Kimlin Tam Ashing

Cheat Sheet / Updated 09-18-2023

Breast cancer is a particularly devastating and intimate disease. Although not as deadly as some other forms of cancer — five-year survival rates in the United States are between 80 percent and 90 percent — the toll that breast cancer takes on the body, mind, and psychology make it an especially difficult disease to contend with. The good news is that it is a relatively easy cancer to detect early, and usually the earlier it is caught, the better the prognosis. Breast cancer survivors have several treatment avenues, including chemotherapy, radiation, therapy, hormonal therapy, and a few different surgery options, including different mastectomies.

Step by Step / Updated 10-15-2020

Following are ten inspiration stories from breast cancer survivors — some of them in their own personal words. Survivorship is broken into three categories: Acute survivorship: This is just after getting the diagnosis of breast cancer. Women often experience "the shock" and immediately start thinking about life decisions. Transitional survivorship: This comes just after initial treatment for breast cancer (whether surgery, chemotherapy, or radiation). You may be taking endocrine therapy for 5–10 years after treatment to reduce your recurrence risk. This is also the time when most women feel uneasy because their medical visits are not as frequent and they are taking less medication. Sometimes women may even equate not getting active treatment to increasing the chance of breast cancer coming back. You may also see a reduction in social support while you are struggling to get control over your symptoms or lifestyle. This transition into a "new normal" is not one that happens instantly; it's a process that comes with time, self-perseverance, objectivity, and self-discovery. The best therapy for this stage of survivorship is to engage in exercise (Zumba, sporting activities, and so forth), eat healthy, and focus on the renewed you. Extended survivorship: You will continue to have follow-up visits for 5–10 years with your cancer doctor depending on whether you're on endocrine therapy. If you're not on endocrine therapy, you will continue your regular follow-up with your primary care or general practitioner. During this period you may have unresolved issues that are important to you, such as managing lingering side effects of breast cancer treatment and any perceived psychosocial stress.

Article / Updated 03-13-2018

Your body makes great efforts to fight off many diseases on its own, but it must have the right resources on its side to be able to do that. Poor nutrition reduces mental function and productivity as well as diminishes your body's immunity against diseases such as cancers. When you are getting sufficient calories for energy and sufficient nutrients to support body function and growth, you can say you have good nutrition. Maintaining good nutrition and normal body function is a kind of balancing act. Your food must include a variety of fruits and vegetables, grains, fiber, protein with small amounts of fats, and lots of water to maintain good nutrition. The best health outcomes occur when good nutrition is combined with regular physical activity. One hundred and fifty minutes of moderate exercise per week can lower your risk of breast cancer. No vigorous or intense exercises are needed to reduce your risk — if you walk for 30 minutes daily, your risk for breast cancer can reduce by 3 percent. Exercise can keep you at your ideal weight. When you're overweight, you have more fat cells or adipose tissue, which can release high levels of estrogen into your body. In general, obesity increases women's risk for any hormone-related cancer such as breast and endometrial cancer. Men who are overweight have an increased risk of prostate cancer. Exercise is great for lowering insulin levels, hormones, and proteins (known as growth factors). Growth factors must be present for any cancer to grow. Exercise reduces stress by releasing the brain's feel-good neurotransmitters, the endorphins. More endorphins reduce the urges to smoke and drink alcohol, which reduces your overall risk of breast cancer. Researchers have found that high levels of stress can damage your immune system, which can increase your risk of developing cancer.

Article / Updated 11-07-2017

Sometimes the option to remove both breasts is based on the disease, and sometimes it's based on the disease plus a patient's anxiety. The guidelines do state that if you have left breast cancer, you can have a lumpectomy with radiation or a mastectomy. Yet often women choose to remove both breasts to reduce the risk of getting another breast cancer. Breast reconstruction options for the non-breast cancer side are the same for a breast cancer side. Here are some possible reasons for removing the other breast when there is no cancer: Breast cancer gene mutation carriers (BRCA1, BRCA2, and so on) Strong family history of breast cancer The original cancer was not found by mammograms or other tests Personal choice of a woman after considering her breast cancer risk Advantages Easier to have both breasts look the same or symmetric One surgery and one hospital stay Reduced chance of getting breast cancer No need for future mammograms (if all tissue from both breasts is removed) Disadvantages If abdominal flaps are being used, only half the abdominal tissue can be used for each breast (which limits the size of the reconstructed breasts). Implants, tissue expanders, or back tissue may be needed to make the breasts the right size. Lengthy surgery compared to reconstructing one breast Increased risk for complications

Article / Updated 11-07-2017

Breast reconstruction can be done at the same time as the breast cancer surgery (called immediate reconstruction). It can also be done in a two-stage process where tissue expander (a temporary placeholder) is placed at the time of breast cancer surgery. For the final breast reconstruction, a synthetic implant or tissue from another part of your body is used to complete the procedure at a later date. You can also have breast reconstruction after breast cancer surgery, called delayed reconstruction. Your breast plastic surgeon will consider the following before making a recommendation for your breast reconstruction surgery. Type and stage of your breast cancer Additional treatments that you might need for your breast cancer Your body shape Your feelings Your personal preferences and lifestyle When you meet with your breast plastic surgeon, she will discuss your reconstructive options, including the risks, benefits, and options available for each procedure. You'll also discuss the expected cosmetic outcomes from the reconstruction. Immediate breast reconstruction An immediate reconstruction is typically recommended when you have no known breast cancer in the breast, and it gives you a new breast straight away. For example, when women have pre-cancerous lesions removed or when women with positive BRCA mutation who have not yet developed cancer have their breast removed (called a prophylactic mastectomy), they may have immediate reconstructive surgery reconstruction. Even though the breast is not identical to the one that was removed, most women find that immediate reconstruction helps them cope better with the loss of a breast. When you do have breast cancer, you will have delayed reconstruction because it gives time for the final surgery pathology to determine whether you have clear margins (that is, no cancer cells are seen at the outer edge of the tissue that was removed). If you are found to have positive margins, or cancer cells are seen at the outer edge of the tissue, then an additional surgery may be indicated to remove the cancer cells. Having had immediate reconstruction would interfere with the surgery in this case. Advantages You will have your newly reconstructed breast after waking up from your lumpectomy or mastectomy. Immediate breast reconstruction may also have a psychological benefit, as you won't have a period of time with "no breasts." You will have fewer surgeries and fewer anesthetics. Your reconstructed breasts may form better because the plastic surgeon can use the extra skin that's already there, leading to improved cosmetic outcome. You may have less scarring on the reconstructed breast itself. It involves lower healthcare costs. Disadvantages You may not have as much time to decide on the type of breast reconstruction that you want. If you're having radiation therapy after surgery, it may cause injury to the reconstructed breast. Difficulty in detecting mastectomy skin problems. Your doctor may advise you not to have implant reconstruction if you're having radiation therapy afterwards. However, you may have a temporary implant during radiation with another breast reconstruction surgery after radiation has completed. You will have longer hospitalization and recovery times than if you had mastectomy alone. Complications from breast reconstruction surgery may delay chemotherapy that you need. Chemotherapy stops the body from being able to heal well, so if you have any problems with wound healing after your breast reconstruction, you won't be able to start chemotherapy until the problems have been resolved. If you were given chemotherapy at this time, it would stop the wound healing and cause a serious infection. Research has shown that the most benefit received from chemotherapy is when it is given within six weeks of breast cancer surgery. And if your breast reconstruction surgery causes delayed wound healing, then chemotherapy could be delayed beyond those six weeks. Immediate breast reconstruction requires a lot of coordination between the breast surgeon and plastic surgeon operating room (OR) schedules, because they both will have to be in the OR at the same time, along with other members of the team to ensure the success of the procedure. Immediate breast reconstruction may be a good option if you have the following: Smaller tumor size (less than 2 cm) Low chance of needing radiation therapy after surgery Diagnosis of a non invasive cancer or pre-cancer (such as ADH or DCIS) Auxiliary lymph nodes under your armpit don't have cancer Clear margins from surgery You're healthy to undergo general anesthetic Prophylactic (preventive) mastectomy due to having a genetic mutation (such as BRCA 1 or 2) Delayed breast reconstruction Some women prefer to get over the mastectomy and breast cancer treatment first, before they think about reconstruction. Delayed reconstruction is typically done after the mastectomy site has healed. Healing can take six months or even several years after the mastectomy. Advantages You have more time to look at all types of reconstruction options and discuss them with your plastic surgeon. If you're having additional cancer treatment after mastectomy (such as radiation), it won't cause problems at the reconstruction site. You schedule the surgery at your leisure or at the time you elected. Disadvantages You have a period after the mastectomy during which you have no breast tissue, but you can choose to wear a false breast. You will have a mastectomy scar on the chest wall, which is a larger scar on the reconstructed breast than after immediate reconstruction. Delayed reconstruction requires additional surgery and recovery time. The breast is sometimes difficult to reconstruct after scarring occurs. Delayed reconstruction may be a good option if you have the following: Larger breast tumor (over 2 cm) Tumor-free from breast cancer (all cancer was successfully removed in your first surgery) and have completed chemotherapy/radiation therapy Healthy to undergo general anesthesia Radiation therapy completed at least six months prior to surgery

Article / Updated 11-07-2017

Targeted therapy is also called biological therapy. It affects specific protein-receptor targets (called biomarkers) found only on cancer cells. These protein-receptor targets are responsible for the growth and spread of cancer cells. Targeted therapy medicines block the growth and spread of cancer because they interfere with processes in the cells that cause cancer to grow. Targeted therapy causes less harsh or toxic side effects because it does not affect healthy rapidly dividing cells. The most well-known targeted therapy is trastuzumab (marketed as Herceptin), a medicine that kills specific cancer cells that are HER2+ (HER2-positive). A protein called human epidermal growth factor receptor 2 (HER2), which is found on the surface of the cancer cell, in large quantities can promote the rapid growth of cancer cells. Approximately 20–25 out of every 100 patients with breast cancer are HER2+ and are most likely to respond well to Herceptin treatment. This figure illustrates HER2 receptors. It's difficult to predict how any one person will respond to a treatment. Therefore, targeted therapies were developed based on a particular group of factors that may be found on a tumor. Herceptin treatment was made possible through the results from clinical trials that show specific therapies to be more effective on certain types of breast cancer cells. Clinical trials have shown that Herceptin reduces the risk of HER2-positive breast cancers from coming back. In other words, individuals with HER2+ breast cancer get personalized treatment, which is as a result of precision medicine. This figure illustrates how Herceptin works on HER2+ breast cancer cells. Other targeted therapies besides Herceptin include the following: Bevacizumab (marketed as Avastin): Used to treat colon cancer and ovarian cancer. Lapatinib: Used to treat HER2+ metastatic breast cancer. Everolimus (marketed as Afinitor): Used to treat kidney cancer, breast cancer, and brain cancer. Pertuzumab (marketed as Perjeta): Used in combination with Herceptin and/or Taxotere to treat metastatic breast cancer. T-DM1 (marketed as Kadcyla): Used to treat HER2+ metastatic breast cancer. Denosumab (marketed as Xgeva): Used for treatment of secondary breast cancer in the bone.

Article / Updated 11-07-2017

Radiation, or radiotherapy, involves the use of a beam of high-energy rays to kill cancer cells in your breast or lymph nodes under your armpit or chest wall. Radiation therapy is usually recommended after a lumpectomy, when the breast cancer has spread to the lymph nodes under the armpit, or after a mastectomy and the surgical margins are still positive for cancer. Side effects Side effects from radiation can be immediate (also called acute or early side effects) or long-term, occurring after six months of radiation treatment. Immediate side effects are typically related to skin reactions that may occur during radiation and may last for up to six months. If you are exposed to the sun a lot without wearing sunscreen, for example, you are more likely to get sunburn. Similarly, radiation will increase your risk of skin damage and other side effects that include the following: Sunburn. Darkening. Tenderness and/or itching of the skin in the treatment area. Peeling or flaking of the skin as treatment goes on, and this may result in a red, blistering, weepy skin reaction. Note that many individuals do not experience this symptom, and your radiation oncologist may provide you with special topical creams to use during radiation to reduce the risk of peeling and blisters from developing. Side effects that may occur immediately and long-term Pain in the breast or chest area in the form of aches, twinges, or sharp shooting pain Swelling of the breast or chest Stiffness or discomfort around the breast/chest or shoulder Fatigue or tiredness Hair loss under the armpit or chest area Sore throat Hardening of the tissue, known as fibrosis, caused by the accumulation of scar tissue Dry cough or shortness of breath because of inflamed treatment area Serious side effects that can occur later Weakening of the bones under the treated area, which can lead to rib and collarbone fractures Injury to the nerves in the arm, which may cause numbness, tingling, weakness, pain, and possible loss of movement Immediate side effects usually occur around 10–14 days after starting radiation treatment, but can happen later in treatment or after it has finished. The severity of your skin reactions depends on a few factors: Dose of radiation given Your skin type Existing skin conditions, such as eczema, psoriasis, and so on If you have existing skin conditions, let your radiation oncologist/doctor know before starting treatment because it may be useful for you to meet with a dermatologist (skin specialist) for advice. Skincare during radiation therapy You must take special care of your skin that is being treated with radiation. Your radiation oncologist or radiation technologist (who administers the radiation therapy treatments) will provide you with specific skincare instructions at the center. Most instructions will include the following actions and precautions: Have a shower instead of a bath. Wash the treated area gently with warm water using a mild soap and pat the skin dry with a soft towel. Use a fragrance-free deodorant. Use a mild moisturizer or recommended topical cream to keep skin soft. If you want to use anything else on the skin in the treatment area, you must discuss this with your radiation doctor. Avoid exposing the treated area to extremes of temperature such as heat pads, saunas, or ice packs during radiation treatment. Avoid exposing the treated area to sun while having radiation and afterwards, until all skin changes at the treatment site have healed. Avoid getting sunburn after treatment. Always use a sunscreen with a high sun protection factor (SPF) of 50 and above. You should also apply sunscreen under clothes because, thought it isn't widely known, it is possible to contract sunburn through clothing. Avoid swimming during treatment and afterwards until all skin reactions have healed. Chemicals in the swimming pool may cause skin irritation, and a swimsuit can cause friction and discomfort at the treatment site. Wear a soft cotton bra or vest during treatments to avoid rubbing or friction that can worsen skin reactions. Avoid wearing underwire bras until your skin is healed. Your radiation technologist will monitor your skin during treatments. When a skin reaction develops, they will advise you on caring for your skin. If you develop a skin reaction during radiation, it should heal within four weeks from the date of your last treatment. If your skin is taking longer than four weeks to heal, or you have severe blisters and skin peeling, you must contact your radiation treatment team or breast care nurse for advice.

Article / Updated 11-07-2017

There are several surgical options for treating breast cancer, but it is your stage of breast cancer that determines which surgical options are best for you. Breast reconstruction is when a surgeon rebuilds the breast using one of two main types of breast reconstruction: implant or your own tissue (tissue from belly, back, thigh, or buttock). The figure illustrates sources of breast construction. Sometimes, based on the size of your tumor, your doctor may recommend a lumpectomy with or without a sentinel lymph node biopsy followed by several weeks of radiation with minimal change in the size of your breasts. But you may prefer to have the whole breast removed (mastectomy) and perhaps have a breast reconstruction. Regardless of what your doctor recommends and your preferences, here are some things you may find it helpful to consider as you decide among options: How do you feel about having your whole breast removed? How do you feel about having part of your breast removed? How do you feel about having radiation therapy? How quickly do you want your treatment to be completed? How will you cope with travelling daily to get radiation therapy for several weeks? Will you want to have immediate breast reconstruction or wait some months after surgery? There are no right or wrong answers to these questions — it is based on your values and preferences. Each woman is different and will approach their treatment decisions differently in a way that may be personal, social, financial, religious, or cultural. Some women may feel compelled to keep their breast and choose a lumpectomy even though that wasn't recommended by their surgeon because of the stage of their breast cancer. If you are that person, you should speak to your doctor or psychologist to help you determine why you are willing to put your life at risk by not getting the recommended type of surgery. In this case, a mastectomy would better ensure that all your cancer is removed and your risk of cancer coming back will be minimal. If you feel strongly about not getting radiation, then lumpectomy should not be an option for you because you will not be receiving the standard treatment for your breast cancer. Mastectomy and possible breast reconstruction may be your only option in such a case, according to standard NCCN guidelines. The type and timing of breast reconstruction may depend on your need for further treatment post–breast surgery, such as chemotherapy or radiotherapy. Breast reconstruction is optional — it's not required and won't change the outcome of the cancer. Take the time you need to make the right decision after hearing all the options available to you for your treatment. Every decision you make may impact your survival positively or negatively. You can discuss your concerns with your doctor, family, and friends. Feel free to contact your breast specialist or nurse if you have additional questions before you make your treatment decision.

Article / Updated 11-07-2017

You should watch for changes in your nipples. Remember that knowing your breast through regular self-examinations is the key to identifying changes that may be a sign of breast cancer. Nipple inversion Sometimes women may naturally have inverted nipples — in which the nipple does not protrude. That is their normal. But for some women, one of the nipples may become inverted or retracted when their normal is having "outies." If this happens, it is important to see your doctor, as it may be a sign of breast cancer. But before you run off to the doctor, make sure your nipple wasn't temporarily inverted because of chest compression from a sports bra. If that was the cause, the nipple will pucker out eventually and was not related to breast cancer. Milky nipple discharge And when we hear the words nipple discharge, we usually think of pregnancy and breastfeeding. But it's normal for a milky discharge to continue for up to two years after stopping breastfeeding. There are other times that nipple discharge may occur outside of breastfeeding and pregnancy. Nipple discharge can occur during or after sexual stimulation that includes foreplay or sucking on the breasts. It also can be caused by medication use. Breast milk is enabled by a hormone called prolactin, produced by the pituitary gland in the brain. Prolactin is regulated by dopamine, and when certain medications interfere with the level of dopamine in the brain, that can lead to elevated prolactin levels. Such medications include the following: Phenothiazines Selective serotonin reuptake inhibitors (SSRI), more commonly known as antidepressants Metoclopramide Risperidone Estrogens Verapamil An underactive thyroid can cause also prolactin level to increase and cause nipple discharge. Kidney disease and stress can also elevate your prolactin levels. At the extreme is a noncancerous adenoma (tumor) called prolactinoma in the pituitary gland that increases the production of prolactin. Milky discharge is not commonly seen in breast cancer, but if you do start having discharge you should see your doctor to determine the cause. Bloody nipple discharge Very often women think that nipple discharge means they have cancer, but most nipple discharge is from noncancerous causes. Bloody nipple discharge is often caused by a small noncancerous (benign) tumor called intraductal papilloma (IP) that is formed in the milk duct of the breast. IP is made up of fibrous tissue, glands, and blood vessels and is common in women between the ages of 35 and 55. IP can occur in one breast or both breasts at the same time and does not mean you have breast cancer. However, sometimes IP can contain abnormal or atypical cells, and these cells may increase your risk of breast cancer. IP is usually painless, but because of the risk that it contains abnormal or cancer cells, the treatment recommendation is to have it surgically removed. Once the tumor is removed, it can be examined in more detail and determined if there are any areas of cancer within it. Most often there is no cancer associated with IP, but it is important to make sure. If you are diagnosed with IP, talk to your doctor to discuss the treatment best for you. If you've had nipple discharge and wondered why the doctor kept asking you about the medications you were taking and ordered several blood tests, now you know that it was to determine whether your Prolactin level was normal. Thyroid function was normal. Kidneys were functioning well. Medications could be causing increased prolactin. In addition, your doctor may order a mammogram, breast ultrasound, and/or breast biopsy (see Chapter 4 for more on these) to help confirm the diagnosis of IP. Nipple discharge is more suspicious for breast cancer when it only involves one nipple and when it occurs along with skin changes. You must seek medical care if you develop nipple discharge along with skin changes.

Article / Updated 11-07-2017

Breast aches and pains are cause by compression of the nerve endings in the breast. Basically, neurotransmitters in the nerves send messages to the brain that the breast hurts. Anything that causes the nerves to be compressed can cause breast pain, including a breast mass, breast cyst, fluid/inflammation (which can be caused by infection or trauma), and scarring. A poorly fitted bra can also cause breast pain because it compresses areas of the breast, and fluid may be trapped in certain locations that compresses the nerve endings. Not wearing a good supportive bra while running or engaging in high-impact exercises can cause trauma to the chest wall and breast. Chest wall tenderness can last for several weeks because the muscle is strained. If you experience any of these symptoms, talk to your doctor to be treated. Iron deficiency can also cause breast pain, due to iron's function of regulating thyroid hormones. There have been studies showing that 6 mg of an iodine supplement can reduce breast pain and boost thyroid function. If you have breast pain and think it is caused by iodine deficiency, you should discuss with your doctor to determine whether iodine supplements are best for you.