Anatomy of the human female breast
Breast cancer is a type of cancer that is present in the cells of the breasts. Also, breast cancer is the most common fast-spreading cancer in women, and the second major cause of cancer death amongst women, after cancer of the lungs. Breast cancer can be found in both men and women, but it is predominantly found more in women.
In the U.S., breast cancer is the most common cancer diagnosed amongst women after skin cancer. Strong support for breast cancer awareness and research funding has helped developed advances in the diagnosis and treatment of breast cancer. This has made the survival rates of breast cancer increased, and also reduces the number of deaths associated with this cancer as a result of several factors like early detection of the disease, a newly devised approach to treatment and a good knowledge of the disease.
Furthermore, about 3.1 million breast cancer survivors are found in the U.S. This has made the chance of any woman dying from this disease to be around 1 in 37 or 2.7%.
It was also found that about 252,710 new diagnoses of breast cancer were expected in women in 2017, and about 40,610 women were likely to die from the disease. Its risks can be reduced by paying close attention to the symptoms and the need for proper screening.
Types of this disease
Here are the various types of breast cancer
Ductal carcinoma in situ (DCIS): It is the most common type and it emanates from the milk duct.
Invasive lobular carcinoma: This begins in the lobules as the cancer cells break out from inside the ducts or lobules and enter nearby tissue, increasing the chance of transferring to other parts of the human body.
Male breast cancer: This particular cancer is found around the breast of most men.
Recurrent breast cancer: This particular type resurfaces after treatment as it does not go away completely.
Inflammatory breast cancer: Here there is inflammation around the breast.
Lobular carcinoma in situ (LCIS): It begins in the lobules. In non-invasive breast cancer, the cancer is still inside its place of origin and has not busted. Although, these cells can eventually grow into invasive breast cancer.
Paget’s disease of the breast
Symptoms of breast cancer
The early symptom of breast cancer involves an area of thickened tissue in the breast or a lump in an armpit or in the breast.
Other symptoms include the following:
- Breast being reddish in color or pitting, like the skin of an orange
- Nipple discharge that may contain blood
- Changes in its shape or size of the breast
- Pains around the breast or armpits that doesn’t correspond with the monthly cycle
- Feelings of rash on one of the nipples or around the nipples
- An inverted or sunken nipple
- Experiencing some flaking, peeling, or scaling of the skin on the breast or nipple
Although most lumps aren’t cancerous, they should be checked regularly by health care professionals
When you can see your doctor
If you discover a change or lump in your breast, even if your mammogram results shows you are normal, always visit your doctor for optimal evaluation of the disease.
What are the stages of this cancer?
Its stages arise from the size of the tumor and whether it has been transmitted to other parts of the body or lymph nodes. Breast cancer is staged from stage 0 to 4 which may be further broken down into smaller stages.
Stage 0: Usually called the DCIS (ductal carcinoma in situ) as the cells are restricted to within the duct and have not entered surrounding tissues.
Stage 1: Here the tumor is usually up to 2 cm across at the beginning of this stage and has not attacked any lymph nodes.
Stage 2: The tumor is 2 cm across and has begun to spread to close nodes in the body.
Stage 3: The tumor is now 5 cm across and may have transmitted to some lymph nodes.
Stage 4: Here cancer has already spread to distant organs like the liver, bones, lungs, or brain.
Consequently, once your doctor has successfully diagnosed your breast cancer, he or she deduces the stage of your cancer as your cancer’s stage helps determine your prognosis and the optimal treatment options.
You may not be provided with the complete information about your cancer’s stage until after successful undergoing of breast cancer surgery.
The following are the tests and procedures used to stage breast cancer effectively:
- Blood tests are carried out to determine your complete blood count
- Other parts of your breast will be screened with a mammogram to check for signs of cancer
- You will undergo breast MRI, followed by bone scan
- CT (computerized tomography) scan will be performed to check for cancer
- PET (positron emission tomography) scan
Although, not all women will be required to undergo these tests and procedures as your doctor will select the best tests based on your specific circumstances and also consider the new symptoms you may be going through.
Breast cancer staging takes into account your cancer’s grade, the availability of tumor markers like receptors for estrogen, progesterone/HER2, and accelerating factors.
What are the causes of breast cancer?
It is known by doctors that breast cancer occurs when some breast cells start to grow abnormally. These cells divide more quickly than healthy cells do and keep accumulating, forming a mass or a lump. Cells may spread across your breast to your lymph nodes or to several parts of your body.
Most at times, breast cancer begins with cells in the milk-producing ducts known as invasive ductal carcinoma. This type of cancer may also emanate in the glandular tissue known as invasive lobular carcinoma or in other cells/tissue within the human breast.
Scientists have deduced lifestyle, hormonal, and environmental factors are capable of increasing your chance of developing breast cancer. But it’s not certain why some people who have no risk factors tend to develop this disease, yet other people with risk factors never experience it. It is then deduced that breast cancer arises as a result of a complex interaction of your genetic makeup and your immediate environment.
Are breast cancer linked to gene mutations?
Yes, they are as doctors estimated about 5 to 10% of breast cancers are associated with gene mutations that can pass through generations of a family. Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), are the two most common inherited mutated genes capable of increasing your chance of having breast cancer. These inherited mutated genes also increase your chance of developing both ovarian and breast cancer.
A person with a strong family lineage of breast cancer or other cancers may be asked by the doctor to undergo a blood test to help locate specific mutations in breast cancer gene or other genes that are being transferred through your family.
You can also inquire from your doctor for a referral to a genetic counselor, which is capable of reviewing your family health history. The genetic counselor can also explain in details the risks, benefits, and limitations of genetic testing to help you with shared decision-making.
What is the risk factor for this cancer?
The risk factors of this disease are things that can increase your chance of developing breast cancer rapidly. A person may have one or several breast cancer risk factors but may also not develop breast cancer. Most women who develop this disease have no identifiable risk factors other than simply being women.
A person with one or more of the following risk factors may be susceptible to breast cancer:
Having dense breast tissue: Women with higher density breast tissue are more likely to develop breast cancer easily.
As long as you’re a woman, you are more likely to develop breast cancer than a man.
An individual history of breast conditions: Your chances of developing breast cancer could be increased if you have had a breast biopsy that discovered LCIS (lobular carcinoma in situ) or typical hyperplasia of the breast.
A family history of the disease: Where members of your family either your mother or sisters were diagnosed with breast cancer, especially at their tender age, will definitely increase your risk of developing breast cancer. It’s unfortunate that most of the people diagnose with breast cancer have no family history of the disease making it difficult to identify the main causes of the disease.
Exposure to radiation: A person, who must have undergone radiation treatments to her chest as a kid or young adult, would likely be vulnerable to developing breast cancer.
Experiencing your period at a tender age: When you start menstruating before age 12, your chances of developing breast cancer increases.
Being pregnant at an older age: A woman who gives birth to her first child usually after 30 years may stand a higher chance of developing breast cancer.
Taking postmenopausal hormone therapy: Most women who take hormone therapy medications that bring together progesterone and estrogen to treat the signs/symptoms of menopause may be exposed to developing breast cancer. But when you stop taking these medications, your risk of developing breast cancer is reduced.
Increases as you age: It may sound weird but your chances of having breast cancer increases as you age each day. Also, at age 20, the chance of developing breast cancer in the next 10 years is 0.6%. When someone reaches age 70, the figure rose up to 3.84%.
An individual history of breast cancer: If you have been diagnosed with breast cancer in one part of your breast, your chance of developing cancer in the other breast is increased.
Inherited genes that increase the disease risk: These gene mutations like BRCA1 and BRCA2 are mainly passed from parents to their children and as such increases your risk of breast cancer and other cancers. Also, have in mind that these genes don’t make cancer unavoidable.
An overweight person: Being obese increases your chance of developing breast cancer very easily.
Experiencing menopause at an older age: A lady who begins her menopause at an older age is more likely to develop breast cancer readily.
You’ve never been pregnant: Women who have never taken in before are more susceptible to developing breast cancer than women who must have had one or several pregnancies before.
Consumption of alcohol: If you are a type that consumes alcohol, you are more likely to develop breast cancer.
Occupational hazards: A study by researchers in 2012 deduced that exposure to certain carcinogens and endocrine disruptors like at the workplace, could be associated with breast cancer.
Also in 2017, scientists say that working during the night could increase your risk of having breast cancer, but more recent research deduces it’s unlikely to have the disease.
Breast cancer associated with cosmetic implants
Most women with cosmetic breast implants who are diagnosed with breast cancer are at a higher risk of dying from the disease and a 25% higher chance of being diagnosed at a later stage, compared with women without cosmetic breast implants.
This arises as to the result of the implants hiding cancer during screening, or because the implants cause the breast tissue to change its form. But more researches are needed to ascertain this fact.
How can I diagnose breast cancer?
A diagnosis is performed as the result of routine screening, or when a woman visits her doctor after suspecting some symptoms. Several diagnostic tests and procedures are needed to help ascertain a diagnosis.
Inculcating breast MRI
The following are the tests and procedures used in effective diagnoses of the disease:
Breast examination: Here your doctor will screen both your breasts and lymph nodes around your armpit and feelings of any lumps/other abnormalities.
Breast ultrasound: This involves the use of sound waves to form images of structures deep within the body. This particular test helps ascertain if a new breast lump is a solid mass or a fluid-filled cyst for optimal diagnosis.
Breast MRI (magnetic resonance imaging): It uses a magnet and radio waves to produce pictures of how your breast looks inwardly. A patient is always given an injection of dye before undergoing breast MRI. One distinct advantage of MRI over other imaging test is that it doesn’t use radiation to produce its images.
Mammogram screening: This is simply having an X-ray of the breast. This machine is mainly used to check for breast cancer. In a case where an abnormality is discovered on a screening mammogram, you will be recommended by your doctor to undergo a diagnostic mammogram to further assess that abnormality. There are instances where mammogram screening can detect a suspicious area that is not cancer as this may bring about unnecessary stress and sometimes interventions.
Undergoing biopsy: This is the only definitive method to make a diagnosis of breast cancer. Most at times while undergoing biopsy, your medical doctor uses a specialized needle device (core needle biopsy) with the help of an X-ray or another imaging test to remove a core of tissue from the affected area. Usually, a small metal marker is left at the area within your breast so the site can be easily detected on future imaging tests.
Furthermore, these biopsy samples are transported to a laboratory for analysis by experts to check if the cells are cancerous or not. Its biopsy sample can also be analyzed to know the type of cells that makes up the breast cancer, the grade of cancer, if it has spread to other parts of the body, and whether the cancer cells contain hormone receptors or other receptors that may alter your optimal treatment options.
Breast cancer best treatment method
Effective breast cancer treatment options will be based on your type of breast cancer, its size, stage/grade, and whether the cancer cells are hormones sensitive. Notwithstanding, your doctor will also take into consideration your overall health, age, and your own preferences before giving you any treatment.
Furthermore, most women prefer breast cancer surgery and are also given additional treatment after successful surgery, like hormone therapy, chemotherapy or radiation. In some cases, chemotherapy might also be employed before surgery.
Major treatment options for this disease include the following:
Biological therapy/targeted drug therapy
There are several factors that may affect a person’s choice such as the stage of cancer, individual preferences, and other medical conditions.
The outcome of your diagnosis and the individual will help determine the type of surgery to be carried out. Surgery may include the following types:
Use of mastectomy: This involves the removal of lobules, areola, fatty tissue, ducts, nipple, and some skin. Care should be taken as a radical mastectomy can remove muscle from the chest wall as well as the lymph nodes around the armpit.
Lumpectomy: It involves the removal of a tumor and a small amount of healthy tissue surrounding it. Lumpectomy helps prevent the spread of cancer to other parts of the body. This method is suitable where the tumor is small and easy to be separated from the tissue surrounding it.
Use of sentinel node biopsy: This is the removal of one lymph node to prevent cancer from spreading because if the disease reaches a lymph node, it can spread beyond the lymphatic system into other parts of the human body.
Dissection of the axillary lymph node: The presence of cancerous cells on a node known as sentinel node may prompt your doctor to request for the several lymph nodes around your armpit to be removed to help prevent the disease from spreading.
Inculcating reconstruction: Accompanying breast surgery, your doctor can perform a reconstruction to help recreate the breast so that it looks similar to the unaffected one. This can also be done the same time while undergoing mastectomy, or at a later date. A breast implant or tissue from another part of the patient’s body may be used.
Here controlled doses of radiation are directed at the tumor to kill the cancer cells. You can only undergo this therapy from around a month after surgery, together with chemotherapy as it really helps in destroying any cancer cells that may be left.
Although its session lasts for a few minutes, you’ll need 3-5 sessions each week for 3-6 weeks, depends on the aim and severity of cancer.
The breast cancer type will show what type of radiation therapy, if any, is the best suitable. You may experience adverse effects like lymphedema, fatigue, irritation of the breast skin, and darkening of the breast skin in the course of undergoing radiation therapy.
Most doctors prescribe cytotoxic drugs to help destroy cancer cells, in the aspect of a high-risk recurrence or spread. This is also known as adjuvant chemotherapy.
Your doctor may choose to administer chemotherapy before the surgery if there is a large tumor to help reduce the size of the tumor and make it easy to remove. This method is known as neoadjuvant chemotherapy. Cancer that has been metastasized, or spread to other parts of the body can also be treated with chemotherapy. Its symptoms can also be reduced especially in the later stages.
Estrogen production can also be reduced, as the presence of estrogen can favor the growth of some breast cancers in the body. Chemotherapy may bring about some adverse effects like vomiting, fatigue, loss of hair, nauseating feelings, loss of appetite, sore mouth, and a slightly higher vulnerability to infections. Although medications can be used to control many of these adverse effects.
Use of hormone-blocking therapy
Hormone-blocking therapy is used to avert recurrence in hormone-sensitive breast cancers in the body. They are also referred to as ER (estrogen receptive-positive) and PR (progesterone receptor-positive) cancers.
Its normal administered hormone-blocking therapy is mainly used after surgery, but might sometimes be used beforehand to help shrink the tumor.
This may be the only option for patients who can’t undergo surgery, radiotherapy, or chemotherapy. Its effects usually last for up to 5 years after successful surgery. But the treatment can have no effect on cancers that are not sensitive to hormones.
Most commonly use hormone-blocking therapy medications are aromatase inhibitors, Goserelin, tamoxifen, and ovarian suppression/ablation. Have it mind that hormone treatment may affect a woman’s fertility in the future, so diligent consultation should be made before opting for it.
Targeted drugs like trastuzumab (Herceptin), bevacizumab (Avastin), and lapatinib (Tykerb) are used in destroying specific types of breast cancer. These drugs are administered by doctors for different purposes. Also, know that treatments for breast and other cancers can have severe side effects. It is advisable for a patient to discuss with a doctor the risks involved and ways to curb the negative effects before deciding on a treatment.
Recent advances in breast cancer treatment
A study in 2018 advised that a better understanding of the tumor biology of breast cancer can bring about the development and popularity of special care for each individual.
Another research in 2018 suggested that scientists have discovered a mutation that enables cancer cells to be resistant to treatment drugs like olaparib and other PARP inhibitors. These drugs are prescribed by doctors to treat various cancers in the body. This helps to identify whether PARP inhibitors or other drugs like platinum-based therapies, could be more effective in a personalized treatment.
Furthermore, a study in 2018 suggested that the drug crizotinib, which are mainly prescribed to treat lung cancer, can also destroy breast cancer cells with a particular genetic defect. This discovery has paved the way for major funding to help in challenges faced in its clinical trial.
How you can prevent the disease
The following are the breast cancer risk reduction for women with average risk:
- Always make an inquiry about breast cancer screening from your doctor.
- Familiarize yourself with your breasts by self-examining it occasionally to see if there are any new changes, lumps or abnormal signs in your breasts.
- Try to indulge in exercise at least three times a week and aim for at least 30 minutes while exercising.
- Watch your weight by limiting your intake of calories each day and engage in significant exercises to help stay fit.
- Avoid excessive consumption of alcohol and if you’re to drink never exceed more than one drink per day.
- Limit your combination of hormone therapy so as to avoid increasing the risk of breast cancer.
- Always consume a healthy diet like eating a Mediterranean diet supplemented with extra-virgin olive oil and add a nut to it helps lower your risk of developing breast cancer.
Breast cancer risk reduction for women with a high risk includes the following:
Use preventive medications like estrogen-blocking medications (aromatase inhibitors and selective estrogen receptor modulators) helps lower the risk of breast cancer amongst women with a high risk of the disease. Make sure you discuss the risks and benefits of this medication with your doctor and have him give you the approval.
Inculcating preventive surgery: Most women with a very high risk of breast cancer may prefer to have a part of their healthy breasts surgically removed by prophylactic mastectomy. Some may ask for their healthy ovaries to be removed by prophylactic oophorectomy so as to lower the risk of developing both ovarian cancer and breast cancer.
What is the outlook of patients with this disease?
Inculcating treatment, a woman who undergoes a diagnosis of stage 0 or stage 1 breast cancer has an almost 100% chance of surviving for a minimum of 5 years.
If its diagnosis is made at stage 4, the chance of the patient surviving another 5 years is around 22%. Regular medical checks up and screening can help identify symptoms early. Why not discuss your options with your doctor for optimal assistance.