Breast Cancer

Overview

Breast cancer is a cancer type that occurs in the tissues of the breasts. While it may affect both men and women, this disease is more common in females. It occurs due to changes in DNA that lead to uncontrolled growth of breast cells, forming malignant tumours.
The main types of breast cancer include ductal carcinoma, lobular carcinoma, and inflammatory breast cancer. The other rare types of cancer include phyllodes tumour, male breast cancer, angiosarcoma and Paget disease or breast.

Factors such as genetics, lifestyle, and hormonal changes may increase the risk of developing the disease. Hence, prompt diagnosis and treatment after you start noticing the symptoms is a must. Even, you can opt for regular screenings, a healthy lifestyle, and self-exams to prevent the onset of this condition.

What is Breast Cancer?

Breast cancer refers to the uncontrolled growth of the cells that are found along the inner lining of breast tissue. This out-of-control growth of cells leads to the formation of tumours. The tumour can be “invasive”, meaning that it spreads to the nearby tissues outside the breast, or “in-situ”, where the tumour does not spread outside the breast region.
Usually, the “in situ” type of tumour is non-cancerous and non-life-threatening. However, in the case of invasive tumours, the cancerous cell mass can spread to the lymph nodes and further metastasis, that is, spread to other body parts through it. About 80% times the breast cancer cases are invasive. Hence, upon noticing symptoms like lumps, changes in breast shape, or abnormal nipple discharge, you must promptly consult a doctor.

While both men and women can develop it, in 99% of cases of breast cancer, women are seen to be affected by it. Only 0.5 to 1% of men are affected due to this condition. Furthermore, the condition is mostly prevalent in women with age 50 or more. Nonetheless, it can also develop in women below the age of 50.

Types of Breast Cancer

Breast cancer can originate from different parts of the breast. Based on this factor, breast cancer can be classified into the following types:

Ductal Carcinoma

Non-invasive breast cancer starts in the cells lining the milk duct of the breasts. The two main types of ductal carcinoma include ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (ICS). In DCIS, cancer cells are confined to the ducts, while in ICS, the cancer cells spread beyond the ducts.

Lobular Carcinoma

It starts in the lobules or milk-producing glands of the breasts, affecting both breasts. In its two main subtypes of breast cancer, lobular carcinoma in situ (LCIS) leads to the confinement of abnormal cells to the lobules, increasing the risk of cancer. However, in invasive lobular carcinoma, the cancer cells spread to the breast tissue.

Inflammatory Breast Cancer

It occurs when abnormal cells block lymph vessels in the breasts’ skin, causing the breast to appear red, warm and swollen. This cancer type spreads rapidly, within months or weeks. It is often hormone receptor-negative, implying this disease cannot be treated with hormone therapies, including tamoxifen.

Triple Negative Breast Cancer

Rare and aggressive breast cancer where the cancer cells are not affected by receptors for estrogen, progesterone or the protein HER2. The absence of these receptors makes hormone therapy ineffective. It spreads rapidly, affecting mostly younger women with a BRCA1 gene mutation. This breast cancer type is aggressive in nature and may be treated with chemotherapy, radiation or surgery.

Hormone Receptor (HR)-Positive Breast Cancer

Invasive breast cancer usually tests positive for high levels of HER2 protein. The presence of the receptors results in the growth of the cancer cells, making the cancer type more responsive to hormone therapies. Common therapies include tamoxifen, which blocks estrogen receptors, and aromatase inhibitors, reducing estrogen production in women post-menopause.

Paget Disease of the Breast

A rare form of breast cancer that affects the skin of the nipple and areola. It often appears as scaly, red, itchy, or irritated skin. Paget disease is usually associated with underlying ductal breast cancer, either in situ or invasive. Early diagnosis and treatment, which may include surgery, radiation, or chemotherapy, are crucial to control this type of cancer.

Phyllodes Tumour

It is a breast tumour type that develops in the connective tissue (stroma) of the breast. These tumours can be benign, borderline, or malignant and tend to grow rapidly. Phyllodes tumours often appear as a painless, fast-growing lump in the breast. Treatment involves surgical removal, sometimes requiring a wide excision or mastectomy, as they tend to recur.

Angiosarcoma

A rare and aggressive cancer that originates in the blood vessels or lymphatic vessels. It can occur in various parts of the body, including the breast. In the breast, angiosarcoma may present as a mass or abnormal changes in the skin. Treatment plans may involve surgery and may be combined with radiation and chemotherapy depending on the tumour's stage and spread.

Male Breast Cancer

Malignant cells grow and multiply in the tissues of the breasts in males. Factors such as family history of breast cancer or gene mutations raise the risk of developing the disease in males. Symptoms may include lumps in the chest or armpit, nipple discharge, reddening or dimpling of breast skin.

Subtypes of Breast Cancer

Breast cancer subtypes are classified by the status of receptor cells, which are protein molecules that attract blood and hormones. The presence of estrogen and progesterone in receptors can cause the growth of cancerous cells. On that basis, the subtypes of breast cancer include the following:

ER Positive (ER+): Have estrogen receptors
PR Positive (PR+): Contain progesterone receptors
HR Negative (HR-): Do not have estrogen or progesterone receptors
HR Positive (HR+): Both progesterone and estrogen receptors
HER2 Positive (HER2+): Contains higher than normal levels of HER2 protein

Symptoms of Breast Cancer

Some common symptoms of breast cancer include flattened or turned inward nipple; lump in breast or thickened area in chest and armpits, persisting through the menstrual cycle; clear fluid or blood-stained nipple discharge; scaling, peeling, crushing or flaking of breast skin; dimpled skin breasts and appearance of marble-like areas on breasts.
Other alarming symptoms may include a change in breast skin colour such as red, pink or purple; change in shape, size and appearance of the breast; breast or nipple pain; swollen lymph nodes; an indented area on your breast; and burns or itches experienced on nipples.

Causes of Breast Cancer

Breast cancer occurs when changes in DNA cause cells lining the breast to grow uncontrollably. The out-of-control growth of the cells primarily occurs due to mutations in BRCA1 and BRCA2 genes. This uncontrollable cell growth forms a tumour that can invade surrounding tissue or spread to other body parts.
Breast cancer usually onsets in the milk ducts (invasive ductal carcinoma) or milk-producing glands (invasive lobular carcinoma). While certain factors like hormones, lifestyle, and genetics increase risk, the exact cause is unclear, and not everyone with risk factors develops this condition.

Risk Factors of Breast Cancer

About 15% of the time the cause of breast cancer is inherited genetic mutations. However, the risk of developing the disease may increase if you are a female and have a family history of breast cancer; experience early menstruation at 12 years; and undergo early menopause at the age of 55. Other risk factors may include being less physically active, taking hormonal therapy after menopause, drinking alcohol or smoking, exposure to radiation therapy, and conceiving at an older age.

Complications of Breast Cancer

The complications of breast cancer may include neurological problems such as confusion, risk of spreading cancer to the lungs and liver, and kidney failure. Other complications may also include lymphedema, spinal cord compression and kidney failure.

Diagnosis of Breast Cancer

A healthcare professional may consider the following diagnostic tests for breast cancer:

Physical Exam: The doctor examines the individual physically, checking for any lumps or abnormalities in the breasts.

Mammogram: It involves X-ray imaging of the breast to confirm cancerous areas or masses.

Ultrasound: Here, sound waves are used to create detailed images of the breast and help distinguish between solid masses and fluid-filled cysts.

Biopsy: In this test, a small tissue sample is taken from lumps or masses in breasts for microscopic analysis to confirm the presence of cancer cells.

MRI: Magnetic resonance imaging gives detailed images of the breasts, that help in the identification of tumours.

Hormone Receptor Test: It determines if the cancer cells have hormone receptors, which can influence treatment options.

The diagnosis of breast cancer mainly involves the confirmation of its occurrence and the stage it is at. The different stages of breast cancer include:

Stage 0: Cancer has not spread from ducts to the breasts
Stage I: Cancerous cells are present near the breast tissue
Stage II: Malignant cells have formed tumours
Stage III: Breast cancer has spread to lymph nodes and nearby tissue
Stage IV: Cancer spreads from breasts to brain, liver, lungs and bones

Treatment for Breast Cancer

The treatment options for breast cancer may include chemotherapy, radiation therapy, targeted drug therapy, immunotherapy and hormone therapy. In some severe cases, a doctor may prescribe surgery to completely cure the condition.

Self Examination for Breast Cancer

To self-examine if you have breast cancer, use your left hand and move your fingers in a circular motion across the outer edge of the breast until reaching the nipple. Use pressure to feel any lumps, hardened knots or thickening. Ensure to squeeze the nipple for any discharge such as milky or bloody.

Preventive Measures for Breast Cancer

Following are the measures that help individuals lower the risk of developing breast cancer:

• Consume a healthy diet including lean protein, whole grains, nuts, fruits and green leafy vegetables
• Stay physically active by doing strength-based exercises, jogging, yoga or aerobics
• Avoid the consumption of alcohol, processed meat, fast food and sugary food
• Breastfeed your baby
• Avoid hormone therapy after menopause

Myths and Facts Related to Breast Cancer

Here are some of the common myths and facts related to breast cancer:

Myth 1: Only women with a family history of breast cancer develop the disease

Fact: While family history plays a part in developing the disease, other factors, such as age, lifestyle habits, and environmental factors, also contribute to its development.

Myth 2: Only women have breast cancer

Fact: 99% of the women tend to be diagnosed with breast cancer. However, 0.5% - 1% of men can also develop the disease, for which they must be aware of the symptoms.

Myth 3: Breast cancer is always associated with a lump

Fact: While lumps in the breast are a symptom of breast cancer, the disease may manifest in other ways including skin dimpling, nipple discharge, or changes in colour and size of breasts.

Myth 4: Only older women are affected by breast cancer

Fact: Age plays a significant role in this case. However, several younger women are also vulnerable to this disease. Regular screening and self-examinations are crucial for prevention.

Myth 5: Wearing a bra causes breast cancer

Fact: No research supports the claim. However, wearing a bra restricts the lymphatic flow through which the cancerous cells spread across the body.