In This Issue

Stages of Breast Cancer

Cancer is staged according to how far it has spread into the body. The standard stages are:

0 – The early stage when the disease is localized to the breast with no evidence of spread to the lymph nodes (carcinoma in situ).

I – The cancer is 2 centimeters or less in size and hasn’t spread.

IIA – The cancer is a tumor smaller than 2 centimeters across with lymph node involvement or a tumor that is larger than 2 but less than 5 centimeters across without underarm lymph node involvement.

IIB – A cancer tumor that is greater than 5 centimeters across without underarm lymph node involvement or a tumor that is larger than 2 but less than 5 centimeters across with lymph node involvement.

IIIA – Often called locally advanced breast cancer, the tumor is larger than 5 centimeters and has spread to the lymph nodes under the arm, or the tumor is any size with cancerous lymph nodes that adhere to one another or surrounding tissue.

IIIB – This is a breast cancer tumor of any size that has spread to the skin, chest wall or internal mammary lymph nodes (located beneath the breast and inside the chest).

IIIC – A breast cancer tumor of any size that has spread more extensively and involves more lymph node invasion.

IV – This is a breast cancer tumor, regardless of size, that has spread (metastasized) to places far away from the breast, such as the bones, lungs, liver, brain or distant lymph nodes.


Early breast cancer usually does not cause pain, and when breast cancer first develops, there may be no symptoms at all. As the cancer grows, it can cause changes. Below are some changes to look out for:

  • A lump or thickening in or near the breast or in the underarm area
  • A change in the size or shape of the breast
  • Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
  • Ridges or pitting of the breast (the skin looks like the skin of an orange)
  • A change in the way the skin of the breast, areola, or nipple looks or feels (warm, swollen, red or scaly).

Report any of these symptoms to your doctor. More often than not, they are not cancer, but it’s important to not only be reassured, but to have any potential problems diagnosed and treated as early as possible.

Most Breast Changes Don’t Signal Cancer

While finding a breast lump strikes fear in the hearts of women, the majority turn out to be benign (non-cancerous). Still, all changes to your breast, including lumps, soreness or a nipple discharge, should be checked by your physician.

According to the American Cancer Society, nine out of every 10 women have some kind of breast abnormality when their tissue is examined under a microscope. Yet less than 20 percent of these are diagnosed as cancer.

Benign conditions, although not life-threatening, can still cause pain or discomfort for some women. The most common benign breast conditions include fibrocystic changes, fibroadenoma and nipple discharge.

As the name “fibrocystic” implies, these are changes in the fibrous tissue and the development of cysts within the breast. Fibrocystic breasts will become tender during premenstrual days.

Fibroadenoma is a solid tumor made up of both glandular breast tissue and fibroconnective tissue. These benign tumors are most common in women in their 20s and 30s, but can occur at any age. They are often revealed by a mammogram and diagnosed with a needle biopsy.

Nipple discharge is the third most common breast complaint after lumps and breast pain. While the majority of nipple discharges are associated with non-malignant changes, all should be reported to your physician.

Because finding breast cancers early is so important to your survival, following a regular schedule of mammograms and examinations is recommended by the American Cancer Society. Remember, only your physician can offer the tests that are needed to rule out cancer and give you peace of mind.

Breast Cancer Screening Guidelines

The American Cancer Society offers the following cancer screening guidelines for people at average risk for breast cancer (unless otherwise specified) and without any specific symptoms. People who have an increased risk for certain cancers may need to follow a different screening schedule that may include starting the screening tests at an earlier age or more frequent screenings. If you exhibit symptoms that could be related to cancer, you should see your doctor right away.

Breast Cancer

Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health.

Clinical breast exam (CBE) should be part of a periodic health exam, about every three years for women in their 20s and 30s and every year for women 40 and over.

Women should know how their breasts normally feel and report any breast change promptly to their healthcare providers. Breast self-exam is an option for women starting in their 20s.

Women at high risk (greater than 20 percent lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15 percent to 20 percent lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15 percent.

Cancer-related Checkup

For people aged 20 or older having periodic health exams, a cancer-related checkup should include health counseling. Depending on a person’s age and gender, this could include exams for cancers of the thyroid, oral cavity, skin, lymph nodes, testes, and ovaries, as well as for some non-malignant (non-cancerous) diseases.

Steps to Detection

The sooner you find it, the faster you can fix it, the better the outcome.

Early detection is the best defense when it comes to breast cancer survival.

According to the National Cancer Institute, the five-year survival rate for women whose breast cancer tumors have not spread is 92 percent. If the tumors have spread to lymph nodes under the arm, the survival rate drops to 71 percent. Tumors that have spread to the liver, lungs or brain will drop a patient’s survival rate to 18 percent.

There are three ways women—and men—can screen for breast cancer: self-examination, a physical breast exam by a health professional, and a mammogram.

Breast Self-Examination (BSE)

You can learn what your normal breasts feel like by regularly examining yourself. Beginning at age 20, women should perform a BSE right after their menstrual cycle. Men should also perform regular BSEs. It’s important to get in the habit, because it will be easier to notice any changes from month to month.

Physical Breast Exam

Women age 20 and older should have their health professional perform a physical breast exam on a yearly basis. During the exam, the doctor feels the breast and underarms for lumps.


This is the most important breast cancer screening exam. An x-ray of the breast, the mammogram can reveal tumors and other changes in the breast that may be too small to be felt by hand.

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