BREAST CANCER
What is breast cancer?
Breast cancer is a disease in which cells in the breast grow and multiply abnormally. This can happen if the genes that regulate growth control no longer work. As a result of this, the cells multiply uncontrollably and form a tumor. Tumors can sometimes be seen as “lumps” under the skin and are sometimes seen on imaging studies such as a mammogram.
It is important to know that most of the "tumors" in the breast are benign; this means that they do not spread to other parts of the body and are not life-threatening.
Malignant tumors, on the other hand, are cancerous. If these tumors are not treated, the cancer can invade nearby tissues and can “spread” (metastasize) to other parts of the body.
Symptoms for breast cancer
Although many breast cancers are diagnosed on screening tests such as mammograms, suspicious signs can sometimes be identified:
-Bulging or thickening of the breast or armpit.
Unexplained swelling or shrinkage of the breast, particularly on one side only.
-Dimples or puckering of the breast.
-Discharge of fluid from the nipple other than milk that occurs without pressing on the nipple.
-Changes in the skin of the breast such as redness, thickening or swelling that looks like orange peel.
Am I at risk for breast cancer?
- Women in their thirties have a 0.44% chance of developing breast cancer, or one in 227 women.
- Women in their sixties have a 3.6% chance of developing breast cancer, or one in 28 women.
- The lifetime risk for breast cancer at age 90 is 12.4%, or one in eight women.
- It is also important to know that the current risk of developing breast cancer for most women in any year of their life is lower than that 12.4%.
- If you have developed cancer in one breast, you are more likely to develop cancer in the other breast compared to another woman who has not.
Hereditary breast cancer
As for heredity, only 5 to 10% of all breast cancer cases are related to heredity. Usually, if a first-degree relative (mother, sister, or daughter) has had breast cancer, you are two to three times more likely to develop breast cancer.
Some cases of hereditary cancer are related to mutations in the BRCA1, BRCA2 and PALB2 genes. Mutations are changes in the molecular sequence of the DNS. Having certain mutations in these genes increases the risk of breast cancer. A woman can inherit an abnormal gene from both her mother and her father.
The BRCA and PALB2 genes normally function as "caretakers." They help cells repair their DNA when it is damaged as a normal consequence of living. Women without a mutation have two normal copies of these genes, so they are at lower risk of developing breast cancer than those with a mutation.
In most cases, a single normal gene is enough for good health. If that healthy gene is lost, only the mutated copy remains; this compromises the cell's ability to repair its DNA and that is when cancer develops.
Aside from breast cancer, women with BRCA mutations have an increased risk of developing ovarian cancer. Men with BRCA mutations may be at increased risk of developing male breast cancer and prostate cancer. Mutations of the PALB2 gene are also associated with pancreatic cancer.
Counseling can benefit you and your family members if:
- Several members of your family over multiple generations have had breast or ovarian cancer.
- Your breast cancer occurred at an age younger than fifty.
- Your breast cancer is Triple Negative, which means that it does not have receptors for estrogen, progesterone or HER2.
Risk factors for breast cancer
- Women in their thirties have a 0.44% chance of developing breast cancer, or one in 227 women.
- Women in their sixties have a 3.6% chance of developing breast cancer, or one in 28 women.
- The lifetime risk for breast cancer at age 90 is 12.4%, or one in eight women.
- It is also important to know that the current risk of developing breast cancer for most women in any year of their life is lower than that 12.4%.
- If you have developed cancer in one breast, you are more likely to develop cancer in the other breast compared to another woman who has not.
Other risk factors for breast cancer:
Very young menstruation or late menopause.
If you started having menstrual periods before the age of 12 or passed the age of 50 without being menopausal, your risk of breast cancer is slightly higher than average. This may be because your breasts have been exposed to estrogen for a longer time during your life.
Age of first pregnancy.
If you had your first child after age 30, you have a slightly higher risk of breast cancer. This may be due to the protection conferred on the breast tissue by a pregnancy carried to term.
Benign diseases of the breast
Some non-cancerous conditions of the breast can increase your risk of breast cancer. These include ductal hyperplasia with atypia and lobular carcinoma in situ. Having had cysts in your breast, fibrocystic changes, or small growths in your milk ducts, called intraductal papillomas, does not increase your risk of breast cancer.
Hormone replacement therapy
Using certain types of hormone replacement therapy after menopause slightly increases the risk of breast cancer. This added risk disappears three to four years after stopping taking hormones. The risk increases if different hormonal agents are combined.
Contraceptive therapies
Birth control pills slightly increase the risk of breast cancer. This risk disappears ten years after the end of the treatment. Birth control pills probably reduce the risk of ovarian cancer.
Overweight or obesity
Excess weight increases the risk of breast cancer. It also increases the chance that the cancer will come back after treatment, particularly after menopause. The reason is probably because being overweight increases the level of estrogen in the body. Overweight is defined as having a body mass index of 25 or more. Obesity is defined as having a body mass index of 30 or more.
Radiation exposure
The relationship of radiation to breast cancer is particularly strong during the first two to three decades of their lives. This includes radiation to the chest for cancers such as lymphoma, as well as radiation for cancers of the thymus. The amount of radiation from a mammogram, however, is very small and does not increase the risk of developing breast cancer to any significant degree.
What is a female breast made of?
The mammary glands are composed of a milk production system made up of lobes and ducts, as well as fatty tissue along with blood vessels (veins and arteries), nerves, and lymph nodes. There are also bands of fibrous connective tissue called ligaments which hold the rest of the structures together.
How often should I be screened for breast cancer?
The guidelines recommend an annual clinical examination by a trained health professional starting at age 25 and an annual mammogram starting at age 40 for women at average risk who do not have symptoms.
How is breast cancer diagnosed?
If a medical exam, mammogram, or other imaging study shows something suspicious about your breast, the next step is usually a breast biopsy. Biopsy is the only test that can give a definitive diagnosis of breast cancer. This study involves taking a sample of the suspicious tissue, which is reviewed under a microscope by a specialist (pathologist).
What are the types of breast cancer?
There are many types of breast cancer. Most cancers start from the milk ducts and are called ductal carcinoma. Others originate from the lobes that produce milk; this type is called lobular carcinoma. Very rare tumors sometimes occur in the breast, called sarcomas, or tumors that originate in the skin of the nipples, called Paget's disease.
The tumors are analyzed under a microscope by a specialist, who is in charge of determining if these tumors have estrogen, progesterone and HER2 receptors. Once the expression of these three key proteins is determined, the biology of the tumor is determined and a specific type of treatment for that cancer is chosen.
What are the stages of breast cancer?
Stages are used to describe the extent of the cancer at the time of diagnosis. The stage of the cancer is determined based on the physical exam and other diagnostic tests, also called the clinical stage. The pathological stage is the stage determined once surgery has been done, which is the main treatment and is done again by a pathologist.
Knowing the stage helps guide the plan. Breast cancer is usually staged in Roman numerals, from 0 (earliest stage) to IV (most advanced stage). The stages in cancer are based on:
-Whether the cancer is invasive or non-invasive.
-The size of the tumor.
-Whether the cancer has spread to the lymph nodes and, if so, how many of them.
-If the cancer has spread to other organs of the body, such as the liver or lungs.
What is the treatment for breast cancer?
The mainstay of treatment in breast cancer is surgery, however, currently the three main treatments in oncology are combined to eradicate cancer or establish good control of it. Chemotherapy can be given before or after surgery depending on the goal; endocrine therapy is usually also used when there are precise indications and radiotherapy is used occasionally after surgery and chemotherapy to reinforce local control of the cancer. Each patient is different and unique, so each treatment is decided in order to give the greatest possible benefit.