Introduction:
Breast cancer is a type of cancer that originates in the cells of the breast. It typically begins in the milk-producing lobules or the milk ducts that carry the milk to the nipple. In some cases, breast cancer can also develop in the fatty tissue or fibrous connective tissue within the breast. As the cancer cells grow uncontrollably, they can invade surrounding healthy tissue and may spread to the lymph nodes located under the arms. Once cancer reaches the lymph nodes, it can use this network to spread to other areas of the body. While breast cancer is more common in females, men also have breast tissue and, although rare, can develop breast cancer as well.
Signs and Symptoms of Breast Cancer
In the early stages of breast cancer, there may be no noticeable symptoms. Often, the tumor is too small to be felt, but abnormalities may be detected through a mammogram. When a tumor is large enough to be felt, the most common sign is a new lump in the breast that wasn’t there previously.
However, it’s important to note that not all lumps are cancerous. Other possible symptoms include changes in the size, shape, or appearance of the breast, skin dimpling, or unusual nipple discharge. If any of these symptoms are noticed, it’s important to consult a healthcare provider for further evaluation.
- A breast lump or tissue thickening that feels different from surrounding tissue and is new
- breast pain
- discolored and pitted skin on your breast
- swelling in all or part of your breast
- a nipple discharge other than breast milk
- bloody discharge from your nipple
- peeling, scaling, or flaking of skin on your nipple or breast
- a sudden, unexplained change in the shape or size of your breast
- inverted nipple
- changes to the appearance of the skin on your breasts
- a lump or swelling under your arm
Types of Breast Cancer
Breast cancer can be categorized into two main types: invasive and noninvasive. Noninvasive breast cancer, also referred to as breast cancer in situ, is confined to the area where it began, without spreading to other parts of the breast. In contrast, invasive breast cancer has spread beyond its original location in the breast ducts or glands to surrounding tissues.
Types of Noninvasive Breast Cancer:
- Ductal Carcinoma in Situ (DCIS): DCIS is a noninvasive form of cancer where abnormal cells are confined to the ducts of the breast and have not spread to surrounding tissue.
- Lobular Carcinoma in Situ (LCIS): LCIS occurs in the milk-producing glands of the breast. Like DCIS, the cancer cells do not spread to surrounding tissue.
Types of Invasive Breast Cancer:
- Invasive Ductal Carcinoma (IDC): IDC is the most common type of breast cancer. It begins in the milk ducts of the breast and then spreads to surrounding tissue. Once it invades beyond the ducts, it can spread to other parts of the body.
- Invasive Lobular Carcinoma (ILC): ILC starts in the lobules, or milk-producing glands, of the breast, and then spreads to nearby tissue.
- Inflammatory Breast Cancer (IBC): IBC is a rare and aggressive form of breast cancer, making up only about 1% to 5% of all breast cancer cases. It blocks the lymph nodes, preventing proper drainage from the lymph vessels in the breast.
- Paget's Disease of the Nipple: This type of cancer starts in the ducts of the nipple, but as it progresses, it affects the skin and areola surrounding the nipple.
- Triple-Negative Breast Cancer: A rare form of breast cancer that makes up about 10% to 15% of cases. It lacks three key receptors (estrogen, progesterone, and HER2) which are targeted by certain treatments.
- Angiosarcoma: This cancer grows in the blood vessels or lymphatic vessels of the breast and is extremely rare.
Risk Factors for Breast Cancer
Several risk factors can increase the likelihood of developing breast cancer, though having one or more of these factors doesn’t guarantee that you will get the disease.
Risk factors you can change:
- Alcohol use: Drinking alcohol has been linked to an increased risk of breast cancer. The more alcohol you consume, the higher the risk.
- Hormone therapy: Individuals who have taken or are currently taking postmenopausal hormone therapy, specifically estrogen and progesterone, to alleviate menopause symptoms, have a higher risk of developing breast cancer.
- Not getting enough exercise: A sedentary lifestyle, lacking regular physical activity, can increase the risk of breast cancer.
Risk factors you cannot change:
- Age: The risk of developing breast cancer increases with age, particularly for those over 55 years old, as most cases are diagnosed in older adults.
- Having dense breast tissue: Dense breast tissue can make it more difficult to interpret mammograms, and it has been associated with a higher risk of breast cancer.
- Genes: Genetic mutations, such as those in the BRCA1 and BRCA2 genes, can significantly increase the risk of breast cancer. Other genetic mutations may also contribute to higher risk.
- Inherited risk: A family history of breast cancer, especially in close relatives like a mother, sister, or grandmother, increases your chances of developing the disease.
- Never having been pregnant: People who have never been pregnant or carried a pregnancy to full term are at a higher risk of developing breast cancer.
Diagnosis of Breast Cancer
To determine whether your symptoms are caused by breast cancer or a benign condition, a doctor will start with a thorough physical examination and a breast exam. If necessary, they will recommend additional diagnostic tests to get a clearer understanding of the cause.
Imaging Tests :
The most common method for examining the inside of the breast is an imaging test called a mammogram. This is typically recommended for females over 40 as part of routine breast cancer screenings. If a doctor suspects a tumor or sees an abnormal spot on the mammogram, further testing may be required. One such test is a breast ultrasound, which uses sound waves to create images of the deeper tissues of the breast and can help distinguish between solid masses and benign cysts.
Breast Biopsy:
If a doctor suspects breast cancer based on imaging tests, they may recommend a breast biopsy. This procedure involves removing a sample of tissue from the suspicious area to be tested in a laboratory. If cancer is detected, the biopsy can help identify the specific type of cancer.
Breast Cancer Stages:
Breast cancer is divided into stages based on the size of the tumor and how far it has spread. The stage of the cancer is critical in determining the treatment plan. The stages range from 0 to 4:
- Stage 0: Ductal carcinoma in situ (DCIS), where cancer cells are confined to the ducts and have not spread to surrounding tissue.
- Stage 1: The tumor is small (less than 2 cm), and no lymph nodes are involved.
- Stage 2: The tumor may be larger, or cancer may have spread to nearby lymph nodes.
- Stage 3: The cancer has spread to several lymph nodes or the chest wall/skin.
- Stage 4: Metastatic breast cancer, where cancer has spread to distant parts of the body.
- Breast Cancer Treatment Treatment depends on the stage, size, and grade of the cancer.
- Surgery is the most common treatment, but many patients also undergo chemotherapy, radiation therapy, targeted therapies, or hormone therapy.
Surgery
- Lumpectomy: Removal of the tumor and some surrounding tissue, preserving most of the breast.
- Mastectomy: Removal of one or both breasts, sometimes recommended for high-risk individuals or in more advanced stages.
- Lymph Node Removal: Depending on whether cancer has spread to the lymph nodes, a sentinel node biopsy or axillary lymph node dissection may be performed.
Radiation :
- Therapy Radiation therapy uses high-powered beams of radiation to target and destroy cancer cells. It is commonly used after surgery to eliminate any remaining cancer cells.
Chemotherapy :
- Chemotherapy uses drugs to destroy cancer cells and is often given after surgery to prevent the cancer from returning. It can also be used before surgery to shrink tumors.
Hormone Therapy:
- For cancers that are hormone-sensitive, hormone therapy can block the hormones that fuel cancer growth or prevent the body from producing them.
Breast Cancer :
Prevention While some risk factors are uncontrollable, maintaining a healthy lifestyle, avoiding excessive alcohol, staying active, and following recommended screening guidelines can help reduce the risk of developing breast cancer.
- Ages 40-44: Option to start yearly mammograms
- Ages 45-54: Annual mammograms
- Ages 55+: Option for annual or biennial mammograms
Breast Cancer Outlook
The outlook for breast cancer can vary significantly depending on several factors, including the type of cancer, its stage at the time of diagnosis, and other individual characteristics. Key factors that influence your prognosis include:
- Age
- Sex
- Race
- The growth rate of the cancer
- Research has shown that people of color, particularly Black and Hispanic individuals, tend to have higher mortality rates for breast cancer compared to their white counterparts.
- This discrepancy is largely attributed to healthcare disparities, such as limited access to high-quality medical care.
- The encouraging news is that survival rates for breast cancer have been improving over time. According to the American Cancer Society, the 5-year relative survival rates for breast cancer are:
- 99% for localized breast cancer (cancer that is confined to the breast)
- 86% for regional breast cancer (cancer that has spread to nearby lymph nodes)
- 31% for distant breast cancer (cancer that has spread to other parts of the body)
- 91% for all stages combined
