Breast Cancer: Symptoms, Prevention, and Treatment

18 March,2024

Breast cancer is a growing concern among the medical fraternity all over the world. With one woman being diagnosed with breast cancer every 4 minutes, it is one of the highest prevailing cancers in India. There is a need for spreading awareness about the disease as ~50% of patients visit doctors when the cancer has reached stage 3. 

Early diagnosis or detection plays a vital role in cancer treatment. When diagnosed in the initial stages, breast cancer has a 5-year survival rate of 99%. And here is another good news. With constant improvements in cancer screening and genetic studies, oncologists can now easily detect breast cancer in the early stages. The number of people dying due to breast cancer is gradually decreasing. This blog will help you understand breast cancer's symptoms, prevention, and treatment. 

What is Breast Cancer?

Breast cancer is a disease condition marked by the turning of normal cells in the breasts into cancerous cells. They start dividing uncontrolled and form a cluster known as a tumor. When cancerous cells from the breast spread to other body parts and start dividing there, it is known to metastasize. 

The breast is made up of ducts (milk-carrying ducts), lobules (milk-producing glands), and connective tissues (fibrous and fatty tissue). Breast tumors can originate from any of these parts. 

Breast cancer of various types can be classified in the following ways –

• Ductal Carcinoma In Situ (DCIS): Ductal carcinoma in situ is an early-stage (stage 0) breast cancer that is localized to the milk ducts. However, if not treated, it can turn invasive.
• Lobular Carcinoma In Situ: Abbreviated as LCIS, lobular carcinoma in situ is found in the breast lobules. It is not a cancer in the true sense but indicates a high probability of developing breast cancer in the future. Frequent screening is advised in LCIS. 
• Invasive Ductal Carcinoma: Infiltrative or invasive ductal carcinoma (IDC) starts from the ducts but then breaks the duct walls and invades the fatty tissue. It is the most common form of breast cancer and accounts for 80% of the invasive cases.
• Invasive Lobular Carcinoma (ILC): ILC accounts for 10% of invasive breast cancers. It starts in the lobules and then spreads to nearby tissues and other body parts. Subtypes include adenoid cystic carcinoma, medullary carcinoma, mucinous carcinoma, papillary carcinoma, triple-negative breast cancer, and tubular carcinoma. 

What Causes Breast Cancer?

A mutation in the DNA of the breast cells causes breast cancer. However, why exactly the mutations occur and the exact reason for breast cancer is still unknown. Several risk factors are found to be linked with breast cancer. These are –

• Age: Breast cancer can affect an individual at any age. But the chances of it increases when a woman is aged 55 and above.
• Sex: Women and AFAB (people assigned female at birth) are at a higher chance of developing breast cancer than men and people assigned male at birth (AMAB). 
• Family History: The chances of breast cancer increase if your parents, children, siblings, or other close relatives have breast cancer.
• Genetic Makeup: Inherited genetics is one of the significant risk factors for breast cancer, with 15% of cases occurring due to inherited genes. BRCA1 and BRCA2 are the common genetic mutations responsible for breast cancer.
• Smoking and Alcohol Consumption: Beverages containing alcohol and smoking are linked not just to breast cancer but to many other types of cancers. 
• Radiation Exposure: Your likelihood of developing breast cancer increases if you have had prior radiation therapy, especially to the head, neck, and chest.
• Hormone Replacement Therapy (HRT): People placed on HRT take estrogen and progesterone medications and have greater chances of breast cancer. 

What are the Symptoms of Breast Cancer?

The breast cancer affects the breast tissue in multiple ways. Different people can have various symptoms. It is also possible for breast cancer to not show any specific symptoms in the initial stages. But when it does, symptoms include – 

• A mass/lump that may be as small as the size of a pea
• Changes in shape, size, and contour of the breast
• A change in the skin of the breast or the nipple
• Fluid or blood discharge from the nipple
• Hardened area under the skin
• A lump in the breast or underarm that stays through periods 
• Pulling in of the nipple
• Pain in the breast and nipple

How is Breast Cancer Diagnosed?

Breast cancer screening is the best way to diagnose the disease early. It involves examining breasts before there are any signs and symptoms of the disease. If the oncologist suspects any lumps or changes in the breast, they will do the following tests to confirm their diagnosis. 

• Mammogram: A mammogram is a part of cancer screening in which X-rays produce images of the breasts. It can show any lumps and abnormalities in the tissue.
• Ultrasound: This imaging test involves using sound waves to differentiate between fluid-filled sacs and solid mass. 
• MRI Scan: This scan gives the most precise images of the breast and surrounding tissues and helps detect any abnormal tumor or mass in the region. 
• Biopsy: A biopsy is done by extracting a small sample from the tissue and sending it to the laboratory for further studies. It tells whether the tumor is cancerous or not, and if it is, then which type of breast cancer has developed.

If the diagnosis of breast cancer is confirmed, the oncologist will order a few more tests to decide the best course of treatment based on the type of cancer cells. These include –

• Genetic Tests: These tests look for genetic changes in cells, such as changes in the TP53 and BRCA genes.
• HER2 Test: It is a protein present outside all breast cells. High levels of HER2 mean the cancer has a high growth rate and can invade other body parts.
• Estrogen and Progesterone Receptor Test: A more than average level of estrogen receptors (ER) and progesterone receptors (PR) in the tumor means the cancer is progesterone/estrogen positive. It proliferates and requires immediate treatment.

Can Breast Cancer Be Prevented?

Prevention is always better than cure. Anyone can reduce the chances of developing breast cancer by following measures such as – 

• Get regular breast cancer screening. Mammograms can detect lumps/tumors when they are too little to be felt. 
• Learn breast self-exam. It may not prevent cancer, but it will help you discover the disease early.
• Quit smoking and drinking alcohol. Join support groups that would help you quit these harmful habits. If you can’t quit, at least limit the intake.
• Exercise for at least 30 minutes every day. 
• Put a limit on hormone replacement therapy. Talk with a healthcare professional and weigh the benefits and risks of the HRT.
• Maintain a healthy weight. If you are obese, try to shed those extra kilos. Eat a healthy and balanced diet. 

Do Males Develop Breast Cancer?

Everyone is born with breast tissues. Although rarely, men can also develop breast cancer at any point in life. 10 out of every 1000 breast cancer cases diagnosed in the US is male. The most common types of breast cancer in males are invasive ductal carcinoma and ductal carcinoma in situ. Symptoms of male breast cancer are lump/swelling in the breast, redness in the breast, fluid discharge from nipples, irritation of breast skin, and pulling in of the nipple. 

How is Breast Cancer Treated?

There are many treatment plans for breast cancer. Surgery is done in almost every case. It is then followed by chemotherapy and radiation therapy. A cancer specialist will decide the best course of treatment for the patient based on the type and stage of the cancer. A combination of the following treatment modalities is used for breast cancer treatment. 

Surgery

Surgery for breast cancer involves removing the tumor and nearby lymph nodes. There are various types of surgeries to treat breast cancer. These include – 

• Lumpectomy: Wide local excision or a lumpectomy means removing only the tumor and the nearby marginal healthy tissues.
• Mastectomy: When the surgeon removes the complete breast tissue, it is known as mastectomy. Several newer variations in mastectomy are skin-saving mastectomy and nipple-saving mastectomy.  
• Lymph Node Removal Surgery: Breast cancer tends to spread to the other body parts, and the first lymph nodes affected by it are in the armpit (axilla). The surgeon will perform an axillary lymph node dissection and remove all or most of the lymph nodes from the armpit.
• Contralateral Prophylactic Mastectomy: There are chances that the surgeon might remove both breasts even when the tumor is present in a single breast. It is done for patients who have a high chance of getting breast cancer in the future. 
• Breast Reconstruction: Most women opt for breast reconstruction surgery after a mastectomy. The surgery does not remove the tumor but aims at recreating a breast of similar shape and size for aesthetic purposes. 

Chemotherapy

• Chemotherapy for breast cancer involves using cytotoxic drugs to destroy tumor cells. 
• An oncologist might recommend chemotherapy before surgery to shrink the tumor (neoadjuvant chemotherapy). Neoadjuvant chemotherapy is done in cases of large breast cancers, triple-negative breast cancer, HER2-positive breast cancer, and inflammatory breast cancer. 
• Chemotherapy, when given after surgery, is known as adjuvant chemotherapy. Indications include cancerous cells in lymph nodes, hormone receptor-negative breast cancer, small HER2-positive breast cancer, and high-grade breast cancers (grade 3).
• Drugs used for chemotherapy are paclitaxel, docetaxel, epirubicin, carboplatin, capecitabine, eribulin, etc. 
• A combination of drugs can also be used, such as epirubicin and cyclophosphamide (EC), doxorubicin and cyclophosphamide (AC), docetaxel and cyclophosphamide (TC), etc.

Radiation Therapy

• Radiation therapy is often done after a lumpectomy or a mastectomy. For breast cancers, external beam radiation is done in which the patient lies on a table, and a machine delivers radiation precisely to the tumor. 
• Radiation therapy helps in killing any of the remaining cancerous cells after the surgery. It significantly reduces the chances of cancer coming back. 
• Side effects of radiotherapy include feeling tired, sunburn-like rashes, swollen breasts, etc.

Hormone Therapy

• Hormone therapy for breast cancer aims at blocking certain hormones that are responsible for the growth of cancer cells. These include estrogen and progesterone. 
• Hormone therapy is also given after breast cancer surgery and lowers the risk of cancer coming back. It is also helpful in cases where the cancer metastases to other body parts. 
• Hormone therapy includes 
  • Medicines to block hormones from attaching to the tumor (selective estrogen receptor modulators)
  • Medicines to stop the production of estrogen after menopause (aromatase inhibitor)
  • Medicines to prevent ovaries from producing hormones
• Side effects of hormone therapy include night sweats, hot flashes, vaginal dryness, risk of bone thinning, etc.

Immunotherapy and Targeted Therapy

• These are relatively new forms of breast cancer treatment. In targeted therapy, drugs target the specific differentiating factors in the cancer cells. Immunotherapy works by activating and boosting the immune system to identify and kill cancer cells.
• Immunotherapy and targeted therapy also help in the treatment of secondary breast cancer (when the breast cancer has spread to other body parts)
• The drugs used for the treatment are decided after various tests on the cancer cells. Not all drugs work on every cancer. The oncologist makes a personalized treatment plan based on the type of breast cancer the patient has. 
• Examples of targeted therapy and immunotherapy drugs include abemaciclib, denosumab, neratinib, olaparib, pembrolizumab, trastuzumab, etc.
• Side effects include tiredness, loss of appetite, skin changes, diarrhea, flu-like symptoms, and low blood cell count.

What is the Survival Rate of Breast Cancer?

Once diagnosed with breast cancer, everyone thinks about getting the best treatment. But at the same time, they think about the survival rates as cancer is known to be a fatal disease. Your treating oncologist will tell you about the prognosis of your disease. Prognosis means how the disease will go for you. Breast cancer prognosis depends on multiple factors such as type and stage of cancer, how fast it is growing, your age, overall health, and how the cancer responds to the treatment. 

Treatment of breast cancer has a high success rate, especially in the initial stages. The success is measured in terms of 5-year survival rates. The combined 5-year survival rate of breast cancer is around 90%.

• Localized Breast Cancer: Stage 1 A and a few cases of stage 2 A and B cancer have a survival rate of 99%. 
• Regional Breast Cancer: Stage 1 B, a few cases of stage 2 A and B, and all stage 3 breast cancer have a survival rate of 86%. 
• Distant Breast Cancer: Once the breast cancer has metastasized and reached other body parts, the survival rate is 28%.

The age-wise 5-year survival rate of breast cancer is as follows – 

• Women <45 years: 88%
• Women aged 45-54: 91%
• Women aged 55-64: 91%
• Women aged 65-74: 92%
• Women above 75 years of age: 86%

Takeaway

Breast cancer affects men and women in every country. Over 2.3 million cases are diagnosed annually worldwide. The disease can run in your family without you knowing. Regular screening is essential to diagnose breast cancer in the early stages. The chances of beating breast cancer are as high as 100% when the tumor is localized. With the correct information and help, you can defeat the fatal disease. Consult an oncologist today and save your future.