Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also start in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast. Breast cancer is the most common cancer diagnosed in women in India. Breast cancer can occur in both men and women, but it's far more common in women.
Breast cancer survival rates have increased, and the number of deaths associated with this disease is steadily declining, mainly due to factors such as earlier detection and newer advanced treatments.
When to see a doctor?
● A hard painless lump in the breast that feels different from the surrounding tissue
● A lump in the axilla
● Recent changes to the skin over the breast, such as dimpling
● A recently inverted nipple
● Recent nipple discharge
Researchers have identified genetic, hormonal, lifestyle, and environmental factors that may increase your risk of breast cancer. But it's unclear why some people with no risk factors develop cancer, yet other people with risk factors never do. A complex genetic makeup and environmental interaction likely cause breast cancer.
Inherited breast cancer
Doctors estimate that about 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family.
A number of inherited mutated genes that can increase the likelihood of breast cancer have been identified. The most well-known are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which significantly increase the risk of both breast and ovarian cancer.
If you have a strong family history of breast cancer or other cancers, your doctor may recommend a blood test to help identify specific mutations in BRCA or other genes that are being passed through your family.
Consider asking your doctor for a referral to a genetic counselor, who can review your family health history. A genetic counselor can also discuss the benefits, risks, and limitations of genetic testing to assist you with shared decision-making.
Other Risk factors
Factors that are associated with an increased risk of breast cancer include:
● Being female. Women are much more likely to develop breast cancer than men.
● Increasing age. Your risk of breast cancer increases as you age.
● A personal history of breast conditions. If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.
● A personal history of breast cancer. If you've had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
● Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
● Obesity. Being obese increases your risk of breast cancer.
● Early menarche - periods starting at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
● Late menopause - periods stopping at an older age. If you attain menopause at an older age, you're more likely to develop breast cancer.
● Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
● Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than women who have had one or more pregnancies.
● Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone for many years to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
● Drinking alcohol. Drinking alcohol increases the risk of breast cancer.
Average risk women:
Making changes in your daily life may help reduce your risk of breast cancer.
● Ask your doctor about breast cancer screening. Discuss with your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms.Talk to your doctor about the benefits and risks of screening. Together, you can decide what breast cancer screening strategies are right for you.
● Become familiar with your breasts through breast self-exam for breast awareness. Women may become familiar with their breasts by occasionally inspecting them during a breast self-exam for breast awareness. Talk to your doctor promptly if there is a new change, lumps, or other unusual signs in your breasts.
Breast awareness can't prevent breast cancer, but it may help you better understand the normal changes your breasts undergo and identify any unusual signs and symptoms.
● Stay physically active. Aim for at least 30 minutes of exercise on most days of the week.
● Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy.Some women experience bothersome signs and symptoms during menopause and, for these women, the increased risk of breast cancer may be acceptable in order to relieve menopausal signs and symptoms.To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.
● Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask your doctor about healthy strategies to accomplish this.
High risk women:
Suppose your doctor has assessed your family history and determined that you have other factors, such as a precancerous breast condition, that increase your risk of breast cancer. In that case, you may discuss options to reduce your risk, such as:
● Preventive medications (chemoprevention). Estrogen-blocking medications, such as selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast cancer in women with a high risk of the disease.
These medications carry a risk of side effects, so doctors reserve these medications for women who have a very high risk of breast cancer. Discuss the benefits and risks with your doctor.
● Preventive surgery. Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed (prophylactic mastectomy). They may also choose to remove their healthy ovaries (prophylactic oophorectomy) to reduce the risk of both breast and ovarian cancer.
Diagnosing breast cancer
Tests and procedures used to diagnose breast cancer include:
● Breast examination. Your doctor will check both of your breasts and lymph nodes in your armpit, feeling for any lumps or other abnormalities. This is a very important first step in the diagnosis process
● Mammogram. A mammogram is an X-ray of the breast. Mammograms will give information about whether the swelling looks like cancer and also about the spread to lymph nodes in the armpit.
● Breast ultrasound. Ultrasound is used along with a mammogram for a better reporting of the disease. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst
· Biopsy. A biopsy is the only definitive way to make a diagnosis of breast cancer. During a biopsy, your doctor uses a specialized needle device guided by X-ray or another imaging test to extract a core of tissue from the suspicious area.
Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in breast cancer, the aggressiveness (grade) of cancer, and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options.
● Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. Unlike other types of imaging tests, an MRI doesn't use radiation to create the images. Breast MRI is done only in very few situations and not done routinely for all patients.
Staging breast cancer
Once your doctor has diagnosed your breast cancer, he or she works to establish the extent (stage) of your cancer. Your cancer's stage helps determine your prognosis and the best treatment options.
Tests and procedures used to stage breast cancer may include:
● Blood tests, such as a complete blood count
● Mammogram of the other breast to look for signs of cancer
● Bone scan
● Computerized tomography (CT) scan
● Positron emission tomography (PET) scan
Not all women will need all of these tests and procedures. Your doctor selects the appropriate tests based on your specific circumstances and takes into account new symptoms you may be experiencing.
Breast cancer stages range from 0 to IV with 0 indicating cancer that is noninvasive or contained within the milk ducts. Stage IV breast cancer, also called metastatic breast cancer, is cancer that has spread to other body areas.
Breast cancer staging also takes into account your cancer's grade; the presence of tumor markers, such as receptors for estrogen, progesterone, and HER2; and proliferation factors.
There are two major types of surgical procedures enabling the removal of breast cancerous tissues and those include
(1) Breast-conserving surgery (BCS) and
BCS:Enables the removal of the cancerous tissue with simultaneous preservation of intact breast tissue. It is often combined with plastic surgery techniques called oncoplasty, which helps maintain the shape and volume of the operated breast.
Mastectomy is the complete removal of the breast. This may be followed by breast construction either immediately or later.
The procedures for the removal of affected lymph nodes involve sentinel lymph node biopsy (SLNB) and axillary lymph node dissection (ALND).
Sentinel lymph node biopsy involves the removal of a few nodes in the armpit and testing for the spread of cancer. Complete clearance of the nodes and fat of the axilla is needed only if sentinel nodes tested positive. This type of procedure may be beneficial for the patients in avoiding problems like arm swelling, which may be seen in some patients after routine axilla surgery.
Chemotherapy is a systemic treatment of breast cancer involving intravenous injections. They are given to try to control the chances of the spread of cancer to other parts of the body. Chemotherapy is given either before or after surgery depending on the stage of the cancer. Choosing the most appropriate one is individualized according to the characteristics of the breast tumor. Although some side effects like temporary hair loss, nausea, vomiting, fatigue, and long-standing neuropathy are seen, the benefits may be more important and therefore recommended in some groups of patients. In younger women, menstrual cycle disruptions and fertility issues might also appear.
Targeted therapy and Harmonal therapy:
Based on ER/PR/Her2neu receptors, targeted and Hormonal therapy may be advised. These medicines specifically target cancer cells with particular receptors. Combining targeted therapy with chemotherapy will help synergistic activity with more control of cancer cells.
Radiotherapy is another additional local breast cancer treatment given after surgery. It is given to ensure that all of the cancerous cells remain destroyed, minimizing the possibility of breast cancer recurrence in the axilla or in the remaining part of the breast in case partial breast resection is done. Irritation and darkening of the skin exposed to radiation, fatigue, and lymphoedema are one of the most common side effects of radiation therapy. Nonetheless, radiation therapy is significantly associated with improving the overall survival rates of patients and lowering the risk of recurrence.
Breast cancer is a type of cancer that can be completely controlled with effective treatments when screened and detected early. The more the delay in diagnosis, the lesser the chances of cure. General advice is to consult a specialist doctor if you are above 40 years and willing for breast screening or feel some abnormality in the breast.