Childhood Breast Cancer Treatment (PDQ®): Treatment - Patient Information [NCI]

General Information About Childhood 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.

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless, watery fluid called lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body. They filter lymph and store white blood cells that help fight infection and disease. Groups of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.

Breast cancer can occur in the breast tissue of both males and females.

Anatomy of the female breast. The nipple and areola are shown on the outside of the breast. The lymph nodes, lobes, lobules, ducts, and other parts of the inside of the breast are also shown.

Breast cancer is the most common cancer among female adolescents and young adults (age 15 to 39 years), but less than 5% of all breast cancers occur in this age group. Breast cancer in adolescents and young adults is often more aggressive and more difficult to treat than in older women, but treatment options are similar.

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

Fibroadenomas are benign tumors. Other benign breast tumors may include tubular adenomas, phyllodes tumors, and fibroepithelial neoplasms. While most phyllodes tumors are benign, some can be cancer. If a breast tumor grows quickly, is large in size, or there is more than one tumor, a core-needle 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 a person's chance of getting a disease is called a risk factor. Not every child with one or more risk factors will develop childhood breast cancer, and it will develop in some children who don't have any known risk factors. 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 BRCA2gene or in other genes that increase the risk of breast cancer.

Genetic counseling may be done for patients with breast cancer and a family history of breast cancer.

It is not always clear from the family medical history whether a condition is inherited. Certain families may benefit from genetic counseling and genetic testing. Genetic counselors and other specially trained health professionals can help parents understand the following:

• Their family medical history.
• Their options for genetic testing for the BRCA1, BRCA2, or other genes that increase the risk for breast cancer.
• The risk of cancer for the child and the child's siblings.
• The risks and benefits of learning genetic information.

Genetic counselors can also help parents cope with their child's genetic testing results, including how to discuss the results with family members.

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 diagnose breast cancer.

In addition to asking about your child's personal and family health history and doing a physical exam, your child's doctor may perform the following tests and procedures.

• 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 8 years after finishing radiation therapy, whichever is later.
• Breast 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.
• 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

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 staging system for childhood breast cancer. The results of tests and procedures done to diagnose breast cancer are used to help make decisions about treatment.

Sometimes childhood breast cancer recurs (comes back) in the breast or other parts of the body after 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.

Treatment Option Overview

There are different types of treatment for children and adolescents with breast tumors or 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.
• Fertility 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.

Three 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 area of the body with cancer.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drug enters the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

New types of treatment are being tested in clinical trials.

Information about clinical trials is available from the NCI website.

Treatment for childhood breast cancer may cause side effects.

To learn more about side effects that begin during treatment for cancer, visit Side Effects.

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, including fertility 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. For more information, see Late Effects of Treatment for Childhood Cancer.

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.

As your child goes through treatment, they will have follow-up tests or check-ups. Some of the tests that were done to diagnose the cancer may be repeated 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).

Treatment of Benign Childhood Breast Tumors

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

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

• Watchful waiting. These tumors may disappear without treatment.
• Surgery to remove the tumor. Surgery may also be used for tumors that recur (come back).

Treatment of Childhood Breast Cancer

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

Treatment of newly diagnosed breast cancer in children may include the following:

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

Sometimes childhood breast cancer may come back after treatment. If your child is diagnosed with recurrent breast cancer, your child's doctor will work with you to plan treatment.

For more information on the treatment of adolescents and young adults with breast cancer, see Breast Cancer Treatment (Adult).

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
• BRCA Gene Changes: Cancer Risk and Genetic Testing
• Genetic Testing for Inherited Cancer Susceptibility Syndromes

For more childhood cancer information and other general cancer resources, visit:

• About Cancer
• Childhood Cancers
• CureSearch for Children's Cancer
• 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

About This PDQ Summary

About PDQ

Physician Data Query (PDQ) is the National Cancer Institute's (NCI's) comprehensive cancer information database. The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries come in two versions. The health professional versions have detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions have cancer information that is accurate and up to date and most versions are also available in Spanish.

PDQ is a service of the NCI. The NCI is part of the National Institutes of Health (NIH). NIH is the federal government's center of biomedical research. The PDQ summaries are based on an independent review of the medical literature. They are not policy statements of the NCI or the NIH.

Purpose of This Summary

This PDQ cancer information summary has current information about the treatment of childhood breast cancer. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.

Reviewers and Updates

Editorial Boards write the PDQ cancer information summaries and keep them up to date. These Boards are made up of experts in cancer treatment and other specialties related to cancer. The summaries are reviewed regularly and changes are made when there is new information. The date on each summary ("Updated") is the date of the most recent change.

The information in this patient summary was taken from the health professional version, which is reviewed regularly and updated as needed, by the PDQ Pediatric Treatment Editorial Board.

Clinical Trial Information

A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.

Clinical trials can be found online at NCI's website. For more information, call the Cancer Information Service (CIS), NCI's contact center, at 1-800-4-CANCER (1-800-422-6237).

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The best way to cite this PDQ summary is:

PDQ® Pediatric Treatment Editorial Board. PDQ Childhood Breast Cancer Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/breast/patient/child-breast-treatment-pdq. Accessed <MM/DD/YYYY>.

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Last Revised: 2024-08-23

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