  • Lymph node removal

Chemotherapy involves the use of anticancer drugs. It is commonly used to treat breast cancer. 

Anticancer drugs (also called cytotoxic drugs) are designed to destroy cancer cells. These drugs generally circulate through the entire body and even act against cancer cells that have broken away from the main tumour. Different chemotherapy treatments are available and are chosen based on the specific needs of a given patient. 

Chemotherapy can be used to treat breast cancer in the following ways: 

  • After surgery in order to destroy cancer cells left behind and to reduce the risk of cancer recurrence
  • Before surgery to shrink a large tumour
  • To treat a recurrence of breast cancer
  • To relieve pain or control symptoms of advanced breast cancer (palliative chemotherapy)

Chemotherapy is not generally offered for the treatment of stage 0 breast cancers because the risk of the cancer spreading or recurring is low. 

Chemotherapy can be used for the following situations:

  • Stage I or II breast cancer with high risk of recurrence
  • Locally advanced breast cancer; for example, a large tumour that cannot be removed by surgery and has spread to other parts of the breast and to the lymph nodes but not to other body sites
  • Actively growing (metastatic) or recurrent breast cancer in patients who have negative hormone receptor status

For more information about breast cancer stages.

 

Chemotherapy medications

Chemotherapy for stage I and II most commonly involves a combination of drugs.

Chemotherapy combinations are often referred to with letters, for example, “AC ” refers to a combination of the drugs doxorubicin and cyclophosphamide. In another example, ’’TC’’ refers to a combination of the drugs docetaxel and cyclophosphamide. 

Some drugs are also used on their own in certain situations when the breast cancer is advanced or has metastasized or if the patient is no longer responding to other treatments. Some of these common drugs, which can be used on their own or in combination with other drugs include: 

5-fluorouracil capecitabine cisplatin
cyclophosphamide docetaxel doxorubicin
epirubicin eribulin etoposide
gemcitabine methotrexate mitomycin
paclitaxel protein-bound paclitaxel vinorelbine

The choice of chemotherapy is influenced by many factors including the type of breast cancer, the size and location of the tumour, the patient’s overall health and her preferences, and the outcome of any prior chemotherapy.

Side effects of chemotherapy drugs depend on the type of drug or combination of drugs used, the dose, the way the chemotherapy drug is administered and the patient’s overall health. Here are some examples of side effects:

  • Bone marrow suppression
  • Nausea and vomiting
  • Diarrhea
  • Constipation
  • Weight gain
  • Loss of appetite
  • Sore mouth
  • Urine that has a reddish color
  • Hair loss
  • Fatigue
  • Muscle and [no-lexicon]joint[/no-lexicon] pain
  • Pain at the injection site
  • Hand-food syndrome
  • Skin and nail changes
  • Allergic reactions
  • Treatment-induced menopause
  • Fertility problems
  • Changes to memory
  • Nervous system damage
  • Bladder damage
  • Heart damage
  • Second cancers

Hormonal therapy can help slow the growth and spread of breast cancer cells by changing hormone levels in the body or by stopping the breast cancer cells from using a specific hormone called estrogen. Various means can be used to change hormone levels in the body; these include drugs, surgery or radiation. 

Female hormones estrogen and progesterone can promote growth of some breast cancers. Estrogen and progesterone bind to hormone receptors (estrogen receptor [ER] and progesterone receptor [PR]) which allow the hormones to act on the cells. Women with breast cancer are tested to see if their breast cancer cells contain the estrogen or the progesterone receptors. Hormonal therapy is not used in women who are ER or PR negative because their body cells are less “reactive” to the hormone therapy. 

The most common hormonal therapies used to treat breast cancer are listed below: 

  • Anti-estrogens
  • Aromatase inhibitors, which block the actions of aromatase, an enzyme involved in the production of estrogen
  • Treatments that stop the ovaries from making estrogen (also called ovarian ablation)
  • Progestins, used to prevent estrogen from being made and cancel out the negative effects of estrogen
  • Androgens, male hormones used to control the production of estrogen

Side effects of hormonal therapy depend on the type of drug used, the dose and the patient’s overall health. Here are some examples of side effects:

  • Hot flashes
  • Nausea and vomiting
  • Treatment-induced menopause
  • Headache
  • Dizziness
  • Skin rash
  • Muscle and joint pain
  • Eye problems
  • Constipation
  • Diarrhea
  • Hair loss
  • Swelling or weight gain
  • Decreased interest in sex
  • Fatigue
  • Fertility problems
  • Blood clots
  • Bone density loss (also called osteoporosis)

 

Biological therapy are special treatments that destroy, control or change the behaviour of cancer cells. Different biological therapies act in different ways.

Biological therapy is an option in the following situations: 

  • For high risk, advanced or metastatic breast cancer (in combination with hormonal or chemotherapy)
  • To treat bone marrow suppression due to chemotherapy

The following is a list of biological therapies available in Canada for the treatment of breast cancer:

  • Trastuzumab, which attaches to HER2 proteins to stop HER2-positive cancer from growing
  • Pertuzumab, which attaches to a different place on HER2 proteins to stop HER2-positive cancer from growing; used in combination with trastuzumab and docetaxel (a chemotherapy medication)
  • Trastuzumab emtansine, a combination of products that stops HER2-positive cancer from growing (trastuzumab) and destroys targeted HER2-positive cancer cells
  • Lapatinib, used in HER2-positive cancer to block the activity of HER2 proteins, blocking the cells’ ability to grow
  • Colony stimulating factors (also referred to as CSFs), used to reduce some side effects of cancer treatment, by stimulating the production of blood cells

Side effects of biological therapies depend on the type of drug used, the dose and the patient’s overall health. Here are some examples of side effects:

  • Headache
  • Diarrhea
  • Nausea and vomiting
  • Skin rash
  • Flu-like symptoms
  • Fatigue
  • Allergic reaction
  • Constipation
  • Muscle and joint pain
  • Swelling, redness or rash at injection site
  • Loss of appetite
  • Sore mouth
  • Change in blood pressure
  • Heart damage

Radiation therapy utilizes high energy rays to destroy cancer cells.

In breast cancer, radiation therapy can be used in the following ways: 

  • After chemotherapy or surgery to destroy cancer cells left behind and to decrease the risk of cancer recurring
  • With other therapies to treat stage III breast cancer
  • To treat breast cancer that has recurred in the area where a mastectomy was done
  • To relieve pain and/or control symptoms in patients with advanced breast cancer (palliative radiation therapy)

Side effects from radiation therapy depend on the following factors:

  • Size of the treatment area
  • Organs/area being treated
  • Strength of the radiation
  • Schedule of radiation therapy

Side effects from radiation therapy can include:

  • Fatigue
  • Skin reactions
  • Changes to the breast
  • Breast pain
  • Difficulty swallowing
  • Shoulder stiffness
  • Nausea
  • Radiation pneumonitis
  • Nerve damage
  • Heart damage
  • Rib fractures

Disclaimer 

Please note that the information on this Web site should not be used as a substitute for seeking medical advice or treatment from a physician. You should not use this information to diagnose or treat a medical condition or health problem. Speak to your health care provider if you have any questions about your medical condition, symptoms or treatment options.