Dr. Rohit R Singh

Cancer is the abnormal, uncontrolled growth of cells in a particular body part. With continued growth, pieces of this tissue travel through the blood to different body parts and continue to grow in the new area. This is known as metastases. Breast cancer is one of the most common forms of cancer and affects about 1 in 8 women in the USA. Read on to know more details of breast cancer – breast anatomy, causes, symptoms, risk factors, detection, prevention, and of course treatment.

Anatomy: The main function of the breast is lactation through its milk-producing tissue that are connected to the nipple by narrow ducts. In addition, there is surrounding connective tissue, fibrous material, fat, nerves, blood vessels and lymphatic channels which complete the structure. This is essential to know as most breast cancers develop as small calcifications (hardened particles) in the ducts or as small lumps in the breast tissue which then continues to grow into cancer. The spread can happen through lymphatic or blood flow to other organs.

Warning signs/symptoms: The following are some symptoms that need to be watched out for if you have a predisposition to breast cancer.

1. A lump in either of the breasts or armpits
2. Change in size, shape, or contour of either breast
3. Redness of your breast or nipple
4. Discharge of clear or bloody fluid
5. Thickening of breast tissue or skin that lasts through a period
6. Altered look or feel of the skin on the breast or the nipple (dimpled, inflamed, scaly, or puckered)
7. One area on the breast that looks very different from the other areas
8. Hardened area under the breast skin

Either one or a combination of these should be an indication to get a detailed checkup done. Early diagnosis results in controlling the disease with minimal treatment and reduced complications.

Causes and risk factors: The exact cause for breast cancer is yet to be pinned down. However, risk factors are clearly identified, and women with risk factors need to watch out for warning signs.

1. Family history: Of all the risk factors, the family history is the most important. Breast cancer runs in families, and if there is a first-degree relative with the breast cancer, the chances of developing it are almost double. Two genes BRCA1 and BRCA2 are the carriers of the disease, and this testing can be done in women to identify if they are at risk.
2. Family history of other cancers: Even if there is no breast cancer, if there are other cancers that run in the family, watch out.
3. Age: Women over 50 are at higher risk of developing breast cancer.
4. Race: Caucasian and Jewish women are at higher risk of breast cancer than African-American women.
5. Hormones: Greater exposure to the female hormone estrogen increases the chances of developing breast cancer. Women who use birth control pills for contraception and hormone replacement after menopause are at a higher risk of developing breast cancer.
6. Gynecologic milestones: Women who have abnormal menstrual milestones need to watch out. These include those who attain menarche before 12 years of age, get pregnant after 30, attain menopause after 55, and have menstrual cycles shorter than 26 days or longer than 29 days.
7. Obesity and alcohol abuse are also likely to increase a woman’s chances of developing breast cancer.

Stages: Starting from stage 0, higher stages indicate advanced disease.

1. Stage 0: The growth which has begun in the milk-producing tissue or the ducts has remained there (in situ) and not spread to any other area, including the rest of the breast.
2. Stage I: The tissue slowly becomes invasive and has begun to affect the surrounding healthy tissue. It could have spread to the fatty breast tissue and some breast tissue may be found in the nearby lymph nodes.
3. Stage II: The cancer at this stage grows considerably or spreads to other parts. There are chances that cancer may grow and also spread.
4. Stage III: It may have spread to the bones or other organs but small amounts are present in up to 9 to 10 of the lymph nodes in the armpits and collar bones which makes it is difficult to fight.
5. Stage IV: The cancer is widespread to far-flung areas like the liver, lungs, bones, and even the brain.

Screening: This is one of the most effective ways to identify the disease in its early stages. This will help in controlling cancer from spreading with minimal treatment.

1. Self-examination: A thorough self-examination to look for changes in terms of shape, size, colour, contour, and firmness should be learned by all women. Watch for any discharge, sores, rashes, or swelling in the breasts, surrounding skin, and nipple. Examine them while standing and when lying down.
2. In most women, annual screening mammograms are advised after the age of 40. However, in women who have a strong family history or genetic makeup, it is advisable to have screening mammograms starting at age 20 every 3 years and then annually from the age of 40.
3. Women in high-risk categories should have screening mammograms every year and typically start at an earlier age.
4. Ultrasound screening can also be given in addition to mammograms.
5. Breast MRI is another way to screen for breast cancer if the risk is greater.

Breast Cancer Prevention: Now that there is so much awareness about causes and risk factors, there are definitely ways to prevent or delay the onset of the disease.

1. Exercise and a healthy diet with reduced amount of alcohol are definitely effective in minimising the chances of developing cancer.
2. Tamoxifen is used in women who are at high risk for breast cancer.
3. Evista (raloxifene) which is used to treat osteoporosis after menopause. It is also widely used in preventing breast cancer.
4. In high-risk women, breasts are surgically removed to prevent the development of cancer (preventive mastectomy).

Treatment: As with all cancers, treatment would depend on the stage at which it is identified and include a combination of chemotherapy, radiation, and surgery. As noted earlier, if you are at risk, look out for warning signs as early diagnosis is the key to maximum recovery.