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INTRODUCTION   Breast cancer, the second-leading cause of cancer deaths in women, is the disease women fear most  Breast cancer can also occur in men, but it's far less common  Yet there's more reason for optimism than ever before  In the last 30 years, doctors have made great strides in early diagnosis and treatment of the disease and in reducing breast cancer deaths  80% of breast cancers occur in women older than age 50 In 30s, have a one in 233 chance of developing breast cancer By age 85, chance is one in eight  In 1975, a diagnosis of breast cancer usually meant radical mastectomy – removal of the entire breast along with underarm lymph nodes and muscles underneath the breast  Today, radical mastectomy is rarely performed Instead, there are more and better treatment options, and many women are candidates for breast-sparing operations SIGNS AND SYMPTOMS  When the disease is discovered early, have more treatment options and a better chance for a cure  Most breast lumps aren't cancerous Yet the most common sign of breast cancer for both men and women is a lump or thickening in the breast Often, the lump is painless  Spontaneous clear or bloody discharge from the nipple, often associated with a breast lump  Retraction or indentation of the nipple  Change in the size or contours of the breast  Any flattening or indentation of the skin over the breast  Redness or pitting of the skin over breast, like the skin of an orange  A number of conditions other than breast cancer can cause the breasts to change in size or feel  Breast tissue changes naturally during pregnancy and the menstrual cycle  Other possible causes of noncancerous (benign) breast changes include fibrocystic changes, cysts, fibroadenomas, infection or injury  If patient haven't yet gone through menopause, may want to wait through one menstrual cycle before seeing the doctor  If the change hasn't gone away after a month, have it evaluated promptly CAUSES   In breast cancer, some of the cells in the breast begin growing abnormally  These cells divide more rapidly than healthy cells and may spread (metastasize) through the breast, to lymph nodes or to other parts of the body  The most common type of breast cancer begins in the milk-producing ducts, but cancer may also begin in the lobules or in other breast tissue  In most cases, it isn't clear what causes normal breast cells to become cancerous  Only 5-10% of breast cancers are inherited  Families that have genetic defects in one of two genes, breast cancer gene (BRCA1) or breast cancer gene (BRCA2), have a much greater risk of developing both breast and ovarian cancer  Other inherited mutations – including the ataxiatelangiectasia mutation gene, the cell-cycle checkpoint kinase (CHEK-2) gene and the p53 tumor suppressor gene – also make it more likely that will develop breast cancer  If one of these genes is present in the family, will have a 50 percent chance of having the gene  Yet most genetic mutations related to breast cancer aren't inherited  These acquired mutations may result from radiation exposure – women treated with chest radiation therapy for lymphoma in childhood or during adolescence when breasts are developing have a significantly higher incidence of breast cancer than women not exposed to radiation  Mutations may also develop as a result of exposure to cancer-causing chemicals, such as the polycyclic aromatic hydrocarbons found in tobacco and charred red meats