Breast Cancer

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According to the World Health Organization , breast cancer is the most common cancer among women all over the world. If you or someone close to you has been affected by breast cancer, understanding more about it can help you cope.

In this section you can find more information about the risk factors, symptoms, diagnosis and treatment options available, as well lots of handy resources to help you through the journey.

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It is important for every woman to know the symptoms of breast cancer, the most common sign being the discovery of a new lump or mass on the breast. If there are any changes in your breast, be sure to get it checked immediately by a doctor. Symptoms of breast cancer include:

  • A lump or thickening in or near the breast or underarm area
  • Unexplained swelling or shrinkage of the breast (especially if on one side only)
  • Skin irritation or dimpling
  • Breast pain
  • Nipple tenderness or the nipple turning inward
  • Redness, scaliness, or thickening of the nipple or breast skin
  • Recent asymmetry of the breasts
  • Nipple discharge when a woman is not breastfeeding, particularly if the discharge is clear or bloody.
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Breast cancer is a malignant tumor that starts in the cells of the breast. A malignant tumor is a group of cancer cells that can then invade surrounding tissues or spread (metastasise) to other areas of the body. The disease occurs almost entirely in women, although men can get it too.

What are the causes of breast cancer?

Cancer grows when a cell’s DNA is damaged, but what causes the DNA damage is not yet known. While the causes are not definitive, certain genetic and environmental risk factors are linked with the disease.

Genetic factors include:

  • Gender: The National Breast Cancer Foundation asserts that breast cancer occurs nearly 100 times more often in women than in men.
  • Age: 2 out of 3 women with invasive breast cancer are 55 or older when the cancer is found.
  • Race:  Breast cancer is diagnosed more often in caucasian women than women of other races.
  • Family History:  Having a mother, sister or daughter who has been diagnosed with breast cancer doubles a woman’s risk.
  • Certain Genome Changes:  Mutations in certain genes, such as BRCA1 and BRCA2, can increase your risk of breast cancer. This is determined through a genetic test, which you may consider taking if you have a family history of breast cancer.
  • Personal History of Breast Cancer:  If you have been diagnosed with breast cancer in one breast, you have an increased risk of being diagnosed with breast cancer in the other breast in the future.
  • Menstrual history: Women who began having periods early (before age 12) or who went through menopause after the age of 55 have a slightly increased risk of getting breast cancer.
  • Dense Breast Tissue:  Having dense breast tissue can increase your risk for breast cancer and make lumps harder to detect. Dense breast tissue can also make it harder for doctors to spot problems on mammograms.
  • Certain benign (not cancer) breast problems: Women who experience certain benign breast changes may have an increased risk of breast cancer. Some of these are more closely linked to breast cancer risk than others.

Environmental and lifestyle factors include:

  • Reproductive history: Women who have had not had children, or who had their first child after age 30, have a slightly higher risk of breast cancer. Being pregnant many times and at an early age reduces breast cancer risk.
  • Recent use of birth control pills: Studies have found that women who are using birth control pills have a slightly greater risk of breast cancer than women who have never used them. This risk seems to go back to normal over time once the pills are stopped. Women who stopped using the pill more than 10 years ago do not seem to have any increased risk.
  • Not breastfeeding: Some studies have shown that breastfeeding slightly lowers breast cancer risk, especially if the breastfeeding lasts 1½ to 2 years.
  • Lack of Physical Activity:  A sedentary lifestyle with little physical activity can increase your risk for breast cancer. One study found that as little as 1 hour and 15 minutes to 2½ hours of brisk walking per week reduced the risk by 18%.
  • Poor Diet:  A diet high in saturated fat and lacking fruits and vegetables can increase your risk for breast cancer.  
  • Being Overweight or Obese:  Being overweight or obese after menopause, or because of weight gain that took place as an adult, is linked to a higher risk of breast cancer.
  • Drinking Alcohol:  Frequent consumption of alcohol can increase your risk of getting breast cancer. Those who have 2 to 5 drinks daily have about 1½ times the risk of women who don’t drink alcohol.
  • Breast radiation early in life:  Having radiation therapy to the chest (as treatment for another cancer) before the age of 30 can increase your risk for breast cancer. The risk varies with the patient’s age when she had radiation. The risk from chest radiation is highest if the radiation were given during the teens, when the breasts were still developing.
  • Treatment with DES: In the past, some pregnant women were given the drug DES (diethylstilbestrol) because it was thought to lower their chances of having a miscarriage. Studies have shown that these women have a slightly increased risk of getting breast cancer.
  • Combined Hormone Replacement Therapy (HRT):  Taking combined hormone replacement therapy, prescribed for menopause, can increase your risk for breast cancer and increases the risk that the cancer will be detected at a more advanced stage.
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All women should be aware of how their breasts normally look and feel, and consult immediately with a doctor if they experience any changes. When no breast changes are visible, here is a guide to follow for breast cancer screening, depending on your age:

  • If you’re in your 20s and 30s: Breast self-exam is recommended for women in their 20s and 30s. Also, Clinical breast exams (CBE) should be conducted once every 3 years.
  • If you’re in your 40s and up: For women in their 40s, CBE’s should be conducted once every year. Mammograms should also start being done every year, as part of your annual health check.

Women with a very high risk of getting breast cancer, due to their genetic make-up, family history and environmental factors, should also be screened with magnetic resonance imaging (MRI) in addition to mammograms. Only a very small percentage of women are at very high risk, so please speak with your doctor about risk factors and whether you should have any additional tests.

How is breast cancer diagnosed?

To diagnose breast cancer, doctors will conduct certain tests and procedures. These commonly include:

  • Breast exam: Your doctor will do a physical exam of both of your breasts, checking for any abnormalities or lumps.
  • Mammogram: A mammogram is an X-ray of the breast. In a diagnostic mammogram, more x-rays are taken, providing views of the breast from multiple vantage points.
  • Breast ultrasound: Ultrasounds use penetrating sound waves to produce images of what’s happening inside the breast tissue. Ultrasounds are used to distinguish fluid-filled masses from solid masses.
  • Biopsy: A breast biopsy is a test that removes a sample of breast cells for examination under a microscope. The sample is analyzed to determine the presence of cancer.
  • Magnetic Resonance Imaging (MRI): During a breast MRI, a magnet connected to a computer transmits magnetic energy and radio waves through the breast tissue to create pictures of the interior of your breast. This helps the medical team assess the extent of the disease.

 

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If your doctor makes a diagnosis of breast cancer, he or she will then establish the stage of your cancer. Knowing your breast cancer stage will help to inform your options for treatment.

  • Stage 0: Stage 0 represents the earliest detection of breast cancer development. At stage 0, the disease is localized to the breast with no evidence of spread to the lymph nodes.
  • Stage I: Stage I cancer includes tumors less than 2cm in diameter that do not appear to have spread beyond the breast.
  • Stage II: Stage II refers to tumors that are larger than 2cm and/or have spread to the lymph nodes under the arm on the same side as the breast cancer. It is still contained to the breast area and is generally very effectively treated.
  • Stage III: Stage III indicates a locally advanced breast cancer with evidence of the cancer invading surrounding tissues near the breast.
  • Stage IV: Stage IV breast cancer is one that, regardless of its size, has metastasized (spread) to different sites, such as the brain, bones, lung or liver.

Taking into account the type, stage and grade of your breast cancer, as well as your overall health, there are a variety of treatment options:

  • Surgery: Surgery is the most common form of treatment for breast cancer. This involves removing the tumor and nearby margins. Surgical options may include a lumpectomy, partial mastectomy, radical mastectomy, and reconstruction. Complications of breast cancer surgery depend on the procedures you choose.
  • Radiation therapy: Radiation therapy uses high-energy rays to kill cancer cells. It is typically done using a large machine that aims the energy beams at your body, known as external beam radiation. However, radiation can also be done by placing radioactive material inside your body (brachytherapy). The main side effects of radiation therapy include fatigue as well as a red, sunburn-like rash where the radiation is aimed. 
  • Chemotherapy: Chemotherapy uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells. Side effects can include nausea, hair loss, early menopause, hot flashes, fatigue, and temporarily lowered blood counts.
  • Hormone therapy: Hormone therapy is often used to treat breast cancers that are sensitive to hormones. This procedure uses drugs to prevent hormones, especially estrogen, from promoting the growth of breast cancer cells that may remain after breast cancer surgery. Side effects can include hot flashes and vaginal dryness.
  • Targeted drugs: Targeted therapy uses drugs that block the growth of breast cancer cells in specific ways. For example, targeted drug treatments may block the action of an abnormal protein that stimulates the growth of breast cancer cells.
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While there are certain risk factors for getting breast cancer that can’t be controlled, there are healthy habits that can help you to reduce your risk. These include:

  • Limit alcohol: The more alcohol you drink, the greater your risk of developing breast cancer. Avoid it as much as possible. If you choose to drink alcohol, Breastcancer.org recommends limiting yourself to no more than 2 drinks per week.
  • Control your weight: Being overweight or obese increases the risk of breast cancer. This is especially true if obesity occurs later in life, particularly after menopause.
  • Be physically active: Physical activity can help you maintain a healthy weight, which, also helps to prevent breast cancer.
  • Breast-feed: Breast-feeding may play a role in breast cancer prevention. The longer you breast-feed, the greater the effect.

Other ways to prevent the risk of developing breast cancer

  • Avoid or limit hormone therapy:  If you're taking hormone therapy for menopausal symptoms, ask your doctor about other options. If you decide that the benefits of short-term hormone therapy outweigh the risks, use the lowest dose that works for you.
  • Avoid exposure to radiation: Medical-imaging methods use high doses of radiation, which have been linked with breast cancer risk. Reduce your exposure by having such tests only when absolutely necessary.
  • Breast cancer chemoprevention: Chemoprevention is the use of drugs to reduce the risk of cancer. The drugs tamoxifen and raloxifene have both been shown to lower breast cancer risk in studies, and are approved for use. Speak to your doctor to learn more about these drugs.
  • Preventive surgery: Surgery can sometimes be recommended for women with a very high risk of getting breast cancer. A double mastectomy (an operation to remove both breasts) can greatly reduce the risk of breast cancer by removing nearly all of the breast tissue. Preventative ovary removal in some women can also reduce the risk of breast cancer as removing the ovaries eliminates the main source of estrogen in the body.
  • Find breast cancer early: While an early detection plan doesn’t prevent cancer, it provides the greatest chance of successful treatment. An early detection plan should include habitual breast self-exams, regular visits to the doctor for scheduled clinical breast exams and following your healthcare provider’s recommendation for mammograms.
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