Breast Cancer- What Is Breast Cancer? What Causes Breast Cancer?

Breast cancer is a kind of cancer that develops from breast cells. Breast cancer usually starts off in the inner lining of milk ducts or the lobules that supply them with milk. A malignant tumor can spread to other parts of the body. A breast cancer that started off in the lobules is known as lobular carcinoma, while one that developed from the ducts is calledductal carcinoma.

The vast majority of breast cancer cases occur in females. This article focuses on breast cancer in women since  there are cases of breast cancer in men.Breast cancer is the most common invasive cancer in females worldwide.

Breast cancer rates are much higher in developed nations compared to developing ones. There are several reasons for this, with possibly life-expectancy being one of the key factors – breast cancer is more common in elderly women; women in the richest countries live much longer than those in the poorest nations. The different lifestyles and eating habits of females in rich and poor countries are also contributory factors, experts believe.

 

What is the difference between invasive and non-invasive breast cancer?

Invasive breast cancer – the cancer cells break out from inside the lobules or ducts and invade nearby tissue. With this type of cancer, the abnormal cells can reach the lymph nodes, and eventually make their way to other organs (metastasis), such as the bones, liver or lungs. The abnormal (cancer) cells can travel through the bloodstream or the lymphatic system to other parts of the body; either early on in the disease, or later.

Non-invasive breast cancer – this is when the cancer is still inside its place of origin and has not broken out. Lobular carcinoma in situ is when the cancer is still inside the lobules, while ductal carcinoma in situ is when they are still inside the milk ducts. “In situ” means “in its original place”. Sometimes, this type of breast cancer is called “pre-cancerous”; this means that although the abnormal cells have not spread outside their place of origin, they can eventually develop into invasive breast cancer.

 

What are the signs and symptoms of breast cancer?

A symptom is only felt by the patient, and is described to the doctor or nurse, such as a headache or pain. A sign is something the patient and others can detect, for example, a rash or swelling.

The first symptoms of breast cancer are usually an area of thickened tissue in the woman’s breast, or a lump. The majority of lumps are not cancerous; however, women should get them checked by a health care professional.

 

According to the National Health Service, UK, women who detect any of the following signs or symptoms should tell their doctor:

 

• A lump in a breast
• A pain in the armpits or breast that does not seem to be related to the woman’s menstrual period
• Pitting or redness of the skin of the breast; like the skin of an orange
• A rash around (or on) one of the nipples
• A swelling (lump) in one of the armpits
• An area of thickened tissue in a breast
• One of the nipples has a discharge; sometimes it may contain blood
• The nipple changes in appearance; it may become sunken or inverted
• The size or the shape of the breast changes
• The nipple-skin or breast-skin may have started to peel, scale or flake

What are the causes of breast cancer?

Experts are not sure what causes breast cancer. It is hard to say why one person develops the disease while another does not. We know that some risk factors can impact on a woman’s likelihood of developing breast cancer.

• Getting older– the older a woman gets, the higher is her risk of developing breast cancer; age is a risk factor. Over 80% of all female breast cancers occur among women aged 50+ years (after the menopause).

 

• Genetics– women who have a close relative who has/had breast or ovarian cancer are more likely to develop breast cancer. If two close family members develop the disease, it does not necessarily mean they shared the genes that make them more vulnerable, because breast cancer is a relatively common cancer.The majority of breast cancers are not hereditary.Women who carry the BRCA1 and BRCA2 genes have a considerably higher risk of developing breast and/or ovarian cancer. These genes can be inherited. TP53, another gene, is also linked to greater breast cancer risk.

 

• A history of breast cancer– women who have had breast cancer, even non-invasive cancer, are more likely to develop the disease again, compared to women who have no history of the disease.

 

• Having had certain types of breast lumps– women who have had some types of benign (non-cancerous) breast lumps are more likely to develop cancer later on. Examples include atypical ductal hyperplasia or lobular carcinoma in situ.

 

• Dense breast tissue– women with more dense breast tissue have a greater chance of developing breast cancer.

 

• Estrogen exposure– women who started having periods earlier or entered menopause later than usual have a higher risk of developing breast cancer. This is because their bodies have been exposed to estrogen for longer. Estrogen exposure begins when periods start, and drops dramatically during the menopause.

 

• Obesity– post-menopausal obese and overweight women may have a higher risk of developing breast cancer. Experts say that there are higher levels of estrogen in obese menopausal women, which may be the cause of the higher risk.

 

• Height– taller-than-average women have a slightly greater likelihood of developing breast cancer than shorter-than-average women. Experts are not sure why.

 

• Alcohol consumption– the more alcohol a woman regularly drinks, the higher her risk of developing breast cancer is.

 

• Radiation exposure– undergoing X-rays and CT scans may raise a woman’s risk of developing breast cancer slightly. Scientists at the Memorial Sloan-Kettering Cancer Center found that women who had been treated with radiation to the chest for a childhood cancer have a higher risk of developing breast cancer.

 

• HRT (hormone replacement therapy)– both forms, combined and estrogen-only HRT therapies may increase a woman’s risk of developing breast cancer slightly. Combined HRT causes a higher risk.

 

• Certain jobs– French researchers found that women who worked at night prior to a first pregnancy had a higher risk of eventually developing breast cancer.Canadian researchers found that certain jobs, especially those that bring the human body into contact with possible carcinogens and endocrine disruptors are linked to a higher risk of developing breast cancer. Examples include bar/gambling, automotive plastics manufacturing, metal-working, food canning and agriculture. They reported their findings in the November 2012 issue of Environmental Health.

 

• Cosmetic implants may undermine breast cancer survival– women who have cosmetic breast implants and develop breast cancer may have a higher risk of dying prematurely form the disease compared to other females, researchers from Canada reported in the BMJ (British Medical Journal) (May 2013 issue).The team looked at twelve peer-reviewed articles on observational studies which had been carried out in Europe, the USA and Canada.Experts had long-wondered whether cosmetic breast implants might make it harder to spot malignancy at an early stage, because they produce shadows on mammograms.

Women with cosmetic breast implants who are diagnosed with breast cancer have a 38% higher risk of death from the disease, compared to other patients diagnosed with the same disease who have no implants, the researchers wrote.

After warning that there were some limitations in the twelve studies they looked at, the authors concluded “Further investigations are warranted into the long term effects of cosmetic breast implants on the detection and prognosis of breast cancer, adjusting for potential confounders.”

Diagnosing breast cancer

Women are usually diagnosed with breast cancer after a routine breast cancer screening, or after detecting certain signs and symptoms and seeing their doctor about them.

If a woman detects any of the breast cancer signs and symptoms described above, she should speak to her doctor immediately. The doctor, often a primary care physician (general practitioner, GP) initially, will carry out a physical exam, and then refer the patient to a specialist if he/she thinks further assessment is needed.

Below are examples of diagnostic tests and procedures for breast cancer:

• Breast exam– the physician will check both the patient’s breasts, looking out for lumps and other possible abnormalities, such as inverted nipples, nipple discharge, or change in breast shape. The patient will be asked to sit/stand with her arms in different positions, such as above her head and by her sides.

 

• X-ray (mammogram)– commonly used for breast cancer screening. If anything unusual is found, the doctor may order a diagnostic mammogram.Breast cancer screening has become a controversial subject over the last few years. Experts, professional bodies, and patient groups cannot currently agree on when mammography screening should start and how often it should occur. Some say routine screening should start when the woman is 40 years old, others insist on 50 as the best age, and a few believe that only high-risk groups should have routine screening.In July, 2012, The American Medical Association said that women should be eligible for screening mammography from the age of 40, and it should be covered by insurance.

  Another study, carried out by scientists at the The Dartmouth Institute for Healthy Policy & Clinical Practice in Lebanon, N.H., and reported in the New England Journal of Medicine (November 2012 issue), found that mammograms do not reduce breast cancer death rates.
  2013 issue).

 

• Beast ultrasound– this type of scan may help doctors decide whether a lump or abnormality is a solid mass or a fluid-filled cyst.

 

• Biopsy– a sample of tissue from an apparent abnormality, such as a lump, is surgically removed and sent to the lab for analysis. It the cells are found to be cancerous, the lab will also determine what type of breast cancer it is, and the grade of cancer (aggressiveness). Scientists from the Technical University of Munich found that for an accurate diagnosis, multiple tumor sites need to be taken.

 

• Breast MRI (magnetic resonance imaging) scan– a dye is injected into the patient. This type of scan helps the doctor determine the extent of the cancer. Researchers from the University of California in San Francisco found that MRI provides a useful indication of a breast tumor’s response to pre-surgical chemotherapy much earlier than possible through clinical examination.

 

Staging describes the extent of the cancer in the patient’s body and is based on whether it is invasive or non-invasive, how large the tumor is, whether lymph nodes are involved and how many, and whether it has metastasized (spread to other parts of the body).

A cancer’s stage is a crucial factor in deciding what treatment options to recommend, and in determining the patient’s prognosis.

Staging is done after cancer is diagnosed. To do the staging, the doctor may order several different tests, including blood tests, a mammogram, a chest X-ray, a bone scan, a CT scan, or a PET scan.

 

Male Breast Cancer – What Is Male Breast Cancer
Male breast cancer is a relatively rare cancer in men that originates from the breast. Most cases of male breast cancer develop in men who are 65 years of age, or over, although cases have been recorded in men aged who are between 20-90 years of age.

Breast cancer is 100 times more common in women than in men. The American Cancer Society estimates that each year, about 1,990 new cases of breast cancer in men will be diagnosed and that breast cancer will cause approximately 480 deaths in men. A man’s lifetime risk of developing breast cancer is about one in one thousand.

The estimated five year survival rate for early-stage male breast cancer is 75-100%. For mid-stage male breast cancer it is 50-80%, and for advanced-stage male breast cancer there is 30-60% chance of survival after five years from detection.

 

What are the symptoms of Male Breast Cancer?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign.

Adjusted for age and stage the prognosis for breast cancer in men is similar to that in women. Men will experience smaller tumor size and absence or paucity of local lymph node involvement. Hormonal treatment may be associated with hot flashes and impotence.

The most common symptom of male breast cancer is the appearance of a lump in the breast. In most cases, the lump will be painless.

Less common symptoms of male breast cancer usually affect the nipple. Such symptoms include nipple retraction, ulceration and discharge, where fluid begins to leak from the nipple.

If the cancer spreads additional symptoms may include breast pain, bone pain, and swelling of the lymph nodes (glands) near the breast, usually in or around, the armpit.

What are the causes of Male Breast Cancer?

It is not known for certain what causes the cells in the breast to become cancerous. However, a number of risk factors for male breast cancer have been identified.

About 85% of breast cancers in men have estrogen receptors on their cell membranes. Estrogen receptors on the cell membranes allow estrogen molecules to bind to the cancer cells. Estrogen binding to the cancer cells stimulates cell growth and multiplication.

Klinefelter’s syndrome is a major risk factor for male breast cancer because men with the condition are 20 times more likely to develop male breast cancer than the male population at large. Klinefelter’s syndrome is where baby boys are born with much higher levels of estrogen than normal.

A number of mutated genes have been linked to an increase risk of male breast cancer. For example, a mutation known as the BRAC2 mutation has been found in an estimated 5% of men with male breast cancer.

There is also evidence that male breast cancer can run in families, as 1 in 5 men who develop breast cancer, have a first-degree male relative, such as a father, or brother, who also has a history of breast cancer.

Diagnosing Male Breast Cancer

Typically self-examination leads to the detection of a lump in the breast which requires further investigation.

Biopsy, ultrasound and mammography may be sometimes used for further definition.

What are the treatment options for Male Breast Cancer?

Surgery is usually the first treatment option for male breast cancer, and usually involves an operation called a modified radical mastectomy. This involves the surgeon removing the entire breast as well as the lymph nodes in the armpit.

Estrogen hormone therapy can be used in cases of male breast cancer where there are estrogen receptors on the walls of the cancerous cells. This means that the cells can use estrogen to help them grow and reproduce. Therefore, the aim of hormone therapy is to block the effects of estrogen. In addition, Tamoxifen is a widely used medication in hormone therapy. It works by blocking the estrogen receptors so that estrogen is unable to enter into cancerous cells. In another treatment option, aromatase inhibitors block the effects of the aromatase protein which, in turn, lowers the amount of estrogen in the body.

Chemotherapy is used to treat cases of male breast cancer where the cancerous cells do not have estrogen receptors, meaning that hormone therapy would be mostly ineffective. Chemotherapy is usually given after surgery in order to prevent the cancer returning, or it is used to treat the symptoms of incurable cancer.

 

Preventing Male Breast Cancer

Early detection can help prevent the spread of cancer. If there is a history of male breast cancer in the family, a person should check regularly for lumps and report any changes to a doctor as soon as possible.

In general, leading a healthy lifestyle is a good way to help prevent male breast cancer, as well as many other serious health conditions.