Breast Cancer – Causes, Symptoms, Risk Factors, Diagnosis, Treatment, Complications And Prevention
Breast cancer is an affliction in which the cells that make up the breasts start to grow abnormally and uncontrollably. It is the most frequent type of cancer in women, although lung cancer remains the prime cause of death in both men and women. Approximately 1% of all cases of breast cancer appear in adult males.
Breast Cancer Causes
The exact cause of breast cancer is unknown. Female hormones and old age play an important role in this affection. Breast cancer is more frequent in women over the age of 50. The risk of breast cancer in women between 30 and 40 is approximately 1 in 250 women, while in women between 40 and 50 years old is 1 in 70.
Breast Cancer Symptoms
Early stages of breast cancer are often discovered through mammograms, before any symptoms actually appear. The most frequent symptom is a painless breast nodule, or lump. Mammograms are usually made by radiologists. If further evaluation is needed, patients should see a general surgeon or a surgeon specialized in the breast are. Breast cancer is treated by a surgeon, oncologist and radiotherapist.
Symptoms may include:
- A recently appeared lump at breast or armpit level;
- Slight modifications in shape and size of the breast;
- Breast skin modifications, such as a stain;
- Nipple modifications, retraction or indentation;
- The appearance of crusts on the nipple.
Breast Cancer Risk Factors
The risk of breast cancer grows with age:
- It is rare among women younger than 35;
- All women aged 40 or over 40 have a risk to develop breast cancer;
- Most cases appear at women over 50.
Breast cancer is more frequent in Caucasian women rather than other races. Women who have had breast cancer to one breast may eventually develop the cancer to the other breast as well. The cancer may as well relapse in the same breast, the other breast or other areas of the body, like the lungs, the liver, the brain or the bones.
The risk of breast cancer is higher if the patient’s mother, sister, daughter or close relatives such as cousins have breast cancer antecedents, especially if they were diagnosed before the age of 50. Women who inherit specific genetic mutations in BRCA1 and BRCA2 genes have a much higher risk of breast cancer.
Other factors that increase the risk of breast cancer are:
- Radiotherapy: women that have been exposed to significant amounts of breast level radiation, especially those treated for Hodgkin’s Lymphoma, have a higher risk of breast cancer.
- Advanced age at first childbirth: women who give birth to their first child after the age of 30 have a higher risk of breast cancer.
- Hormones: specialty studies suggest that undergoing hormone substitute therapy for more than 4 years increases the risk of breast cancer. The risk increases during therapy and becomes normal after the therapy is interrupted.
When breast cancer is suspected, confirmation is made through a tissue biopsy. Tissue samples for the biopsy can be obtained through a needle inserted in the lump or near the suspicious looking area seen on the mammography. The sample will be further analyzed under a microscope by a pathologist. Early detection means easier treatment and higher treatment success rates.
The most common methods of detecting breast cancer are:
- Mammography - radiography to the breast that can detect tumors that are too small for doctors to palpate. Specialist doctors recommend regular recurring mammograms, especially for women with a high risk of cancer;
- Clinical breast examination - consisting in the close examination (inspection, palpation) of the breast and armpits in order to find lumps or other abnormal formations.
- Breast self-examination - this is a simple procedure that allows women to detect breast lumps. There is a debate concerning the necessity of self-examination. Studies have failed to show a decrease in the number of deaths cause by breast cancer after using this method. For this reason it is not recommended to replace clinical breast examinations and mammograms with self-examination.
Breast Cancer Diagnosis
If breast cancer is suspected, further tests include:
- Mammography – if not already done;
- Breast ultrasonography - recommended in case the clinical examination or mammography detects a breast lump;
- Tissue biopsy – in case a lump is detected, a small portion of the lump is removed to be examined under a microscope in order to find cancerous cells.
Further tests that can be done if cancerous cells are found include:
- Estrogen and progesterone receptor status – these hormones stimulate the growth of normal breast cells and some cancerous breast cells. The receptors of these hormones can control the growth of cancerous cells;
- HER-2 receptor status – HER-2/neu is a protein that controls the growth of certain cancerous cells;
- CBC (Complete Blood Count) – this test offers important information about blood cells, including red blood cells, white blood cells and blood platelets;
- Biochemical blood tests – these measure the blood level of some specific substances (such as liver transaminase);
- Thoracic radiography – presenting the image of the organs within the thoracic cavity, including the heart, lungs, blood vessels and the diaphragm.
If the doctor suspects a metastatic breast cancer he may recommend additional tests:
- CT (Computed Tomography) – gives detailed images of organs and structures within the thorax, abdomen and pelvis;
- Bone Scintigraphy – used for detecting bone metastases;
- Brain MRI (Magnetic Resonance Imaging) – can be used for detecting metastases at brain level.
Breast Cancer Treatment
Types of treatment include:
- Surgical excision – removal processes are:
- Removal of the nodule while keeping the breast intact;
- Removal of the entire breast (mastectomy);
- Hormone therapy with Tamoxifen or an aromatease inhibitor;
- Biological therapy with monoclonal antibodies that block the HER-2 protein (this therapy is sometimes used to treat breast cancer that has spread to other parts of the body).
Treatment is usually surgical, medical and radio-therapeutic.
Decision on the method of treatment is based on a combination of factors including specific information about cancer, patient preferences and health.
When deciding the treatment method, both the doctor and the patient must take into consideration:
- The size and location of the breast cancer;
- The microscopic aspect of the cancerous cells;
- The cancer response to hormone action;
- The presence or absence of cancerous cells in the palpable armpit lymph nodes.
The doctor should also take into account personal preferences and health status of the patients, including the desire to keep the breast, personal and family history of breast cancer and other existing disorders.
Many women with breast cancer require the complete excision of the affected breast. The excision of one or more armpit lymph nodes might be necessary as well. Even if the entire affected area is removed, radiotherapy is required. Chemotherapy and hormone therapy might also be recommended. These two treatment methods can be recommended before the surgical intervention to try to reduce the size of the affected area.
Initial treatment in breast cancer might include surgical intervention, be it mastectomy or the excision of lymph nodes without removal of the breast. Radiotherapy, chemotherapy and hormone therapy are also a part of the initial treatment.
In the case of recent breast cancer diagnose, women experience a variety of emotions. Most experience denial, anger and grief. Other women do not suffer as much. There is no “typical” reaction upon hearing the diagnosis. There are many ways to help women in this situation. Discussions with family and friends can be very helpful. Some women feel better if they are left alone to get over these emotions. If emotions interfere with the ability to make decisions about personal health it is very important to discuss this with the doctor. Cancer treatment centers offer various psychological and financial services. Talking with other women with breast cancer can be very helpful as well.
- Surgical techniques – most cancer patients are subjected to a surgery that extirpates the cancerous lump. Usually some, if not all, lymph nodes are also removed for further microscopic examination in search of cancerous cells.
- Surgical removal of the breasts – removing both breasts (prophylactic mastectomy) reduces the risk of breast cancer in approximately 90% of women who have a significant family history. This decision is best taken after careful assessment of the risk of breast cancer, genetic testing and counseling psychology.
- Surgical removal of ovaries – genetic mutations that increase the risk of breast cancer also increases the risk of ovarian cancer. Hormones synthesized by the ovaries increase the risk of breast cancer as well. Surgical removal of the ovaries (prophylactic oophorectomy) reduces the risk of both breast and ovarian cancer for women with genetic mutations. This decision should be taken after risk assessment, genetic testing and counseling.
After the initial treatment of breast cancer, regular controls are recommended. The interval of time between regular checks will gradually increase for 5 years after the initial treatment, and if nothing is suspected the regular checks will be made once a year.
The ongoing treatment includes:
- Physical examination – the frequency of this examination depends on the general health status and type of breast cancer. Generally, these examinations are made every 3-6 months during the first 3 years and every 6 months for the next 2 years. After 5 years, the examination will be made once a year.
- Mammography – will be made in order to monitor the evolution.
Monthly breast self-examination is recommended after breast cancer treatment. This type of examination can help early detection of recurrence. Early signs may appear near the surgical intervention, in the opposite breast, in the armpit or under the clavicle. In case of recurrence signs there is need for additional tests, such as blood tests, thoracic radiography, CT or MRI.
Tamoxifen is a drug that blocks the effect of estrogen on normal and cancerous breast cells. This drug reduces breast cancer risk in women with an increased risk. However this drug increases the risk for other serous disorders, including endometrial cancer, stroke, venous thrombosis and pulmonary thrombosis. Women that present a high risk of breast cancer should discuss the decision to initiate the treatment with Tamoxifen with their doctor. It is very important to consider both the risks and benefits of this treatment.
During any stage of treatment you can seek additional home treatment to relieve the adverse effects that can accompany breast cancer or its treatment. Doctors can recommend certain drugs or give certain instructions that can be followed at home to relieve symptoms. In general, healthy habits, such as a balanced died, proper sleep and regular exercise is helpful in controlling these symptoms.
- Home treatment for nausea or vomiting includes careful monitoring to detect early signs of dehydration, such as dry mouth, increased saliva consistency and decreased dieresis (a small amount of urine) with dark-yellow urine.
- Home treatment for diarrhea includes resting your stomach and watching for signs of dehydration. Your doctor will recommend use of some anti-diarrheal medication, which can be bought without a prescription.
- Home treatment of constipation includes mild exercise, adequate fluid consumption and a diet rich in vegetables, fruits and dietary fiber.
- Home treatment for fatigue includes enough rest during chemo and radiotherapy. Symptoms must be those that guide during the bed rest. Some patients are forced to deviate from routine, needing only a little more sleep. Fatigue is often worse towards the end or immediately after completion of treatment.
Breast Cancer Complications
Hair loss – can affect the patient emotionally. Not all chemotherapy drugs cause hair loss, while for some women they may cause the thinning of hair, visible only to themselves. Patients should consult their doctor if such side effects occur.
Lymphedema – represents the swelling of the upper limb on the same side as the affected breast and is determined by surgery or radiotherapy. It occurs in 100% of the cases. The risk can be decreased by placing the upper limb at rest and protecting the affected side. Your doctor should be announced as soon redness appears.
Sleep disorders – lifestyle changes might help with this, such as regular sleep times, light exercise during the day, avoiding sleep after lunch, etc.
Diagnosing breast cancer and the need of treatment can be very stressful. A method of reducing stress might be discussing these issues with others. Relaxation techniques can also be helpful.
Feelings can change over time. Adapting to the new changes may require lengthy discussion with your partner and doctor. Doctors can guide cancer patients to specialized organizations that can provide support and information in this matter. Not all cancers and not all types of treatment cause pain. If pain occurs, there are many treatments to relieve it. If the doctor has made recommendations regarding the treatment of pain, patients need to abide.
It is recommended to discuss all these issues with your doctor.
Breast Cancer Prevention
Breast cancer is sometimes linked to certain risk factors. Unfortunately, not all of them can be avoided.
- Diet and lifestyle – diet has been studied as a risk factor for breast cancer. Weight gain, especially after the age of 60 increases the risk. Studies have shown that women who follow a diet rich in fat are more likely to develop breast cancer, compared to those following a low fat diet. Studies also suggest that alcohol consumption slightly increases the risk.
- Hormones – certain hormonal changes affect the risk of cancer. Hormone replacement therapy (administered for the relief of symptoms after menopause) increases the risk of breast cancer. Age at first menstruation of less than 12 and onset of menopause after the age of 55 increases the risk of breast cancer. Studies suggest that young age at first childbirth decreases the risk of breast cancer. Breastfeeding also reduces the risk.
Women who have had breast cancer have an increased risk of developing a new cancer or a second breast cancer (recurrent or metastatic breast cancer). In order to avoid recurrence we recommend regular health checks, which include physical examinations and mammography. If palpable lymph nodes, bone pain or unusual modifications appear in the treated area of a breast cancer patient we recommend an urgent medical consult.