Breast cancer is the leading cause of cancer death among women between the ages of 20 and 59 worldwide. One out of eight women will develop breast cancer symptoms some time during her life, according to the National Breast Cancer Coalition (NBCC). Breast cancer is three times more common than all gynecologic malignancies put together.
This year in America, more than 211,000 women will be diagnosed with breast cancer and 43,300 will die. If breast cancer is detected early, the five-year survival rate exceeds 95%. Mammograms are among the best early detection methods, yet 13 million U.S. women 40 years of age or older have never had a mammogram.
Breast cancer does not have a unique cause; in fact, it may be produced by a combination of genetics and environmental stimuli. Either way, the best way to fight against breast cancer is getting informed, with special attention to prevention because breast cancer is much easier to prevent than treat.
Knowledge is your first tool in countering breast cancer. Keep reading to learn all about the risks of breast cancer, how breast cancer develops, the signs and symptoms it has, and how it is diagnosed and treated, as well as how you can detect it with a breast self-exam.
There is not only one main cause for breast cancer; in fact, it may be caused by a combination of factors, giving rise to different types of breast cancer. Breast cancer is started by faulty genes. You can inherit a faulty gene from your father or mother. Actually, even an inherited gene needs something in the environment to cause the final mutation needed to lead to breast cancer. So breast cancer, like other cancers, is caused by a combination of abnormal genes and environmental risk factors.
Hormone replacement therapy (HRT) as a cause of breast cancer
HRT is synthetic estrogen often in combination with progesterone - specifically, a form called progestin. It is designed to "replace" a woman's low hormone levels at menopause. HRT is commonly prescribed to relieve menopause symptoms, such as hot flashes and vaginal dryness. Hormone replacement therapy is also used to help prevent osteoporosis.
The possible link between hormone replacement therapy (HRT) and breast cancer is the source of most of the controversy surrounding hormone use in menopausal women. HRT does carry with a sizable increase in breast cancer risk.
A review of preliminary data of the Women's Health Initiative study, the largest clinical trial ever undertaken in the United States, showed a 26% increase in breast cancer in women receiving hormone replacement therapies compared with women receiving a placebo. In addition, instead of a heart benefit, there were a 29% increase in heart attacks and a 22% increase in total cardiovascular disease among women receiving the synthetic hormones.
The medical establishment is becoming increasingly wary about how much HRT to prescribe and when, since the risk of ovarian and breast cancer as well as heart disease, blood clots, and strokes is associated with conventional HRT treatment.
Balancing hormonal levels without side effects
Breast Cancer Development
Breast cancer occurs when a cell within a breast undergoes changes that cause it to grow and divide uncontrollably, and the body's natural anticancer mechanism also fails. Usually, the cancer develops from tissue that forms milk ducts.
- At first, extra cells begin to form in this lining, a condition called hyperplasia, which means "too many cells."
- Then these cells become odd-looking and start filling the milk duct. In this stage the cancer is called ductal carcinoma in situ, or pre-cancer.
- In about one third of the cases, the cells develop the ability to break out of the duct and destroy tissue around it. Any tissue in the breast can be affected. At that stage, it is called cancer.
Cancer cells can also spread, or metastasize, to other parts of the body through the bloodstream. These cells can travel to other tissues and spread new forms of tumors to main organs of the body like the lungs, brain, bones, or the liver. In many cases, this is what actually causes death.
Another step in educating yourself about breast cancer is to learn about the different forms. There are many different types of breast cancer, but the vast majority – over 80% - begins in either the milk ducts or the lobular (milk-producing) tissue.
These two types are called ductal carcinoma and lobular carcinoma. Either type, if diagnosed early enough, may be called in situ, which means that the cancer has not invaded surrounding fatty tissues in the breast nor spread to other organs in the body. The outcome for the invasive or infiltrating version of either type depends on many factors, such as the stage of the cancer, your age, and your general health.
There are also some other types of breast cancer, which appear less commonly than the abovementioned types:
- Medullary carcinoma. This type of infiltrating breast cancer accounts for about 5% of breast cancers. It has a rather well-defined, distinct boundary between tumor tissue and normal tissue, and it has some unique features, including the large size of the cancer cells and the presence of immune system cells at the edges of the tumor.
- Inflammatory breast cancer. This type of invasive breast cancer accounts for about 1 – 3% of all breast cancers. It makes the skin of the breast look red and feels warm and gives the skin a thick, pitted appearance.
- Tubular carcinoma. Tubular carcinomas are a special type of infiltrating breast carcinoma. They account for about 2% of all breast cancers and have a better prognosis than infiltrating ductal or lobular carcinomas.
- Paget's disease of the nipple. This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and then to the areola, the dark circle around the nipple. It accounts only 1% of all cases of breast cancer. The skin of the nipple and areola often appears crusted, scaly, and red, with areas of bleeding or oozing. The woman may notice burning or itching.
There are not only different types of breast cancer, but also different stages. Learn about breast cancer stages, as every stage means a different chance of recovery.
Stages of Breast Cancer
When physicians talk about breast cancer, they also use terms such as "early" or "advanced." Although these terms are not medically precise (they may be used slightly differently by different doctors), here is a general idea of how they apply to the official staging system and a short description:
- Early stage: Stages 0 - II
- Later stage: Stages III (IIIA - IIIB)
- Advanced stage: Stages IV
Stage 0: This stage describes non-invasive breast cancer. There is no evidence of cancer cells breaking through to or invading neighboring normal tissue.
Stage I: This stage describes invasive breast cancer in which the tumor measures up to three-quarters of an inch (2 cm) AND no lymph nodes are involved.
Stage II: This stage describes invasive breast cancer in which the tumor measures 0.75 – 2.0 inches (2 – 5 cm) OR the cancer has spread to the lymph nodes under the arm on the same side as the breast cancer.
Stage IIIA: This stage describes invasive breast cancer in which the tumor measures larger than two inches (5 cm) OR the tumor has spread to lymph nodes, and nodes are clumping or sticking to one another or surrounding tissue.
Stage IIIB: This stage describes invasive breast cancer in which a tumor of any size has spread to the breast skin, chest wall, or internal mammary lymph nodes (located beneath the breast inside the chest) and includes inflammatory breast cancer.
Stage IV: This stage includes invasive breast cancer in which a tumor has spread beyond the breast, underarm, and internal mammary lymph nodes to main organs of the body, like the lungs, brain, bones, or liver.
Women must know that breast cancer often shows symptoms that can be easily noticed. Keep reading to know about the signs and symptoms of breast cancer, as the earlier breast cancer is detected, the better are the chances of defeating it. Being aware of different risk factors may also help in prevention.
Risk Factors and Triggers
All women are at risk of getting breast cancer, though some more than others based largely on genetic factors. As you get older, your risk increases. Assuming you live to age 90, your risk of getting breast cancer over your lifetime is about 12%. Does that sound like a big risk? It might sound scary, because it means that an average of about one out of every 8 women will get breast cancer in the course of a 90-year life span. Or, you can look at it another way: a 12% risk means there's an 88% chance that you won't get breast cancer.
Breast cancer, like other cancers, is caused by a combination of abnormal genes and other health factors. There are several risk factors that you can work on and consequently decrease your risk of getting breast cancer, though some are uncontrollable.
What increases risk
- Family history of breast cancer
- Excessive weight
- Prolonged estrogen exposure
- Abnormal breast cell growth
- Pregnancy after age 30
- Heavy alcohol use
- Late menopause
- Early start of menstruation
- Never having a full-term pregnancy
What decreases your risk?
- Eating a healthy diet
- Quitting smoking
- Losing extra weight
- Regular exercise
- Reducing alcohol use
- Avoid medication that may stimulate breast cancer as much as possible
Risk reduction is a good way to prevent breast cancer
Combined with annual breast cancer tests, risk reduction can be a good way to minimize the probability of getting breast cancer. Rather than passing through the experience of hard and difficult treatments, women should avoid this by following a prevention program. For more information, please read the section about breast cancer prevention.
Signs and Symptoms
Breast cancer symptoms can be detected when lump grows large enough to either be felt or seen on a mammogram. Sometimes, a tumor isn't found for many years. The tumor may distort the shape of the breast or the texture of the skin as it becomes larger. This is because surrounding tissues become fixed to the tumor. The tumor can grow through the breast to the outer skin if left untreated.
Breast changes occur in almost all women at some point in their lives, and most of these changes are not cancer. Usually, early breast cancer does not cause pain or have other symptoms, but there are some signs you should watch for.
Signs of breast cancer
- A lump or thickening in or near the breast or in the underarm area
- A change in the size or shape of the breast
- Redness or scaling of the skin or nipple
- A discharge from the nipple or nipple turning inward
Description of breast cancer symptoms
A breast lump or thickening is probably the most common presentation of breast cancer symptoms. It is important to distinguish between a true lump and a lumpy area of breast tissue. Don't panic if you think you feel a lump. Most women have some lumps or lumpy areas in their breasts all the time. Eight out of ten breast lumps that are removed are benign (non-cancerous).
Breast change in size or shape may occur as a consequence of the presence of a tumor, nipple retraction, skin changes, or a combination of all three. Swelling may occur due to a large tumor occupying the affected breast.
Nipple changes include inversion, alteration in skin color, and discharge. The causes of nipple discharge can be cancerous and non-cancerous. If you are young and the discharge is not bloody or if it comes from more than one duct, there is less concern about breast cancer; however, it is abnormal to have a change in the shape or form of the nipple.
Learn how to conduct a breast self-exam to increase your chances of early detection and decrease your risk of having untreated breast cancer.
Breast Cancer Diagnosis
An abnormal area, like a lump or other changes in the breast, found by a breast self-exam, can be caused by cancer or by other, less serious problems. To find out the cause of any of these signs or symptoms, a woman's doctor does one or more of the physical exams described below.
- Palpation. By carefully feeling the lump and the tissue around it, the doctor can tell a lot about a lump, like its size, texture, and whether it moves easily.
- Mammography. The breast is exposed to a small dose of radiation to produce an image of internal breast tissue. X-rays of the breast can give important information about a breast lump and help in diagnosis.
- Ultrasonography. Using high-frequency sound waves, ultrasonography can reveal information about the shape, texture, and composition of tumors and cysts that cannot be seen on conventional x-rays.
- Needle biopsy. The doctor uses a needle to remove fluid or a small amount of tissue from a breast lump. This procedure may show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may be cancer).
- Surgical biopsy. The surgeon removes the area of concern often along with a part of the surrounding, normal breast tissue. A pathologist examines the tissue under a microscope to check for cancer cells.
Based on these exams, the doctor may decide, if no further tests are needed and a biopsy is not necessary, to make a diagnosis.
When cancer is present, the pathologist can tell what type of breast cancer it is, in what stage it is, and whether it is invasive or not. Special laboratory tests of the tissue, for example hormone receptor tests, can help predict whether the cancer is sensitive to hormones. Either way, these tests help to choose what treatment should be used in each specific case.
Prevention and Management
Nowadays, doctors don't point at a cause of breast cancer. In fact, doctors believe that it's produced by a conjunction of risk factors. This is the reason why women must understand that there is no available prevention mechanism, such as vaccines. However, what women can do is reduce breast cancer risk factors as well as having regular diagnostic tests.
Early breast cancer diagnosis
Breast cancer is very likely to be efficiently controlled when it's detected early. Therefore, it is important for women to have an annual mammogram and a breast exam during your annual checkup. Also, women should learn how to perform a self-examination in order to be aware if their breasts present changes.
Reducing risks factors
Risk reduction means making choices to avoid or minimize any possible risk factors that you can. It also means increasing the protective factors in your life so that your chances of developing breast cancer are lower.
For example, if you are overweight, you can seek to lose excess pounds, which may reduce your risk of breast cancer. As well, if you're under a hormonal imbalance treatment, you should avoid the intake of synthetic hormones if possible because it has been shown that they can estrogen can increase the risk of developing breast cancer.
Breast Self Exam
Examining your breasts is one way to help find breast cancer early, when it's most likely to be treated successfully. Not every instance of cancer can be found this way, but it is a critical step you can and should take for yourself. The more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something unusual has occurred. The breast self-exam (BSE) is an essential part of taking care of yourself and reducing your risk of breast cancer, in addition to the diagnostic methods gynecologists provide.
Don't panic if you think you feel a lump or another sign or symptom of breast cancer. Most women have some lumps or lumpy areas in their breasts all the time. Eight out of ten breast lumps that are removed are benign.
Follow the 4 steps below to exercise the BSE right!
- Stand in front of a mirror that is large enough for you to see your breasts clearly. Examine your breast with your arms down, up, and on your hips, like shown in the pictures. Check each breast for any change in the shape or contour and the skin for puckering, dimpling, or scaliness.
- Raise one arm. Use the pads of the fingers of your other hand to check the breast and the surrounding area firmly and thoroughly, working around the breast in circular direction. Feel for any unusual lump or mass under the skin. Feel the tissue by pressing your fingers in small, overlapping areas. The important thing is to cover the whole breast and to pay special attention to the area between the breast and the underarm. Check the area above the breast, up to the collarbone and all the way over to your shoulder.
- It is important to repeat exam 2 while you are lying down. Lie flat on your back, with one arm over your head and a pillow or folded towel under the shoulder. This position flattens the breast and makes it easier to check.
- Gently squeeze each nipple and look for a discharge. Finally, check under the nipples.
If you discover a lump in one breast or feel something "different" in the tissue, examine the same spot in the opposite breast. Usually if the same area in the opposite breast feels the same, there is little need for worry. Sometimes, the lumpiness may be due to menstrual changes. However, if you have nipple discharge or skin changes such as dimpling or puckering, or you feel a definite lump, there may be valid reason for concern and it is important to contact your physician right away.
Today, most women with breast cancer are diagnosed at an early stage and they benefit from newer, more effective treatments. There are treatments available for patients at all stages of breast cancer. Often, more than one type of treatment is needed. The common treatments used today are described below.
- Surgery. It is used for early breast cancer. Most women can choose between breast-conserving surgery (lumpectomy with radiation therapy) and removal of the breast (mastectomy).
- Radiation therapy. High-dose x-rays are used to destroy cancer cells or keep them from dividing and growing. Radiation therapy is sometimes used to shrink tumors before or instead of surgery and sometimes used along with chemotherapy.
- Chemotherapy. This is the use of anticancer drugs to kill or stop the growth of cancer cells. This therapy affects the whole body by going through the bloodstream and destroying all rapidly-dividing cells.
- High-dose chemotherapy. In difficult cases, high doses of anticancer drugs with peripheral stem cell transplantation and bone marrow transplantation are used to kill cancer cells.
- Biological therapy (immunotherapy). This is a treatment prompting the immune system to fight cancer or to lessen the side effects that may be caused by some cancer treatments. These treatments are designed to repair, stimulate, or increase the body's natural ability to fight infections and cancer.
- Hormonal therapy. Using hormones to prevent the growth, spread, or recurrence of breast cancer, because some tumors depend on natural hormones like estrogen or progesterone to grow.
The best approach to treating breast cancer will depend on the individual case. A woman's medical history and her personal preference also influence the treatment path that is pursued.
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- National Library of Medicine. (2017). Breast Cancer. Retrieved on September 6th, 2017 from https://medlineplus.gov/breastcancer.html