Breast Cancer: From Discovery to Recovery............

• 18th November 2020

Breast cancer or other forms of cancer occur due to a problem in the genes which control cell growth. This problem in technical terms is referred to as a mutation. Mutations cause cell growth to become uncontrolled, and this is what is known as cancer.

October is signified as the breast cancer awareness month with the goal to educate people on the various types of breast cancer and breast health. Having a whole month dedicated to spreading awareness, it’s no surprise that breast cancer is the second most common form of cancer globally (closely following lung cancer) affecting 1 in 8 women just in the United States.

According to the World Cancer Research Foundation, there were 2 million global cases of breast cancer in the year 2018. Although awareness does not guarantee prevention, earlier detection does help with a higher survival rate. Over the years, due to better research of the disease and advancement in diagnosis and treatment, the survival rate has drastically improved.

Types

Breast cancer is divided into 2 main categories: invasive and non-invasive (in situ). It is further subdivided according to the structure it affects in the breast.

Non-invasive breast cancer (in situ) forms in one area of the breast tissue and does not spread in the surrounding tissues.

Invasive breast cancer, after forming in one area, spreads to the surrounding tissues and organs, such as the bones, heart, throat, etc.

The types of breast cancer that comprise of both categories are:

         1.   Ductal Carcinoma In Situ (DCIS)

         2.   Invasive Ductal Carcinoma (IDC)

         3.   Lobular Carcinoma In Situ (LCIS)

         4.   Invasive Lobular Cancer (ILC)

         5.   Triple Negative Breast Cancer (TNBC)

         6.   Inflammatory Breast Cancer (IBC)

Symptoms

• In the initial stages, there may be no symptoms of breast cancer at all. In most cases, the first symptom is a region of thickened skin (lump) in the breast or the armpit. In 50% cases, the location of the lump is in the upper outer quadrant and in 20% cases, in the central portion of the breast. Many times, the lump may initially be too small to be palpable, but it can be viewed on a mammogram. However, all lumps on the breast are not cancer.
• Some other symptoms include:
• Redness and/or pitting over the entire breast
• Nipple discharge other than milk, may contain blood
• Swelling of the entire breast or partially
• Changes in the appearance of the breast
• Inversion of the nipple
• Scaling, flaking or peeling of the pigmented skin surrounding the nipple
• Persistent pain in the breast and/or armpit.
• Pain in the nipple.

If any of these symptoms are experienced, the individual must seek medical attention as soon as possible.

Causes

Breast cancer is caused by the uncontrolled division of cells within different structures of the breast such as lobules, ducts etc. Since these abnormal cells do not die at the usual point, masses of abnormal cells continue to grow, taking excess nutrients and energy and consequently killing the healthy cells. This condition is termed as cancer. These masses of cells (tumours) may eventually spread to other tissues and organs such as bones, liver etc.

Risk Factors

Several risk factors are linked to breast cancer. Some of these include:

• Gender: Women are at a higher risk of developing breast cancer than men.
•  Age: Facts prove the risk of developing breast cancer increases with age. Women aged 25 and below are at a significantly less risk of developing breast cancer than women over the age of 30. 75% of breast cancer cases in women include individuals over the age of 50.
• Genetics: Women having mutations in genes BRCA1 and BRCA2 are more likely to get breast cancer than women without the mutations. For individuals with multiple first-degree relatives having breast cancer, the risk of getting it is high.
• Ethnicity: Women of European background are at a higher risk than other women. African American and Hispanic women may get aggressive tumours at a younger age.
• Ionizing Radiation: Radiation therapy for some other cancer may increase the risk of developing breast cancer. 25-30% of women developed breast cancer after being treated with radiotherapy for Hodgkin’s lymphoma in their teens.
• Alcohol consumption: Moderate and heavy drinkers are at a higher risk of developing breast cancer than light drinkers or women who do not drink alcohol.
• Early menstruation: Women having started menstruation before the age of 12 are more prone to developing breast cancer.
• Hormone therapy: Studies have shown that Hormone Replacement Therapy is linked to an elevated risk of getting affected.

Diagnosis and Screening

A physician may use the following diagnostic and screening methods to confirm the presence of a breast tumour.

Breast Exam

This can be performed as a self-examination as well. This is not a screening test. The goal is to check the breasts for any lumps, spots or abnormalities that can be seen or felt using the hands. It’s recommended that self-examination is performed once a month. Once the individual is familiar with how their breasts feel, noticing any abnormality becomes easier.

When performed by a doctor, they will also check for any spots or lumps in the breast or the armpit. The doctor may ask the patient to raise their arms or orient them in different positions. The exam will not hurt, so there is no need to worry!

Mammogram

This is simply an x-ray of the breasts. A mammogram may be ‘screening’ which is to detect any breast tumours when there are no apparent signs or symptoms or ‘diagnostic’ which is utilised when there is some suspicion such as a lump or pain in the breast.

Mammograms usually take 30 minutes, and they can even detect tumours too small to be felt or present within the ducts (Ductal Carcinoma In Situ).

Sonogram

In a sonogram, ultrasound waves are utilised to visualise the inside of the breast tissue. This helps the doctor determine whether the lump is a solid mass or a fluid-filled cyst. Cysts are mostly non-cancerous. Ultrasound is requested when a suspicious area has been detected on the breast using a screening mammogram. The ultrasound waves are not audible and do not damage the breast tissue.

MRI

If the initial tests (mammogram, sonogram, etc.) are nonconclusive, the doctor may request an MRI which gives a variety of images of the breast tissue. This helps in the assessment of the extent of disease. This technique is also preferred in individuals who are not fit to be exposed to radiation.

Biopsy

A sample of the tissue is carefully taken by the doctor and sent to the laboratory for examination. This is done to determine the type of cancer, the size of the tumour and whether it is invasive or in situ.

Treatment

The treatment options for breast cancer include:

1: Radiotherapy

Strong radiation is used to kill the cancer cells. The radiation source may be an external beam emitted by a machine or radioactive pellets surgically placed inside close to the tumour site to kill the cancer cells.

2: Chemotherapy

Drugs are utilised to shrink or eradicate the tumour. This option can be used on its own or combined with surgery or other treatment options.

3: Surgery

The tumour or affected area is removed surgically. Depending on the extent of severity of the breast cancer, the surgery may be performed to get rid of a tumour and some of the surrounding tissue (lumpectomy), one or more affected lymph nodes (axillary lymph node dissection) or the entire breast (mastectomy).

4: Hormone therapy

This therapy is used for breast cancers sensitive to hormones. The female hormones estrogen and progesterone fuel the growth of many types of breast cancer, so hormone therapy hinders the body’s natural production of these hormones and/or blocks the hormone receptors (ER, PR) stopping the tumour growth.

The kind of treatment depends on various factors such as the type and stage of cancer, the overall health of the patient etc.

Prevention

Although doctors don’t know what exactly causes breast cancer, making some healthy choices can go a long away. Breast cancer is linked with obesity, so eating healthy and exercising regularly are the two lifestyle factors that can help.

Furthermore, avoiding alcohol may also prove to be beneficial because alcohol consumption increases the risk of developing breast cancer.

Regular checkups at the doctor can ensure the detection of any tumour in its early stages. The sooner the detection, the quicker the treatment.