Breast Cancer: Your Questions Answered
Medically reviewed on Feb 12, 2017 by C. Fookes, BPharm.
1. Why Did I Get Breast Cancer?
The reason why some women get breast cancer and not others comes down to a combination of many factors, such as genetics, age, family history, personal history of cancer, ethnicity, previous breast changes, weight, pregnancy and breastfeeding history, use of hormonal medications and history of alcohol or tobacco use. Having dense breasts is thought to be the number one risk factor for developing breast cancer. Doing little or no exercise can also contribute.
Certain occupations are also associated with a higher rate of breast cancer. Female aircrew have a 30% higher incidence of breast cancer than non-aircrew. Flight attendants are exposed to repeated and prolonged solar radiation, cosmic radiation and regularly have disruptions to their sleep cycle. They are also more likely to have children later in life, another risk factor for breast cancer. Women in the military are almost 50% more likely to get breast cancer, possibly as a result of an increased exposure to various chemicals while on active duty.
To reduce your chances of developing breast cancer, keep to a healthy weight, exercise daily, sleep well, don't drink alcohol, avoid exposure to chemicals including nicotine, and breastfeed your babies if possible.
2. My Doctor Is Not Worried About An Unusual Thickening In My Breast. Should I Be?
Weight loss can also make your breasts feel lumpy because adipose (fat) tissue is lost from the breasts, making it easier to feel their actual structure. In women who have lost a lot of weight, doctors must use their experience and the results of a mammogram or ultrasound to decide whether the findings represent an unusual mass or common fibrocystic changes which can now be felt because there is no longer a cushion of fat.
Overall, women with breast thickening and negative mammograms and/or ultrasound scans are at low risk of cancer. However, if a doctor choses not to biopsy the area, the woman should be followed up at short-term intervals with a physical examination and repeated mammograms or ultrasound scans.
3. Does Anything Help Relieve Joint Pain Associated with Tamoxifen or Aromasin?
However, up to half of all women taking AIs and a smaller number of women taking tamoxifen experience joint pain and stiffness. Symptoms may be experienced in the hands, arms, knees, feet, pelvic and hip bones, or back, which may coincide with starting therapy or develop after several months of therapy.
Experts aren't sure why the pain happens with AIs but attribute it to the acute drop in estrogen produced by these drugs. While pain relievers such as acetaminophen and NSAIDs can help relieve the pain, NSAIDs themselves have their own side effects and should not be taken long-term unless under a doctor's advice. Exercise, especially weight-bearing exercise, has also been shown to be beneficial, as has abstaining from smoking, reducing alcohol intake, and relaxation.
4. How Long Can I Stay On Herceptin For?
The blockbuster chemotherapy drug, herceptin, blocks HER2 function (Her2 is a type of protein found in 15-20% of all breast cancers which makes the cancer more aggressive).
Treatment regimens for herceptin vary depending on hospital protocols; however some studies have shown that shorter treatment courses appear just as effective as longer ones.
Some women are kept on herceptin long-term if their cancer progresses. How long a women can stay on herceptin for is not known. The main concerns with long-term therapy are the potential cardiac side effects of herceptin. Previous studies have shown that for every three lives saved by reducing breast cancer, two women died of heart disease or other complications. However, one report describes a women who remained on herceptin for nine years without cardiac toxicity.
5. Is It Common To Lose Hair AFTER Stopping Tamoxifen?
Unfortunately, there is a lack of information regarding hair loss AFTER finishing tamoxifen, although several women anecdotally have reported similar experiences.
Tamoxifen has anti-estrogen effects in breast tissue but estrogen-like effects in other tissues. One possible explanation is that your body (in particular your hair) is readjusting itself to the different levels of hormones following the withdrawal of tamoxifen; a similar experience to the many women who report hair loss following child birth. Estrogen has varying effects on hair growth - it reduces bodily hair but promotes the growth of hair on your scalp. Theoretically, tamoxifen could be having an estrogen effect (and promoting hair growth); which is noticed as hair loss once the tamoxifen is stopped. More research is needed in this area.
Hair loss during tamoxifen therapy is much more common. One study reported hair loss or hair thinning in almost 25% of women prescribed endocrine therapies such as tamoxifen. In these women, tamoxifen may be having an anti-estrogen effect on their hair, and hair is likely to regrow once the tamoxifen is stopped.
6. Will I Still Be Able To Have Children After I Finish Chemo?
Many women develop breast cancer at an early age; some before they have even had the chance to consider whether or not they want children.
Some breast cancer treatments can cause temporary infertility or reduce your chances of getting pregnant after treatment ends. Other treatments may cause permanent infertility by inducing irreversible menopause.
While treating breast cancer effectively is of course the most important outcome, it may not have to be at the expense of your fertility. Many women successfully complete treatment and go on to have a healthy baby. Talk to your doctor about your fertility options before starting chemo or having surgery. It may be possible to bank fertilized eggs in case you are unable to produce eggs later. Other fertility options post chemo include egg donation, embryo donation and surrogacy.
7. How Many Years Before I Can Say I'm Cured Of Breast Cancer?
Rather than use the word "cured", most experts talk about the 5-year survival rate after cancer. Generally, survival rates are higher for women diagnosed with earlier stage cancers (Stage 0 or Stage I); however, it also depends on a person's age and health, the presence of specific receptors on cancer cells, what treatment was given, and how the woman responded to treatment. Bear in mind that survival rates become out of date quickly as new treatments become available.
Almost 100% of women diagnosed with Stage 0 or stage I breast cancer are alive five years after the initial diagnosis. This drops to 93% in women diagnosed with Stage II breast cancer, and 72% for women with Stage III. But as treatment evolves, so does survival rate, and many women still live complete and happy lives even though some residual cancer may still remain.
Finished: Breast Cancer: Your Questions Answered
Whelan EA Cancer incidence in airline cabin crew Occupational and Environmental Medicine 2003;60:805-806. Thorne C. Management of arthralgias associated with aromatase inhibitor therapy. Current Oncology. 2007;14(Suppl 1):S11-S19.
Irwin ML, Cartmel B, Gross CP, et al. Randomized Exercise Trial of Aromatase Inhibitor–Induced Arthralgia in Breast Cancer Survivors. Journal of Clinical Oncology. 2015;33(10):1104-1111. doi:10.1200/JCO.2014.57.1547.
Tonyali O, Coskun U, Sener N et al.Nine-week trastuzumab treatment versus 52-week trastuzumab treatment for HER2-positive early-stage breast cancer. J Cancer Res Clin Oncol. 2012 Dec;138(12):2145-51. doi: 10.1007/s00432-012-1296-x. Epub 2012 Aug 10.
Badulescu F, Badulescu A, Paul D, Popescu CF, Florescu C. More than 9 years of continuous trastuzumab treatment in metastatic breast cancer without cardiac toxicity: a case report and literature review. OncoTargets and therapy. 2014;7:1911-1917. doi:10.2147/OTT.S69343.
Littlejohns, P. Trastuzumab for early breast cancer: evolution or revolution? The Lancet Oncology; 7(1):22-3
Karatas F, Sahin S, Sever AR, Altundag K. Management of hair loss associated with endocrine therapy in patients with breast cancer: an overview. SpringerPlus. 2016;5:585. doi:10.1186/s40064-016-2216-3.
Gallicchio L, Calhoun C, Helzlsouer KJ. Aromatase inhibitor therapy and hair loss among breast cancer survivors. Breast Cancer Res Treat. 2013 Nov;142(2):435-43. doi: 10.1007/s10549-013-2744-2. Epub 2013 Nov 7.
Stevenson S, Thornton J. Effect of estrogens on skin aging and the potential role of SERMs. Clinical Interventions in Aging. 2007;2(3):283-297.
Estrogen and hair loss. Hair Sentinel http://www.hairsentinel.com/estrogen-and-hair-loss.html
Fertility and Pregnancy Issues During and After Breast Cancer. BreastCancer.org http://www.breastcancer.org/tips/fert_preg_adopt
Breast Cancer Survival Rates. American Cancer Society. https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/breast-cancer-survival-rates.html