Breast Cancer - Quick Overview

October 25th, 2007

What is breast cancer?

Breast cancer is cancer that forms in tissues of the breast, usually the ducts (tubes that carry milk to the nipple) and lobules (glands that make milk). The cancer cells can spread (metastasize) to the lymph nodes and other parts of the body. Many people think that only women get breast cancer. But about 1 in every 100 cases of breast cancer occurs in men. So any breast lump in an adult male should be checked. More than 200,000 women are diagnosed with breast cancer every year.

What causes breast cancer?

Doctors do not know exactly what causes breast cancer. But some things are known to increase the chance that you will get it. These are called risk factors. The main risk factors for breast cancer include:

• Age. Most breast cancer occurs in women older than 50, and the risk is greatest in women older than 60
• Family history. If a woman’s blood-related relatives on either her mother or father’s side of the family have had breast cancer, then she is at increased risk for the disease. Having a first-degree relative (mother, sister, daughter) with breast cancer can double a woman’s risk.
• Female hormones. Your risk is higher if you have used hormone replacement therapy for more than 4 years, started your period before age 12, or began menopause after age 55.1
• Genetic predisposition. Women who inherit certain genes called BRCA1 and BRCA2 are more likely to have breast cancer.
• Menstrual periods. Women who begin menstruating at an early age (before age 12) and those who reach menopause after age 55 have an increased risk of breast cancer.
• Radiation exposure. If you received radiation treatments to your chest as a child or young adult, you’re more likely to develop breast cancer later in life. Your risk is greatest if you received radiation as an adolescent during breast development.
• Excess weight. The link between weight and breast cancer risk is controversial. Some studies suggest that overweight (obese) women who gained weight as adults are at an increased risk of developing breast cancer, but women who have been overweight since childhood are not at any significantly higher risk.
• First pregnancy at older age. Women who have their first child after age 30 or who never have a child are at a slightly higher risk for developing breast cancer.
• Smoking. Smoking increases a woman’s chance of developing several types of cancer, including breast cancer.
• Excessive use of alcohol. Breast cancer risk increased between 40 and 70 percent with about two drinks daily

Many women who have risk factors do not get breast cancer. And many women who get breast cancer do not have any known risk factors.

Breast cancer symptoms

• The first symptom of breast cancer for many women is a lump in their breast. But 9 out of 10 breast lumps (90%) are benign. That means they are not cancers.
• A spontaneous clear or bloody discharge from your nipple, often associated with a breast lump
• Retraction or indentation of your nipple
• A change in the size or contours of your breast
• Any flattening or indentation of the skin over your breast
• Redness or pitting of the skin over your breast, like the skin of an orange

How is breast cancer diagnosted?

If a woman has any breast symptoms it is very important that she consult her doctor so that the cause of these symptoms can be found. If breast cancer is found at an early stage this improves the chances of recovery. As a rule, the doctor will ask her a number of questions.
- Does the lump vary in relation to her menstrual cycle?
- What previous breast problems has she had?
- Is there any breast cancer in her family?
- How many children has she had?

Physical examination
Your breasts will be thoroughly examined for any lumps or suspicious areas and to feel their texture, size, and relationship to the skin and chest muscles. Any changes in the nipples or the skin of your breasts will be noted. The lymph nodes under the armpit and above the collarbones may be palpated (felt), because enlargement or firmness of these lymph nodes might indicate spread of breast cancer. Your doctor will also probably do a complete physical exam to judge your general health and whether there is any evidence of cancer that may have spread.

If breast symptoms and/or the results of the physical exam suggest breast cancer might be present, more involved tests will likely be done. These might include imaging tests, looking at samples of nipple discharge, or doing biopsies of suspected areas.

Mammograms
If the patient is over 35 and has not had a breast X-ray within the past year, the doctor may arrange for one to be performed. Breast X-rays are known as mammograms. Mammograms are a good way of identifying abnormalities in the breast, but they don’t always tell whether they are benign or malignant. Further tests are sometimes necessary and these tests include ultrasound and fine needle aspiration cytology (FNAC).

Ultrasound scanning
X-rays do not pass easily through the breasts of young women. Ultrasound scanning, which is familiar to many women by its use to look at babies during pregnancy, can also be used in the breast to tell whether a lump is fluid or solid.

Magnetic Resonance Imaging (MRI)
MRI can be used along with mammograms for screening women who have a high risk of developing breast cancer, or it can be used to better examine suspicious areas found by mammogram. MRI is also used for women who have been diagnosed with breast cancer to better determine the actual size of the cancer and to look for any other cancers in the breast.

MRI scans use radio waves and strong magnets instead of x-rays. The energy from the radio waves is absorbed and then released in a pattern formed by the type of body tissue and by certain diseases. A computer translates the pattern into a very detailed image of parts of the body. A contrast material called gadolinium is often injected into a vein before the scan to better show up details.

Ductogram
This test, also called a galactogram, is sometimes helpful in determining the cause of nipple discharge. In this test a fine plastic tube is placed into the opening of the duct in the nipple. A small amount of contrast medium is injected, which outlines the shape of the duct on an x-ray image and shows if there is a mass inside the duct.

Biopsy
A biopsy is done when mammograms, other imaging tests, or the physical exam finds a breast change (or abnormality) that is possibly cancer. A biopsy is the only way to tell if cancer is really present. During a biopsy, the doctor removes a tissue sample to be looked at under a microscope.

There are several types of biopsies, such as fine needle aspiration biopsy, core (large needle) biopsy, and surgical biopsy. Each type of biopsy has its own advantages and disadvantages. The choice of which to use depends on your specific situation. Some of the factors your doctor will consider include how suspicious the lesion appears, how large it is, where in the breast it is located, how many lesions are present, other medical problems you may have, and your personal preferences. You might want to discuss the advantages and disadvantages of different biopsy types with your doctor.

Needle tests (FNAC)
Inserting a needle into the lump will show whether it is full of fluid (a cyst) or solid. The needle can allow a sample of cells to be removed for examination under the microscope (a process called cytology) and this is a very accurate method of finding out whether the lump is benign or malignant.

If there is an abnormality on the mammogram, but no lump to feel, then using either the X-ray machine or the ultrasound machine, it is possible to guide the needle into the area of abnormality and to obtain enough cells or tissue to obtain a definite diagnosis. The very fine needles used for this procedure give rise to its name.

Treatment methods for breast cancer

The treatment of the disease depends on the tumour type and the stage of disease - how far it has spread to involve either lymph glands or other organs in the body. There are various ways a cancer can be staged and classified.

Local therapy: Surgery and radiation therapy are local treatments. They remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Systemic therapy: Chemotherapy, hormone therapy, and biological therapy are systemic treatments. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic treatments also are used for cancer that has spread.

How can breast cancer be prevented?

You cannot control some things that put you at risk for breast cancer, such as your sex and age. But you can change others. To stay as healthy as you can:

• Eat a healthy diet with lots of fruits, vegetables, and whole grains.
• Be active. Try to get 30 minutes of exercise at least 5 days a week.
• Stay at a healthy weight. Getting regular exercise and watching what you eat can help.
• If you drink alcohol, limit the amount. After menopause, even having one drink a day or less may increase the risk for breast cancer.

Still, there is no sure way to prevent breast cancer, so it is very important to have regular exams and mammograms. Discuss your risk factors with your doctor to find out how often you should have a mammogram.

If you have a strong family history of breast cancer, ask your doctor about genetic testing. A blood test can check for changes in the BRCA genes that may increase your chance of getting breast cancer.

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Entry Filed under: Health