Breast cancer is one of the most common cancers in women, following skin cancer. Currently, research shows us that one in eight women in the United States will develop breast cancer in her lifetime.
It’s also the second leading cause of cancer death in women after lung cancer. The survival rate has increased in recent years, due to greater awareness, breast cancer research, and breast cancer screening, as well as better breast cancer treatments.
Breast cancer is a disease that occurs when cells in breast tissue mutate and keep reproducing. When these abnormal cancer cells cluster together, they form a tumor. A tumor is malignant when these abnormal cells invade other parts of the breast or when they travel (or metastasize) to other parts of the body through lymph nodes, or the bloodstream, a network of vessels and lymphatic system in the body that plays a role in fighting infection.
What Causes Breast Cancer?
Like most cancers, breast cancer is a very complex disease. The exact cause of many cases of breast cancer may be unknown. However, breast cancer does seem to have both genetic and hormonal risk factors.
Breast cancer has a strong hereditary component. If you have an immediate relative (mother, sister, or daughter) who have gotten breast cancer, then statistically you are two to three times more likely to develop breast cancer yourself. Having a close blood relative with breast cancer increases your risk of developing the disease. A woman’s breast cancer risk is almost double if she has a mom, sister, or daughter with breast cancer and about triple, if she has two or more first-degree relatives with breast cancer.
Genetic testing may be an option to consider to determine if you are at higher risk of breast cancer.
Research has established a strong link between a woman’s exposure to estrogen and her risk for breast cancer. Namely, the more estrogen a woman has been exposed to in her life, the more likely she is to develop breast cancer. Estrogen, a hormone that is essential to a woman’s reproductive functions, signals cells to divide. The more cells divide, the more likely an abnormal cell will be produced.
Estrogen is a hormone that is naturally produced in the body. Your individual exposure to estrogen depends on some conditions you can control, and others that you can’t.
You may be at an increased risk of breast cancer if you:
- Had your first child after the age of 30.
- Began menstruating earlier than age 12
- Stopped menstruating after the age of 55
- Have an abnormally short or long menstrual cycle.
It does not appear that hormonal birth control significantly increases the risk of breast cancer. However, hormone replacement therapy, usually taken as a treatment for symptoms of menopause, might increase the risk when taken for longer than 5 years.
Age is a well-known risk factor. Women over 50 years old are more likely to develop breast cancer than younger women. Being overweight, physically inactive, and consuming alcohol on a regular basis could also increase breast cancer risk.
Symptoms of Breast Cancer
Some breast cancers can be treated if they are caught early, but they may become untreatable and deadly if caught the later stages. Although many breast cancers have no symptoms in the earliest stages, you can sometimes catch the warning signs of a developing tumor. This is why it is important to perform a monthly breast self-exam and to attend your annual well-woman appointments. The warning signs include:
- A lump in the breast or armpit that lasts throughout your menstrual cycle. Lumps are usually painless, although some may produce a prickling sensation when touched. A mammogram can often detect a lump before it can be felt.
- A lump or a mass that is at least the size of a pea
- Pain or tenderness in the breast
- A change in the size or shape of the breast
- A change in the texture or appearance of the breast skin or in the nipple (becomes puckered, flattened, dimpled, scaly, red, marbled, or swollen)
- Itching or burning nipples, or ulceration of the nipples
- Bloody or clear discharge from the nipple
- A change in the look or feel of one isolated region of the breast
Diagnosing Breast Cancer
If you notice one or more of these symptoms, make an appointment with us for breast cancer screening. The sooner we can make a diagnosis, the better the chances for a successful breast cancer treatment. We recommend performing regular breast self-exams in conjunction with attending yearly well-woman exams, as well as having yearly mammograms in women over 40.
We need to know the type of breast cancer you have for the best outcome. Your breast cancer treatment will depend on where it started, whether it has spread to other parts of your body or invaded other breast tissue, and if hormones like estrogen or progesterone are fueling its growth, among other factors.
Most breast cancers are carcinomas or cancers that start in cells lining the organs or tissues. If breast cancer hasn’t spread to surrounding tissue, which will make them more treatable, while “invasive” breast cancers have invaded surrounding tissue. “Metastatic” breast cancer means it has spread to other parts of your body, such as the lungs, bones, liver, or brain. And “recurrent” breast cancer means breast cancer has returned.
Since men have less breast tissue and less breast cancer, screening them for the disease is not routine. If there is a strong family history of breast cancer or a known breast cancer gene mutation in the family, he may consider having genetic testing to see if he is at risk for male breast cancer.
Men who are at high risk for breast cancer should discuss with their health care provider about having their breasts examined during routine checkups and doing breast self-exams.
Breast cancer screening and early detection remains as the primary defense in the prevention and treatment of breast cancer
The latest recommendation of the American Cancer Society suggests that starting at age 20, women should begin a regular routine of breast self-examination. Even though breast cancer is unlikely at a young age, it’s important for young women to get to know the normal look and feel of their breasts so that they can detect changes.
Perform a breast-exam about 4 days after the last day of your period. With the help of a mirror, check for changes in the shape, color, or contour of your breasts and nipples, and look for any asymmetries. Then, feel for breast lumps or bumps both near the surface and deeper into the tissue in your breasts and underarms. It’s usually easiest to perform this part of the self-exam in the shower. If you see any nipple discharge or notice any breast lumps, it’s imperative that you see your doctor.
Mammograms are considered the most effective cancer screening method since they can detect most lumps about two years earlier than they could be felt with a self-exam.
The American Cancer Society recommends that women between the ages of 40 and 75 have yearly mammograms. Though, if you’re at a higher risk for breast cancer, your doctor may recommend you start mammograms earlier. The important thing to note is only you and your doctor should decide how often you should be screened.
Breast cancer can only be diagnosed for certain with a biopsy. This is typically performed via needle aspiration or through surgical removal of the tissue.
Types of Breast Cancer
Ductal carcinoma in situ (DCIS): A highly treatable pre-cancer starts in a milk duct. It’s the most common type of non-invasive breast cancer, meaning the cells are abnormal but haven’t spread to the surrounding tissue. Over time, DCIS may progress to invasive breast cancer.
Invasive ductal carcinoma (IDC): The most common breast cancer, accounting for 80% of all invasive breast cancer diagnoses. IDC starts in a milk duct, breaks through the duct wall, and invades the surrounding breast tissue. It can spread to other parts of the body as well.
Invasive lobular carcinoma (ILC): This type of breast cancer begins in the milk-producing glands, called lobules. ILC can spread beyond the lobules into surrounding breast tissue and metastasize to other parts of the body. It accounts for about 10% of invasive breast cancers.
Lobular carcinoma in situ (LCIS): Also called lobular neoplasia, starts in the milk-producing lobules. Technically, it’s not breast cancer, but rather a collection of abnormal cells. People with LCIS are more likely to develop breast cancer in the future.
Inflammatory breast cancer (IBC): A rare, aggressive type of breast cancer causes redness and swelling of the breast. The affected breast can feel warm, heavy, and tender. The skin may become hard or ridged like an orange rind. If you have these symptoms, it is imperative to see your doctor immediately. Inflammatory breast cancer tends to strike five years earlier, on average, than other types of breast cancer, and it might not show up on a mammogram.
Paget disease of the breast (or the nipple): This rare cancer affects the skin of the nipple and the darker circle of skin, called the areola, surrounding it. People with Paget disease may notice the nipple and areola becoming scaly, red, or itchy. Most people who have this condition also have one or more tumors (either DCIS or invasive cancer) in the same breast.
Metaplastic breast cancer: This rare, invasive breast cancer begins in a milk duct and forms large tumors. It may contain a mix of cells that look different than typical breast cancers and can be more difficult to diagnose.
Angiosarcoma of the breast: This quickly growing cancer is rare. It is usually a complication of prior radiation treatment of the breast.
Treatment for Breast Cancer
Treatment regimens for breast cancer are highly individualized based on your personal and medical history, the type of cancer, which stages your cancer has reached, and your family planning needs for cancer care. Common treatment options for treating breast cancer cases typically include one or a combination of these treatments:
Breast Cancer Surgery
Most of the time it is recommended to surgically remove the tumor. Your surgeon may recommend a lumpectomy, partial mastectomy, or complete mastectomy in one or both breasts. If you wish, you may opt for breast reconstruction at a later time for cosmetic reasons.
Radiation refers to a few different types of therapies that involve directing high-energy rays at the affected area to kill cancerous cells. It’s usually recommended in conjunction with surgery to lower the chances that cancer will relapse. Radiation can also target cancer when it has spread outside the breasts.
“Chemo” is a type of systemic therapy that targets all cancerous cells in the body by means of intravenous or orally-administered drugs. Chemotherapy can be very hard on the body with severe side effects, so patients typically undergo several rounds followed by periods of recovery. This treatment is usually recommended for patients with locally advanced or metastatic breast cancer.
Certain types of breast cancer are worsened by the presence of estrogen. There are therapies available to suppress the production of estrogen in the body, helping to reduce the risk of cancer spreading or coming back after surgery.
Drugs that target the specific genetic characteristics of cancerous cells are known as targeted therapies. There are several drugs on the market and they work in widely different ways. Targeted therapy is usually gentler on the body than chemotherapy, but the two therapies are most successfully used together.