Overview of breast cancer
Breast cancer or ‘breast carcinoma’ is the most common form of cancer and the second leading cause of death in women. This occurs when the abnormal cells multiply and go out of control. It begins with the formation of a tumor. If the tumor is malignant, it has the potential to grow and spread or metastasize to different parts of the body through the blood stream or the lymphatic system. In the recent years, the frequency of breast cancer has increased and has become a source of suffering to the persons affected and also their families. Men also can get affected with the breast cancer but the frequency is very less. Breast cancer can be completely cured if detected early, if not it is very difficult to get rid of it completely through treatment. Treatment of breast cancer involves controlling the spread of the disease for years.
Breast cancer can be ‘invasive’ (spreading) or ‘noninvasive’ (do not spread and is confined to the original site).
There are different kinds of breast cancer and few of them are discussed below.
Ductal carcinoma in situ (DCIS):
This is noninvasive type of breast cancer and the cancer occurs only in the ducts. If the women are diagnosed in this stage through a mammogram, it can be easily cured.
Lobular carcinoma in situ (LCIS):
This condition is not a true cancer. It begins in the milk producing glands. Presence of this condition in women increases the risk of getting affected with breast cancer later.
Invasive (infiltrating) ductal carcinoma (IDC):
This kind of cancer begins in the milk passage, breaks through the wall of the passage and spreads in the breast tissue. Later the cancer cells spreads to different parts of the body.
Invasive (infiltrating) lobular carcinoma (ILC):
This condition begins in the milk lobules and spreads to different parts of the body.
Inflammatory breast cancer (IBC): This is a rare invasive condition where a tumor or lump is not seen, instead the skin of the breast looks red and warm to feel. The skin is thick with pitted appearance and looks like an orange peel. The breast becomes larger, firmer, tender and itchy.
Breast cancer is the most common cancer in women. About 1 in 7 women have the probability of developing the disease in their lifetime. Approximately, 15% of the female deaths are caused due to breast cancer. It is 100 times less common in men when compared to women. The survival rate ranges from 98% if the patient is in stage I cancer to about 16% for patients who are in their stage IV cancer. The overall survival rate is 85% after 5 years of cancer, 71% after 10 years of cancer, 57% after 15 years of cancer, 52% after 20 years of cancer. Studies have shown that the incidence of breast cancer has increased recently but the death rates have declined.1
Signs and Symptoms of breast cancer
The most common symptom of breast cancer is a detection of a palpable mass. The mass may be painful in 10–15% of the patients. The other symptoms seen later include:2
- A thickening or lump in the breast or armpit usually observed after the menstrual cycle.
- Swelling in the armpit.
- A change in the size or shape of the breast and pain in the breast.
- Changes in the skin of the breast like dimple in the skin or skin that looks like an orange peel.
- Changes in the nipple like indrawn nipple, nipple that is itchy or ulcerous.
- Unusual discharge from the nipples including occasional blood discharge.
- Marble like area under the skin.
- change in the color or peel of the skin around the nipple.
- Dilated veins.
- Hardness of the breast.
- Visible flattening on the breast.
Since breast cancer is rare in men, any lump in a male is considered abnormal.3
Causes and Risk Factors for breast cancer
The actual cause of breast cancer is not known. Some of the risk factors, which cause breast cancer, may be:
Age: Chances are high as the age increases.
Females: Although breast cancer is rare in men, females are at a very increased risk.
Family history: Chances are high if anybody in the family has suffered from breast cancer indicating genes are responsible. Mutations in the genes BRCA1 and BRCA2 are known to cause breast cancer in females. Females who have family history of breast cancer have normal BRCA genes.
Personal History: If women had breast cancer in one of the breast, there is a likelihood of getting affected to the other breast also. Chances of recurrences are high to the same part or to different parts of the body.4,5
Hormonal therapy: Women who have undergone menopause and taken hormone therapy for more than 4 years with estrogen and progesterone have high chances.6
Mensturation: Women with mensturation beginning before the age of 12 years and menopause occurring after the age of 55 years are at high-risk of getting affected with breast cancer.
Having higher estrogen levels increases the risk.
More fat in the body and consuming alcohol increases estrogen levels especially after menopause leading to an increased risk.
Radiation therapy: Young women who have exposed their breasts to radiations due to some diseased condition like Hodgkin’s lymphoma are likely to develop breast cancer in the later ages.7
Late child-bearing: Women bearing children after the age of 30 years and women who never bear children are at high-risk of being affected with breast cancer.
Not breast-feeding: Women who never breast-feed their children are at high risk.
Diagnosis of breast cancer
Diagnosis is based on detection and screening. Detection can be done through self-examination of the breast frequently and finding out for the presence of lumps, pain in the breast, thickness, changes during menstruation. Getting checked with a physician is necessary if anything unusual is observed. Self-examination helps in early diagnosis of the disease and reduces the number of deaths caused due to breast cancer.8
The following are some of the methods used in detecting breast cancer.
A mammogram is the X-ray of the breast to find out the smallest tumor present in the breast, which cannot be felt.
Clinical Breast Exam (CBE)
Clinical breast examination is done by the physician who carefully examines the breast and under arms for the presence of lumps or abnormal changes.
Magnetic Resonance Imaging (MRI)
An MRI scan is much more sensitive scan when compared to the mammogram. It provides pictures of the inside parts of the breast, thereby helping in better diagnoses. This is very helpful to women are at a very high-risk for breast cancer.9
An ultrasound is done to detect whether the lump is a fluid filled lump or a solid lump.
A breast biopsy is done by removing a small sample and a microbiological examination is conducted for the presence of cancer cells. A lymph node biopsy is also done to check the spread of cancer cells to axillary lymph nodes present under the arms.
Complete Blood Count
This test is done to detect the kinds and number of cells present in the blood.
This is done to measure the several components of the blood.
Treatment of breast cancer
Treatment of breast cancer is based on:
- Size and location of lump
- Stage of the cancer
- Metastasis of the cancer
- Family history
- Age and other health problems
The aim of the treatment would be:
- Removal of cancer with a single treatment or a combination of treatment
- Preventing recurrence of cancer
The following are some of the treatments opted cure breast cancer.
Surgery is done to remove the cancer from the breast through breast conserving surgery, lymph nodes from under arm is removed through axillary lymph node dissection or sentinel node biopsy. In some cases the whole breast may be removed through mastectomy.
This therapy involves exposing to high-energy radiation generated by radioactive substances like cobalt using specialized equipment. These radiations destroy the cancer cells and shrink the tumor.
This therapy involves using drugs to wipe out the cancer cells. The drugs are designed to cause more harm to the cancer cells. Most drugs are not selective and normal cells also undergo certain amount of damage. Hence, chemotherapy affects normal cells and also causing side-effects. Chemotherapic drugs kill the cancer cells by attacking certain pathways and processes important to the cancer cells’ survival and growth. Chemotherapic drugs are given intravenously through cycles or orally. Some of the chemotherapeutic drugs used are cyclophosphamide, doxorubicin, epirubicin, fluorouracil, methotrexate and paclitaxel.
This is done using tamoxifen or an aromatase inhibitor, which is an estrogen-blocking drug. It changes the route of the hormones, which lead to cause cancer.10
Natural substances or slightly modified natural substances like herceptin works on the body immune system to eliminate the cancer cells. Herceptin targets the breast cancer cells with has increased levels of protein called HER2.
- Chemotherapy causes nausea, vomiting, infertility problems and early menopause by destroying the eggs in the ovaries.
- Hormonal therapy causes vaginal dryness and hot flashes after menopause.
- Herceptin can cause heart problems by weakening the heart muscles.
- Side-effects of radiation therapy include swelling in the breast, reddening and blistering of the skin and fatigue.
Management of breast cancer
Some non-modifiable risk factors causing breast cancer include age and female gender. Risk of getting affected with breast cancer can be lowered by prevention and management of modifiable risks. Here are some useful tips, which can help in managing this condition.
- Avoid long-term hormone intake after menopause.11
- Breast-feeding will lower the risk.12
- Conceiving before 30 years of age.
- Loosing extra kilos, as extra fat increases estrogen production.
- Consuming healthy food with plenty of fruits, vegetables and whole grains.
- Exercising regularly.
- Decrease alcohol consumption.13
If the risk level is high in some women, consulting with the physician and taking the medicines should be helpful in preventing this condition.
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10 .Boccardo F, Rubagotti A, Puntoni M. Switching to an aromatase inhibitor provides mortality benefit in early breast carcinoma. Cancer. 2007;109(6): 1060–1067.
11. Thurlimann B, et al. A comparison of letrozole and tamoxifen in postmenopausal women with early breast cancer. New Eng J Med. 2005; 353(26): 2747–2757.
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Written by: healthplus24.com team
Date last updated: June 18, 2015