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Understanding Breast Cancer Guide

The Understanding Breast Cancer Guide provides an overview of the Understanding Breast Cancer section to give you quick access to areas of interest.

Breast Facts

The Breast and Breast Cancer	Other Breast Conditions
Introduction Structure and function of the breasts What is cancer? What is breast cancer? Invasive cancer Non-invasive breast cancer (ductal carcinoma in situ, DCIS) What are the warning signs of breast cancer?	Lobular carcinoma in situ (LCIS) Benign breast conditions (benign breast disease) Hyperplasia Cysts Fibroadenomas Intraductal papillomas Sclerosing adenosis Radial scars Benign phyllodes tumor Diabetic mastopathy (lymphocytic mastitis, sclerosing lymphocytic lobulitis)
Breast Cancer Statistics	Breast Facts for Men
Breast cancer statistics Breast cancer in the U.S. Breast cancer in women Breast cancer in men Time trends of breast cancer in the U.S. Rates of breast cancer over time Mammography and rates of early detection over time Race/ethnicity and breast cancer rates over time Male breast cancer rates over time Geographic variation in breast cancer rates Worldwide variation Variation within the U.S. Race/ethnicity and breast cancer rates Migration to the U.S. and breast cancer rates African American women Ashkenazi Jewish women Asian American and Pacific Islander women Hispanic/Latina women American Indian and Alaskan Native women Lesbian, gay and bisexual women Transgender people Age and breast cancer Younger women Pregnant women Glossary References	Breast facts for men Male breast cancer in the U.S. Warning signs of male breast cancer Types of male breast cancer Benign breast conditions in men Gynecomastia Risk factors for male breast cancer Age Klinefelter’s syndrome BRCA2 gene mutations and family history of breast cancer Gynecomastia Other risk factors

Risk Factors and Prevention

Understanding Risk and Prevention	Summary Tables of Risk Factors
Introduction Understanding risk Breast Cancer Risk Assessment Tool (Gail model) Understanding breast cancer prevention	Breast cancer risk factors table Risk factors summary table of relative risks
Topics for People at Higher Risk of Breast Cancer	Other Issues Related to Breast Cancer Risk
Gene mutations and genetic testing Options for women at higher risk More frequent or earlier screening Preventive surgery Risk-lowering drugs (tamoxifen and raloxifene)	Healthy behaviors Race and ethnicity Breast cancer risk among lesbian, gay and bisexual women Breast cancer and the environment Emerging areas in estimating risk and risk reduction Questions for your provider Glossary References
Factors that Affect Breast Cancer Risk (listed alphabetically, in order of level of evidence and strength of association)	Factors that Do Not Increase Breast Cancer Risk
Age Being female Inherited gene mutations Family history of breast, ovarian or prostate cancer Breast density on mammogram Benign breast conditions (benign breast disease, hyperplasia) Lobular carcinoma in situ (LCIS) Personal history of breast cancer or other cancers Radiation treatment (radiation exposure) Childbearing (age at first birth and number of children) Blood estrogen levels Age at first period Age at menopause Drinking alcohol Ashkenazi Jewish heritage Body weight and weight gain Birth control pill use Height Socioeconomic status Menopausal hormone therapy (postmenopausal hormone use) Breastfeeding Blood androgen levels Bone density Light at night and shift work Exercise (physical activity) Breast cancer risk factors table	Factors that do not increase breast cancer risk Abortion Blood organochlorine levels (exposure to certain types of pesticides and industrial chemicals) Breast implants Electromagnetic fields (EMF) Hair dyes Breast cancer risk factors table
Factors Under Study	Factors Not Likely Related to Risk
Factors under study Antibiotic use Aspirin use Birthweight (a person's weight at birth) Body care cosmetics containing parabens Breast size Caffeine Cell phone use Dairy products Dietary fat Folic acid (folate) and multivitamin use French fry consumption Fruits, vegetables and carotenoids Glycemic index and insulin Hair relaxers In utero exposure to DES and breast cancer risk among offspring Left-handedness Meat consumption Migraine headaches Protein hormones (prolactin and IGF-1) Secondhand smoke Smoking Soy and phytoestrogens Stress Vitamin D Breast cancer risk factors table	Factors not likely related to risk Bras/underwire bras Breast milk (having been breastfed as an infant) Deodorant/antiperspirant use Fertility drugs Plastics Trauma to the breast Breast cancer risk factors table
Risk Factors Research Tables	Risk-Lowering Drugs (Chemoprevention) Research Tables
Table 1: Body weight and breast cancer risk Table 2: Weight gain and breast cancer risk Table 3: Alcohol and breast cancer risk Table 4: Physical activity and breast cancer risk Table 5: Breastfeeding and breast cancer risk Table 6: Blood estrogen levels and breast cancer risk Table 7: Blood androgen levels and breast cancer risk Table 8: Menopausal hormone therapy (postmenopausal hormone use) and breast cancer risk Table 9: Birth control pills and breast cancer risk Table 10: Age at menopause and breast cancer risk Table 11: BRCA1 and BRCA2 gene mutations and cancer risk Table 12: Hyperplasia and breast cancer risk Table 13: Light at night/shift work and breast cancer risk Table 14: Dairy products and breast cancer risk Table 15: Dietary fat and breast cancer risk Table 16: Fruits and vegetables and breast cancer risk Table 17: Carotenoids and breast cancer risk Table 18: Meat and breast cancer risk Table 19: Soy and breast cancer risk Table 20: Vitamin D and breast cancer risk Table 21: IGF-1 and breast cancer risk Table 22: Smoking and breast cancer risk Table 23: Secondhand smoke and breast cancer risk Table 24: Hair dyes and breast cancer risk Table 25: Abortion and breast cancer risk Table 26: Electromagnetic fields and breast cancer risk Table 27: Blood organochlorine levels and breast cancer risk Table 28: Breast implants and breast cancer risk	Table 29: Chemoprevention—the use of tamoxifen and raloxifene to reduce the risk of breast cancer

Early Detection and Screening

Screening Tests	Screening Recommendations
Mammography Digital mammography Dense breast tissue Follow-up after an abnormal mammogram Accuracy of mammograms The mammography debate Low-cost and free mammograms Calcifications (and microcalcifications) MRI Clinical breast exam Follow-up after an abnormal clinical breast exam	For women at average risk For women at higher risk Lobular carcinoma in situ (LCIS) or atypical hyperplasia BRCA1 or BRCA2 gene mutation Strong family history Past radiation treatment Li-Fraumeni, Cowden or Bannayan-Riley-Ruvalcaba syndrome Personal history of breast cancer (including DCIS) Dense breast tissue For men at higher risk due to an inherited gene mutation or strong family history
Other Issues Related to Early Detection and Screening	Clinical Trials
What to do if you find a lump Breast self-exam Disparities in breast cancer screening Quality of screening tests Emerging areas in early detection Questions for your provider Glossary References	Clinical trials The importance of clinical trials Benefits of clinical trials Taking part in a clinical trial Questions to ask your health care provider and the clinical trial research coordinator, nurse or physician Who sponsors clinical trials Where to find a clinical trial
Research Tables
Table 30a: Breast cancer screening with mammography for women 40-49 Table 30b: Breast cancer screening with mammography for women 50-69 Table 31: Digital mammography vs. film mammography for breast cancer screening Table 32: Breast MRI plus mammography vs. mammography alone in some women at high risk

Diagnosis

Types of Biopsies	Pathology Reports
Biopsies Needle biopsies Core needle biopsy Fine needle aspiration (fine needle biopsy) Surgical biopsies Excisional biopsy Incisional biopsy How can a biopsy miss breast cancer?	What is a pathology report? Contents of a pathology report
Factors that Affect Treatment Decisions and Prognosis	How is Breast Cancer Staged?
Introduction Lymph node status Tumor size Tumor grade Tumor type (where are the cancer cells and how do they look in the lab) Tumor characteristics Hormone receptor status (estrogen receptor status and progesterone receptor status) HER2/neu status Proliferation rate Tests for metastases Oncotype Dx	Staging of breast cancer Tumor size Lymph node status Metastasis Stages Chances for survival based on breast cancer stage Distribution of breast cancer stages in the population
Types of Tumors	Clinical trials
Types of tumors Ductal carcinoma in situ (DCIS) Invasive ductal carcinoma (IDC) Invasive lobular carcinoma (ILC) Medullary carcinoma Mucinous (colloid) carcinoma Papillary carcinoma Tubular carcinoma Inflammatory breast cancer Paget disease of the breast (Paget disease of the nipple) Metaplastic breast cancer Other types of cancer that occur in the breast Molecular subtypes of breast cancer Triple negative breast cancer	Clinical trials The importance of clinical trials Benefits of clinical trials Taking part in a clinical trial Questions to ask your health care provider and the clinical trial research coordinator, nurse or physician Who sponsors clinical trials Where to find a clinical trial
Other Issues Related to Diagnosis	Research Tables
Emerging areas in diagnosis Quality of life issues Diagnosis during pregnancy Questions for your provider Glossary References	Table 33: Lymph node status and breast cancer survival Table 34: Accuracy of sentinel node biopsy in predicting axillary lymph node status Table 35: Tumor size and breast cancer survival Table 36: Estrogen receptor status and overall survival

Treatment

Overview of Treatment Options	Types of Treatment for Different Stages of Breast Cancer
Introduction Surgery Lumpectomy Mastectomy Breast reconstruction Radiation therapy Chemotherapy Chemotherapy drugs Hormone therapies Tamoxifen Aromatase inhibitors Ovarian suppression (therapies that stop the ovaries from producing hormones) Targeted therapies Trastuzumab (Herceptin) Lapatinib (Tykerb) and other tyrosine-kinase inhibitors Neoadjuvant (preoperative) therapies Personalized medicine - tailoring breast cancer treatment Emerging therapies	Treatment options for different stages of breast cancer Ductal carcinoma in situ (DCIS, stage 0) Early breast cancer (stage I and II) Locally advanced/inflammatory breast cancer (stage III) Metastatic breast cancer (stage IV)
Factors that Affect Treatment Decisions and Prognosis	Other Issues Related to Treatment
Introduction Lymph node status Tumor size Tumor grade Tumor type (where are the cancer cells and how do they look in the lab) Tumor characteristics Hormone receptor status (estrogen receptor status and progesterone receptor status) HER2/neu status Proliferation rate Tests for metastases Oncotype Dx	Subtypes of breast cancer Things to consider before beginning treatment Importance of following your breast cancer treatment plan Quality of life issues Coping with stress Pain management related to treatment Risk of developing invasive breast cancer after ductal carcinoma in situ (DCIS) The return of cancer after treatment (recurrence, relapse) Survival and risk of having cancer return (recurrence) after treatment for early breast cancer Breast reconstruction Breast prosthesis Getting good care Insurance and other financial issues Insurance Transportation and lodging assistance Prescription drug assistance Glossary References
Treatment Issues for Younger Women	Breast Cancer in Men
Unique issues for young women with breast cancer Prognosis for young women Breast cancer treatment for young women Breast cancer treatment and fertility Breast cancer during pregnancy Diagnosis of breast cancer in pregnant women Breast cancer treatment for pregnant women Prognosis for pregnant women with breast cancer Breastfeeding after a breast diagnosis	Breast cancer in men Prognosis and survival Breast cancer screening in men Types of breast cancer in men Treatment for breast cancer in men Breast facts for men
Clinical Trials	Questions for Your Provider
Clinical trials The importance of clinical trials Benefits of clinical trials Taking part in a clinical trial Questions to ask your health care provider and the clinical trial research coordinator, nurse or physician Who sponsors clinical trials Where to find a clinical trial	Questions for your provider Surgery Breast reconstruction Radiation therapy Chemotherapy Hormone therapy Ductal carcinoma in situ (DCIS) Early breast cancer Locally advanced breast cancer
Research Tables
Table 37: Mastectomy versus lumpectomy (breast conserving surgery) plus radiation and overall survival in early breast cancer Table 38: Radiation therapy following mastectomy and overall survival in stage II & III breast cancer Table 39: Adjuvant chemotherapy and overall survival Table 40: Different adjuvant chemotherapy combinations and overall survival in early breast cancer Table 41: Tamoxifen and overall survival in estrogen receptor-positive breast cancer Table 42: Trastuzumab (Herceptin) and overall survival in early breast cancer Table 43: Aromatase inhibitors and disease-free survival in early breast cancer Table 44: Lumpectomy plus radiation therapy in the treatment of ductal carcinoma in situ (DCIS) Table 45: Tamoxifen in the treatment of ductal carcinoma in situ (DCIS) Table 46: Neoadjuvant (preoperative) chemotherapy for women with stage II or stage III breast cancer Table 47: Neoadjuvant (preoperative) hormone therapy for women with estrogen receptor-positive breast cancer Table 48: High-dose chemotherapy with stem cell transplant for women with metastatic breast cancer and for women with non-metastatic breast cancer at high risk for recurrence Table 49: Combined modality treatment and overall survival in inflammatory breast cancer Table 50: Trastuzumab (Herceptin) and overall response rate in metastatic breast cancer Table 51: Lapatinib (Tykerb) and overall response rate in metastatic breast cancer

Metastatic Breast Cancer

Metastatic Breast Cancer	Support for People with Metastatic Breast Cancer and Their Families
Metastatic breast cancer introduction Recommended treatments for metastatic breast cancer Hormone therapy Chemotherapy Targeted therapies Trastuzumab (Herceptin) Lapatinib (Tykerb) and other tyrosine-kinase inhibitors Additional care for metastatic breast cancer Pain management related to metastatic breast cancer Pain related to the tumor itself Emerging areas in metastatic breast cancer treatment Glossary References	Support Sources of support for spouses, partners and other loved ones Finding local sources of support Quality of life issues Depression Hospice and end-of-life issues Support resources
Clinical Trials	Research Tables
Clinical trials The importance of clinical trials Benefits of clinical trials Taking part in a clinical trial Questions to ask your health care provider and the clinical trial research coordinator, nurse or physician Who sponsors clinical trials Where to find a clinical trial	Table 48: High-dose chemotherapy with stem cell transplant for women with metastatic breast cancer Table 50: Trastuzumab (Herceptin) and overall response rate in metastatic breast cancer Table 51: Lapatinib (Tykerb) and overall response rate in metastatic breast cancer

Getting Good Care

Quality of Care	Resources for Getting Good Care
What is quality of care (good care)? Choosing a physician Getting a second opinion Talking to your health care provider Interpreter (translator) services Choosing a hospital Tips for finding a hospital Importance of following your breast cancer treatment plan Treatment outside the United States	Online resources for finding a health care provider and hospital or medical center Financial assistance for people living with breast cancer Questions for your potential provider Glossary References
Research Tables
Table 54: Regional differences in rates of mastectomy in the United States

Insurance and Other Financial Issues

Insurance

Other Financial Issues Related to Breast Cancer Care

Insurance
Health insurance
     Getting health insurance coverage
     Comparing health insurance plans
     Limited health insurance policies
     What to do if an insurance claim
     is denied
    Maintaining coverage during a job
    change or job loss
Disability insurance
Long-term care insurance
Questions for your insurance provider
Glossary

Breast cancer screening

Low-cost and free mammograms

Breast cancer treatment

Transportation and lodging assistance
Prescription drug assistance
Mastectomy and reconstructive surgery coverage
Financial resources for people living with breast cancer

Survivorship Topics

Common Concerns of Breast Cancer Survivors	Other Topics for Breast Cancer Survivors
Fear of getting cancer again (recurrence, relapse) Quality of life issues Lymphedema Side effects of treatment Radiation therapy Chemotherapy Targeted therapy Hormone therapy Sexuality and intimacy Having children after breast cancer Menopausal hormone therapy (postmenopausal hormone use) Alternatives to menopausal hormone therapy (postmenopausal hormone use) Concern for family members	Medical care after treatment Coping with stress Healthy weight, diet and exercise Being a young survivor Getting involved Questions for your provider Glossary References
Research Tables
Table 55: Pregnancy and breast cancer survival Table 56: Menopausal hormone therapy (postmenopausal hormone use) and recurrence after breast cancer diagnosis Table 57: Total fat intake and breast cancer survival Table 58: Body weight and breast cancer survival Table 59: Physical activity and breast cancer survival Table 60: Acupuncture for menopausal symptoms Table 61: Antidepressants and other non-hormone medications for menopausal symptoms Table 62: Soy for menopausal symptoms Table 63: Black cohosh for menopausal symptoms Table 64: Other supplements for menopausal symptoms

Support

Types of Support for People with Breast Cancer	Other Issues Related to Support
Introduction Support groups Health care providers Spiritual advisors and religious organizations Hospice	What is social support? Sources of social support Benefits of social support Sources of support for spouses, partners and other loved ones Finding local sources of support Quality of life issues Depression Support resources Glossary References
Research Tables
Table 52: Support groups and breast cancer survival Table 53: Social support and breast cancer survival

Integrative and Complementary Therapies

Integrative and Complementary Therapies
5-htp Acupressure Acupuncture Acustimulation Aloe Arginine Art therapy Astragalus Ayurveda Black cohosh Calcium Chinese medicine Coenzyme Q10 Coriolus mushroom Dandelion Echinacea Essiac Evening primrose oil Fermented wheat germ extract Flaxseed/flaxseed oil Focusing Folate Ginger Ginkgo biloba Ginseng Green tea Guided imagery	Hydrazine sulfate Hypnosis Lycopene Macrobiotic diet Maitake mushroom Massage Meditation Melatonin Milk thistle Mistletoe Modified citrus pectin Music therapy Niacin Omega-3 fatty acids (fish oils) Organic food Pet therapy Physical therapy Polysaccharide K (PSK) Prayer Probiotics Psychotherapy Qi gong Quercetin Reflexology Reiki Reishi mushroom		Relaxation therapy Resveratrol Selenium Shark cartilage Shiatsu Shiitake mushroom Soy St. John's wort Tai chi Therapeutic touch Traditional Chinese medicine Turmeric (curcumin) Vitamin A Vitamin B6 Vitamin B12 Vitamin C Vitamin D Vitamin E Vitamin K Yoga Zinc
Issues Related toIntegrative and Complementary Therapies		Recipes for Healthy Living
Introduction Major categories of complementary therapies Who's using complementary therapies? Why do people use complementary therapies? Working with health care providers Is it safe? Is it effective? The importance of scientific evidence Safety of complementary therapies Finding acomplementary therapyprovider Clinical trials of complementary therapies Seven tips on complementary therapies Questions to ask your provider Glossary Resources References		Introduction Featured recipe of the month Recipe search tool

Breast Cancer Research

Research Tables (by topic)	Other Issues Related to Breast Cancer Research
Risk factors Risk-lowering drugs Early detection and screening Diagnosis and prognostic factors Treatment Support Getting good care After treatment	How to read a research table Finding individual studies Different types of research studies Large studies and statistical power Glossary

Resources

Websites Listed throughout Understanding Breast Cancer (by topic)	Breast Cancer 101 Interactive Tool (by topic)
Website resources Risk factors and prevention Early detection and screening Diagnosis Treatment Integrative and complementary therapies Getting good care After treatment Support Insurance and financial issues International resources	Breast Cancer 101 (interactive tool) Incidence and risk factors Genetics and breast cancer Breast self-awareness Living a healthy lifestyle Special populations The breast and breast cancer Cancer Medical imaging Diagnosis Types and stages of breast cancer Treatment Local therapy Surgery Breast reconstruction Radiation therapy Chemotherapy Hormone therapy Targeted therapy Treatment options Integrative and complementary therapies Survivorship and recurrence Review
Finding Health Information	Glossary
Using the Internet to find health information	Glossary
Other Susan G. Komen^® Educational Resources	Translated Komen Educational Materials
Interactive treatment navigation tool Facts for Life (fact sheets on many breast cancer topics) Order educational materials at ShopKomen.com Komen Perspectives (our perspective on recent study findings and special topics) Netquiz (test your breast cancer knowledge)	Translated Komen educational materials

Updated 06/03/13

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