Diagnosis

• All women should have physical examinations, including careful breast exams. Mammograms in all women over 50 are an effective screening tool that clearly decreases mortality from breast cancer. In women with increased risk, initial screenings may be started earlier.
  
• All breast lumps that are found on examination should be evaluated with mammography or ultrasound. In some cases, an MRI scan may also be used.
  
• If there is suspicion for cancer, a biopsy is necessary for definitive diagnosis.
  

Treatment

• Surgery to remove the breast cancer is the preferred therapy. The surgical options include lumpectomy plus radiation therapy, or mastectomy.
  
  The choice of surgical therapy often presents difficulties for doctors and patients. Lumpectomy followed by radiation may be considered in the case of smaller tumors and/or in women with larger breasts where a good cosmetic result is anticipated. Mastectomy virtually eliminates the risk of local recurrence, but may result in poorer cosmetic results.
  
• Chemotherapy is indicated for most patients in addition to surgery.
  
• Breast cancers are also evaluated based on whether they contain estrogen or progesterone hormone receptors. Women with hormone–positive cancers are treated with long–term medications (e.g., tamoxifen) in addition to surgery and/or chemotherapy.
  
  Further, in high–risk women without breast cancer, tamoxifen taken for five years decreases the risk of developing breast cancer by 50 percent or more.