Breast cancer: Symptoms, risk factors and all you need to know

Breast Cancer is the most common cancer observed and diagnosed worldwide. Though it can affect men and women, breast cancer is predominantly diagnosed among women. According to National Cancer registries, breast cancer has been ranked the number one cancer among Indian females, with age adjusted rate as high as 25.8 per 100,000 women and a mortality of 12.7 per 100,000 women.

Breast cancer is caused by DNA mutations, where the cells multiply abnormally and rapidly. The cells affected here are that of the breast tissues. Keeping a check on the early signs of breast cancer and noting changes in the breasts can help early detection. 

One of the major risk factors of breast cancer includes advancing age, medical history, or family history of breast cancer. Diagnosis can be through a breast examination, mammography, ultrasonography, Magnetic Resonance Imaging (MRI) scans, and others. Breast cancer treatment involves everything from surgical removal of lumps or breasts to radiation, hormonal, chemo, and immunotherapy. 

Cancer is a disease that can significantly affect and cripple the body’s tissues and organs. As breast cancer is the most diagnosed cancer type, the entire month of October is marked as breast cancer awareness month, and October 13th, 2022, is a dedicated Metastatic breast cancer awareness day. 

This article deep dives into everything you need to know about breast cancer, its early signs, causes, risk factors, diagnosis, and treatment options. 

Breast Cancer and its types

Breast cancer is defined as the abnormal growth of cells in the breasts that can eventually form mass for cells called tumours. Depending on the specific cells of the breasts that develop cancer, breast cancer can be distinguished into different types.

• Ductal and lobular carcinoma

Most breast cancers are carcinomas or tumours that develop in the epithelial cells lining the organs or tissues. Breast cancer-causing carcinomas are called adenocarcinoma that begins in the milk ducts (Ductal carcinoma) or lobules producing milk (Lobular carcinoma). 

• In situ vs. invasive breast cancers

This categorisation depends on whether the cancer has metastasized (spread). Ductal carcinoma in situ (DICS) and lobular carcinoma in situ (LCIS) refer to the carcinoma breast cancer that has not spread into the surrounding breast tissues. Hence also referred to as intraductal, non-invasive, or pre-invasive breast cancer.

However, invasive lobular carcinoma (ILC) or invasive ductal carcinoma (IDC) is carcinomas that have spread or invaded the nearby breast tissues, accounting for almost 70 to 80% of all breast cancers. 

• Triple-negative breast cancer

An aggressive form of invasive breast cancer, where the cancer cells are devoid of oestrogen or progesterone receptors and cannot produce HER2 protein, making it difficult to treat and accounting for about 15% of breast cancer types.  

• Inflammatory breast cancer

It is another aggressive type of invasive breast cancer, where the cancer proliferation blocks the lymph vessels, making the breasts appear swollen, and accounts for 1-5% of all breast cancer types. 

• Other Less common breast cancer types 

They include Paget disease of the breast (affects the ducts, nipples, and areola), phyllodes tumour (that begins in the connective tissue of the breast), and angiosarcoma (that develops in the cells lining the lymph vessels or blood vessels).

Causes of Breast Cancer

The abnormal cell growth in the breast cells multiplies rapidly and forms a lump or mass of cells called tumours. These abnormal cell growths spread or metastasize to the nearby lymph nodes and adjacent organs. 

Breast cancer predominantly begins in the milk-secreting ducts in the glandular tissues called lobules or other breast cells. Researchers believe that the reason for breast cancer may be due to hormonal, lifestyle, or environmental factors that may have triggered abnormal cell growth and proliferation. 

It is also believed that the complex interaction between the DNA and the triggering factors may also contribute to its onset. This interaction can lead to altered genetic material or DNA that can also be inherited. Researchers estimate that nearly 5 to 10% of breast cancers are linked to genetic mutations passed through the family generations. 

Of the many gene mutations involved in breast cancer, breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) are the common gene variations identified as the reasons for breast cancer in India. Both BRCA1 and BRCA2 genes can significantly increase the risk of breast and ovarian cancer in women and prostate cancer in men.

And so, if you have a family history of breast cancer or are associated with other cancer types, your doctor may recommend blood analysis to verify the presence of BRCA gene mutations. 

Genetic counsellors help review your family history and risk of having the mutation and guide you through the genetic testing procedures essential for breast cancer. 

Risk factors that trigger breast cancer onset

Taking care of your breasts and registering even the slightest changes in breasts stands as a vital part of your breast health. The American Cancer Society recommends regular breast screening and mammograms for people who are at risk of developing breast cancer, including:

• Older age,
• Having a family history of breast tumours or other cancers, 
• Having a personal or medical history of cancer,
• Inheritance of cancer-causing genes,
• Periods starting at a younger age,
• Exposure to radiation,
• Menopause begins at an older age,
• Being overweight or obese,
• Having your first child at an older age,
• Not being able to get pregnant,
• Post-menopausal hormonal therapy,
• And excessive alcohol intake. 

Signs and symptoms of Breast Cancer to keep an eye on

The symptoms of breast cancer stage 1 cannot be easy to recognise, but the most common symptom is a lump or mass found in the breasts. However, it is essential to note that not all lumps or masses formed are cancerous or malignant. A painless, hard lump with irregular sides is more likely to be cancerous. But lumps can be soft, tender, and painful at times. 

Other noticeable symptoms include:

• Swelling of a part of the breast or entire breast even if there is no lump,
• Skin dimpling that looks similar to an orange peel,
• Pain in the breasts and nipples,
• Nipple retraction or inward turning of the nipples,
• Puckering of skin near the nipples,
• Breast skin becomes red, dry, flaky, or thickened,
• Nipple soreness and redness, 
• Nipple discharge that is not breast milk,
• Swelling of lymph nodes under the arms or near the collarbone, 

Although most symptoms are often seen in non-cancerous types, it is necessary to check with the doctor if you observe even one or more signs or symptoms of breast cancer. Early detection of breast cancer can pave the way for better possibilities of successful treatment. 

Breast Cancer: Diagnosis and Treatment

Triple assessment of breast cancer is considered a ‘gold standard’ in diagnosing all palpable breast cancer types. This triple assessment- of breast cancer includes clinical examination, radiological imaging, and pathological tests. 

• Clinical Examination

Physical or breast examination of regions in and around the breasts for nodes, lumps, or any changes.

• Radiological imaging tests

Imaging tests include a mammogram- an X-ray of the breast that helps screen for breast cancer or any abnormality of the breasts, and Breast ultrasound- Sound waves help determine breast cancer lumps, solid mass, or cysts. Breast magnetic resonance imaging (MRI) is also a part of imaging tests- radio waves help create images of the inside of the breast. 

• Pathological investigations

Pathological tests include blood tests to check for blood parameters, hormones, and genetic mutations. Breast tissue biopsy, as per the college of Pathologists or CAP protocol breast tissue evaluation, helps identify the breast tumour type.  

Treatment Options for Breast Cancer

After a detailed evaluation and diagnosis, the doctor will first determine the extent or stage of cancer for a better prognosis and help decide the best treatment option. This is done via a series of tests and scans, such as:

• Complete blood count,
• Mammogram of the other breast,
• MRI Scan,
• Bone scan,
• Computerised tomography (CT) scan,
• Positron emission tomography (PET) scan. 

Based on the condition, your doctor will decide on the tests or a combination of tests needed. Staging cancer range from 0 to 4; 0 shows slow proliferation of cancer cells, and stage 4 or stage 3 breast cancer indicates quicker cancer spread and metastasis to other organs and areas of the body. 

The cancer grading can also be via tumour biomarkers, such as oestrogen, progesterone, HER2, and others. After staging and grading cancer, the doctor will devise a treatment plan that can include the following options. 

• Breast Cancer Surgery

Breast cancer surgery includes, 

• Lumpectomy- Surgery helps remove the lumps and a part of surrounding healthy tissues. 
• Mastectomy- Surgery is done to eliminate the entire affected breast. 
• Sentinel node biopsy- It involves the removal of affected nodes.
• Axillary lymph node dissection- removal of lymph nodes of the armpits. 
• Contralateral prophylactic mastectomy- surgically removing both the breasts to prevent possible cancer risks. 

• Chemotherapy

In chemotherapy, a single drug or a combination of cancer-killing drugs is intravenously administered to eliminate the rapidly growing cancer cells. 

• Immunotherapy

Immunotherapy utilises the immune system to fight cancer. In cancer, the body’s disease-fighting immune system may not attack the cancer cells, as they produce proteins that blind the immune cells. 

Immunotherapy works by uncovering the blinders and strengthening the immune system to fight against cancer cells. Immunotherapy is a proven effective treatment of triple-negative breast cancer, where the cancer cells lack receptors for oestrogen, progesterone, or HER2.

• Targeted therapy

Targeted drug therapy works by countering the specific abnormalities of cancer cells. For instance, several targeted therapy drugs focus on proteins like HER2- overproduced by some breast cancer cells. The excess proteins are breeding grounds for breast cancer cell amplification. Targeted drug therapy can help destroy such cells, can help control cancer cell growth, and prevent healthy cell damage.  

• Hormone therapy

Hormone therapy includes hormone medications or injectables that can help treat breast cancers sensitive to hormones. Hormone therapy can work effectively for specific cancer types, such as oestrogen positive (ER+) and progesterone positive cancers (PR+). Hormone-blocking therapy can be used before or after surgery or other treatments to decrease the possibility of cancer recurrence. If cancer has already spread or metastasized, hormone therapy helps shrink and control cancer spread.

• Radiation therapy

In radiation therapy, high-powered energy beams like X-rays and protons help destroy cancer cells. 

The prognosis of cancer treatment and the combination of treatment options required depends on the staging, grading, and associated health conditions. However, connecting with your doctor to know more and get an accurate diagnosis of your symptoms is always recommended. 

Conclusion

Cancer of the breast or breast cancer is one of the most commonly diagnosed cancers worldwide. Breast cancer reasons can be genetic, hormonal, environmental, or lifestyle factors that can cause DNA mutations in the breast cells, leading to its uninterrupted growth and proliferation. 

Knowing the signs and symptoms of breast cancer and noting possible changes in the breasts and nipples can help in early detection. Early or timely detection and diagnosis of cancer can open windows to a better prognosis and best treatment options. 

If you have observed or experienced one or more signs of breast cancer, get yourself diagnosed without much ado. 

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