October is termed as Breast cancer Awareness month across the globe.After skin & lung cancer, breast cancer is the most common cancer diagnosed in women and rarely in men. Breast cancer is cancer that forms in the cells of the breasts.Its treatment depends on the stage of cancer. It may consist of chemotherapy, radiation, hormone therapy and surgery.
Fortunately, breast cancer is very treatable if you spot it early. Localized cancer (meaning it hasn’t spread outside your breast) can usually be treated before it spreads.
Once the cancer begins to spread, treatment becomes more complicated. It can often control the disease for years.
What is Breast Cancer?
The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.
A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.
Breast cancer is always caused by a genetic abnormality (a “mistake” in the genetic material). However, only 5-10% of cancers are due to an abnormality inherited from your mother or father. Instead, 85-90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and the “wear and tear” of life in general.
Causes Of Breast Cancer: How Did This Happen?
When you’re told that you have breast cancer, it’s natural to wonder what may have caused the disease. But no one knows the exact causes of breast cancer. Doctors seldom know why one woman develops breast cancer and another doesn’t, and most women who have breast cancer will never be able to pinpoint an exact cause. What we do know is that breast cancer is always caused by damage to a cell’s DNA.
Different people have different symptoms of breast cancer. Some people do not have any signs or symptoms at all.
Few warning signs of breast cancer are—
- New lump in the breast or underarm (armpit).
- Thickening or swelling of part of the breast.
- Irritation or dimpling of breast skin.
- Redness or flaky skin in the nipple area or the breast.
- Pulling in of the nipple or pain in the nipple area.
- Nipple discharge other than breast milk, including blood.
- Any change in the size or the shape of the breast.
- Pain in any area of the breast.
Keep in mind that these symptoms can happen with other conditions that are not cancer.
A doctor stage cancer according to the size of the tumor and whether it has spread to lymph nodes or other parts of the body.
There are different ways of staging breast cancer. One way is from stage 0–4, with subdivided categories at each numbered stage. Descriptions of the four main stages are listed below, though the specific substage of a cancer may also depend on other specific characteristics of the tumor, such as HER2 receptor status.
- Stage 0: Known as ductal carcinoma in situ (DCIS), the cells are limited to within the ducts and have not invaded surrounding tissues.
- Stage 1: At this stage, the tumor measures up to 2 centimeters (cm) across. It has not affected any lymph nodes, or there are small groups of cancer cells in the lymph nodes.
- Stage 2: The tumor is 2 cm across, and it has started to spread to nearby nodes, or is 2–5 cm across and has not spread to the lymph nodes.
- Stage 3: The tumor is up to 5 cm across, and it has spread to several lymph nodes or the tumor is larger than 5 cm and has spread to a few lymph nodes.
- Stage 4: The cancer has spread to distant organs, most often the bones, liver, brain, or lungs.
- Age. Women over 50 are more likely to get breast cancer than younger women.
- Race: African American women are more likely than white women to get breast cancer before menopause.
- Dense breasts. If your breasts have more connective tissue than fatty tissue, it can be hard to see tumors on a mammogram.
- Personal history of cancer. Your odds go up slightly if you have certain benign breast conditions. They go up more sharply if you’ve had breast cancer before.
- Family history. If a first-degree female relative (mother, sister, or daughter) had breast cancer, you’re two times more likely to get the disease. Having two or more first-degree relatives with a history of breast cancer increases your risk at least three times. This is especially true if they got cancer before menopause or if it affected both breasts. The risk can also rise if your father or brother was diagnosed with breast cancer.
- Genes. Changes to two genes, BRCA1 and BRCA2, are responsible for some cases of breast cancer in families. About 1 woman in 200 has one of these genes. While they make you more likely to get cancer, they don’t mean you definitely will. If you have a BRCA1 or BRCA2 mutation, you have a 7 in 10 chance of being diagnosed with breast cancer by age 80. These genes also raise your odds of ovarian cancer, and they’re linked to pancreatic cancer and male breast cancer. Other gene mutations linked to breast cancer risk include mutations of the PTEN gene, the ATM gen, the TP53 gene, the CHEK2 gene, the CDH1 gene, the STK11 gene, and the PALB2 gene. These carry a lower risk for breast cancer development than the BRCA genes.
- Menstrual history. Your breast cancer odds go up if:
- Your periods start before age 12.
- Your periods don’t stop until after you’re 55.
- Radiation. If you had treatment for cancers like Hodgkin’s lymphoma before age 40, you have an increased risk of breast cancer.
- Diethylstilbestrol (DES). Doctors used this drug between 1940 and 1971 to prevent miscarriage. If you or your mother took it, your breast cancer odds go up.
- Physical activity The less you move, the higher your chances.
- Weight and diet. Being overweight after menopause raises your odds.
- Alcohol. Regular drinking — especially more than one drink a day — increases the risk of breast cancer.
- Reproductive history.
You have your first child after age 30.
You don’t breastfeed.
You don’t have a full-term pregnancy.
- Taking hormones. Your chances can go up if you:
Use hormone replacement therapy that includes both estrogen and progesterone during menopause for more than 5 years. This increase in breast cancer risk returns to normal 5 years after you stop treatment.
Use certain birth control methods including birth control pills, shots, implants, IUDS, skin patches, or vaginal rings that contain hormones.
Still, most women who are at high risk for breast cancer don’t get it. On the other hand, 75% of women who develop breast cancer have no known risk factors.
There are several different types of breast cancer, including:
- Ductal carcinoma: This begins in the milk duct and is the most common type.
- Lobular carcinoma: This starts in the lobules.
Invasive breast cancer occurs when the cancer cells break out from inside the lobules or ducts and invade nearby tissue. This increases the chance of cancer spreading to other parts of the body.
Noninvasive breast cancer develops when the cancer remains inside its place of origin and has not yet spread. However, these cells can sometimes progress to invasive breast cancer.
If you feel a lump or if something shows up on a mammogram, your doctor will begin the breast cancer diagnosis process.
They’ll ask about your personal and family healthy history. Then, they’ll do a breast exam and order tests that include:
Imaging tests. Your doctor will use these to learn more about your breast.
- Ultrasound. This test uses sound waves to make a picture of your breast.
- Mammogram. This detailed X-ray gives doctors a better view of lumps and other problems.
- Magnetic resonance imaging (MRI). This body scan uses a magnet linked to a computer to create detailed images of the insides of your breasts.
- Biopsy. For this test, the doctor removes tissue or fluid from your breast. They look at it under a microscope to check for if cancer cells and, if they’re there, learn which type they are. Common procedures include:
- Fine-needle aspiration. This is for easy-to-reach lumps or those that might be filled with fluid.
- Core-needle biopsy. This type uses a bigger needle to remove a piece of tissue.
- Surgical (open) biopsy. A surgeon removes the entire lump along with nearby breast tissue.
- Lymph node biopsy. The doctor removes a part of the lymph nodes under your arm to see if the cancer has spread.
- Image-guided biopsy. The doctor uses imaging to guide the needle.The doctor can test your biopsy sample for:
- Tumor features. Is it invasive or in situ, ductal, or lobular? Has it spread to your lymph nodes? The doctor also measures the margins or edges of the tumor and their distance from the edge of the biopsy tissue, which is which is called margin width.
- Estrogen receptors (ER) and progesterone receptors (PR). This tells the doctor if the hormones estrogen or progesterone make your cancer grow. This affects how likely it is that your cancer will come back and what type of treatment is most likely to prevent that.
- HER2. This test looks for the gene human epidermal growth factor receptor 2. It can help cancer grow more quickly. If your cancer is HER2-positive, targeted therapy could be a treatment option for you.
- Grade. This tells the doctor how different the cancer cells look from healthy cells and whether they seem to be slower-growing or faster-growing.
- Oncotype Dx. This test evaluates 16 cancer-related genes and five reference genes to estimate the risk of the cancer coming back within 10 years of diagnosis.
- Breast Cancer Index. This test can help your doctor decide how you need endocrine therapy.
- MammaPrint. This test uses information from 70 genes to predict the risk of the cancer coming back.
- PAM50 (Prosigna). This test uses information from 50 genes to predict if the cancer will spread.
You might get blood tests including:
- Complete blood count (CBC). This measures the number of different types of cells, like red and white blood cells, in your blood. It lets your doctor know if your bone marrow is working like it should.
- Blood chemistry. This shows how well your liver and kidneys are working.
- Hepatitis tests. These are sometimes done to check for hepatitis B and hepatitis C. If you have an active hepatitis B infection, you may need medication to fight the virus before you get chemotherapy. Without it, chemo can cause the virus to grow and damage your liver.
Treatment will depend on several factors, including:
- the type and stage of the cancer
- the person’s sensitivity to hormones
- the age, overall health, and preferences of the individual
The main treatment options include:
- biological therapy, or targeted drug therapy
- hormone therapy
Factors affecting the type of treatment a person has will include the stage of the cancer, other medical conditions, and their individual preference.
If surgery is necessary, the type will depend on both the diagnosis and individual preference. Types of surgery include:
Lumpectomy: This involves removing the tumor and a small amount of healthy tissue around it.
A lumpectomy can help prevent the spread of the cancer. This may be an option if the tumor is small and easy to separate from its surrounding tissue.
Mastectomy: A simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. In some types, a surgeon will also remove the lymph nodes and muscle in the chest wall.
Sentinel node biopsy: If breast cancer reaches the sentinel lymph nodes, which are the first nodes to which a cancer can spread, it can spread into other parts of the body through the lymphatic system. If the doctor does not find cancer in the sentinel nodes, then it is usually not necessary to remove the remaining nodes.
Axillary lymph node dissection: If a doctor finds cancer cells in the sentinel nodes, they may recommend removing several lymph nodes in the armpit. This can prevent the cancer from spreading.
Reconstruction: Following mastectomy, a surgeon can reconstruct the breast to look more natural. This can help a person cope with the psychological effects of breast removal.
The surgeon can reconstruct the breast at the same time as performing a mastectomy or at a later date. They may use a breast implant or tissue from another part of the body.
A person may undergo radiation therapy around a month after surgery. Radiation involves targeting the tumor with controlled doses of radiation that kill any remaining cancer cells.
A doctor may prescribe cytotoxic chemotherapy drugs to kill cancer cells if there is a high risk of recurrence or spread. When a person has chemotherapy after surgery, doctors call it adjuvant chemotherapy.
Sometimes, a doctor may choose to administer chemotherapy before surgery to shrink the tumor and make its removal easier. Doctors call this neoadjuvant chemothera
Hormone blocking therapy
Doctors use hormone blocking therapy to prevent hormone sensitive breast cancers from returning after treatment. Hormone therapy may be used to treat estrogen receptor (ER)-positive and progesterone receptor (PR)-positive cancers.
They usually administer hormone blocking therapy after surgery but might sometimes use it beforehand to shrink the tumor.
Hormone blocking therapy may be the only option for people who are not suitable candidates for surgery, chemotherapy, or radiotherapy.
Doctors may recommend a person has hormone therapy for 5–10 years after surgery. However, the treatment will not affect cancers that are not sensitive to hormones.
Examples of hormone blocking therapy medications may include:
- aromatase inhibitors
- ovarian ablation or suppression
- Goserelin, which is a luteinizing hormone-releasing agonist drug that suppresses the ovaries
Hormone treatment may affect fertility.
Targeted drugs can destroy specific types of breast cancer. Examples include:
- trastuzumab (Herceptin)
- lapatinib (Tykerb)
- bevacizumab (Avastin)
Treatments for breast and other cancers can have severe adverse effects. When deciding on a treatment, people should discuss the potential risks with a doctor and look at ways to minimize the side effects.
Facts to know about Breasts
- Breasts contain fat cells, not muscles
- Breast size cannot be altered by any excercise. it can only be altered by painful surgery.
- Breast size depends upon a lot of factors such as harmonalchanges, bodyfat, genetics etc.
- Most of the time when body gains or losses fat, breast size changes.
There are steps every person can take to help the body stay as healthy as possible, such as eating a balanced diet, maintaining a healthy weight, not smoking, limiting alcohol, and exercising regularly . While these may have some impact on your risk of getting breast cancer, they cannot eliminate the risk.
Developing breast cancer is not your or anyone’s fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is not productive.
Regular checks and screening can help detect symptoms early. Women should discuss their options with a doctor.There is no way to prevent breast cancer. However, certain lifestyle decisions can significantly reduce the risk of breast cancer as well as other types.