Detecting & Living With Breast Cancer for Dummies

From the breast health experts at the American Breast Cancer Foundation comes a sensitive and authoritative guide to the most common cancer in women: breast cancer. Covering everything from prevention to dealing with a diagnosis to coping with life after cancer, it serves as a trusted resource for anyone whose life has been touched by this dreaded disease.

Advancements in breast cancer prevention, detection, and treatment are being made every day, but it can be overwhelming and confusing knowing where to turn and who to trust. Detecting & Living with Breast Cancer For Dummies distills the information into one easy-to-follow guide, giving you quick, expert advice on everything you'll face as you manage your breast health. From getting to know your treatment options to talking to loved ones about breast cancer—and everything in between—it does the legwork for you so you can take a deep breath and focus on your health.

• Perform regular self-exams the right way
• Cope with the many decisions that need to be made if you're diagnosed
• Ask the right questions about surgery, chemotherapy, radiation, and breast reconstruction
• Decipher complicated pathology reports with confidence

Whether you're at risk for breast cancer or have been diagnosed and want to know your options, Detecting & Living with Breast Cancer For Dummies empowers you to take your health into your own hands.

Marshalee George, PhD, is Faculty and Oncology Nurse Practitioner at the Johns Hopkins University School of Medicine, Division of Surgical Oncology at Johns Hopkins Breast Center.

Kimlin Tam Ashing, PhD, is Professor and Founding Director of City of Hope's Center of Community Alliance for Research and Education. Together they have over 40 years combined experience in treating breast cancer patients through diagnosis, treatment, recovery, and recurrent illness, as well as survivorship and follow-up care.

Foreword xvii

Introduction 1

About This Book 2

Foolish Assumptions 2

Icons Used in This Book 3

Beyond the Book 3

Where to Go from Here 4

Part 1: Knowing About Breast Cancer 5

Chapter 1: Breast Cancer 101 7

Breast Cancer Basics 8

Finding your way around your breast 8

Knowing about breast cancer risk factors and indicators 9

Distinguishing Different Breast Cancers 10

Detecting breast cancer 13

Biopsies and how they work 14

The pathologist and diagnosis 14

Grading and Staging of Breast Cancer 15

Planning Your Treatment 15

Looking at your treatment options 15

Considering breast surgery 16

Treating breast cancer with radiation 17

Treating breast cancer with chemotherapy 17

Treating breast cancer with endocrine (hormonal), biological, and other cutting-edge therapies 17

Treating advanced breast cancer 18

Chapter 2: Risk Factors for Breast Cancer 19

Advanced Age 19

Gender 20

Race and Ethnicity 21

Early Menstruation and Late Menopause 23

Use of Birth Control Pills 23

Genetic Risk: BRCA1 and BRCA2 Genes 23

Poor Nutrition 26

Fats 27

Red meat and processed meats 27

Obesity 28

Smoking 29

Alcohol Use 29

Prior Treatment and Chemical Exposures 30

Exposure to DES (diethylstilbestrol) 30

Hormones: Estrogen and progesterone use 30

Environmental factors 31

Chapter 3: Indicators of Breast Cancer 33

Monitoring Changes in Breast Size and Shape 34

Breast increasing in size 35

Breast decreasing in size 35

Watching for Skin Changes 36

Rash 36

Paget’s disease 36

Skin thickening 37

Cellulitis 37

Mastitis 38

Breast abscess 38

Checking Out Lumps and Bumps 39

Breast masses and fibroadenomas 39

Breast cysts 39

Dense breasts 40

Dealing with Breast Aches and Pains 40

Nipple Changes 41

Nipple inversion 41

Milky nipple discharge 41

Bloody nipple discharge 42

Part 2: Diagnosing Breast Cancer 45

Chapter 4: Physical Awareness and Detecting Breast Cancer 47

What to Look For 49

Doing a Breast Self-Examination 50

In the shower 50

In front of the mirror 50

While lying down 51

Breast Cancer Screening Guidelines 52

Mammograms: The Go-to Tool 55

Tomosynthesis (tomo) mammogram 55

Advantages of screening mammograms 56

Disadvantages of screening mammograms 56

How a mammogram is done 58

Other Screening Tests: MRI and Ultrasound 59

Chapter 5: Understanding Breast Biopsies 63

Knowing What a Breast Biopsy Entails 65

Getting the Right Type of Breast Biopsy 65

Playing an Active Role in Your Breast Biopsy: Before, During, and After 67

Preparing for your biopsy and reducing risks and complications 68

Knowing what to expect on the day of your biopsy 69

Waiting for your biopsy results 70

Making Sense of Your Biopsy Results 71

Grasping some basic medical terminology 71

Sorting out the nuances of “abnormal” 72

Most common types of breast cancer 73

Less common types of breast cancer 73

Digging deeper into the pathology report when cancer is detected 74

Discussing your pathology report 76

Discussing next steps if cancer is found 76

The shades of your pathology result 76

Following up when no cancer is found 77

Chapter 6: Stages of Breast Cancer 79

Testing to Determine Stages 80

Overview of Breast Cancer Staging 80

Early 81

Locally advanced 82

Local recurrence 82

Metastatic or secondary breast cancer 82

Deciphering the TNM Staging System 83

Understanding Breast Cancer Stages 85

Stage 0 (zero) 85

Stage I 85

Stage II 85

Stage III 86

Stage IV 88

Part 3: Treating Breast Cancer 91

Chapter 7: Looking at Treatment Options 93

Surgery 96

Lumpectomy or partial mastectomy (breast- conserving surgery) 96

Mastectomy (total or simple) 96

Modified radical mastectomy 98

Axillary lymph node dissection 98

Breast Reconstruction 101

Radiation Therapy 102

Side effects 103

Skincare during radiation therapy 104

Chemotherapy 105

Endocrine or Hormonal Therapy 106

Targeted Therapy: Herceptin and Others 106

Considering Clinical Trials 109

Randomized controlled trials (RCT) 110

Placebos and double-blind trials 110

Length of clinical trials 111

Chapter 8: Breast Surgery 113

Types of Breast Surgery 114

Preparing for Surgery 115

Talking to your surgeon before surgery 116

Pre-surgical restrictions 117

Special Pre-Surgery Concerns 118

Alcohol consumption 118

Smoking tobacco or cannabis 119

Sleep apnea 119

Following a pre-surgery checklist 121

During the Surgery 122

Post-Surgery Tips 123

Drains and drips 123

Going home 124

Restrictions on activity 124

Chapter 9: Radiation Therapy 127

How Radiation Therapy Works 128

Planning for Radiation Treatment 131

Things to Do before Radiation Therapy 132

Post-Radiation Skincare 133

Radiation Therapy Side Effects 134

Skin reactions 134

Change in breast size and consistency 134

Swelling or edema of the breast 135

Pain in the breast area 135

The Importance of Exercising 135

Warm-up and cool down exercises 135

Basic exercises to do in the first week after surgery or radiation and beyond 136

Advanced exercises for the second week after surgery or radiation and beyond 136

Tiredness and fatigue 137

Lymphedema 137

Change in breast shape, size, and color 137

Hair loss in the armpit or chest area 138

Sore throat 138

Late side effects 138

Chapter 10: Chemotherapy 141

Different Types of Chemotherapy and How They Work 142

How Chemotherapy Is Given 146

Common Side Effects of Different Chemotherapies 147

The “Chemo Brain” Effect 149

Understanding the Oncotype DX Test 150

Who should have an Oncotype Dx test? 151

How does Oncotype DX work? 151

Interpreting the recurrence score 152

Understanding the MammaPrint Test 152

Interpreting MammaPrint results 152

Preparing for Chemotherapy 153

Chemotherapy before surgery: Neoadjuvant chemotherapy 153

Chemotherapy after surgery: Adjuvant chemotherapy 153

Good Questions to Ask Your Doctor 154

Chapter 11: Endocrine, Biological, and Cutting-Edge Therapies 155

Endocrine Therapy in the Treatment of Breast Cancer 156

Side effects of endocrine therapy 157

Preparing for Endocrine Therapy 158

Endocrine therapy before surgery 159

Endocrine therapy after surgery 159

If you can’t have surgery 159

Asking plenty of questions 159

Biological or Targeted Therapy in the Treatment of Breast Cancer 160

Types of biological therapies 161

Trastuzumab and pertuzumab: Monoclonal antibodies 163

Immunotherapy and Cancer Vaccines 164

Cancer vaccines 165

Cancer treatment vaccines 165

The making of a cancer vaccine 165

Cancer vaccine side effects 167

Precision Medicine 168

Benefits of precision medicine 168

Emerging Therapies 168

Targeted therapy: Immunoliposomes 169

Cell signaling 169

Chapter 12: Breast Reconstruction 171

When Should You Have Breast Reconstruction? 172

Immediate breast reconstruction 173

Delayed breast reconstruction 175

Having both breasts removed 176

Methods of Breast Reconstruction 176

Breast implant reconstruction 177

Autologous breast reconstruction 179

Autologous tissue with implant reconstruction 180

Risks of Breast Reconstruction 183

Questions to Ask Your Plastic Surgeon 184

Choosing Among Your Options 185

Chapter 13: Treating Advanced Breast Cancer 187

Treatment Decisions and Treatment Options 188

Treatment decisions for advanced breast cancer 189

Treatment options for advanced breast cancer 189

Endocrine or Hormone Therapy for Advanced Breast Cancer 190

Chemotherapy for Advanced Breast Cancer 191

Biological Therapies for Advanced Breast Cancer 193

Role of HER2 receptors in advanced breast cancer 193

Trastuzumab (Herceptin) 194

Pertuzumab (Perjeta) 195

Denosumab (Prolia, Xgeva) 196

Everolimus (Afinitor) 197

Other issues with biological treatment 199

Radiation Therapy for Advanced Breast Cancer 201

Radiation as injection 201

Side effects of radiation for advanced breast cancer 201

End of Life Concerns 202

Communicating to Providers 203

Part 4: Dealing with Breast Cancer and Everyday Life 205

Chapter 14: Psychosocial Concerns and Breast Cancer Diagnosis 207

Fear and Worry and Their Physical and Emotional Toll 208

Functional Concerns: Work and Home Life 210

Functional capability for occupational activities 211

Fear of infertility 212

Worrying about work and finances 213

Spirituality 214

Seeking Support 215

Purpose and benefits of participating in a support group 215

How support groups are structured and organized 215

How to find a support group 216

Chapter 15: Managing Stress 217

Incorporating Relaxation Techniques 220

Visualization exercise: Lying in a meadow 222

The Importance of Sleep 222

Spirituality and Meditation 224

Tips for finding comfort, meaning, and spiritual support 224

Call for inner peace 225

Health affirmation 226

Chapter 16: Coping with Changes after Treatment 227

Cancer-Related Fatigue 228

Recognizing cancer-related fatigue 228

Managing cancer-related fatigue 229

Dealing with Hair Loss 230

Caring for your hair when it begins to grow back 231

Talking with your healthcare team about hair loss 231

Addressing Skin Changes 232

Understanding discoloration and hyperpigmentation 232

Experiencing Numbness and Tingling: Peripheral Neuropathy 233

Being at increased risk for peripheral neuropathy 234

Knowing the symptoms of peripheral neuropathy 234

Reducing the effects of neuropathy from chemotherapy 235

Relieving constipation induced by neuropathy 236

Checking out medications and treatments prescribed for neuropathy 237

Coping with Lymphedema 238

Knowing the symptoms of lymphedema 239

Treatment for lymphedema 239

Taking preventative measures 240

Resources for lymphedema management 241

Changing Tastes and Smells 242

Countering Changes in Appetite 243

Dealing with weight gain 245

Managing weight gain 246

Dealing with Diarrhea 247

Chapter 17: Cancer Treatment, Fertility, and Sexuality 249

Infertility and Breast Cancer 250

General causes of infertility 250

Fertility and cancer treatment 251

Permanent infertility 253

Temporary infertility 253

Early menopause 254

How to help preserve your fertility 254

Tissue banking and fertility preservation 255

Alternative complementary and alternative medicine fertility treatments 256

Good clinical care practice for infertility 257

The BETTER model approach 257

The emotional side of fertility issues 258

Pregnancy and cancer 258

Sexuality and Breast Cancer 259

Physical effects of cancer treatment on sexuality 259

Sexuality and intimacy 262

Sex after cancer 263

Dating after cancer 265

Chapter 18: Making Healthy Lifestyle Changes 267

Healthy Lifestyle Changes to Lose Weight 268

Healthy Lifestyle Changes for Anxiety and Depression 269

Exercise 269

Quitting Bad Habits Like Smoking, Drinking, and Drug Abuse 272

Quitting smoking 272

Limiting or avoiding alcohol 274

Treatment for alcoholism 275

Overcoming drug abuse 276

Maintaining Good Nutrition and Diet 277

Foods that can increase or lower estrogen 278

Cooking and food preparation 279

Weight Control and Activity 280

Concrete steps to take toward healthier lifestyle changes 281

Quick meals to make for healthy living 282

General Health Guidelines for Optimal Health 283

Part 5: The Part of Tens 285

Chapter 19: Ten Inspiring Breast Cancer Survivors 287

Helen Hosein-Mulloon 288

Linda Doyle 290

Felicia Smith 292

Kelly M 293

Joy Walker 295

Abbie Savadera 296

Rhonda M Smith 297

Rosa Amelia Tena-Krapes 298

Linda Butzner 299

Alice Loh 300

Chapter 20: Ten Ways Family and Friends Can Help You 303

Learn to Listen 303

Be Your Advocate and Note Taker 304

Keep It Lighthearted 304

Distract You with a Surprise 305

Help You Understand That You Need Help 305

Leave a Message after the Tone 305

Ask You Before Bringing Food 306

Buy You Groceries Instead of Bringing Prepared Foods 306

Help Make Life Normal for Your Kids 306

Don’t Forget You 306

Chapter 21: (At Least) Ten Ways Life Can Be Better After Cancer 307

Adopting an Attitude of Gratitude 308

Enjoying the Moment 308

Knowing Why You Deserve Happiness 308

Learning about Your Health 309

Learning to Pick Your Battles 310

Learning to Be in the Here and Now 311

Engaging in Positive Self-Talk and Conversations 311

Managing Physical Changes 312

Achieving Self-Acceptance and the New You 313

Following a Cancer Survivorship Plan 314

Screening for Breast Cancer and Wellness 315

Appendix A: Breast Health Glossary 317

Appendix B: Support Groups, Resources, and Organizations 327

Index 337

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