October is breast cancer awareness month and a great opportunity to find out all the information you might need to know about breast cancer including prevention and treatment.
Breast cancer is a cancer that forms in the cells of the breast; it is the most common invasive cancer in women and the second main cause of cancer death in women, after lung cancer. It can occur in women and rarely in men. Breast cancer usually starts in the inner lining of milk ducts or the lobules that supply them with milk, from there; it can spread to other parts of the body. The exact cause remains unclear but some risk factors make it more likely.
After puberty, a woman’s breast consists of fat, connective tissue, and thousands of lobules, tiny glands that produce milk for breast-feeding. Tiny tubes, or ducts, carry the milk toward the nipple.
In cancer, the body’s cells multiply uncontrollably. It is the excessive cell growth that causes cancer.
Breast cancer can be:
Ductal carcinoma: This begins in the milk duct and is the most common type.
Lobular carcinoma: This starts in the lobules.
Invasive breast cancer is when the cancer cells break out from inside the lobules or ducts and invade nearby tissue, increasing the chance of spreading to other parts of the body.
Non-invasive breast cancer is when the cancer is still inside its place of origin and has not broken out. However, these cells can eventually develop into invasive breast cancer.
The first symptoms are usually an area of thickened tissue in the breast or a lump in the breast or in the armpit.
Other symptoms include:
- A pain in the armpits or breast that does not change with the monthly cycle
- A rash around or on one of the nipples.
- Pitting or redness of the skin of the breast, like the skin of an orange.
- A discharge from a nipple, possibly containing blood
- A change in the size or shape of the breast or nipple.
- A sunken or inverted nipple.
- Peeling or flaking or scaling of the skin on the breast or nipple.
Note however that most lumps are not cancerous but women should have them checked by a healthcare professional.
The risk increases with age. At 20 years, the chance of developing breast cancer in the next decade is 0.6 percent. By the age of 70 years, this figure goes up to 3.84 percent.
If a close relative has or has had, breast cancer, the risk is higher.
Women who carry the BRCA1 and BRCA2 genes have a higher risk of developing breast cancer, ovarian cancer or both. These genes can be inherited. TP53 is another gene that is linked to a greater breast cancer risk.
- A history of breast cancer or breast lumps
Women who have had breast cancer before are more likely to have it again, compared with those who have no history of the disease.
Having some types of benign or non-cancerous breast lumps increases the chance of developing cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.
- Dense breast tissue
Dense breasts have lots of fibrous and glandular tissue, this can make it hard to see a cancer on a mammogram because the cancer can blend in with the normal tissue. Breast cancer is more likely to develop in higher density breast tissue.
- Estrogen exposure and breast-feeding
Being exposed to estrogen for a longer period appears to increase the risk of breast cancer.
This could be due to starting periods earlier or entering menopause later than average. Between these times, estrogen levels are higher.
Breast-feeding, especially for over 1 year, appears to reduce the chance of developing breast cancer, possibly because pregnancy followed by breastfeeding reduces exposure to estrogen.
- Body weight
Women who are overweight or have obesity after menopause may have a higher risk of developing breast cancer, possibly due to higher levels of oestrogen. High sugar intake may also be a factor.
- Alcohol consumption
A higher rate of regular alcohol consumption appears to play a role. Studies have shown that women who consume more than 3 drinks a day have a 1.5 times higher risk.
- Radiation exposure
Undergoing radiation treatment for a cancer that is not breast cancer increases the risk of breast cancer later in life.
- Hormone treatments
The use of hormone replacement therapy (HRT) and oral birth control pills have been linked to breast cancer, due to increased levels of oestrogen. Naturally occurring oestrogen and progesterone have been found to influence the development and growth of some cancers. Because birth control pills contain female hormones, researchers have been interested in determining whether there is any link between these widely used contraceptives and cancer risk.
The results of population studies to examine associations between oral contraceptive use and cancer risk have not always been consistent. Overall, however, the risks of endometrial and ovarian cancer appear to be reduced with the use of oral contraceptives, whereas the risks of breast, cervical, and liver cancer appear to be increased.
- Occupational hazards
In 2012, researchers concluded that exposure to certain carcinogens and endocrine disruptors, for example in the workplace, could be linked to breast cancer.
- Cosmetic implants and breast cancer survival
Women with cosmetic breast implants who are diagnosed with breast cancer have a higher risk of dying from the disease and a 25 percent higher chance of being diagnosed at a later stage, compared with women without implants.
This could be due to the implants masking cancer during screening, or because the implants bring about changes in breast tissue. However more research is required.
A diagnosis often occurs as the result of routine screening, or when a woman approaches her doctor after detecting symptoms.
Some diagnostic tests and procedures help to confirm a diagnosis.
- Breast exam
The physician will check the patient’s breasts for lumps and other symptoms.
The patient will be asked to sit or stand with her arms in different positions, such as above her head and by her sides.
- Imaging tests
A mammogram is a type of x-ray commonly used for initial breast cancer screening. It produces images that can help detect any lumps or abnormalities. Mammography is not prevention, it is a screening test to detect cancer already in the breast but it will not always detect the disease so if you have a personal history of breast cancer, never rely on technology as your sole method of surveillance
A suspicious result can be followed up by further diagnosis. However, mammography sometimes shows up a suspicious area that is not cancer. This can lead to unnecessary stress and sometimes interventions.
An ultrasound scan can help differentiate between a solid mass or a fluid-filled cyst.
An MRI scan involves injecting a dye into the patient, so find out how far the cancer has spread.
A sample of tissue is surgically removed for laboratory analysis. This can show whether the cells are cancerous, and, if so, which type of cancer it is, including whether or not the cancer is hormone-sensitive.
Diagnosis also involves staging the cancer, to establish:
- the size of a tumour
- how far it has spread
- whether it is invasive or non-invasive
- whether it has metastasised, or spread to other parts of the body
Staging will affect the chances of recovery and will help decide on the best treatment options.
Treatment will depend on the Stage of the cancer. The main options include chemotherapy, radiation therapy, surgery, biological therapy and hormone blocking therapy.
There is no sure way to prevent breast cancer, but some lifestyle decisions can significantly reduce the risk of breast and other types of cancer.
- avoiding excess alcohol consumption
- following a healthy diet with plenty of fresh fruit and vegetables
- getting enough exercise
- maintaining a healthy body mass index (BMI)
Women should think carefully about their options for breast-feeding and the use of HRT following menopause, as these can affect the risk.
Preventive surgery is an option considered in special cases for women at high risk. This option should never be embarked upon lightly.
Regular checks and screening can help detect symptoms early. Women should discuss their options with a doctor.
Points to note
- The leading risk factor for breast cancer is simply being a woman and getting older
- Most breast cancer (about 85%) occurs in women who have no family history of breast cancer.
- Men can also get breast cancer about 2150( 1 in 1000) are diagnosed annually
- The risk of overweight women developing breast cancer after menopause is 1.5times higher than in lean women. Obese women are at twice the risk of lean women.
- Exercises reduces breast cancer risk for women of all body types even lean women
- Minimize alcohol intake to control risk
- With eight out of ten breast lumps discovered by women themselves, don’t underestimate the importance of a monthly breast self-exam.
- Quit smoking to control risk of many diseases, including breast cancer. Younger women who smoke have a higher risk of breast cancer than their nonsmoking peers.
- Making responsible health choices: eating a healthy diet, practising stress management techniques that work for you, staying active and minimising your exposure to environmental chemicals all help to reduce risk of developing breast cancer.