Breast cancer: Symptoms, risk factors, and treatment

By Keno Ekpokpobe

An early diagnosis of breast cancer increases the chance of recovery.

Breast cancer is the most common invasive cancer in women, and the second main cause of cancer death in women, after lung cancer.

Breast cancer can affect men too, but this article will focus on breast cancer in women.

Fast facts on breast cancer:

Here are some key points about breast cancer. More detail is in the main article.

• ·         Breast cancer is the most common cancer among women.

• ·         Symptoms include a lump or thickening of the breast, and changes to the skin or the nipple.

• ·         Risk factors can be genetic, but some lifestyle factors, such as alcohol intake, make it more likely  to happen.

• ·         A range of treatments is available, including surgery, radiation therapy and chemotherapy

• ·         Most breast lumps are not cancerous, but any woman who is concerned about a lump or change should see a doctor.

What is breast cancer?

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.

Symptoms

The first symptoms of breast cancer are usually an area of thickened tissue in the breast, or a lump in the breast or in an armpit.

Other symptoms include:

• a pain in the armpits or breast that does not change with the monthly cycle
• pitting or redness of the skin of the breast, like the skin of an orange
• a rash around or on one of the nipples
• a discharge from a nipple, possibly containing blood
• a sunken or inverted nipple
• a change in the size or shape of the breast
• peeling, flaking, or scaling of the skin on the breast or nipple

Most lumps are not cancerous, but women should have them checked by a health care professional.

Ten risk factors

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. Some of these are preventable.

1. Age

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.

2. Genetics

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.

3. 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.

4. Dense breast tissue

Breast cancer is more likely to develop in higher density breast tissue.

5. Estrogen exposure and breast-feeding

Being exposed to oestrogen 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, oestrogen 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 oestrogen.

6. 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.

7. 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.

8. Radiation exposure

Undergoing radiation treatment for a cancer that is not breast cancer increases the risk of breast cancer later in life.

9. 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.

10. 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.

Diagnosis

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.

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.

Treatment

Treatment will depend on:

• the type of breast cancer
• the stage of the cancer
• sensitivity to hormones
• the patient's age, overall health, and preferences

Surgery

If surgery is needed, the choice will depend on the diagnosis and the individual.

Lumpectomy: Removing the tumor and a small margin of healthy tissue around it can help prevent the spread of the cancer. This may be an option if the tumor is small and likely to be easy to separate from the surrounding tissue.

Mastectomy: Simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy removes muscle from the chest wall and the lymph nodes in the armpit as well.

It could also be sentinel node biopsy, axillary lymph node dissection, reconstruction, radiation therapy or chemotherapy

Prevention

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.

These include:

• 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 for women at high risk.