Everything You Need to Know About Breast Cancer

Table of Contents

Overview
Signs and Symptoms
Risk Factors
Screening and Prevention
When to See a Doctor
Diagnosis
Types
Staging of Breast Cancer
Prognosis
Complications
Treatments
Living with Breast Cancer
Frequently Asked Questions
Outlook

Overview

Breast cancer is characterized by the uncontrolled growth of cells in the breast.

After skin cancer, breast cancer is the second most commonly diagnosed cancer in American women. In fact, experts estimate that as many as 3.1 million women in the U.S. are living with a history of breast cancer.

After lung cancer, breast cancer is the second most common cause of death among all forms of cancer. Nearly 12 percent of women in the U.S. will develop breast cancer at some point in their lifetime.

Signs and Symptoms

If you are in the early stages of breast cancer, you may not have any symptoms. This is most likely a function of the tumor being too small to be palpable, although there is a possibility that an irregularity could show up on X-rays.

If a tumor is indeed palpable, the first sign of breast cancer is generally a newly diagnosed lump in the breast. It could be found through a breast self-exam (BSE) or clinical breast exam (CBE). However, not all newly diagnosed lumps in the breast are malignant, or cancerous. Most breast lumps are actually benign, or noncancerous.

Each type of breast cancer can cause a specific set of symptoms, many of which are similar. In addition to a breast lump that doesn’t resolve after your next menstrual cycle, early signs and symptoms for the most common forms of breast cancer may include:

  • Breast pain that doesn’t resolve after your next menstrual cycle;
  • Breast discharge, which can be clear, brown, yellow, or bloody;
  • Changes in the nipple, such as inversion;
  • Unexplained changes in the breast or nipple, such as redness, swelling, skin irritation, itchiness, or rash, and;
  • A lump or swelling near the collarbone or in the armpit.

Later signs of breast cancer may include:

  • Pitting of the skin of the breast similar to the peel of an orange (“peau d’orange”);
  • Significant and recent breast asymmetry;
  • Involuntary weight loss;
  • Vaginal pain, and;
  • Visible veins on the breast.

It is important to keep in mind that these symptoms can happen with other conditions of the breast that are benign.

Risk Factors

The most significant risk factors for breast cancer are:

  • Gender: Although there are rare cases where it has affected men, breast cancer mostly affects women.
  • Advancing Age: Approximately 66 percent of invasive breast cancers are diagnosed in women aged 55 or older.

Non-Modifiable Risk Factors

Risk factors that you cannot change are:

  • Family History of Breast Cancer: Plays a significant role in just about 15 percent of all breast cancers. In fact, a woman’s risk of breast cancer is nearly doubled if she has a first-degree relative who has been diagnosed with the disease.
  • Genetic Mutations: Between five percent and 10 percent of breast cancers can be linked to inherited genetic mutations. The BRCA1 and BRCA2 genes are the most common. Women who have inherited the BRCA1 or BRCA2 gene are not only at increased risk for breast cancer but also at increased risk for ovarian cancer. The lifetime risk for developing breast cancer in women with the BRCA1 gene is 72 percent, while that same risk is slightly lower at 69 percent for women with the BRCA2
  • Previous Radiation Therapy or Exposure to Diethylstilbestrol (DES): Women treated with radiation therapy to the chest for cancer prior to the age of 30 are at increased risk of developing breast cancer. DES has not been prescribed to pregnant women to prevent miscarriage since 1971. However, if your mother took this medication during her pregnancy with you, you are at increased risk for breast cancer.

One last non-modifiable risk factor is having dense breasts.

Modifiable Risk Factors

Risk factors for breast cancer that you can change include

  • Lack of Physical Activity: It is well-known that the lack of exercise in women can increase their risk of being diagnosed with breast cancer.
  • Being Overweight or Obese: Obesity, especially after menopause, can increase your risk of breast cancer.
  • Hormone Replacement Therapy (HRT): Some types, including both estrogen and progesterone, can increase your risk of breast cancer if taken for a duration greater than five years.
  • Reproductive History: Women experiencing their first pregnancy after age 30, not breastfeeding, or never carrying a pregnancy to full-term are at higher risk for the development of breast cancer.
  • Excessive Alcohol Consumption: There is a positive correlation between a woman’s risk for breast cancer and increasing consumption of alcoholic beverages beyond the recommended one drink per day for women.

Screening and Prevention

Breast cancer screening refers to periodic checks of a woman’s breasts for cancer before the appearance of any signs or symptoms of the disease.

Several leading medical organizations have published breast cancer screening guidelines. The United States Preventive Services Task Force recommends that women who are 50 to 74 years old and are at average risk for breast cancer should obtain a mammogram every two years. Women who are 40 to 49 years old should weigh the benefits and risks of breast cancer screening after an in-depth discussion with their doctor or other qualified health care professional. The American Cancer Society recommends yearly mammograms for women 45 to 54 years of age. Increase the interval to every two years in women 55 years of age or older.

The mammogram, or X-ray of the breast, is the best screening test for breast cancer, especially if you are at average risk. If you are at high risk for the development of breast cancer, breast magnetic resonance imaging (MRI) combined with a mammogram is the best screening test. Regular mammograms have the potential to lower your risk of death from breast cancer.

BSE and CBE can be used to screen for lumps in the breast or other changes in the breast suspicious for malignancy. However, performing monthly BSEs or receiving a CBE has not been found to lower the risk of death from breast cancer.

While breast cancer screening cannot prevent breast cancer, breast cancer prevention has taken center stage as of late. This is due to some women who have inherited the BRCA1 or BRCA2 gene. They are opting to undergo preventative bilateral removal of their breasts with or without removal of their ovaries due to their extremely high risk of developing breast and/or ovarian cancers.

When to See a Doctor

If you have any of the potential signs and symptoms of breast cancer, it is imperative you make an appointment to see your doctor. Only your doctor will be able to tell if your symptoms are malignant or benign.

Additionally, many of these so-called signs and symptoms of breast cancer may be due to another medical condition, which also could be life-threatening. Your doctor can help determine what is affecting you and come up with the correct course of action.

Even if you don’t have any symptoms, don’t forget to do your part as it regards breast cancer screening and prevention. Monthly SBEs, yearly CBEs, and mammograms at appropriate intervals are in order and can all be taught and accomplished through your doctor.

Diagnosis

A diagnosis of breast cancer is pretty straightforward.

It begins with a thorough medical history focusing on risk factors for breast cancer. This is followed by a physical examination, including a CBE and evaluation of lymph nodes. This may reveal a discrete breast mass or enlarged lymph nodes. Also, your doctor will ask you in-depth questions to discern your risk/likelihood of breast cancer.

Diagnostic Imaging Tools for Breast Cancer

If you present symptoms or a worrisome finding on the CBE, a diagnostic mammogram may be in order. On the other hand, if you have no symptoms and are in the appropriate age group, a screening mammogram is a typical starting point.

Another diagnostic imaging tool for breast cancer is breast ultrasound. It utilizes sound waves to produce images of a breast lump that has been palpated by you or your doctor, revealing if a breast mass is solid or cystic. If the breast mass is solid, it raises the possibility of cancer. If the breast mass is cystic, fluid may be aspirated and sent for cell analysis to rule out cancer.

The last diagnostic imaging tool that may be utilized for the diagnosis of breast cancer is a breast MRI. It is usually used in conjunction with a mammogram or another breast imaging technique to investigate the possibility of breast cancer. A breast MRI may be used to gather information regarding the extent of disease after a definitive diagnosis of breast cancer or as a screening tool for women at high risk for breast cancer.

Breast Biopsy

A breast biopsy is the only way to definitively diagnose breast cancer. This is because physical examination and breast imaging techniques are unable to accomplish this task.

During a breast biopsy, a needle and syringe, which may be guided by CT or ultrasound, are used to remove a sample of tissue and/or fluid from the suspicious area in the breast. Then, the tissue and/or fluid are examined under a microscope.

There are different kinds of biopsies that may be used to diagnose breast cancer. This includes fine-needle aspiration, core biopsy, and open biopsy.

Analysis of the biopsy can determine the:

  • Particular type of breast cancer;
  • Grade or aggressiveness of the cancer, and;
  • Presence or absence of hormone receptors.

Types

Most experts divide breast cancers into two general categories:

  1. Non-invasive (in situ), and;
  2. Invasive (infiltrating).

Non-invasive breast cancers are confined to the ducts. As such, they do not invade the surrounding fatty and connective tissues of the breast. The most common form of non-invasive breast cancer with 90 percent of cases is ductal carcinoma in situ. Lobular carcinoma in situ occurs much less often.

Invasive breast cancers go beyond the ducts and invade the surrounding fatty and connective tissues of the breast. The most common form of invasive breast cancer with 80 percent of cases is invasive ductal carcinoma. Invasive lobular carcinoma occurs much less often.

Other less common types of breast cancers include the following:

TypesOccurrence
Inflammatory Breast Cancer1% of cases
Paget’s Disease of the Nipple1% of cases
Phyllodes TumorsVery rare;10 women per year die from this type
Medullary Carcinoma5% of cases
Tubular Carcinoma2% of cases

Staging of Breast Cancer

After a diagnosis of breast cancer, a stage is assigned that conveys how advanced the cancer is. The stage of breast cancer that is assigned by your doctor is determined based on the:

  • Cancer being non-invasive or invasive;
  • Size of the tumor;
  • Presence or absence of lymph node involvement, and;
  • Presence or absence of spread.

Breast cancer has five main stages, with subgroups for some stages, as follows:

  1. Stage 0 Breast Cancer: Considered in situ. This means the cancerous tumor has not invaded the surrounding breast tissues.
  2. Stage I Breast Cancer: Characterized by a tumor less than 2cm in diameter that has not spread beyond the breast.
  3. Stage II Breast Cancer: Can be divided into subgroups:
    • IIA: Tumor less than 2cm in diameter and has spread to one to three axillary lymph nodes or tumor between 2cm and 5cm in diameter without spread to lymph nodes.
    • IIB: Tumor between 2cm and 5cm in diameter and has spread to one to three axillary lymph nodes or greater than 5cm without spread to lymph nodes.
  4. Stage III Breast Cancer: Can be divided into subgroups:
    • IIIA: Tumor can be any size and has spread to four to nine axillary lymph nodes or greater than 5cm in diameter and has spread to one to three axillary lymph nodes.
    • IIIB: Tumor has invaded the chest wall and/or skin and spread to up to nine axillary lymph nodes.
    • IIIC: Tumor can be any size with spread to at least 10 axillary lymph nodes.
  5. Stage IV Breast Cancer: Tumor can be any size and has spread to distant lymph nodes and organs.

Prognosis

The prognosis, or your chances of recovery, is most commonly referred to as the five-year survival rate. For particular breast cancer, the prognosis is determined by its stage at diagnosis.

The Surveillance Epidemiology and End Results database from the National Cancer Institute estimates the following five-year survival rates based on breast cancer stage:

Breast Cancer StageFive-Year Survival Rate for Women
0100%
I100%
II93%
III72%
IV22%

Complications

The complications of breast cancer are variable and tend to increase with advancing stage, especially stage IV breast cancer.

The following complications may arise from breast cancer:

  • Cancer-related pain;
  • Bone complications, such as bone pain, spinal compression, and elevated levels of calcium in the blood;
  • Lung complications, such as shortness of breath, wheezing, cough, and “fluid on the lungs”;
  • Liver complications, such as jaundice, and;
  • Cancer treatment-related complications, such as nausea, vomiting, diarrhea, and lymphedema.

Treatments

There are a variety of treatment options for breast cancer. This includes:

  • Surgery;
  • Radiation therapy;
  • Chemotherapy;
  • Hormone therapy, and;
  • Targeted therapy.

Most breast cancer patients require a combination of two or more treatments.

Surgery

Surgery for breast cancer includes two options:

  1. Breast-conserving surgery, and;
  2. Mastectomy.

The most commonly performed breast-conserving surgery is lumpectomy. Other breast-conserving surgeries for breast cancer include wide excision and quadrantectomy.

Radiation Therapy

Radiation therapy uses high-energy X-rays to kill breast cancer cells. It is usually administered after surgery. Also, it is a fundamental component of breast-conserving therapy.

There are two main kinds of radiation therapy:

  1. Traditional external beam radiation, and;
  2. The newer internal radiation.

Chemotherapy

Chemotherapy uses drugs that are toxic to cells to treat breast cancer. It is most commonly administered after surgery but can be given prior to surgery to reduce the size of the tumor. This sometimes allows for breast-conserving surgery rather than a mastectomy.

Hormone Therapy

Most breast cancer cells will be tested for the presence of estrogen receptors and progesterone receptors, which may be fueling the growth of breast cancer tumors. As a result, hormone therapy can block or inhibit these receptors, shrinking and even sometimes eradicating the cancer completely.

Drugs used in hormone therapy include tamoxifen (Nolvadex), leuprolide (Eligard), and aromatase inhibitors.

Targeted Therapy

Targeted therapy for breast cancer is relatively new. It has the advantage of attacking cancer cells without harming normal cells.

An example of targeted therapy is rastuzumab (Herceptin). Rastuzumab blocks the action of the abnormal protein human epidermal growth factor receptor 2 (HER2) that is known to stimulate the growth of breast cancer cells.

Living with Breast Cancer

A diagnosis of breast cancer almost ensures that some degree of fatigue will be experienced by women, regardless of the staging of disease and subsequent treatment. As a result, fatigue could potentially have a negative impact on the quality of life of breast cancer patients. Women undergoing treatment for breast cancer must be active in the follow-up care of this potentially life-threatening disease.

An integral part of living with breast cancer is obtaining proper nutrition. The Mediterranean diet or a plant-based diet would be ideal for eating programs to consider while going through the stresses of breast cancer treatment and recovery. Your doctor should be able to refer you to a dietician/nutritionist for diet recommendations.

Another integral part of living with this type of cancer is getting adequate levels of physical activity. Experts recommend at least 30 minutes per day, five or more times per week. Consider forms of exercise such as power walking, swimming, tai chi, and yoga. Your doctor should be able to refer you to a physical therapist for an exercise prescription.

Frequently Asked Questions

How Often Should I Do a BSE?

Women should perform a BSE once per month. Ideally, it should be performed seven to 10 days after the start of their menstrual period, which corresponds to when their breasts should be the least tender and lumpy.

What Do Lumps in My Breast Mean?

Cancer is only one of many conditions that can cause breast lumps. Hence, the majority of cases are not related to cancer.

Common causes of benign breast lumps include:

  • Breast infection;
  • Fibrocystic breast disease;
  • Fibroadenoma;
  • Fat necrosis, and;
  • Sclerosing adenosis.

What Is Triple-Negative Breast Cancer?

As of late, a type of cancer referred to as triple-negative breast cancer has garnered attention. It does not have any of the receptors or additional HER2 proteins on its surface that are commonly found in breast cancer, making it more difficult to treat.

What Can I Do to Reduce My Risk of Breast Cancer?

The best ways to negatively impact your risk of breast cancer include:

  • Maintaining a normal weight;
  • Exercising regularly;
  • Not drinking alcohol;
  • Avoiding HRT or birth control pills, and;
  • Breastfeeding your children.

Outlook

Breast cancer is one of the most commonly diagnosed cancers in women, with African American women more likely to die from the disease.

In general, your stage of disease at diagnosis dictates your treatment options. Additionally, early diagnosis and treatment can significantly improve the prognosis for breast cancer patients.

Burak Karademir / Getty Images

Nov 13, 2019