Breast Health Resources

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Breast Cancer

Do you know every 4 minutes, a woman is diagnosed with breast cancer, worldwide? According to the American Institute for Cancer Research, breast cancer is the most common cancer in women, and overall, the second most common cancer. As per the Indian Council of Medical Research (ICMR) data, every year about 1,00,000 new breast cancer cases are diagnosed in India.

What is breast cancer?

Breast cancer is a type of cancer that develops when breast cells begin to grow and divide abnormally, thereby forming a mass of cells known as a tumor. This tumor is usually seen in a mammogram or felt as a lump. Breast cancer is one of the most common cancers in women. It can also occur in men, although rare.

Breast Anatomy

Several kinds of tissue from the breasts of women and people AFAB. Muscles connect your breasts to your ribs. The three different types of breast tissue in women include:

Glandular: Also called lobules, glandular tissue produces milk for lactation.
Connective or fibrous: This tissue holds glandular and fatty breast tissue in place.
Fatty: This tissue fills in the areas between glandular and connective tissue and determines your breast size.

Men and people AMAB have gynecomastia glandular tissue and fatty tissue. Their glandular tissue contains underdeveloped milk ducts.

There are many different parts to female breast anatomy, including

Adipose tissue: Your breast is mainly made up of fatty tissue (adipose tissue). It extends from your collarbone to your armpit and across your ribcage.

Lobes: Each breast has between 15 to 20 lobes or sections. These lobes surround your nipple like spokes on a wheel.

Glandular tissue (lobules): These small sections of tissue found inside lobes have tiny bulblike glands at the end that produce milk.

Milk (mammary) ducts: These small tubes, or ducts, carry milk from glandular tissue (lobules) to your nipples.

Nipples: The nipple is in the center of your areola. Each nipple has about nine milk ducts, as well as hundreds of nerves.

Areolae: The areola is the circular darker-colored area of skin surrounding your nipple. Areolae have glands called Montgomery’s glands that secrete a lubricating oil. This oil protects your nipple and skin from chafing during breastfeeding.

Blood vessels: Blood vessels circulate blood throughout your breasts, chest and body.

Lymph vessels: Part of your lymphatic system, these vessels transport lymph, a fluid that helps your body’s immune system fight infection. Lymph vessels connect to lymph nodes, which are found under your armpits, in your chest and in other places.

Lymph nodes: Small organs that help fight infection.

Nerves: Nipples have hundreds of nerve endings, which makes them extremely sensitive to touch.

How does breast cancer develop?

In normal conditions, cells are programmed to grow, divide, and die at a specific time in the correct order. However, in some cases, when cells are damaged either due to mutations or inheritance of mutated genes, they develop abnormalities in the genes that instruct the cells how to behave. Over time, the accumulation of these abnormalities causes abnormal cell growth and division.
Breast cancer can develop in any part of the breast. If cancer begins in the ducts then it is referred to as ductal carcinoma, or if it develops within the lobules then it is referred to as lobular carcinoma.

How does breast cancer metastasize?

The primary tumor breaks and travels through the bloodstream or lymphatic system and spreads to nearby organs or distant parts of the body, such as the liver, lungs, bone, or brain. Breast cancer when spreads to other parts of the body is known as metastatic or stage-4 breast cancer. Although metastatic breast cancer can be treated, it cannot be cured.

Types of Breast Cancer

Most types of breast cancers are classified as carcinomas that develop in the epithelial cells. When carcinomas develop in the breast they are specifically referred to as adenocarcinomas. Although, breast cancer is referred to as a single disease, it is categorized into non-invasive and invasive breast cancers based on its origin.

Non-invasive breast cancer (carcinoma in situ): These cancers arise within the milk ducts or lobules, but do not invade the normal cell lining of either the ducts or the lobes. They are further divided into the following types

Ductal carcinoma in situ (DCIS)

It is the most common type of non-invasive breast cancer that develops in the milk ducts of the breast, but do not spread to the surrounding breast tissue.

Lobular carcinoma in situ

This type of cancer originates in the lobules and does not spread to the surrounding breast tissue.

Invasive breast cancers

These are the most common type of breast cancers, which can invade the surrounding breast tissues. The following are the common type of invasive breast cancers

Invasive ductal carcinoma

It is the most common form of invasive ductal carcinoma that originates in cells that line the milk duct and spread to the surrounding breast tissues. During this point, cancer may gradually spread to other parts of the body through the bloodstream or lymphatics.

Invasive lobular carcinoma

This type of cancer accounts for 1 in 10 invasive lobular carcinomas. In this type, cancer originates in lobules and can spread to other parts of the breast or the body.

Inflammatory breast cancer

t is a rare, advanced, and aggressive type of breast cancer that originates in the blood vessels of the skin or lymphatic vessels present in the breast. It if often mistaken as an infection of the breast, which causes a delay in the diagnosis.

Locally advanced breast cancer

It is an invasive form of breast cancer that has spread to a large part of the breast, invading the overlying skin, underlying chest wall, muscle, and the nodes in the armpit.

Metastatic breast cancer

It is the advanced stage where breast cancer has spread into other parts of the body, such as the liver, lungs, brain or bones.

There are many other types of cancers such as papillary carcinoma, mucinous carcinoma, micropapillary carcinoma, tubular carcinoma, medullary carcinomas etc which are less common types of breast cancer.

Some rare types of breast cancer include the following:

Paget’s disease of the nipple: In this type cancer cells originate in the nipple or areola region. People with Paget’s disease may have an underlying in-situ or invasive breast cancer. Scaly, itchy, red, or irritated nipple or areola region is the first sign of Paget’s disease of the nipple. Accurate diagnosis involves a biopsy of the involved area.
Phyllodes tumours: These are the rare type of tumours that accounts for less than one percent of all breast tumours. They develop in the connective tissues of the breast and may rarely spread outside the breast. If malignant, such tumours may spread to the lungs.
Angiosarcoma: This is the rarest form of breast cancer that originates in the lining of the blood vessels and lymph vessels.

Symptoms and Causes

Although the exact cause of breast cancer is unknown, researchers believe gene mutations, hormonal changes or environmental factors can cause cancer. Familial cancers account for approximately 10% of breast cancers. Tumour suppressor genes such as BRCA1, and BRCA2 are normally present in our body, whose function is to slow down cell division, repair DNA mistakes or tell cells when to die. Alterations or mutations in these genes, fail to fix the errors in the cell’s DNA and begin to grow and divide abnormally, thereby leading to breast cancer.

Additionally, there are certain environmental and hormonal factors that gradually increase a person’s risk of developing breast cancer. These risk factors could either be modifiable or non-modifiable

Non-modifiable risk factors include

Age : The risk of breast cancer is more in women aged over 50 years. However, in India, the average age of diagnosis if between 40-49 years.
Family history : The risk of breast cancer in a woman is high if her mother, sister, or daughter, or relatives either on her maternal or paternal side had a history of breast or ovarian cancer.
Genetics : A woman with inherited mutated BRCA1 and BRCA2 genes is at an increased risk of breast cancer.
Breast density : Dense breast comprises of more connective tissue than fatty tissue. Because of this reason, the identification of tumours on a mammogram is difficult. Thus, it increases the chance of breast cancer.
Personal history of breast cancer : The chance of recurrence of breast cancer is higher in women with a history of breast cancer.
History of radiation therapy : Women who underwent radiation therapy to the chest or breast before the age of 30 years are at an increased risk of breast cancer.

Modifiable risk factors include

Alcohol consumption : Consumption of alcohol is linked with increased levels of oestrogen. Oestrogen is a natural female hormone, which instructs the breast cells to grow in an uncontrolled way.
Obesity : Having more body fat increases the levels of oestrogen, which increases the chance of breast cancer.
Diet : A diet rich in fat, unsaturated fatty oils, cholesterol, low in vitamins, greens etc increase the risk of breast cancer. Having a good wholesome diet is essential for lowering the risk.
Sedentary lifestyles : Sitting for too long or doing very minimal physical activity increases breast cancer risk.
Pregnancy : Getting pregnant after the age of 30 years or never having a full-term pregnancy can raise the risk.
Smoking : According to some studies, smoking increases the risk of breast cancer by 21%.
Taking hormonal medications : Using hormone replacement therapy during menopause increases the risk of breast cancer. Consuming oral contraceptive pills for long periods of time increases the risk in certain patients.

Symptoms

Not all patients with breast cancer have the same symptoms. In some cases, the person may not have any warning signs. However, in some cases breast cancer may cause the following signs and symptoms:

A lump in the breast or underarm that does not go away could be the first sign of breast cancer

Swelling in the armpit or near the collarbone, usually caused when breast cancer has spread to lymph nodes

A soft and painless lump, which sometimes cause a prickling sensation

Change in skin colour and texture near the nipple

A flat or inverted nipple

A noticeable change in breast size, texture, and shape

Unusual nipple discharge, could be clear, bloody, brownish or another colour

Having these symptoms does not always indicate breast cancer, they can also occur due to any other conditions. However, if you are noticing any of these signs or symptoms consult a doctor immediately.

Prevention of breast cancer

There is no proven preventive step for breast cancer. Throughout life, people come across several factors that increase their risk. Among them, some factors, such as alcohol consumption, smoking, and a sedentary lifestyle may be changed, whereas some factors, such as getting older and family history cannot be changed. According to WHO, about 30% to 50% of cancer deaths can be prevented by taking certain measures in their day-to-day life to avoid key risk factors.

Early diagnosis is the key for better outcomes and prognosis. Therefore, annual screening (>40years) and monthly self-breast examination are important.

1. Breast self-examination

Self-breast examination must be done every month, usually two days after the menstrual cycle in premenopausal women. Post-menopausal woman can choose any one particular day of the month. This is done to look for any lumps, tenderness, nipple discharge, swellings or any abnormal changes in the size, shape, or texture of breasts.

Steps to do a self-breast examination

Step-1

Keep your shoulders straight and the arms on your hips, now look at your breasts in the mirror. Check if the breasts are in their usual size, shape, and colour. See if the nipples are normal or inverted. Notice the outline of each breast. Also, look for any nipple discharge on slightly squeezing your nipples.

Step-2

Repeat step-1 by raising your arm above the head. Look at your arm pit and under-surface of the breasts for any abnormal findings.

Step-3

Begin this step by lying on your back on a bed in a semi propped position. Place your left hand on the right breast and feel the breast. Keep your finger together and move them in a circular motion with a firm and smooth touch. Make sure that you cover the entire breast tissue. During this step gently squeeze the nipple to check for discharge. Extend the examination to the arm pit. Repeat the same process on the left breast. Please do not pinch your breasts as it is likely that you will find something abnormal on pinching.

Step-4

Most women can feel their breasts better when the skin is wet and slippery. So, this step can be done in the shower. This step can be done either by standing or sitting and using the same hand movement as described in the above step. If you notice anything abnormal on self-examination, make sure to reach out to a doctor near you. If not, please repeat the process on the same day the following month.

2 . Breast cancer screening

It is an effective method to detect breast cancer in the early stage and improve survival rates. Mammography is the best imaging test to screen for breast cancer in healthy women. It uses low doses of X-rays to detect any lumps, which cannot be felt during a physical examination. Screening is encouraged in women above the age of 40 (average risk) and earlier in women with a strong family history of breast or ovarian cancer.

In addition to the above measures, the following steps may help in reducing the risk of breast cancer

Adopting a healthy lifestyle
More than 3 hours of brisk exercise a week.
Maintaining a healthy body weight (>5 servings of vegetables or fruits a day)
Limiting or avoiding alcohol consumption
Smoking cessation
Conceiving at an early age
Breastfeeding, if possible
Avoiding the use of birth control pills, especially after the age of 35 years

Diagnosis

The diagnosis must be initiated immediately on noticing any suspicious lumps or nodules in the breast. Initially, the symptoms, social habits, medical history, menstrual and reproductive history and family history of the patient are reviewed. A physical examination is done to identify lumps and observe any changes in the breast’s size, shape, and colour

To confirm the diagnosis, the patient is recommended to undergo the following tests:

Imaging tests: These help to identify the stage and extent of breast cancer, and may include the following:

Digital Tomosynthesis or 3D mammography

This kind of imaging is a test that combines multiple breast X-rays to create a three-dimensional picture of the breast. It increases the detection of breast cancer by approximately 25% and decreases the false positive callbacks.

Breast ultrasound

Breast ultrasound uses sound waves to produce internal images of the breasts. It helps to detect any lumps or abnormalities in breasts and distinguish cancerous solid mass from a non-cancerous fluid-filled cyst or other kinds of lumps.

Mammograms

A mammogram uses low-dose x-rays to screen breast cancer. It helps in locating the lumps and identifying any other breast abnormalities.

Breast MRI

MRI involves using powerful magnetic fields to create images of the breast to identify lumps that are not visible with other imaging tests. It is mostly recommended in women with dense breast tissue.

Biopsy

Cancer staging is performed using the TNM system to get detailed information about:

Tumor (T): Assessing if the primary tumor has penetrated the breast tissue.
Node (N): Evaluating the presence of cancer in nearby lymph nodes.
Metastasis (M): Determining if cancer has disseminated to distant organs.

Based on TNM staging, breast cancer is divided into the following stages

Stage 0a/0is: cancer cells are confined only in the ducts of the breast tissue, they have not spread to the surrounding breast tissue.
Stage 1: the size of the tumor is up to 2 cm and is confined only to the breast.
Stage 2: the tumor size is 2 to 4 cm and the cancer could have spread to surrounding lymph nodes or the tumor is larger than 5cms but no spread to the axillary nodes or there is no tumour in the breast but only in the lymph nodes.
Stage 3: the tumour size is > 5 cm and cancer has spread to the chest wall or surrounding tissues and surrounding lymph nodes or the tumour is less than 5 cm with large nodes in the armpit. .
Stage 4: cancer has spread to distant organs of the body.

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Myths Vs Facts about Breast Cancer

Like many other conditions that are feared of, breast cancer also is associated with many myths regarding its occurrence, diagnosis, treatment, and management. One needs to dispel these myths and try to understand the disease from a scientific perspective in order to get maximum benefits of the diagnostic and treatment modalities. Here are a few common myths and the associated facts about breast cancer.

Myth 1

I don’t have a family history of breast cancer. So, I don’t have to worry about getting breast cancer.

Myth 2

I don’t have to worry about breast cancer if I follow a healthy lifestyle and exercise.

Myth 3

Wearing a bra, using antiperspirants, hair dyes, and cell phones cause breast cancer.

Myth 4

People with breast cancer always feel a lump in the breasts.

Myth 5

Mammograms are unsafe.

Myth 6

Young women don’t get breast cancer.

Myth 7

Men don’t get breast cancer.

Fact

1 in 100 men get breast cancer. Although the risk of breast cancer is more in women, men can also get it. A hard lump near the nipple and areola region is an important sign of breast cancer in men. Usually, men don’t produce breast-stimulating hormones, hence their breast stays small or flat. In some cases, due to hormonal imbalance or usage of medicine, men may also develop real breast gland tissue, which may increase the risk of breast cancer.

Myth 8

Women with breast implants are at higher risk of breast cancer.

Myth 9

Early-stage breast cancer do not recur.

Myth 10

Breast cancer treatment is the same for all the patients.