Breast Cancer

Breast Cancer 

Breast Cancer is the second most common cancer in the world. It forms in one or both breasts. It affects mostly older women above age 50. Men can also develop breast cancer but it is quite a rare case. It is also the second leading cause of death in women after lung cancer. 

Types of Breast Cancer

There are several types of breast cancer, which can be categorized based on the specific cells within the breast where the cancer originates. The main types of breast cancer include –

1. Ductal Carcinoma In Situ (DCIS) – DCIS refers to the presence of abnormal cells within the milk ducts of the breast. It is considered a non-invasive form of breast cancer because the abnormal cells have not spread beyond the ducts into the surrounding breast tissue.
2. Invasive Ductal Carcinoma (IDC) – This is the most common type of breast cancer, accounting for about 80% of all breast cancer cases. IDC begins in the breast’s milk ducts and then invades and spreads into the surrounding breast tissue. It can also metastasize to other parts of the body.
3. Lobular Carcinoma In Situ (LCIS) – LCIS is a condition in which abnormal cells develop in the lobules (milk-producing glands) of the breast. It is not considered true cancer but is considered a risk factor for developing invasive breast cancer in the future.
4. Invasive Lobular Carcinoma (ILC) – ILC begins in the lobules of the breast and then spreads to the surrounding breast tissue. It accounts for about 10% of all invasive breast cancer cases. ILC can also metastasize to other parts of the body.

Breast Cancer

5. Inflammatory Breast Cancer (IBC) – IBC is a rare but aggressive form of breast cancer. It is characterized by redness, swelling, warmth, and a pitted appearance of the breast skin. Unlike other types of breast cancer, IBC does not typically present as a distinct lump but as a more diffuse involvement of the breast tissue.

6. Paget’s Disease of the Nipple – Paget’s disease is a rare form of breast cancer that starts in the ducts of the breast and spreads to the nipple and areola (the darker area surrounding the nipple). It often presents with itching, redness, scaling, crusting, and nipple discharge.

In addition to these main types, breast cancer can also be classified based on its hormone receptor status (estrogen receptor-positive or progesterone receptor-positive) and HER2 status (HER2-positive or HER2-negative). These subtypes help guide treatment decisions and determine the effectiveness of hormone therapy and targeted therapies.

The specific treatment and prognosis for each type of breast cancer may vary, and a proper diagnosis and consultation with healthcare professionals are necessary for personalized management and care.

Signs and Symptoms of Breast Cancer

Breast Cancer signs can vary from person to person. The most significant and early signs of breast cancer are –

• Change in shape, size, and color of breast
• A lump in the breast
• Redness of the skin around the nipple or breast
• Discharge or blood stain from nipples
• The hardened area under your skin
• Peeling, scaling, or flaking of breast skin
• Inverted nipple

Causes and Risk Factors of Breast Cancer

The causes of breast cancer are still unknown. However, there are certain risk factors that scientists have researched over the years which can increase your chances of developing breast cancer. The risk factors included are-

• Age – Above the age group of 50 or more.
• Sex – Both men and women are affected by breast cancer. Men have a significantly lower chance of developing breast cancer compared to women.
• Family history and genetics – If you have a family history of parents or siblings who’ve been affected by breast cancer then there is a high likelihood of you getting cancer. Some cancers are also transferred from parents to children through a single abnormal gene.
• Consumption of Alcohol – Drinking alcohol can raise estrogen levels in the human body and can increase the risk of breast cancer in women.
• Smoking – Smoking affects the DNA and increases the human receptor-positive in the breast causing breast cancer. It also has significant side effects too such as sagging of breasts or loose skin in women.
• Obesity – It can increase the estrogen levels in the body due to the formation of excessive fat tissues that increase the chances of getting various types of cancer from ovarian, endometrial, and breast cancer.
• Exposure to Radiation – High-level of exposure to radiation can increase the risk of getting breast cancer early in life.

Diagnosis and Tests

The diagnosis of breast cancer typically involves a combination of clinical examinations, imaging tests, and tissue sampling. Here are the common diagnostic procedures and tests used in the diagnosis of breast cancer –

1. Clinical Breast Examination – A healthcare professional examines the breasts and surrounding areas for any abnormalities, such as lumps, changes in breast shape or texture, or nipple discharge.

2. Mammography – Mammography is a type of X-ray imaging specifically designed to visualize the breast tissue. It can detect abnormal masses or calcifications that may be indicative of breast cancer. Mammograms are commonly used for breast cancer screening in asymptomatic individuals and for further evaluation in cases of suspicious findings.

3. Ultrasound – Ultrasound uses sound waves to create detailed images of the breast tissue. It is particularly useful in distinguishing between solid masses and fluid-filled cysts. Ultrasound is often used in conjunction with mammography for further evaluation of suspicious areas.

4. Magnetic Resonance Imaging (MRI) – MRI uses powerful magnets and radio waves to produce highly detailed images of the breast tissue. It is often used in specific situations, such as for evaluating high-risk individuals or assessing the extent of cancer in the breast.

5. Biopsy – A biopsy is a definitive procedure to obtain a sample of breast tissue for examination under a microscope to determine if cancer is present. There are different types of biopsies –

• Fine-Needle Aspiration (FNA) – A thin needle is used to extract cells or fluid from a suspicious lump or cyst.
• Core Needle Biopsy – A larger needle is used to remove a small cylinder of tissue from the suspicious area.
• Vacuum-Assisted Biopsy – A vacuum-powered device is used to obtain a larger tissue sample.
• Surgical Biopsy – A surgical procedure is performed to remove a portion of the suspicious tissue or the entire lump.

6. Pathology Analysis – The tissue samples obtained from the biopsy are sent to a laboratory, where a pathologist examines them under a microscope. They determine whether cancer is present, the type of cancer, its grade (aggressiveness), and other characteristics that help guide treatment decisions.

Additional tests may be performed to determine the stage of cancer and assess if it has spread to other parts of the body. These tests may include blood tests, imaging scans (such as bone scans, CT scans, or PET scans), and possibly lymph node biopsy.

It is essential to consult with a healthcare professional who will guide you through the diagnostic process and interpret the results accurately. This will allow for appropriate treatment planning based on the specific characteristics of the breast cancer.

Treatment

The treatment of breast cancer depends on several factors, including the stage of cancer, the type of breast cancer, the tumor’s hormone receptor status, HER2 status, overall health, and individual preferences. The primary treatment modalities for breast cancer include –

1. Surgery

• Lumpectomy – Also known as breast-conserving surgery, a lumpectomy involves the removal of the tumor and a small margin of surrounding healthy tissue. This is typically followed by radiation therapy.
• Mastectomy – Mastectomy involves the surgical removal of the entire breast tissue. In some cases, a double mastectomy may be recommended, especially if there is a high risk of cancer recurrence or if it is indicated for genetic or personal reasons.
• Lymph Node Removal – During surgery, nearby lymph nodes may be removed and examined to determine if the cancer has spread.

2. Radiation Therapy – Radiation therapy uses high-energy X-rays or other types of radiation to destroy cancer cells. It is often recommended after lumpectomy or mastectomy to target any remaining cancer cells in the breast, chest wall, or nearby lymph nodes.

3. Chemotherapy – Chemotherapy involves the use of anti-cancer drugs that are given intravenously or orally to destroy cancer cells or prevent their growth. It is commonly used in cases of invasive breast cancer, including before surgery (neoadjuvant chemotherapy) to shrink tumors, or after surgery (adjuvant chemotherapy) to eliminate any remaining cancer cells.

4. Hormone Therapy – Hormone therapy is used when breast cancer cells have hormone receptors (estrogen receptor-positive or progesterone receptor-positive). Medications such as selective estrogen receptor modulators (SERMs) or aromatase inhibitors (AIs) are prescribed to block the effects of estrogen or reduce estrogen production, as hormones can stimulate the growth of hormone receptor-positive breast cancer cells.

5. Targeted Therapy – Targeted therapy is used in cases where breast cancer cells have an overexpression or amplification of the HER2 protein (HER2-positive). Drugs such as trastuzumab (Herceptin), pertuzumab (Perjeta), or other HER2-targeted agents may be administered to specifically target and inhibit the HER2 protein, preventing the growth of cancer cells.

6. Immunotherapy – Immunotherapy is a type of treatment that helps the immune system recognize and destroy cancer cells. It may be used in specific cases of advanced or metastatic breast cancer, particularly those with triple-negative breast cancer.

The specific treatment plan will be personalized based on individual factors and may involve a combination of these treatment modalities. Treatment decisions should be made in consultation with a multidisciplinary team of healthcare professionals, including surgeons, medical oncologists, radiation oncologists, and other specialists.

Additionally, supportive care, including counseling, support groups, and rehabilitation services, plays a vital role in managing the physical and emotional effects of breast cancer treatment. Regular follow-up visits and surveillance are important to monitor for any recurrence or side effects and ensure long-term well-being.

Outlook

In conclusion, breast cancer is a complex disease that affects many individuals worldwide. The outlook for breast cancer has improved over the years due to advancements in early detection, personalized treatment options, and supportive care services. Early detection through regular screenings and self-exams is key to achieving better outcomes. Treatment approaches may include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy, depending on the stage and type of breast cancer. 

Ongoing research and innovation continue to contribute to our understanding of breast cancer and the development of new treatments. It’s important for individuals diagnosed with breast cancer to work closely with their healthcare team to determine the most appropriate treatment plan and receive the necessary support throughout their journey.