Breast Cancer

Cancer and Neoplasms, Women's Health and Childbirth

Breast cancer is a group of diseases characterized by the abnormal growth of cells in breast tissue that often form into a tumor or mass. These abnormal cells divide uncontrollably and may spread into nearby tissues if left untreated. It is most common for breast cancer to move into the lymph nodes located in the armpit, neck, and chest. In advanced stages, the cancerous cells may spread throughout the entire body, including the liver, lungs, blood vessels, and bones. There are little to no symptoms of breast cancer in the early stages when the cancer is easily treated. The first sign is usually a painless lump. Less common symptoms are breast pain or heaviness and swelling and redness in the skin of the breast or nipple.

Breast cancer is the second leading cause of death among women in the United States. It is the most common female cancer with 268,600 cases diagnosed in 2019. While rare, men (2,670 cases in 2019) can also suffer from breast cancer. If you are facing breast cancer yourself or a loved one, the following information can help you understand this disease and the importance of treatment. Most importantly, breast cancer treatment has a high success rate especially when the cancer is caught early.

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Symptoms

The signs of breast cancer are not always evident until the disease is advanced. This is why monthly self-breast exams are important. Here are the most common symptoms:

  • A lump in your breast
  • Inverted nipple
  • Change in breast shape or size
  • Change in breast skin (orange peel appearance)
  • Redness and inflammation
  • Dimples in the breast tissue
  • Flaky nipple skin
  • An open lesion on the breast
  • Bloody nipple discharge

Types

There are several types of breast cancer that are categorized as non-invasive, invasive, or metastatic (spread of cancer cells from the place of origin) and be of a different subtype.

Ductal carcinoma in situ (DCIS). Non-invasive breast cancer that starts in the milk ducts. A carcinoma is a type of cancer that begins in the skin or lining of tissues.
Invasive ductal carcinoma (IDC). Consists of five subtypes. IDC is the most common type of breast cancer. It begins in the milk ducts (the milk-producing lobules of the nipple) and invades nearby breast tissues.

Invasive lobular carcinoma (ILC). Also known as infiltrating lobular carcinoma. ILC is the second most common type of breast cancer that begins in milk-producing lobules of the nipple.

Inflammatory breast cancer. A rare and aggressive type of breast cancer that begins with reddening and swelling of the breast as opposed to from a mass or lump. IBC spreads quickly (at worst within hours). Seek treatment promptly if you recognize any symptoms.

Lobular carcinoma in situ (LCIS). A non-invasive cancer that begins in the lobules, or milk-producing glands at the end of breast ducts. In situ means that the cancerous cells remain inside the lobule and does not spread.

Male breast cancer. Less than 1% of all breast cancers occur in men. Some men have real breast gland tissue or take medicines with hormones that can promote this type of breast cancer.

Molecular subtypes of breast cancer. These are based on the genes a cancer expresses. Luminal A, luminal B, and HER2-enriched are examples of these molecular subtypes.
Paget’s disease of the nipple. A rare form of breast cancer in which cancer cells are found in and around the nipple, thus causing the area to become scaly, irritated, red, and itchy.

Metastatic breast cancer. This is stage IV breast cancer that has spread throughout the body, especially the livers, bones, lungs, and brain.

Phyllodes(Greek for leaflike) tumor of the breast. This rare type of breast cancer consists of tumor cells that grow in a leaflike pattern. These tumors grow quickly but are rarely found outside of the breast.

Risk Factors

Breast cancer is often found in women around menopause. However, women and men of any age have been diagnosed with the disease. Several risk factors contribute to breast cancer. If you have one or more of the following, make sure you do your self-exams monthly, get a mammogram yearly, and consider genetic testing.

Age. As you get older, the chances of getting breast cancer increase.

Alcohol use. Drinking alcohol is associated with elevated risk for many types of cancer, including breast. Heavy alcohol use damages DNA and may increase hormone levels, two factors related to breast cancer.

Family history. Women with a close blood relative (mom, sister, daughter, aunt, etc.,) have a higher risk.

Environmental factors. DES (diethylstilbestrol) is a synthetic nonsteroidal estrogen found in animal feed and in some medicines that may increase the risk of breast cancer. Further, some pesticides have been shown to mimic estrogen hormonal effects in women.

Tobacco use. Like alcohol, smoking increases the risk of getting many types of cancer. This is a modifiable risk.

Genetic risk factors. This is the most common factor in the increased risk of breast cancer. The genes, BRCA1 and BRCA2 are mutated genes inherited from parents and those with this mutation have a high risk of developing cancer in their lifetime.

DNA changes. Cancer is closely related to DNA damage, with an accumulation of damage possibly leading to abnormal cell division. Environmental toxins, lifestyle behaviors, and genetics all can cause damage to DNA over time.

Current or recent use of birth control pills. A few studies have shown a small increased risk in women who have used oral contraceptives before the birth of their first child.
Family history of breast cancer.

Exposure to ionizing radiation. Radiation directed at the chest early in life raises the risk of breast cancer.

Dense breast tissue. Women with denser breast tissue that is seen on a mammogram have a higher risk.

Postmenopausal obesity. If your weight is in the range of obesity, your risk is higher.

More monthly periods. There is a slightly higher risk if you started menstruating early or had menopause late.

Delayed childbirth. If you had your first baby after the age of 35 the risk of breast cancer goes up.

Absence of pregnancies. If you have never been pregnant, there is a higher risk of breast cancer.

Not breastfeeding. Breastfeeding may lower the risk of getting breast cancer.

Using hormone replacement. Hormone replacement used after menopause increases the risk.

Diagnosis

If you find a lump, any abnormality in one or both breasts, or any changes in your breast and/or nipples, see your doctor right away. Your physician will most likely perform the following tests:

History and physical. You will need to give your complete medical and family history, especially if you have a personal or family history of breast cancer. Your physician will do a thorough check of both breasts for lumps. The lymph nodes are usually checked for firmness and swelling.

Mammogram. A mammogram will be ordered to check the lump. This is usually a routine x-ray to check annually. It is often the first test ordered when a breast lump is found.

Ultrasound. The doctor may refer you to a radiologist who will take an ultrasound to get a better look at the lump. This ultrasound shows the density and consistency of the mass using sound wave interpretation by a radiologist. An “ultrasound-guided biopsy” checks the fluids in the mass. The radiologist inserts a needle during the ultrasound and takes a sample that is sent to a lab for analysis.

Magnetic Resonance Imaging (MRI). An MRI can look deeper into the tissues of the breast. Your healthcare provider may want you to have a dye injection to better outline any abnormalities.

Treatments

The treatment for breast cancer you receive will depend on the stage of the cancer itself. You will be sent to an oncologist (cancer doctor) and they will use either systemic or local treatments or a combination of both. Here are the treatments:

Surgical treatment. If the disease is at an early stage, you may only have a lumpectomy. This involves removing only cancerous tissue from the breast. If the disease is at a later stage, you may need a mastectomy. This is a total removal of one or both breasts. Side effects of surgery usually involve the same issues as with any other surgery including the risk of bleeding, risk of cancer spreading, infection, and recovery time. The emotional side effects of a mastectomy can be overwhelming. Remember to surround yourself with a positive support system and know there are many resources available to you in your time of recovery.

Radiation treatment. Radiation can be given topically to the area where the cancer is, or internally by taking radiation capsules orally. One therapy is to “superheat” the cancer cells to kill them off. Radiation is a common treatment that follows surgery. Side effects of radiation usually involve the skin such as itching, burning, redness, and peeling skin. Your oncologist will give you medications to help relieve the side effects of radiation and chemotherapy.

Chemotherapy. Chemotherapy is the use of strong medications that kill off cancer cells. This may be used alone, or as a third line of combination therapy after mastectomy and radiation are completed. Side effects include nausea, vomiting, hair loss, severe fatigue, and absence of periods.

Hormonal treatments. Certain hormones like; tamoxifen (Nolvadex©) or anastrozole (Arimidex©) counteract estrogen in the body to prevent cancer growth. Side effects include vaginal dryness, hot flashes, any symptom associated with lack of estrogen.

Biological treatments. These treatments are immune system “helpers” that give the body’s immune system what it needs to fight cancer. These include trastuzumab (Herceptin©) and lapatinib (Tykerb©). These are also used after the treatments listed above are completed to help completely clear the body of cancer.

Alternative Treatments and Home Remedies

Chinese or ayurvedic medicine. Chinese medicine traditionally uses herbs and acupuncture and Ayurvedic medicine from India uses a combination of herbal, yoga, and massage therapies.

Mind-body-soul therapies. These can help you through the symptoms and side-effects of cancer treatment. They are based on focusing inward to help your body heal itself through; meditation, art, music, guided imagery, reiki, qigong, hypnosis, and prayer.

Natural remedies. Naturopathic style medicine combines herbal remedies with supplements and proper nutrition.

Note: To date, no research has proven that alternative medicine can cure cancer. Please check with your doctor before starting any alternative therapies.

Prevention

If you have an increased risk for breast cancer or a family history of breast cancer, take these steps now to lessen the risk:

  • Quit smoking
  • Reduce Drinking
  • Exercise regularly
  • Keep your weight in check
  • Limit hormone therapies, especially estrogens
  • Breastfeed your babies
  • Avoid chemical exposures

References

American Cancer Society. (2019) Breast cancer: Facts and figures 2019-2020. Retrieved from cancer.org: https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/breast-cancer-facts-and-figures/breast-cancer-facts-and-figures-2019-2020.pdf

Breastcancer.org Writing Staff. (2018, October 18). Types of breast cancer. Retrieved from https://www.breastcancer.org/symptoms/types?gclid=CjwKCAiAudD_BRBXEiwAudakX39dmvaw5vPVVvvZBKBNZ1Atb8BbSQdn0eaMMhieGTiTLvgJ2bIBDRoCpSkQAvD_BwE

Ganz, P. A. (2005, December 19). Breast cancer, menopause, and long-term survivorship: critical issues for the 21st century. The American Journal of Medicine, 118(12B). Retrieved from https://www.amjmed.com/article/S0002-9343(05)00905-8/pdf

Kamińska, M., Ciszewski, T., Łopacka-Szatan, K., Paweł Miotła, E. (2015). Breast cancer risk factors. Menopausal Review 3(3), 196-202. Retrieved from https://www.researchgate.net/publication/282777240_Breast_cancer_risk_factors

Kori, Shivpoojan. (2018, July 18). An overview: Several causes of breast cancer. Epidemiology International Journal, 2(1). Retrieved from:  https://www.researchgate.net/publication/326462891_An_Overview_Several_Causes_of_Breast_Cancer

National Cancer Institute. (2020). Breast cancer- health professional version. Retrieved from NIH: https://www.cancer.gov/types/breast/hp

National Cancer Institute. (2020). Breast cancer- patient version. Retrieved from NIH: https://www.cancer.gov/types/breast

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