Breast Cancer In Female: Symptoms, Types, Risk Factors, Stages, Diagnosis And Cancer Care

Introduction.

Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer.

Advances in screening and treatment for breast cancer have improved survival rates dramatically since 1989. According to the American Cancer Society (ACS), there are more than 3.1 million breast cancer survivors in the United States. The chance of any woman dying from breast cancer is around 1 in 38 (2.6%).

The ACS estimate that 268,600 women will receive a diagnosis of invasive breast cancer, and 62,930 people will receive a diagnosis of noninvasive cancer in 2019.

In the same year, the ACS report that 41,760 women will die as a result of breast cancer. However, due to advances in treatment, death rates from breast cancer have been decreasing since 1989.

Awareness of the symptoms and the need for screening are important ways of reducing the risk. In rare instances, breast cancer can also affect men, but this article will focus on breast cancer in women. 

Symptoms of Breast Cancer.

The first symptoms of breast cancer usually appear as an area of thickened tissue in the breast or a lump in the breast or an armpit.

Other symptoms include:

pain in the armpits or breast that does not change with the monthly cycle

pitting or redness of the skin of the breast, similar to the surface of an orange

a rash around or on one of the nipples

discharge from a nipple, possibly containing blood

a sunken or inverted nipple

a change in the size or shape of the breast

peeling, flaking, or scaling of the skin on the breast or nipple

Most breast lumps are not cancerous. However, women should visit a doctor for an examination if they notice a lump on the breast.

Stages of Breast Cancer.

A doctor stages cancer according to the size of the tumor and whether it has spread to lymph nodes or other parts of the body.

There are different ways of staging breast cancer. One way is from stage 0–4, with subdivided categories at each numbered stage. Descriptions of the four main stages are listed below, though the specific substage of a cancer may also depend on other specific characteristics of the tumor, such as HER2 receptor status.

Stage 0: Known as ductal carcinoma in situ (DCIS), the cells are limited to within the ducts and have not invaded surrounding tissues.

Stage 1: At this stage, the tumor measures up to 2 centimeters (cm) across. It has not affected any lymph nodes, or there are small groups of cancer cells in the lymph nodes.

Stage 2: The tumor is 2 cm across, and it has started to spread to nearby nodes, or is 2–5 cm across and has not spread to the lymph nodes.

Stage 3: The tumor is up to 5 cm across, and it has spread to several lymph nodes or the tumor is larger than 5 cm and has spread to a few lymph nodes.

Stage 4: The cancer has spread to distant organs, most often the bones, liver, brain, or lungs.

After puberty, a woman’s breast consists of fat, connective tissue, and thousands of lobules. These are tiny glands that produce milk for breastfeeding. Tiny tubes, or ducts, carry the milk toward the nipple.

Cancer causes the cells to multiply uncontrollably. They do not die at the usual point in their life cycle. This excessive cell growth causes cancer because the tumor uses nutrients and energy and deprives the cells around it.

Breast cancer usually starts in the inner lining of milk ducts or the lobules that supply them with milk. From there, it can spread to other parts of the body.

Risk factors of Breast Cancer.

The exact cause of breast cancer remains unclear, but some risk factors make it more likely. It is possible to prevent some of these risk factors.

1. Age

The risk of breast cancer increases with age. At 20 years, the chance of developing breast cancer in the next decade is 0.06%. By the age of 70 years, this figure goes up to 3.84%.

2. Genetics

Women who carry certain mutations in the BRCA1 and BRCA2 genes have a higher chance of developing breast cancer, ovarian cancer, or both. People inherit these genes from their parents.

Mutations in the TP53 gene also have links to increased breast cancer risk.

If a close relative has or has had breast cancer, a person’s chance of developing breast cancer increases.

Current guidelines recommend that people in the following groups seek genetic testing:

those with a family history of breast, ovarian, fallopian tube, or peritoneal cancer

those in whose ancestry there is a history of breast cancer related to BRCA1 or BRCA2 gene mutations, for example, people with Ashkenazi Jewish ancestry.

3. A history of breast cancer or breast lumps.

Women who have previously had breast cancer are more likely to have it again than those who have no history of the disease.

Having some types of noncancerous breast lump increases the chance of developing cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.

Individuals with a history of breast, ovarian, fallopian tube, or peritoneal cancer should ask their doctors about genetic testing.

4. Dense breast tissue

Women with more dense breasts are more likely to receive a diagnosis of breast cancer.

5. Estrogen exposure and breastfeeding.

Breastfeeding for over 1 year appears to reduce the risk of breast cancer.

Extended exposure to estrogen appears to increase the risk of breast cancer.

This could be due to a person starting their periods earlier or entering menopause at a later than average age. Between these times, estrogen levels are higher.

Breastfeeding, especially for over 1 year, appears to reduce the chance of developing breast cancer. This is possibly due to the drop in estrogen exposure that follows pregnancy and breastfeeding.

6. Body weight.

Women who become overweight or develop obesity after menopause may also have a higher chance of developing breast cancer, possibly due to increased estrogen levels. High sugar intake may also be a factor.

7. Alcohol consumption.

A higher rate of regular alcohol consumption appears to play a role in breast cancer development.

According to the National Cancer Institute (NCI), studies have consistently found that women who consume alcohol have a higher risk of breast cancer than those who do not. Those who drink moderate to heavy levels of alcohol have a higher risk than light drinkers.

8. Radiation exposure.

Undergoing radiation treatment for a different cancer may increase the risk of developing breast cancer later in life.

9. Hormone treatments.

According to the NCI, studies have shown that oral contraceptives may slightly increase the risk of breast cancer

According to the ACS, studies have found that hormone replacement therapy (HRT), specifically estrogen-progesterone therapy (EPT), is related to an increased risk of breast cancer.

Cosmetic implants and breast cancer survival

A 2013 review found that women with cosmetic breast implants who received a diagnosis of breast cancer also had a higher risk of dying from the disease.

This could be due to the implants masking cancer during screening or because the implants bring about changes in breast tissue.

However, a 2015 review published in Aesthetic Surgery Journal found that having cosmetic breast implant surgery did not increase the risk of breast cancer.

Types of breast cancer.

There are several types of breast cancer, and they are broken into two main categories: “invasive” and “noninvasive,” or in situ. While invasive cancer has spread from the breast ducts or glands to other parts of the breast, noninvasive cancer has not spread from the original tissue.

These two categories are used to describe the most common types of breast cancer, which include:

Ductal carcinoma in situ

Ductal carcinoma in situ (DCIS) is a noninvasive condition. With DCIS, the cancer cells are confined to the ducts in your breast and haven’t invaded the surrounding breast tissue.

Lobular carcinoma in situ

Lobular carcinoma in situ (LCIS) is cancer that grows in the milk-producing glands of your breast. Like DCIS, the cancer cells haven’t invaded the surrounding tissue.

Invasive ductal carcinoma

Invasive ductal carcinoma (IDC) is the most common type of breast cancer. This type of breast cancer begins in your breast’s milk ducts and then invades nearby tissue in the breast. Once the breast cancer has spread to the tissue outside your milk ducts, it can begin to spread to other nearby organs and tissue.

Invasive lobular carcinoma

Invasive lobular carcinoma (ILC) first develops in your breast’s lobules and has invaded nearby tissue.

Other, less common types of breast cancer include:

Paget disease of the nipple.

This type of breast cancer begins in the ducts of the nipple, but as it grows, it begins to affect the skin and areola of the nipple.

Phyllodes tumor

This very rare type of breast cancer grows in the connective tissue of the breast. Most of these tumors are benign, but some are cancerous.

Angiosarcoma

This is cancer that grows on the blood vessels or lymph vessels in the breast.

The type of cancer you have determines your treatment options, as well as your likely long-term outcome.

Inflammatory breast cancer

Inflammatory breast cancer (IBC) is a rare but aggressive type of breast cancer. IBC makes up only between 1 and 5 percentTrusted Source of all breast cancer cases.

With this condition, cells block the lymph nodes near the breasts, so the lymph vessels in the breast can’t properly drain. Instead of creating a tumor, IBC causes your breast to swell, look red, and feel very warm. A cancerous breast may appear pitted and thick, like an orange peel.

IBC can be very aggressive and can progress quickly. For this reason, it’s important to call your doctor right away if you notice any symptoms. Find out more about IBC and the symptoms it can cause.

Triple-negative breast cancer.

Triple-negative breast cancer is another rare disease type, affecting only about 10%-20% of people with breast cancer. To be diagnosed as triple-negative breast cancer, a tumor must have all three of the following characteristics:

It lacks estrogen receptors. These are receptors on the cells that bind, or attach, to the hormone estrogen. If a tumor has estrogen receptors, estrogen can stimulate the cancer to grow.

It lacks progesterone receptors. These receptors are cells that bind to the hormone progesterone. If a tumor has progesterone receptors, progesterone can stimulate the cancer to grow.

It doesn’t have additional HER2 proteins on its surface. HER2 is a protein that fuels breast cancer growth.

If a tumor meets these three criteria, it’s labeled a triple-negative breast cancer. This type of breast cancer has a tendency to grow and spread more quickly than other types of breast cancer.

Triple-negative breast cancers are difficult to treat because hormonal therapy for breast cancer is not effective. Learn about treatments and survival rates for triple-negative breast cancer.

Metastatic breast cancer.

This is another name for stage 4 breast cancer. It’s breast cancer that has spread from your breast to other parts of your body, such as your bones, lungs, or liver.

This is an advanced stage of breast cancer. Your oncologist (cancer doctor) will create a treatment plan with the goal of stopping the growth and spread of the tumor or tumors. Learn about treatment options for metastatic cancer, as well as factors that affect your outlook.

How To Diagnose Breast Cancer?

To determine if your symptoms are caused by breast cancer or a benign breast condition, your doctor will do a thorough physical exam in addition to a breast exam. They may also request one or more diagnostic tests to help understand what’s causing your symptoms.

Tests that can help diagnose breast cancer include:

  Mammogram

The most common way to see below the surface of your breast is with an imaging test called a mammogram. Many women aged 40 and older get annual mammograms to check for breast cancer. If your doctor suspects you may have a tumor or suspicious spot, they will also request a mammogram. If an abnormal area is seen on your mammogram, your doctor may request additional tests.

Ultrasound

A breast ultrasound uses sound waves to create a picture of the tissues deep in your breast. An ultrasound can help your doctor distinguish between a solid mass, such as a tumor, and a benign cyst.

Your doctor may also suggest tests such as an MRI or a breast biopsy.

Breast biopsy.

If your doctor suspects breast cancer, they may order both a mammogram and an ultrasound. If both of these tests can’t tell your doctor if you have cancer, your doctor may do a test called a breast biopsy.

During this test, your doctor will remove a tissue sample from the suspicious area to have it tested. There are several types of breast biopsies. With some of these tests, your doctor uses a needle to take the tissue sample. With others, they make an incision in your breast and then remove the sample.

Your doctor will send the tissue sample to a laboratory. If the sample tests positive for cancer, the lab can test it further to tell your doctor what type of cancer you have. Learn more about breast biopsies, how to prepare for one, and what to expect.

Breast cancer treatment.

Your breast cancer’s stage, how far it has invaded (if it has), and how big the tumor has grown all play a large part in determining what kind of treatment you’ll need.

To start, your doctor will determine your cancer’s size, stage, and grade (how likely it is to grow and spread). After that, you can discuss your treatment options. Surgery is the most common treatment for breast cancer. Many women have additional treatments, such as chemotherapy, targeted therapy, radiation, or hormone therapy.

Surgery.

Several types of surgery may be used to remove breast cancer, including:

Lumpectomy: This procedure removes the tumor and some surrounding tissue, leaving the rest of the breast intact.

Mastectomy: In this procedure, a surgeon removes an entire breast.In a double mastectomy, both breasts are removed.

Sentinel node biopsy

This surgery removes a few of the lymph nodes that receive drainage from the tumor. These lymph nodes will be tested. If they don’t have cancer, you may not need additional surgery to remove more lymph nodes.

Axillary lymph node dissection: If lymph nodes removed during a sentinel node biopsy contain cancer cells, your doctor may remove additional lymph nodes.

Contralateral prophylactic mastectomy. Even though breast cancer may be present in only one breast, some women elect to have a contralateral prophylactic mastectomy. This surgery removes your healthy breast to reduce your risk of developing breast cancer again.

Radiotherapy.

With radiation therapy, high-powered beams of radiation are used to target and kill cancer cells. Most radiation treatments use external beam radiation. This technique uses a large machine on the outside of the body.

Advances in cancer treatment have also enabled doctors to irradiate cancer from inside the body. This type of radiation treatment is called brachytherapy. To conduct brachytherapy, surgeons place radioactive seeds, or pellets, inside the body near the tumor site. The seeds stay there for a short period of time and work to destroy cancer cells.

Chemotherapy.

Chemotherapy is a drug treatment used to destroy cancer cells. Some people may undergo chemotherapy on its own, but this type of treatment is often used along with other treatments, especially surgery.

In some cases, doctors prefer to give patients chemotherapy before surgery. The hope is that the treatment will shrink the tumor, and then the surgery will not need to be as invasive. Chemotherapy has many unwanted side effects, so discuss your concerns with your doctor before starting treatment.

Hormone therapy.

If your type of breast cancer is sensitive to hormones, your doctor may start you on hormone therapy. Estrogen and progesterone, two female hormones, can stimulate the growth of breast cancer tumors. Hormone therapy works by blocking your body’s production of these hormones, or by blocking the hormone receptors on the cancer cells. This action can help slow and possibly stop the growth of your cancer.

Medications.

Certain treatments are designed to attack specific abnormalities or mutations within cancer cells. For example, Herceptin (trastuzumab) can block your body’s production of the HER2 protein. HER2 helps breast cancer cells grow, so taking a medication to slow the production of this protein may help slow cancer growth.

Your doctor will tell you more about any specific treatment they recommend for you. Learn more about breast cancer treatments, as well as how hormones affect cancer growth.

Breast cancer care.

If you detect an unusual lump or spot in your breast, or have any other symptoms of breast cancer, make an appointment to see your doctor. Chances are good that it’s not breast cancer. For instance, there are many other potential causes for breast lumps.

But if your problem does turn out to be cancer, keep in mind that early treatment is the key. Early-stage breast cancer can often be treated and cured if found quickly enough. The longer breast cancer is allowed to grow, the more difficult treatment becomes.

If you’ve already received a breast cancer diagnosis, keep in mind that cancer treatments continue to improve, as do outcomes. So follow your treatment plan and try to stay positive. Find out more about the outlook for different stages of breast cancer.

Prevention of Breast Cancer.

There is no way to prevent breast cancer. However, certain lifestyle decisions can significantly reduce the risk of breast cancer as well as other types.

These include:

avoiding excessive alcohol consumption.

following a healthful diet containing plenty of fresh fruit and vegetables.

getting enough exercise.

maintaining a healthy body mass index (BMI).

Women should consider their options for breastfeeding and the use of HRT following menopause, as these can also increase the risk.

Preventive surgery is also an option for women at high risk of breast cancer.

Sources:

Health line.

Medical News Today.

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