Breast Cancer

Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast. Damage to the DNA of these cells results in uncontrolled cell division and growth, and, eventually, sufficient cells accumulate to form a lump.

The cells invade normal surrounding breast tissue and can break off from the primary lump to spread in lymph channels or the blood stream to other organs where secondary lumps (metastases) may form.

The breast is divided into ducts and lobules. The most common form of breast cancer arises from the ducts and is known as invasive ductal carcinoma. Cancers arising from the lobules (invasive lobular carcinomas) are less common.

As with most cancers, the key to successful treatment is early diagnosis before the cancer has had the chance to spread to other organs.

Breast Cancer Causes

The precise reasons why a woman develops breast cancer are still unknown, but are thought to be a combination of genetic, environmental and lifestyle factors. Scientists have now identified many genes which are more likely to be defective in someone with breast cancer. These genes are also blamed for some other cancers. However, genetic abnormalities are currently thought only to be responsible for approximately five per cent of breast cancer cases.

Breast Cancer Risk Factors

Hormones seem to have an important role in breast cancer. Research has shown a link between oestrogen levels (the female sex hormone) and the risk of developing breast cancer. The exact causes of breast cancer have not been clearly identified, but there are certain risk factors:

• Getting older – 80 per cent of breast cancer cases are in postmenopausal women – it’s relatively unusual in younger women.
• Having a significant family history of breast cancer, which may be associated with inherited gene mutations.
• Having no children or women who have their first child later in life.
• Starting your periods early or going through the menopause late.
• Certain types of hormone replacement therapy (HRT) for menopause over a prolonged period – for example, the most recent rates show a slight downturn in incidence for the 50-64 age-group, most likely to be associated with the declining use of hormone replacement therapy (HRT). The risk of breast cancer after stopping HRT seems to fall very quickly.
• Being overweight.
• Drinking excess alcohol.

Breast Cancer and Genetics

Since alterations in genes BRCA1, BRCA2, P53, P65 and ATM were shown to have a role in breast cancer, a rapidly increasing number of genes have been now implicated in its development or progress. These are recorded on the Breast Cancer Gene Database, part of the Tumour Gene Family database.

As a result it is becoming increasingly difficult to say exactly how many cases of breast cancer are inherited or have a genetic element, but probably at least 1 in 20 women are likely to carry a faulty gene that gives them a higher risk than the general population of developing breast cancer. So all women should be ‘breast aware’, and consult their doctor if they notice any changes at all, not just a lump. However, you should be even more wary if you have:

• A relative who was diagnosed under the age of 40.
• A close relative with cancer in both breasts.
• A male relative with breast cancer.
• Two close relatives on the same side of the family diagnosed with breast cancer under 60 or with ovarian cancer.
• Three close relatives diagnosed with breast or ovarian cancer at any age.
• If you come from certain ethnic backgrounds such as the Ashkenazi Jewish community which has a higher incidence of genes which increase the risk.
• If some other uncommon cancers have occurred in family members. For example: ovarian cancer, sarcoma in someone younger than 45, a glioma, or childhood adrenal cancer.
• It may be worth writing out a family health history record, to help you work out patterns of disease that run in the family.

Breast Cancer Prevention

There is an increasing body of evidence to suggest that breastfeeding can protect you against developing breast cancer. It’s not known exactly how this occurs but a large study (150,000 women) by Cancer Research UK in 2002 compared the breastfeeding histories of women who had breast cancer with women who hadn’t.

The results showed that the longer the women had breastfed during their lifetime, the less likely they were to get breast cancer, lowering risk by 4.3 per cent for every year of feeding and by 7 per cent for each child born and fed.

Breast Cancer Symptoms

The most common way that a potential problem is detected is when physical changes are noticed in the breast. The key is for the woman to know what ‘normal’ is – then changes can be noticed. All women should practise breast awareness. This involves getting to know what’s normal for your breasts in terms of look and texture, so you can spot any changes and get them checked as soon as possible.

Signs and Symptoms of Breast Cancer Include:

• Lumps or thickening of the tissue.
• Any flaking skin or discharge from the nipple.
• ‘Tethering’ of the skin, as if it’s being pulled from the inside.
• Any unusual sensation or discomfort.
• A change in outline, shape or size of the breast.
• Remember, although most lumps are harmless and will turn out not to be cancerous, you should still get them checked by a doctor as soon as possible, especially if you’re young.

Breast Cancer Diagnosis

If a lump is found, techniques used to investigate it include using ultrasound and mammogram. Doctors may take a sample of tissue using a needle. This is then analysed to assess whether malignant cells are present and confirm the diagnosis of cancer.

These cancer cells may be tested to see if they carry certain receptors, which may influence the treatments offered. If they carry hormone receptors, it suggests they’re sensitive to female sex hormones and hormone therapies are likely to be used in their treatment.

All patients suspected of having breast cancer must be seen by a hospital specialist within two weeks of an urgent referral by their GP. Some hospitals run ‘one-stop shops’ for rapid assessment of breast lumps where all the examinations can be done on the spot, often with the results available on the same day.

Inflammatory breast cancer (IBC)

IBC is a rare but aggressive type of breast cancer. The cancer cells block the lymph vessels that drain the breast tissue, making the breast swollen and inflamed. Symptoms, which often develop rapidly, include a red, swollen, warm breast, with bruised or pitted skin. The breast can be painful and you may be able to feel a distinct lump. See Breast Cancer Care for more detailed information.

Breast cancer treatment

If cancer is suspected, other investigations such as blood tests, chest x-rays and CT scans may also be done.

Once a diagnosis of breast cancer is confirmed, the exact treatment used, how soon it’s given and how long it takes all depends on several factors, including:

• The stage of the tumour (how far it has spread) and whether there is secondary cancer.
• The receptor status of the breast cancer.
• Fitness and wellbeing.
• If you’ve had the menopause.
• Your own wishes on the treatments you may receive.

Management of breast cancer is a team effort and a number of specialists may be involved including surgeons, oncologists and breast care nurses.

The bigger the tumour relative to the size of the breast, the more likely that a mastectomy will be recommended. In a procedure known as a ‘lumpectomy’, just the cancerous lump is removed. After both kinds of operation, radiotherapy may be given to reduce the chance that the cancer will return. Most women with breast cancer don’t need to have a breast removed.

If the tumour is very large, treatment may be given to reduce its size before the operation takes place. In most cases, the surgeon also removes lymph nodes under the arms to find out if cancer cells have spread into the lymphatic system (a network of vessels which link different parts of the body). If the cancer has reached the lymph nodes, it’s more likely to have spread to other parts of the body.

Hormone therapy – The breast cancer cells may be tested to see if they are oestrogen receptor positive (ER+) – sensitive to oestrogen – and are more likely to grow if the hormone is present. If this is the case, you may be given one of several drugs which block the action of the hormone, restricting the cancer growth. However, as some forms of these drugs produce menopausal symptoms, younger women whose breast cancer is more likely to have spread could be offered a combination of surgery and chemotherapy instead. If oestrogen receptors are not found (ER-) tests may be done for progesterone receptors, although as oestrogen receptors play a more important role than progesterone receptors, the benefits of hormone therapy are less certain is the cells are only progesterone receptor positive (PR+ and ER-). In this case your specialist will discuss with you whether hormone therapy is appropriate for you.

Targeted therapy looks at whether the cancer cells carry the Her2 receptor as they may respond to a group of drugs that block the growth and spread of cancer by interfering with the biology of the cancer cells. The best known of these is the drug trastuzumab (herceptin), which may be used in the treatment of some Her2 positive cancers.

Following breast surgery, or even breast removal, reconstructive surgery is possible to restore the appearance of the breast. This could even be carried out at the same time as mastectomy. Techniques have improved in recent years, and surgeons are able to more closely mimic the appearance of the other breast, giving a normal appearance in clothes.

Some of the techniques employed include the use of implants, fat from other parts of the body, such as the tummy, or even a back muscle which is bent round to form the new breast.

Secondary Breast Cancer

Cells may break away from a breast tumour and spread to another part of the body via the blood or lymph fluid. Often they die, or remain inactive, but sometimes they start to divide and form a new, secondary tumour, which may develop years later. The symptoms of secondary breast cancer very much depend on to which part of the body the cancer cells have spread.

Among the places where breast cancer cells tend to end up are:

• Lymph glands.
• Bones.
• Liver.
• Lungs.
• Brain (although this is less frequent).

Secondary breast cancer often only affects one part of the body. But it’s possible for secondary breast cancer to affect more than one place at a time.

Breast Self-Examination

One of the best ways to detect any physical or visual changes in your breast is through personal screening.

A breast self-examination or BSE allows one to examine their breast tissue to check for any abnormalities. It is the best way to be used as an early detection approach for breast cancer.

No matter how much you may want to write it off as a ‘female’ thing, this should be done by men too at least once every month.

If you have no idea where to begin or even how to do it, follow these simple steps.

Breast Self Examination Steps

Breast Self Examination Step 1:

Begin the self-exam by observing your breasts in a mirror. Your shoulders should be in a straight position and arms placed on the hip area. While gazing in the mirror, look out for these changes.

• Breasts change in usual size, color and shape
• Ensure both breasts are evenly shaped with no visible swelling or distortion
• Puckering, dimpling or bulging of the skin
• Soreness, redness, swelling or rash
• An inverted nipple or a nipple that has changed position

Breast Self Examination Step 2:

After that, try raising your arms and observe if there are any changes as outlined in step 1.

Breast Cancer Self Exam Step 3:

While still in the mirror, carefully inspect your nipples. Do this by looking for any signs of fluid coming out of any of your nipples. It could be yellowish, milky or a watery fluid. Take note. This could be serious or simply nothing.

Breast Cancer Self Exam Step 4:

Next, lie down and examine your left breast by using your right hand and the left hand to feel the right breast. Use a firm and smooth touch using three finger pads of each of your hands. Keep each of the fingers together and must be flat. Try and use a circular motion while covering the entire breast side to side and from top to bottom, and from the cleavage to the armpits.

Following a pattern will make certain you cover the entire breast during the self-examination. For example, you can begin at the nipple and move gently using smaller and larger circular strokes until you reach the outer edges of each of the breasts.

Moving your fingers in rows and vertically is also an excellent strategy. It is known as the up-and-down approach and ensures you cover all the tissues from the front to the back of the breast. Moreover, for the tissue and skin beneath and the deep tissues, you should try and use light to medium pressure.

Not every lump is cause for worry as some are benign and not cancerous

Breast Cancer Self Exam Step 5:

Finally, feel the breast while either sitting or standing. Dampen your skin to make it wet and slippery. Why you may ask? With enough resistance and grip you will be able to feel every part of your breast. Alternatively, you can do this in the shower. Ensure that you cover your entire breast area using the hand movement described in step 4.

For Breast Cancer Examination Take to Consideration

It is worth noting that breast self-examination is an effective screening approach and tool that should be complemented with regular physical examinations by your doctor, an ultrasound, and/or MRI and a mammography. Each of the above-mentioned screening tools works differently and they all have their strengths and weaknesses. For this reason, it is advisable to make use of them regularly to increase the odds of detecting breast cancer in its early stages.

Breast self-examination is easy to use, a no-cost, and convenient tool that a person can use on a regular basis, particularly after the age of 18. It is of the essence that all women should routinely conduct breast-exams as part of their wellbeing.

Should you feel something is off, do not panic. Not every lump is cause for worry. Some of these lumps are benign and not cancerous. Normal hormonal changes or an injury could be the possible cause of a non-cancerous lump. It is the reason why it is important to see a doctor before making any conclusions.