Breast cancer is cancer that forms in the cells of the breasts. It is when cells in the breast begin to grow out of control. cancer of the breast usually starts in the milk-producing glands of the breast called (Lobules) or the tube-shaped ducts that carry milk from the lobules to the nipple. Less often, cancer begins in the fatty fibrous tissue of the breast. It is the most common cancer diagnosed in women after skin cancer and the second most common cause of cancer death in women after lung cancer.
Even though it occurs in both men and women but it is far more common in women than in men. According to the World Cancer Research Fund, over two million new cases were diagnosed in 2018 alone, accounting for 25.4% of all cancer diagnosed in women excluding non-melanoma skin cancer.
The survival rate for cancer of the breast have improved and death caused by the disease has declined in recent years due to early detection, better treatment, as well as greater awareness and screening.
Signs And Symptoms Of Breast Cancer
Signs and symptoms may include:
- A breast lump or thickening of the breast that feels different from the surrounding tissue.
- Change to the skin over the breast.
- Changes in size, shape, and appearance of the breast.
- Pitting or redness of the skin of the breast.
- Discharge from nipple, possibly containing blood.
- Breast, nipple or armpit pain
- Redness or unusual warmth. This can be a sign of inflammatory breast cancer, a rare and aggressive form of the disease.
Most lumps are not concerns or mean breast cancer, but women should always have them checked by a specialist to eradicate any doubt.
Causes Of Breast Cancer
Normal breast cells become cancerous because of mutations of DNA. Some mutations may develop randomly over time, while others are inherited or may be the result of environmental or lifestyle factors.
Risk factors for breast cancer
The exact cause of cancer remains unclear but some risk factors make it more likely. Some of the risk factors can be modified while others cannot be influenced.
Genetic Risk Factor – Women who carry BRCA 1 and BRCA 2 genes have a higher risk of developing breast cancer or ovarian cancer or both. Inheriting a mutated gene from a parent significantly increase the risk of developing breast cancer.
Age – The chances of breast cancer increases with age. The risk begins to climb after forty and is highest for women in their seventies.
History Of Breast Cancer – Women who have had breast cancer before are more likely to have it again compared to women who have no history of the disease.
Menstruation – Women who started their menstrual cycle earlier or went through menopause later have a slightly increased risk.
Dense Breast Tissue – Women with dense breast tissue have a higher risk of breast cancer.
Exposure To Radiation – Women who undergo radiation treatment for cancer that is not breast cancer are at risk of the disease later in life.
Hormonal Treatment – The use of oral birth control pills and hormone replacement therapy (HRT) has been linked to breast cancer due to the increased level of estrogen.
Alcohol Consumption – Alcohol is known to increase the risk of cancers. studies have shown that women who consume too much alcohol daily have a 1.5 times higher risk of breast cancer.
Weight – Women who are obese or overweight after menopause are at increased risks. This is due to the high levels of estrogen produced by fat cells after menopause.
Late Pregnancy – Having no children or having the first child after thirty may also increase your risk.
All breast cancers are assigned a stage based on biopsy plus other findings from blood tests and imaging scans. It is also staged according to the size of the tumor and where it has spread to.
Stage 0 – This is also known as Ductal Carcinoma In Situ (DCIS) or pre-cancer. It is the earliest stage of breast cancer and involves abnormal cells that have not spread into nearby tissues.
Stage 1 – This is an invasive cancer, meaning it is invading healthy breast tissues, but it has not spread outside the breast.
Stage 2 – Cancer is growing in the breast or near the lymph nodes.
Stage 3 – It may have spread into the lymph nodes but has not spread to other organs.
Stage 4 – Tumor has spread to distant organs, often the bones, liver, brain or lungs. Although it is considered incurable at this stage, new treatments allow patients to live with their disease.
Treatments Of Breast Cancer
Treatment of the disease in women depends on the type of the disease, the stage of cancer, sensitivity to hormones and patients age, overall health and preferences.
The main treatments are:
surgery is usually the first treatment for breast cancer. The type of surgery depends on the type of disease. types of surgeries include:
- Lumpectomy – It involves the removal of the tumor and a small amount of normal tissue surrounding it.
- Mastectomy – This is a surgery to remove the whole breast, including all the tissue and sometimes nearby tissues.
- Sentinel Node Biopsy – A procedure to remove only the lymph nodes to which the cancer would likely first spread. These lymph nodes will be tested, if they don’t have cancer additional surgery may not be needed.
- Axillary Lymph Node Dissection – If the lymph nodes removed in sentinel node biopsy have cancer cells. More lymph nodes will be removed.
- Breast Reconstruction – After having breast surgery, a woman might want to have the breast mould rebuilt to restore the breasts appearance. There are several types of reconstruction, the option may depend on medical situation and personal preference.
The need for radiation depends on the type of surgery. If the cancer has spread to the lymph nodes or somewhere else in the body and in some cases age. Radiation therapies are targeted at the tumors to destroy the cancer cells and it is usually given in addition to other treatments. The procedure is painless and although the treatment itself lasts only a few minutes the set-up time to get the patient into place for treatment usually take longer.
Possible side effects of radiation are swelling in the breast, skin changes in the treated area, and fatigue amongst others.
In treating breast cancer, chemotherapy uses anticancer drugs that are typically given intravenously (injected into the vein) over a few mins or as an infusion over a longer period of time. Not all women will need chemotherapy but there are several situations where chemo may be recommended.
After Surgery (Adjuvant Chemotherapy) – This is used to try to kill any cancer cells that might have been left behind or have spread but can’t be seen even on imaging tests.
Before Surgery (Neoadjuvant Chemotherapy) – This can be used to shrink the tumor so it can be removed with less extensive surgery.
Possible side effects of chemotherapy for breast cancer include:
- Hair loss
- Nail changes
- Mouth sores
- Loss of appetite
- Weight changes
- Nausea and vomiting
Hormone Block Therapy
Hormone block therapy reaches cancer cells almost anywhere in the body and not just in the breast. It is recommended for women with hormone receptor-positive (ER-Positive or PR-Positive) breast cancer. (I.e. women whose breast tumor has a significant number of estrogen receptors or progestogen receptors). It does not help women with hormone receptor-negative (both ER-Negative and PR-Negative).
Hormone therapy may be the only option for women who cannot undergo surgery, radiation therapy or chemotherapy.
Targeted therapy or biological targeted therapy are new drugs used to alter the behavior of cancer cells.
There are two types of biological therapy
Herceptin (Trastuzumab) – This drug binds to the HER2 receptor on the surface of the cells to prevent them from receiving signal growth thereby slowing or stopping the growth of breast tumor.
Pertuzumab – This is an antibody that treats HER2-positive breast cancer. Pertuzumab may be harmful to a fetus and so not given to pregnant women.
Prevention Of Breast Cancer
Although some risks like family history cannot be changed, certain lifestyle changes can decrease the risk of the disease. Research shows that lifestyle changes can lower the risk of breast cancers, even in women with high risk.
- Maintain a healthy weight
- Stay physically active
- Avoid too much alcohol
- Quit smoking
- Avoid birth control pills after the age of 35
- Avoid exposure to radiation and environmental pollution
- Maintain a healthy diet