Category: Breast Health

Breast cancer occurs when breast cells grow abnormally. It is the most common cancer diagnosed in the US after skin cancer. There are different types of breast cancer based on the particular cells in the breast that are affected. Nearly all breast cancers are carcinomas, or tumors that start in the epithelial cells lining the organs and tissues in the body. When carcinomas form in the breasts, they are called adenocarcinoma. Tumors first appear in cells in the milk ducts or the milk-producing glands.

There are many types and subtypes of breast cancer:

Types of Breast Cancer

• Non-Invasive Breast Cancers: These cancers are present in the milk ducts or lobules in the breast. They haven’t spread out of the milk duct and have a low risk of becoming invasive. Non-invasive cancers are called carcinoma in situ and are sometimes referred to as pre-cancers. The two types of non-invasive cancers are:
  
  • Ductal Carcinoma in Situ: This is the most common type of non-invasive breast cancer. DCIS starts in the breast’s milk ducts and does not spread into any surrounding tissues as it is non-invasive. DCIS is not life-threatening, but having it can increase your chance of having invasive breast cancer later.
  • Lobular Carcinoma in Situ: LCIS is not cancer. It is an uncommon condition in which cells grow abnormally in the breast’s milk glands (lobules). If you are digonosed with LCIS, it shows you have an increased risk of developing breast cancer.
• Invasive Breast Cancers: These are cancers that have spread outside the ducts or lobules of the breast into the breast tissues surrounding it. ‘Early breast cancer’ is refers to cancer in the breast that may have spread to surrounding lymph nodes in the breast or armpit but not anywhere else in the body.
  
  • Invasive Ductal Carcinoma: Cancer cells grow outside the ducts and spread into other parts of the breast tissue. Invasive cancer cells can also spread, metastasize, to other body parts. IDC is the most common form of breast cancer and represents 80% of all breast cancer diagnoses.
  • Invasive Lobular Carcinoma: ILC is the second most common type of breast cancer after IDC. The cancer cells spread from the milk glands to the nearby breast tissues. Over time, it can also spread to other parts of the body.
  • Paget’s Disease of the Nipple or Paget’s Disease of the Breast: This is a rare condition associated with breast cancer. Eczema-like changes will happen to the nipple skin and the area surrounding the nipple. Usually, it is a sign of breast cancer in the tissue behind the nipple.
  • Inflammatory Breast Cancer: Inflammatory breast cancer is a rare and aggressive form of invasive breast cancer. It affects the blood vessels in the skin and/or lymphatic vessels of the breast. Although IBC is often a type of IDC, its symptoms, outlook, and treatment differs from other breast cancer types.
  • Phyllodes Tumors of the Breast: They are an unsusal presentation of breast cancer. Some phyllodes tumors are cancerous. They are a form of sarcoma and grow in the connective tissues of the breast, not in the ducts. They tend to grow fast, but rarely spread outside the breast. Phyllodes tumors are a rare cancer and confirmation is required by a second pathologist.
  • Locally Advanced Breast Cancer: Locally advanced breast cancer is large or has spread to other surrounding areas like skin, muscle, or chest wall and have extensive local lymph node involvement.
  • Metastatic Breast Cancer: Metastatic breast cancer is also called stage IV breast cancer that has spread to other parts of the body. The cancer cells of the original tumor in the breasts break away and travel to other parts of the body through the bloodstream or the lymphatic system especially to the liver, bones, brain, or lungs.

Subtypes of Breast Cancer

Subtypes are based on the genes a cancer expresses.

• Hormone Receptor Positive Breast Cancer: This type of cancer needs female hormones such as estrogen and progesterone to grow and reproduce. Hormone therapy drugs that lower estrogen levels or block estrogen receptors are used to treat this type of breast cancer.
• HER2 Positive Breast Cancer: This is a type of breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2). It promotes cancer cell growth. This type of cancer is said to be more aggressive than other breast cancer types. A drug called Herceptin is used to treat HER2 positive breast cancer and has proven a very effective treatment.
• Triple-Negative Breast Cancer: Triple-negative breast cancer does not have receptors like estrogen, progesterone, and HER2 protein that are usually found in other breast cancers. This means that traditional breast cancer treatment or hormone therapy would not be effective to treat this cancer type. Here the patient requires chemotherapy, targeted therapy, and radiation.

Breast cancer is not a single disease. As there are different types and subtypes of this disease, the treatment that a patient receives for her breast cancer will differ. There are risk factors of breast cancer that you can change and cannot change. Understand them and take appropriate steps to detect breast cancer early to reduce disease risk.

Breast cancer is the most common cancer in American women. Detecting breast cancer early and getting treatment at the right time are the most crucial strategies to prevent deaths from this disease. There are methods to detect breast cancer early, when it is small and has not spread. When the disease is detected in an early stage, chances of successful treatment and better outcomes are high due to the availability of increased number of treatments, longer survival and improved quality of life.

The American Cancer Society recommends screening guidelines for the early detection of breast cancer. Screening tests help find breast cancer before any symptoms (like a lump that can be felt) appear.

Screening involves performing tests and exams to find a disease in people who don’t have any symptoms. Early detection means finding and diagnosing a disease earlier than if your waited for symptoms to start. Breast cancer found during screening tests will be probably smaller and still restricted to the breast. Breast cancer size and the range of spread are crucial factors in estimating the prognosis of a woman with this disease.

The American Cancer Society recommends mammography, clinical breast exam, and breast self-exam as early detection methods for women at average risk. Average risk women are considered as the women who don’t:

• Have a strong family history of breast cancer.
• Have a strong personal history of breast cancer.
• Have a genetic mutation known to increase risk of breast cancer like in a BRCA gene and has not had chest radiation therapy before 30 years old.

The recommended detection methods for women at average risk are as follows:

• Mammogram: Mammogram is the most important screening test for breast cancer. It is a low-dose x-ray of the breasts. Having regular mammograms can help detect breast cancer at an early stage, when the treatment is most effective.

  If your mammogram is normal, continue to get mammograms according to recommended time intervals. It helps the radiologists to compare your latest results with the previous results and can look for changes in your breasts. If your mammogram is abnormal, you will need more tests, mammograms, or exams to determine if the detected change is cancer or not. You will also be referred to a breast specialist or surgeon to diagnose the problems. They will do follow-up tests to diagnose breast cancer or to find that there is no cancer.

  Generally, regular mammograms aren’t recommended for women under 40 years of age, in part because breast tissue tends to be dense and it makes the mammograms less effective. For younger women with a family history of breast cancer and other risk factors, the American Cancer Society recommends mammograms for women ages:

  • Between 40 and 44 years of age should have a choice to begin screening mammograms yearly if they would like.
  • From 45 to 54 should do mammograms yearly.
  • 55 and over should continue getting mammograms every 1 to 2 years.

   
  While mammograms are the best cancer screening tests, women should understand that they are not 100% accurate in showing if a woman has breast cancer. They can give a negative result even if the breast cancer is present and a positive result even though there is no cancer in the breast. So, it is important that women who do mammograms know what to expect and understand the benefits and limitations of screening.

  Tips for getting a mammogram:

  • Try not to get your mammogram during your periods or the week before you get your period because your breasts may be tender or swollen then.
  • Don’t wear deodorant, perfume or powder on the day of your mammogram; these products will display as white spots on the X-ray.
• Clinical breast exam and breast self-exam: Clinical breast examination is the examination done by a trained health professional of woman’s breasts before the woman herself notes it. It is performed to detect if there is any changes on the breast like skin changes, nipple discharge, lumpiness, or change in shape or size. There is only a little evidence showing that this method is effective for early detection of breast cancer who are already undergoing regular mammogram screening. For women who are not getting regular mammograms, this method may be useful. This method is not recommended for breast cancer screening among average risk women at any age.

  Regular breast self-exams or clinical breast exams are not recommended by the American Cancer Society as a part of a routine breast cancer screening schedule; but it doesn’t mean that these exams should never be done. In some situations, for women at average risks, healthcare providers still offer clinical breast exams along with offering counseling about the risk and early detection. Many women find it comfortable doing regular self-exams to keep track of the look and feel of their breasts. Keep in mind that there is a very little evidence showing that doing these exams routinely is helpful for women at average risk of breast cancer.

Women who are at high risk for breast cancer based on specific factors should get a mammogram and a breast MRI annually, starting age 30. Women who are considered at high risk are the one who have:

• A first degree relative (parents, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation and haven’t had any genetic testing themselves.
• Any syndromes like Cowden syndrome or Li-Fraumeni syndrome, Bannayan-Riley-Ruvalcaba syndrome or have any first degree-relatives with any of these syndromes.
• A known BRCA1 or BRCA2 gene mutation.
• A lifetime risk of breast cancer of about 20% to 25% or greater according to risk assessment tools (mainly based on family history) and had chest radiation therapy between the ages 10 and 30.

A woman should be familiar with how her breasts usually look and feel and consult the doctor if there are changes such as:

• A new lump or lumpiness, specifically one-sided.
• Change in breast or nipple size or shape.
• Unusual pain, specifically one-sided.
• Nipple discharge.
• Change in the breast skin.

There are risk factors for breast cancer that you can change and cannot change. Understanding these risk factors and taking steps to detect breast cancer early will help reduce your risk of developing breast cancer.

Breast cancer occurs when some breast cancer cells starts to grow abnormally and result in a lump or mass. Breast cancer is a malignant tumor that has developed from cells in the breast. The American Cancer Society predicted that in 2020:

• Around 276,480 of women (new cases) will be diagnosed with invasive breast cancer.
• Around 48,530 new cases of carcinoma in situ (non-invasive, the earliest form of breast cancer) will be diagnosed.
• Around 42,170 women are expected to die from breast cancer.

In women, breast cancer is the second leading cause of cancer death in the U.S. (lung cancer is the first). It is estimated that 1 in 38 women will die from breast cancer.
The main factors that can increase the risk of having breast cancer are:

• Environment
• Not maintaining a healthy lifestyle
• Not maintaining a healthy weight
• Not following a healthy diet
• Genetics
• Getting older

Increased awareness about breast cancer can help to detect breast cancer early. It allows the patient to get better treatment, which reduces the risk of death.

People should be aware of the things that can be controlled by themselves to prevent or lower the risk of breast cancer. Here are some things you can do to reduce your risk of breast cancer:

• Eat healthy foods: It is important to avoid sugary beverages, fried foods, processed foods, and red meat and include dietary fiber and antioxidants, a variety of fruits and vegetables, and foods that contain healthy fat such as olive oil, avocado, nuts, etc. Your physician can recommend a proper diet chart for you to follow.
• Avoid consuming alcohol on a regular basis: Studies show that regular consumption of alcohol increases the risk of developing breast cancer. It is reported that alcohol consumption can lead to rising estrogen levels and can damage DNA (breastcancer.org). If your alcohol consumption is more than a drink a day, then you should stop or cut it down to lower the risk of breast cancer.
• Breastfeed as much as you can: Breastfeeding can help you to shed breast tissue, and this removes the breast cells with potential DNA damage, thus reduce the risk of developing breast cancer. It will also provides excellent health benefits for your child.
• Stay physically active: The American Cancer Society suggests that adults get 75 to 150 minutes of vigorous-intensity or 150 to 300 minutes of moderate-intensity activity or both combined each week. Regular exercise can lower the risk of breast cancer.
• Maintain a healthy weight: The risk of developing breast cancer will increase if you are obese. Having more fatty tissue can increase the level of estrogen and thus increase the chance of developing breast cancer. Also, being overweight can lead to higher insulin levels which is linked to breast cancer.
• Avoid hormone therapy after menopause: It is also known as post-menopausal hormone therapy (PHT). Women use this therapy to ease symptoms of menopause like hot flashes and sweating. It increases the risk of breast cancer. Women who choose post-menopausal hormones should do it for the shortest time possible. To take best decision about this, talk with your healthcare provider.
• Avoid smoking: Everbody knows the harmful effects of smoking. It lowers the quality of life and increase the risk of many diseases, including different types of cancer. Risk of breast cancer are higher among women who started smoking during adolescence.
• Avoid the use of birth control pills: Using birth control pills have both risks and advantages. Women who take birth control pills have an increased risk of breast cancer. If you stop using the pill, the risk is reduced.
• Screening mammograms: Women are advised to have mammogram screening starting at the age of 40 to detect cancer early when it is more treatable. If something is found in the mammogram, more tests may be needed to confirm whether it is cancer or not. Early detection improves the opportunity for better treatment options.

Women with a family history of cancer should take proper steps to protect themselves. Maintain a healthy lifestyle, and don’t forget to self-examine your breasts regularly. If you notice any changes, consult a doctor without any delay. Symptoms of breast cancer include pain, swelling, redness or thickening of skin. Following these stesps can lower your risk of developing breast cancer and improve quality of life.

Having several risk factors doesn’t mean that you are likely to develop breast cancer and having low risk factors doesn’t mean that you will never develop it. The term risk describes the number or percentage of the possibility for a certain event to occur. Understanding the risk factors can help you take certain preventive strategies.

Absolute risk describes the probability of an individual to develop breast cancer. When you say that 12% of U.S women or 1 in 8 U.S women will develop breast cancer over the course of a lifetime, it shows the absolute risk. Over an 80-year lifespan, on average, a woman has a 1 in 8 chance of developing breast cancer. On the other hand, the chance of not developing breast cancer is 87.2%, or about 7 in 8.

The younger you are, the lower the risk. For instance:

• According to breastcancer.org, if your present age is 20, for the next 10 years, the chance of developing invasive breast cancer, is .06% or 1 in 1,732 which means that, 1 in 1732 women in the same age group can expect to develop breast cancer. It can also be said that, if you are in this age group, your chance of developing breast cancer is 1 in 1732.
• If your present age is 30, for the next 10 years, your chance of developing invasive breast cancer is .44% or 1 in 228.
• If your present age is 40, for the next 10 years, your chance of developing invasive breast cancer is 1.45% or 1 in 69.
• If your present age is 50, for the next 10 years, your chance of developing invasive breast cancer is 2.31 or 1 in 43.
• If your present age is 60, for the next 10 years, your chance of developing invasive breast cancer is 3.49% or 1 in 29.
• If your present age is 70, for the next 10 years, your chance of developing invasive breast cancer is 3.84% i.e. 1 in 26.

So, this means that when you are younger, the risk of developing breast cancer is low and when you get older, the probability of developing breast cancer increases. That means the older you are, the higher your absolute risk of breast cancer. Remember that these numbers and percentages are averages for the whole population.

Your individual breast cancer risk can be higher or lower based on family history, gender, race, weight, reproductive history, and other factors.

For instance, considering family history, the absolute risk of breast cancer for women who have inherited mutations in the genes known as BRCA1 or BRCA2 is much higher. For women with a BRCA1 mutation, the risk of developing breast cancer is 72% by age 80. This shows that, out of 100 women who have this mutation, 72 of them can expect the chance of developing breast cancer should they live to age 80. The risk is a bit lower for the women who have BRCA2 mutation, it is 69%.

If you have breast cancer, absolute risk can also describe the chance of the outcome of a certain treatment, or the course of the disease. For instance, based on the characteristics of the breast cancer like stage, grade, other test results, your age and medical history, and the treatments you have, your doctor will tell you that your chance of disease-free survival or being alive with no evidence of breast cancer within 5 years is 90%. That means that your absolute risk of having breast cancer come back within 5 years is 10% or 1 in10.

In other words, 1 out of 10 women with similar characteristics and the same treatment plan have the chance of having breast cancer to come back within 5 years, and 9 out of 10 have no chance of recurrence.

Relative Risk provides the percentage or number by comparing one group’s risk of developing breast cancer to another group’s risk. Relative risk is the type of risk that research studies normally use to compare groups of women with different characteristics or behaviours to find out whether one group has a higher or lower risk of breast cancer than the other (either as a first-time diagnosis or recurrence).

Higher Breast Cancer Risk

Studies have shown that many women consuming two or more alcoholic drinks (means 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of 80-proof liquor) per day have a higher risk of developing breast cancer.

• Women who consume two or more alcoholic drinks per day have 50 % higher risk of developing breast cancer when compared to women who do not drink. This doesn’t mean that their risk of developing breast cancer is 50% for the lifetime, it means that the risk is 50 % higher when compared to non-drinkers. This percentage is how you are likely to see relative risk reported by the internet, television, and newspapers.
• Women who consume two or more alcoholic drinks per day have a relative risk of 1.5 when compared to women who do not drink. This is the number that researchers and scientific papers would usually talk about relative risk. The number “1” is the baseline group i.e. the women who do not drink, since the risk remains the same for them. The .5 is the relative increase in the risk for the other group, it is expressing the 50% higher lifetime risk in another way (50%= .5).

  In other words, the women who have alcoholic drinks per day for two or more times, the risk of developing breast cancer is 1.5 times than women who don’t drink.

Here 50% risk is the risk relative to the people who do not drink. However, it does not tell a women about her lifetime risk if she drinks two or more drinks per day for the rest of her life. It is necessary to multiply the absolute risk of breast cancer (12%) for women in the general population by relative risk (1.5), since women in this group have 1.5 times the risk of developing breast cancer.

• 12*1.5 = 18. This means that the absolute lifetime risk of developing breast cancer for a women, if she drinks two or more alcoholic drinks per day is about 18%, versus 12% for women who do not drink.

Lower Breast Cancer Risk

• If you had early breast cancer and lumpectomy, the absolute risk of having the recurrence of breast cancer within 10 years is 35%.
• According to a study that reviewed 17 clinical trials of radiation therapy after lumpectomy, if you have radiation therapy to the remaining breast tissue, the risk is reduced by about 46%.
• Compared to a woman who had a lumpectomy alone, within 10 years, your risk of developing cancer is 46% lower if you have radiation therapy after lumpectomy.
• Medical researchers might say, when compared to the women who do not have radiation therapy, your relative risk of developing breast cancer is 1 – .46=.54. The number “1” remains in the baseline group. Just because it shows the decrease in risk, .46 is subtracted from 1. That means, when compared to the women who have lumpectomy alone, you have 54% of the risk of developing breast cancer again in the same breast as they do within 10 years.
• To know the difference what radiation therapy really make you to reduce the absolute risk of cancer recurrence in the same breast, you have to multiply the 10-year risk of recurrence without radiation by the relative risk i.e. .35*.54 = 19.
• This means 19% of absolute risk or just under 1 in 5 of cancer recurrence in the same breast, if you have radiation therapy versus about 35% or just over 1 in 3, if you don’t have radiation therapy. So, fewer than 1 in 9 women can expect the recurrence of breast cancer in the same breast versus more than 1 in 3 women who do not have radiation therapy.

A relative risk of .5 means that your risk goes down by half or 50%, 1.88 means your risk goes up by 88% and 3.0 means your risk has become 3 times or goes up by 300%.

From this, it is obvious that lifestyle factors and treatment options can increase or decrease the risk of breast cancer. As mentioned earlier, when you get older, the risk of developing breast cancer goes up. So, it is better to understand the risk factors and monitor yourself even if your risk factors are low to prevent the occurrence of breast cancer.

Breast cancer occurs due to abnormal growth of some breast cells. According to U.S Breast Cancer Statistics, in 2020, about 42, 170 women in the U.S are expected to die from breast cancer. There are so many misconceptions out there about breast cancer and it’s important to understand the facts.

Misconception 1: If you don’t have a family history of breast cancer, you don’t get it.

Fact: Many people think that breast cancer is an inherited disease. But only 5-10% of people who have a family history of breast cancer are diagnosed with it. The vast majority who get breast cancer have no family history, with environment and lifestyle being the prominent causative factors.

Misconception 2: You can do nothing to reduce your risk of getting breast cancer.

Fact: In a vast majority of women with breast cancer, the condition is caused due to the factors such as environment and lifestyle. You can reduce your risk by leading a healthy lifestyle – maintaining a healthy weight, following a nutritious diet, avoiding too much alcohol, not smoking, and starting mammograms at the age 40.

Misconception 3: A mammogram can cause breast cancer to spread.

Fact: A mammogram is the x-ray of the breast that helps in early detection of breast cancer. Mammograms require a small dose of radiation and the risk of harm from this radiation is extremely low. Screening can find cancer before any symptoms appear.

Misconception 4: Only women get breast cancer.

Fact: This is a big misconception. According to nationalbreastcancer.org, each year, approximately 2,190 men will be diagnosed with breast cancer and it is estimated that about 410 will die. Men should do self-examination of their breasts to check whether there any changes are happening, and if there are changes, report them to their physician immediately.

Misconception 5: Antiperspirants and deodorants can cause breast cancer.

Fact: There is no evidence that the use of antiperspirants and deodorants can cause breast cancer.

Misconception 6: If you find a lump in your breast, it is cancer.

Fact: Not all lumps are cancerous. Some may form due to cysts or scar tissue. However, if you feel any changes in your breasts it is better to consult a physician. Other symptoms of breast cancer include pain, swelling, redness or thickening of skin.

Misconception 7: Too much sugar consumption causes breast cancer.

Fact: There is no such evidence that sugar causes breast cancer. Eating too much sugar can lead to obesity that can increase the risk of various cancer.

Misconception 8: Breast implants increase breast cancer risk.

Fact: The risk of breast cancer is same for women with or without breast implants. However, standard mammograms don’t always work well for women with breast implants, and so they need additional X-rays to fully examine their breast tissue.

Misconception 9: Birth control pills can cause breast cancer.

Fact: Studies in 1990s showed that taking birth control pills may slightly increase risk of breast cancer. However, since then, the pills produced contain much lower doses of the hormones linked to those risks.

Misconception 10: Coffee can cause breast cancer.

Fact: There is no link between caffeine and breast cancer. In fact, research shows that caffeine may lower your risk of breast cancer.

Misconception 11: All breast cancer is treated the same way.

Fact: Depending on the characteristics of the cancer and patient preferences, treatment for breast cancer may vary. Some breast cancers are small, yet aggressive. Some grow slowly and become life-threatening. So, for each patient, the treatments and outcomes are different.

Maintaining a healthy diet, restricting intake of fat and sugars, staying physically active, and performing routine breast self-exams are some of the things you can do to decrease your breast cancer risk. Also, don’t forget to self-examine your breasts regularly. If you find any unusual changes, report it to your doctor as soon as possible.