Detecting & Living with Breast Cancer For Dummies

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 xviiIntroduction 1About This Book 2Foolish Assumptions 2Icons Used in This Book 3Beyond the Book 3Where to Go from Here 4Part 1: Knowing About Breast Cancer 5Chapter 1: Breast Cancer 101 7Breast Cancer Basics 8Finding your way around your breast 8Knowing about breast cancer risk factors and indicators 9Distinguishing Different Breast Cancers 10Detecting breast cancer 13Biopsies and how they work 14The pathologist and diagnosis 14Grading and Staging of Breast Cancer 15Planning Your Treatment 15Looking at your treatment options 15Considering breast surgery 16Treating breast cancer with radiation 17Treating breast cancer with chemotherapy 17Treating breast cancer with endocrine (hormonal), biological, and other cutting-edge therapies 17Treating advanced breast cancer 18Chapter 2: Risk Factors for Breast Cancer 19Advanced Age 19Gender 20Race and Ethnicity 21Early Menstruation and Late Menopause 23Use of Birth Control Pills 23Genetic Risk: BRCA1 and BRCA2 Genes 23Poor Nutrition 26Fats 27Red meat and processed meats 27Obesity 28Smoking 29Alcohol Use 29Prior Treatment and Chemical Exposures 30Exposure to DES (diethylstilbestrol) 30Hormones: Estrogen and progesterone use 30Environmental factors 31Chapter 3: Indicators of Breast Cancer 33Monitoring Changes in Breast Size and Shape 34Breast increasing in size 35Breast decreasing in size 35Watching for Skin Changes 36Rash 36Paget’s disease 36Skin thickening 37Cellulitis 37Mastitis 38Breast abscess 38Checking Out Lumps and Bumps 39Breast masses and fibroadenomas 39Breast cysts 39Dense breasts 40Dealing with Breast Aches and Pains 40Nipple Changes 41Nipple inversion 41Milky nipple discharge 41Bloody nipple discharge 42Part 2: Diagnosing Breast Cancer 45Chapter 4: Physical Awareness and Detecting Breast Cancer 47What to Look For 49Doing a Breast Self-Examination 50In the shower 50In front of the mirror 50While lying down 51Breast Cancer Screening Guidelines 52Mammograms: The Go-to Tool 55Tomosynthesis (tomo) mammogram 55Advantages of screening mammograms 56Disadvantages of screening mammograms 56How a mammogram is done 58Other Screening Tests: MRI and Ultrasound 59Chapter 5: Understanding Breast Biopsies 63Knowing What a Breast Biopsy Entails 65Getting the Right Type of Breast Biopsy 65Playing an Active Role in Your Breast Biopsy: Before, During, and After 67Preparing for your biopsy and reducing risks and complications 68Knowing what to expect on the day of your biopsy 69Waiting for your biopsy results 70Making Sense of Your Biopsy Results 71Grasping some basic medical terminology 71Sorting out the nuances of “abnormal” 72Most common types of breast cancer 73Less common types of breast cancer 73Digging deeper into the pathology report when cancer is detected 74Discussing your pathology report 76Discussing next steps if cancer is found 76The shades of your pathology result 76Following up when no cancer is found 77Chapter 6: Stages of Breast Cancer 79Testing to Determine Stages 80Overview of Breast Cancer Staging 80Early 81Locally advanced 82Local recurrence 82Metastatic or secondary breast cancer 82Deciphering the TNM Staging System 83Understanding Breast Cancer Stages 85Stage 0 (zero) 85Stage I 85Stage II 85Stage III 86Stage IV 88Part 3: Treating Breast Cancer 91Chapter 7: Looking at Treatment Options 93Surgery 96Lumpectomy or partial mastectomy (breast- conserving surgery) 96Mastectomy (total or simple) 96Modified radical mastectomy 98Axillary lymph node dissection 98Breast Reconstruction 101Radiation Therapy 102Side effects 103Skincare during radiation therapy 104Chemotherapy 105Endocrine or Hormonal Therapy 106Targeted Therapy: Herceptin and Others 106Considering Clinical Trials 109Randomized controlled trials (RCT) 110Placebos and double-blind trials 110Length of clinical trials 111Chapter 8: Breast Surgery 113Types of Breast Surgery 114Preparing for Surgery 115Talking to your surgeon before surgery 116Pre-surgical restrictions 117Special Pre-Surgery Concerns 118Alcohol consumption 118Smoking tobacco or cannabis 119Sleep apnea 119Following a pre-surgery checklist 121During the Surgery 122Post-Surgery Tips 123Drains and drips 123Going home 124Restrictions on activity 124Chapter 9: Radiation Therapy 127How Radiation Therapy Works 128Planning for Radiation Treatment 131Things to Do before Radiation Therapy 132Post-Radiation Skincare 133Radiation Therapy Side Effects 134Skin reactions 134Change in breast size and consistency 134Swelling or edema of the breast 135Pain in the breast area 135The Importance of Exercising 135Warm-up and cool down exercises 135Basic exercises to do in the first week after surgery or radiation and beyond 136Advanced exercises for the second week after surgery or radiation and beyond 136Tiredness and fatigue 137Lymphedema 137Change in breast shape, size, and color 137Hair loss in the armpit or chest area 138Sore throat 138Late side effects 138Chapter 10: Chemotherapy 141Different Types of Chemotherapy and How They Work 142How Chemotherapy Is Given 146Common Side Effects of Different Chemotherapies 147The “Chemo Brain” Effect 149Understanding the Oncotype DX Test 150Who should have an Oncotype Dx test? 151How does Oncotype DX work? 151Interpreting the recurrence score 152Understanding the MammaPrint Test 152Interpreting MammaPrint results 152Preparing for Chemotherapy 153Chemotherapy before surgery: Neoadjuvant chemotherapy 153Chemotherapy after surgery: Adjuvant chemotherapy 153Good Questions to Ask Your Doctor 154Chapter 11: Endocrine, Biological, and Cutting-Edge Therapies 155Endocrine Therapy in the Treatment of Breast Cancer 156Side effects of endocrine therapy 157Preparing for Endocrine Therapy 158Endocrine therapy before surgery 159Endocrine therapy after surgery 159If you can’t have surgery 159Asking plenty of questions 159Biological or Targeted Therapy in the Treatment of Breast Cancer 160Types of biological therapies 161Trastuzumab and pertuzumab: Monoclonal antibodies 163Immunotherapy and Cancer Vaccines 164Cancer vaccines 165Cancer treatment vaccines 165The making of a cancer vaccine 165Cancer vaccine side effects 167Precision Medicine 168Benefits of precision medicine 168Emerging Therapies 168Targeted therapy: Immunoliposomes 169Cell signaling 169Chapter 12: Breast Reconstruction 171When Should You Have Breast Reconstruction? 172Immediate breast reconstruction 173Delayed breast reconstruction 175Having both breasts removed 176Methods of Breast Reconstruction 176Breast implant reconstruction 177Autologous breast reconstruction 179Autologous tissue with implant reconstruction 180Risks of Breast Reconstruction 183Questions to Ask Your Plastic Surgeon 184Choosing Among Your Options 185Chapter 13: Treating Advanced Breast Cancer 187Treatment Decisions and Treatment Options 188Treatment decisions for advanced breast cancer 189Treatment options for advanced breast cancer 189Endocrine or Hormone Therapy for Advanced Breast Cancer 190Chemotherapy for Advanced Breast Cancer 191Biological Therapies for Advanced Breast Cancer 193Role of HER2 receptors in advanced breast cancer 193Trastuzumab (Herceptin) 194Pertuzumab (Perjeta) 195Denosumab (Prolia, Xgeva) 196Everolimus (Afinitor) 197Other issues with biological treatment 199Radiation Therapy for Advanced Breast Cancer 201Radiation as injection 201Side effects of radiation for advanced breast cancer 201End of Life Concerns 202Communicating to Providers 203Part 4: Dealing with Breast Cancer and Everyday Life 205Chapter 14: Psychosocial Concerns and Breast Cancer Diagnosis 207Fear and Worry and Their Physical and Emotional Toll 208Functional Concerns: Work and Home Life 210Functional capability for occupational activities 211Fear of infertility 212Worrying about work and finances 213Spirituality 214Seeking Support 215Purpose and benefits of participating in a support group 215How support groups are structured and organized 215How to find a support group 216Chapter 15: Managing Stress 217Incorporating Relaxation Techniques 220Visualization exercise: Lying in a meadow 222The Importance of Sleep 222Spirituality and Meditation 224Tips for finding comfort, meaning, and spiritual support 224Call for inner peace 225Health affirmation 226Chapter 16: Coping with Changes after Treatment 227Cancer-Related Fatigue 228Recognizing cancer-related fatigue 228Managing cancer-related fatigue 229Dealing with Hair Loss 230Caring for your hair when it begins to grow back 231Talking with your healthcare team about hair loss 231Addressing Skin Changes 232Understanding discoloration and hyperpigmentation 232Experiencing Numbness and Tingling: Peripheral Neuropathy 233Being at increased risk for peripheral neuropathy 234Knowing the symptoms of peripheral neuropathy 234Reducing the effects of neuropathy from chemotherapy 235Relieving constipation induced by neuropathy 236Checking out medications and treatments prescribed for neuropathy 237Coping with Lymphedema 238Knowing the symptoms of lymphedema 239Treatment for lymphedema 239Taking preventative measures 240Resources for lymphedema management 241Changing Tastes and Smells 242Countering Changes in Appetite 243Dealing with weight gain 245Managing weight gain 246Dealing with Diarrhea 247Chapter 17: Cancer Treatment, Fertility, and Sexuality 249Infertility and Breast Cancer 250General causes of infertility 250Fertility and cancer treatment 251Permanent infertility 253Temporary infertility 253Early menopause 254How to help preserve your fertility 254Tissue banking and fertility preservation 255Alternative complementary and alternative medicine fertility treatments 256Good clinical care practice for infertility 257The BETTER model approach 257The emotional side of fertility issues 258Pregnancy and cancer 258Sexuality and Breast Cancer 259Physical effects of cancer treatment on sexuality 259Sexuality and intimacy 262Sex after cancer 263Dating after cancer 265Chapter 18: Making Healthy Lifestyle Changes 267Healthy Lifestyle Changes to Lose Weight 268Healthy Lifestyle Changes for Anxiety and Depression 269Exercise 269Quitting Bad Habits Like Smoking, Drinking, and Drug Abuse 272Quitting smoking 272Limiting or avoiding alcohol 274Treatment for alcoholism 275Overcoming drug abuse 276Maintaining Good Nutrition and Diet 277Foods that can increase or lower estrogen 278Cooking and food preparation 279Weight Control and Activity 280Concrete steps to take toward healthier lifestyle changes 281Quick meals to make for healthy living 282General Health Guidelines for Optimal Health 283Part 5: The Part of Tens 285Chapter 19: Ten Inspiring Breast Cancer Survivors 287Helen Hosein-Mulloon 288Linda Doyle 290Felicia Smith 292Kelly M 293Joy Walker 295Abbie Savadera 296Rhonda M Smith 297Rosa Amelia Tena-Krapes 298Linda Butzner 299Alice Loh 300Chapter 20: Ten Ways Family and Friends Can Help You 303Learn to Listen 303Be Your Advocate and Note Taker 304Keep It Lighthearted 304Distract You with a Surprise 305Help You Understand That You Need Help 305Leave a Message after the Tone 305Ask You Before Bringing Food 306Buy You Groceries Instead of Bringing Prepared Foods 306Help Make Life Normal for Your Kids 306Don’t Forget You 306Chapter 21: (At Least) Ten Ways Life Can Be Better After Cancer 307Adopting an Attitude of Gratitude 308Enjoying the Moment 308Knowing Why You Deserve Happiness 308Learning about Your Health 309Learning to Pick Your Battles 310Learning to Be in the Here and Now 311Engaging in Positive Self-Talk and Conversations 311Managing Physical Changes 312Achieving Self-Acceptance and the New You 313Following a Cancer Survivorship Plan 314Screening for Breast Cancer and Wellness 315Appendix A: Breast Health Glossary 317Appendix B: Support Groups, Resources, and Organizations 327Index 337