Question: I have a lump in my breast and I’m afraid it’s cancer. Should I be worried?Answer: Eight out of 10 lumps that women may feel in their breasts are benign (not cancerous). A benign lump can be a collection of normal or hyperactive breast gland cells, or it may be a water-filled sac (cyst). In any event, if you feel a lump and you’re worried about it, DON’T HESITATE TO SEE A DOCTOR. By getting a doctor to check the lump you’ll ease your fears. And if it’s something serious, you can start getting treatment right away. One way to make lumps less frightening is to get to know what your breasts normally feel like. There’s no better way to find out than by doing your monthly breast self-exam. The upper, outer area—near your armpit—tends to have the most prominent lumps and bumps. The lower half of your breast can feel like a sandy or pebbly beach. The area under the nipple can feel like a collection of large grains. Another part might feel like a lumpy bowl of oatmeal. If you notice any changes in your breasts that last over a full month’s cycle or that seem to get worse or more obvious over time, tell your doctor. Knowing how your breasts usually look and feel may also help you avoid needless biopsies. Question: What are the side effects of chemotherapy and what are some ways of dealing with them?Answer:The side effects of chemotherapy are different for different people, different drugs, and different drug doses. Some people may not be able to tolerate one particular drug, but do quite well on another. A lot depends on finding the right dose that will be effective against the cancer but still be tolerable for each person. This is something your doctor will monitor. Fortunately, a number of effective medications are available to manage side effects. Some side effects of chemotherapy include nausea and vomiting, hair loss, fatigue and anemia, mouth sores, taste and smell changes, suppression of the immune system, which increases the risk of infection, diarrhea, menopause, infertility. Other side effects may include fluid retention, rashes, irritated bladder, swelling and soreness of the mucous membranes, and numbness and aching of the joints, hands, and feet. There are a few other, very rare side effects from specific drugs. Question: What are the side effects of tamoxifen, and what are the alternatives to this treatment?Answer: Tamoxifen (brand name: Nolvadex) is a medicine that is very effective in preventing the recurrence of estrogen-receptor-positive breast cancer. But it does have side effects. The most common are menopausal symptoms including hot flashes, vaginal dryness, low libido, mood swings, and nausea. If you’re at an age when you would soon enter natural menopause, tamoxifen can nudge you into menopause sooner. If tamoxifen gives you uncomfortable menopausal symptoms, and your doctor advises you not to take hormone replacement therapy (HRT), other effective treatments are available. Tamoxifen may also cause non-cancerous changes in the uterus. In some women, it may increase the risk of blood clots or endometrial cancer (cancer in the lining of the uterus).Remember that each woman’s risk factors are different. When you discuss your medical history with your doctor, you may find that the benefits of tamoxifen far outweigh the risks. Read the breastcancer.org section on tamoxifen for more information about relative risks and benefits. Alternatives to tamoxifen include: other anti-estrogen medications, aromatase inhibitors, non-estrogen options, and ovary removal. [pagebreak] Question: I’ve had breast cancer. Is it safe to take hormone replacement therapy (HRT) for menopausal symptoms like hot flashes and vaginal dryness?Answer: This is a controversial issue. If you’ve had breast cancer, most doctors will automatically say you cannot take HRT (also called MHT, or menopausal hormone therapy, and sometimes ERT, or estrogen replacement therapy). Many doctors consider HRT risky because estrogen can stimulate the growth of breast cells—both normal cells and cancerous ones. So doctors feel HRT may increase a woman’s risk of breast cancer recurring or of her developing a new breast cancer. A cancer that is hormone-receptor positive (ER-positive or PR-positive) may be more likely to be stimulated by estrogen than a cancer without hormone receptors. Thus, HRT may pose a higher risk for a woman with this type of cancer. Yet some women affected by breast cancer may be good candidates for HRT. In the few studies that have been done, breast cancer survivors with severe menopausal symptoms who were given HRT had a risk of cancer recurrence that was no higher than expected, given the cancer’s stage, its type, and the kind of treatment the women had received. If you have severe menopausal symptoms that are not relieved by other means, try to find a doctor who will look closely at your individual case. There are choices in type of estrogen, dose, and how it’s given. Question: How long must a woman survive after breast cancer to be considered cancer-free or cured?Answer: According to the National Cancer Institute, the five-year survival rate for non-metastatic breast cancer (breast cancer that has not spread beyond the breast) is 80%. Newspapers and television usually translate that to, “If you’ve survived for five years, you’re cancer-free.” This is a bit misleading. It’s true that during the first five years, the risk of recurrence is highest. But breast cancer can recur even after five years. The important point to know is that the more time passes, the lower the risk of recurrence becomes. The chance of surviving breast cancer depends on MANY different factors taken together. Lymph node involvement has a strong influence on prognosis. The more lymph nodes involved, the more serious the cancer. Some of the other factors that affect outcome are your general health, the size of the cancer, hormone receptor status, growth rate, tumor grade, and HER2/neu status. Even with the best information, no one can predict the future. Each of us is unique, and how each woman’s body and mind handle breast cancer and treatment is truly a mystery. Many women have beat the odds, while other women “sure to do well” somehow didn’t. You just have to do the best you can, with the best team of doctors and nurses that you can assemble, together with your support network. Then focus on the power of your mind, and you can experience the momentum you need to move through treatment and beyond. The good news is that more and more women are living longer than five years past breast cancer as a result of early detection, more effective breast cancer therapy, and better overall medical care. More from Prevention: 10 Ways To Stop Breast Cancer
