Understanding Breast Cancer: An In Depth Guide to the Disease

Breast cancer refers to cancer that starts in the breast. It is an uncontrolled multiplication of abnormal cells and can appear in one or both breasts.

Invasive breast cancer accounts for approximately 80% of all breast cancer cases, which means the cancer has spread outside the breast tissue and to other body parts. Cancer cells sometimes remain confined to their original development place and do not spread to other body parts. This condition is referred to as “in situ.”

Multiple factors are associated with the growing incidence of breast cancer. More than half of the cases have no known risk factors other than age and female sex. Various genetic predispositions make a woman more susceptible to breast cancer.

Women usually complain of a lump in the breast noticed during their daily activities. These lumps are generally painless; hence, they are ignored at times. Regular self-clinical examination helps to detect such lumps at an early stage.

Breast cancer cells usually form a tumour mass that can be detected on a mammogram or ultrasound scan or felt as a lump. It is common in women, but Men can also get Breast Cancer.

What are the types of breast cancer?

There are different kinds of breast cancer, based on which breast cells turn into cancer.

Some breast cancer types are:

Ductal carcinoma – DCIS is referred to as stage 0 breast cancer or intraductal carcinoma. Pre-invasive or non-invasive breast cancer is known as DCIS. It indicates that the duct-lining cells have transformed into cancerous cells but haven’t penetrated the duct walls or the breast tissues around them.
Invasive Breast Cancer: This breast cancer that has broken out to invade the surrounding areas and nearby breast tissues. The two most common are:

Invasive Ductal Carcinoma (IDC): Invasive Ductal Carcinoma or (IDC) breast cancer is common and takes up 80% of Invasive Breast Cancer cases (8/10 Invasive breast cancer cases are Invasive Ductal Carcinoma). IDC occurs in the milk ducts in the breast. It can spread throughout the rest of the body through the lymph nodes and bloodstream.

Invasive Lobular Carcinoma (ILC): Invasive Lobular Carcinoma (ILC) is a kind of breast cancer that starts in the milk-producing glands called lobules. The development of invasive lobular carcinoma is linked to DNA mutations that cause the cells lining the milk-producing glands to proliferate uncontrollably.

Inflammatory breast cancer – Among all the breast cancer cases, Inflammatory Breast Cancer (IBC) comprises only 1% to 5% of all cases. It is believed that the primary cause of IBC is alterations in breast cell DNA, which is typically found in the milk ducts. Afterwards, these cells divide quickly, obstructing lymphatic blood vessels.

Paget Disease of the Breast – In rare cases, breast cancer, known as “Paget disease” of the breast, can affect the skin of the nipples or the surrounding area called the areola. Individuals having Paget’s disease of the breast are most likely (80-90%) to be detected with either ductal carcinoma in situ or invasive ductal carcinoma.

Adenoid Cystic Breast Cancer: Less than 1% of breast cancer cases are due to a rare subtype of invasive ductal carcinoma called adenoid cystic breast cancer. Its cells are very similar to those found in salivary glands and saliva when examined under the microscope.

Apocrine Breast Cancer: Cells that line up the milk ducts can also develop into the rare subtype of invasive ductal carcinoma known as Apocrine breast cancer. What makes apocrine breast cancer different from other types of invasive ductal carcinoma are its cells when examined under the microscope.

Triple-negative breast cancer (TNBC): Triple-negative breast cancer (TNBC) is a kind of breast cancer that makes up around 10-15% of all breast cancer cases. Triple-negative breast cancers multiply and spread more quickly than other types of breast cancer. Therefore, this type of cancer is known to be more aggressive when compared to other forms of breast cancer.

Metastatic Breast Cancer: Since metastatic breast cancer has spread to other parts of the body, such as the lungs, liver, bones, and brain, it is often classified as stage 4 breast cancer. Metastatic breast cancer cells proliferate by penetrating adjacent cells, breaching lymph nodes and blood vessel walls, and circulating throughout the body. Symptoms of metastatic breast cancer vary based on affected body parts and spread.

Metaplastic Breast Cancer: Metaplastic breast cancer also initiate in the milk ducts, like invasive breast cancer. But what distinguishes metaplastic breast cancer from invasive breast cancer is the kind of tumour cells. Metaplastic breast cancer, which comprises less than 1% of breast cancer cases, is an uncommon type.

Other types of breast cancer consist of:

Tubular breast cancer
Cribriform breast cancer
Mucinous breast cancer
Medullary breast cancer
Papillary breast cancer
Phyllodes tumours

What are breast cancer’s signs and symptoms?

Breast cancer symptoms vary among individuals. Some individuals exhibit no symptoms or signs at all.

A few breast cancer signs and symptoms are:

New breast lump or underarm (armpit) lump.
A portion of the breast that is swollen or thickened.
Skin dimpling or irritation on the breasts.
Flaky or red skin on the breasts or nipples.
Nipple pulling or pain in the nipple region.
Other than breast milk, breast discharge, such as blood.
Any difference in the breast size or shape.
Breast pain in any part of the breast.

When should I see a doctor?

Schedule an appointment with your general practitioner if you have any bothersome or unexplained symptoms; the physician might suggest a few diagnostic tests. You will be referred to an oncologist or gynaecologist for additional breast cancer treatment if the tumour is confirmed.

Consult our gynaecologist and oncologists for more details and appropriate breast cancer treatment.

What causes breast cancer?

It is hard to determine the exact cause of breast cancer. There’s no single cause, but it usually results from a combination of our lifestyle habits, genetic and environmental factors.

We can’t predict who will get breast cancer, and it’s hard to identify what might have triggered the occurrence of cancer. However, you can follow specific preventive methods to lessen your chances of getting it.

What are breast cancer risk factors?

Numerous factors increase breast cancer risk. The two significant factors are ageing and being female. Breast cancer is mainly diagnosed in women who are 50 years of age or older. Not all with risk factors get breast cancer, and the impact of each risk factor varies.

The breast cancer risk factors are as follows:

Risks of Breast Cancer That You Cannot Change-

Old age – The risk of breast cancer increases in old age.
Gender – Breast cancer is far more common in women than in men.
Personal or family history – If any close family members have been diagnosed with breast cancer or ovarian cancer, you may be more susceptible to developing breast cancer.
Inherited genes that increase cancer risk – Breast cancer is most commonly associated with genetic mutations related to the BRCA1 and BRCA2 genes.
Dense breast tissues – Dense breasts increase the likelihood of breast cancer and can make breast masses more difficult to detect.
History of menstrual and reproductive health issues – Breast cancer risk factors include early menstruation (before the age of 12), late menopause (after the age of 55), older childbearing age, and never giving birth.

Breast cancer risks related to lifestyle-

Being overweight or obese: Obesity and excess weight can raise the risk of breast cancer, especially after menopause.
Lack of physical activity: Being inactive raises the risk of breast cancer.
Alcohol: Frequent consumption of alcohol raises the risk of breast cancer.
Hormone therapy: During menopause, the use of hormone replacement therapy for longer than five years raises the risk of breast cancer. Additionally, some birth control pills or oral contraceptives also increase the cancer risk.
Childbirth: If you never had biological children, had your first child after the age of 35, or never breastfed, your chances of developing breast cancer increase.
Radiation: Radiation exposure to the chest before age thirty may raise your cancer risk.

What are the breast cancer preventive methods?

To reduce the likelihood of developing breast cancer, it’s possible to combine lifestyle choices and early detection strategies. Although eliminating the risk may not be possible, there are ways to lower it significantly. These steps can help in preventing breast cancer.

Eat a balanced diet.
Control your weight
Exercise regularly
Limit Alcohol Consumption
Don’t smoke
Breastfeed
Regular Screenings and Self-Exams
Know Your Family History
Limit exposure to environmental toxins.
If you are taking, or have been told to take, contraceptive pills or hormone replacement therapy, talk to your healthcare provider regarding benefits and risks.

How to diagnose breast cancer?

The following methods diagnose breast cancer:

Self-examination: An independent examination of your breasts for breast awareness is called a breast self-exam. You use your hands and eyes to detect any changes in the feel and appearance of your breasts, which can help you become more aware of them.

Breast ultrasound scan: It is a safe, painless imaging test used to examine tumours or any abnormalities in the breast.

Digital Mammogram: Mammograms are an essential diagnostic imaging tool for the early detection of breast cancer and other diseases. It serves as a tool for cancer screening and diagnosis.

Breast magnetic resonance imaging (MRI): It produces finely detailed images of the structures inside the breast. It can be used to screen high-risk women for breast cancer, assess the disease’s progression after diagnosis, or further assess abnormalities observed on mammography.

Biopsy: In this test, breast tissue or fluid is removed in order to be examined under a microscope and subjected to additional testing. There are various types of biopsies.

Breast cancer diagnosis

Breast Cancer Staging: What is it?

If you are a patient with breast cancer, your doctor will want to know the extent of the disease. Staging identifies the cancer’s stage and helps doctors decide on a treatment plan for the patient.

The stage explains how the cancer has spread throughout the breast. It also illustrates whether the tumour has affected distant organs or neighbouring lymph nodes.

There are four stages of cancer: 0, 1, 2, 3, or 4. The smaller the number, the less widespread the cancer is. A higher number, such as stage 4, denotes a more advanced form of the disease that has spread outside the breast.

Breast cancer treatment:

Local therapies – Radiation therapy and surgery are used to treat cancer in a particular body area (like the breast); they do not affect other bodily parts.

Systemic therapies – Hormone therapy, targeted therapy, immunotherapy, and chemotherapy (chemo) can reach cancer cells virtually everywhere in the body.

The cancer treatment is dependent upon multiple factors, such as:

Age of the patient
The cancer’s stage and grade
If particular proteins, such as hormone receptors, the HER2 protein, or specific gene alterations, are present in the cancer.
The possibility that a given course of treatment will either help or cure the cancer.
Any other existing health problems.

Breast cancer surgery:

Typical forms of breast surgery include mastectomy, underarm lymph node excision, and conservative breast surgeries. Rebuilding the breast shape is an option for women who undergo breast surgery, either concurrently or after. The term for this is breast reconstruction.

Lumpectomy: The lump and some surrounding normal breast tissues are removed during a lumpectomy. The major part of the breast is preserved.

Mastectomy: It involves removing the whole breast, including all of its connective tissues and fat. The drawback is that radiation therapy will probably be required following surgery.

Reconstructive surgery: Consider having your breast shape restored (breast reconstruction) if you have undergone breast surgery. It’s not carried out to treat cancer. It creates a breast shape that closely resembles your breasts.

If you’re considering reconstruction, talk to a reconstructive surgeon before getting breast surgery. Reconstruction of your breast may be possible either during or after the surgery.

Other breast cancer therapies:

Radiation therapy – The destruction of cancer cells is achieved by radiation using high-energy rays, such as X-rays. Radiation can eliminate any remaining cancerous cells in the breast, chest, or armpit following surgery. It can also be used in some non-breast regions where cancer has metastasised.

There are two primary ways to give radiation:

A machine outside the body directs external beam radiation toward the breast.
Radioactive seeds are inserted directly into the breast tissue surrounding the cancer during brachytherapy.

Radiotherapy side-effects:

The type of radiation used will determine the side effects. Most side effects improve after treatment, but some might stay longer. The side effects are:

Skin changes in the radiation-exposed areas
Feeling tired (fatigue)

Chemotherapy- The term “chemo” refers to using medications to treat cancer. Whether administered intravenously or orally, these cancer drugs enter the bloodstream and are distributed throughout most body parts. Chemotherapy can be administered before, following, or concurrently with surgery.

Drugs are given in rounds or cycles. After every treatment round, there is a pause. Usually, two or more chemotherapy drugs are administered, and therapy frequently lasts for several months.

Chemotherapy side effects: Chemotherapy patients may experience extreme fatigue, nausea, and hair loss. However, once treatment is over, most of these issues will disappear. Most side effects associated with chemotherapy are curable. If you experience any side effects, inform your doctors.

Hormone therapy- Hormone-sensitive breast cancer can be treated with hormone therapy. Hormones are prevented from binding to receptors on cancer cells in certain types of hormone therapy for breast cancer. In certain cases, the amount of hormones produced within the body is reduced.

Receptors for the naturally occurring hormones progesterone or estrogen are the only ones in breast cancers for which hormone therapy is indicated.

Side effects of hormone therapy –

The side effects of all hormone therapies are vaginal dryness, night sweats, and hot flashes. In premenopausal women, hormone therapy may also interfere with the menstrual cycle.

Targeted drug therapy- Specific forms of breast cancer that produce an excessive amount of the HER2 protein might be treated with targeted therapy medications. These medications mainly target cancerous cells and rarely affect healthy body cells. Even if other treatments don’t work, they might. They typically don’t have the same side effects as chemotherapy.

Side effects of targeted drug therapy –

Damage to the heart is a severe side effect of drugs that target the HER2 protein. Your physician will closely monitor you and perform routine cardiac exams.   

Immunotherapy- Immunotherapy can strengthen your body’s defences against breast cancer cells. These medicines can be taken as pills or as a vein infusion.

Side effects of immunotherapy-

When administered intravenously, immunotherapy medications may cause an allergic reaction. Your doctor will watch you closely during and after your treatment to ensure your well-being.

FAQ’S

What is breast cancer, and how does it develop?

The formation of malignant growth in breast tissue refers to breast cancer. It can develop from an uncontrolled proliferation of abnormal cells in the breast that eventually turns into a tumour.

2. What are the common signs and symptoms of breast cancer?

Breast cancer often appears as a lump in the breast or underarms, changes in breast size or shape, discharge from the nipple, skin changes on the breast, and continuous pain.

3. Does every swelling or lump indicate breast cancer?

Most breast lumps are benign or non-cancerous. But, to find out if a breast lump or swelling can be felt and if it’s benign or malignant, one should see a doctor and get examined.

4. Is breast cancer caused by wearing a bra?

The link between breast cancer and bras, particularly padded ones, has been the subject of much debate. Yet, no research or survey has established that using a padded bra can increase your risk of developing cancer.

5. Is it possible to lower the chances of developing breast cancer?

Although there are no known ways to prevent breast cancer, some lifestyle changes can lower the risk. Maintaining a healthy weight, leading an active lifestyle, consuming less alcohol, and timely pregnancy could all help reduce the cancer risk.

6. Can breast pain indicate the presence of breast cancer?

Breast soreness, pain, or mastalgia/mastodynia is typically linked to the period. Many women often mistake it as a symptom of breast cancer. It is uncommon, though, for the pain to be related to cancer. However, consulting a physician is advised if the pain persists for over three weeks.

7. Is mammography imaging painful?

Mammography can cause a little discomfort, but it’s painless. The procedure takes a few moments to complete, and the discomfort is over.

8. Is there any association between breast cancer and implants?

The use of breast implants does not cause breast cancer, and they are not the risk factors for breast cancer.

9. Can men have breast cancer?

Men may also get breast cancer, although this is highly uncommon.

10. Which doctor should I visit if I have a suspicion of having breast cancer?

You can consult an Internal/Family Medicine Doctor, Gynaecologist, Medical Oncologist, Radiation oncologist, or Breast Care Specialist.

Cancer care at Omega hospitals

Omega Hospitals comprises top oncologists in India skilled in delivering patients with the best medical care possible, showing empathy and consideration. The specialists treat breast cancer using a multidisciplinary approach that involves active participation from other medical professionals to treat the illness and promote a speedy recovery.

References-

https://www.hopkinsmedicine.org/health/conditions-and-diseases/breast-cancer

https://www.who.int/news-room/fact-sheets/detail/breast-cancer

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8966510/

https://www.breastcancer.org/treatment/planning/finding-the-right-doctor

https://www.cancerresearchuk.org/about-cancer/breast-cancer/getting-diagnosed/seeing-your-gp