Types/breast/patient/child-breast-treatment-pdq

Childhood Breast Cancer Treatment Version

General Information About Childhood Breast Cancer

KEY POINTS

• Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

• Most breast tumors in children are fibroadenomas (not cancer).

• Radiation therapy to the breast or chest to treat a previous cancer increases the risk of breast cancer.

• Signs of breast cancer include a lump or thickening in or near the breast.

• Tests that examine the breast are used to help detect (find) and diagnose breast cancer.

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Breast cancer can occur in the breast tissue of both male and female children.

Breast cancer is the most common cancer among females aged 15 to 39 years; but less than 5% of all breast cancers occur in females in this age group. Breast cancer in females aged 15 to 39 years is more aggressive and more difficult to treat than in older women. Treatments for younger and older women are similar. Younger patients with breast cancer may have genetic counseling (a discussion with a trained professional about inherited diseases) and testing for family cancer syndromes. Also, the possible effects of treatment on fertility should be considered.

Most breast tumors in children are fibroadenomas (not cancer).

Fibroadenomas are benign tumors. Rarely, these tumors become large phyllodes tumors (cancer) and begin to grow quickly. If a benign tumor begins to grow quickly, a fine-needle aspiration (FNA) biopsy or an excisional biopsy will be done. The tissues removed during the biopsy will be viewed under a microscope by a pathologist to check for signs of cancer.

Radiation therapy to the breast or chest to treat a previous cancer increases the risk of breast cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your child's doctor if you think your child may be at risk for breast cancer.

Risk factors for breast cancer in children, adolescents, and young adults include the following:

• Past treatment with radiation therapy to the breast or chest for another cancer, such as Hodgkin lymphoma.

• Having a personal history of a type of cancer that may spread to the breast, such as leukemia, rhabdomyosarcoma, soft tissue sarcoma, or lymphoma.

• A family history of breast cancer in a mother, father, sister, or brother.

• Inherited changes in the BRCA1 or BRCA2 gene or in other genes that increase the risk of breast cancer.

Signs of breast cancer include a lump or thickening in or near the breast.

These and other signs and symptoms may be caused by breast cancer or by other conditions.

Check with your child's doctor if your child has any of the following:

• A lump or thickening in or near the breast or in the underarm area.

• A change in the size or shape of the breast.

• A dimple or puckering in the skin of the breast.

• A nipple turned inward into the breast.

• Fluid, other than breast milk, from the nipples, including blood.

• Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin that is around the nipple).

• Dimples in the breast that look like the skin of an orange, called peau d’orange.

Tests that examine the breast are used to help detect (find) and diagnose breast cancer.

The following tests and procedures may be used:

• Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

• Clinical breast exam (CBE): An exam of the breast by a doctor or other health professional. The doctor will carefully feel the breast and under the arm for lumps or anything else that seems unusual.

• Mammogram: An x-ray of the breast. When treatment for another cancer included radiation therapy to the breast or chest, it is important to have a mammogram and MRI of the breast to check for breast cancer. These should be done beginning at age 25, or 10 years after finishing radiation therapy, whichever is later.

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of both breasts. This procedure is also called nuclear magnetic resonance imaging (NMRI).

• Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. The picture can be printed to be looked at later.

• PET scan (positron emission tomography scan): A procedure to find malignant tumor cells in the body. A small amount of radioactive glucose (sugar) is injected into a vein. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do.

Positron emission tomography (PET) scan. The child lies on a table that slides through the PET scanner. The head rest and white strap help the child lie still. A small amount of radioactive glucose (sugar) is injected into the child's vein, and a scanner makes a picture of where the glucose is being used in the body. Cancer cells show up brighter in the picture because they take up more glucose than normal cells do.

• Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.

• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

Stages of Childhood Breast Cancer

KEY POINTS

• There is no standard staging system for childhood breast cancer.

• There are three ways cancer spreads in the body.

• Cancer may spread from where it began to other parts of the body.

There is no standard staging system for childhood breast cancer.

The process used to find out if cancer has spread from the breast to nearby areas or to other parts of the body is called staging. There is no standard system for staging childhood breast cancer. The results of tests and procedures done to diagnose breast cancer are used to help make decisions about treatment.

There are three ways cancer spreads in the body.

Cancer can spread through tissue, the lymph system, and the blood:

• Tissue. The cancer spreads from where it began by growing into nearby areas.

• Lymph system. The cancer spreads from where it began by getting into the lymph system. The cancer travels through the lymph vessels to other parts of the body.

• Blood. The cancer spreads from where it began by getting into the blood. The cancer travels through the blood vessels to other parts of the body.

Cancer may spread from where it began to other parts of the body.

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began (the primary tumor) and travel through the lymph system or blood.

• Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor (metastatic tumor) in another part of the body.

• Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor (metastatic tumor) in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bone, the cancer cells in the bone are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.

Recurrent Breast Cancer

Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast or in other parts of the body.

Treatment Option Overview

KEY POINTS

• There are different types of treatment for children and adolescents with breast cancer.

• Children and adolescents with breast cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.

• Two types of standard treatment are used for benign breast tumors:

• Watchful waiting

• Surgery

• Two types of standard treatment are used for breast cancer:

• Surgery

• Radiation therapy

• New types of treatment are being tested in clinical trials.

• Targeted therapy

• Treatment for childhood breast cancer may cause side effects.

• Patients may want to think about taking part in a clinical trial.

• Patients can enter clinical trials before, during, or after starting their cancer treatment.

• Follow-up tests may be needed.

There are different types of treatment for children and adolescents with breast cancer.

Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Because cancer in children is rare, taking part in a clinical trial should be considered. Some clinical trials are open only to patients who have not started treatment.

Children and adolescents with breast cancer should have their treatment planned by a team of doctors who are experts in treating childhood cancer.

Treatment will be overseen by a pediatric oncologist, a doctor who specializes in treating children with cancer. The pediatric oncologist works with other pediatric health professionals who are experts in treating children with cancer and who specialize in certain areas of medicine. This may include the following specialists and others:

• Pediatrician.

• Pediatric surgeon.

• Radiation oncologist.

• Pathologist.

• Pediatric nurse specialist.

• Social worker.

• Rehabilitation specialist.

• Psychologist.

• Child-life specialist.

Two types of standard treatment are used for benign breast tumors:

Watchful waiting

Watchful waiting is closely monitoring a patient's condition without giving any treatment until signs or symptoms appear or change. Benign breast tumors may disappear without treatment.

Surgery

Surgery is done to remove the tumor, but not the whole breast.

Two types of standard treatment are used for breast cancer:

Surgery

Surgery is done to remove the cancer, but not the whole breast.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the cancer.

New types of treatment are being tested in clinical trials.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI website.

Targeted therapy

Targeted therapy is a type of treatment that uses drugs or other substances to attack cancer cells. Targeted therapies usually cause less harm to normal cells than chemotherapy or radiation therapy do.

Targeted therapy is being studied for the treatment of childhood breast cancer that has recurred (come back).

Treatment for childhood breast cancer may cause side effects.

For information about side effects that begin during treatment for cancer, see our Side Effects page.

Side effects from cancer treatment that begin after treatment and continue for months or years are called late effects. Late effects of cancer treatment may include:

• Physical problems.

• Changes in mood, feelings, thinking, learning, or memory.

• Second cancers (new types of cancer) or other conditions.

Some late effects may be treated or controlled. It is important to talk with your child's doctors about the possible late effects caused by some treatments. See the PDQ summary on Late Effects of Treatment for Childhood Cancer for more information.

Patients may want to think about taking part in a clinical trial.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.

Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.

Patients can enter clinical trials before, during, or after starting their cancer treatment.

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Follow-up tests may be needed.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.

Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your child's condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.

Treatment of Benign Childhood Breast Tumors

For more information about the treatments listed below, see the Treatment Option Overview section.

Treatment of benign breast tumors in children may include the following:

• Watchful waiting. These tumors may disappear without treatment.

• Surgery to remove the tumor.

Treatment of Childhood Breast Cancer

For more information about the treatments listed below, see the Treatment Option Overview section.

Treatment of breast cancer in children may include the following:

• Surgery to remove the tumor, but not the whole breast. Radiation therapy may also be given.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Treatment of Recurrent Childhood Breast Cancer

For more information about the treatment listed below, see the Treatment Option Overview section.

Treatment of recurrent breast cancer in children may include the following:

• A clinical trial that checks a sample of the patient's tumor for certain gene changes. The type of targeted therapy that will be given to the patient depends on the type of gene change.

See the PDQ summary Breast Cancer Treatment (Adult) for more information on the treatment of adolescents and young adults with breast cancer.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

To Learn More About Childhood Breast Cancer

For more information from the National Cancer Institute about breast cancer, see the following:

• Breast Cancer Home Page

• Targeted Cancer Therapies

• BRCA Mutations: Cancer Risk and Genetic Testing

• Genetic Testing for Inherited Cancer Susceptibility Syndromes

For more childhood cancer information and other general cancer resources, see the following:

• About Cancer

• Childhood Cancers

• CureSearch for Children's CancerExit Disclaimer

• Late Effects of Treatment for Childhood Cancer

• Adolescents and Young Adults with Cancer

• Children with Cancer: A Guide for Parents

• Cancer in Children and Adolescents

• Staging

• Coping with Cancer

• Questions to Ask Your Doctor about Cancer

• For Survivors and Caregivers