Breast Cancer

Aside from non-melanoma skin cancers, breast cancer is the most common form of cancer in women. Statistically, around one in eight women will get diagnosed with breast cancer at some point during their lifetime.

It is predicted that 12% of women in the United States will develop breast cancer over the course of her lifetime. Among other risk factors, genetic predisposition is responsible for the development of this disease in up to 10% of all cases.

Since breast cancer is the number one female cancer concern worldwide, it has attracted a lot of attention from scientists and medical experts. The main focus of research in this area is on prevention and treatment. Raising awareness about this disease remains a top priority, especially in less developed parts of the world.

While the death rate of breast cancer continues to remain high, the survival rate has greatly improved over the years thanks to new screening guidelines and treatment. It is estimated that the survival rate has tripled over the past 60 years and are improving faster than any other cancer.

Men are not exempt from this disease, with 2,125 new breast cancer cases diagnosed in men and 405 male deaths occurring in the United States during 2012. Although commonly viewed as a female disease, a man’s lifetime chance of developing breast cancer is around 1 in 1000. Therefore it is important for men to be aware of breast cancer screening methods and to be checked by a doctor if they notice any unusual breast lumps.

Early Signs

The treatment outlook and survival rates are good if breast cancer is discovered at an early stage. That is why self-checkups and regular screenings are extremely important.

It is recommended that women at age 40-54 have breast screens with mammogram every year, and those over the age of 55 years can drop down to every 2 years. The treatment plan depends entirely on the type and stage of cancer, but often involves a combination of methods or one of the following: surgery, chemotherapy, and/or radiation therapy.

A lump in any of the breasts is the number one sign that you should go and get checked out. Other common signs include:

  • Change in breast shape
  • Liquid discharge from the nipple
  • Lump or swelling in any of the armpits
  • Dimpling of the skin
  • Newly-inverted nipple (sunken nipple)
  • A patch of scaly or red skin

There are several types of breast cancer and not all of them tend to spread to other parts of the body. The best diagnostic methods are mammography screening (X-ray) and biopsy. Ultrasound and other diagnostic methods such as MRI can also be used.

A biopsy is used to determine the type of cancer. During this procedure, a small sample of breast tissue is taken to be examined under a microscope.

The treatment plan depends entirely on the type and stage of cancer. It usually involves a combination of methods or one of the following:

  • Surgery
  • Chemotherapy
  • Radiation therapy

Causes of Breast Cancer

Breast cancer develops when cells of one type of breast tissue begin to grow and multiply abnormally. Once this happens, these cells form a tumor, which is seen as a lump inside the breast. The growth rate of cancer cells is higher than the one of normal cells, which is why they tend to accumulate quickly.

When this process is not recognized on time and no action is taken to counter it, cancer cells can spread through the lymph nodes to other parts of the body and cause tumor growths there. This is known as metastases.

There are different types of breast cancer based on the location of the breast that is involved. Some forms of breast cancer do not tend to spread to other parts of the body as much as others.

The most common type of breast cancer is invasive ductal carcinoma and forms in the tissue of milk-producing ducts. Another type called invasive lobular carcinoma develops inside the lobules, a type of glandular tissue.

Researchers do not know exactly why some women develop breast cancer and others do not. They believe that the causes are a combination of environmental and genetic factors.

Some lifestyle factors increase the risk of breast cancer. However, there are exceptions too. Some women with all risk factors may never develop breast cancer and others will, even without any risk factors.

Genetic factors are the cause of five to ten percent of all female breast cancers. These are referred to as “inherited breast cancers”. Scientists have detected some gene mutations responsible for breast cancer which are known to run in families.

The best-known of these mutations are BRCA1, or cancer gene 1, and BRCA2 also known as cancer gene 2. These two genes are strongly associated with an increased risk of ovarian and breast cancer.

Breast Cancer Types

There are seven recognized types of female breast cancer, these are:

  • Angiosarcoma
  • Ductal Carcinoma In Situ (DCIS)
  • Inflammatory Breast Cancer
  • Invasive Lobular Carcinoma
  • Lobular Carcinoma In Situ (LCIS)
  • Paget’s Disease of the Breast
  • Recurrent Breast Cancer

Angiosarcoma

This is a very rare type of cancer. It usually develops in lymph nodes and blood vessels, anywhere in the body. Therefore, it can also form inside the breast. However, this is extremely rare and usually a consequence of previous radiation treatment.

Angiosarcoma can be treated surgically, with medications (chemotherapy), or with radiation.

Ductal Carcinoma in Situ (DCIS)

DCIS is a common form of breast cancer. It is characterized by a formation of a tumor (lump) inside the milk ducts. In most cases, DCIS is noninvasive. This means it does not spread outside of the ducts.

DCIS is an early form of breast cancer. It is detected by mammography screening and can often be treated surgically with good outcomes.

Inflammatory Breast Cancer

This is another rare type of breast cancer. However, when it does develop, it is characterized by the rapid onset of symptoms which include: swelling, redness, and tenderness of the affected breast.

This is not necessarily a bad thing. The quick onset of symptoms means that cancer can be discovered early on.

With inflammatory breast cancer, rapidly growing cancer cells block lymphatic vessels and cause the swelling of the breast. The good thing is that this cancer type usually only spreads locally and affects nearby tissues.

A prompt reaction is very important for the outcome of the treatment. The symptoms of this disease are similar to symptoms of less dangerous conditions, such as breast infection. Because of this, it is necessary to visit a doctor and get a full checkup.

Invasive Lobular Carcinoma

Invasive lobular carcinoma develops inside the lobules, the milk-producing glands located in the breasts. It is not a very common type of breast cancer. However, as its name suggests, it is invasive and has a high risk of spreading to other parts of the body.

At an early stage, invasive lobular carcinoma usually does not produce any symptoms. Furthermore, this type of cancer rarely forms a lump, a physical change most commonly associated with breast cancer.

Instead, invasive lobular carcinoma usually causes the following symptoms:

  • Sunken nipple
  • Thickening and dimpling of the skin
  • A feeling of fullness or swelling of the breast

Regular mammography screenings are very important and more efficient than self-checkups for early detection of invasive lobular carcinoma. Women diagnosed with Lobular Carcinoma in Situ (LCIS), inherited genetic cancer syndromes, and those on postmenopausal hormone therapy are at a higher risk of developing invasive lobular carcinoma.

Lobular Carcinoma in Situ (LCIS)

Lobular carcinoma in situ (LCIS) is not a type of cancer. It is a sign that there is an increased risk of breast cancer development.

LCIS is a condition characterized by the growth of abnormal cells inside the milk glands (lobules).

Mammography is not a reliable way to diagnose LCIS because this condition usually does not show up on mammograms. The most certain way to discover LCIS is with a breast biopsy.

The risk of invasive breast cancer is high in women with LCIS. That is why this condition requires frequent screening and sometimes treatment to reduce the risk.  

LCIS does not cause any symptoms. It is usually discovered by accident when a specialist performs breast biopsy for another reason (e.g. suspicious breast lump).

Paget’s disease of the Breast

This a rare type of breast cancer that usually affects women above the age of 50. Most women affected by Paget’s disease also have ductal breast cancer.

Paget’s disease develops on the nipple and spreads to the area around the nipple (areola). Because of this, it is easily mistaken for skin irritation or some other less dangerous condition.

The main symptoms of Paget’s disease are:

  • Flaky skin on and around the nipple
  • Itching
  • Redness
  • Bloody nipple discharge

Recurrent Breast Cancer

A type of breast cancer that occurs again after treatment. The common cause of recurrent breast cancer are cancer cells that have survived the initial treatment. Even if there are only a few of these cells they can multiply and cause recurrent breast cancer.

This process can last several months or several years and cancer can recur locally (in the same place) or in another area of the body (distance recurrence).

Symptoms of recurrent breast cancer can be similar to the symptoms of initial cancer if the recurrence is local. However, different symptoms are possible if cancer recurs in another part of the body.

Some common symptoms of distant recurrence are:

  • Persistent pain in a certain area of the body
  • Persistent cough
  • Unwanted weight loss
  • Loss of appetite
  • Severe headaches
  • Breathing difficulties
  • Swelling of the lymph nodes

Risk Factors

The risk of developing breast cancer is influenced by genetic, personal, and behavioral factors. Some of these factors are modifiable, meaning within the individual’s power to change. While other factors are nonmodifiable, meaning not able to be changed.

Modifiable factors include lifestyle, weight, birth control choices, diet, smoking, substance abuse, etc. Nonmodifiable factors include genetics age, sex, the age of first period, the age of last period (menopause), and environmental pollution.

Genetic Factors

Genetic factors including mutations within the body’s entire genome or just the tumor itself can result in a higher risk of developing breast cancer. The most well known genetic abnormalities that increase the risk for breast cancer are the Breast Cancer gene 1 and 2 (BRAC1 or BRACA2).

These genes are inherited from family and result in a 60% increased risk of developing breast cancer. This is considerably higher than the 12% overall risk for a woman in the general population. There are a number of other genes that have been associated with a higher risk of developing breast cancer, although the mechanisms behind their function are less studied. These include mutations in the ATM, p53, CHEK2, PTEN, and CDH1 genes.

Genetic mutations and abnormalities are inherited, and therefore nothing can be done to prevent the increased risk of developing breast cancer. However, if a patient is identified to be a carrier of any of these particular mutations, then the patient’s doctor can implement additional screening and monitoring methods for early identification of breast cancer. This assists in identifying the disease in a timely manner and therefore potentially preventing its invasion and spread into other adjacent tissues or bodily organs.

Age

Age is one factor that is strongly linked to the development of breast cancer. As women age their risk of developing breast cancer increases. Age is not only pertaining to the number of years lived, but also the age of first childbirth and period. Having your first child after the age over 30, having your first period before the age of 12, or starting menopause later than 55years of age will all increase the risk of breast cancer. Therefore age at a number of major life events greatly impacts one’s breast cancer risk.

Ethnicity

Ethnicity is another indicator of breast cancer risk. Caucasian women are slightly more likely to develop the breast cancer as opposed to other ethnicities. African American women, on the other hand, are more likely to develop breast cancer before the age of 45. They are also more likely to die from the disease at any age. Asian, Hispanic, and Native American women generally have a lower risk of developing or dying from breast cancer.

Breasts Density

Breast tissue with added density can increase the risk of developing breast cancer by 1.2 to 2 times compared women with standard breast density. Breast density is measured by comparing the amount of fatty, fibrous, and glandular tissues present in the breast. Women with more of these breast characteristics tend to have a higher risk of developing breast cancer.

Birth Control

The use of birth control increases the risk of breast cancer. While it decreases the risk of uterine cancer.

Behavioral Factors

Behavioral factors that include regular alcohol consumption and smoking increase the risk of developing breast cancer. Drinking between two and five drinks a day can increase the risk of developing breast cancer by 1.5 times that of a non-drinker. Night work, which includes late night or overnight work, also increases the risk of breast cancer.

Some behavior factors can also decrease risk of breast cancer. These activities include breastfeeding, eating lots of fruits and vegetables, exercising both before and after menopause, and maintaining a healthy weight. Consumption of carotenoids, which are the pigments that make foods like carrots, melons, and sweet potatoes appear orange, can also decrease the risk breast cancer.

For example, most environmental (non-hereditary) factors are preventable while genetically inherited factors are non-preventable.

Preventable breast cancer risk factors include:

  • Obesity
  • Lack of exercise
  • Alcohol intake
  • Fat intake
  • Exposure to polycyclic aromatic carbons
  • Lack of calcium in the diet
  • Lack of vitamin D
  • Iodine deficiency
  • Older age at first childbirth
  • Hormonal contraception
  • Hormonal therapy
  • Use of endocrine disrupters
  • Tobacco use

Prevention

Some preventive methods can potentially reduce the risk of breast cancer. These include:

  • Maintaining a healthy weight
  • Breastfeeding – women who breastfeed are less likely to develop breast cancer compared to those who do not. Breastfeeding keeps the estrogen levels stable and reduces the frequency of ovulation.
  • Genetic testing
  • Surgery – preventive mastectomy (breast removal) significantly lowers the risk of breast cancer development in women with a genetic predisposition.
  • Medications – there are some medications such as anastrozole, raloxifene, and tamoxifen that can reduce breast cancer risk for both premenopausal and postmenopausal women. However, these medications are known to cause side effects such as sickness, sweating, hot flushes, leg cramps, tiredness, etc.  

Available Treatments

The treatment for breast cancer is usually created by a group of medical specialists. It commonly involves one or a combination of several treatments methods such as:

  • Surgery
  • Chemotherapy
  • Radiation
  • Hormone therapy
  • Targeted therapy

The course of the treatment depends on the type of breast cancer, stage and grade of cancer, and general health of the patient.

Surgery

Surgery is usually the best and first-choice treatment for breast cancer. A surgical procedure can, but it does not have to be, followed by chemotherapy or radiotherapy.

There are two types of breast cancer surgery:

Breast-conserving surgery

Breast-conserving surgery involves the removal of the tumor only. It is usually followed by radiotherapy and it is an effective way of treating early-stage breast cancer.

Mastectomy

Mastectomy is the removal of the whole breast. The lymph nodes from the area under the arm can also be removed during mastectomy if cancer has spread there.

Mastectomy is usually followed by breast reconstruction surgery.

Chemotherapy

Chemotherapy can be used before and after surgery. It uses anti-cancer medications to kill cancer cells. Usually, more than one medication is used at the same time. The exact combination depends on the type and stage of breast cancer.

Chemotherapy is administered intravenously. Unfortunately, it can also affect healthy cells. Major side effects of chemotherapy are:

  • Loss of appetite
  • Fatigue
  • Hair loss
  • Infections
  • Feeling sick
  • Sore mouth

Other medications can be used to control the side effects of chemotherapy.

Radiation

Radiation therapy delivers controlled doses of radiation at the cancer site to kill cancer cells. This therapy usually follows after a surgical procedure.

There are several types of radiation therapy:

  • Breast radiotherapy – after breast-conserving surgery
  • Chest-wall radiotherapy – after mastectomy
  • Lymph nodes radiotherapy
  • Breast boost – high dose radiotherapy

Radiation therapy can have some side effects. The most common ones are:

  • Fatigue
  • Irritation and darkening of breast skin
  • Fluid build-up under the arm (lymphedema)

Living with Breast Cancer

Breast cancer is a potentially life-threatening condition. Therefore, for most women, it is not simple to cope with a breast cancer diagnosis.

The support of friends and family is very important. Getting to know more about the disease can also be helpful.

Since the treatment usually involves surgery, the recovery period can be uncomfortable and difficult too. Very often, surgery is followed by other treatments such as chemotherapy and radiotherapy. These can cause tiredness, fatigue, loss of appetite, etc.

Because of all this, it is normal to feel a bit down or even depressed. Talking to other people who are in the same situation can help. You should also take time for yourself and avoid pushing yourself to the limit.

The Bottom Line

Breast cancer is a serious and potentially fatal disease that predominantly affects women after the age of forty. In many cases breast cancer can be treated successfully if it is discovered early on. This is why it is important to preform self checks and see your doctor for your yearly visits or any concerns around breast changes.

While there are many risk factors associated with this disease and there are also preventative measures that can be taken to lower these risks. Self-checkups and regular mammography screening remain the best ways for early detection of breast cancer.

Finding a support group for those going through cancer themselves or have a family member with cancer is shown to increase feelings of emotional support, safety, and community.

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