Risk Factors

Several factors influence the risk of developing breast cancer. Learn more below or watch our Breast Cancer Risk Factors Interactive Program.

• Age: Most breast cancers are diagnosed after the age of 60.
• Family history of breast cancer: Close relatives (parents, siblings, or children) of a person with a history of breast cancer may be more likely to develop this disease themselves, especially if the relative had the cancer at a young age. If many close relatives have a history of breast cancer, the risk is even greater. Learn more about hereditary cancer risk from our Family Cancer Assessment Clinic.
• Genetic changes: Women and men who have a BRCA1 or BRCA2 genetic mutation have a much higher risk of developing breast cancer.
• Overweight and obesity: Women who are overweight or obese after menopause have a higher risk of developing breast cancer.
• Estrogen exposure: Chances of developing breast cancer are higher in women who
  • had their first menstrual period before age 12
  • go through menopause after age 55
  • had no pregnancies
  • use hormone replacement therapy after menopause
  • did not breastfeed

Symptoms

These changes in the breast may be symptoms of breast cancer:

• A lump or thickening in the breast or underarm area
• Discharge from the nipple
• Dimpling or pulling in of the skin of the breast
• A change in the size or shape of the breast
• Retracted or inverted nipple
• Red, warm, tender skin on the breast that has the texture of an orange peel

A person with any of these symptoms should see his or her health care provider as soon as possible.

Screening and Diagnosis

Current screening recommendations for women with an average risk of breast cancer include the following:

• Ages 20-39: A clinical breast exam every one to three years
• Starting at age 40: A mammogram every one to two years, while continuing clinical exams

Those with a family history of breast cancer or with a BRCA1 or BRCA2 genetic mutation may need to follow a different screening schedule based on recommendations from his or her health care provider.

To schedule a mammogram at HCI, call 801-581-5496.

If Screening Shows Abnormality

If an abnormal area is detected with screening, diagnostic tests will determine if cancer is present.

• Ultrasound: This procedure uses high-energy sound waves bounced off tissues in the breast to make echoes. The echoes form a picture called a sonogram. The picture can be printed to be looked at later.
• Magnetic Resonance Imaging (MRI): This procedure uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body.
• Biopsy: The doctor removes tissue to look for cancer cells. A biopsy is the only way to know for sure if cancer is present. 

Staging

If the biopsy shows that cancer is present, doctors need to know the stage (extent) of the disease to plan the best treatment. The stage is determined by whether the cancer has invaded nearby tissues, whether the cancer has spread and, if so, to what parts of the body. This is done through the following diagnostic tests:

• Bone scan: The doctor injects a small amount of a radioactive substance into a blood vessel. It travels through the bloodstream and collects in the bones. A machine called a scanner finds and measures the radiation. The scanner makes pictures of the bones. The pictures may show cancer that has spread to the bones.
• CT scan: Doctors often use CT scans to take pictures of tissue inside the body. An x-ray machine linked to a computer takes several pictures. The pictures may show whether cancer has spread to lymph nodes or other areas in the body.
• Lymph node biopsy: The stage often is not known until after surgery to remove the tumor in the breast and one or more lymph nodes under the arm. Surgeons use a method called sentinel lymph node biopsy to remove the lymph node most likely to have breast cancer cells. Cancer cells usually appear first in the sentinel node before spreading to other lymph nodes.

Once breast cancer is diagnosed, it may be described as one of the following:

• Ductal carcinoma in situ (DCIS): Cancer that is found only inside the duct of the breast, and has not invaded any surrounding tissue.
• Invasive ductal carcinoma: Cancer that started in a breast duct, but has invaded surrounding tissue and/or has spread to lymph nodes.
• Lobular carcinoma in situ (LCIS): Abnormal, pre-cancerous cells are found in a lobule of the breast. Doctors will watch this closely to find any signs of cancer growth.
• Invasive lobular carcinoma: Cancer that started in a breast lobule, but has invaded surrounding tissue and/or has spread to lymph nodes.
• Inflammatory breast cancer: Cancer that develops in the skin of the breast, making it appear inflamed and warm with a thick, lumpy texture similar to an orange peel.

Stages of Breast Cancer

Stage 0: Cancer is found only in the duct of the breast (also called DCIS).

Stage I: The cancer is 2 centimeters or less and has not spread to lymph nodes.

Stage II: The cancer is larger than 2 centimeters and/or has spread to one to three lymph nodes under the arm.

Stage III: The cancer has spread to more than four lymph nodes under the arm, or to lymph nodes under the breast bone or above or below the collar bone, or is inflammatory.

Stage IV: The cancer that has spread to other parts of the body, such as the bones or liver.

Treatment

At Huntsman Cancer Institute, breast cancer is treated by a team of specialists, including surgeons, medical oncologists, radiation oncologists, nurses, social workers, dietitians, and other professionals.

Breast cancer treatment options include the following:

• Surgery
• Radiation therapy
• Hormone therapy
• Targeted therapy
• Chemotherapy
• Clinical trials

The treatment that's right for each patient depends on many factors:

• The stage of the cancer
• The presence of hormone receptors
• The presence of HER2/neu protein
• The patient's overall general health before diagnosis

Surgery

This is the most common treatment for breast cancer. Types of surgery include the following:

• Breast-sparing surgery: This is an operation to remove the cancer but not the breast. It is also called breast-conserving surgery. It can be a lumpectomy or a partial mastectomy.
• Mastectomy: This is an operation to remove the entire breast (or as much of the breast tissue as possible). In some cases, a skin-sparing mastectomy is used in which the surgeon removes the breast tissue but as little skin as possible.

The patient may choose to have breast reconstruction surgery to rebuild the shape of the breast. It may be done at the same time as the cancer surgery or later.

Learn more about surgery options in our video about breast cancer surgery.

Radiation therapy

This treatment involves two types:

• External radiation therapy: The radiation comes from a large machine outside the body. Treatment is done as outpatient in a hospital or clinic. External radiation is the most common type used for breast cancer.
• Internal radiation therapy (implant radiation therapy or brachytherapy): The doctor places one or more thin tubes inside the breast through a tiny incision. A radioactive substance is loaded into the tube. The treatment session may last for a few minutes, and then the substance is removed. When it's removed, no radioactivity remains in the body. Internal radiation therapy may be repeated every day for a week.

Hormone therapy

This treatment may also be called anti-hormone treatment. If lab tests show that the tumor has hormone receptors, then hormone therapy may be an option. Hormone therapy keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow.

Hormone Therapy Options before Menopause

If the patient has not gone through menopause, treatment options include the following:

• Estrogen receptor blockers: This drug can prevent the original breast cancer from returning elsewhere in the body and also helps prevent the development of new cancers in the other breast. As treatment for metastatic breast cancer, estrogen receptor blockers slows or stops the growth of cancer cells that are in the body. It's a pill taken every day for five years. Side effects include hot flashes, higher risk for blood clots, and slightly higher risk for endometrial cancer.
• LH-RH agonist: This type of drug can prevent the ovaries from making estrogen. The estrogen level falls slowly. Examples are leuprolide and goserelin. This type of drug may be given by injection under the skin in the stomach area. Side effects include hot flashes, headaches, weight gain, thinning bones, and bone pain.
• Surgery to remove the ovaries: Until a woman goes through menopause, the ovaries are the body's main source of estrogen. When the surgeon removes the ovaries, this source of estrogen is also removed. (A woman who has gone through menopause wouldn't benefit from this kind of surgery because her ovaries produce much less estrogen.) When the ovaries are removed, menopause occurs right away. A woman's health care team can suggest ways to cope with menopausal symptoms.

Hormone Therapy Options after Menopause

If the patient has gone through menopause, treatment options include the following:

• Aromatase inhibitor: This type of drug prevents the body from making a form of estrogen (estradiol). Examples are anastrazole, exemestane, and letrozole. Common side effects include hot flashes and joint pain. Other side effects include thinning bones and an increase in cholesterol.
• Estrogen receptor blockers: Hormone therapy is given for at least five years. Women who have gone through menopause receive estrogen receptor blockers for two to five years. If estrogen receptor blockers are given for less than five years, then an aromatase inhibitor often is given for the remaining time to equal a total of five years. Some women have hormone therapy for more than five years. See above for more information about estrogen receptor blockers and its possible side effects.

Targeted therapy

Some women with breast cancer may receive targeted therapy. Targeted therapy uses drugs that block the growth of breast cancer cells. For example, targeted therapy may block the action of an abnormal protein (such as HER2) that stimulates the growth of breast cancer cells.

Chemotherapy

This treatment uses drugs to destroy or control cancer throughout the body. Learn more about this treatment in our introduction to chemotherapy video.

Clinical trials

These studies discover and evaluate new and improved cancer treatments. Patients are encouraged to talk with their doctors about participating in a clinical trial or any questions regarding research studies. For more information, also visit HCI's clinical trials website.

Support

When you or someone you love is diagnosed with cancer, concerns about treatments and managing side effects, hospital stays, and medical bills are common. You may also worry about caring for your family, employment, or how to continue normal daily activities.

Here's where you can go for support:

• Your health care team can answer your questions and talk to you about your concerns. They can help you with any side effects and keep you informed of all your treatments, test results, and future doctor visits.
• The Cancer Learning Center has hundreds of free brochures and more than 3,000 books, DVDs, and CDs available for checkout. You can browse the library, perform Internet research, or talk with a cancer information specialist. Call 801-581-6365 or toll free 1-888-424-2100, or e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
• Our Patient and Family Support Services professionals offer HCI patients and their families emotional support and resources for coping with cancer and its impact on daily life.
• The Linda B. and Robert B. Wiggins Wellness-Survivorship Center offers support groups, classes, and activities aimed to increase the quality of life and well-being of HCI patients and their families.