Breast Cancer

Breast Cancer

Breast Cancer

What is Breast Cancer?

Cancer is caused due to an abnormal growth of cells that start invading the normal cells around them. When these abnormal tumor cells are present in the breast, they lead to breast cancer. They are capable of spreading to other parts of the body, like in the lymph nodes under the collar bone, thus extending the reach of the tumor. Though it is a disease that affects primarily women, men can get it, too. But don’t worry! Regular screenings and mammograms (an x-ray exam of the breast that is used to detect and evaluate breast changes) can help in early detection and prevention of the cancer’s spread through timely or early treatment.

Anatomy of Breast

What are the general symptoms of Breast Cancer?

The most visible symptom of breast cancer is a new lump or mass on or near your breast. This may be dormant (benign) or malignant. Usually, malignant tumors are hard with irregular edges, but may also be soft and rounded. More often than not, they are painless, but not always. Hence, it is best to get any new lump in that area checked by the relevant doctors or experienced healthcare professionals.

However, lumps or masses are not the only possible symptom of breast cancer.

Some other symptoms include:

  • Breast or nipple pain
  • Skin irritation
  • Swelling of the breast – all or in part
  • Nipple discharge (does not include breast milk)
  • Retraction of nipple (i.e. when it turns inward)
  • Redness of the breast skin or nipple
  • Scaling or thickening of the breast skin or nipple
  • Swelling of the lymph nodes near the collar bone and under the arm. This indicates that the cancer may have spread to the nodes.

While any or all these symptoms may not always end in breast cancer, it is advisable to consult a healthcare professional when any of these symptoms appear. Mammograms may help in detecting breast cancer before the appearance of a symptom. However, it must be stressed that mammograms are not always successful in discovering breast cancer. That does not mean you should not take one! Any prevention is better than cure.  So, go out there, make that visit, consult your doctor and take a step closer to knowledge and, perhaps, relief!

What are the general causes of Breast cancer?

Certain lifestyles and, sometimes, our genes make us prone to breast cancer. A person’s chances of getting this disease are calculated based on certain “risk factors”. These risk factors are different for different kinds of cancer.

Risk factor here may refer to anything from age to habits to genetics. But the presence of these risk factors doesn’t always mean that one shall definitely be diagnosed with cancer. Let’s take a look at a few factors.

NATURAL FACTORS

  • Gender : Women are 100 times more likely to get breast cancer than men. Certain medical professionals believe that this is due to the presence of oestrogen and progesterone in the females as these two hormones are capable of promoting the growth of breast cancer cells.
  • Ageing: The older you get, the more you are at risk. Hence, you should start going for mammogram tests as soon as you reach your 40s.
  • Genes: Breast cancer is considered to be hereditary 5-10% of the time. Tests can be done to check for the same for early detection and action.
  • Family history: If you have close blood relatives with breast cancer, chances are that you are at a greater risk of  developing it as well. However, research shows that over 85% of the women diagnosed with breast cancer did not have any close relatives with the same disease. Hence, a regular check-up would help greatly.
  • If the cancer is present in one breast, you are 3 times more likely to develop it in the other breast. This also occurs if cancer in the first breast starts to spread.
  • Asians, Hispanics and Native Americans are at a lower risk as compared to Caucasian or white women, who are prone to developing breast cancer. It may even prove fatal for African-Americans!

Other risk factors include:

  • Dense breast tissue
  • Early onset of menstruation (before age 12) and/or late onset of menopause (post-55)
  • Exposure to radiation – primarily during teenage years. Radiation treatment after the sage of 40 does not appear to enhance the risk.
  •  Diethylstilbestrol - a drug given to women to lower chances of miscarriage in the mid-90s.
  • Benign/dormant breast issues - non-proliferative lesions, proliferative lesions, lobular carcinoma in situ (lobular neoplasia)
  • Lifestyle choices - Certain lifestyle choices may increase one’s risk of breast cancer. Some of these lifestyle decisions include:

Having children after the age of 30: Though pregnancy affects different kinds of breast cancers in different ways, having a child after 30, definitely increases chances of breast cancer.

The Combined Hormone Therapy for menopause increases chances of developing the cancer as well as the chances of dying from it.

Intake of alcohol is directly proportional to the increase in risk of getting breast cancer.

Obesity during menopause may increase the risk. This does not seem to hold true if the individual was obese since childhood.

Tobacco smoke

Chemicals in the environment

Lowering the risk of breast cancer

Breastfeeding may lower the risk of cancer, according to research.

Exercises seem to lower chances of developing breast cancer. According to a study in Women’s Health Initiative, brisk-walking as little as 1.25 to 2.5 hours per week can reduce the risk by 18%! So grab those running shoes!

What are the stages of breast cancer?

Cancer has different stages, each depicted by a Roman numeral from 1 to 4 (I, II, III and IV). Stage I is the first stage where the tumor is still small while at Stage IV, the patient’s condition is said to be critical because the tumor  has spread to other organs of the body. Hence, a cancer’s stage refers to the tumor’s size and extent of spread. This is the simplest form of staging.

In breast cancer, the stage depends on whether it is confined to breasts (localized cancer, Stage I), whether it has invaded the (regional) lymph nodes or whether it has spread to other organs (metastatic cancer).

The stage decides the kind of treatment you need to get. The greater the stage number, the more complex the treatment.

What are the survival rates of breast cancer?

Needless to say, if the cancer is detected while it is still in Stage I, survival rate is higher. The rate decreases progressively with the increase in stage. Stage III is considered critical, while stage IV is, more often than not, fatal.

However, medicine is evolving everyday to meet these challenges and to keep you happy, healthy and alive!

Can breast Cancer be detected early?

Early detection is possible for breast cancer. However, for this you must be regular and disciplined with your check-ups, screenings and mammogram tests. These are there to help detect the cancer before it starts causing symptoms, and while it is still small and restricted to the breast. If you can feel the cancer as a lump or mass on or near your breast, it is an indication that the cancer has already spread beyond the breast to other parts of the body. Women with a higher risk are encouraged to get an MRI done for detection.

And remember, if you feel a lump or unusual mass on your breast at home, visit a doctor as soon as possible. It may be nothing, but why not go ahead and give yourself a chance for early detection?

What are the Treatments available?

Treatments available are dependent on the stages of cancer. Primary treatments available are as follows:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Hormone therapy
  • Targeted therapy
  • Bone-directed therapy

Treatments can also be divided into broader groups basis their process and time of use.

Local Therapy: Intended to treat a tumor at the site, without affecting the rest of the body.

Examples:

  • Surgery
  • Radiation

Systemic Therapy:  This involves drugs which can be given orally or directly into the bloodstream to reach cancer cells anywhere in the body.

Types of Systemic therapy:

  • Chemotherapy,
  • Hormone therapy
  • Targeted therapy

Adjuvant Therapy: Post-surgery, patients undergo treatment to prevent the cancer from returning. This is known as adjuvant therapy. As the tumor (Breast Cancer) grows, tumor cells may break away from the main breast tumor and start spreading. These cells cause no symptoms and are undetectable via x-rays. But they can start a new cancer in a different part of the body. The therapy kills these hidden, ninja cells.

Systemic therapy and radiation can be used as adjuvant therapy.
Neo-adjuvant Therapy: This is the treatment given before surgery to shrink/reduce the tumor for the possibility of a less extensive operation. It lowers the chance of a relapse. It includes treatments such as chemotherapy or hormone therapy.

If the therapeutic outcome depends on early diagnosis then can Breast Cancer be Diagnosed early?

Yes, breast cancer can be detected early. Please refer "Can Breast Cancer be detected early? section.

How can I as a patient know it early?

If you feel any of the symptoms mentioned in the Symptoms section (Hyperlink to that part of page), you should probably visit a doctor. You can also get your genetic make-up checked to see if you are prone to breast cancer or not.

How is Breast Cancer Diagnosed?

Diagnostic methods include a screening mammogram and a clinical breast examination. Sometimes, breast cancer can even be diagnosed with a simple self-examination, when you look for lumps on or near your breasts. However, not every change on your breast is a sign of breast cancer. It is advisable to visit the doctor nonetheless as more information is needed for an accurate diagnosis.

Breast Self Examination (BSE) You can use this method at home to check for lumps once a month.

(Adapted from the American Cancer Society by Health Gate Editorial Staff)

If you still menstruate, the best time to do BSE is 2 or 3 days after your period ends. These are the days when your breasts are least likely to be tender or swollen. If you no longer menstruate, pick a certain day—such as the first day of each month—to remind yourself to do BSE.

If you are taking hormones, talk with your doctor about when to do BSE.

Step 1

Stand in front of a mirror that is large enough for you to see your breasts clearly. Check each breast for anything unusual. Check the skin for

  • puckering,
  • dimpling, or
  • scaliness.

Look for a discharge from the nipples.

Steps 2 and 3

Check for changes in the shape or contour of your breasts. As you do these steps, you should feel your chest muscles tighten.

Step 2 – watching closely in the mirror, clasp your hands behind your head and press your hands forward.

Step 3 – press your hands firmly on your hips and bend slightly toward the mirror as you pull your shoulder and elbows forward.

Step 4 – gently squeeze each nipple and look for a discharge.

Step 5 – raise one arm. Use the pads of the fingers of your other hand to check the breast and the surrounding area—firmly, carefully, and thoroughly. Some women like to use lotion or powder to help their fingers glide easily over the skin. Feel for any unusual lump or mass under the skin.

Feel the tissue by pressing your fingers in small, overlapping areas about the size of a dime. To be sure you cover your whole breast, take your time and follow a definite pattern: lines, circles, or wedges.

Pay special attention to the area between the breast and the underarm, including the underarm itself. Check the area above the breast, up to the collarbone and all the way over to your shoulder.

Here are some tips on patterns that you can use:

  • Lines:
    • Start in the underarm area and move your fingers downward little by little until they are below the breast.
    • Then move your fingers slightly toward the middle and slowly move back up.
    • Go up and down until you cover the whole area.
  • Circles:
    • Beginning at the outer edge of your breasts, move your fingers slowly around the whole breast in a circle.
    • Move around the breast in smaller and smaller circles, gradually working toward the nipple.
    • Don't forget to check the underarm and upper chest areas, too.
  • Wedges:
    • Starting at the outer edge of the breast, move your fingers toward the nipple and back to the edge.
    • Check your whole breast, covering one small wedge-shaped section at a time.
    • Be sure to check the underarm area and the upper chest.

Step 6 – repeat step 5 while you are lying down. Lie flat on your back, with one arm over your head and a pillow or folded towel under the shoulder.

Step 7 – you may want to repeat step 5 in the shower. Your fingers will glide easily over soapy skin, so you can concentrate on feeling for changes underneath.

It is recommended that all women over the age of 20 examine their breasts once a month. One must not forget that delaying the diagnosis of breast cancer would not change the diagnosis, it can only worsen the outcome.

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