Breast cancer

What is breast cancer?

Breast cancer starts when cells in the breast begin to grow out of control. These cells form a tumor that can be seen via radiological imaging or felt as a lump. The tumor is malignant (cancerous) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. It is said to be benign if it cannot grow beyond the breast.  Breast cancer occurs almost entirely in women, but men can get it, too.

A woman’s chance of being diagnosed with breast cancer is about 1 in 233 when she’s in her 30s and rises to 1 in 8 by the time she’s reached 85. There’s no connection between the size of your breasts and your risk of getting breast cancer, however, women with dense breast tissues tend to present with advanced stages of cancer due to more difficulty in detecting it earlier with clinical breast exams and even mammograms. But all women, regardless of breast size, should commit to routine screenings and checkups.

Types

Most breast cancers begin in the ducts that carry milk to the nipple (ductal cancers). Some start in the glands that make breast milk (lobular cancers)

Roughly 80% of lumps in women’s breasts are caused by benign (noncancerous) changes, cysts, or other conditions. Doctors encourage women to report any changes at all, however, because catching breast cancer early is so beneficial. Your doctor may recommend a mammogram, ultrasound, MRI and/or biopsy to determine whether a lump is cancerous.

Signs and Symptoms

A lump may indicate breast cancer (or one of many benign breast conditions), but women should also be on the alert for other kinds of changes that may be signs of cancer. These include:

  • Swelling
  • Skin irritation or dimpling
  • Breast or nipple pain
  • Nipple retraction (turning inward)
  • Redness, scaliness, or thickening of the nipple or breast skin
  • Discharge (other than breast milk during late pregnancy and lactation) 

Spreading

Breast cancer can spread to underarm lymph nodes and cause swelling there before a tumor in the breast is large enough to be felt. On the other hand, a mammogram may pick up breast cancer that has no outward symptoms at all.

If cancer cells have spread to your lymph nodes, there is a higher chance that the cells could have spread (metastasized) to other sites in your body. The more lymph nodes with breast cancer cells, the more likely it is that the cancer may be found in other organs as well. Because of this, finding cancer in one or more lymph nodes often affects your treatment plan. Usually, a biopsy (surgery to remove one or more lymph nodes) will be needed to know whether the cancer has spread there.

Still, not all women with cancer cells in their lymph nodes develop metastases, and some women can have no cancer cells in their lymph nodes and later develop metastases.

In those with distant spread of the disease to the bones, lymph nodes, lungs or liver, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin and eyes respectively 

Family History

Most women diagnosed with breast cancer have no identifiable risk factors for the disease. But the family-history risks are these: If a first-degree relative (a parent, sibling, or child) has had or has breast cancer, your risk of developing the disease approximately doubles. Having two first-degree relatives with the disease increases your risk even more.

Risk factors

  • Linkages have been noted between exposure to artificial light at night (LAN), suppression of pineal melatonin production and breast & prostate cancers (BC&PC) in humans
  • Chemicals; polychlorinated biphenyls, polycyclic aromatic hydrocarbons, organic solvents
  • obesity
  • lack of physical exercise
  • drinking alcohol
  • hormone replacement therapy during menopause
  • ionizing radiation
  • early age at first menstruation (<11 years) 
  • Late menopause (>52 years) 
  • having children late (>30 years at first full-term pregnancy) or not at all
  • older age
  • Family history. About 5–10% of cases are due to genes inherited from a person’s parents, including BRCA1 and BRCA2 among others

Myths debunked

  • Claims that underwire bras compress the lymphatic system of the breast, causing toxins to accumulate and cause breast cancer, have been widely debunked as unscientific.
  • Annual mammograms expose you to radiation that can increase your risk of cancer. While it’s true that radiation is used in mammography; the amount is so small that any associated risks are tiny when compared to the huge preventive benefits reaped from the test.
  • Despite their importance for breast cancer screening and diagnosis, mammograms fail to detect around 10% to 20% of breast cancers. This is why clinical breast exams and, to some extent, breast self-exams are crucial pieces of the screening process.
  • Having an abortion does not raise your risk of getting breast cancer. Because abortion is believed to disrupt hormone cycles during pregnancy and breast cancer is linked to hormone levels, numerous studies have investigated a causal link—but found no conclusive evidence for one.
  • Breast cancer is not really preventable. Although it is possible to identify risk factors (such as family history and inherited gene mutations) and make lifestyle changes that can lower your risk (reducing or eliminating alcohol consumption, losing weight, getting regular exercise and screenings, and quitting smoking), roughly 70% of women diagnosed with breast cancer have no identifiable risk factors, meaning that the disease occurs largely by chance and according to as-yet-unexplained factors.

Screening

  • Women who are 50 to 74 years old and are at average risk for breast cancer get a mammogram every two years.
  • Women who are 40 to 49 years old should talk to their doctor or other health care professional about when to start and how often to get a mammogram. Women should weigh the benefits and risks of screening tests when deciding whether to begin getting mammograms at age 40.
  • Self breast examinations

 

Pregnancy

Breast cancers can occur during pregnancy at the same rate as breast cancers in non-pregnant women of the same age. Postpartum breast cancer has worse outcomes including an increased risk of distant spread of disease and mortality.

Diagnosing a new cancer in a pregnant woman is difficult, in part because any symptoms are commonly assumed to be a normal discomfort associated with pregnancy.  As a result, cancer is typically discovered at a somewhat later stage than average in many pregnant or recently pregnant women.

Treatment is generally the same except for radiation which is avoided during pregnancy. Elective abortions are not required and do not improve the likelihood of the mother surviving or being cured.

Psychological aspects

The emotional impact of cancer diagnosis, symptoms, treatment, and related issues can be severe. Cancer support groups which provide a supportive environment to help patients cope and gain perspective from cancer survivors are very important.

Not all breast cancer patients experience their illness in the same manner. Factors such as age can have a significant impact on the way a patient copes with a breast cancer diagnosis.

Management

The management of breast cancer depends on various factors, including the stage of the cancer and the age of the patient. Increasingly aggressive treatments are employed in accordance with the poorer the patient’s prognosis and the higher the risk of recurrence of the cancer following treatment.

Breast cancer is usually treated with

  • Surgery with any or combination of the two below
  • Chemotherapy including  Hormone therapy
  • Radiation therapy
  • Immune modulators

A multidisciplinary approach is preferable and usually employed.

Surgery involves the physical removal of the tumor, typically along with some of the surrounding tissue.

Standard surgeries include:

  • Mastectomy: Removal of the whole breast.
  • Quadrantectomy: Removal of one quarter of the breast.
  • Lumpectomy: Removal of a small part of the breast.

Once the tumor has been removed, if the patient desires, breast reconstruction surgery, a type of plastic surgery, may then be performed to improve the aesthetic appearance of the treated site. Alternatively, women use breast prostheses to simulate a breast under clothing, or choose a flat chest. Nipple prosthesis can be used at any time following the mastectomy.

 

Advertisements

Author: Dr Ahmad Abdullah, MBBS, MSc Clinical Pathology

Ahmad is a father, a husband and a poet. He was born and raised in Lagos, Nigeria. He earned his medical degree from the University of Juba, currently in South Sudan. He is interested in medical research and currently practicing in Lagos, Nigeria.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s