This article has been reviewed and approved by Dr Niti Raizada for authenticity and medical correctness on 10 May 2020

All about Breast Cancer

Breast cancer occurs when some cells in the breast start multiplying abnormally. While men can also develop breast cancer, it is much more common in women. The risk increases with age. 

Breast cancer can be fatal if not detected and treated at the early stages. It usually starts as a small lump in the breast, usually found during self-examination. 

The easiest and best way to detect early-stage breast cancer is through mammography. 

Risk factors for breast cancer

Some factors increase the risk of breast cancer such as 

  • Gender-Being woman 
  • Age- Your chances of getting breast cancer increase with age. While you have a 1 in 300 chance in your 30's, it becomes a 1 in 30 chance when you reach your 60 years.
  • Personal history- A woman with a previous personal history of breast cancer is four times more prone.
  • Family history- Women who have blood relatives with breast cancer are at very high risk. 
  • Early puberty- An early onset of menstruation (below the age of 12) increases the risk. 
  • Late menopause- Those who attain menopause at a later age are at increased risk. 
  • Prolonged use of oral contraceptives- The risk reduces on discontinuation of the pills. 
  • No Breastfeeding – Breastfeeding helps to reduce the risk of cancer, and hence women with no children are at increased risk.
  • Being obese or overweight
  • Excessive use of alcohol
  • An inactive lifestyle with no exercise

How to check for breast cancer

  • Self-check- It is the easiest and reliable method. You can run your fingers over the contours of your breast to look for any lumps or hard areas. The presence of any explained lumps needs further steps like mammography, biopsy, etc.
  • Mammography- It is a detailed x-ray of the breast tissues from different angles. The x-rays so taken are called as mammograms. By viewing these x-rays, the doctors can identify areas that could be cancerous. These areas or lumps will be subject to biopsy if cancer is suspected.
  • Ultrasound Breast MRI (Magnetic Resonance Imaging) of Breast
  • Biopsy- They will take a small sample of your breast tissue from the area suspected of cancer and look for cancer cells under a microscope. A biopsy is a confirmatory test for breast cancer. It also helps to identify the type of cancer and plan the treatment. 

Stages of Breast Cancer

There are four main stages of breast cancer with some sub-stages. These stages help the doctor in planning the right form of treatment for you.

Stage 0

Stage 0 indicates non-invasive breast cancers, such as DCIS (ductal carcinoma in situ). There is no evidence of cancer cells invading to surrounding tissues.

Stage I

Stage I indicates invasive breast cancers that involves normal surrounding breast tissue. There are two sub-stages here.

Stage IA 

The tumor measures up to 2 cm and has not spread outside the breast. No lymph nodes are involved

Stage IB 

There is no tumor in the breast, but there are small groups of cancer cells measuring up to 2 mm in the lymph nodes

Or  

There is a tumor, but not larger than 2 cm. Cancer cells, less than 2mm, has spread to the lymph nodes now.

Stage II

Stage IIA 

Cancer cells, larger than 2mm, has spread to 1-3 lymph nodes now

Or

The tumor, which measures less than 2 cm, has spread to the axillary lymph nodes

Or

There is a tumor of size between 2 cm and 5 cm, but not spread to the axillary lymph nodes.

Stage IIB 

The tumor size is between 2 cm and 5 cm and has spread to the lymph nodes

 Or

The tumor is larger than 5 cm but not spread to the axillary lymph nodes.

Stage III

Stage IIIA 

The tumor has spread to 4 to 9 lymph nodes 

Stage IIIB 

The tumor has spread to the chest wall or skin of the breast or both.

It may have now spread up to 9 axillary lymph nodes.

Stage IIIC

The tumor has now spread to more than ten lymph nodes. Lymph nodes above or below the collar bone may be involved

Stage IV

Stage IV indicates invasive breast cancers that have spread beyond the breast and to the nearby or distant lymph nodes. It may have also spread to other organs of the body, such as the lungs, bones, liver, or brain

Signs and Symptoms of breast cancer

The symptoms of breast cancer may be different for different people. Certain people may not have any signs at all.

Some of the signs of breast cancer are

  • A new lump in the breast or armpits
  • Abnormal thickening or swelling of all or a part of the breast
  • Irritation or itching in the skin over the breast
  • Dimpling of breast skin.
  • Redness or flakiness of the skin in the nipples or the breast
  • Pulling in of the nipple 
  • Pain in the nipple area
  • Breasts are tender to touch.
  • Abnormal discharges other than breast milk, like blood from the nipples
  • A sudden or gradual change in the size or the shape of the breast
  • Breast cancer treatments

 

While planning treatment for breast cancer, the doctors will consider the following factors.

  • The stage and grade of your cancer 
  • Your general health
  • Your menstrual status- whether you have attained menopause or not
  • Is your cancer sensitive to hormones

 

Treatment includes:

  1. Surgery
  2. Chemotherapy
  3. Biologic Therapy
  4. Radiotherapy
  5. Hormonal Therapy

 

The type of treatment and the order is as per the expression of certain markers like Estrogen Receptors(ER), Progesterone Receptors(PR), Her-2-neu.

In advanced-stage breast cancers, treatment aims to shrink the secondary tumors to bring about remission. 

 

Surgery for breast cancer

There are two main types of surgeries for breast cancers. They are

  1. Breast-conserving surgeries – removes only the cancerous lump or area affected by cancer.
  2. Radical mastectomy – A surgery to remove the whole breast

 

Breast-conserving surgeries

There are many types of breast-conserving surgeries such as

  • Lumpectomy- Only removes the cancerous lump
  • Wide local excision surgery- Here, the surgeon will remove the cancerous area along with a safe margin of healthy breast tissue. 
  • Partial mastectomy - A surgery to remove up to a quarter of the affected breast 

Mastectomy

A mastectomy involves the removal of the entire breast tissue, including the nipple. If cancer has spread to the lymph nodes, you may also have a lymph node dissection.

Radiotherapy for breast cancer

Radiotherapy uses metered doses of radiation to destroy cancer cells. It may also be done after surgery and chemotherapy to kill any remaining cancer cells.

If you are having radiotherapy after surgery or chemotherapy, there will be a gap of around one month to help you recover.These sessions last only a few minutes, and you may have it for 3 to 5 days in a week for 5-6 weeks.

There are two main types of radiation treatments for breast cancers. 

  1. External beam radiation therapy(EBRT)- Radiation is delivered from an external device placed close to the body.
  2. Internal radiation therapy – Also called brachytherapy, this technique involves the placement of radioactive beads or pellets close to the area affected by cancer.

Chemotherapy for breast cancer

Chemotherapy uses medicines to kill cancer cells. You may have this before or after surgery, depending on the size and extent of the tumor.

If done after surgery, to destroy any remaining cancer cells, it is called adjuvant chemotherapy. If done before surgery to shrink the tumor, it is neo-adjuvant chemotherapy. 

Hormone therapy for breast cancer

The naturally occurring hormones fuel the growth of certain types of breast cancers in the body, namely estrogen or progesterone.

These types of cancer are hormone receptor-positive cancers. Hormone therapy aims to lower the levels of hormones in the body and thereby reducing their effects.

Biological therapy for breast cancer 

This treatment uses medicines that increase the immunity of the body and thereby helping it to destroy the cancer cells.

The treatment is common for cancers that are HER2-positive. It is not the right option if you have heart problems or hypertension.

Rehabilitation after breast cancer treatment

The surgical removal of a breast can be very upsetting for a woman as it results in a change in the shape of the body. Breast reconstruction surgery helps to restore the original shape. This surgery uses breast implants or tissues from other parts of the body to reconstruct your breast.

Other side effects like early onset menopause, loss of interest in sexual activity can cause emotional problems. Proper counseling and guidance will help in this situation.

How to prevent breast cancer

As we do not know the proper cause, prevention is not easy. However, you can make some lifestyle changes to reduce the risk. They include

  • Being physically active- Mild to moderate exercises daily can reduce the risk.
  • Breastfeeding- Do not shy away from breastfeeding your children 
  • Limiting the intake of alcohol- Limit the amount of alcohol if you drink
  • Avoiding long-term use of oral contraceptives
  • Avoid long term use of hormone supplements

Breast cancer treatment in India
Breast cancer treatment in India

References / Additional Reading
This article has been reviewed by Dr Niti Raizada for authenticity and medical correctness on 10 May 2020
Dr Niti Raizada
Dr Niti Raizada
MBBS, MD, DM-Medical Oncology, MRCP
Dr. Niti Raizada is a senior Medical Oncologist with over fifteen years of experience in the field. Dr Niti has special interests in the areas of Thoracic, Gastrointestinal, Breast, Gynaecological Oncology, and Bone Marrow Transplants. She did her MBBS at Gandhi Medical College, Bhopal; MD-General Medicine at G R Medical College, Gwalior, DNB-General Medicine from National Board Of Examination,DM from Adyar Cancer Institute Chennai and Fellowship in Hematology from Hammersmith Hospital and Imperial College,London. She is a member of American Society of Clinical Oncology,USA; Royal College of Physicians,Edinburgh,UK; Member of Pharmacy Committee,Member of DNB teaching program in Medical Oncology and European Society of Medical Oncology (ESMO).
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