Breast cancer is the most commonly diagnosed cancer among women worldwide. In addition, this type of cancer is widely researched with decades' worth of screening, treatment, and outcomes data for it; thus, the patients are able to receive more accurate diagnosis and more efficient treatment than ever before in history. The survival rates have increased dramatically during the past few decades, due to early detection and improved treatment; the increase was not caused by decrease in frequency of this disease occurrence.
This page will provide the information about breast cancer, including definition of this type of cancer, the symptoms and causes of it, the ways of diagnostics and staging, as well as the types of treatments available.
What is Breast Cancer?
Breast cancer occurs because of abnormal division and multiplication of cells of the breast tissue; as a result, the tumor grows. There are two major types of it according to the places where cancer originates:
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Ductal carcinoma: The cells of the tumor originate in the milk ducts, which transfer the milk to the nipple. It is the most widespread type of breast cancer.
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Lobular carcinoma: The cancer cells develop in the lobules, which are responsible for production of the milk.
The other type is further subdivided into invasive or non-invasive. Non-invasive is when the cancer is still restricted within the duct and has not spread in the breast tissue, whereas in invasive, the cancer spreads outside of its origin in the tissue, and then it can potentially go through the lymphatic system or the blood stream in the metastasis process.
Mostly it happens in women although it can also happen in men; this is a minority form of cancer.
Breast Cancer Symptoms
There are different symptoms for breast cancer and one of the most important factors is that early-stage breast cancer does not have any symptoms at all, and for this reason, mammogram screenings exist. If there are any symptoms, then some of the most common ones include:
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Appearance of a new lump or mass in the breast or the armpit area; it is usually without any pain. Even today, a very large portion of breast cancers around the world are discovered by the women themselves and not via screenings.
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Changes in size, shape, or contour of the breast
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Skin changes on the breast such as dimpling, puckering, or a rough skin texture similar to an orange peel
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Changes in the nipple, including nipple inversion, scaling, or redness
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Any unusual discharge from the nipples, especially if bloody or in the absence of pressure
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Chronic breast or nipple pain (although pain is a less common symptom compared to a lump)
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Breast swelling without a palpable lump
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Swollen lymph nodes in the armpit or around the collar bone area.
And now the truth needs to be told: the vast majority of lumps discovered on the breast are noncancerous, mostly cysts or fibroadenomas. But any new lump or change in the breast or nipple area should not be ignored since that is the only way to determine what it really is.
Causes of Breast Cancer
Breast cancer occurs as a result of mutation in breast cells and the development of cancerous cells that grow and replicate to form tumors. What causes these changes is still unknown. However, experts found out that there are multiple risk factors associated with the increased likelihood of developing breast cancer, which include the following:
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Age: over 55 years old.
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Sex: women have much higher chances of having breast cancer compared to men.
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Hereditary factor: if either your parents, brothers or sisters, or kids or any other close relatives suffer from the condition, you are also at risk of getting it.
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Genetic predisposition: about 15% of people have inherited the mutated genes and, therefore, have breast cancer. Mutations mostly occur in BRCA1 and BRCA2 genes.
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Smoking: using tobacco products increases one’s risk of developing many types of cancer, including breast cancer.
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Consuming beverages with alcohol.
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Being obese.
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Radiation: if before you underwent any type of radiation treatment, in particular of the head, neck, or chest area, you are at increased risk of developing breast cancer.
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Hormone replacement therapy: using HRT increases one’s chances of developing the condition.
Breast Cancer Diagnosis
Typically, a diagnosis is made using the following methods:
1. Clinical Breast Exam
The breast and nearby lymph nodes are examined by a physician looking for lumps.
2. Imaging
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Mammogram: an X-ray of the breast tissue, and the primary tool for identifying problems, often before lumps become palpable.
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Breast ultrasound: common follow-up after a mammogram that reveals an abnormality, and used to differentiate a lump from a cyst
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Breast MRI: done in special cases, such as high genetic risk women or for obtaining additional details of the findings
3. Biopsy
The only method of proving the diagnosis of breast cancer is a biopsy (the removal of a tissue sample for further investigation) where pathologists study cells to check for the presence of cancer and to obtain other significant information that can help develop a treatment strategy, including:
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Estrogen or progesterone receptors: if there are receptors, a cancer can be responsive to hormone therapy
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Human epidermal growth factor receptor 2 (HER2): if cancer overproduces HER2 protein, HER2 targeted treatment can be prescribed
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Tumor grade: a degree of cellular abnormality and how fast a cancer grows.
All this determines a molecular subtype of a cancer (e.g. hormone receptor positive, HER2 negative). It has become one of the crucial factors in determining breast cancer treatment nowadays.
Staging of Breast Cancer
TNM staging of breast cancer consists of tumor size, the presence of regional lymph nodes involvement and metastases. All of these features together determine a total stage of cancer from 0 to IV:
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Stage 0 – non-invasive (DCIS) – a cancer that stays within the ducts of a breast
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Stage I – a small and localized tumor with no or minimal lymph nodes involvement
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Stage II-III – larger tumors and/or more regional lymph nodes involved
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Stage IV – the tumor metastasizes to distant organs, including the bones, liver, lungs, or brain.
Stage has a strong link to prognosis wherever breast cancer occurs; cancers that have not yet spread, when detected during the localized stage, have an excellent survival prognosis compared to those that have spread either regionally or distantly from the primary site. In addition, this disparity is one of the largest health inequalities that exist in the field of oncology today; research based on the GLOBOCAN data of the WHO shows that in countries with a low Human Development Index ranking, there is poorer survival rates due to cancers being detected at a later stage.
Read: Breast Cancer Treatment cost in India
Treatment Options for Breast Cancer
Treatment is very personalized, taking into consideration the stage, molecular subtype, and patient preferences. Treatment usually involves a combination of more than one modality.
Surgery
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Lumpectomy (breast conserving surgery) – removal of the tumor with some margin of the tissue around it, thus preserving the majority of the breast
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Mastectomy – complete removal of the breast tissue, possibly including breast reconstruction, either simultaneously or subsequently
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Sentinel lymph node biopsy or axillary lymph node dissection – used for determining if there was metastasis of the cancer to the nearby lymph nodes.
Radiation Therapy
Radiation therapy uses high energy beams to kill residual cancer cells, and is commonly prescribed after the lumpectomy surgery, sometimes after the mastectomy surgery for large tumors or extensive lymph node involvement.
Chemotherapy
Chemotherapy can be used prior to the surgery (neoadjuvant – to shrink the tumor) or post-surgery (adjuvant – to get rid of the microscopic disease), and plays a major role in the treatment of aggressive or high stage cancers.
Hormone Therapy
Hormone therapy for the breast cancer that is positive for the hormone receptors – most cases – uses the medications to block the action of estrogen on the breast cancer cells, or decrease estrogen levels in the body.
Targeted Therapies
The use of targeted therapies in HER2-positive breast cancers involves blocking the HER2 protein responsible for growth, and has proven very effective for an otherwise highly aggressive subtype of breast cancer.
Immunotherapies
Are becoming increasingly common for certain subtypes of breast cancers, especially for the triple-negative breast cancer subtype, which is negative for both hormones and HER2, and therefore cannot be treated with any of these therapies.
Living With and After Breast Cancer
Breast cancer care can continue to last long after surgery and chemotherapy have occurred. Other long-term treatment may include:
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Hormone therapy for breast cancer, if the cancer is hormone receptor positive
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Follow-up imaging and exams to keep track of recurrence
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Reconstruction after a mastectomy, if desired by the patient
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Psychosocial care, like counseling and survivorship programs, as the emotional toll of the diagnosis and treatment cannot be overlooked
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Management of lymphedema if this occurs in those who underwent lymph node removal or radiation
Conclusion
Breast cancer being such a prevalent type of cancer means that there is just as extensive research when it comes to the detection and treatment of it, and this is exactly why it is that treatment has become so effective within the past 30 years. Being aware of breast cancer's symptoms, risk factors, mammogram screening recommendations, and how the molecular subtype influences treatment are all factors contributing to detecting and treating this disease early on. If you notice any changes in your body, such as a lump, change in the skin, or anything that persists, you should see your doctor.