14 Reasons Your Feet Hurt–and How to Ease the Pain

What causes foot pain?

Our feet are the foundation for our entire body, and they serve us well—carrying us around 110,000 miles over an average lifetime by some estimates. But with 26 bones, 33 joints, and a network of more than 100 tendons, muscles, and ligaments, a lot can go wrong with these amazingly complex structures. Whether your heels ache or you have toe troubles, here’s how to step away from foot pain.

Heel pain: Plantar fasciitis

Heel pain is the most common problem affecting the foot, according to the American Academy of Orthopaedic Surgeons (AAOS), and plantar fasciitis is the most common cause of heel pain. If the first step you take when you get out of bed in the morning feels like a sharp pain under your heel, you probably have plantar fasciitis, or inflammation of the plantar fascia, a thick band of tissue that connects the heel to the front of your foot and supports your arch.

Plantar fasciitis, which usually stems from repeated stress to the foot that strains the fascia beyond its normal extension, is often worse after long periods of inactivity and temporarily diminishes as you begin to walk around. “The fascia relaxes when you’re sleeping and the swelling kicks in more,” says Jacqueline Sutera, DPM, a podiatric surgeon in New York City. “Then, when you stand, you put all your body weight on this inflamed tissue.”

“Plantar fasciitis is aggravated by tight muscles in your feet and calves,” says Dr. Sutera, so stretch your Achilles tendon and calf muscles several times throughout the day. Treatments to reduce inflammation include rest (avoid activities that make the pain worse), nonsteroidal anti-inflammatory medications (NSAIDs), ice, and massage (rub lengthwise and across your arch, ideally after taking a bath or shower).

Wearing shoes (even slippers) with good arch support is also key, since supporting the arch takes tension off the fascia. Flip-flops, ballerina flats, and going barefoot are no-no’s. Your weight and gait may play a role too: In one study, people with chronic plantar fasciitis were three times more likely to be obese and nearly four times more likely to have feet that roll inward more than normal, so consider orthotics to decrease strain on the plantar fascia.

If pain lingers longer than two weeks, see your doctor, who may recommend physical therapy, cortisone injections, or a night splint.

3 of 15 Kris Ubach and Quim Roser/Getty Images

Heel pain: Heel spur

A heel spur is growth of extra bone that protrudes from the base or the back of the heel. It often occurs alongside plantar fasciitis, has similar symptoms (sharp pain at the back of the bottom of the foot), and responds to the same treatments, but—despite common belief—the conditions are not the same. In fact, heel spurs aren’t necessarily even a problem: According to the AAOS, while one out of 10 people have them, only one out of 20 people with heel spurs experiences foot pain.

While heel spurs by themselves may not be painful, these pointy calcifications can cause irritation in the surrounding tissue, including where the plantar fascia attaches onto the heel bone, says Dr. Sutera. Common causes of heel spurs are repetitive trauma to the base of the heel, obesity, poorly fitting shoes, or genetics. Treatment is rest, managing pain with NSAIDs, ice, and stretching, and correcting biomechanical problems with shoe inserts.

Bottom of foot pain: Plantar warts

Feel like you have pebbles in your shoe? Check the soles of your feet for plantar warts. Plantar warts are caused by an infection in the skin due to one of the many forms of human papillomaviruses (HPV). But unlike other types of warts, the plantar variety doesn’t grow outward; instead, the pressure from walking and standing causes them to grow into the skin, creating pain and tenderness on the bottom of your feet. You may develop just one wart or they may occur in a cluster (called mosaic warts). Because they’re flat and tough, it’s easy to confuse plantar warts for calluses. Warts are more likely to have black seed-like dots, which are small areas of dried blood.

Plantar warts can disappear with no treatment at all, but it may take several years. They don’t pose a serious health threat, but they can cause discomfort and pain, so you may want to speed their departure. Over-the-counter peeling medications or patches contain salicylic acid to gradually dissolve the dead cells of the warts.

If your wart doesn’t improve with home treatment, your doctor can try using liquid nitrogen to freeze it off or burning, scraping, cutting, or shaving it off. Warts are contagious, so to avoid getting or spreading them, wear flip-flops in locker rooms, don’t touch someone else’s wart, and—since moisture tends to allow warts to spread—keep foot warts dry.

Bottom of foot pain: Calluses

These thick, hard patches of skin form over time as part of your body’s normal protection against prolonged rubbing or pressure—the buildup helps protect the underlying skin. (Calluses are not to be confused with blisters, which have a watery liquid inside and tend to develop more quickly.) When calluses appear on the feet, they’re typically on the underside (sole), often on the ball or heel, and they can be painful when standing or walking. Ill-fitting shoes are frequently the culprit, but gait issues can create excess pressure that causes skin to thicken too.

To treat a callus, NYC dermatologist Sejal Shah, MD, recommends using a pumice stone to gently remove the buildup of dead skin after bathing. Be careful not to take off too much skin, which can cause bleeding and infection. Then apply a moisturizer with salicylic acid, urea, or ammonium lactate twice a day to the area to gradually soften tough skin. Avoid razors and scissors (you don’t want to cut into living tissue and expose it to infection!), and don’t use a medically treated pad unless your doctor advises you to. “Try to avoid any repetitive actions that may be causing the calluses,” advises Dr. Shah, who also suggests using cushioned pads to protect calluses from further irritation: Cut a piece of moleskin into two half-moon shapes and place them around the callus. To prevent future calluses, wear properly fitting shoes and consider orthotics to correct any gait abnormality.

Toe pain: Bunions

Unlike many foot problems, which are felt but not seen, it’s easy to spot bunions, the bony protrusions that form at the base of the big toe. Bunions are caused by faulty foot mechanics that affect the way you walk: Years of abnormal motion and pressure on the big-toe joint forces the big toe to tilt in toward the second toe. As the bones are progressively thrown out of alignment, the telltale bump appears. People with certain foot types—flat feet, low arches, or feet that roll inward—are most likely to develop bunions. Since the mechanical structure of your feet is often inherited, bunions tend to run in families.

The big-toe joint carries much of your weight while walking, so untreated bunions can cause severe and constant pain. The fluid-filled sac surrounding the joint can also become inflamed, compounding the problem. Symptoms mostly occur when you wear shoes that crowd the toes (think narrow, pointy shoes or high heels), which may explain why the American Podiatric Medical Association says that women are up to nine times more likely than men to develop bunions. To reduce pain, opt for shoes with a wide toe box and heels two inches or lower. Gel pads placed over bunions can cushion the area and reduce pain. Also helpful are ice, NSAIDs, and avoiding activity that causes pain, including standing for long periods of time.

For severely inflamed bunions, your doctor can inject cortisone right into the joint to reduce swelling and discomfort. If a bunion continues to worsen, becomes very painful, or begins to affect your mobility, you may want to consider surgery to realign the joint and shave off the protruding bone. Don’t wait too long though, advises Dr. Sutera. “Results may not be as good when the problem is too severe.”

Toe pain: Corns

Corns and calluses are essentially the same thing, except corns occur on parts of your feet that don’t bear weight, such as the sides or tops of toes. “They’re usually small and circular with a well-defined center that can be hard or soft,” says Dr. Shah, who notes that mushy corns tend to develop between the toes where the skin is moist and sweaty. Unlike blisters, which form quickly, corns develop over time as a result of repeated friction and can be painful when you walk or stand. Treatment is the same as for calluses: Buff to remove the buildup of skin and moisturize regularly to soften skin. Corns can form when too-long toenails force the toes to push up against your shoe, so keep your toenails trimmed to help prevent them.

Toe pain: Gout

Gout is a form of inflammatory arthritis that triggers a sudden episode of burning pain, stiffness, and swelling in a joint—often in the joint of the big toe. The guilty party in gout is an excess of uric acid, a substance that’s naturally found in the body. While your body is usually proficient at regulating the level of uric acid in your blood, too much can lead to the creation of crystals that are deposited in joints.

A gout attack happens when something (such as an evening of drinking) causes uric acid levels to spike or jostles the needle-like crystals in your joints. The pain usually strikes at night and intensifies over the next eight to 12 hours before easing after a few days. Gout is more common in men than women, and an unlucky 60% of people who have an attack will have a second one within a year. To prevent future attacks, your doctor may prescribe medication, as well as suggest lifestyle changes, including modifying your diet to lower your body’s level of uric acid.

Toe pain: Hammertoes

If a toe (usually the second, third, or fourth) becomes bent upward in the middle in a V shape so it looks like it could hammer a nail, you’re said to have a hammertoe. This often occurs in conjunction with other toe problems, like bunions or corns on top of the bent toe where it rubs against your shoe. Hammertoes develop over time, often from wearing high-heeled or toe-cramping shoes that push toes into a flexed position. Initially, hammertoes are flexible and can be corrected; if left untreated, toe muscles are unable to straighten and the deformity can become permanent.

Step one to reducing the pain and stopping the progression of a hammertoe is to buy shoes with soft, roomy toe boxes that can accommodate the hammertoe. Placing cushioned pads on the tops of hammertoes may prevent or limit corns. Taping the bent and painful toe to a neighboring straight one (called “buddy taping”) or using straps and splints to keep a hammertoe in its correct place are also helpful. Exercises, such as using your toes to pick things like marbles up off the floor, can stretch and strengthen muscles. If conservative measures fail to alleviate pain, you may need surgery.

Toe pain: Ingrown toenails

Any toenail can become ingrown, but this painful problem is most common on the big toe. Ingrown toenails occur when the nail grows into the surrounding skin or when the skin on one or both sides of a nail grows over the nail’s edge. The toe might throb and become red and swollen. The real agony sets in if the skin around the toenail becomes infected, which can happen if the nail pierces the skin. “It causes so much pain with every step that people are literally tortured by it,” says Dr. Sutera.

She recommends treating ingrown toenail pain by soaking feet in warm water and Epsom salts to reduce inflammation. Then, gently nudge the skin away from the nail bed with a cotton swab and smooth the corner of the nail with an unused fine emery board. Swab the area with antibiotic cream. See a physician if there’s swelling, redness, pus, or increased pain; chances are the skin has become infected.

You might get an ingrown toenail after injuring your toe, but too-tight shoes and poor nail-grooming habits are the main causes of ingrown nails. To prevent future ingrowns, cut nails straight across and then file the corners into a slightly rounded shape—avoid “points” that can jab skin.

Toe pain: Osteoarthritis

Almost everyone will eventually develop some degree of osteoarthritis (OA), which is caused by the wear and tear on the cartilage that acts as a shock absorber between bones. As the cartilage breaks down, bones rub against each other, causing pain and restricting movement. The most common site of OA in the foot is in the joint at the base of the big toe, according to the AAOS. Adding insult to injury, a bone spur can develop where the bones rub together, and this overgrowth can keep the toe from bending as much as it needs to when you walk, resulting in a stiff big toe (technically called hallux rigidus).

There are many ways to ease the pain of OA, including NSAIDs, heat and ice, exercise and physical therapy, and losing weight. If you don’t find relief from these options, your doctor may recommend more aggressive treatment.

If you develop hallux rigidus, wearing the right shoes is important. Make sure they have plenty of room for your toes, and consider shoes with stiff soles—some people find they relieve pain. You may need to avoid high-impact activities like running. If these remedies aren’t enough to reduce pain, your doctor may recommend cortisone injections or surgery to shave the bone or realign the big toe.

Ball of foot pain: Fat pad atrophy

When the natural protective cushioning in the ball of your foot becomes diminished, it can feel like you’re walking on rocks or standing right on the bones of the ball of the foot. Ouch! Sadly, this thinning of the fat there is common and permanent: “Over time, you just wear out your fat pad and you can’t regrow fat,” says Dr. Sutera.

To prevent the problem and keep it from progressing, avoid anything that puts pressure on the balls of your feet. That includes wearing high heels and going barefoot, especially on hard surfaces like cement, stone, and tile. Choose supportive footwear and padded socks that cushion your feet and replace high-impact activities like running with swimming or cycling. Cushioned pads or insoles reduce pain, and since mechanical issues like having high arches or excessive pronation can exacerbate the problem, orthotics can help support the foot, absorb shock, and evenly distribute weight.

Ball of foot pain: Metatarsalgia

Metatarsalgia is a condition where the ball of the foot, the part of the sole just behind your toes, becomes painful and inflamed. It’s so-named because the pain strikes where the metatarsals (the bones in the midfoot that give your foot its arch) attach the toes to the rest of the foot. Over time, the area becomes tender, sort of like having a toothache, and may be swollen, though pain can also be sharp or burning. “Swelling occurs after a long period of time of wearing high heels or doing any kind of activity where you’re pounding on the ball of the foot,” says Dr. Sutera. The pain generally worsens when you stand, run, flex your feet, or walk and improves when you rest.

Treatment includes avoiding activities that cause pain, ice, compression, cushioned shoes (no going barefoot or wearing high heels!), and NSAIDs. If the pain doesn’t fade within a couple of weeks, see your doctor.

Ball of foot pain: Neuromas

Sometimes referred to as a “pinched nerve,” a neuroma is inflammation and/or thickening of tissue around the nerve between the base of the toes. People often describe the pain as being similar to having a stone in their shoe, but symptoms also include a burning sensation, tingling, or numbness between the toes and in the ball of the foot. The most common type of foot neuroma is Morton’s neuroma, which occurs at the base of the third and fourth toes.

Neuromas mostly occur in women who wear high heels, says Dr. Sutera, though they can also develop as a result of injury, repetitive stress, or foot abnormalities like hammertoes, bunions, flat feet, and high arches. Shoes with low heels and a wide toe box prevent strain, and OTC shoe pads reduce pressure. Rest, ice, and NSAIDs can temporarily alleviate pain. If left untreated, neuromas tend to get worse, so see a physician if you think you have one. Physical therapy and cortisone injections can help, but ultimately surgery may be necessary.

Top of foot pain: Tendonitis

Inflammation of the extensor tendons that straighten the toes is a very common cause of pain on the top of the foot. “This area is very bony, so it’s easy for all the tendons there to become inflamed,” explains Dr. Sutera. “It could be from wearing strappy or badly fitting shoes, tying your laces too tight, walking too long—really anything that causes pressure, because the area is so sensitive.”

Treatments include rest (limit walking and standing until the pain is gone), ice, NSAIDs, and compression. Supportive shoes are a must: “This is not the time to be in heels or flats,” says Dr. Sutera. Once the pain has subsided, ease back into high-impact exercise. Tendonitis is often an overuse injury, and doing too much too soon increases the chances of re-injury. If self-care doesn’t help, your doctor may recommend physical therapy.

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Men's Sperm Counts Are Down Worldwide: Study

A new report reveals that sperm counts among men in Western countries, including men in North America, Australia, New Zealand and Europe, have dropped substantially over the years. According to study authors, in less than 40 years, collective sperm count among this group of men has declined more than 50%. Sperm count is currently considered the best measure of male fertility.

The new study, published Tuesday in the journal Human Reproduction Update, not only shows that men’s sperm counts are dropping, but that the continued decline does not appear to be leveling off.

“The results are indeed very profound, and even shocking,” says study author Dr. Hagai Levine, head of the environmental health track at the Hebrew University-Hadassah Braun School of Public Health and Community Medicine in Jerusalem.

While the study is not the first to suggest that men’s sperm counts are dropping, the researchers say it’s the first ever meta-analysis on the subject. The new findings have limitations—they don’t include men from non-Western countries, for one—but the researchers say the study adds to a growing body of research on how changes in environments might be affecting male fertility.

TIME Health NewsletterGet the latest health and science news, plus: burning questions and expert tips. View Sample

“For me it was an important scientific and public health question I had to answer: have sperm counts really declined?” says Levine. “The impact of the modern environment on health of populations and individuals is clearly huge, but remains largely unknown.”

The researchers screened 7,500 studies and found 185 that met their criteria. Studies were included in the analysis if they looked at either men who were unaware of their fertility (for example, men who had never tried to conceive) or men who were deemed fertile (for instance, men known to have conceived a pregnancy). They excluded studies with men who had been included for suspected infertility, such as men attending an IVF clinic.

They found that from 1973 to 2011, there was a steep decline of more than 50% in both sperm concentration and total sperm count among men from Western countries. The researchers also restricted the analysis to studies after 1995 and reported that the decline does not appear to be abating.

Other male fertility experts say the study helps confirm what has been suspected for some time. “This has been a recognized phenomenon for over 50 years,” says Enrique Schisterman, chief of the epidemiology branch at the National Institute of Child Health and Human Development at the the National Institutes of Health. (Schisterman was not involved in the study.) “There has never been a systematic review of the literature as this analysis has done,” he says. “I think it’s confirmatory and well done. This is a serious problem.”

The study did not explain why sperm counts might be down in this group of men, but there are several theories based on prior research performed by the study authors and other groups. Levine says that drops in sperm counts have, in the past, been associated with environment and lifestyle factors including prenatal chemical exposures, adult pesticide exposures, smoking, stress and obesity.

MORE: Exercise May Be the Key to Better Sperm

“One possible explanation is that men residing in Western countries over the last decades were exposed to new manmade chemicals during their life course, and there is more and more evidence that these chemicals hurt their reproductive function,” he says. “We don’t know for sure why this is happening, but our findings should drive massive scientific effort to identify the causes and modes of prevention.”

Schisterman also suspects that environmental factors may be having an impact. “I think there is a consensus in the scientific community that if the results are real, it has to be an environmental factor,” he says. “Genetics would not explain such a rapid decline.”

Levine and his co-authors argue that more research needs to be done to understand the potential causes for these widespread drops in sperm counts, as well as to find ways to prevent possible issues from arising in the first place.

“We should solve this by addressing the root causes, whether by regulation of chemicals or health promotion in the broad sense to improve diet and physical activity or tobacco control,” says Levine. “On the personal level, every man can live healthier life by reducing stress, not smoking, being physically active and keeping a good diet and weight.”

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5 Things You Should Absolutely, Positively, Never Ever Ever Say to Someone Dealing With Infertility

If you have a friend or family member who’s struggling to get pregnant, your instinct may be to comfort her by telling her not to stress, and that eventually, it will all work out.

But while you mean well, this kind of advice might make your loved one feel worse. She knows very well it may not work out in the end. And a “don’t worry” directive can feel insensitive and glib.

The kindest thing you can do is offer her a listening ear, and allow her to share (or not share) as much as she chooses.

Don't have time to watch? Here's what not to say to a woman who’s dealing with infertility:

Have you tried: Eating pineapple? Propping your hips up after sex? Drinking cough syrup? Taking herbs? Getting him to switch to boxers?

Chances are, she’s already heard and tried it all.

Maybe you need to gain/lose weight.

Your friend’s weight (and how it affects or doesn’t affect her fertility) is between her and her doctor.

Why don’t you just adopt?

Adoption isn’t a replacement for having biological children. It’s a different path to building a family.

Maybe you’re not meant to be a parent.

Come on. That’s just cruel.

Instead, let your friend know that you care.

Ask what she needs. And how you can be supportive. And then, do that. Enough said.

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5 Moves to Prevent Back Pain

Back pain is super common, especially as our lifestyles are becoming increasingly sedentary. Do not despair! There are ways to prevent and even lessen the effects of back pain. Watch this video to learn five exercises that you can add into your daily routine to strengthen your core and keep the aches and pains at bay. 

Don’t have time to watch? Here’s the full transcript:

Back pain is super common, especially if you work at a desk, or if you don’t have a regular fitness routine. The best way to tackle it is by strengthening your core. So, here are five moves to help prevent back pain.

Bird dog: This move is great for working your core. I especially like it because it works your cross-body myofascial chain. You're going to come into your tabletop position. Hands are stacked under your shoulders. Knees are underneath your hips. You're going to find a neutral spine so you're not pressing up or sinking down, right in the middle. I want you to reach your right hand forward, left leg back. Really reach toward opposite sides of the room, then come back through neutral and switch sides.

Forearm plank reach: This move is a moving forearm plank that forces you to activate your core as you move to different positions. You’re going to come onto your elbows and find a nice, solid core. I like to widen my feet so I’m super stable. From here, you’re going to reach one hand forward, and then alternate. Notice that my hips are not moving. That is your goal, to keep your hips nice and still, and parallel to the ground.

World’s greatest stretch: This move is great because it opens up both your hips and your back. Often times, back pain can be the result of tightness in other areas of your body such as your upper back or your hips, so you want to stretch them. Come into a plank, bring your hands underneath your shoulders, you’re going to bring your right foot up to meet your right hand, and then you’re going to twist open. You’re going to make sure that left leg stays straight by squeezing your butt. Then you’re going to switch sides. Left foot to left hand, open up, and repeat.

Spinal twist: This move is a twist designed to open up your T-spine, which is your middle spine. So to prevent back pain, you want to create stability in your lower spine and mobility in your middle spine.

Come down to the ground and bring your knees into your chest. Stack your shoulders and your hands on top of each other, and then you’re going to open up, reaching that top hand towards the back wall and then back. Make sure you do it on both sides.

Hollow hold leg twist: For this move, you will just need a towel—fold it in half and then roll it up. Place it underneath your lower back and then lie down against it.

Engage your core. You can bring your neck off the ground. Then do a hollow hold with alternating legs. The towel is there for you to press into, give you some feedback, and make sure you’re activating your lower core. 

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BREAST CANCER

What is breast cancer?

Breast cancer is the most common cancer among women, after skin cancer. One in eight women in the United States (roughly 12%) will develop breast cancer in her lifetime. It is also the second leading cause of cancer death in women after lung cancer. Encouragingly, the death rate from breast cancer has declined a bit in recent years, perhaps due to greater awareness and screening for this type of cancer, as well as better treatments.

Breast cancer is a disease that occurs when cells in breast tissue change (or mutate) and keep reproducing. These abnormal cells usually cluster together to form a tumor. A tumor is cancerous (or malignant) when these abnormal cells invade other parts of the breast or when they spread (or metastasize) to other areas of the body through the bloodstream or lymphatic system, a network of vessels and nodes in the body that plays a role in fighting infection.

Breast cancer usually starts in the milk-producing glands of the breast (called lobules) or the tube-shaped ducts that carry milk from the lobules to the nipple. Less often, cancer begins in the fatty and fibrous connective tissue of the breast.

New cases of breast cancer are about 100 times more common in women than in men, but yes, men can get breast cancer too. Male breast cancer is rare, but anyone with breast tissue can develop breast cancer.

What causes breast cancer?

Breast cancer is caused by a genetic mutation in the DNA of breast cancer cells. How or why this damage occurs isn’t entirely understood. Some mutations may develop randomly over time, while others are inherited or may be the result of environmental exposures or lifestyle factors.

Most breast cancers are diagnosed in women over age 50, but it’s not clear why some women get breast cancer (including women with no risk factors) and others do not (including those who do have risk factors).

Some breast cancer risks may be preventable. Of course, you cannot control every variable that may influence your risk. Here are the key breast cancer risk factors to know.

• Age and gender. If you are a woman and you’re getting older, you may be at risk of developing breast cancer. The risk begins to climb after age 40 and is highest for women in their 70s.
• Family history. Having a close blood relative with breast cancer increases your risk of developing the disease. A woman’s breast cancer risk is almost double if she has a mom, sister, or daughter with breast cancer and about triple if she has two or more first-degree relatives with breast cancer.
• A breast cancer gene mutation. Up to 10% of all breast cancers are thought to be inherited, and many of these cases are due to defects in one or more genes, especially the BRCA1 or BRCA2 genes. (Scientists are studying several other gene mutations as well.) In the U.S., BRCA1 and BRCA2 mutations are more common in Jewish women of Eastern European descent. Having these defective genes doesn’t mean you will get breast cancer, but the risk is greater: A woman’s lifetime risk of breast cancer with a BRCA1 gene mutation, for example, may be more like 55% to 65% compared to the average 12%.
• Breast changes and conditions. Women with dense breasts or with a personal history of breast lumps, a previous breast cancer, or certain non-cancerous breast conditions are at greater risk of developing breast cancer than women who do not have these conditions.
• Race/ethnicity. White women are slightly more likely to develop breast cancer than Asian, Hispanic, and African American women. But African American women are more likely to develop more aggressive breast cancer at a younger age and both African American and Hispanic women are more likely to die from breast cancer than white women.
• Hormones. Women with early menstrual periods (starting before age 12) and late menopause (after age 55) are at greater risk of getting breast cancer. Scientists think their longer exposure to the female hormone estrogen may be a factor, because estrogen stimulates growth of the cells of the breast. Likewise, use of hormone therapy after menopause appears to boost the risk of breast cancer. Oral birth control pills have been linked to a small increase in breast cancer risk compared with women who never used hormonal contraception. But that risk is temporary: More than 10 years after stopping the pill, a woman’s breast cancer risk returns to average.
• Weight. Women who are overweight or obese after menopause are more likely to get breast cancer. The exact reason why isn’t clear, but it may be due to higher levels of estrogen produced by fat cells after menopause. Being overweight also boosts blood levels of insulin, which may affect breast cancer risk.
• Alcohol consumption. Studies suggest women who drink two or more alcoholic beverages a day are 1 1/2 times more likely than non-drinkers to develop breast cancer. The risk rises with greater alcohol intake, and alcohol is known to increase the risk of other cancers too. For that reason, the American Cancer Society (ACS) recommends that women stick to one drink a day–or less.
• Radiation exposure. A woman’s risk of developing breast cancer may be higher than normal if she had chest radiation for another disease as a child or young adult.
• Pregnancy history. Having no children or having a first child after age 30 may increase your risk of breast cancer.
• DES exposure. Women who were given the now-banned drug diethylstilbestrol to prevent miscarriage decades ago face a slightly increased risk of breast cancer, as do their daughters.

Scientists are studying a slew of other factors to determine what role, if any, they may play in the development of breast cancer. There’s not enough evidence to say for sure whether smoking, dietary fat, or environmental exposure to certain chemicals, for example, ramp up the risk for breast cancer because study results to date are mixed.

Breast cancer symptoms

Breast cancer symptoms vary from one person to the next. Knowing what your breasts normally look and feel like may help you recognize possible signs and symptoms.

What does breast cancer feel like? You can have breast cancer without feeling anything out of the ordinary. But, if you find an area of thickening breast tissue, a lump in your breast (usually painless, but not always) or an enlarged underarm lymph node, see your physician.

What does breast cancer look like? You may notice a change in the shape or size of your breast. You could have an area of skin that dimples or a nipple that leaks fluid.

Often, there are no early warning signs of breast cancer. Even if you develop a lump, it may be too small to feel. That’s why breast cancer screening, typically using mammography, is so important. Early signs and symptoms of breast cancer that some women and men might experience include:

• New lump in the breast or armpit, with or without pain. Lumps are often hard but can be soft as well. (Not all lumps are breast cancer. Some lumps may be noncancerous changes or benign, fluid-filled cysts, but they should be checked by your physician.)
• Change in breast size or shape. Look for swelling, thickening, or shrinkage, especially in one breast.
• Dimpling, pitting, or redness. Breast skin may take on the appearance of an orange peel.
• Peeling, flaking, or scaling breast skin.
• Red, thick, or scaly nipple.
• Breast, nipple, or armpit pain.
• Inverted nipple. Look for a nipple that turns inward or flattens.
• Nipple discharge. It may be clear or bloody.
• Redness or unusual warmth. This can be a sign of inflammatory breast cancer, a rare and aggressive form of the disease.
• Swollen lymph nodes under the arm or around the collarbone, which could be a sign that breast cancer has spread.

Breast cancer screening and diagnosis

With breast cancer, early detection is key. The earlier the disease is diagnosed the less it has progressed, and the better the outcome with treatment.

Screening for breast cancer

A screening mammogram (a type of breast X-ray) can identify the presence of cancer, often before symptoms arise. Women at high risk for breast cancer may also be screened with other imaging tests, like a breast MRI.

Medical organizations and breast cancer advocacy groups urge women to undergo routine screening to find and treat breast cancer early. But experts do not agree on exactly when to begin screening or how frequently women should be tested.

The National Comprehensive Cancer Network (an alliance of cancer centers) recommends annual screening beginning at age 40.

The ACS says women ages 40 to 44 should have the option to begin screening every year. It recommends annual screening for women ages 45 to 54. At 55, a woman can decide to continue annual screening or go for her mammogram every other year for as long as she is healthy and has 10 more years of life to live.

The U.S. Preventive Services Task Force advises women 40 to 49 to talk to their health care provider about when to start screening and how often to be screened. For women 50 to 74, it recommends a mammogram every two years.

Women at high risk of developing breast cancer should be screened earlier and more often. The ACS recommends annual mammograms and breast MRIs starting at age 30 for women with a higher-than-average risk of developing breast cancer, including those with a known breast cancer gene mutation or a first-degree relative with an inherited breast cancer gene mutation.

Since men have less breast tissue and less breast cancer, they are not routinely screened for the disease. If there is a strong family history of breast cancer or a known breast cancer gene mutation in the family, a man might consider having genetic testing to see if he has a mutation that increases his risk for male breast cancer.

Men who are at high risk for breast cancer should talk to their health care provider about having their breasts examined during routine checkups and doing breast self-exams.

Male or female, it is helpful to know what your breasts normally look and feel like so that you can report any changes to your doctor. The American College of Obstetricians and Gynecologists recommends “breast self-awareness,” meaning knowing what’s normal for your own breasts and paying attention to any changes you may feel.

Regular breast self-exams are no longer recommended as a routine screening method for women because there isn’t sufficient evidence that they offer any early detection or survival benefits.

But should women still have their breasts examined by a doctor every year? Some medical groups see no clear benefit of a clinical breast exam, while others continue to recommend one every year as part of a routine checkup.

Diagnosing breast cancer

An abnormal finding on a screening mammogram or discovering a lump or other breast changes doesn’t necessarily mean you have breast cancer.

First, your doctor will need to perform follow-up testing using one or more types of scans. A diagnostic mammogram, which involves more X-rays than a screening mammogram, can offer a more detailed view of the area of concern. Two other tests, a breast MRI or a breast ultrasound, may be ordered to gather additional diagnostic information.

There is only one way to confirm a cancer diagnosis. You will need a biopsy to extract cells or tissue from the area of the breast that is causing concern. A fine needle may be used to remove cells or tissue, or you may undergo a surgical procedure to remove a piece of breast tissue.

A pathologist will use these specimens to look for cancer under a microscope and may perform additional testing on the tissue sample. The pathology findings can confirm whether or not you have breast cancer and what your chances of beating it–your prognosis–may be. This information can help your medical team (your doctor, your surgeon, your radiologist, and other providers) determine the best course of treatment.

Types of breast cancer

You and your doctor need to know the type of breast cancer you have to get the best outcome. Your treatment will depend on where your cancer started, whether it has invaded other breast tissue or spread to other parts of your body, and whether hormones like estrogen or progesterone fuel its growth, among other factors.

Most breast cancers are carcinomas, or cancers that start in cells lining the organs or tissues. “In situ” breast cancers haven’t spread to surrounding tissue, which makes them more treatable, while “invasive” breast cancers have invaded surrounding tissue. “Metastatic” breast cancer means it has spread to other parts of your body, such as the lungs, bones, liver, or brain. And “recurrent” breast cancer means breast cancer has returned.

Ductal carcinoma in situ (DCIS)

This highly treatable pre-cancer (sometimes called “stage 0” breast cancer) starts in a milk duct. It’s the most common type of non-invasive breast cancer, meaning the cells are abnormal but haven’t spread to the surrounding tissue. Over time, DCIS may progress to invasive breast cancer.

Invasive ductal carcinoma (IDC)

This is the most common breast cancer, accounting for 80% of all invasive breast cancer diagnoses. Also called “infiltrating ductal carcinoma,” IDC starts in a milk duct, breaks through the duct wall, and invades the surrounding breast tissue. It can spread to other parts of the body as well. There are also several subtypes of IDC, which are categorized based on features of the tumors that form.

Invasive lobular carcinoma (ILC)

This type of breast cancer begins in the milk-producing glands, called lobules. Also known as “infiltrating lobular carcinoma,” ILC can spread beyond the lobules into surrounding breast tissue and metastasize to other parts of the body. It accounts for about 10% of invasive breast cancers.

Lobular carcinoma in situ (LCIS)

LCIS, also called lobular neoplasia, starts in the milk-producing lobules. Technically, it’s not breast cancer (even though it has carcinoma in its name), but rather a collection of abnormal cells. People with LCIS are more likely to develop breast cancer in the future.

Inflammatory breast cancer (IBC)

This rare, aggressive type of breast cancer causes redness and swelling of the breast. The affected breast can feel warm, heavy, and tender. The skin may become hard or ridged like an orange rind. See a doctor right away if you have these symptoms. Inflammatory breast cancer tends to strike five years earlier, on average, than other types of breast cancer, and it might not show up on a mammogram. African American women are at greater risk for IBC than white women.

Paget disease of the breast (or the nipple)

This rare cancer affects the skin of the nipple and the darker circle of skin, called the areola, surrounding it. People with Paget disease may notice the nipple and areola becoming scaly, red, or itchy. They may also notice yellow or bloody discharge coming from the nipple. Most people who have this condition also have one or more tumors (either DCIS or invasive cancer) in the same breast.

Metaplastic breast cancer

This rare, invasive breast cancer begins in a milk duct and forms large tumors. It may contain a mix of cells that look different than typical breast cancers and can be more difficult to diagnose.

Angiosarcoma of the breast

This quickly growing cancer is rare. It is usually a complication of a prior radiation treatment of the breast.

Breast cancer subtypes

Breast cancers can also be classified by their genetic makeup. Knowing your cancer’s hormone receptor and HER2 status can help guide treatment.

Hormone receptor positive breast cancer

Some breast cancers are fueled by the hormones estrogen and/or progesterone. Some are not. Knowing whether your cancer is sensitive to these hormones is a crucial piece of the treatment equation. Hormone receptor-positive breast cancer cells have proteins called hormone receptors that attach to estrogen and/or progesterone circulating in your body. Hormonal therapies may be used to fight hormone receptor-positive breast cancer. All invasive breast cancers and DCIS should be tested for hormone status, according to the ACS.

HER2-positive breast cancer

Some breast cancers have higher levels of a protein that promotes cancer growth called human epidermal growth factor receptor 2 (HER2). Using certain medicines that target HER2 can help kill the cancer.

Triple negative breast cancer

Triple negative breast cancer is estrogen receptor-negative, progesterone receptor-negative, and HER2-negative. Using hormone therapies or HER2 drugs will not slow these aggressive cancers. Triple negative breast cancer is more common among Hispanic and African American women, as well as younger women.

Triple positive breast cancer

Cancers that are positive for estrogen receptors, progesterone receptors, and HER2 can be treated with hormone therapies and drugs that target HER2.

Breast cancer stages

All breast cancers are assigned a stage based on biopsy results plus other findings from blood tests and imaging scans. Staging can help you and your medical team make decisions about appropriate treatment and understand your chances of survival.

Breast cancer stages reflect the size of the tumor, whether it is invasive, whether it has reached the lymph nodes (glands that are part of the body’s immune system), and whether it has spread to other parts of the body.

Stage 4 breast cancer

At Stage 4, breast cancer has traveled to distant sites in the body, often the bones, liver, brain, or lungs. This is called metastatic breast cancer. Although this stage is considered incurable, new treatments allow patients to live longer with their disease.

Stage 3 breast cancer

Stage 3 breast cancer is an advanced cancer. It’s in the lymph nodes but has not spread to other organs. This stage is divided into three categories, 3A, 3B and 3C, based on the size of the tumor and how many and which lymph nodes are involved.

Stage 2 breast cancer

At Stage 2, breast cancer is growing but is only in the breast or nearby lymph nodes. This stage has two categories, 2A and 2B, based on how large the tumor is and whether or not it has spread to nearby lymph nodes.

Stage 1 breast cancer

Stage 1 is an invasive cancer, meaning it is invading healthy breast tissue, but it has not spread outside the breast. This stage also has two categories, 1A and 1B, based on whether there is any evidence of small clusters of breast cancer cells in nearby lymph nodes.

Stage 0 breast cancer

Also called pre-cancer, this is the earliest stage of breast cancer. It involves abnormal cells that have not spread into breast tissue from the ducts or lobules where they began. Stage 0 breast cancer also has not spread to lymph nodes or other parts of the body. Stage 0 breast cancer is non-invasive, like ductal carcinoma in situ (DCIS).

Breast cancer treatment

Breast cancer treatment regimens differ widely based on the type of cancer, its stage, its sensitivity to hormones, the patient’s age and health, and other factors. Treatments for men and women are similar.

Surgery and radiation therapy are mainstays of breast cancer treatment. These are known as “local therapies” because they target the tumor without affecting the rest of the body.

With a breast-conserving surgery called a lumpectomy, only the portion of the breast containing cancer is removed. A mastectomy involves removing the entire breast and possibly some of the surrounding tissue. Lymph nodes may be removed as part of breast cancer surgery or a separate operation.

Radiation therapy uses high-energy waves to kill cancer cells and shrink tumors. It may be recommended for patients who have breast cancer surgery or whose cancer has spread to other parts of the body.

Cancer-killing chemotherapy medicines are delivered intravenously (into a vein) or taken by mouth. Chemo may be given before or after surgery. It’s also used in treating advanced cancer cases. Because these medicines travel through the bloodstream, they can have significant side effects, including mouth sores, hair loss, nausea, vomiting, and diarrhea.

Some breast cancers are sensitive to hormones produced in the body. In these hormone receptor-positive breast cancers, estrogen and/or progesterone fuels cancer growth. Hormone therapy can lower the body’s estrogen levels or stop hormones from binding to cancer cells. This category of breast cancer treatment includes the oral medicine tamoxifen, which is often given after surgery to women with hormone receptor-positive breast cancer.

Newer medicines, called targeted therapies, specifically attack cancer cells while sparing normal cells, meaning patients experience fewer side effects. Trastuzumab (Herceptin), for example, is a drug that starves HER2-positive breast cancers by blocking the HER2 protein.

Treatment outcomes may depend on the stage of cancer, a patient’s response to treatment, and other factors.

Generally speaking, stage 0 and 1 breast cancers are highly treatable. The five-year survival rate for women diagnosed with breast cancer in these early stages is close to 100%. At stages 2 and 3, some 93% and 72% of women, respectively, can expect to live at least five years after being diagnosed with breast cancer. Stage 4 or metastatic breast cancer is difficult to treat. The five-year survival rate is about 22%.

For men with breast cancer, the five-year survival rates are similar: 100% for stages 0 and 1, 91% for stage 2, 72% for stage 3, and 20% for stage 4.

Remember, breast cancer statistics are just averages. They don’t reflect an individual patient’s experience.

Breast cancer prevention

While no one can tell you how to prevent breast cancer with any sort of guarantee, there’s evidence to suggest that certain healthy lifestyle changes can lower your breast cancer risk.

• Limit your alcohol intake. The more you drink, the higher your risk of breast cancer.
• Watch your weight. Being overweight or obese boosts your breast cancer risk.
• Exercise. Women who work out regularly have a lower risk of breast cancer than less active women.
• Consider breastfeeding your baby. Women who breastfeed have a lower risk of breast cancer than moms who do not breastfeed their children.
• Reduce your hormone intake. Hormone therapy users are at higher risk for breast cancer. If you’re taking hormones to relieve menopausal symptoms, talk to your doctor about taking the lowest dose that works for you for the shortest time.

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