Breast Cancer: Diagnosis, Treatment, and Prevention
Breast cancer is cancer that forms in the breast tissue. This type of cancer is mostly found in women but affects men as well. Chances of survival rise significantly if the cancer is caught early.
With advancements in medicine, breast cancer patients have a much better chance of survival. Contributing factors such as greater awareness, regular screenings, and a better overall understanding of cancer have all played a role in how this disease is treated today.
How does breast cancer develop?
Breast cancer is defined as abnormal cell growth in breast tissue that develops into a tumour. These tumours commonly start developing in milk ducts and can spread to other parts of the breast if not treated.
Who gets breast cancer?
Breast cancer can affect a person of any sex, however, it is 100 times more likely to occur in women than in men. Women's’ breasts develop over the course of three to four years, completing the process around the age of 14. As the breasts form, the cells become responsive to estrogen and other hormones, including hormone disrupters in the environment. This makes them vulnerable to abnormal cell development. Men don’t develop lactating breasts so their breast cells remain inactive, making them less vulnerable to this type of cancer.
How does giving birth affect a woman’s risk of breast cancer? The answer is complex and not yet fully understood. The immediate effect is to increase the risk slightly. This increase lasts for a period of about ten years. After that, the effect is the opposite—after ten years or so the risk of breast cancer is somewhat less than that of a woman who has never given birth.
Although just being a woman makes you more susceptible to breast cancer, only about 12% actually develop the disease. Risk factors can be divided into two categories—modifiable (things you can change) and fixed (things you can't change).
Modifiable risk factors include obesity, high consumption of alcohol, smoking, certain dietary patterns, lack of exercise, and the use of hormonal birth control, especially certain forms of synthetic estrogen. However, the correlation between these factors and breast cancer is anything but straightforward.
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Fixed risk factors include:
- Age—women over the age of 50 are more likely to develop breast cancer, however women who bear children earlier in life might receive the long-term risk-reduction.
- Inheritance—a family history of breast cancer increases a woman’s risk of developing the disease. Risk increases with proximity (your mother vs a distant relative).
- Exposure to ionising radiation—radiation is a well-known contributor to many kinds of cancers.
- Dense breast tissue—women with low-fat tissue and dense breast tissue have higher risks of breast cancer compared to women with a less dense breast mass.
- Hormonal imbalances—women who have estrogen dominance are more likely to get breast cancer, as the disease is directly linked to overproduction of oestrogen.
Learn more about female hormones in our article here.
Types of breast cancer
Breast cancer is classified into types, stages, and grades. Stage indicates how far cancer has spread or if it’s spreading at all. Grade describes the condition of the tumour cells—whether they are similar to normal breast cells or have more abnormalities.
Cancer types can be non-invasive or invasive—cancer that spreads beyond the tissue it develops in. Breast cancer is commonly divided into the following types:
- Invasive ductal breast cancer develops in the milk ducts and spreads to surrounding tissues.
- Invasive lobular breast cancer develops in lobules (the glands that produce milk) and spreads to surrounding tissues.
- Ductal carcinoma in situ is non-invasive cancer that develops in the milk ducts.
- Lobular carcinoma in situ is non-invasive cancer that develops in the lobules.
Self-exam and symptoms of breast cancer
A breast self-exam is a precautionary measure that can be done at home. Taking the time to examine your own breasts on a regular basis will make you aware of any changes in the tissues that should be checked by a doctor.
When performing a self-exam, timing is important. As your menstrual cycle can impact the tenderness and size of your breasts. Adjust the time according to your personal experience—breasts tend to be less tender approximately one week after your period starts.
Start the self-exam by checking for any changes in the way your breasts look. Are there any differences in shape and size? Notice if your nipples look the same. Signs of breast cancer include nipples becoming inverted and/or changing colour. Any unusual discharge (clear or bloody) is cause for concern. Other visual symptoms can include swelling, rash, redness, and changes in breast fullness.
Follow by gently touching your breasts with the pads of your fingers, going around the soft tissue and nipples. Feel for lumps and knots. Notice any discomfort or pain when you examine your breast. Next, lift your arms and examine the sides of your breasts and armpits where your lymph nodes are located. Again, look for any painful sensations, lumps, or knots.
What you might find
If you find any abnormal symptoms, don’t panic. Breast cancer is not the only thing that causes changes, but it's best if you consult your doctor for a diagnosis.
Breast lumps, although scary, 9 times out of 10 these lumps aren’t cancerous. The appearance of lumps is often caused by hormonal fluctuations in the body. Non-cancerous lumps are usually small (up to 2 cm) and can be moved from side to side.
Breast tenderness is most often caused by hormonal changes in the body. Your breasts can be tender and even painful before your period, while taking hormonal birth control, and during pregnancy or other reproductive health events. Hormonal breast pain will eventually pass, while inflammatory pain usually stays. This type of pain increases with time and may be located in one spot.
Breast shape and skin. Most women don’t have symmetrical breasts, and that’s completely normal. Breast shape might also change over the course of your menstrual cycle—your breasts may feel fuller in the last days of the cycle. Pregnancy and birth also impact the way breasts look. The things to look out for are redness, swelling, or irritation of the skin on and around your breasts. A rapid change in size may be cause for concern, especially if the change affects only one breast.
Diagnosis and treatment
If your symptoms are indicative of cancer, your doctor will refer you to an oncological disease department for further tests. The first tests are unusually non-invasive—an ultrasound scan, followed by a mammogram (x-ray of the breast). If these exams show abnormalities in breast tissue, a biopsy of the breast tissue will be taken to determine if cancer is present.
Treatment depends on the type, stage, and grade of cancer—how big the tumours are and how far cancer has spread. The most common types of treatment are:
- Partial surgery (lumpectomy)—for non-invasive cancers; only the affected area is removed.
- Mastectomy (removal of the breast)—this is necessary if cancer has spread to the surrounding tissue.
- Lymph node surgery—if cancer spreads to the lymph nodes, some of them may need to be removed.
- Radiotherapy—x-rays used to kill cancer cells; a course of radiotherapy is recommended along with a mastectomy to ensure cancer doesn’t return.
- Chemotherapy and hormonal therapy use drugs or hormones to reduce cancer and eliminate cancer cells. Doctors often recommend chemotherapy before and after surgery, as it can reduce the size of cancer, meaning that less tissue must be removed.
Living with breast cancer
Being diagnosed with breast cancer can impact your mental health. The healing process includes both your physical and mental wellbeing. It’s important not to be alone with these feelings and thoughts. Having someone to talk to can be of great help—this could be a trusted friend, a relative, or even a complete stranger. Whatever works best for you.
Breast cancer treatment takes a toll on many aspects of your life—relationships and family, finances, mental state, and self-image. Many women struggle to establish a new positive sense of self after experiencing a mastectomy and chemotherapy. These treatments have mental and physical consequences that can be difficult to accept. Cancer medications can make you sick, and all aspects of the disease and treatment will sap your resources and leave you feeling tired. Finding support and different ways to cope is important for recovery.
Therapy can help cancer patients manage and improve their situation. Many breast cancer patients find comfort in group therapy where other people with cancer share their experiences. Many find a sense of belonging and the understanding that even in fighting cancer we need not be alone.
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