An understanding of breast cancer and overall breast health is important, no matter your age and where you are in your journey. As part of our initiative for breast cancer awareness month 2024, this october Artemis Hospitals aim to share vital information that equips you with the knowledge necessary to prioritise breast health and navigate a diagnosis.
What is Breast Cancer?
Breast cancer is one of the most common types of cancers that affects women. Breast cancer is caused by the cancerous cells in the breasts which multiply and develop into a tumor. Such tumors are invasive and have the potential risk of spreading from one part of body to other. It typically affects women of age 50 and above, however, it can also affect women who are younger. Men can also develop breast cancer.
Types of Breast Cancer
Doctors determine the subtypes and types of breast cancer in a patient to tailor treatment to be as effective as possible with fewer side effects. The most common types of breast cancer based on the histology are:
IDC (Infiltrating/invasive ductal carcinoma): This type of breast cancer starts in the milk ducts and spreads to the nearby breast tissue.
Lobular breast cancer: This type of breast cancer starts in the lobules or milk-producing glands in the breast and often spreads to the nearby breast tissue.
Ductal carcinoma in situ: Similar to invasive ductal carcinoma, this type of breast cancer starts in the milk ducts. The difference is that ductal carcinoma in situ or DCIS does not spread beyond the milk ducts.
The less common types of breast cancer include:
IBC (Inflammatory breast cancer): This rare and fast-growing type of breast cancer appears with a mass and skin changes.
Paget’s disease of the breast: This rare type of breast cancer affects the skin of the nipple and looks eczema/ulcer. Less than 1% of breast cancers are Paget’s disease of the breast.
Breast Cancer Subtypes
Breast cancer subtypes are classified based on receptor cell status. These receptors are protein molecules found inside or on the surface of the cells. These cells can attract or attach to different hormones like progesterone and estrogen. These hormones help cancerous cells to grow. Detecting if cancerous cells have progesterone or estrogen receptors helps understand the best breast cancer treatment plan.
TNBC (Triple-negative breast cancer), also known as Basal-like breast cancer, is an invasive breast cancer that spreads faster than all the other breast cancers. Common treatments for this breast cancer subtype include; surgery, radiation therapy, chemotherapy and immunotherapy.
Breast Cancer Symptoms
Breast cancer can affect the breasts in a variety of ways. A few of the breast cancer symptoms are highly distinctive while others may be hardly noticeable. Breast cancer symptoms may include:
A change in the shape, size, or contour of the breast.
A lump or mass which may be of variable size, but often tend to grow and are mostly painless.
A change in the look and feel of the skin on the breast or nipple. The skin may appear scaly, inflamed, puckered or dimpled.
A lump in the axilla.
Blood-stained fluid discharge from the nipple.
Ulceration of nipple or skin over breast.
Point to Note: A painless lump in the breast is usually one of the first symptoms of breast cancer in women.
In fact, at the time of diagnosis, a majority of women do not have any apparent signs and symptoms of breast cancer. When the breast tumor is in the early stages, it's rarely noticeable to touch or visible to the naked eye.
Causes of Breast Cancer and Risk Factors
Breast cancer happens when the breast cells mutate and become cancerous cells that divide and multiply to form breast tumors. Even though the factors that trigger this change are unknown, several risk factors may increase the chance of developing breast cancer. These risk factors can be as follows:
Age: Women of the age 55 and above are more likely to develop breast cancer.
Family history: If your parents, children, siblings, or other close relatives have been diagnosed with breast cancer, you’re at a higher risk of developing the cancer.
Genetics: Up to 5-10% of individuals with breast cancer develop the disease because of inherited genetic mutations. The most common genetic mutations in the breast involve BRCA1 and BRCA2 genes.
Early menarche, late menopause and nulliparity are associated with higher risk of breast cancer development.
Smoking: Tobacco use is associated with many different types of cancer, including breast cancer. Also, excessive alcohol consumption may increase the risk of breast cancer.
Exposure to radiation: if an individual has had prior radiation therapy, especially for the chest, head, or neck is more likely to be diagnosed with breast cancer.
HRT (Hormone replacement therapy): People who have undergone hormone replacement therapy are at a higher risk of developing breast cancer.
Obesity: Excess weight or obesity increases the risk of breast cancer. In fact, being overweight or obese after menopause further elevates the breast cancer risk.
Breast Cancer Complications
The most significant sequelae of breast cancer is spread to other organs (metastasis). Breast cancer can spread to other parts of the body including the brain, lungs, liver, and bones.
Breast Cancer Diagnosis
A doctor may perform physical examinations or mammograms to look for signs of breast cancer. Mammograms are an essential diagnostic tool using low-dose X-rays. This type of screening tool shows abnormal tissues in the breast. However, the following tests may be performed to diagnose breast cancer:
1. Breast ultrasound
A breast ultrasound is an imaging test that generates pictures of the inside of the breast. A breast ultrasound may be done if a doctor wants another look at an area that appeared unclear on a mammogram.
2. Breast MRI (magnetic resonance imaging) scan
A breast MRI is an imaging test that produces clear pictures of the breast tissue. A breast MRI is used to evaluate an abnormal breast tissue on mammogram or USG to better characterise the tissue or in a known of breast cancer or after breast implants.
3. Breast biopsy
A breast biopsy is a diagnostic procedure used to confirm if a suspicious area in the breast can be cancerous. These biopsies usually involve a biopsy needle or surgery.
Point to Note: Needle biopsy procedures are relatively safe and do not increase the risk of disease progression or spread.
4. Immunohistochemistry to detect hormone receptors
IHC (Immunohistochemistry) uses antibodies to detect antigens in the tissue. It’s a lab technique that may be used to confirm breast cancer following a biopsy and to study the receptor status.
5. Genetic tests to identify breast cancer-causing mutations
Genetic or DNA tests confirm if someone has hereditary cancer caused by genetic mutations.
Breast Cancer Treatment and Management
Surgery is the primary breast cancer treatment. Breast cancer surgeries may include:
1. Mastectomy
A mastectomy or breast removal surgery is done to remove the entire breast tissue in case an individual is diagnosed with breast cancer or is at a high risk of getting breast cancer.
2. Breast Conservation Surgery or Lumpectomy
A common breast cancer treatment, lumpectomy removes the tumor along with some surrounding healthy breast tissue.
3. Breast reconstruction
Breast reconstruction is a type of surgery to help recreate breasts post a mastectomy. There are several types of breast reconstruction and some of the techniques even use implants. A reconstruction surgery may be done right after a mastectomy or later.
4. Oncoplastic surgery
Breast oncoplastic surgery is a type of breast surgery that combines breast cancer treatment with plastic surgery to reconstruct the breast after cancer removal. It provides better aesthetic appearance of breast without affecting the oncological safety.
5. Sentinel Lymph Node Biopsy
A sentinel lymph node biopsy (SLNB) is a surgical procedure that identifies and removes the sentinel lymph nodes(the first nodes of disease spread) to see if it contains cancer cells. It's a test used to determine if cancer has spread to nearby lymph nodes.
6. Axillary dissection
Axillary lymph nodal dissection is a procedure done to remove the lymph nodes in the armpit. It is a procedure done to identify, examine and remove the lymph nodes in the axilla and is a part of breast cancer surgery and is done in cases where the cancer cells have spread to the axillary nodes.
Doctors may combine surgical procedures with one or more of the below treatments:
7. Chemotherapy
Breast cancer chemotherapy is a type of treatment that may be done before or after surgery. During chemotherapy, a patient may receive more than one type of chemotherapy drug. It works by killing the cancer cells in the body.
8. Radiation therapy
Breast cancer radiation therapy uses high dose of radiation to kill cancer cells in the breast. It is offered to patients after breast cancer surgery to eliminate the remaining cancer cells.
9. Immunotherapy
Immunotherapy for breast cancer treatment works by boosting the immune system to help kill cancerous cells. This type of breast cancer treatment is used to treat some specific subtype of early breast cancer and in metastatic cancer.
10. Hormone therapy
Breast cancer hormone therapy treats HR+ (hormone receptor positive) breast cancer, i.e, the ER+ (estrogen receptor positive) breast cancer.
Breast Cancer Prevention and Early detection
Modifications in daily life can help lower the risk of breast cancer. Here are a few important steps that can be taken to reduce the risk of breast cancer:
Maintaining a healthy weight: Avoid becoming overweight, especially after menopause.
Exercise regularly: Research suggests that physical activity can reduce the risk of breast cancer by at least 10%. Aim for at least 30 minutes of exercise five days a week and work to maintain a healthy weight.
Eating a healthy diet: Eat a diet high in fruits and vegetables, whole grains, and pulses, and low in refined carbohydrates, fatty foods, and sugary drinks.
Breastfeeding: Breastfeeding your children can reduce your risk of breast cancer.
Limiting alcohol: Drinking alcohol is associated with an increased risk of breast cancer.
Avoiding tobacco: Smoking is associated with an increased risk of breast cancer.
Consult a doctor for breast cancer screening: Talk to a doctor about the right time to undergo breast cancer screening and its benefits.
Self-examination for breast awareness: It is crucial to become familiar with your breasts and periodically inspect them to detect a new change such as a lump.
FAQs
1. Is it possible to recover from breast cancer?
Survival rates for breast cancer are generally good, especially if an individual is diagnosed at an early stage.
Survival for breast cancer depends on several factors including:
2. What are the top five warning signs of breast cancer?
The top five warning signs of breast cancer include:
Feeling a lump in the breast with or without pain
Bloody nipple discharge
Swelling and redness in the breast
Dimpling in the breast or nipple
Sudden changes in the size of a breast
3. How to prevent breast cancer?
Here are the top breast cancer prevention tips:
New mothers must consider breastfeeding
Workout to maintain a healthy weight
Limit alcohol consumption
Eat a balanced diet
Quit smoking
Manage stress
4. Is breast cancer painful?
Even though a majority of breast cancers may not cause pain in the breast or nipple, some do. However, some women may experience breast discomfort or pain related to the menstrual cycle or pain may be associated with some non cancerous changes in the breast.
Article By Dr. Preeti Vijayakumaran
Consultant - Oncology
Artemis Hospital