Breast Cancer

Who is at risk of getting breast cancer?

All women are at some risk of getting breast cancer. The risk increases with age. More than half the women who are diagnosed with breast cancer are 60 years of age or older. Most women who get breast cancer do not have a family history of breast cancer. However, if a woman’s mother, sister or daughter got breast cancer before the age of 50, she could be at higher risk than the average woman.

What are some of the symptoms of breast cancer?

In its very early stages, there might not be any symptoms. An unusual lump is often the first symptom; a lump can be found by a doctor during a clinical breast exam, by a mammogram or by a woman checking her own breasts. Other symptoms might be a dimpling of the skin on the breast, an inverted (pulled inward) nipple or a rough texture similar to an orange peel. A very late stage of breast cancer could have symptoms such as an enlarged, swollen breast, with a possibility of the tumor coming through the skin.

How is breast cancer diagnosed?

One of the first steps in finding breast cancer is usually a mammogram. The results of a mammogram can show signs of a tumor. If the doctor thinks the mammogram results are suspicious, he or she can suggest diagnostic exams such as an ultrasound or a biopsy. An ultrasound can often tell the difference between a fluid-filled cyst (usually not cancerous) and a solid tumor. A biopsy, which is when some tissue from the tumor or cyst is removed and examined in a lab, can determine if the woman has cancer. Some biopsies are done with a needle while others are done with surgery.  Women need to be aware that inflammatory breast cancer (IBC) is an aggressive cancer that often is not detected by a mammogram.  Women who observe a rash, dimpling, inversion of the nipple, or redness on the breast should be examined to rule out IBC.  Biopsy and/or MRI may be the best means to detect IBC. 

Can breast cancer be prevented?

Women can make changes in their lives to reduce the chance of getting breast cancer. However, breast cancer is usually not considered truly preventable. The best way to fight breast cancer is to find it early by getting regular mammograms and clinical breast exams. When found at its earliest stage, breast cancer has over a 95 percent five-year survival rate.

Studies are currently underway to see what behaviors might have an impact on a woman’s risk. Some of these studies are looking at exercise, the use of hormone replacement therapy, diet, alcohol consumption and exposure to pesticides. Other studies will see if medications can reduce the risk of breast cancer in women who have a higher risk than average.
 

What are some treatment options for people diagnosed with breast cancer?

Treatment options continue to get better. For women with an early stage of breast cancer, when the tumor is small and confined to the breast, treatment might be a lumpectomy (surgical removal of the tumor), possibly followed by radiation or chemotherapy. Chemotherapy is when medications are given over a period of time to kill off any cancer cells that might be circulating in the body. Sometimes a lumpectomy alone is enough. If the cancer has spread to the lymph nodes under the arm, then those would be surgically removed as well. In later stages, a mastectomy (removal of the breast) would be performed. In these cases, the woman would have some form of chemotherapy and perhaps radiation. Radiation is a type of high-energy X-ray that can kill cancer cells. Radiation doses are now lower and more accurate than just 10 years ago.

Note: The information given above is for educational purposes only. These questions and answers should not replace a discussion with a doctor if you think you might have breast or cervical cancer.

For More Information

Please visit the following resources for more information on breast cancer:

National Cancer Institute: Did you Know? Breast Cancer

National Cancer Institute: Breast Cancer - Patient Version

BCCP Resources

Mammography

Who should get a mammogram and how often?

The Ohio Department of Health's Breast and Cervical Cancer Project follows the United States Preventative Services Task Force (USPSTF) recommendations for screening services.

The USPSTF recommends screening mammography every 2 years for women ages 50 to 74 years.  The decision to start screening mammography in women before age 50 years should be an individual one. Women, who place a higher value on the potential benefit than the potential harms, may choose to begin screening every 2 years between the ages of 40 to 49 years. The current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women age 75 years and older.

These recommendations apply to asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age.

Can a mammogram always find breast cancer?

Mammograms are quite accurate, especially in women over 50. Mammograms are the best method to detect breast cancer early when it is easier to treat and before it is big enough to feel or cause symptoms. However, mammograms are not perfect. Sometimes a mammogram film will show something that might be a tumor, but further tests show that it is not. Conversely, a mammogram film will sometimes look like everything is normal, but the woman actually has a small tumor. 

Women need to be aware that Inflammatory Breast Cancer (IBC) is an aggressive type of breast cancer that often is not detected by a mammogram.  Women who observe a rash, dimpling, inversion of the nipple, or redness on the breast should be examined to rule out IBC.  Biopsy and/or MRI may be the best means to detect IBC.

What happens if the doctor feels a lump, but the mammogram doesn’t show anything?

Whenever a doctor or nurse finds a suspicious lump during a clinical breast exam, extra tests should be done, even if the mammogram results are normal. Most often the woman will get an ultrasound, which is a painless breast exam that uses sound waves. Another option is to see a breast specialist, such as a breast surgeon, who will repeat the clinical breast exam.

What is mammography?  

A mammogram is an X-ray of the breast.  To prepare for mammography, a woman will remove clothing above the waist and put on a hospital gown.  The mammogram X-rays are taken by a radiological technician (RT).  The RT will help position the woman in relation to the mammography unit in order ensure an accurate film.  Breasts are X-rayed one at a time.  To obtain the X-ray, the breast is positioned on a clear, flat plate. Another plate is lowered onto the breast, compressing it, and the X-ray is taken.  Each breast is X-rayed at one angle, then again at another angle.  After the breasts are X-rayed, the RT will typically check the films to be certain they are good ones.

Mammography may be offered in a variety of clinic settings, including clinic, hospital and mobile unit.  A woman may be advised to remove deodorant, antiperspirant or lotion prior to mammography.

Note: The information given above is for educational purposes only. These questions and answers should not replace a discussion with a doctor if you think you might have breast or cervical cancer.

For More Information

Please visit the following resources for more information on screening recommendations:

Breast Cancer Screening Final Recommendations

Breast Cancer: Screening (Release Date: January 2016)  

Screening for Breast Cancer: Consumer Guide

Cervical Cancer

What is cervical cancer? 

Cancer is a disease in which cells in the body grow out of control. Cancer is always named for the part of the body where it starts, even if it spreads to other body parts later. When cancer starts in the cervix, it is called cervical cancer. The cervix is the lower, narrow end of the uterus. The cervix connects the vagina (birth canal) to the upper part of the uterus. The uterus (or womb) is where a baby grows when a woman is pregnant. Cervical cancer is highly preventable in most Western countries because screening tests and a vaccine to prevent human papillomavirus (HPV) infections are available. When cervical cancer is found early, it is highly treatable and associated with long survival and good quality of life. 

What causes cervical cancer? 

According to the CDC, all women are at risk for cervical cancer. It occurs most often in women over age 30. Each year, about 12,000 women in the United States get cervical cancer and about 4,000 women die from it. Human papillomavirus (HPV) is the main cause of cervical cancer. HPV is a common virus that is passed from one person to another during sex. At least half of sexually active people will have HPV at some point in their lives, but few women will get cervical cancer. Other things can increase your risk of cervical cancer:
       Meeting any of the above criteria does not mean that a woman will definitely get cervical cancer. However, those women should make sure they have annual Pap tests.

• Smoking.

• Having HIV (the virus that causes AIDS) or another condition that makes it hard for your body to fight off health problems.

• Using birth control pills for a long time (five or more years).

• Having given birth to three or more children.

• Having several sexual partners. 

How is cervical cancer treated? 

Sometimes cervical cancer is found before it is even considered cancer. These pre-cancerous lesions can often be removed in a doctor’s office or clinic. Two common procedures are called the LEEP and Cone. Both of these involve removing the lesion from the cervix. If the cancer is more serious, the woman will have surgery. Cervical cancer tumors, if left untreated, can expand to the uterus, vagina and other surrounding tissue. Some women need a hysterectomy, followed by either chemotherapy and/or radiation.  
 

How is cervical cancer prevented? 

According to the National Cancer Institute (NCI) a well-proven way to prevent cervix cancer is to have testing (screening) to find pre-cancers before they can turn into invasive cancer. The Pap test (or Pap smear) and the human papilloma virus (HPV) test are used for this. If a pre-cancer is found it can be treated, stopping cervical cancer before it really starts. Most invasive cervical cancers are found in women who have not had regular Pap tests. There are also some things you can do to prevent pre-cancers, such as: 

• Avoiding exposure to HPV

• Getting an HPV vaccine

• Not smoking

Note: The information given above is for educational purposes only. These questions and answers should not replace a discussion with a doctor if you think you might have breast or cervical cancer.

For More Information

Please visit the following resources for more information on cervical cancer screening and prevention: 

National Cancer Institute: Did You Know? 

Cervical Cancer Cervical Cancer 

Prevention and Early Detection 

National Cancer Institute: Cervical Cancer – Patient Version 

PAP Test

What is the purpose of a Pap test?

The Pap test is a way of checking the cervix to see if any abnormal cells or cancerous cells are present. When performing a Pap test, a nurse practitioner or doctor uses a very small brush or spatula to remove cells from the cervix. The cells are then placed on a slide or in a fluid that is sent to a laboratory for testing.

When should a woman get a Pap test?

The Ohio Department of Health's Breast and Cervical Cancer Project follows the United States Preventative Services Task Force (USPSTF) recommendations for screening services. If you are ages 21 to 29, you should get a Pap test every 3 years. If you are ages 30 to 65 and only get a Pap test, you should be screened every 3 years. If you are ages 30 to 65 and get both a Pap test and an HPV (human papillomavirus) test, you should be screened every 5 years. If you are older than 66, ask your doctor if cervical cancer screening is recommended for you. Please note: if you get the HPV test along with the Pap test, the cells collected during the Pap test will be tested for HPV at a laboratory. Talk with your doctor, nurse or other healthcare provider about whether the HPV test is right for you.

Where could I go to get a Pap test?

You can get a Pap test (sometimes called a Pap smear) at your doctor's office or clinic as part of a well woman visit. With the Affordable Care Act (ACA) virtually all health insurance plans cover a pap test with no copay or deductible. Check your plan's coverage for more information. For those without insurance, check your eligibility for a free Pap test with the Breast and Cervical Cancer Project (BCCP). 

Note: The information given above is for educational purposes only. These questions and answers should not replace a discussion with a doctor if you think you might have breast or cervical cancer.