Lymph Node Status and Your Treatment Decisions

by palm stephan
When I woke up from my breast biopsy, my husband told me it was indeed cancer. I began to weep, thinking I would have to undergo surgery, chemotherapy, and updating my will (just in case). But more news was to come, and so much to learn.

At first we thought it was well-contained (in-situ), not invasive breast cancer. But we also needed to know the tumor size, grade, hormone status, HER2 status, and whether it had spread beyond my breast. So I started down the road for more tests, including testing of my lymph nodes. I had no idea why those tiny things were so important.

But now I know, and to help you understand how your lymph node status affects your treatment decisions, I looked up the experts in UpToDate -- a trusted electronic reference used by many of the oncologists who treat breast cancer patients.

Here's what the experts say, and below that, you'll see my notes about lymph node status and how that may affect your treatment decisions.

The importance of the axillary lymph nodes: A discussion on diagnosis and staging workup from UpToDate

"One of the first sites of breast cancer spread is to the lymph nodes located in the armpit (axilla). These nodes (referred to as axillary lymph nodes) can become enlarged and can sometimes be felt during a breast examination. However, even if the lymph nodes are enlarged, the only way to determine if they truly contain cancer is to examine a sample of the tissue under the microscope.

The presence or absence of lymph node involvement is one of the most important factors in determining the long-term outcome of the cancer (prognosis), and it often guides decisions about treatment."

Why Are Lymph Nodes Important?
Breast cancer starts out with just a few cells, which group together in your breast tissue. They may be camping out in the system where breast milk is produced: your ducts and lobes. As these cells grow and divide, they may also invade nearby tissue. A growing tumor may shed a cell, or a clump of cells. This independent cancer cell can use your blood or lymph system like a network of highways so it can travel throughout your body. Your lymph system works with your circulating blood to provide nutrients to all your cells, as well as remove cellular waste products. The lymph nodes are the "pit stops" on this highway system, where lymphatic fluid is filtered, mixed with immune cells (lymphocytes), and passed back into your circulating lymph fluid. So, if a loose cancer cell makes it to your lymph nodes, it's also possible that the cancer could get sent along to other parts of your body. If you get an infection, your lymph nodes near the affected area may swell because they have collected germs. And if you develop breast cancer, the lymph nodes in your armpit (axillary lymph nodes) is the most common place that cancer cells would lodge, causing those nodes to swell.

Why Do I Need a Lymph Node Biopsy?
Breast tissue itself contains some lymph nodes, which process lymphatic fluid and pass it along. Breast tumors tend to drain towards your axilla, or underarm area. Checking the underarm lymph node location should be part of a clinical breast exam, as well as your breast self-exam. Swollen lymph nodes might be evidence that cancer has spread beyond your breast, but the only way to know for sure is to have them removed and tested. There are two procedures for lymph node biopsy: sentinel node biopsy and axillary lymph node dissection (removal of all the nodes). The pathology report about these lymph nodes gives you your lymph node status.

How Does My Lymph Node Status Affect My Treatment Options?
Your lymph nodes may be clear of cancer, and if so, your lymph node status is negative, and rated N0. If you have a small tumor and clear nodes, it is less likely that you will need to have chemotherapy. That is not a guarantee, however, because your doctor will also consider your tumor grade, tumor size, hormone receptor status and how effective surgery can be for you. If your lymph nodes do contain cancer, they are considered positive, or involved, and are rated N1, N2, or N3 depending on the number affected and the location. Having involved lymph nodes suggests that the cancer has demonstrated an ability to spread beyond your breast, and you will be advised to have adjuvant systemic therapy, such as chemotherapy, after surgery to kill any additional cancer cells that persist in your body.

What Does All This Mean For My Prognosis?
Prognosis, also called outlook, is one way a doctor talks about how the odds for survival stack up for you, after you've completed treatment. Remember, having just one cancer cell in your body is one too many. Treatment is designed to kill off as many, if not all, of your cancer cells as possible. If you had clear lymph nodes and a small, low-grade tumor, your prognosis after treatment is pretty good. On the other end of the spectrum, if you had 10 or more involved lymph nodes and a larger tumor, your treatment will likely be more aggressive, and your outlook will be harder to determine, until after you've finished all treatments. No matter where your diagnosis fits on that scale, please know that survival rates are improving, treatments are becoming more efficient and effective, and even metastatic breast cancer can be managed like a chronic disease.

Want to learn more? See UpToDate’s topic, "Patient information: Breast cancer guide to diagnosis and treatment: The importance of the axillary lymph nodes," for additional in-depth, current and unbiased medical information on breast cancer, including expert physician recommendations.

Axillary Lymph Node Dissection - Types of Surgery and Effect on Treatment Plans

by palm stephan
A breast tumor can shed cancer cells into your lymph system. Those cells may get trapped in nearby lymph nodes, usually your axillary nodes. Your surgeon may remove some lymph nodes so they can be examined under a microscope. If cancer cells are present in your lymph nodes, your risk for metastatic breast cancer rises. The procedure for underarm lymph node removal is called axillary lymph node dissection.

Axillary Lymph Node Dissection (ALND)
Axillary lymph node dissection may be done as part of a lumpectomy or mastectomy. Your surgeon may remove a small group of nodes or all of the nodes in your axilla. These will be sent to the pathology lab where they will be carefully examined for cancer cells. You will need to know if your lymph nodes are negative (clear of cancer) or positive (contain cancer). This important information affects the staging of your cancer and influences your treatment options.
Importance of Lymph Nodes
Although lymph nodes are present in groups throughout your body, your axillary nodes are the most likely location to which breast cancer cells may travel. Lymph nodes work as filters where bacteria, viruses or cancer cells are caught. When cancer cells are present in your nodes it means that the disease has gained the ability to leave your breast and travel to other parts of your body.

If cancer cells do lodge in a lymph node, it may swell. You should always check your underarm area during your monthly breast self-exam to keep tabs on your axillary lymph nodes.
Types of Lymph Node Dissection
Lymph nodes may be removed as part of breast surgery, or as a separate procedure. Here are different types of lymph node dissection surgeries:

* Sentinel Lymph Node Biopsy (SLNB): This is a diagnostic procedure done to remove a small sample of lymph nodes to which the cancer may be draining. These sentinel nodes are thought to be the first nodes to which cancer cells must travel before going any further. A blue dye and a weak radioactive agent will be used to help your surgeon locate the specific nodes. This procedure removes the least number of lymph nodes.

* Axillary Lymph Node Dissection (ALND): This procedure is usually done as part of a radical or modified radical mastectomy or a lumpectomy. As few as 10 or as many as 40 lymph nodes may be removed for testing.

* Full Axillary Lymph Node Dissection:
If cancer is found during your sentinel node or axillary node biopsy, your surgeon may go ahead and remove all of your axillary lymph nodes, so that all of the nodes can be examined for possible metastasis.

Risks and Side Effects of Axillary Lymph Node Dissection
The most common side effect of a lymph node dissection is lymphedema (swelling of the arm). Since, after surgery, you have fewer lymph nodes under your arm to process lymphatic fluid, the fluid may build up and cause swelling along your arm and sometimes your hand. If just a few nodes are removed, lymphedema may be a temporary condition, but if most of your lymph nodes were removed, it may be a long lasting problem.

Therapeutic massage and pressure garments can help with lymphedema. Your axillary skin may be numb or less sensitive to touch after surgery, because nerves may have been damaged during the procedure. Arm and shoulder range of motion may be affected, so be sure to ask for physical therapy to help regain your motion and strength.

Lymph Node Status Affects Treatment
Axillary lymph node dissection is an important part of your complete diagnosis and staging. Clear nodes and a small tumor will require less treatment because the chances of metastasis are low. However, it's important to know how many nodes are involved with cancer, so more tests can be done to determine if and where the cancer may have spread. This information impacts your treatment options and helps you and your doctor choose the most effective treatment plan for you.

Sentinel Node Biopsy What To Expect During Sentinel Node Biopsy

by palm stephan
Sentinel Node Biopsy - An Important Diagnostic Test:
Sentinel node biopsy is a surgical diagnostic procedure done to remove a small sample of lymph nodes so they can be tested for metastasis. Those sentinel nodes will be examined to determine if cancer cells have metastasized (spread) beyond the original tumor. If done no other surgery is being done at the same time, this is an outpatient procedure, and is important in staging of your breast cancer. If you are having a lumpectomy or mastectomy, sentinel node biopsy may be done along with that procedure. Here's what to expect during a sentinel node biopsy.

Getting Started With Medical Imaging:
Before this surgical procedure, your surgeon will need to know the locations of your tumor and the sentinel lymph node. A combination of imaging techniques will be used to find and mark these locations before surgery.
Finding The Tumor:
You will go to the Nuclear Medicine Department of the hospital or clinic where your sentinel node biopsy will be done. As you would for a mammogram or breast ultrasound, you will undress from the waist up, and put on a hospital gown. Next, you will lie down on an exam table. A radiology technician will use an ultrasound machine to find your tumor. The tumor site will be marked on your skin, so your surgeon can easily find it.
One Shot or Two – Blue Dye and Painkiller:
A radiologist or nuclear medicine specialist will inject a weak radioactive dye (technetium-labeled sulfur colloid), or a blue dye (isosulfan blue), or a combination of both, into the tumor site. This can be painful, so you may be given a choice of whether or not to have an injection of numbing medication first. Since injecting the dyes can take longer than a flu shot usually does, you might like to seriously consider asking for the numbing medication, if it is not offered.
Lymph Node Mapping:
Once injected, the dyes need some time to travel from your tumor site to your lymph nodes. You will spend some time in a nearby waiting room, so bring along some reading material or music. When the dyes have reached their destination, you be asked to return to the Nuclear Medicine Department, and lie down on the exam table again. Imaging studies (lymphoscintigraphy) will be done to show which clump of lymph nodes is receiving the dyes, and that indicates where your sentinel lymph node will be found. The technician will mark this location on your skin, so your surgeon will know where to start looking.
Removing the Sentinel Lymph Node:
You will be brought into the operating room, where your surgeon will be ready to begin. You will be given general anesthesia. The surgeon will use a hand-held probe to find the lymph nodes that contain the most radioactive dye. In that location, your surgeon will make a small curved incision, and look for the lymph nodes that have been stained with blue dye. Only one to three nodes will be removed, unless many more are stained. These nodes are sent to the pathology department, where they are examined for metastasis and micrometatasis.
Your incision will be closed and dressed, and you will be taken to Recovery.
Testing the Sentinel Node in Pathology:
Once in the pathology lab, your nodes will be tested for cancer. Sometimes your surgeon will order a frozen section test for the nodes, in order to get results right then. If your nodes do contain cancer cells, you may have a full lymph node dissection immediately, to find the full extent of lymph node involvement. If a frozen section is not ordered, and your nodes contain cancer, a full lymph node dissection will be done later.
Recovering From Your Sentinel Node Biopsy:
If blue dyes were used to find your sentinel lymph node, expect to see blue dye in your urine for about 24 hours. Sometimes there will be some bruising and blue dye on the skin around the incision. You will have a dressing and sutures to keep dry, and may need pain medications until healing begins. Use the surgery-side arm gently (no lifting!) for at least a week after the procedure. The stains from the blue dye will diminish and the bruises will heal, the incision itself will fade to a fine line over time.
Getting Your Biopsy Results:
Your surgeon or oncologist will call you about results of the biopsy as soon as the pathologist has completed their analysis. The report will include information on how many, if any, lymph nodes contain cancer cells. Ask for a copy of your pathology report and keep it with your health records. If a node contains cancer, it is diagnosed as positive, and if no cancer is found in a node, it is diagnosed as negative. A diagnosis of positive lymph nodes means that your cancer has spread (metastasized) beyond the original tumor. These results will affect the staging and treatment needed to treat your breast cancer.
Risks of Sentinel Node Biopsy:
Lymphedema
A common result of a full lymph node dissection is a condition called lymphedema. Because lymph nodes in your armpit area are missing, the lymph fluid that is usually processed there can build up and cause swelling. If this persists or increases, it can become painful. However, if you require only a sentinel node biopsy, you will still have enough nodes to handle the lymph fluid that travels through your armpit region, so the rate of lymphedema in that case is only about five percent.
False Positives or Negatives
Lymph nodes can vary in size, some small as a pinhead, others large as a bean. Your surgeon will be hunting through skin and fat, looking for blue-dyed nodes, and must use some skill and judgment. It's possible that the sentinel node will test negative (clear of cancer), but cancer may be in some other lymph nodes. This is called a false negative. To protect you from false results, your surgical and pathology teams will follow strict guidelines, and if the results are in any doubt, more nodes will be removed and tested, to make sure of accurate results.

Ductal Lavage Screening for Pre-Cancerous and Cancerous Breast Cells

by palm stephan
What is Ductal Lavage?:
Ductal Lavage has been referred to as the "Pap smear for the breast." With a very tiny tube, fluid can be sampled from the breast ducts, and examined under a microscope or screened at the molecular level for cancer cells.
Who needs this test?:
Women who are at high risk for breast cancer should ask their doctor if this test would help determine whether they may have a pre-cancerous condition, or if they have breast cancer cells present in the breast ducts.
How ductal lavage is done:
The nipple has many milk ducts that open onto its surface. A very tiny tube is inserted into one (or more) of these ducts, and intense suction is applied to the nipple. Some saline solution (mild salt water) is sent through the tube and into the duct, then washed out again, carrying with it a sample of cells from the duct tissue.
Does this test hurt?:
You will feel suction on your nipple - without it, the test won't work properly. You may feel a slight bit of poking sensation when the tube is being positioned and placed into your nipple. The tiny tube which is inserted in through the nipple should not be painful. If it is, let your doctor or nurse know about it.
How are the duct cell samples screened for breast cancer?:
There are now two ways the cells can be screened:

* microscopic pathology - the cells will be viewed under a microscope by a pathologist, and visually compared for irregular shape. Cancer cells have a particular shape which sets them apart from healthy cells.
* cytopathology - the cells will be separated from the saline wash, and sorted for chemical tags in their DNA that indicate whether or not they are cancerous.

What are the advantages?:
This is a non-surgical technique, and therefore less invasive than a biopsy. It may be done during an office visit, so it should cost less than a biopsy, and will not leave any scars. Recovery time, if needed, should be very quick.
What are the disadvantages?:
While ductal lavage can help determine if breast cancer is present in the ducts, it cannot show us precisely where the cancer is living. So, if the results of your test come back positive for ductal carcinoma, you will also need a dagnostic mammogram and perhaps an ultrasound as well, in order to locate the actual site of the cancer.

Open Surgical Breast Biopsy

by palm stephan
Surgical Biopsy for Breast Lumps:
Most breast lumps are benign. In fact, 4 out of every 5 breast lumps are not cancerous. If you have a breast lump and want it checked out, a surgical biopsy is a good way to get a clear diagnosis. This type of breast biopsy removes the largest size of tissue sample, as compared to any type of needle biopsy. Surgical biopsy is done in a hospital, with general anesthetic, and is usually an outpatient procedure.
Other Terms Used for a Surgical Biopsy:

* Open surgical biopsy
* Breast biopsy
* Partial mastectomy
* Excisional breast biopsy

Reasons for a Surgical Biopsy:
An open surgical breast biopsy is needed if the results of a needle biopsy are unclear or if a lump is so hard that a needle cannot obtain a good tissue sample. Also called a "partial mastectomy," a surgical biopsy is done to remove a tissue sample that is larger than a sample from a core needle or vacuum-assisted biopsy. In some cases, the entire mass and a margin of healthy tissue may be removed. The tissue will be examined in a lab right away to ensure that it is an accurate sample and get a diagnosis.
Finding the Breast Lump for a Biopsy:
For a breast mass that is easy to locate by touch, your surgeon may use mammograms or ultrasound and palpation to locate the tissue for a biopsy. If your mass is quite small or hard to find by touch, you may have a wire localization done prior to your biopsy. This is done while you are awake, and local anesthesia is used to numb your breast. Using mammography, a hollow needle is guided in to your breast mass, and a thin wire is fed through the needle to that location. The wire is left in place to help guide your surgeon to the right spot for your biopsy.
What to Expect During Your Breast Biopsy:
You will be prepared for surgery and given a general anesthetic, which puts you to sleep. Your surgeon will make an incision over the mass to be biopsied and locate the mass using touch or wire localization. Small masses may be removed entirely, but in most cases, a slice of the mass will be taken and sent to the lab. When there is enough tissue to make a clear diagnosis, your incision will be closed with stitches and dressed. You will be taken to Recovery to sleep until the anesthetic wears off. You will be able to go home the same day, but someone else must drive for you.
Recovery and Self-Care:
A surgical biopsy will result in a small scar on your breast skin. Be sure to keep your surgical dressing dry until you have gone for your follow-up visit. Take a full day to recover from your biopsy, as you may have some residual anesthetic in your system. If you have pain at the biopsy site, it's OK to take ibuprofen and use a cold pack.
Getting Fast, Accurate Results from Pathology:
A pathology lab can use two methods to study your tissue sample. The quickest method is called "frozen section" or cryosection. The tissue is rapidly frozen and sliced with a special blade into a section thin enough to see through. This gives a diagnosis of benign or malignant, but no other details. A permanent section is a more thorough process, using special chemicals to get more information from the tissue slide. This process takes about 48 to 72 hours and gives a bigger picture of your diagnosis: if it is malignant, you can find out if it is hormone sensitive and whether it is high or low grade.
Dealing with Your Biopsy Results:
When you awaken from surgery, you may be told your preliminary biopsy results. If your mass was benign, then you won't need any further surgery. If your diagnosis was malignant (cancerous), though, you will need to wait two or three days to get your full pathology results. Your doctor will meet with you to explain the details of your diagnosis, but you won't need to rush in to treatments. Take your time to study all of your options before deciding on a treatment plan. Remember, you are still the same person you were before your biopsy — having breast cancer does not define you!
Pros and Cons of a Surgical Biopsy:
Surgical breast biopsy takes the largest tissue sample and has the highest accuracy rate of all biopsy methods. On the other hand, some disadvantages may be the need for stitches to close your incision and the resulting scar and internal scar tissue that will appear on future mammograms. In a few cases, patients develop bleeding and infection at the biopsy site or have a bad reaction to the anesthesia. Be sure to ask your doctor if a surgical biopsy will really work best for you or if other methods, such as core needle biopsy or vacuum-assisted breast biopsy, would be good alternatives.

Stereotactic Breast Biopsy for Breast Abnormalities

Definition of Stereotactic Breast Biopsy:
A stereotactic biopsy is used take samples from a lump that cannot be felt during a breast exam, but can be seen on a mammogram or an ultrasound. A lump deep inside the breast, or an abnormality too small to feel, can be biopsied using this technique.
Stereotactic Imaging Improves Accuracy:
During stereo imaging, two-dimensional digital images of your breast are taken from two different angles. Both images are sent to a computer for image analysis. The computer compares the data from each image and calculates the three-dimensional location coordinates for your breast abnormality. With such precise information to guide the biopsy needle, your doctor or radiologist can accurately sample fluid or tissue.
Other Terms for Stereotactic Biopsy:

* Stereotactic (mammographically guided) breast biopsy
* Stereotactic core needle biopsy
* Stereotactic-guided biopsy
* Breast stereotaxy
* Mammotome vacuum-assisted biopsy

Reasons to Have a Stereotactic Biopsy:
When your mammogram shows an abnormality that raises concern, and your doctor needs a tissue sample, a stereotactic biopsy is one way to get tissue from a specific location. Examples of abnormalities could be: a dense, irregularly-shaped mass, microcalcifications, a distortion of breast tissue or internal structure, or a new mass at a previous surgery site. Stereotactic biopsy is a good alternative to surgical biopsy if you or your doctor prefers to try a needle biopsy before opting for surgery.
Stereotactic Guidance Assists Needle Biopsies and Wire Placement:
The accuracy of stereotactic images can assist in several types of biopsy:

* fine needle aspiration - removing fluid from a cyst
* core needle biopsy - taking tissue from a mass
* vacuum-assisted biopsy - using suction to collect several tissue samples
* wire localization - locating the mass in preparation for surgical biopsy

Patient Comfort and Biopsy Technology:
Stereotactic biopsy can be done in a clinic or hospital that has special breast biopsy equipment. The equipment consists of a digital mammogram machine, linked to a computer, and a needle guidance system. Since you will be awake during the procedure, but must remain very still, your comfort is very important. Some biopsy equipment is configured so that you can sit in a chair during the imaging and biopsy, while other clinics use a special exam table that you can lie down on. Your breast will be given a local anesthetic, so you should not feel anything other than some pressure.
What to Expect During a Stereotactic Biopsy:
Your breast is numbed, and you are positioned for stereotactic mammography. Some compression is used to keep your breast still. Several pairs of images are taken. A small cut is made in your breast skin, so the needle can enter your breast. Your doctor or radiologist uses the image-guided needle to target the breast abnormality. More images are taken to confirm that the needle is in the right place. Using suction or special blades, fluid or tissue is collected for examination. If you're having a surgical biopsy, a wire will be placed at the location and depth of the tumor to guide your surgeon.
Getting Tagged, Recovery and Self-Care:
A fine needle or core needle biopsy won't leave any internal scars, but a vacuum-assisted biopsy (which may take eight or ten tissue samples) will leave its mark. Because those scars can show up on mammograms and ultrasound, a tiny metal tag, clip, or marker may be left at the biopsy site. This tag should not cause discomfort or harm; it will help radiology technicians locate the biopsy site.

It is normal to have some bruising and swelling after a biopsy. Use cold packs and ibuprofen while you are recovering, which should take about 24 hours. If you have bleeding, drainage or inflammation, alert your doctor.
Getting Results from Your Biopsy:
Your fluid or tissue samples will be given to a pathologist, who will carefully examine and test them. A pathology report will be written and sent to your doctor, who will contact you about the results. Remember that having a biopsy doesn't mean that you have a malignancy, since four out of five biopsies come back negative for cancer.
Accuracy of a Stereotactic Biopsy:
Compared to a freehand needle aspiration or an ultrasound-guided needle biopsy, a stereotactic breast biopsy will give you the most accurate results. The precision of a computer-guided needle, combined with larger tissue samples, yields the most information of any type of needle biopsy. An open surgical biopsy, which removes the largest sample of tissue, may be more accurate than a stereotactic biopsy.

Benefits and Risks of Stereotactic Biopsy
A stereotactic biopsy is less invasive and less expensive than an open surgical biopsy. This is a fairly simple and quick biopsy method, with a short recovery time. You do have a small risk of infection, bleeding, and pain following the procedure. If you are pregnant, or think you may be, let your doctor know so that you can be protected from x-rays used in breast imaging.

Mammotome and ABBI, and MRI Technologies
Two other techniques are used with stereotactic imaging to perform breast biopsy to remove twice as much tissue than is taken with a core needle. Mammotome uses a hollow probe with a rotating blade to suction and cut a cylinder of tissue from the target area. ABBI (Advanced Breast Biopsy Instrument) uses a probe, a circular blade, and a thin, electrically heated wire to capture and remove a cylinder of tissue that is larger than the Mammotome sample. MRI (magnetic resonance imaging) is sometimes used in place of stereotactic mammography.

Core Needle Biopsy - Breast Biopsy

by palm stephan
Core Needle Biopsy for Breast Masses:
A core needle biopsy is used when your doctor needs more information about a breast lump than a mammogram, ultrasound, or fine needle aspiration can give.

A core needle, or hollow core needle, can be used to get small tissue samples from a breast lump. The tissue samples will be sent to the pathology lab for examination. This procedure can be done in an office, clinic or hospital by a doctor who is trained in the technique.

Having a core needle biopsy might help you avoid an open surgical biopsy.
Other Names for a Core Needle Biopsy:

* CNB
* hollow core needle biopsy
* incisional needle biopsy

Reasons to Have a Core Needle Biopsy:
Having a breast biopsy of any kind can be stressful, but it's a good way to find out the true nature of a breast mass that is causing concern. You may have already had a fine needle aspiration (to remove fluid or tissue), but didn't get clear results. A hollow core needle (16-, 14-, or 11-gauge needle) can take larger tissue samples of a breast mass as well as nearby healthy breast tissue. Your pathologist can do more accurate tests and microscopic examinations on larger tissue samples, giving you and your doctor a better idea of how to proceed.
Techniques for Core Needle Biopsy:
Core needle biopsies are done several different ways, depending on the size or location of the breast mass being sampled. Freehand needle biopsy can be used for lumps or masses that can easily be felt. But if a lump is too small to be felt, or too deep to aim a needle at, there are other methods that use imaging and mechanical assistance: ultrasound-guided needle biopsy, stereotactic needle biopsy, and vacuum-assisted biopsy.
What to Expect During a Core Needle Biopsy:
You will be awake during the procedure, but your breast will be numbed with a local anesthetic. Your doctor will locate the lump by touch or with guidance from imaging technology. Your doctor will insert the core needle through your skin into the lump to take tissue samples. To ensure accuracy of results, three to six samples will be taken. You should expect to feel some pressure during the procedure, but be sure to let your doctor know if you feel significant pain. After the procedure, you may have some bruising at the needle sites, but no scars. You will be able to return to work or home right away.
Getting Results From Your Biopsy:
Your tissue samples will be tested in the pathology lab, and a written report will be sent to your doctor. A negative result means that no cancer was found. A positive result means that the mass is malignant, and more tests will be needed to get an accurate diagnosis.
Accuracy of a Core Needle Biopsy:
Because a core needle can remove a larger tissue sample, and more samples are taken for comparison, a core needle biopsy is more accurate than a fine needle aspiration. A core needle biopsy may be between 97 and 100% accurate in giving a diagnosis. If you have very small breasts or very hard lumps, a core needle may not be able to take a good tissue sample, and other biopsy methods may be required.
Benefits and Risks of This Procedure:
A core needle biopsy is more accurate than an aspiration and less invasive than an open surgical or excisional biopsy. The needle biopsy will leave no external or internal scars, and so it will not affect future breast imaging studies. There is always the chance that the needle may miss a malignant area, but your doctor will try to minimize this possibility. A core needle biopsy is not a treatment, and it will not remove all of a malignancy. If your results come back positive for cancer, you will need to consider more tests and treatment.

Fine Needle Aspiration of a Breast Cyst

by palm stephan
Fine Needle Aspiration for a Breast Cyst:
A breast cyst is a harmless, fluid-filled sac that shows up easily on an ultrasound. Other types of breast lumps may feel similar to a cyst, but one way to be sure that your breast lump is a cyst and not a different mass is to have a fine needle aspiration. Your doctor will use a very fine needle (smaller than a blood-draw needle) to suction out some fluid, which will be examined under a microscope. This procedure can be done in an office or clinic – by a doctor who is trained in the technique and has access to a pathology lab that can examine the resulting fluid.
Also Known As:
Breast cyst aspiration, fine needle aspirate of breast, breast FNA, fine needle aspiration biopsy, FNAB
Reasons to Have a Fine Needle Aspiration Biopsy:
Getting any breast lump checked out is a wise move. Having a fine needle aspiration may seem scary, but it can give you the clearest information about the nature of the lump. If the lump turns out to be a cyst, the fluid can be drained out, relieving any pressure it may have been causing. Most breast lumps are not cancerous, but a small percent of them are malignant. In either case, the examination of the fluid resulting from your aspiration can give your doctor enough information to determine what the next steps should be, to deal with the lump.
What to Expect During a Fine Needle Aspiration Biopsy:
You will be awake during the procedure, but you can ask for local anesthetic to numb the area of your breast that the needle will enter. Your skin will be cleaned to prevent infection. Your doctor will locate the lump by feeling it, or by using an ultrasound to see it. Then your doctor will immobilize the lump and use a very fine-gauge needle, to pierce the lump, and draw fluid out with a syringe. If no fluid comes out, the doctor may reposition the needle and try again. Once fluid is captured, the needle is removed, pressure is applied to prevent a bruise, and a bandage is used to cover the site.
Getting Results From an Aspiration:
The color of the fluid drawn out of the lump will give some clues about its nature. If the fluid is clear or watery and not bloody, and the lump shrinks as a result of the aspiration, it is most likely a cyst. Sometimes the fluid will be white, yellow-green, brown, or bloody – only in rare cases will this mean that the lump is cancerous. If the needle draws out small bits of tissue and very little fluid, that indicates a solid mass. Those tissue samples should be examined by a pathologist, to determine their nature.
Accuracy of this Procedure:
A needle aspiration is 80 to 85% accurate in giving a clear indication as to whether a breast lump is a cyst or a solid breast mass. But since some possibility of error exists, it is important to go for your follow-up visits. A cyst can refill, and need more aspiration, or if a lump grows or the needle biopsy site becomes bruised, infected, or tender, your doctor should examine it again.
Benefits and Risks:
A fine needle aspiration may result in draining a cyst, and the lump will go away. This is a good indication that the lump was not cancerous. However, some cysts do refill, and if they become bothersome, can be surgically removed. If the needle biopsy misses a cancerous lump, or if the fluid or tissue sample does not give a clear diagnosis, then your doctor may recommend doing another FNA biopsy, or a core needle, stereotactic, or open surgical biopsy.

Questions to Ask After Your Breast Biopsy

by palm stephn
When your breast biopsy results in a diagnosis of cancer, you may want to ask a lot of questions. Knowing the answers to the questions will help you make good treatment decisions. Here is a list of questions to ask after a breast biopsy. You may want to print this out and bring it the next time you see your doctor.
1. What type of breast cancer do I have?
Breast cancer is not just one disease. It may be precancerous, non-invasive or invasive, ductal or lobular. Some people may have a type of breast cancer that does not yield a palpable lump, and some may have another type that just affects the skin of the nipple. Your treatment options will be tailored to the type of cancer you have, as well as several other factors.
2. What size is my tumor?
Tumor size is an important part of staging breast cancer, and it affects your treatment decisions. Breast imaging allows for an estimation of tumor size, but the final measurements will be determined by a pathologist after the tumor is removed surgically.
3. Is there only one tumor?
A mammogram is often the first test that shows an abnormality in one breast. Before treatment for breast cancer begins, both breasts should be carefully imaged to ensure that the diagnosis and plan for treatment is appropriate and comprehensive. Sometimes a breast MRI will be done to get a different kind of image of the breasts, which can sometimes find abnormalities missed on a mammogram.
4. What is the grade of my tumor?
Tumor grade is a measure of how aggressive the cancer cells are behaving. A pathologist will examine the cancer cells for several characteristics, and give the tumor a grade of 1, 2, or 3.
5. What was my proliferation score?
If your cancer is high-grade, it may be given a Ki-67 tumor marker test. Your score on this test helps predict the way your tumor will respond to chemotherapy, and what your chances of recurrence after treatment may be.
6. What is my cancer's hormone status?
Most breast cancers are driven by estrogen , progesterone, or both of those hormones. Understanding the test results is important, because this information affects your treatment as well as your follow-up care. If your hormone tests come back negative, you may have triple negative breast cancer, for which new treatments are being developed.
7. How did my HER2/Neu Status come out?
Her2 is a protein that sends control signals to your cells, telling them to grow, divide, and make repairs. If your cancer makes too much HER2, you may need to add Herceptin to your treatments to target the HER2 receptors on the cancer cells.
8. Which type of surgery do you recommend? Why?
Surgery will be done to remove as much of the cancer as possible. Discuss with your doctor whether you can have breast-conserving surgery or a mastectomy. Be sure to tell your doctor if you have a family history of breast cancer, as that may affect your choices.
9. Should I have chemotherapy before surgery?
In some cases, chemotherapy may be given before surgery to shrink the tumor. That might make the difference between a lumpectomy and a mastectomy.
10. Are there other tests I should have before treatment?
Some tests may determine which treatments will most effectively kill your cancer and prevent recurrence. Other tests may be needed to check on the health of your major organs and bones.

Breast Biopsy Overview1

by palm stephn
If you've had a mammogram or a breast exam that has caused concern, or if you've felt a lump in your breast, you should talk to your doctor or nurse practitioner about it. If the doctor recommends it, you may need to have a breast biopsy done, to determine whether the affected tissue is actually worrisome, is only a cyst, or is just a normal change. There are several kinds of breast biopsy techniques, and each one has advantages and disadvantages.

A biopsy is a procedure that takes a sample of tissue, so that it can be sent for testing by a lab. It's important to get accurate results from a biopsy, because if there is any disease, the biopsy result will help to determine what your next course of action should be.

* Fine-needle aspiration During a fine-needle aspiration, the surgeon will put a thin needle through the skin and into the lump. Cells will be drawn into the needle, and given to a pathologist to look at under a microscope. Needle aspiration might also be done to determine if the lump is solid or liquid (a cyst). If the lump is a cyst, after the fluid has been removed, the cyst will deflate and disappear. If there is no fluid, and the tissue in the lump is too hard to draw into the needle, then you may need a different type of biopsy, in order to get the best results.

* Core needle biopsy For a core needle biopsy, the surgeon will use a large, hollow-core needle, which has a special tip. The surgeon puts this needle through the skin and into the lump. A very small tissue sample will be taken into the core needle. Sometimes the surgeon will also use suction, in order to remove a slightly larger sample of tissue. The sample is then sent for lab tests. If the surgeon has difficulty targeting the lump, and the tissue sample does not give a clear result, you may need to have this done again, or your doctor may suggest a different type of procedure.

* Stereotactic biopsy This kind of biopsy is used to get a tissue sample from a lump that cannot be felt during a breast exam, but can be seen on a mammogram or an ultrasound. The lump may be too deep inside the breast to be palpable (felt by your fingers.) The surgeon will use a special type of X-ray imaging, to find the lump that the needle must target, in order to get an accurate tissue sample. The needle will follow the X-ray to the area of concern, and take a tissue sample. Recently, some surgeons have begun to implant a small bit of metal at the biopsy site, after taking a tissue sample, so that in future mammograms or ultrasounds, they can see where a biopsy was done. This kind of biopsy will create some scar tissue, where the biopsy occurred, but the metal tag will help your doctors distinguish between scar tissue and a benign area in your breast.

* Open biopsy, or surgical biopsy This surgical technique requires a cut in the skin, in order to remove a sample of the lump, or sometimes, the entire lump. An open surgical biopsy will be done in a hospital or surgical center. If your surgeon cannot feel the lump, and does not know where to take a tissue sample, then you will be asked to have a mammogram done just before the surgery. The mammogram will show the target area, and a needle will be placed in the suspicious area, to guide the surgeon right to the site. A tissue sample will be surgically removed and sent for testing immediately. If the surgeon missed the target area, they may have to take another sample, during the same procedure. This helps you get the most accurate results from the lab tests, which the lab does on the tissue sample. This can be a minimally invasive procedure, which may leave a small scar on your skin, and will create some scar tissue at the biopsy site.

You may need further tests or biopsies, if problems are found during the first biopsy, or if the results of the tests are unclear, or if your doctor is concerned about a particular area of your breast.

Breast Biopsies

by palm stephn
A biopsy is a procedure that takes a sample of tissue that is then sent for testing by a lab. It's important to get accurate results from a biopsy. If there is any disease, it's the biopsy result that will help to determine what your next course of action should be.

* Breast Biopsy Overview
* 10 Questions to Ask After Your Breast Biopsy
* Fine-Needle Aspiration FNA
* Core Needle Biopsy CNA
* Stereotactic Breast Biopsy

* Open Surgical Biopsy
* Ductal Lavage - Screening for Cancer & Pre-Cancerous Cells
* Sentinel Node Biopsy - What To Expect
* Axillary Lymph Node Dissection
* Lymph Node Status and Your Treatment Decisions

Breast Lumps Overview

By Pam Stephan
During a breast self-exam, you may notice lumps or a change in texture. Knowing the difference between harmless and harmful lumps is important to your breast health.

There are three kinds of benign breast lumps:

* Cysts
* Fibroadenomas
* Pseudolumps

A malignant breast lump: Breast cancer

Breast Lumps in Detail:
Breast Cysts:
What is it? This is a harmless (benign) fluid - filled sac of tissue. It can grow right within the breast tissue.

What does it feel like? This will feel smooth and squishy. If you are pressing on a cyst, it will have some give to it, like a water balloon. A cyst can move around and can change in size during your menstrual cycle.

Where is it? Breast cysts can be located near the surface, or deeper inside, close to your chest wall. If the cyst is closer to the surface, it is easy to find and easy to distinguish from other lumps. But if it is deeper inside, it's more difficult to distinguish it from other kinds of lumps, because when you press on it, you're actually trying to work through layers of breast tissue, which may be dense and firm.

Treatment: Your doctor can help you determine that a lump is a harmless cyst, by doing a fine needle aspiration with a syringe. This procedure removes the fluid from inside the cyst, which deflates and most likely will not return.

When does it appear? Commonly appears in women who are in their 30's, 40's and 50's. They are most often found in women who are nearing menopause.

Does it show up on a mammogram? Yes. See what breast cysts look like on a mammogram.

Breast Fibroadenomas:
What is it? This is a benign group of cells that support other kinds of cells in your breast. These are made of fibrous and glandular tissues.

What does it feel like? This will feel like a round lump, and can be hard or firm. It can be moved around during a breast self-exam.

Where is it? These can be located near the surface of the breast and are easily felt.

Treatment: A fibroadenoma can be removed, if needed, with a surgical procedure. If there is some doubt about the fibroadenoma, it can biopsied, to make sure that it is harmless.

When does it appear? Usually appears in teens and younger women. Not common in post menopausal women.

Does it show up on a mammogram? Yes. See a breast fibroadenoma on a mammogram.

Breast Pseudolumps:
What is it? These are benign, and may be scar tissue, hardened silicone, necrotic (dead) fat, or a rib bone pressing into breast tissue and compressing it.

What does it feel like? This kind of lump can feel quite hard and usually doesn't change shape or size during a menstrual cycle. It may or may not be movable, depending on what it is actually composed of.

Where is it? Pseudolumps can be located near the surface, or deeper inside the breast, close to the chest wall.

Treatment: To be sure that a pseudolump is harmless, get a mammogram and ultrasound, and if those are not clear, have a needle biopsy done, so that a tissue sample can be analyzed by a pathologist. If it is bothersome, you can have it surgically removed.

When does it appear? If you've previously had breast surgery or enhancement done, or if a rib has shifted, then a pseudolump may occur.

Can Pseudolumps Show up on a Mammogram? Maybe. Find out more about breast pseudolumps and mammograms.

Breast Cancer:
What is it? A malignant lump that is made of abnormal breast tissue cells, growing in an uncontrolled way.

What does it feel like? A malignant lump will have an irregular shape (not round) with a pebbly surface, somewhat like a golf ball. It will be very hard, like a slice of raw carrot. It may not be movable during a breast self-exam, but since tissue around it may move, it's sometimes hard to know if the lump is moving, or if healthy tissue around it is moving. A clinical breast exam and a mammogram will help to clear up the diagnosis. A needle biopsy would provide more information about the lump.

Where is it? Breast cancer can be located near the surface, or deeper inside the breast, close to the chest wall. It can also occur in the armpit area, where there is more breast tissue.

Treatment: The lump itself may be treated with one, or a combination of therapies: surgery, chemotherapy, radiation, and hormone suppression therapy. Talking with your doctor will help you decide on the best treatment plan for your particular diagnosis.

When does it appear? Breast cancer may appear in women who are pubescent, in their fertile years, peri-menopausal, or postmenopausal.

Tips For Doing Your BSE

1. Mark your calendar to remind yourself to do your BSE regularly. This is a good way to prevent worry if find a normal cyclic change.
2. Stay relaxed and breathe normally as you do your BSE. Becoming tense will produce some knots that you may mistake for something worrisome.
3. Report any changes or unusual pain to your doctor or nurse practitioner. Keep a log of changes, if that helps you remember.
4. Remember to have an annual clinical exam and a mammogram.

How To Do a Breast Self Exam (BSE)6

By Pam Stephan
6. Manual Exam - Recline and Stroke
"Breast Self Exam: Recline Stroke 6"Photo Courtesy of National Cancer Institute
This is best done in your bedroom, where you can lie down. Place a pillow on the bed so that you can lie with both your head and shoulders on the pillow. Lie down and put your left hand behind your head. Use your right hand to stroke the breast and underarm, as you did in step 4. Take note of any changes in texture, color, or size. Switch sides and repeat.

How To Do a Breast Self Exam (BSE)5

By Pam Stephan
5. Manual Exam - Check Your Nipples
"Breast Self Exam: Check Nipple 5"Photo Courtesy of National Cancer Institute
Still facing the mirror, lower both arms. With the index and middle fingers of your right hand, gently squeeze the left nipple and pull forward. Does the nipple spring back into place? Does it pull back into the breast? Note whether or not any fluid leaks out. Reverse your hands and check the right nipple in the same way.

How To Do a Breast Self Exam (BSE)4

By Pam Stephan
4.Manual Exam - Stand and Stroke
"Breast Self Exam: Stroke Exam 4"Photo Courtesy of National Cancer Institute
Raise your left arm overhead, and use your right-hand fingers to apply gentle pressure to the left breast. Stroke from the top to the bottom of the breast, moving across from the inside of the breast all the way into your armpit area. You can also use a circular motion, being sure to cover the entire breast area. Take note of any changes in texture, color, or size. Switch sides and repeat. This is best done in the shower, as wet skin will have the least resistance to the friction of your fingers.

How To Do a Breast Self Exam (BSE)3

By Pam Stephan
3. Visual Exam - Arms Over Your Head
"Breast Self Exam: Visual Exam 2"Photo Courtesy of National Cancer Institute
Still standing in front of the mirror, raise your arms over your head and see if your breasts move in the same way, and note any differences. Look at size, shape, and drape, checking for symmetry. Pay attention to your nipples and areolas, to see if you have any dimples, bumps, or retraction (indentation). Look up toward your armpits and note if there is any swelling where your lymph nodes are (lower armpit area).

How To Do a Breast Self Exam (BSE)2

By Pam Stephan
2. Visual Exam - Hands on Hips
"Breast Self Exam: Visual Exam 3"Photo Courtesy of National Cancer Institute
In the privacy of your bathroom, strip to the waist and stand before a mirror. You will need to see both breasts at the same time. Stand with your hands on your hips and check the appearance of your breasts. Look at size, shape, and contour. Note changes, if any, in the skin color or texture. Look at the

How To Do a Breast Self Exam (BSE)

By Pam Stephan
reast self examination (BSE) is to be performed each month in addition to an annual mammogram or a clinical exam. Knowing your cyclical changes, what is normal for you, and what regular monthly changes in the breast feel like is the best way to keep an eye on your breast health. Breast tissue extends from under your nipple and areola up toward your armpit.

Difficulty: Easy

Time Required: 15 minutes a month

What You Need:

* A mirror which lets you see both breasts
* A pillow for your head and shoulders
* Privacy

1. Make a regular date for your BSE
"Breast Self Exam: Visual Exam"Photo Courtesy of National Cancer Institute
If you are pre-menopausal: Set a regular time to examine your breasts a few days after your period ends, when hormone levels are relatively stable and breasts are less tender.

If you are already menopausal (have not had a period for a year or more): Pick a particular day of the month to do the exam, and then repeat your BSE on that day each month.

Surviving Breast Cancer and Finding Strength

By Pam Stephan
Patience is a financial administrator who lives in Zimbabwe. She is married, has 3 children and one grandchild. Highly educated, she has worked in banking and private business for many years but is now taking time off from work during treatment for breast cancer. She writes about finding strength and has advice for other women who may face a diagnosis of breast cancer.

Q: What happens if a women delays treatment for breast cancer?
A: When I last visited my surgeon for a checkup, he told me a story about another patient of his. He had first seen this lady in 2005 and had recommended a mastectomy after having confirmed she had breast cancer, but she did not come back for surgery. She had just visited him in April 2008 with a breast that was now painful and had developed sores. She obviously had no understanding of the disease and the need to deal with it urgently.

Q: What advice would you give to other women who may be at risk of developing breast cancer?
A: Do your physical examinations and don’t get tired of doing them and do go have your regular mammograms. The sooner you catch breast cancer, the better for you. It may just be a lump and chances are you feel perfectly OK but get it checked out and be sure. In HIV circles, they say, "Know your status." In breast cancer, it should be, "Do right by yourself." Women need to be proactive about their health and learn about different ways of dealing with cancer. Many women are ignorant about this disease, and increased awareness is needed.

Q: Did you feel that health professionals treated you well and were supportive?
A: I was quite happy with the treatment by my health professionals, although they could have taken more time in explaining issues and procedures. While I had read a lot on the subject, I still learned a lot as I was going through the treatment process. The Cancer Association has helped in filling in the gaps and enlightening me on some issues. Their support is outstanding, and they are always ready to give moral support.

Q: What gives you the strength to face this hardship in your life?
A: I only consider this a hardship because of the financial strain it has put on my family. A lot of things have had to be put on hold until I get over the treatment and recover — physically and financially. For me, this is a wake-up call. I now need to do all those things that I have always said I should do (once I am done with the treatment). So in a way, this is a blessing in disguise. Thinking about my future is giving me strength.

Breast cancer has no regard for international boundaries. As Patience told her story, I was struck by how similar our experiences are. A lump found by accident, avoidance of regular mammograms (yes, I was guilty!) and very similar treatments and side effects. Like her, I purposely began planning for my future after breast cancer diagnosis, hoping that a positive attitude would help me endure chemotherapy, and like Patience, I would urge women everywhere to do breast self-exams on a monthly basis, and don't skip your annual mammograms. Early detection means better survival, less treatment and a more healthy life ahead.

Personal Story of Breast Cancer in Zimbabwe

By Pam Stephan
In America, African-American women have the lowest incidence but highest death rate from breast cancer. American black women are more likely to be diagnosed at a later stage of breast cancer than white women and are at high risk for early-onset, high-grade, node-positive and hormone receptor–negative disease, which is often more difficult to treat successfully. Women in a sub-Saharan Africa breast cancer study had the same diagnoses, prompting the theory that risk factors for breast cancer may be inherited. Patience wrote to me from her home in southeastern Africa, where she is midway through chemotherapy treatments for breast cancer.

Patience Mtakwa is a financial administrator who lives in Zimbabwe. She is married, has 3 children and one grandchild. Highly educated, she has worked in banking and private business for many years but is now taking time off from work during treatment for breast cancer. She is interested in developing ways to help those in her country who cannot afford treatment for breast cancer. Patience is currently working on a documentary project that will assist breast cancer patients in her country.

Patience's Breast Cancer Diagnosis

Age at diagnosis: 44
Date of diagnosis: February 21, 2008
Lymph node status: Four of seven nodes positive, no metastasis found with medical imaging or bloodwork
Tumor description: Stage 3, grade 3 tumor
Treatment Plan: Mastectomy, chemotherapy (Cytoxan, Adriamycin, fluorouracil) and radiation

Q: How did you react when you first learned that you had breast cancer?
A: I wasn’t shocked, as I have always had it in the back of my mind that it could happen to me. The irony is that in 1996 and 1999, I went for mammograms and didn’t have another one after that. I even stopped doing breast self-examinations. I was OK with the whole cancer thing and was more worried about my family's reaction and how they would deal with it. It was and still is the chemo that I am more afraid of, after having read and watched movies on how chemo affects the patient. My mother was diagnosed with breast cancer in 1973 but didn’t have a mastectomy. She only had radiation treatments. She passed away five years later at the age of 35.

Q: Tell me about discovering your breast lump.
A: I discovered it by accident. I have high blood pressure and don't like taking medication continuously. I am in the habit of checking my pulse rate to find out if my blood pressure is OK or not. The best way I can get a clear pulse is by putting my fingers on my heart, under my left breast. On this particular day, I was lying in bed on my back and thought I should check my pulse. This was the first time I had ever checked my pulse lying down. In trying to look for the right spot, I felt the lump that at first I thought was my rib. After checking my pulse, I decided to check out the "rib" again, and that is when I realized it was actually a lump in my left breast.

Q: How has breast cancer affected your everyday life? Does this diagnosis affect your self-image?
A: My self-image hasn’t been affected at all, even after having the mastectomy. There are people who have lost an arm or a leg, something that is so crucial in daily life, so why should I worry about losing a breast? That is something that no one notices, unless I tell them about it. Since I am still undergoing treatment, I have had to stop working and put my own business on hold, as it has become difficult to plan. My chemo treatments have had to be delayed because of low blood counts, and I've had other side effects. Other aspects of my life haven’t changed much as yet, but I am reading on holistic healing and listening to your body and helping it heal itself. This will definitely lead to some changes in my diet and daily activities. Also, I am looking for someone to teach me how to meditate. This will be a positive change.

Q: What challenges are there to being treated for this disease in Zimbabwe?
A: Because the cost of living has become so high, many medical costs are beyond the reach of many Zimbabweans. I am fortunate that I have managed to pay for treatment by sacrificing a few luxuries. Many more aren’t as fortunate as I am.

The average person in Zimbabwe is not able to afford doctor's fees, surgery costs and medication. Even people who work as nurses, teachers, office clerks or supervisors and civil servants have difficulty paying for healthcare. For the majority of women in Zimbabwe, a diagnosis of breast cancer can be a death sentence, as there is no way they can get treated.

There is only one radiation treatment machine in this country, and I have just learned that there is a one month waiting list for it. It has broken down often and not been serviced. The breakdown of the machine reminds me of how our healthcare delivery system has broken down. It used to be one that was sought after by people from this region [of Africa]. But now Zimbabweans that can afford health care now seek treatment outside the country. Due to the economic hardships, few oncologists are left in this country. They have moved away to other countries in search of greener pastures and a chance to own a home.

Premature Menopause Due To Breast Cancer Treatment

by Rosalyn Carson-DeWitt
(LifeWire) - Every year, approximately 276,000 women are diagnosed with breast cancer -- facing challenges, both physical and emotional. Approximately 25% of these women are diagnosed prior to menopause and may face an added challenge -- premature menopause.

What Is Premature Menopause?

Menopause refers to the point when a woman stops having menstrual periods. In the United States, women reach menopause, on average, at age 51. Ordinarily, this process -- known as the menopausal transition or perimenopause -- is gradual, often beginning when a woman is in her 40s. The symptoms of menopause, such as vaginal dryness, fatigue, and depression or anxiety, result from a decrease in estrogen production.

Certain breast cancer treatments produce similar symptoms, which can result in premature menopause. For example, women with specific genes linked to breast cancer (BRCA2 or BRCA2 mutations) are at high risk for ovarian cancer and may be advised to have their ovaries removed. Doing so means cessation of periods, leading to the symptoms commonly seen during menopause.

Symptoms And Signs of Premature Menopause

The main symptoms and signs of premature menopause are:

* Uncomfortable hot flashes and night sweats
* Bone loss (osteoporosis)
* Vaginal dryness, resulting in discomfort and painful intercourse
* Cardiovascular disease and an increased risk for heart attack and stroke
* Loss of fertility

What Is Distinctive About This Type Of Menopause?

Though women who experience premature menopause have the same symptoms as other menopausal women, theirs do not appear gradually. Rather, they can come on suddenly and with surprising severity.

Because such women experiencing premature menopause go largely without estrogen, they may be at increased risk for other health problems -- notably osteoporosis and cardiovascular disease -- against which estrogen offers some protection.

Who Experiences Premature Menopause?

Various factors affect whether a woman has premature menopause, including her age when treated, various family and genetic factors, her chemotherapy regimen (if any) and whether she receives continuous endocrine treatment (hormone therapy with pills or shots instead of surgery).

Weighing a number of factors can help women and their doctors predict who will avoid menopause, who will have a temporary cessation of periods, and who will face permanent menopause.

How Is It Treated?

Women with breast cancer are advised against taking estrogen-based medications for menopausal symptoms. To address symptoms, consider:

* Hot flashes: Dress in layers; use breathing exercises; consider trying the antidepressant Effexor (venlafaxine) or the antiseizure medication Neurontin (gabapentin)
* Bone loss: Calcium and vitamin D supplements; weight-bearing exercise; bisphosphonate medications (which counter osteoporosis)
* Vaginal dryness: Vaginal lubricants
* Cardiovascular disease: Maintain a healthy weight; eat healthy, low-fat foods; keep blood pressure and cholesterol down; get adequate exercise; quit smoking
* Loss of fertility: If you want biological children, consult a fertility specialist as soon as possible, preferably before starting cancer treatment

Why Seek Emotional Support?

A breast cancer diagnosis is bad enough. But confronting cancer and menopause multiplies the emotional issues, including one's sense of self, body image, and, of course, the potential loss of your ability to bear children. It only makes sense to reach out for support.

Is There Any Good News?

Actually, there is. It is clear that the very treatments that trigger premature menopause are responsible for today's vastly improved breast cancer survival rates. Some research suggests that women who enter premature menopause may actually fare better than other breast cancer patients because these treatments cut their lifetime exposure to estrogen. And -- in many cases -- estrogen plays a crucial role in the growth of breast cancer cells.

Women who hope to have children should speak with their oncologist and a fertility specialist as soon as possible. Significant advances have been made in fertility procedures. For example, a woman may be able to harvest eggs to freeze as eggs or embryos for future use. And adoption continues to be a wonderful gateway to parenthood.

6 Breast Cancer Symptoms that Most Women Don't Know About

By Lisa Fayed
Breast that is warm to the touch:
A breast that always feel warm, sometimes hot to the touch is a symptom of inflammatory breast cancer, a dangerous and rare type od the disease.
Flat or inverted nipple:
A nipple that is flat or inverted is also a symptom of breast cancer. This does not include having an inverted nipple since birth.
A breast that is often itchy:
If you have itchy breasts or nipples, talk to your doctor. These are both symptoms of breast cancer.
The skin around the breast is dimpled or looks like an orange peel:
Breast and surrounding skin can take on a dimpled appearance, looking like an orange peel. Many women are too embarassed to show a doctor, thinking it is cellulite or from being overweight. This is not the case.
Swollen or breast that does not change with menstrual cycle or size increase:
It's normal for a woman's breast to become swollen and tender during a normal menstrual cycle, but when it's constant, it need to be evaluated by a doctor. Women also need to be aware of a sudden breast size increase.
Breast that is red or blotchy:
A breast that is red or blotchy, even having a rash-like appearance should be evaluated by a doctor. It is a symptom of inflammatory breast cancer. Inflammatory breast cancer is a type of cancer that is often undected by a mammogram and self breast exam.

Breast Cancer Symptoms and Explanations

By Pam Stephan
A lump or a thickening in the breast or in the armpit:
Some lumps or swelling in the breast tissue may be due to hormonal changes. But if a lump or thickening persists, whether it is in the breast or in the armpit area, it may be a cause for concern. Swelling in the armpit, where the lymph nodes are located, may indicate that the body is fighting an invasion. A lump in the breast tissue may indicate a cyst, or it may indicate a problem in the duct or the lobes. See your doctor or nurse practitioner for a screening. Here is an overview of lumps.
A change in size or shape of the mature breast:
If a mature breast changes size or shape, and especially if only one breast is changing, it may signal that milk ducts or the lobes deeper within the breast are swelling. This could be due to fibrocystic or regular monthly hormonal cycles. If the changes are not in step with regular periodical changes, consult a health professional and get an exam. Having a baseline mammogram can help you and your doctor keep track of changes with accuracy.
Fluid (not milk) leaking from the nipple:
Between ages 41 - 58, there may be a small bit of non-bloody leakage from the nipples of both breasts. This leakage is usually due to hormonal changes and is not worrisome. However, if the fluid is leaking from only one nipple, is a new discharge, or is bloody, there are several tests that can be done to discover what is causing it. Ask your doctor for a professional opinion on your next steps.
Change in size or shape of the nipple:
Changes in body weight, or natural changes that come with age may affect the size or shape of the nipples. However, if a nipple retracts (pulls in) and does not easily return to its normal shape, see your doctor or a nurse practitioner for a manual exam. If there is a problem with the milk ducts which are just below the surface of the nipple and areola, then having a diagnostic mammogram or ultrasound can help diagnose the trouble.
Changes of color, shape or texture of the nipple or the areola:
If you observe dimples, puckers, or a rash on the skin of the nipple or the areola, (darker skin that surrounds the nipple) and these symptoms persist, or do not respond well to treatment creams, check with your doctor to determine what action to take. One unusual type of breast cancer is called Paget's disease, and starts out in the form of a rash. When caught and dealt with at an early stage, this is a very curable condition.
Unusual pain in the breast or in the armpit:
Know your cyclical pains, and note if breast pain occurs in tune with the monthly period, and in both breasts. While uncomfortable, if it is normal to you, it may not be worrisome. But if you have pain which occurs off-cycle or in only one breast or armpit, get it checked out. Keeping a good record of your cycles will help you understand hormonal changes in your breasts, and also helps your doctor and nurse determine what may be happening in your body.
Everything is Connected:
Our bodies go through cycles and changes, some of which are due to age, weight gain or loss, hormones, medications, pregnancy, stress, or changes in diet. Some of us are very aware of living in our bodies, while others of us live more in our minds or in our emotions. In order to have and keep our health, it's good to be aware of our body and its rhythms.

Just as getting a toothache can seem to make your entire head hurt, or pulling a muscle in your leg causes you to limp and throws you off balance, finding a change in your breast affects your overall health and may signal a need to get a checkup or a diagnostic screening.

Knowing your body's normal changes helps you deal wisely with your health. Regular communication with your health care team can allay fears and help you raise your defenses against disease.

Breast Cancer

By Pam Stephan
Breast cancer is a malignant (cancerous) growth that begins in the tissues of the breast. Cancer is a disease in which abnormal cells grow in an uncontrolled way. Breast cancer is the most common cancer in women, but it can also appear in men. In the U.S., it affects one in eight women.

The most common types of breast cancer are:

* ductal carcinoma (85 - 90% of all cases)
* lobular carcinoma (8% of all cases)

Invasive (Infiltrating) Breast Cancer
Invasive, or infiltrating, breast cancer has the potential to spread out of the original tumor site and invade other parts of your breast and body. There are several types and subtypes of invasive breast cancer.

Less common are:

* inflammatory breast cancer (occurs in the skin)
* Paget's disease of the nipple

Symptoms of Breast Cancer:

* a lump or a thickening in the breast or in the armpit
* a change of size or shape of the mature breast
* fluid (not milk) leaking from the nipple
* a change of size or shape of the nipple
* a change of color or texture of the nipple or the areola, or of the skin of the breast itself (dimples, puckers, rash)
* Read more details about symptoms of breast cancer

If You Have Breast Pain
Early stages of breast cancer may not cause any pain or discomfort. Having a regular mammogram and a clinical breast exam by your health professional can help you understand changes in your breasts. Doing your breast self-exam can help you keep track of regular monthly changes.

Remember, many lumps and rashes are benign (not cancerous) and can respond well to proper treatment. If you experience any symptoms that cause you concern, see your doctor.

Treatments for breast cancer, as well as survival rates, are improving. Early detection and medical help is critical to improving the chances of living beyond a diagnosis of breast cancer.

Read about breast cancer symptoms and their explanations.