Breast cancer is a malignant tumor (a collection of cancer cells) arising from the cells of the breast. Although breast cancer predominantly occurs in women, it can also affect men.
It is the most common invasive cancer in women, and the second main cause of cancer death in women, after lung cancer. Advances in screening and treatment have improved survival rates dramatically since 1989. In 2017, around 252, 710 new diagnoses of breast cancer are expected in women, and around 40,610 women are likely to die from the disease.
Breast cancer is rare in men (approximately 2,400 new cases diagnosed per year in the U.S.) but typically has a significantly worse outcome. This is partially related to the often late diagnosis of male breast cancer when cancer has already spread.
Symptoms are similar to the symptoms in women, with the most common symptom being a lump or change in the skin of the breast tissue or nipple discharge. Although it can occur at any age, male breast cancer usually occurs in men over 60 years of age.
Breast cancer facts
- It is the most common cancer among American women.
- One in every eight women in the United States develops breast cancer.
- There are many types of breast cancer that differ in their capability of spreading (metastasize) to other body tissues.
- The causes are not yet fully known, although a number of risk factors have been identified.
- There are many different types of breast cancer.
- The symptoms and signs include
- a lump in the breast or armpit,
- bloody nipple discharge,
- inverted nipple,
- orange-peel texture or dimpling of the breast’s skin,
- breast pain or sore nipple,
- swollen lymph nodes in the neck or armpit, and
- a change in the size or shape of the breast or nipple.
- It is diagnosed during a physical exam, by self-examination of the breasts, mammography, ultrasound testing, and biopsy.
- Treatment of cancer depends on the type of cancer and its stage (0-IV) and may involve surgery, radiation, or chemotherapy.
Different types of Breast Cancer
There are many types of breast cancer. Some are more common than others, and there are also combinations of cancers.
Some of the most common types of cancer are as follows:
- Ductal carcinoma in situ: The most common type of noninvasive breast cancer is ductal carcinoma in situ (DCIS). This type of cancer has not spread and therefore usually has a very high cure rate.
- Invasive ductal carcinoma: This cancer starts in a duct of the breast and grows into the surrounding tissue. It is the most common form of breast cancer. About 80% of invasive breast cancers are invasive ductal carcinoma.
- Invasive lobular carcinoma: This breast cancer starts in the glands of the breast that produce milk. Approximately 10% of invasive breast cancers are invasive lobular carcinoma.
The remainder of breast cancers are much less common and include the following:
- Mucinous carcinoma is formed from mucus-producing cancer cells. Mixed tumors contain a variety of cell types.
- Medullary carcinoma is an infiltrating breast cancer that presents with well-defined boundaries between the cancerous and noncancerous tissue.
- Inflammatory breast cancer: This cancer makes the skin of the breast appear red and feels warm (giving it the appearance of an infection). These changes are due to the blockage of lymph vessels by cancer cells.
- Triple-negative breast cancers: This is a subtype of invasive cancer with cells that lack estrogen and progesterone receptors and have no excess of a specific protein (HER2) on their surface. It tends to appear more often in younger women and African-American women.
- Paget’s disease of the nipple: This cancer starts in the ducts of the breast and spreads to the nipple and the area surrounding the nipple. It usually presents with crusting and redness around the nipple.
- Adenoid cystic carcinoma: These cancers have both glandular and cystic features. They tend not to spread aggressively and have a good prognosis.
- Lobular carcinoma in situ: This is not cancer but an area of abnormal cell growth that can lead to invasive breast cancer later in life.
The following are other uncommon types of breast cancer:
- Papillary carcinoma
- Phyllodes tumor
- Tubular carcinoma
What causes breast cancer?
There are many risk factors that increase the chance of developing breast cancer. Although we know some of these risk factors, we don’t know the cause of breast cancer or how these factors cause the development of a cancer cell.
We know that normal breast cells become cancerous because of mutations in the DNA, and although some of these are inherited, most DNA changes related to breast cells are acquired during one’s life.
Proto-oncogenes help cells grow. If these cells mutate, they can increase the growth of cells without any control. Such mutations are referred to as oncogenes. Such uncontrolled cell growth can lead to cancer.
How do you get breast cancer?
Some of the breast cancer risk factors can be modified (such as alcohol use) while others cannot be influenced (such as age). It is important to discuss these risks with a health-care provider anytime new therapies are started (for example, postmenopausal hormone therapy).
Several risk factors are inconclusive (such as deodorants), while in other areas, the risk is being even more clearly defined (such as alcohol use).
The following are risk factors:
- Age: The chances of breast cancer increase as one gets older.
- Family history: The risk of breast cancer is higher among women who have relatives with the disease. Having a close relative with the disease (sister, mother, daughter) doubles a woman’s risk.
- Personal history: Having been diagnosed with breast cancer in one breast increases the risk of cancer in the other breast or the chance of additional cancer in the original breast.
- Women diagnosed with certain benign breast conditions have an increased risk of breast cancer. These include atypical hyperplasia, a condition in which there is an abnormal proliferation of breast cells but no cancer has developed.
- Menstruation: Women who started their menstrual cycle at a younger age (before 12) or went through menopause later (after 55) have a slightly increased risk.
- Breast tissue: Women with dense breast tissue (as documented by mammogram) have a higher risk of breast cancer.
- Race: White women have a higher risk of developing breast cancer, but African-American women tend to have more aggressive tumors when they do develop breast cancer.
- Exposure to previous chest radiation or use of diethylstilbestrol increases the risk of breast cancer.
- Having no children or the first child after age 30 increases the risk of breast cancer.
Breastfeeding for one and a half to two years might slightly lower the risk of breast cancer.
- Being overweight or obese increases the risk of breast cancer both in pre- and postmenopausal women but at different rates.
- Use of oral contraceptives in the last 10 years increases the risk of breast cancer slightly.
- Using combined hormone therapy after menopause increases the risk of breast cancer.
- Alcohol use increases the risk of breast cancer, and this seems to be proportional to the amount of alcohol used. A recent study reviewing the research on alcohol use and breast cancer concluded that all levels of alcohol use are associated with an increased risk for breast cancer. This includes even light drinking.
- Exercise seems to lower the risk of breast cancer.
- Genetic risk factors: The most common causes are mutations in the BRCA1 and BRCA2 genes (breast cancer and ovarian cancer genes). Inheriting a mutated gene from a parent means that one has a significantly higher risk of developing breast cancer.
What about antiperspirants or deodorants as causes of breast cancer?
Research has shown that parabens (a preservative used in deodorants) can build up in breast tissues. However, this study did not show that parabens cause breast cancer or that the parabens (which are found in many other products) were linked to the use of deodorants.
A 2002 study did not show any increased risk for breast cancer in women using an underarm deodorant or antiperspirant. A 2003 study showed an earlier age for breast cancer diagnosis in women who shaved their underarms more frequently and used underarm deodorants.
More research is needed to give us the answer about a relationship between breast cancer and underarm deodorants and blade shaving.
There is no sure way to prevent cancer, but some lifestyle decisions can significantly reduce the risk of breast and other types of cancer.
- 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 breastfeeding and the use of HRT following menopause, as these can affect the risk.
Preventive surgery is an option for women at high risk.
Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
Here’s what you should look for:
- Breasts that are their usual size, shape, and color
- Breasts that are evenly shaped without visible distortion or swelling
If you see any of the following changes, bring them to your doctor’s attention:
- Dimpling, puckering or bulging of the skin
- A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)
- Redness, soreness, rash, or swelling
Now, raise your arms and look for the same changes.
While you’re in the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).
Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.
Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.
Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you’ve reached the deep tissue, you should be able to feel down to your ribcage.
Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.
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