• Lobules: milk-producing glands
• Ducts: tube-like structures that connect lobules and the nipple
• Stroma: fatty tissue and ligaments that cover the ducts, lobules, blood vessels and lymphatic vessels (passageways that carry fluid containing immune cells and waste products)

• Noninvasive breast cancers
  The most common noninvasive breast cancers are ductal carcinomas in situ. In situ is a term used to describe tumors that have not spread outside their original locations. Ductal carcinomas in situ are confined to the breast ducts. Almost all women diagnosed with this nonmalignant stage of breast cancer can be cured. Lobular carcinoma in situ is not usually technically classified as a breast cancer. This early grade of tumor involves abnormal cells that do not penetrate through the walls of the lobules. Although these growths are not life-threatening, women who have them are at a greater risk of developing breast cancer in another part of the same breast or in the other breast.
• Invasive breast cancers: Approximately 80 percent of invasive breast cancers are invasive ductal carcinomas, tumors that have spread from the duct to the surrounding fatty tissue. Invasive lobular carcinomas, which start in the milk-producing glands and spread to other tissue, account for 10 to 15 percent of invasive breast cancers. These cancers are more difficult to detect using mammograms than ductal carcinomas.
• Five percent of invasive breast cancers are medullary carcinomas, which are characterized by a distinct boundary marked by immune cells and by larger-sized cancer cells. The chance of survival associated with medullary carcinomas is higher than for other invasive breast cancers.
• Other types of invasive breast cancer that occur less frequently include tubular carcinomas , inflammatory breast cancer , mucinous carcinoma (formed by mucus-producing cells), Paget's disease of the nipple, and phyllodes tumor (made of the breast's connective tissue).

• After increasing an average of 4 percent per year in the 1980s, breast cancer rates appear to be leveling off among white women.
• Breast cancer mortality rates declined between the years of 1990 and 1997, with the most dramatic drops for both white and black women.
• Over 75 percent of women diagnosed with breast cancer are age 50 or older.
• Between 5 and 10 percent of breast cancers are inherited, and breast-cancer-susceptibility genes can be inherited from either parent.
• The majority of women who develop breast cancer Ч around 80 percent Ч do not have a sister or mother with breast cancer.
• With the exception of skin cancer, breast cancer is the most common cancer among women.
• 97.5 percent of women who are diagnosed with breast cancer in an early stage survive at least five years.
• Among American women ages 30 to 69, black women have the highest breast cancer mortality rates. For women ages 70 and over, mortality rates are highest among white women.

• Eat a well-balanced, low-fat diet full of fruits, vegetables and whole grains and maintain a healthy weight.
  
  The relationship between fat intake and breast cancer is not completely understood by researchers. However, countries in which women have diets that are low in total fat, low in polyunsaturated fat and low in saturated fat have lower breast cancer rates than the United States . You can improve your overall well-being and reduce breast cancer risk by maintaining a healthy weight and limiting intake of red meats, especially those high in fat or processed. Increase your intake of plant foods such as fruits, vegetables and whole grains.
  
  Maintaining a health weight is even more important after you have reached menopause, when estrogen is no longer produced in your ovaries. The adrenal glands convert other hormones into estrogen that is then stored in fat cells. The more fat cells Ч the greater amounts of estrogen, which is a major factor in post-menopausal breast cancer.

• Limit alcohol consumption
  
  Regular consumption of even a few drinks per week is associated with an increased risk of breast cancer in women. Women at high risk of breast cancer may want to consider not drinking any alcohol. If you do drink alcohol, do so in moderation. Studies have shown that post-menopausal women who drink less than one drink a day can increase the risk of dying of breast cancer up to 30 percent, compared to non-drinkers. Women who are pre-menopausal should not dismiss the link between alcohol and breast cancer Ч alcohol intake is a strong risk factor for the disease.
  
• Exercise
  
  Several studies suggest that moderate daily physical activity can lower your breast cancer risk. In addition to boosting your immune system, increasing your daily exercise helps prevent obesity and decreases estrogen levels Ч lowering your breast cancer risk. Another hormone called insulin growth factor or IGF is higher in obese women, especially those with fat around their middles. Too much of this hormone can increase risk for breast and colorectal cancer. Physical activity can reduce IGF levels.
  
  If you are overweight, try to incorporate an exercise regimen and low-fat diet into your everyday routine. Becoming more physically fit will not only lower your risk of developing several cancers, but also will improve your overall health and emotional well-being.

• Chemoprevention
  
  Tamoxifen, an anti-estrogen medication that appears to block estrogen's effect on breast tissue, has been used for several years to reduce the risk of recurrence in localized breast cancer and as a treatment for advanced breast cancer. Studies have also show that women at high risk for breast cancer are less likely to develop the disease if they take tamoxifen. It is the only approved breast cancer chemopreventive and is prescribed for women at high-risk.
  
  If you have several breast cancer risk factors and are interested in learning more about chemoprevention, speak with your health care professional. Risk, medical history and age are important topics to discuss when considering chemopreventive agents.
  
  Raloxifene is another estrogen-blocker that has been shown to have protective effects against breast cancer. Scientists are currently conducting clinical trials to compare the effectiveness of raloxifene and tamoxifen in preventing breast cancer. Raloxifene is still being studied and is not yet recommended for use in reducing breast cancer unless you are participating in the clinical trials.
  
  Aromatase inhibitors, drugs that block the production of small amounts of estrogen that post-menopausal women normally make, are also being studied as breast cancer preventative agents for post-menopausal women. New studies are also underway using other drugs, including studies that have found that women who take aspirin or non-steroidal anti-inflammatory drugs, such as ibuprofen, have a lower risk of breast cancer.

• Preventive mastectomy
  
  Healthy women with very high breast cancer risk may elect to have both breasts surgically removed in hopes of drastically lowering their chances of developing breast cancer. Women with the BRCA1 or BRCA2 genetic mutations (genetic testing is now available), previous history of breast cancer, strong family history or a history of lobular breast carcinoma might consider this type of operation after receiving a cancer risk assessment and educational counseling from their health care professional.

• Gender: Simply being a woman is the main risk factor for breast cancer. Men can also get breast cancer, but it is 100 times more common in women than in men.
  
• Age: A woman's breast cancer risk increases as she gets older. Nearly eight to 10 breast cancers are found in women over age 50.
  
• Genetics: Women who have an inherited mutation in one of the two breast-cancer-related genes (BRCA1 or BRCA2) have up to 80 percent chance of developing breast cancer. Between 50 and 60 percent of women who have inherited one of these mutations will develop breast cancer before the age of 70. Inherited mutations in other genes, such as p53, have also been associated with an increased breast cancer risk.
  
• Personal history of breast cancer: A woman with a cancerous growth in one breast is between 3 and 4 times more likely to develop another breast cancer in a different location.
  
• Family history of breast cancer: Having close relatives with breast cancer increases a woman's breast cancer risk. If her mother, sister or daughter has breast cancer, a woman's breast cancer risk is doubled.
  
• Race: White women are more likely to get breast cancer than African-American women. But African-Americans are more likely to die of this disease because theirs are often found at a later stage. Asian, Hispanic and American Indian women have a lower risk of developing breast cancer.
  
• Radiation: Exposure of a woman's chest to repeated or high-dose radiation used for treatment of other diseases is associated with an increased breast cancer risk.
  
• Menstrual periods: Early onset of menstruation (before age 12) and/or late menopause (after age 55) increase breast cancer risk. Scientists expect that this increased risk involves a prolonged exposure to elevated estrogen/progesterone levels circulating in the bloodstream.
  
• Not bearing children: Never having children or having your first child after the age of 30 slightly increases breast cancer risk. This risk factor is also related to exposure to hormone levels. In addition, studies have shown that being pregnant more than once and at an early age, as well as breast-feeding, reduces a woman's chance of developing breast cancer. Other studies have found that women who take birth control pills have a slightly higher risk of breast cancer. Women who stopped taking the pill more than 10 years ago do not have any increased risk.
  
• Alcohol: Consuming two or more alcoholic beverages on a daily basis is associated with a 1.5 time higher breast cancer risk.
  
• Obesity: Women who become obese as adults (particularly after menopause) place themselves at greater risk for breast cancer. Although the ovaries produce most the estrogen in a woman's body, fat tissue can also convert some other hormones into estrogen. As for other risk factors, the link between obesity and breast cancer may involve increased estrogen levels.
  
• Smoking: Although we have known for some time that tobacco use causes cancer, there is some evidence that smoking can also increase risk of breast cancer particularly in women who start smoking in their teen years.

Symptoms

For women receiving annual mammograms, breast cancer is often detected in an early, localized state before it can be felt by a woman or by her health care professional. All women, especially women without access to regular mammograms, should regularly conduct breast self-exams and clinical breast exams to identify changes within breast tissue.

• Breast lump or thickening
• Swelling, redness or tenderness
• Change in the color or texture of the nipple
• Dimpling or puckering of the skin
• Nipple pain, discharge, or retraction (inversion of the nipple)
• Lump in underarm area

Changes in the breast are most commonly due to benign conditions and usually are not signs of breast cancer. However, if you experience any of the above symptoms, contact your health care professional immediately.

• Breast self-exam (BSE): Learning what their normal breast tissue feels and looks like can be helpful to women, who should report any changes to their health care professional. Breast self examination is an option for women beginning in their 20s. The best time for young, menstruating women to conduct a breast self-exam is after they have completed their periods. Since women's breasts often feel different right before and during their periods. So conducting a self-exam at the same stage of the monthly menstrual cycle might prevent women from mistaking hormonal changes for potential trouble signs. Also women should specify a particular time every month to conduct a self-exam Ч this makes it easier to stick to the routine.
  
  What should women look and feel for? Check for any new lump, swelling of the underarm area, dimpled skin, nipple pain, redness or irregular discharge from the nipple. Would consult their health care professional and report any changes.
• Clinical breast exam (CBE): A clinical breast exam Ч one performed by a health care professional Ч should be part of a woman's routine health examination, about every three years when they are in their 20s and 30s and every year from age 40. During a clinical breast exam, your health care professional will examine the appearance of your breasts and will feel for any changes in shape or texture of your breast tissue to identify lumps or other possible warning signs of breast cancer. In addition, the clinical breast exam includes an examination of the underarm areas to make sure that there is no sign of breast cancer in the lymph nodes.
• Mammogram: A mammogram is an x-ray of breast tissue that produces a black and white image on a large film. Mammograms can be used to help diagnose breast cancer for women who present with symptoms, or it can be used to screen for early signs of breast disease in women with apparently healthy breasts. Yearly mammograms should begin at age 40 and continue for as long as a woman is in good health.
  
  It may be appropriate for some women, however, to start having regular mammograms at an earlier age. Women at higher risk for breast cancer due to a genetic predisposition, family history or personal history of breast lumps may be advised by their health care professional to begin screening mammography earlier. If you have several risk factors, you might want to consider having your baseline (initial) mammogram before you turn 40.
  
  During a mammogram, the breast is compressed to flatten and spread the tissue for a better image. Women may find this compression uncomfortable, but it only lasts a few seconds. The entire mammography procedure takes about 20 minutes. For menstruating women, the best time to make an appointment is the week after your period, when your breasts are less tender.
  
  If you have had a mammogram before, bring the films with you to your next screening. If you are going to the same screening location, it should already have the films on file. When you are changing facilities, however, you might have to call your former facility and ask for the films.
  
  When you get a mammogram, expect to:
  • Spend 20 minutes for the entire procedure
  • Tell your health care professional about any breast changes and any personal or family breast cancer history
  • Undress from the waist up
  • Have each breast compressed for a few seconds (This could be uncomfortable, but should not be painful.)
  • Receive your results within 30 days
  • Be contacted within five working days if further tests are needed
    
  In screening mammography, radiologists interpret the films looking for breast abnormalities such as calcifications and masses that are often too small for detection in a breast self-exam or a clinical breast exam. Calcifications are tiny mineral deposits that appear as white dots on the film. They signify changes within the breast tissue and can be a sign of benign changes or breast cancer. Masses are lumps in tissue that may appear with calcifications. Most masses are benign cysts , areas where fluid has collected inside the breast tissue. To determine whether a mass is a cyst, health care professionals typically perform a breast ultrasound or draw fluid from the mass using a needle. An ultrasound is not used by itself as a screening test for breast cancer. Ultrasound is a procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or make echoes to form a picture. If the mass is not filled with fluid, a biopsy Ч removal of a small sample of tissue Ч will be taken determine if the mass is comprised of cancerous cells.
  
  • MRI (magnetic resonance imaging): Women at high risk for breast cancer may be candidates for more careful surveillance using MRI. MRI is a procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. Research has shown that for women with a high genetic risk of breast cancer MRI is more sensitive than mammography for finding breast tumors. MRI screening clinical trials are ongoing across the country.

Treatment

If a mammogram shows an abnormality, your health care professional will conduct additional tests to determine whether or not the growth is cancer. These may include ultrasound (an imaging technique that uses to sound waves to see if the tumor is fluid or solid), fine needle aspiration (a thin needle removes fluid for testing), ductal lavage (a minimally invasive technique that takes a sample of duct fluid can show early warning signs), a core needle biopsy (a slightly larger hollow needle takes tissue samples for study), or a surgical biopsy (a surgeon cuts through the skin and removes an entire growth that is studied under a microscope).

If it is cancer, further tests will help determine whether it has metastasized or spread beyond the ducts or lubes of the breast or to other parts of the body. This is called staging. Breast cancer is rated from Stage 0 (carcinoma in situ or non-invasive cancer) all the way to Stage IV (cancer that has spread to other organs). The cancer is also assigned a grade, which describes how similar the cancer cells are to normal cells and helps predict prognosis for survival. Determining the stage and grade of the tumor is important for selecting the best course of treatment.

Most often surgery is performed. The type of surgery is determined by the stage and grade of the cancer. For some patients whose cancer has not spread, breast conserving surgery or lumpectomy, in which only the breast lump is removed, may be appropriate. For others, mastectomy may be performed. In a simple mastectomy , all of the breast tissue is removed. Some lymph nodes may also be removed. Cancer can spread through the lymph nodes. In a modified radical mastectomy, the breast tissue and many lymph nodes from under the arm are removed, as well as the lining over the chest muscles, and sometimes, part of the chest wall muscles. A radical mastectomy removes the breast, all the lymph nodes and all the chest wall and muscles.

Radiation therapy is used to destroy any remaining cells left in the breast or chest wall or nodes after surgery for some patients, particularly for those who have had a lumpectomy. Systemic therapy is treatment to reach cells that may have moved beyond the breast. This includes chemotherapy , which is given may be given through a vein (intravenous) by pill. Hormone therapy may be given in combination with chemotherapy or alone. It is a cancer treatment that removes or blocks the action of hormones to stop cancer cells from growing. Hormone therapy with the anti-estrogen called tamoxifen is often given to patients with early stages of breast cancer and to women whose cancer has spread.