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• Classic-Fiction

• A nipple that is suddenly pulled back into the breast (inverted)

• Ridges or pitting of the breast resembling an orange peel

• A change in the look or feel of the skin of the breast, areola, or nipple (such as warm, swollen, red, or scaly)

Diagnosis

If you have a lump in your breast or if a lump is detected on a routine mammogram, your doctor will perform a manual breast examination to determine whether more tests are required to rule out cancer. He or she may recommend that you have a diagnostic mammogram to get a close-up view of the area of the lump or an ultrasound of the breast. Your doctor or a breast surgeon may perform a biopsy (take a sample of tissue from the lump for examination under a microscope) or remove fluid or tissue from the lump with a needle (needle aspiration or biopsy; see previous page).

If the lump is found to be cancerous, you will probably have more tests. MRIs (see page 113) and PET scans (see page 114) are being used increasingly to help evaluate breast tumors. A PET scan can help determine if the cancer has spread to the lymph nodes under the arms, but a lymph node biopsy is always done to confirm this. A PET scan can also show whether an advanced cancer has spread to other parts of the body.

Other tests used for diagnosing breast cancer include a hormone receptor test performed on the cancerous tissue to determine if estrogen or progesterone (female sex hormones) stimulates the cancer to grow. Sometimes the tissue is examined to look for a gene called human epidermal growth factor receptor-2 (HER-2), a tumor marker that is associated with an especially aggressive form of breast cancer.

Ductal lavage

A test called ductal lavage is used to evaluate the risk of breast cancer in women who are at high risk, such as those who have a family history of breast cancer. In ductal lavage, an anesthetic cream is applied to the nipple area to reduce discomfort, and a breast pump with gentle suction is applied to the nipple to draw out tiny amounts of fluid from the milk ducts. When fluid is found in a milk duct, the milk duct is washed out with salt water infused through a tiny tube (catheter) inserted into the duct. The collected cells are then examined in the laboratory for precancerous changes or cancer.

Ductoscopy

Ductoscopy is a procedure that uses a thin (smaller than 1 millimeter in diameter), flexible viewing tube (ductoscope) inserted through the nipple into a milk duct to evaluate nipple discharge for abnormalities. The tube is connected to a camera that allows the doctor to examine the ducts directly on a video monitor. Ductoscopy may eventually prove to be useful before a woman has breast-conserving surgery (see next page) to help determine how much tissue to remove, or as a screening test for women who are at high risk of breast cancer.

Treatment

The treatment of breast cancer is complex and depends on many variables, including the characteristics of the tumor (which can sometimes help a doctor determine if it is likely to grow rapidly), whether the cancer has spread to the lymph nodes or to another part of the body, and the sensitivity of the tumor cells to estrogen (which can stimulate tumor growth in some women). Treatment options for a particular woman also depend on her general health. Surgery is usually the first treatment for breast cancer, which may be followed by radiation therapy, chemotherapy, hormone therapy, or biological therapy, or a combination of these.

After any treatment for breast cancer, doctors recommend frequent checkups, at least twice yearly. If breast cancer recurs, it can usually be controlled for many years with drugs, radiation therapy, and, sometimes, more surgery.

When breast cancer spreads

Groups of lymph nodes under the arms and in the chest are located close to the breasts. Breast cancer cells can enter the lymph nodes and be carried in the lymphatic system and bloodstream throughout the body. The sites to which breast cancer most often spreads (metastasizes) are the lungs, liver, bones,