Breast Cancer

What you need to know about BREAST CANCER

The article is a brief study of breast cancer risk factors. Here under described the types, causes, risk factors, symptoms, prevention’s, diagnosing and treatment methods.

Breast cancer, what it is?

  • Cancer is the growth of abnormal cells.
  • Cancer cells can invade and damage normal tissues.
  • Breast Cancer can start in any part of the breast.

Breast Structure

  • The breasts sit on chest muscles that cover the ribs.
  • Each breast consists of 15- 20 lobes, which contain many smaller lobules.
  • Lobules contain a group of tiny glands that produce milk.
  • Milk flows from lobules through thin tubes, called ducts to the nipple.
  • The areola is a dark area of the centre of the skin in the nipple.
  • Fat or stroma fills the spaces between the areola and ducts.

Types of Breast Cancer

Two most common types are:

  • Ductal Carcinoma – Originates from ducts
  • Lobular Carcinoma – Originates from lobules.

Incidence, how big is the problem?

  • Worldwide, Breast cancer is the most common invasive cancer in women.
  • Pakistan has the highest breast cancer incidence in Asia.
  • Every year 44000 women die of breast cancer in Pakistan.
  • At some stage of life, 1 in 9 women in Pakistan has to become a breast cancer patient.
  • Younger women are presenting with advanced stage breast cancer.
  • Iran J Public Health, Vol. 44, No.4, Apr 2015, pp.586-587

Causes

  • Breast cancer is always caused by a genetic abnormality.
  • Only 5-10% of breast cancers are due to inherited abnormality.
  • About 90% of breast cancers are due to genetic abnormalities due to the ageing process and ‘wear and tear’ of life in general.

Risk Factors

  • Risk factors are anything that can increase or decrease a person’s chance of getting a disease such as cancer.
  • There are many known risk factors for breast cancer. Some of these can’t be changed but some can.
  • Gender: Female (1% males only)
  • Race: More common in white.
  • Age: Increases, as a woman gets older.
  • Relative: Mother or Sister
  • Menstrual history: Early onset late menopause
  • Childbirth: First child after the age of 30 yrs or having no children at all.
  • Pregnancy and Breast-feeding are protective against breast cancer.
  • Obesity
  • Diet: Fat, Alcohol
  • Radiation Exposure
  • History of cancer: Breast, Uterus, Cervix, and Ovary.
  • Hormones: Estrogens in hormone replacement therapy and birth control pills.
  • Genetics: Certain conditions, that are inherited, like BRCA 1 and 2 mutations.
  • More than 70% have no risk factor.

Symptoms

  • Early Breast cancer may not have symptoms.
  • Breast Lumps and masses
  • Most common symptom
  • A mass that’s painless, hard, and has irregular edges is more likely to be cancer.
  • But breast cancers can be tender, soft, or rounded. They can even be painful.
  • For this reason, it’s important to have any new breast mass, lump, or change checked by a health care provider experienced in diagnosing breast diseases.

Breast Cancer

Other Symptoms

  • Swelling of all or part of a breast (even if no distinct lump is felt)
  • Skin irritation or dimpling
  • Breast or nipple pain
  • Nipple retraction (turning inward)
  • Redness, scaliness, or thickening of the nipple or breast skin
  • Nipple discharge other than breast milk
  • Sometimes breast cancer can spread to lymph nodes under the arm or around the collarbone and cause a lump or swelling there, even before the original tumour in the breast tissue is large enough to be felt.

Triple assessment

  1. Clinical examination

  • BSE– Breast Self Examination
  • CBE– Clinical Breast Examination by the trained Health care provider.
  1. Radiological assessment

  • Ultrasonography – better age<40 yrs
  • Mammography – better age >40 yrs
  • MRI Breast
  1. Pathological assessment

  • FNAC– Fine needle aspiration cytology
  • True cut biopsy
  • Excision biopsy
  • Incisional / Wedge Biopsy

Prevention 

A)Screening for Breast Cancer

A good Breast Health Plan

  • Self Awareness—BSE, i.e monthly breast self-examination
  • Clinical Breast Examinations— CBE
  • Mammograms

B)Breast Self Examination (BSE)

  • Opportunity for a woman to become familiar with her breasts
  • A monthly examination of breasts and underarm area
  • May discover any changes early
  • Begin at age of 20 yrs, continue monthly.

How to do BSE

  • Menstruating women, 5-7 days after the beginning of their period
  • Menopausal women, same date each month.
  • Pregnant women, same date each month.
  • It takes about 10 minutes.
  • Perform BSE once a month.
  • Examine all the breast tissue and armpits.

Steps of BSE

Step 1:

  • Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.
  • Here’s what you should look for:
  • Breasts that are their usual size, shape, and colour
  • Breasts that are evenly shaped without visible distortion or swelling
  • If you see any of the following changes, bring them to your doctor’s attention:
  • Dimpling, puckering or bulging of the skin
  • A nipple that has changed position or an inverted nipple.
  • Redness, soreness, rash, or swelling

Step 2:

  • Now, raise your arms and look for the same changes.

Step 3:

  • While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood)

Step 4:

  • Next, feel your breasts while standing in front of the mirror. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the circular hand movements.

Step 5:

  • Finally, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast.
  • Use a firm, smooth touch with the finger pads of your hand, keeping the fingers flat and together. Use a circular motion to feel.

Why don’t more women practice BSE?

  • Fear
  • Embarrassment
  • Youth
  • Lack of knowledge
  • Too busy, forgetful.

Clinical breast Examination (CBE)

  • Performed by a doctor or a trained health care provider
  • Annually for women over 40 years
  • At least every 3 years for women between ages 20-40 years.
  • More frequent examinations for high-risk patients.

C) Mammography

  • A mammogram is an X-Ray of the breast.
  • For a mammogram, the breast is pressed between two plates to flatten and spread the tissue and take images.
  • Usually, two views are taken:
  1. Cranio-caudal
  2. Medio-lateral-oblque.

Mammography

Women at average risk of breast cancer

  • Age 40-44—should be able to start breast cancer screening, if they wish to do so.
  • At age 45-54—should get mammograms every year.
  • And at age 55 years or more should switch to mammograms every two years.
  • Screening should continue as long as the woman is in good health or is expected to live ten or more years.

High-Risk Patients

Patients who are high risk based on various risk factors, family history or screening mammograms, should have an MRI breast to complement mammograms.

Pathological Diagnosis

FNAC- Fine Needle Aspiration Cytology

  • A very thin, hollow needle attached to a syringe is used to withdraw (aspirate) a small amount of tissue from a suspicious area, which is then looked at under a microscope.
  • FNAC is the easiest biopsy.
  • But it has some disadvantages. It can sometimes miss cancer.
  • It is usually not possible to determine if the cancer is invasive.
  • There may not be enough cells to perform other lab tests that are done on breast cancer specimens.
  • If the FNA biopsy does not provide a clear diagnosis, or the doctor is still suspicious, a second biopsy or a different type of biopsy should be done.

True-Cut Biopsy

  • A needle with a gap near its tip is passed into the lesion.
  • A surrounding sheath passed down the needle with a cutting tip.
  • The sheath cuts a specimen corresponding to the gap in the needle.
  • The needle and sheath, with the specimen, are then removed from the patient.

True-Cut Biopsy

Benefits

  • Gets a tissue specimen
  • More reliable and authentic histopathological diagnosis
  • As the other benefits, one can perform further tests like receptor status.

Disadvantages

  • A trained doctor needs to perform it.
  • Needs local anaesthesia and a small 2mm incision
  • Needs oral analgesics, post operatively

Excision Biopsy

  • If the lump is small, mobile and has benign cytology on FNAC, then some times it is excised as a whole and sent for histopathology.

Incisional/ Wedge Biopsy

  • If there is a large superficial or advanced fungating lesion then, a small wedge biopsy is taken from the margin of a lesion.

Treatment

Breast cancer treatment can include a combination of all or some of the following treatments:

  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Anti-Hormone therapy
  • Targeted therapy

Myths

  • Breast Cancer can only affect older women.
  • Touching the breasts too often will lead to breast cancer.
  • Talking about cancer causes cancer
  • Herbs cure breast cancer.
  • A bruise on the breast leads to breast cancer.
  • If an incision is made during breast cancer surgery, cancer will spread.
  • Getting too many mammograms can lead to breast cancer.
  • Using antiperspirants causes breast cancer.
  • A breast cancer diagnosis is an automatic death sentence.
Summary
Review Date
Reviewed Item
Dr. Ayesha Javed Consultant General and Laparoscopic Surgeon MBBS (Pak), MRCS (UK), M.D (USA), FCPS (Pak)
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9 thoughts on “What you need to know about BREAST CANCER

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