Information for Patients
What is breast cancer?
Breast cancer is a cancer that starts in breast tissue. It happens when cells in the breast change and grow out of control. The cells usually form a tumor.
Sometimes the cancer does not spread any further. This is called "in situ." If the cancer spreads outside the breast, the cancer is called "invasive." It may just spread to nearby tissues and lymph nodes. Or the cancer may metastasize (spread to other parts of the body) through the lymph system or the blood.
Breast cancer is the second most common type of cancer in women in the United States. Rarely, it can also affect men.
What are the types of breast cancer?
There are different types of breast cancer. The types are based on which breast cells turn into cancer. The types include:
- Ductal carcinoma, which begins in the cells of the ducts. This is the most common type.
- Lobular carcinoma, which begins in the lobules. It is more often found in both breasts than other types of breast cancer.
- Inflammatory breast cancer, in which cancer cells block lymph vessels in the skin of the breast. The breast becomes warm, red, and swollen. This is a rare type.
- Paget's disease of the breast, which is a cancer involving the skin of the nipple. It usually also affects the darker skin around the nipple. It is also rare.
What causes breast cancer?
Breast cancer happens when there are changes in the genetic material (DNA). Often, the exact cause of these genetic changes is unknown.
But sometimes these genetic changes are inherited, meaning that you are born with them. Breast cancer that is caused by inherited genetic changes is called hereditary breast cancer.
There are also certain genetic changes that can raise your risk of breast cancer, including changes called BRCA1 and BRCA2. These two changes also raise your risk of ovarian and other cancers.
Besides genetics, your lifestyle and the environment can affect your risk of breast cancer.
Who is at risk for breast cancer?
The factors which raise your risk of breast cancer include:
- Older age
- History of breast cancer or benign (noncancer) breast disease
- Inherited risk of breast cancer, including having BRCA1 and BRCA2 gene changes
- Dense breast tissue
- A reproductive history that leads to more exposure to the estrogen hormone, including
- Menstruating at an early age
- Being at an older age when you first gave birth or never having given birth
- Starting menopause at a later age
- Taking hormone therapy for symptoms of menopause
- Radiation therapy to the breast or chest
- Drinking alcohol
What are the signs and symptoms of breast cancer?
The signs and symptoms of breast cancer include:
- A new lump or thickening in or near the breast or in the armpit
- A change in the size or shape of the breast
- A dimple or puckering in the skin of the breast. It may look like the skin of an orange.
- A nipple turned inward into the breast
- Nipple discharge other than breast milk. The discharge might happen suddenly, be bloody, or happen in only one breast.
- Scaly, red, or swollen skin in the nipple area or the breast
- Pain in any area of the breast
How is breast cancer diagnosed?
Your health care provider may use many tools to diagnose breast cancer and figure out which type you have:
- A physical exam, including a clinical breast exam (CBE). This involves checking for any lumps or anything else that seems unusual with the breasts and armpits.
- A medical history
- Imaging tests, such as a mammogram, an ultrasound, or an MRI
- Breast biopsy
- Blood chemistry tests, which measure different substances in the blood, including electrolytes, fats, proteins, glucose (sugar), and enzymes. Some of the specific blood chemistry tests include a basic metabolic panel (BMP), a comprehensive metabolic panel (CMP), and an electrolyte panel.
If these tests show that you have breast cancer, you will have tests which study the cancer cells. These tests help your provider decide which treatment would be best for you. The tests may include:
- Genetic tests for genetic changes such as BRCA and TP53
- HER2 test. HER2 is a protein involved with cell growth. It is on the outside of all breast cells. If your breast cancer cells have more HER2 than normal, they can grow more quickly and spread to other parts of the body.
- An estrogen and progesterone receptor test. This test measures the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If there are more receptors than normal, the cancer is called estrogen and/or progesterone receptor positive. This type of breast cancer may grow more quickly.
Another step is staging the cancer. Staging involves doing tests to find out whether the cancer has spread within the breast or to other parts of the body. The tests may include other diagnostic imaging tests and a sentinel lymph node biopsy. This biopsy is done to see whether the cancer has spread to the lymph nodes.
What are the treatments for breast cancer?
Treatments for breast cancer include:
- Surgery such as
- A mastectomy, which removes the whole breast
- A lumpectomy to remove the cancer and some normal tissue around it, but not the breast itself
- Radiation therapy
- Hormone therapy, which blocks cancer cells from getting the hormones they need to grow
- Targeted therapy, which uses drugs or other substances that attack specific cancer cells with less harm to normal cells
Can breast cancer be prevented?
You may be able to help prevent breast cancer by making healthy lifestyle changes such as:
- Staying at a healthy weight
- Limiting alcohol use
- Getting enough exercisee
- Limiting your exposure to estrogen by
- Breastfeeding your babies if you can
- Limiting hormone therapy
If you are at high risk, your health care provider may suggest that you take certain medicines to lower the risk. Some women at very high risk may decide to get a mastectomy (of their healthy breasts) to prevent breast cancer.
It's also important to get regular mammograms. They may be able to identify breast cancer in the early stages, when it is easier to treat.
NIH: National Cancer Institute
General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.
Index of Diseases and Injuries Definitions
- And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
- Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
- Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
- Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
- Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
- NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
- See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
- See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
- 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
- With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.