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Creston News Advertiser | Monday, October 23, 2017

BREAST CANCER

AWARENESS MONTH

Breast density is something you should know

By Marilea Mullen

PR/Foundation coordinator at CHI Health Mercy Corning

It’s time to remind you that one of eight women in the U.S. will develop breast cancer. And according to the American Cancer Society: The earlier breast cancer is found, the better the chances that treatment will work. When breast cancers are found because they can be felt, they tend to be larger and are more likely to have already spread outside the breast. But screen-

ing exams can often find breast cancers when they are small, not able to be felt and still confined to the breast.

You will see messages and advertisements about pros/cons regarding when, how often and what type of mammogram you should have. Instead of taking advice from internet or news, this is a great conversation to have with your provider. Your age and family history are factors in the timing of getting screening exams. A key factor

for type of mammogram you should have is breast density. Breasts are made up of a mixture of fibrous, glandular and fatty tissue.

Your breasts are considered dense if you have a lot fibrous or glandular tissue but not much fat. Having dense breast tissue may increase your risk of getting breast cancer.

Breast density is determined by the radiologist who reads your mammogram. There are four categories of mammographic density. If you have had a

baseline mammogram, your doctor should be able to tell you whether you have dense breast tissue based on where you fall on the density scale. In the United States, 10 percent of women have extremely dense breasts, 10 percent have almost entirely fatty breast and 80 percent are classified into one of the two middle categories. Having dense breast tissue does make it more difficult for doctors to spot cancer on mammograms, but not impossible.

A mammogram is still

the best medical imaging screening test proven to reduce breast cancer deaths. Many cancers are seen on mammograms even if you have dense breast tissue. If you have dense breasts, please talk to your doctor. Together you can decide which, if any, additional screening exams are right for you. If your mammogram shows suspicious shadows, studies have shown that ultrasound and magnetic resonance imaging (MRI) can help find breast cancer that can’t be

seen on a mammogram.

Bottom line, know your family history of cancer, talk with your provider about the best option for you to have for a mammogram, because a mammogram is the best diagnostic tool to catch breast cancer. Your family history may dictate having your first mammogram before the recommended age of 40. And if you have had a mammogram, find out your breast density so you know the best option of type of mammogram to have. It might save your life.

Clinical breast exam Self-exams National Breast Cancer Foundationn, Inc. Adult women of all ages are encouraged to perform breast self-exams at least once a month. Johns Hopkins Medical center states, “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast self-exam is very important.”

While mammograms can help you to detect cancer before you can feel a lump, breast self-exams help you to be familiar with how your breasts look and feel so you can alert your healthcare professional if there are any changes.

What’s the difference between a breast self-exam and a clinical breast exam?

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A clinical breast exam is performed by a healthcare professional who is trained to recognize many different types of abnormalities and warning signs. This in-office exam will most likely be completed by your family physician or gynecologist at your annual exam, whereas your breast self-exam is something every woman should do at once at month at home.

A visual check of skin and tissue

texture or lumps Using the pads of the fingers, your healthcare provider checks your entire breast, underarm, and collarbone area for any lumps or abnormalities.

It is worth noting that some women have breast tissue that appears to be full of tiny fibrous bumps or ridges throughout the breast tissue, known as fibrocystic breasts. Overall lumpy tissue is something your provider will want to note but is unrelated to cancer.

A suspicious lump –the type your physician is checking for– is general-

During a clinical breast exam, your healthcare provider checks your breasts’ appearance. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.

These postures allow your healthcare provider to look for differences in size or shape between your breasts. The skin covering your breasts is checked for any rash, dimpling, or other abnormal signs. Your nipples may be checked to see if fluid is expressed when lightly squeezed.

A manual check for unusual

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ly about the size of a pea before anyone can feel it in the breast tissue. The manual exam is done on one side and then the other. Your healthcare provider will also check the lymph nodes near the breast to see if they are enlarged.

An assessment of any suspicious area If a lump is discovered, your healthcare provider will note its size, shape, and texture. He or she will also check to see if the lump moves easily.

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How should a breast self-exam be performed?

1) In the Shower Using the pads of your fingers, move around your entire breast in a circular pattern moving from the outside to the center, checking the entire breast and armpit area. Check both breasts each month feeling for any lump, thickening, or hardened knot. Notice any changes and get lumps evaluated by your healthcare provider.

2) In Front of a Mirror Visually inspect your breasts with your arms at your sides. Next, raise your arms high overhead.

Look for any changes in

the contour, any swelling, or dimpling of the skin, or changes in the nipples.

Next, rest your palms on your hips and press firmly to flex your chest muscles. Left and right breasts will not exactly match—few women’s breasts do, so look for any dimpling, puckering, or changes, particularly on one side.

3) Lying Down When lying down, the breast tissue spreads out evenly along the chest wall.

Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit.

Use light, medium, and firm pressure. Squeeze the nipple; check for discharge and lumps. Repeat these steps for your left breast.

Can I rely on breast self-exams alone to be sure I am breast cancer free?

Mammography can detect tumors before they can be felt, so screening is key for early detection. But when combined with regular medical care and appropriate guideline-recommended mammography, breast SELF-EXAM | 2B

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BREAST CANCER AWARENESS

Creston News Advertiser | Monday, October 23, 2017

Breast cancer facts Breast cancer risk What is breast cancer?

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

Facts about breast cancer in the United States One in eight women in the United States will be diagnosed with breast cancer in her lifetime.

Breast cancer is the most commonly diagnosed cancer in women.

Breast cancer is the second leading cause of cancer death among women.

Each year it is estimated that over 252,710 women in the United States will be di-

agnosed with breast cancer and more than 40,500 will die.

Although breast cancer in men is rare, an estimated 2,470 men will be diagnosed with breast cancer and approximately 460 will die each year.

On average, every 2 minutes a woman is diagnosed with breast cancer and 1 woman will die of breast cancer every 13 minutes.

Over 3.3 million breast cancer survivors are alive in the United States today.

A global burden According to the World Health Organization, breast cancer is the most common cancer among women worldwide, claiming the

factors

lives of hundreds of thousands of women each year and affecting countries at all levels of modernization.

Good news about breast cancer trends In recent years, perhaps coinciding with the decline in prescriptive hormone replacement therapy after menopause, we have seen a gradual reduction in female breast cancer incidence rates among women aged 50 and older. Death rates from breast cancer have been declining since about 1990, in part due to better screening and early detection, increased awareness, and continually improving treatment options.

Mammograms National Breast Cancer Foundation, Inc.

A mammogram is an x-ray that allows a qualified specialist to examine the breast tissue for any suspicious areas. The breast is exposed to a small dose of ionizing radiation that produces an image of the breast tissue.

Why do I need a mammogram?

Mammograms can often show a breast lump before it can be felt. They also can show tiny clusters of calcium called microcalcifications. Lumps or specks can be caused by cancer, fatty cells, or other conditions

CLINICAL: CONT. FROM | 1B

like cysts. Further tests are needed to find out if abnormal cells are present.

Recommendations for all women: Women 40 and older should have mammograms every 1 or 2 years.

Women who are younger than 40 and have risk factors for breast cancer should ask their healthcare professional whether mammograms are advisable and how often to have them.

Even women who have no symptoms and no known risks for breast cancer should have regularly scheduled mammograms to help detect potential breast cancer at the earliest possible time.

What happens if my mammogram results are abnormal?

pear soft, smooth, round, and movable are likely to be either benign tumors or cysts. A lump that is hard and oddly-shaped and feels firmly attached within the breast is more likely to be cancer, but further tests are needed to diagnose the problem.

exams

Benign lumps often feel different from cancerous ones, but any lump found will likely need to be examined with further diagnostic measures.

It may be helpful to The value of know that lumps that ap- clinical breast

If the mammogram shows an abnormal area of the breast, your doctor will order additional tests offering clearer, more detailed images of that area.

Although lumps are usually non-cancerous, the only way to be certain is to perform additional tests, such as an ultrasound or MRI. If further tests show that the mass is solid, your radiologist may recommend a biopsy, a procedure in which cells are removed from a suspicious area to check for the presence of cancer.

Clinical Breast exams are an important part of early detection. Although most lumps are discovered through breast self-exams, an experienced professional may notice a suspicious place that fails to register as a warning in the patient’s mind.

National Breast Cancer Foundation, Inc.

What do scientists actually know about the cause of breast cancer?

Cancer grows when a cell’s DNA is damaged, but why or how that DNA becomes damaged is still unknown.

It could be genetic or environmental, or in most cases, a combination of the two.

But most patients will never know exactly what caused their cancer. However, there are certain established risk factors that are associated with breast cancer.

Genetic factors Gender: Breast cancer occurs nearly 100 times more often in women than in men.

Age: Two out of three women with invasive cancer are diagnosed after age 55.

Race: Breast cancer is diagnosed more often in caucasian women than women of other races.

Family history and genetic factors: If your mother, sister, father or child has been diagnosed with breast or ovarian cancer, you have a higher risk of being diagnosed with breast cancer in the future. Your risk increases if your relative was diagnosed before the age of 50.

Personal health history: If you have been diagnosed with breast cancer in one breast, you have an increased risk of being di-

agnosed with breast cancer in the other breast in the future. Also, your risk increases if abnormal breast cells have been detected before (such as atypical hyperplasia, lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS)). Menstrual and reproductive history: Early menstruation (before age 12), late menopause (after 55), having your first child at an older age, or never having given birth can also increase your risk for breast cancer.

Certain genome changes: Mutations in certain genes, such as BRCA1 and BRCA2, can increase your RISK | 3B

SELF-EXAM: changes to their healthcare provider. self-exams can help womIf you find a lump, scheden know what is normal for ule an appointment with them so they can report any your doctor, but don’t panCONT. FROM | 1B

ic — 8 out of 10 lumps are not cancerous. For additional peace of mind, call your doctor whenever you have concerns.

Breast cancer symptoms and signs National Breast Cancer Foundation, Inc.

Every person should know the symptoms and signs of breast cancer, and any time an abnormality is discovered, it should be investigated by a healthcare professional.

Most people who have breast cancer symptoms and signs will initially notice only one or two, and the presence of these symptoms and signs do not automatically mean that you have breast cancer.

By performing monthly breast self-exams, you will be able to more easily identify any changes in your breast. Be sure to talk to your healthcare professional if you notice anything unusual.

A change in how the breast or nipple feels

of pores in the skin of the breast (some describe this as similar to an orange peel’s texture) • A lump in the breast (It’s important to remember that all lumps should be investigated by a healthcare professional, but not all lumps are cancerous.)

A change in the • Nipple tenderness or breast or nipple a lump or thickening in or appearance near the breast or underarm area • A change in the skin texture or an enlargement

• Any unexplained change in the size or shape SIGNS | 3B

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RISK:

they are aware of this risk.

Be sure to ask your physician if you have dense breasts CONT. FROM | 2B and what the implications of risk for breast cancer. This having dense breasts are. is determined through a ge- Environmental and netic test, which you may lifestyl risk factors consider taking if you have a Lack of physical activifamily history of breast can- ty: A sedentary lifestyle with cer. Individuals with these little physical activity can gene mutations can pass the increase your risk for breast gene mutation onto their cancer. children.

Poor diet: A diet high in Dense breast tissue: Hav- saturated fat and lacking ing dense breast tissue can fruits and vegetables can inincrease your risk for breast crease your risk for breast cancer and make lumps harder to detect. Several cancer.

Being overweight or states have passed laws reobese: Being overweight quiring physicians to disclose or obese can increase your to women if their mammorisk for breast cancer. Your gram indicates that they risk is increased if you have have dense breasts so that

already gone through menopause.

Drinking alcohol: Frequent consumption of alcohol can increase your risk for breast cancer. The more alcohol you consume, the greater the risk.

Radiation to the chest: Having radiation therapy to the chest before the age of 30 can increase your risk for breast cancer.

Combined Hormone Replacement Therapy (HRT): Taking combined hormone replacement therapy, as prescribed for menopause, can increase your risk for breast cancer and increases the risk that the cancer will be detected at a more advanced stage.

SIGNS:

tom you notice should be investigated as soon as it is discovered. If you have any of these symptoms, you should tell your healthcare provider so that the problem can be diagnosed and treated.

If I have no symptoms, should I assume I do not have cancer?

Although there’s no need to worry, regular screenings are always important.

Your doctor can check for breast cancer before you have any noticeable symptoms. During your office visit, your doctor will ask about your personal and family medical history and perform a physical examination. In addition, your doctor may order one or more imaging tests, such as a mammogram.

ola, or nipple that becomes scaly, red, or swollen or may have ridges or pitting resembling the skin of an orange

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of the breast • Dimpling anywhere on the breast • Unexplained swelling of the breast (especially if on one side only) • Unexplained shrinkage of the breast (especially if on one side only) • Recent asymmetry of the breasts (Although it is common for women to have one breast that is slightly larger than the other, if the onset of asymmetry is recent, it should be checked.)

• Nipple that is turned slightly inward or inverted • Skin of the breast, are-

Any nipple discharge – particularly clear discharge or bloody discharge It is also important to note that a milky discharge that is present when a woman is not breastfeeding should be checked by her doctor, although it is not linked with breast cancer.

Questions If I have some symptoms, is it likely to be cancer?

Most often, these symptoms are not due to cancer, but any breast cancer symp-

Proportion of breast cancer patients undergoing surgery to remove unaffected breast varies greatly by state Nearly half of young women in five states with early-stage cancer in one breast undergo surgery for unaffected breast

n

The proportion of women in the United States undergoing surgery for early-stage breast cancer who have preventive mastectomy to remove the unaffected breast increased significantly in recent years, particularly among younger women, and varied substantially across states. A new study co-led by the American Cancer Society and published in JAMA Surgery finds nearly half of young breast cancer patients in five states undergoing the procedure.

The use of contralateral prophylactic mastectomies (CPMs) among patients with invasive unilateral breast cancer has increased substantially during the past decade in the United States, particularly for patients younger than 45, despite the lack of evidence for survival benefit. The reasons for this increasing pattern are unclear but are thought to include the fear of developing a second breast cancer and the desire for breast symmetry following reconstructive surgery.

To find out more about this trend, investigators from the American Cancer Society, Emory University, Dana-Farber Cancer Institute, and Brigham and Women’s Hospital did a retrospective cohort study of 1.2 million women

Insurance plays significant role in breast cancer disparities Differences in insurance account for a substantial proportion of the excess risk of death from breast cancer faced by black women, according to a new study. The study, appearing in Journal of Clinical Oncology, concludes that equalizing access to care could address much of the existing black/white disparity in breast cancer mortality.

Breast cancer mortality was higher in white women than in black women until the 1980s, when improvements in early detection and treatment began to create a gap between black and white women.

Whites benefited more from these improvements, and since then, the black-white mortality gap has continued to widen. In 2014, the most recent year for which data is available, breast cancer mortality rates were 41 percent higher in black women than white women.

For the new study, investigators from the American Cancer Society, Emory University, and Dana-Farber Cancer Institute examined the contributions of demographics, other medical conditions (comorbidities), insurance, tumor characteristics, and treatment to black-white mortality disparities among more than 550,000 nonelderly women diagnosed with early stage breast cancer. The data come from the National Cancer Database, a national

hospital-based cancer registry cosponsored by the Commission on Cancer (CoC) of the American College of Surgeons and the American Cancer Society.

Compared with white women, black women were more likely to be uninsured or have Medicaid insurance (22.7 percent vs. 8.4 percent) and were more likely to have tumors that were larger, higher grade, and hormone receptor negative. Hormone receptor negative cancers have fewer treatment options and tend to grow faster than hormone receptor-positive cancers.

Among women with hormone receptor–positive tumors, the risk of death in blacks was twice that of whites (100 percent higher).

The excess risk among black patients decreased to 25 percent when they were matched to white patients by demographics (age, year of diagnosis, and area of residence), comorbidities, insurance, tumor characteristics, and treatment.

In other words, these factors together accounted for 75 percent of the total excess risk of death in black patients. Insurance accounted for 37 percent of the total excess, followed by tumor characteristics (23.2 percent), comorbidities (11.3 percent), and treatment (4.8 percent).

Among women with hormone receptor–negative disease, blacks had a 49.5 percent

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excess risk of death compared to whites. As with patients with hormone receptor–positive disease, the excess risk decreased when adjusted for demographics, other conditions, insurance, tumor characteristics, and treatment.

These factors combined accounted for 63.6 percent of the total excess risk of death in blacks. Insurance accounted for 34.1 percent of the total excess, followed by tumor characteristics (22.0 percent), comorbidities (3.8 percent), and treatment (3.6 percent).

“We found that differences in insurance explained onethird of the total excess risk of death in nonelderly black women compared to white women diagnosed with early-stage breast cancer, while differences in tumor characteristics explained approximately one-fifth of the excess risk,” write the authors.

“Health policy makers should ensure that the benefits of important scientific advances in prevention, early detection, and treatment of breast cancer are made available to all women, especially black women, who experience an undue share of the mortality burden from this disease,” they conclude. “Equalization of access to care in nonelderly black women could substantially reduce ethnic/racial disparities in overall mortality of women diagnosed with breast cancer.”

ages 20 and older who had been diagnosed with invasive unilateral early-stage breast cancer and treated with surgery from January 1, 2004, through December 31, 2012, in 45 states and the District of Columbia using data compiled by the North American Association of Central Cancer Registries.

Between 2004 and 2012, the proportion of patients who underwent a CPM nationally increased from 3.6 percent to 10.4 percent among women 45 and older and from 10.5 percent to 33.3 percent in those 20-44 years old.

While the increase was evident in all states, the magnitude of the increase varied substantially depending on the state. For example, among women ages 20 to 44, the proportion of CPM among women with unilateral early stage breast cancer and treated with surgery in New Jersey increased from 14.9 percent in 2004-2006 to 24.8 percent in 2010-2012, while in Virginia, the proportion tripled, from 9.8 percent to 32.2 percent.

Most strikingly, the proportion early-stage breast cancer patients age 20 to 44 receiving CPM in 20102012 were over 42 percent in the contiguous states of Nebraska, Missouri, Colorado, Iowa, and South Dakota.

From 2004 to 2012, the proportion of reconstructive surgical procedures among the women 20 to 44 increased in many states; however, that rise did not correlate with the proportion of women who received a CPM. “Interestingly, the highest proportions of young

women undergoing reconstructive surgery among young women who had a CPM were geographically clustered in several Northeastern states (Massachusetts, Maine, New Jersey, Connecticut, New York, and Delaware) rather than in the Midwestern region where we observed the highest proportions of women who underwent a CPM,” write the authors.

“Several previous studies in the United States have reported an increase in the use of MRI and highrisk genetic testing among patients with breast cancer, coinciding with the increase in the proportion of patients undergoing a CPM nationally,” write the authors. “However, the use of MRI and high-risk genetic testing among women is unknown by state, and we were unable to assess their contributions to the state variation in the proportions of CPMs among women with breast cancer treated with surgery.”

“Future studies should examine patient-, clinician-, and health system– level factors to provide additional insight into the reasons for temporal changes and regional variation in the receipt of a CPM,” said Ahmedin Jemal, D.V.M., Ph.D., senior author and vice president of surveillance & health services research and the American Cancer Society.

“In the meantime, however, surgeons and other health care professionals should educate their patients about the benefit, harm, and cost of a CPM to help patients make informed decisions about their treatments.”

Your doctor-patient relationship National Breast Cancer Foundation, Inc. From the time you ​ are diagnosed with breast cancer, you will work with a team of cancer specialists that may include: • A medical oncologist • A surgical oncologist • A radiation oncologist • A care-manager/caseworker Your health care team may also include an oncology nurse and a registered dietitian.

Can you ask questions and get answers you can understand?

your treatment will progress. Your physicians should be knowledgeable, of course, but they should also welcome questions and be able to explain your treatment options to you in a way you can understand.

Do you understand your treatment goals and why particular treatments are recommended?

Once you’ve identified your team, your doctors can describe your treatment choices, the expected results, and the possible side effects you may experience.

Are your concerns treated with Finding the right team, one that consists of pro- respect?

fessionals with whom you are comfortable, makes a big difference in how

Don’t be afraid to ask questions; raising your concerns—even those

that you may think will be viewed as trivial— with your medical team will help you better understand your options and provide your doctors with insight into what is important to you. Today, there are many treatment options available to you. Work with your team to find the right combination for you.

Do you feel comfortable sharing with your medical team about what you have learned regarding your condition?

Do your research.

Speak with support groups and breast cancer survivors. The more information you gather about your treatment options, the better decisions DOCTOR | 4B

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BREAST CANCER AWARENESS

DOCTOR: CONT. FROM | 3B

you’ll make.

Do you know the parts of your treatment plan that are up to you?

Remember that while your doctors can make recommendations and provide options, the final decisions regarding your treatment are yours. With good research, you can have confidence in the path you take. By embracing your part, you’ll give yourself the best odds for a long and healthy life.

When is a second opinion a good idea?

Having a second opinion can help you be certain of your treatment plan and healthcare partnering decisions. You will have less anxiety if you can cultivate a sense of trust and care with your doctor. In ad-

dition to quality care and good treatment decisions, your peace of mind is an important part of the equation.

Here some ideas that may be important to consider regarding second opinions: Most breast cancer doctors are very comfortable with their patients seeking a second opinion.

Many health insurance companies will pay for a second opinion if you or your doctor requests it, and some companies require a second opinion.

If you get a second opinion, the doctor may agree with your first doctor’s diagnosis and treatment plan.

Or the second doctor may suggest another approach.

Either way, you’ll have more information and perhaps a greater sense of control. You may also feel more confident about the decisions you make, knowing that you’ve looked carefully at your options.

It is important to be sure that treatments you receive

are in keeping with the NCCN treatment guidelines. So consider printing off the NCCN Guidelines for Patients document. It contains the guidelines for treatment based on stage of the disease and prognostic factors of the tumor that are considered the gold standard nationally.

It may take some time and effort to gather your medical records and see another doctor. Usually it’s not a problem if it takes you several weeks to get a second opinion. In most cases, the delay in starting treatment will not make treatment less effective.

To make sure, you should discuss this possible delay with your doctor. Some women with breast cancer need treatment right away.

There are many ways to find a breast cancer doctor for a second opinion. You can ask your doctor, a local or state medical society, a nearby hospital, or a medical school for names of specialists.

Creston News Advertiser | Monday, October 23, 2017

Standard treatment and clinical trials Before selecting your treatment plan, you should first understand the difference between standard treatment and clinical trials.

Breast cancer standard treatments are methods that experts agree are appropriate, accepted, and widely used. These standard procedures have proven useful in fighting breast cancer in the past.

A breast cancer clinical trial, on the other hand, is an approved research study that some doctors believe has a strong potential to improve standard treatments.

When clinical trials demonstrate better results than the standard, that new treatment becomes the standard. Remember, all our current standards were clinical trials at one time.

If a breast cancer clinical trial is an option for you, your doctor will explain the possible trade-offs with the trial treatment versus standard treatment. Together with your medical team, you will need to decide what treatment method is the best for you and your health.

Breast cancer standard treatments by stage • Your treatment options depend on the stage of your disease and these factors: • The size of the tumor in relation to the size of your breast • The results of specific pathology tests (hormone receptors, HER2 receptors, grade of the cells, proliferation rate of the cells) • Whether you have gone through menopause • Your general health • Your age • Your family history or other risk factors associated

with a predisposition for developing breast or ovarian cancer Below are brief descriptions of common treatments for each stage.

Other treatments may be appropriate for some women. Research studies (clinical trials) can be an option at all stages of breast cancer.

Stage 0 (DCIS) Most women with ductal carcinoma in situ (DCIS), also known as non-invasive breast cancer, have breast-conserving surgery, also known as lumpectomyfollowed by radiation therapy. For some women over the age of 70 who have an early diagnosed breast cancer and the tumor is hormone receptor positive, they may be a candidate to forego radiation therapy. Though Stage 0 breast cancer is the very earliest that breast cancer can be diagnosed, there are situations in which there is a lot of DCIS within the breast tissue.

In some situations, it may be necessary to have a mastectomy performed. Some women also may choose to have a mastectomy. Women with DCIS may receive Tamoxifen to reduce the risk of developing invasive breast cancer in the future.

Stages 1, 2, 3A, and some 3C Women with Stage 1, Stage 2, Stage 3A, or operable Stage 3C breast cancer may have a combination of treatments. (Operable means the cancer can be treated with surgery.)

Some may have breast-conserving surgery followed by radiation therapy to the breast. This choice is common for women with Stage I or II breast cancer. Some may decide to have a mastectomy. With either approach, women (especially those with

Real Care.

Stage II or IIIA breast cancer) often have lymph nodes under the arm removed.

Whether or not radiation therapy is used after mastectomy depends on the extent of the cancer. If cancer cells are found in 1 to 3 lymph nodes under the arm or if the tumor in the breast is large, the doctor sometimes suggests radiation therapy after mastectomy. If cancer cells are found in more than 3 lymph nodes under the arm and/or the tumor was very close to the chest wall, the doctor usually will suggest radiation therapy after mastectomy.

Stage 3B and some Stage 3C Women with Stage 3B (including inflammatory breast cancer) or inoperable Stage 3C breast cancer have chemotherapy first and then may be offered other treatments.

(Inoperable means the cancer can’t be treated with surgery without first shrinking the tumor.) They may also have targeted therapy.

Stage 4 and recurrent Women with Stage 4 breast cancer will be treated based on where the cancer returned. If the cancer returned in the chest area or within the breast tissue that remained after surgery, the doctor may suggest surgery, radiation therapy, chemotherapy, hormone therapy, or a combination.

Women with Stage 4 breast cancer or recurrent cancer that has spread to the bones, liver, or other areas usually have hormone therapy, chemotherapy, targeted therapy, or a combination. Radiation therapy may be used to control tumors in certain parts of the body. These treatments are not likely to cure the disease, but they may help a woman live longer.

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