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We've included a list of questions commonly asked by our newly diagnosed cancer patients, along with answers from our specialists.

What are the symptoms of breast cancer?
To detect breast cancer, watch for the following:

• a lump or thickening in or near the breast or in the underarm area
• a clear or bloody discharge from the nipple inverted nipple
• a change in the color or feel of the skin of the breast, areola or nipple (dimpled, puckered or scaly)
• a change in the size or shape of the breast
• a change in the normal balance of your breasts, such as swelling or one being a different shape than the other.

If you notice any of these changes, see a provider who is experienced in breast examination right away. You also can call Virginia Mason's Breast Clinic, an innovative program designed to provide patients with prompt access for the care and treatment of breast concerns. The Breast Clinic offers appointments within 24 hours to evaluate problems and develop a personalized plan of care.

How common is breast cancer?
According to recent National Cancer Institute statistics, an estimated 192,370 women are diagnosed with breast cancer annually and 40,170 women die of the disease each year. One in eight women will be diagnosed with breast cancer during her lifetime. Breast cancer is the most common non-skin cancer and the second leading cause of cancer-related death in women. Only lung cancer causes more cancer deaths in both men and women. NCI statistics also show that the incidence of breast cancer is highest in white women but African-American women have higher mortality rates than any other racial or ethnic group in the United States.

What are the risk factors for breast cancer?
The two main risk factors for breast cancer are being female and getting older. Other factors that have an impact on breast cancer are age at first period, age at first birth, personal history of breast cancer or certain atypical changes found on breast biopsy, and radiation therapy to the chest (not just x-rays). A family history of breast cancer also plays a role: Having one first degree relative with breast cancer doubles risk. A very few women may have an inherited factor that markedly increases their breast cancer risk. Women with 3 relatives on the same side of the family with breast cancer, close relatives with breast and ovarian cancer, a male relative with breast cancer, and women with early onset breast cancer should be evaluated to see if genetic testing to identify such risk is appropriate for them.

Abstracts

How can I prevent breast cancer?
You cannot change your family, gender, or the fact that you are getting older. However, you do have control over other factors that influence beast health.

• Alcohol
  While moderate alcohol intake may help reduce the risk of heart disease, drinking alcohol may raise the risk of developing breast cancer. Studies show that just one drink (four ounces) a day may raise estrogen levels in post-menopausal women receiving hormone replacement therapy. Women who have two to five alcoholic drinks a day are 1 1/2 times more likely to develop breast cancer than those who don't drink.
• Birth Control Pills
  Research indicates that taking birth control pills does not increase your risk of developing breast cancer. Talk with your health care provider about the risks and benefits of birth control pills.
• Breast Feeding
  While there is not a strong link, some studies suggest that breast feeding may slightly lower breast cancer risk, especially if breast feeding is continued for 1 1/2 to two years.
• Childbearing
  Women who have children before the age of 30 have a slightly lower risk of developing breast cancer.
• Diet
  There is much controversy concerning the role of diet, specifically, consumption of dietary fat and the risk of developing breast cancer. Some clinical studies show that decreasing dietary fat or increasing dietary fiber has no effect on lowering breast cancer risk, while others show a distinct link between type of fat consumed, such as saturated fat, and breast cancer risk.
  One clinical study found that it is the total amount of fat consumed regardless of type - saturated, monounsaturated or polyunsaturated - that may increase risk.
• Environment
  There is no clear link between environmental pollutants and breast cancer. Ongoing research into the effects of exposure to pesticides, herbicides, plastics, paper, detergents, textiles, cosmetics, hair colorings and other common products will help us better understand how our environment affects our health.

• Exercise
  The American Cancer Society states that "vigorous physical activity and maintenance of a healthy body weight" are associated with lower breast cancer risk. It may be that exercise reduces estrogen production by burning calories and reducing body fat.One clinical study found that women who participated in 7 or more hours per week of moderate to vigorous physical activity had an 18 percent breast cancer risk reduction. Another study showed a 39 percent risk reduction if a woman was active in both her occupation and recreational activities, with even greater risk reduction in leaner women.
• Smoking
  The link between cigarette smoking and the development of breast cancer has not been firmly established. The highest risk is in women who previously smoked and quit. However, smoking negatively impacts your health and increases the risk for many cancers as well as heart disease. If you smoke, quit. Learn about Virginia Mason's "Free and Clear (Stop Using Tobacco)" Cessation program.
• Weight
  The more overweight a woman is, especially after menopause, the greater her risk for developing breast cancer. The connection between weight and breast cancer risk is affected by whether a woman gained weight as an adult or has been overweight since childhood. Talk with your health care provider about weight concerns.
• Breast Implants
  There is no association between breast implants and breast cancer. You can view these links for more information:
• Breast Reconstruction
  American Society of Plastic Surgeons

What is the difference between invasive (infiltrating) cancer and DCIS (non-invasive) breast cancer?
Invasive or infiltrating cancer occurs when cancer cells migrate out of lobules or ducts within the breast and invade nearby tissue. These cells can also travel throughout the lymph nodes (lymphatic system) and bloodstream to distant parts of the body. Ductal carcinoma in situ is cancer that is contained within the breast ducts. The term "in situ" means "in place." It is cancer that has not spread to nearby tissue.

What does the grade of cancer mean?
The grade refers to how much the cancer cells look like normal breast tissue cells, which can be determined by a pathologist looking at cancer cells under a microscope. Very simplistically, cancer cells that look least like normal cells are more aggressive. There are three grades - I, II, and III - with grade I being the least aggressive and grade III the most.

Does radiation therapy always follow a lumpectomy?
The standard of care today is for women to have radiation therapy following lumpectomy. The theory is that radiation will kill any microscopic cells that may remain following breast cancer surgery. There may be certain instances in which a patient might be treated with surgery and anti-estrogen therapy without radiation, but this is usually only considered in women who are 70 years of age or older.

What does ER/PR positive or negative status mean?
These terms refer to the hormone receptor status of the breast cancer cells. "ER" and "PR" mean "estrogen receptor" and "progesterone receptor." Cancer cells that grow in the presence of estrogen or progesterone have proteins (hormone receptors) on their cell surfaces that attach to estrogen and are called "positive." If no receptors are present, the breast cancer cells are ER/PR negative.
The distinction is important because breast cancer treatment is based upon these designations. The "anti-estrogen" drug tamoxifen, for example, has been found in clinical trials to block the ability of estrogen to attach to hormone receptors on ER-positive and PR-positive breast cancer cells. Tamoxifen is not effective in negative breast cancer, which is a cancer without hormone "receptors."

What does HER2/neu positive/negative mean?
HER2/neu status is also important in guiding therapy for breast cancer. HER2/neu (human epidermal growth factor receptor 2) is a protein that is present on the surface of some breast cancer cells and is responsible for the breast cancer cells' growth. HER2/neu-positive breast cancer is present in about 20 percent of cases and is considered a more aggressive form of the disease. HER2/neu-positive breast cancers can be treated with trastuzumab (Herceptin), which targets the HER2/neu receptor directly.

What is a sentinel node biopsy?
Traditionally, axillary node dissection was performed during surgery to check the lymph nodes under the arm for cancer. An average of 10 to 20 nodes were removed. One of the most significant complications of this operation is lymphedema, a sometimes painful and disfiguring swelling of the arm.
With sentinel lymph node biopsy, usually only one or two nodes are removed, so the surgery is less invasive, has fewer complications, and allows a quicker recovery. This procedure can be performed along with either lumpectomy or mastectomy.

What are the goals of treatment?
Surgery is used to remove the cancer, often followed by chemotherapy or radiation. Women whose cancer is treated before it has spread have a 90% chance of living five years or more after treatment.

How many doctors will be involved in my care?
Several specialists may be involved in your care including a breast cancer surgeon, plastic surgeon, medical oncologist (a doctor who treats cancer with chemotherapy), radiation oncologist (a doctor who treats cancer with radiation), nurses, radiologists and pathologists, all of whom have specialized training and interest in breast health and breast cancer.

What will happen if I decide not to undergo treatment?
The decision to undergo treatment resides completely with you and your family. Many cancers, when caught early, are highly treatable, allowing patients to live years and even decades beyond their initial diagnosis. Patients with advanced cancer may be eligible for enrollment in a clinical trial (study) that offers investigational new treatment not available to most patients. A decision about whether or not to have treatment should be made after discussions with your family, your providers, and after carefully weighing all the options available to you.

Will my age determine the treatment I receive?
More likely, the stage and type of your cancer as well as your overall general health will determine the treatment you receive.

Should my family members be tested for cancer?
Some cancers - breast, prostate, pancreatic and colon, for example - can have a hereditary component that may make it advisable for family members to be tested. Virginia Mason offers a hereditary cancer risk consultation to help patients and their family members who are thinking about having genetic testing performed. Hereditary Cancer Risk Assessment

What do I need to do after I've had all of my treatment?
Virginia Mason specialists are dedicating efforts to helping patients live well beyond a diagnosis of cancer. All Virginia Mason cancer survivors are encouraged to meet with specialists within the Survivorship Clinic to talk about quality of life and "what's next" after their cancer treatment.

Will my cancer come back?
This is one of the most common questions asked by cancer survivors. In some cases cancer can recur or a new cancer can form years or even decades after treatment. One of the goals of the Survivorship Clinic at Virginia Mason is to help patients come to terms with their fears about cancer recurrence so that they can lead productive, fulfilling lives. Another goal is to ensure that survivors realize the importance of, and are scheduled for, periodic check-ups after their last treatment for cancer.