Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.

Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.

Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.

Kinds of Breast Cancer

The most common kinds of breast cancer are—

• Invasive ductal carcinoma. The cancer cells grow outside the ducts into other parts of the breast tissue. Invasive cancer cells can also spread, or metastasize, to other parts of the body.
• Invasive lobular carcinoma. Cancer cells spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.

There are several other less common kinds of breast cancer, such as Paget’s disease, medullary, mucinous, and inflammatory breast cancer.

Ductal carcinoma in situ (DCIS) is a breast disease that may lead to breast cancer. The cancer cells are only in the lining of the ducts, and have not spread to other tissues in the breast.

ductal carcinoma

The most common type of breast cancer. It begins in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple). Ductal carcinoma may be either ductal carcinoma in situ (DCIS) or invasive ductal carcinoma. DCIS is a noninvasive condition in which abnormal cells are found in the lining of a breast duct and have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer. In invasive ductal carcinoma, cancer has spread outside the breast duct to surrounding normal tissue. It can also spread through the blood and lymph systems to other parts of the body.

Ductal Carcinoma in Situ (DCIS)

Ductal carcinoma in situ (DCIS) is a noninvasive breast condition in which abnormal cells are found inside the breast duct but have not spread outside it. DCIS is also called intraductal breast carcinoma or stage 0 breast carcinoma in situ. Although the cells are abnormal, they are not considered cancer because they do not have the ability to break through the duct wall or spread in the body, which is the definition of cancer. DCIS may sometimes become invasive breast cancer and spread to other tissues.

Doctors diagnose some cases of DCIS as being at lower risk of becoming invasive than others. However, since doctors don’t currently know for sure which cases of DCIS will become invasive cancer and which ones won’t, DCIS is almost always treated. Because research is ongoing and you have choices about treatment, it may be helpful to get a second opinion, discuss your treatment options with more than one doctor, and learn about clinical trials for DCIS.

lobular carcinoma

Cancer that begins in the lobules (milk glands) of the breast. Lobular carcinoma may be either lobular carcinoma in situ (LCIS) or invasive lobular carcinoma. LCIS is a noninvasive condition in which abnormal cells are found in the lobules of the breast. LCIS rarely becomes invasive cancer, but having LCIS in one breast increases the risk of developing invasive cancer in either breast. In invasive lobular carcinoma, cancer has spread from the lobules to surrounding normal tissue. It can also spread through the blood and lymph systems to other parts of the body.

Lobular Carcinoma in Situ

A condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer. However, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast. Also called LCIS.

Introduction

Invasive lobular carcinoma is the second most common histologic form of breast cancer, representing 5% to 15% of all invasive breast cancers. It is composed of non-cohesive cells individually dispersed or organized in a single-file linear pattern in a fibrous stroma. Invasive lobular carcinoma is usually associated with lobular carcinoma in situ. It is now recognized as a biologically distinct disease from the more common invasive ductal carcinoma, with unique molecular pathogenesis and consequential implications on diagnosis and treatment. An understanding of these differences is crucial to tailor management strategies.

Etiology

Molecular studies have been instrumental in highlighting the role of E-cadherin inactivation in the development of lobular lesions and in supporting the notion that lobular carcinoma in situ and atypical lobular hyperplasia are, nonobligate precursors for the development of invasive cancer, rather than being simply risk indicators for invasive disease.

Germline CDH1 mutations and the role of genes of the phosphatidylinositol 3-kinase pathway, PIK3CA in the development of lobular breast cancer, is considered important.

Epidemiology

The incidence of breast cancer according to GLOBOCAN 2018 in the world is 46.3 per 100,000 inhabitants, while in the United States the incidence is 84.9 cases per 100,000 inhabitants, and a death rate of 12.7 deaths per 100,000 - which is the second leading cause for death among all cancers after lung cancer. Lobular carcinoma of the breast represents approximately 5% to 15% of all invasive breast cancers, with an average age at diagnosis three years greater than invasive ductal carcinoma. In recent studies, they found that lobular tumors are more likely to be Luminal A between 45% to 51%, these, in turn, are less frequent in young (≤ 50 years) and Black women, and are larger, low grade, with less frequency of TP53 pathway defects and with a tendency to be diagnosed in late stages.

Pathophysiology

Infiltrating lobular breast cancer has low rates (0 to 11%) of complete pathological response after neoadjuvant chemotherapy. The positive resection margins after breast conservation surgery are relatively frequent. 17% to 65% of the cases undergo another surgical intervention. The detection rates of mutations in CDH1/E-cadherin range between 12% and 83%. Several additional molecular factors, namely TP53, PIK3CA, FOXA1, ZNF703, FGFR1, and BCAR4, have been linked to infiltrating lobular breast cancer or the evolution of lobular carcinoma in situ to invasive cancer.

Histopathology

Macroscopic Findings

Invasive lobular carcinomas frequently present as irregular and poorly delimited tumors that can be difficult to define macroscopically because of the diffuse growth pattern of the cell infiltrate. The size of the ILC is additionally difficult to work out, although it has been reported to be slightly larger than that of invasive carcinoma of no special type in some series.

Microscopic Findings

Invasive lobular carcinoma is histologically characterized by a proliferation of small cells lacking cohesion and are often dispersed individually through a fibrous connective tissue or organized in single-file linear cords invading the stroma. The infiltrating cords often present a concentric pattern around normal ducts. There is usually little host reaction of the background architecture. The neoplastic cells have round or notched ovoid nuclei and a thin rim of cytoplasm with an occasional intracytoplasmic lumen, often harboring a central mucoid inclusion. Mitoses are typically infrequent.

Histological Variants

Several variants of invasive lobular carcinoma have been described that share either the cytological or growth pattern of classic invasive lobular carcinoma, but all lack cell-to-cell cohesion.

1. Solid type

2. Pleomorphic lobular carcinoma

3. Tubulo-lobular variant

4. Alveolar variant

5. Mixed type

Immunoprofile

Although the literature suggests that 80% to 95% of invasive lobular carcinomas are positive for estrogen receptor (ER), in current practice, classic invasive lobular carcinomas are almost invariably ER-positive. In comparison, 70-80% of invasive carcinoma of nos special type are ER-positive. Progesterone receptor (PR) positivity is found in 60% to 70% of both tumor types.

HER2 overexpression and amplification are rare in invasive lobular carcinoma, although evident in some pleomorphic lobular carcinomas.

The expression of p53, basal markers (keratin 14, keratin 5/6, EGFR) and myoepithelial markers (smooth muscle actin, and p63), is rare in invasive lobular carcinoma.

The proliferation rate, measured by MIB1/Ki67 labeling, is generally low in invasive lobular carcinoma, although higher in the variants.

One of the most consistent molecular alterations in invasive lobular carcinoma and its variants is the loss of expression of the cell-cell adhesion molecule E-cadherin, which contributes to the characteristic discohesive nature of lobular cells.

Histological Grading

Histologic grading of invasive lobular carcinomas consistent with the Nottingham system is suggested, although it clearly correlates with the nuclear grade. Pure lobular tumors receive a 3 for tubule formation, only nuclear grade 1 lesion is of histologic grade 1, whereas the majority of invasive lobular carcinomas display nuclear grade 2, qualifying thus for a histologic grade 2. Because the mitotic rate is low, except for some pleomorphic invasive lobular carcinomas, few tumors are of histologic grade 3.

History and Physical

Patients with invasive lobular carcinoma present with a mass or vague, diffuse nodularity. They are also detectable by mammographic breast screening. The gross pathologic and clinical features of invasive lobular carcinoma are similar to other forms of invasive breast cancer.

Invasive lobular cancer tends to stay clinically silent and escapes detection on a mammogram or physical examination until the disease is detected at advanced stages. This is secondary to the indolent growth and to the pattern of infiltrative growth of this neoplasm, which makes early diagnosis difficult with a mammogram.

Patients in advanced stages have a palpable mass, sometimes with a slight thickening of the nipple or an exudative scab on the skin, other changes in the skin such as flushing, swelling, the probability of metastasis within the axillary or supraclavicular lymph nodes. Therefore, the doctor should examine the patient very well so that nothing relevant is lost.

It is very important to note that patients with gastric symptoms and a medical history of mammary cancer, namely invasive lobular carcinoma, should undergo a regular check-up with upper digestive endoscopy to detect gastric metastases.

Evaluation

The challenge with invasive lobular carcinomas is that they can be difficult to detect clinically and radiographically, and consequently tend to be larger at the time of diagnosis. They are often poorly circumscribed and can be missed on fine-needle aspiration and needle core biopsies due to low cellularity and the bland nature of the tumor cells.

Mammography

It is often difficult to diagnose invasive lobular carcinoma by mammography with higher false-negative rates than for other invasive cancers.

The mammographic presentations of invasive lobular carcinoma include:

• A mass (up to 65% of cases) with irregular margins mostly speculated but sometimes circumscribed

• Architectural distortion and asymmetric, focal density

• Microcalcifications are uncommon (0 to 24%)

• Normal or benign mammographic findings in invasive lobular carcinoma are reported in 8 to 16% of cases.

Ultrasonography

The different presentations of invasive lobular carcinoma on ultrasonography are:

• A hypoechoic mass with irregular or indistinct margins and posterior acoustic shadowing (60%)

• Shadowing with no appearance of a mass (15 to 18%)

• Well-circumscribed mass lesions (9 to 13%)

• Ultrasonographically invisible (approximately 10%)

In one study, when investigating the role of ultrasound screening as an adjunct to annual mammography in detecting breast cancer in women with a history of lobular neoplasia diagnosed after BACAF or an excisional biopsy, it was found to improve sensitivity and the negative predictive value when used together. (Sensitivity: 83%, Specificity: 72%, Negative Predictive Value: 97%).

Magnetic Resonance Imaging

MRI is useful in estimating the extent of invasive lobular carcinoma since it determines tumor margins, size, and multifocality more accurately than ultrasound and mammography.

The preoperative magnetic resonance is more effective in the detection of contralateral breast cancer in an early stage with positive hormone receptors in older women at high risk of breast cancer.

The most frequent manifestation of invasive lobular carcinoma is an enhancing solitary nodule with spiculated or ill-defined margins.

Significant correlations between histology and MRI enhancement patterns have been demonstrated. Classic invasive lobular carcinomas with tumor cells streaming along septa are visualized at MRI as enhancing septa without a dominant tumor focus.

Treatment / Management

The treatment of invasive lobular carcinomas has been a topic of debate due to the potential bilaterality and multifocality that characterize these tumors. Determining the extent of invasive lobular carcinoma is very important in deciding the treatment modality. The multidisciplinary approach to the treatment includes surgery, hormonal therapy, radiation therapy, and chemotherapy. It is a relatively slow-growing cancer that provides ample time to treat with the help of different modalities of management available.

Mastectomy/lumpectomy is the treatment of choice of invasive lobular carcinomas in most large series, and prophylactic contralateral mastectomy is not infrequently performed. If adequate preoperative investigations exclude extensive multifocal and contralateral disease, conservative treatment is most appropriate for invasive lobular carcinomas. The wider negative margins are not necessary in cases of invasive lobular cancer.

Surgery and radiotherapy provide locoregional control. Markedly decreased amount of fibrotic reaction in the invasive lobular carcinomas makes it difficult for the panel of treating surgeons and pathologists to estimate the expansion of the disease while operating on the tumor and get tumor-free margins after mastectomy/lumpectomy. The course of surgery, regardless of histology, is determined by the TNM stage at presentation. Operable cancer may be approached with upfront surgery if amenable, or undergo surgery after preoperative neoadjuvant therapy, if appropriate. Invasive lobular carcinoma can be treated similarly to invasive ductal carcinoma with surgical excision followed by radiation therapy for early-stage disease.

Adjuvant hormone therapy is also indicated, given the high percentage of cases that are positive for ER and PR.

Chemotherapy is of limited benefit for patients with invasive lobular carcinoma, owing to the low proliferation rates observed in the vast majority of classic invasive lobular carcinoma.

The factors like age, lymph nodes status, tumor size, Ki-67 biomarker, hormonal status can be associated with both recurrence and survival, and histology alone cannot be considered the only predictor.

Differential Diagnosis

The differential diagnoses of invasive lobular carcinoma include both carcinomatous and non-carcinomatous neoplasms :

• Invasive ductal carcinoma with lobular features

• Gastric signet ring carcinoma metastatic to the breast

• Sclerosing epithelioid fibrosarcoma

• Leukemic and lymphomatous involvement of the breast

• Rosai-Dorfman disease

• Granular cell tumor

Surgical Oncology

Breast-conserving surgery (wide local excision) with radiotherapy or mastectomy, depending on the site and size of the tumor and patient choice, is an adequate treatment modality for invasive lobular carcinomas as for other invasive breast cancers. Nonrandomized studies reported that patient survival and local recurrence rates are similar to those of ductal/no special type carcinoma at 5 years when managed by breast-conserving surgery therapy. However, late recurrences in patients who were followed up for 10 years have been reported. Conversion from wide local excision to mastectomy because of positive margins after re-excision has been reported as being required more frequently in patients treated for invasive lobular carcinoma by initial breast-conserving surgery. This is particularly the case for those who have been treated with neoadjuvant chemotherapy; approximately 50% of patients with invasive lobular carcinoma in some series required completion mastectomy to obtain complete excision of disease, due to incomplete resection margins after neoadjuvant therapy. There is also evidence that invasive lobular carcinoma may intrinsically be less responsive to neoadjuvant chemotherapy than invasive carcinoma of ductal/no special type. Conversely, a better response to adjuvant endocrine therapy is described, with a greater improvement in survival in patients with invasive lobular carcinoma receiving hormone therapy compared with those matched patients with ductal/no special type breast cancers.

Radiation Oncology

Radiation therapy following breast-conserving surgery remains the quality of care. It not only decreases the prospect of recurrence within the breast but also improves overall survival.

The substitution of hormonal therapy for radiotherapy could also be a good option in older women with a very limited life expectancy.

Standard fractionation involves extending the radiation over six to 6.5 weeks.

A boost dose of radiation to the lumpectomy site tends to decrease recurrences within the breast. The absolute benefit of the additional radiation is greater in younger women.

Treatment Planning

Although the overarching concepts of treatment are common amongst all breast cancer histological types, most surgeons favor mastectomy relating to factors specific to the patient and other pathological findings. The largely estrogen receptor-positive phenotype of invasive lobular carcinoma is central to the principles of management and the observed responses.

Medical Oncology

Leptomeningeal carcinomatosis(LC) is one of the rare but possible manifestations of the metastasis of ILC. LC commonly presents an initial symptom of headache and requires CSF cytological workup and analysis along with MRI. It is usually responsive to intra-CSF chemotherapy, radiotherapy and supportive care.

Considering a fair chance to development of hypothyroidism due to radiotherapy involving or not involving the supraclavicular region, monitoring the routine thyroid function such patients regardless of treatment status is recommended taking into consideration the risk as compared to the general population.

Staging

Staging of invasive lobular carcinoma of the breast is established clinically by imaging studies and physical examination before treatment and is determined pathologically based on histopathological examination of the primary tumor and regional lymph nodes after surgery.

The most commonly used clinical staging system for invasive lobular breast carcinoma is the one adopted by the American Joint Commission on Cancer (AJCC) and the International Union for Cancer Control.

Its basis is the TNM system (T, tumor; N, nodes; M, metastases). T, N, and M are compound to make five stages (stage 0, I, II, III, and IV) that reveal information about the extent of the regional neoplasm (tumor size, nodal involvement, chest-wall invasion, or skin involvement) and metastasis to distant sites.

Prognosis

Several studies have shown that invasive lobular carcinoma has the same, better, or worse prognosis than invasive ductal carcinoma. Part of this may depend on the time of follow-up and sample size because lobular carcinoma is associated with lower early local recurrence rates and a lower rate of axillary lymph node involvement at the time of diagnosis.

Lobular carcinoma often metastasizes to the ovary, gastrointestinal tract, uterus, serosal cavities, meninges, or bone than to the regional lymph nodes or lungs.

Older age (aged > 60 years) of the patients, larger tumor size, and metastatic axillary lymph node involvement have been suggested as poor prognostic factors.

Limited series reported that pleomorphic is an aggressive tumor with a frequent recurrence rate and death of patients from disease.

Complications

Axillary Nodal Metastasis

A lower frequency of axillary nodal metastasis in invasive lobular carcinoma than in invasive carcinoma of no special type has been reported in some series, the difference ranging from 3% to 10%.

Distant Metastasis

Metastases of invasive lobular carcinoma differ from those of invasive carcinoma of no special type. A higher frequency of tumor extension to the bone, gastrointestinal tract, uterus, meninges, ovary, and diffuse serosal involvement is observed in invasive lobular carcinoma, while the extension to the lung is more frequent in invasive carcinoma of no special type.

Postoperative and Rehabilitation Care

Breast Cancer Postoperative Care

Drain and Wound Care

Patients should receive appropriate instruction in the management of several types of wound coverage. Since surgeons often close wounds with absorbable stitches, stitch removal is not needed. We recommend that patients should shower two days after surgical intervention, including simple mastectomies and breast-conserving surgery. At the time of surgery, flexible tube drains are placed under the skin. Their role is to remove all sorts of fluids that accumulate at the site of surgery. The drain will be taken off after one to two weeks in the clinic when the drainage is minimal.

Patients should consult a doctor if there is:

• Fever (greater than or equal to 38 degrees C)

• Swelling or redness around the operation site

• Discharge around the drain site or from the wound

• Wound breakdown at the wound site

• Pain increased at the operation site

Medication and DietThe medications prescribed by doctors usually continue after surgery, and there are some diet restrictions.

Rehabilitation and Activity

Patients are encouraged to carry on normal mobility and function as early as it is possible after surgical intervention. The majority of patients with simple mastectomies and breast-conserving surgery will be able to carry on usual daily activities just after surgery, with some precautions for those with breast reconstruction.

Arm Exercise Program

The exercises promote the lymphatic system and circulation, hence preventing swelling of the concerned arm. In the first few weeks after discharge, patients should avoid over-strenuous activities.

Arm and Hand Care

Following axillary surgery, lymphedema, and increased risk of infection of the arm may occur. Hence, extra care to protect the arm and the hand on the operated side from injury is recommended. Patients usually receive a referral to a physical or occupational therapist specially-trained in treating lymphedema.

Physical Appearance

With a mastectomy, physical appearance can be maintained by undergoing breast reconstruction or wearing a prosthesis.

A type of invasive breast cancer that begins in the lobules (milk glands) of the breast and spreads to surrounding normal tissue. It can also spread through the blood and lymph systems to other parts of the body. Also called infiltrating lobular carcinoma.

What is breast cancer?

This cancer starts in the tissues of the breast. Breast cancer is the most frequently diagnosed cancer and the second cause of cancer deaths in women. In 2010, 207,090 women were estimated to have been diagnosed with invasive breast cancer in the United States and approximately 40,000 women were estimated to have died of their disease.

Men can also have breast cancer, although male breast cancer is rare. In 2010, 1,970 American men were estimated to have been diagnosed and 390 were estimated to have died of breast cancer.¹ Due to early detection through use of mammograms and improvements in treatment, breast cancer deaths have steadily decreased since the 1990s. Additional information on breast cancer.

TCGA focused mainly on two types of invasive breast cancer: ductal carcinoma and lobular carcinoma. Invasive ductal carcinoma is the most common type of breast cancer. It comprises about 65–85% of all breast cancer and develops in the milk ducts of the breast. About 10% of all cases of advanced breast cancer are invasive lobular breast carcinoma. This cancer develops in the breast milk-producing lobules or glands.

What have TCGA researchers learned about lobular carcinoma?

• Genomic characteristics of lobular carcinoma distinguish it from the more common ductal carcinoma, providing unique opportunities for targeted therapy:
  • All lobular carcinoma tumors were defined by loss of cell-to-cell adhesion protein E-cadherin through varied routes of genomic disruption.
  • Lobular carcinomas demonstrated frequent mutations in different genes involved in estrogen receptor signaling compared to ductal carcinoma, suggesting that these tumor types may rely on different mechanisms to activate estrogen receptor-mediated gene expression.
  • Lobular carcinomas contained a greater degree of Akt signaling pathway activation than ductal carcinomas, indicating that lobular carcinoma may have increased sensitivity to Akt pathway inhibitors.
• Three subtypes of lobular carcinoma: reactive-like, immune-related, and proliferative, show distinct clinical outcomes.
  • The reactive-like subtype was associated with the best outcomes and the proliferative was associated with the poorest.
• Tumors that could not be identified as lobular or ductal based on histology were a mixed subtype, as they could be grouped with either lobular or ductal types based on their molecular features.

Breast pain can be a symptom of cancer. If you have any symptoms that worry you, be sure to see your doctor right away.

Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.

Some warning signs of breast cancer are—

• New lump in the breast or underarm (armpit).
• Thickening or swelling of part of the breast.
• Irritation or dimpling of breast skin.
• Redness or flaky skin in the nipple area or the breast.
• Pulling in of the nipple or pain in the nipple area.
• Nipple discharge other than breast milk, including blood.
• Any change in the size or the shape of the breast.
• Pain in any area of the breast.

Keep in mind that these symptoms can happen with other conditions that are not cancer.

If you have any signs or symptoms that worry you, be sure to see your doctor right away.

What Is a Normal Breast?

No breast is typical. What is normal for you may not be normal for another woman. Most women say their breasts feel lumpy or uneven. The way your breasts look and feel can be affected by getting your period, having children, losing or gaining weight, and taking certain medications. Breasts also tend to change as you age. For more information, see the National Cancer Institute’s Breast Changes and Conditions.

What Do Lumps in My Breast Mean?

Many conditions can cause lumps in the breast, including cancer. But most breast lumps are caused by other medical conditions. The two most common causes of breast lumps are fibrocystic breast condition and cysts. Fibrocystic condition causes noncancerous changes in the breast that can make them lumpy, tender, and sore. Cysts are small fluid-filled sacs that can develop in the breast.

Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.

Some women will get breast cancer even without any other risk factors that they know of. Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.

Risk Factors You Cannot Change

• Getting older. The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.
• Genetic mutations. Inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2. Women who have inherited these genetic changes are at higher risk of breast and ovarian cancer.
• Reproductive history. Early menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
• Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
• Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
• Family history of breast cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
• Previous treatment using radiation therapy. Women who had radiation therapy to the chest or breasts (like for treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.
• Women who took the drug diethylstilbestrol (DES), which was given to some pregnant women in the United States between 1940 and 1971 to prevent miscarriage, have a higher risk. Women whose mothers took DES while pregnant with them are also at risk.

Risk Factors You Can Change

• Not being physically active. Women who are not physically active have a higher risk of getting breast cancer.
• Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight.
• Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Certain oral contraceptives (birth control pills) also have been found to raise breast cancer risk.
• Reproductive history. Having the first pregnancy after age 30, not breastfeeding, and never having a full-term pregnancy can raise breast cancer risk.
• Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks.

Research suggests that other factors such as smoking, being exposed to chemicals that can cause cancer, and changes in other hormones due to night shift working also may increase breast cancer risk.

Who Is at High Risk for Breast Cancer?

If you have a strong family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, you may have a high risk of getting breast cancer. You may also have a high risk for ovarian cancer.

Talk to your doctor about ways to reduce your risk, such as medicines that block or decrease estrogen in your body, or surgery.

Many factors over the course of a lifetime can influence your breast cancer risk. You can’t change some factors, such as getting older or your family history, but you can help lower your risk of breast cancer by taking care of your health in the following ways—

• Keep a healthy weight.
• Be physically active.
• Choose not to drink alcohol, or drink alcohol in moderation.
• If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and find out if it is right for you.
• Breastfeed your children, if possible.
• If you have a family history of breast cancer or inherited changes in your BRCA1 and BRCA2 genes, talk to your doctor about other ways to lower your risk.

Staying healthy throughout your life will lower your risk of developing cancer, and improve your chances of surviving cancer if it occurs.

Breast cancer screening means checking a woman’s breasts for cancer before there are signs or symptoms of the disease. All women need to be informed by their health care provider about the best screening options for them. When you are told about the benefits and risks of screening and decide with your health care provider whether screening is right for you—and if so, when to have it—this is called informed and shared decision-making.

Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast cancer screening tests are right for you, and when you should have them.

Breast Cancer Screening Recommendations

The United States Preventive Services Task Force (USPSTF) is an organization made up of doctors and disease experts who look at research on the best way to prevent diseases and make recommendations on how doctors can help patients avoid diseases or find them early.

The USPSTF recommends that women who are 50 to 74 years old and are at average risk for breast cancer get a mammogram every two years. Women who are 40 to 49 years old should talk to their doctor or other health care professional about when to start and how often to get a mammogram. Women should weigh the benefits and risks of screening tests when deciding whether to begin getting mammograms before age 50.

Breast Cancer Screening Tests

Mammogram

A mammogram is an X-ray of the breast. Mammograms are the best way to find breast cancer early, when it is easier to treat and before it is big enough to feel or cause symptoms. Having regular mammograms can lower the risk of dying from breast cancer. At this time, a mammogram is the best way to find breast cancer for most women.

Breast Magnetic Resonance Imaging (MRI)

A breast MRI uses magnets and radio waves to take pictures of the breast. MRI is used along with mammograms to screen women who are at high risk for getting breast cancer. Because breast MRIs may appear abnormal even when there is no cancer, they are not used for women at average risk.

Other Exams

Clinical Breast Exam

A clinical breast exam is an examination by a doctor or nurse, who uses his or her hands to feel for lumps or other changes.

Breast Self-Awareness

Being familiar with how your breasts look and feel can help you notice symptoms such as lumps, pain, or changes in size that may be of concern. These could include changes found during a breast self-exam. You should report any changes that you notice to your doctor or health care provider.

Having a clinical breast exam or doing a breast self-exam has not been found to lower the risk of dying from breast cancer.

Benefits and Risks of Screening

Every screening test has benefits and risks, which is why it’s important to talk to your doctor before getting any screening test, like a mammogram.

Benefit of Screening

The benefit of screening is finding cancer early, when it’s easier to treat.

Risks of Screening

Harms can include false positive test results, when a doctor sees something that looks like cancer but is not. This can lead to more tests, which can be expensive, invasive, time-consuming, and may cause anxiety.

Tests also can lead to overdiagnosis, when doctors find a cancer that would not have gone on to cause symptoms or problems, or even may go away on its own. Treatment of these cancers is called overtreatment. Overtreatment can include treatments recommended for breast cancer, such as surgery or radiation therapy. These can cause unnecessary and unwanted side effects. Other potential harms from breast cancer screening include pain during the procedure and radiation exposure from the mammogram test itself. While the amount of radiation in a mammogram is small, there may be risks with having repeated X-rays.

Mammograms may also miss some cancers, called false negative test results, which may delay finding a cancer and getting treatment.