Breast Cancer

Overview of breast cancer

Malignancies of any form arise within the body due to abnormal cell growth in specific organs. In due course of time, they might lead to severe clinical complications and even death. Numerous fatalities are reported each year due to different types of cancers. Among them, the most threatening form of cancer that affects lives of millions of women all over the world is “Breast Cancer”. According to research findings by American Cancer Society, nearly 1 million women worldwide are diagnosed with breast cancer each year. At present, breast cancer is one of the leading causes of hospitalization and death throughout the world. Epidemiological studies by World Health Organization (WHO) suggest that nearly 508,000 fatalities are reported each year worldwide due to breast cancer.

What is breast cancer?

Breast cancer is the pathological condition in which cells within the breast grow abnormally and uncontrollably and lead to the formation of masses or lumps called “tumors”.

Breast cancers may occur in any region of the breast.

But normally they originate at the ducts that carry milk to the nipples.

Few other varieties of breast cancer originate from the milk-producing glands.

In the initial stages, breast cancers are limited to the site of origin. But in the more advanced stages, they attack the lymph nodes and gradually progress to remote parts of the body. Nearly 50% of breast cancer cases are reported in underdeveloped countries and 58% of death cases are reported in these countries annually. It is interesting to note that although breast cancer is a disease of women above a certain age, few rare cases of the disease have been observed in men as well.

Causes of breast cancer

Numerous environmental and physiological factors account for breast cancer in women. These are elaborated below-

Heredity: A familial history of breast cancer increases the risks of breast cancer in the future generations. These are mainly caused by mutated variants of certain genes such as BRCA (BRCA1 and BRCA2), ATM, TP53, CHEK2and PTEN. Nearly 15% of women suffering from breast cancer have an ancestral history of the disease.

Ethnicity: African American women are more prone to breast cancer conditions than Native Americans, Hispanic and Asian women.

Breast tissues: Presence of more fibrous and glandular tissues and less fatty tissues increases the overall breast tissue density. Women having high breast tissue density are 1.2 to 2.2 times more likely to develop breast cancer than normal women. This condition is precipitated by multiple factors such as age, genes, menopause, and medications.

Radiation: Unprotected exposure to strong radiations (X-rays and other ionizing radiations) due to some past diseases or some existing cancer conditions can pose as a primary risk factor for breast cancers in future. These risks are highest when the patients receive radiations at the peak age of breast development (early teenage or adolescence) since these radiations adversely affect few of the hormones responsible for breast growth.

Medications: Birth control pills or pills taken during pregnancy period can increase chances of breast cancer. One such drug is diethylstilbestrol (DES) which used to be taken by pregnant women to reduce chances of miscarriage.

Alcohol: Excess alcohol intake can increase possibilities of breast cancer.  There is a 7% increase for each additional 10 grams of alcohol consumed per day.

Obesity: There is no direct connection between obesity and breast cancer. But studies have proved that presence of excess fat tissues (especially after menopause) abnormally increase the production of estrogen hormone, which in turn causes breast cancer. Also, high blood insulin levels due to overweight conditions can result in breast cancer.

Childbirth: Having no child or having a child after the age of 30 can increase can predispose a woman to breast cancer conditions. Taking oral contraceptive pills worsen the conditions. Breastfeeding for over 1 year can reduce the possibilities of breast cancer manifold due to the reduction in the total number of menstrual cycles in a woman’s lifetime.

Toxicity: Exposure to harmful chemicals in the environment such as those found in pesticides, vehicular and industrial emissions or Polychlorinated Biphenyls (PCBs) can increase possibilities of breast cancer. Passive tobacco intake can also be equally harmful.

Hormonal therapy: Combined hormone therapies after menopause (mainly to prevent osteoporosis) can cause breast cancer.

Clothing: Extremely tight-fit clothes and undergarments can cause breast cancer due to impaired blood circulation.

Physical activities: Limited or complete lack of regular physical activities or a completely sedentary lifestyle can increase risks of breast cancer.

Menstruation and menopause: Having menstruation before the age of 12 and having menopause after the age of 15 can increase risks of breast cancer.

Symptoms of breast cancer

Breast cancer symptoms are very subtle in the premature stages. But with the gradual progress of the disease, the fowling symptoms may be observed-

• Swelling and inflammation of a part or whole of the breast
• Dimple formation accompanied by irritation and itching
• Increased breast tenderness and sensitivity
• Redness and increased heat of breasts
• Pain in the breast, nipples, and armpit (regardless of menstrual phase)
• Inward turning or flattening of the nipples (nipple retraction)
• Thickening of the skin of the breast and nipple area
• Peeled off scales from the breast and nipple region
• Abnormal nipple discharge, often with blood (other than breast milk)
• Formation of solid lumps in one or both breasts
• Abnormal changes in the shape, color, and size of breasts (differences in size of the left and right breasts observed)
• Nipple eczema (formation of rashes on the nipples and areola region)
• Changes in the position of nipples
• Ridge and pit formation on the breast skin causing abnormal texture

Types of breast cancer

Breast cancer classification is done mainly on the basis of the disease stage and degree of spread of the disease. The following classification is normally done-

Ductal carcinoma: It is caused due to cancerous cell growth in the inner linings of the milk-carrying ducts. It is of two types-

• Ductal carcinoma in situ: In this condition, the cancerous cells are restricted to the ducts only and do not spread to other parts of the body. This type of breast cancer is curable in most of the cases.
• Invasive ductal carcinoma: This type of breast cancer originates in the milk ducts, infiltrates the walls of the ducts and spreads to the fatty tissues of the breasts. With further progress of the disease, the tumors can spread to the lymphatic nodes and other organs via the bloodstream.

Lobular carcinoma: It originates in the milk-producing glands of the breast called lobules. It is normally invasive in nature and can rapidly spread to other parts of the body (metastasis). Nearly 1 out of 10 invasive carcinoma cases belong to the lobular category.

Another less common classification of breast cancers as given below-

• Inflammatory breast cancer: This type of breast cancer is observed in 1-3% of cases. It is characterized by redness, inflammation and increased the warmth of breasts. The skin of the breasts and nipples becomes pitted and acquires a rough texture. Thickened lumps or tumors are not present. These are mainly caused by the cancerous cells obstructing the lymph vessels in the skin. Larger and thicker breasts result causing tenderness and pain.
• Paget disease of the nipple: This type of breast cancer is very rare and contributes to 1% of all reported cases. It originates in the breast ducts and slowly spreads to the areolar regions and nipples. Crusty scales may form on the breast skin accompanied by nipple bleeding.
• Phyllodes tumor: It is probably the rarest form of breast cancer. Unlike other breast cancers (which originate in ducts or lobules), it originates in the connective tissue of breasts.
• Angiosarcoma: It originates in cells lining the blood vessels or lymph vessels. In most cases, angiosarcoma occurs as a result of radiation therapies in the past.

Stages of breast cancer

Breast cancer spreads through different stages which are described below-

• Stage I: The tumor is restricted to the breasts and is not larger than 2 cm in diameter.
• Stage II: Tumour size is about 5 cm and it spreads to the lymph nodes located below the arm.
• Stage III: The tumors spread to the lymph nodes and the adjoining breast tissues.
• Stage IV: In this stage, the tumor spreads to other organs such as lungs, liver or bones.

Diagnosis

The following diagnostic tests are recommended for breast cancer patients-

• Mammogram or breast X-ray ( to detect breast changes)
• Breast ultrasound (to detect differences between solidified masses and fluid-filled cysts)
• Breast MRI
• Ductogram or Galactogram ( to analyze causes of abnormal nipple discharge)
• Biopsy

 Treatment & Prevention

The treatment for any form of cancer, including breast cancer, involves radiation therapy, chemotherapy, targeted therapy, and biological therapy. The main aim of treatment is to destroy and remove the cancerous cells, without damaging the healthy cells. Surgical intervention includes lumpectomy (removal of a tumor from the breast and/or surrounding area) or aggressive mastectomy (complete removal of the breast). Chemotherapy uses substances which are in general toxic to the body. Sometimes hormone suppressor drugs may also be administered if the cause of breast cancer is a severe hormonal imbalance.

By refraining from heavy alcohol consumption, smoking, unhealthy eating habits, and obesity, women can actually decrease their chances of acquiring breast cancer.

TL;DR?

References