A Visual Guide to Breast Cancer

Breast cancer isn’t what it was 20 years ago. Survival rates are climbing, thanks to greater awareness, more early detection, and advances in treatment. For roughly 284,000 Americans who are diagnosed with breast cancer each year, there are plenty of reasons to be hopeful.

Breast cancer often has no symptoms, but you may notice something you want the doctor to check. Keep an eye out for:

• A painless lump in the breast
• Changes in breast size or shape
• Swelling in the armpit
• Nipple changes or discharge

Breast pain can also be a symptom of cancer, but this isn’t common.

This rare, fast-growing type rarely causes a distinct lump. Instead, breast skin can become thick, red, and look pitted, like an orange peel. The area might also feel warm or tender and have small bumps that look like a rash.

The earlier you find the disease, the easier it is to treat. Mammograms, an X-ray of the breast, can show tumors before they get large enough to feel. The American Cancer Society says women ages 45-54 with an average risk level should get a yearly mammogram. Starting at age 55, mammograms can be perfomed every 2 years. Continue them as long as you’re in good health. The U.S. Preventive Services Task Force says until you’re 50 you should talk to your doctor about your need for testing. After that, get a mammogram every 2 years from ages 50 to 74. You don’t have to stop at 75; the group just doesn’t assess the pros and cons. You can work it out with your doctor.

Your doctor may order an extra test that takes pictures of the inside of your body. A breast ultrasound can help find cysts, fluid-filled sacs that most often aren’t cancer. You might get an MRI along with a mammogram as part of your routine testing if you have a higher risk of breast cancer.

For years, doctors told women to check their own breasts once a month. But studies suggest these exams play a very small role in finding cancer compared to other testing methods. The current thinking is that it’s more important to know your breasts and be aware of any changes, rather than checking them on a regular schedule. If you want to do a self-exam, go over the technique with your doctor.

First, don’t panic. Eighty percent of breast lumps aren’t cancerous. They often turn out to be harmless cysts or tissue changes related to your menstrual cycle. But let your doctor know right away if you find anything unusual in your breast. If it is cancer, the earlier it’s found, the better. And if it isn’t, testing can give you peace of mind.

The only sure way to know a lump is cancer is to do a biopsy. This means removing a sample of the lump so it can be examined in the lab. Your doctor may be able to do this with a small needle. But you might need surgery to take part of or the entire lump for testing. The results will show whether it’s cancer, and if so, what type. There are several forms of breast cancer, and treatments are carefully matched to each type.

Some types of breast cancer are fueled by the hormones estrogen or progesterone. Your doctor will test for hormone receptors -- proteins that pick up signals from the hormone that tell cells to grow. A biopsy can show if a tumor has receptors for estrogen (it’s ER-positive) and progesterone (it’s PR-positive). About 2 out of 3 breast cancers are hormone sensitive. There are several medications that keep the hormones from causing further cancer growth.

The image shows a molecular model of an estrogen receptor.

In about 20% of patients, breast cancer cells have too much of a protein called HER2/neu. It’s important to know whether a tumor is HER2-positive, because there are special treatments for this type of cancer.

A HER2-positive cell is illustrated here. Growth signals that are not normal are shown in green.

In up to 15% of breast cancers the tumor cells are lacking estrogen or progesterone receptors and have only small amounts of the HER2 protein. Doctors call this type of breast cancer "triple negative." It tends to grow and spread faster than other types. Hormone therapy or targeted drugs aren't helpful for this type. But there are other treatment options, including surgery, chemotherapy, and radiation.

If breast cancer is the diagnosis, the next step is to figure out how big the tumor is and how much of your body it affects. This process is called staging. Doctors use stages 0-IV to describe whether cancer is only in the breast, has moved into nearby lymph nodes, or has spread to other organs like the lungs. Knowing the stage and type of breast cancer will help your health care team create a treatment plan.

The odds of beating breast cancer are strongly tied to how early you find it. The American Cancer Society says 99% of women with stage I breast cancer live at least 5 years, and many women in this group remain cancer-free for good. The more advanced the cancer, the lower this figure becomes. By Stage IV, the 5-year survival rate drops to 29%. But these rates will rise as more effective treatments are found.

There are many types of breast cancer surgery, from taking out the area around the lump (lumpectomy or breast-conserving surgery) to removing the entire breast (mastectomy.) Talk about the pros and cons of each with your doctor to decide what’s right for you.

This treatment kills cancer cells with high-energy rays. It may be used after breast cancer surgery to wipe out any cancer cells that remain near the tumor site. Sometimes, it is given during breast conserving surgery to the area where the tumor was removed. It might be paired with chemotherapy to treat cancer that has spread to other body parts. Side effects include fatigue and swelling or a sunburn-like feeling where you were treated.

This treatment uses drugs to kill cancer cells anywhere in the body. They’re often given by IV, but they can be taken by mouth or a shot. You might have it before surgery to shrink a large tumor or after to lower the odds of your cancer coming back. In women with advanced breast cancer, chemo can help control the cancer’s growth. Side effects may include hair loss, nausea, fatigue, and a higher risk of infection.

This is for women with ER-positive or PR-positive breast cancer. These cancers grow faster in response to the hormones estrogen or progesterone. Hormone therapy can block this effect. It might be used after surgery to help keep the cancer from coming back. Doctors sometimes give it to women with high risk factors to reduce the chances of getting breast cancer.

These newer drugs pinpoint specific things inside cancer cells. For example, women with HER2-positive breast cancer have too much of a protein called HER2. Targeted therapies can stop this protein from making cancer cells grow. These drugs are often used along with chemo because they tend to have milder side effects.

This turns your body’s own disease-fighting powers against cancer. Drugs called immune checkpoint inhibitors target certain proteins on immune system cells. They make it harder for cancer cells to evade attacks. Immunotherapy is sometimes used to treat advanced cancer. 

There’s no doubt that cancer is a life-changing experience. The treatments can wear you out. You may have trouble managing daily chores, work, or social outings. This can make you feel isolated. It’s crucial to reach out to friends and family for support. They may be able to go with you to treatments, help out with chores, or just remind you that you aren't alone. Many people choose to join a support group, either near them or online.

Many women who have a breast removed choose to get reconstructive surgery. This replaces the skin, nipple, and breast tissue that are lost during a mastectomy. It can be done with a breast implant or with tissue from somewhere else in your body, like your tummy. Some women start the process right after their mastectomy. But you can also get it months or years later.

Instead of reconstruction, you can be fitted for a breast form. This is a breast-shaped prosthesis that fits inside your bra. Wearing one allows you to have a balanced look when you’re dressed. Like the surgery, breast forms are often covered by insurance.

The most obvious risk factor for breast cancer is being a woman. Men get the disease, too, but it’s about 100 times more common in women. Other things that make it more likely include being over age 55 or having a close relative who had the disease. Still, up to 80% of women with breast cancer have no family history of the illness.

Some women have a high risk of breast cancer because they got changes, or mutations, in certain genes at birth. The genes most often involved in breast cancer are known as BRCA1 and BRCA2. Women with mutations in these genes have a higher chance of getting breast cancer at some point in life than those who don’t. Other genes may be linked to breast cancer risk as well.

Women who breast-feed their children for the recommended length of time (6 months exclusively and up to 2 years or beyond partially) can reduce their risk of breast cancer by 25%. You can also reduce your risk by maintaining a low BMI and by getting exercise. You should also cut back on the amount of alcohol you drink. Birth control pills and some forms of hormone therapy after menopause can boost the odds. But the risk seems to go back to normal after you stop these medications. Good lifestyle choices can help survivors, too. Research says physical activity can lower the chances your cancer will return. And it's a proven mood-booster, too.

Doctors continue to search for treatments that work better and are easier to undergo. Funding for this research comes from many sources, including advocacy groups throughout the country. Many of the 3.8 million breast cancer survivors and their families choose to participate in walk-a-thons and other fundraising events. This links each individual fight against cancer into a common effort for progress.