Your trusted, no-nonsense guide to detecting and managing breast cancer 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.

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

Learn to practice healthy and regular self-careUnderstand your diagnosis and participate in your treatmentAdvocate for the best initial and follow-up care By the best breast experts in association with ABCF Advancements in breast cancer prevention, detection, and treatment are being made every day, but it can be overwhelming to know where to turn for the most trusted information. This book distills it all into one easy-to-follow guide, giving you expert advice on everything you'll face as you manage your health. With this sensitive and authoritative reference by your side, you and your loved ones will be able to rest assured that you're informed, empowered, and getting the care you need. Inside… Determine your best treatmentGet advice from survivorsCope with a diagnosisDecode your pathology reportMake healthy lifestyle changesUnderstand how cancer treatment affects fertility and sexualityKnow your breast reconstruction options

Foreword xvii Introduction 1 Part 1: Knowing About Breast Cancer 5 Chapter 1: Breast Cancer 101 7 Chapter 2: Risk Factors for Breast Cancer 19 Chapter 3: Indicators of Breast Cancer 33 Part 2: Diagnosing Breast Cancer 45 Chapter 4: Physical Awareness and Detecting Breast Cancer 47 Chapter 5: Understanding Breast Biopsies 63 Chapter 6: Stages of Breast Cancer 79 Part 3: Treating Breast Cancer 91 Chapter 7: Looking at Treatment Options 93 Chapter 8: Breast Surgery 113 Chapter 9: Radiation Therapy 127 Chapter 10: Chemotherapy 141 Chapter 11: Endocrine, Biological, and Cutting-Edge Therapies 155 Chapter 12: Breast Reconstruction 171 Chapter 13: Treating Advanced Breast Cancer 187 Part 4: Dealing with Breast Cancer and Everyday Life 205 Chapter 14: Psychosocial Concerns and Breast Cancer Diagnosis 207 Chapter 15: Managing Stress 217 Chapter 16: Coping with Changes after Treatment 227 Chapter 17: Cancer Treatment, Fertility, and Sexuality 249 Chapter 18: Making Healthy Lifestyle Changes 267 Part 5: The Part of Tens 285 Chapter 19: Ten Inspiring Breast Cancer Survivors 287 Chapter 20: Ten Ways Family and Friends Can Help You 303 Chapter 21: (At Least) Ten Ways Life Can Be Better After Cancer 307 Appendix A: Breast Health Glossary 317 Appendix B: Support Groups, Resources, and Organizations 327 Index 337