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How Does Breast Cancer Develop

Types Of Cancers That Are More Likely To Go Undetected

Breast Biologues Ch. 2: How Does the Breast Develop?

Some cancers are more easily detected than others. For example, certain types of skin cancer can be diagnosed initially just by visual inspection though a biopsy is necessary to confirm the diagnosis.

But other cancers can form and grow undetected for 10 years or more, as one study found, making diagnosis and treatment that much more difficult.

This table provides an overview of common cancers that often display little or no symptoms early on, and how theyre typically detected and diagnosed:

Type of cancer

Screening For Breast Cancer

Women aged between 50 and 74 are invited to access free screening mammograms every two years via the BreastScreen Australia Program.

Women aged 40-49 and 75 and over are also eligible to receive free mammograms, however they do not receive an invitation to attend.

It is recommended that women with a strong family history of breast or ovarian cancer, aged between 40 and 49 or over 75 discuss options with their GP, or contact BreastScreen Australia on 13 20 50.

Transformation Of Cells In Culture

The study of induction by radiation, chemicals, or viruses requires experimental systems in which the effects of a carcinogenic agent can be reproducibly observed and quantitated. Although the activity of carcinogens can be assayed in intact animals, such experiments are difficult to quantitate and control. The development of in vitro assays to detect the conversion of normal cells to tumor cells in culture, a process called cell transformation, therefore represented a major advance in research. Such assays are designed to detect transformed cells, which display the in vitro growth properties of tumor cells, following exposure of a culture of normal cells to a carcinogenic agent. Their application has allowed experimental analysis of cell transformation to reach a level of sophistication that could not have been attained by studies in whole animals alone.

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What Happens After The Local Breast Cancer Treatment

Following local breast cancer treatment, the treatment team will determine the likelihood that the cancer will recur outside the breast. This team usually includes a medical oncologist, a specialist trained in using medicines to treat breast cancer. The medical oncologist, who works with the surgeon, may advise the use of the drugs like tamoxifen or anastrozole or possibly chemotherapy. These treatments are used in addition to, but not in place of, local breast cancer treatment with surgery and/or radiation therapy.

After treatment for breast cancer, it is especially important for a woman to continue to do a monthly breast examination. Regular examinations will help you detect local recurrences. Early signs of recurrence can be noted in the incision area itself, the opposite breast, the axilla , or supraclavicular region .

Maintaining your follow-up schedule with your physician is also necessary so problems can be detected when treatment can be most effective. Your health care provider will also be able to answer any questions you may have about breast self-examination after the following procedures.

How Does Cancer Start In The Breast

How Does Breast Cancer Develop?

To understand how cancer can originate, it can be helpful to understand how regular cells and tissues function and develop.

Healthy cells are the basic building blocks of all tissues and organs in the body. The body is constantly making new cells to replace worn out tissue or to heal injuries. Normal cells are programmed to grow and divide in an orderly and controlled manner, so that each new cell replaces ones that are lost.

Sometimes cells become abnormal and keep growing. As they grow, they can form a mass or lump called a tumour. However, not all tumours are cancer. Some tumours are benign , which means they tend to grow slowly and usually do not invade surrounding tissue or other parts of the body. Tumours that are malignant have the potential to invade and spread to other parts of the body.

Breast cancer starts when cells in the breast begin to grow abnormally. These cells have the potential to grow out of control and invade the surrounding tissue. When this occurs, this is called invasive breast cancer. If the cancer cells continue to grow, they may spread beyond the breast to other parts of body, which could become life-threatening.

There are different types of breast conditions which are named after the areas of the breast where they start:

Non-invasive breast conditions

Invasive breast cancers

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Mammographic And Ultrasound Features Of Inflammatory Breast Cancer

The typical findings on screening for inflammatory breast cancers are thickening of the skin and connective tissues and an increase in breast density.

In around 30% of inflammatory breast cancers cases there is no lump . Rather IBC usually presents as a diffuse infiltration of cancer cells, so it is not as easily detected on mammogram or ultrasound.

So, the absence of a true breast mass on mammography does not always rule out cancer.

In addition, the high density of the breast might hide an actual tumor deeper within the breast.

Ultrasound can be helpful in the diagnostic process, as it may be able to detect masses hidden at mammography and on clinical examination.

Ultrasound is also useful to detect axillary adenopathy and this can help with taking more accurate biopsy samples. With inflammatory breast cancer, ultrasound images might show edema and skin thickening along with an ill-defined mass of some kind.

Molecular Basis Of Triple

Triple-negative breast cancer is broadly defined as tumors that lack expression of the estrogen receptor , progesterone receptor , and HER2., , TNBC accounts for approximately 20% of breast cancers and is more commonly diagnosed in women younger than 40 years, as well as in African-American women. Genetically, < 20% of patients with TNBC harbor a breast cancer gene mutation, particularly in BRCA1. Pathologically, TNBC is usually high grade and commonly infiltrating ductal carcinoma exhibiting geographic necrosis. TNBC Patients usually have a poorer outcome compared with those with other breast cancer subtypes owing to an inherently aggressive clinical behavior and a lack of effective targeted therapies., The diagnosis of TNBC relies on the accurate determination of ER and PR protein levels by immunohistochemistry and of HER2 by IHC and/or fluorescence in situ hybridization ., Such accurate assessment is crucial to avoid false diagnosis of ER-negative and/or HER2-negative disease in patients that would be benefited from endocrine therapy and/or HER2-targeted drugs., TNBC clinical phenotype usually consists of the basal-like molecular subtype, although TNBC and basal-like breast cancers are not synonymous and yet there is substantial heterogeneity within TNBCs.

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Cells & Their Community

For a cancer to occur a cell has to mutate and its behavior has to change. We used to think that was all it took. But we now know that this is not enough by itself to create cancer. The mutated cells are in a neighborhood of other cellsfat cells, immune cells, blood, etc.known collectively as the stroma. If these cells are all well behaved, they will have a good influence on the mutated cell, which will coexist peacefully with them, and no disease will occur. But if the neighborhood is not so law abiding and stimulates or at least tolerates bad behavior, there may be trouble. The combination of the mutated cells and the stimulating, or tolerant, neighborhood will create breast cancer. .

Does this mean you can have mutated cells and no cancer? The answer is a surprising yes. In fact, we probably all walk around with mutated cells in our bodies, as we get older. This means that if we knew the right environment, the reverse would be possible as well: we might be able to keep the cancer stem cells from misbehaving. I find this new way of thinking about cancer very exciting because it explains a lot and gives me a new way to think about the disease, its cause and risk factors. We can also figure out what affects the community around the mutated cell. Since the community is also composed of cells, they too can undergo mutations and alter their behavior.

Can Cancer Form In Other Parts Of The Breast

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Cancers can also form in other parts of the breast, but these types of cancer are less common. These can include:

  • Angiosarcomas. This type of cancer begins in the cells that make up the lining of blood or lymph vessels. These cancers can start in breast tissue or breast skin. They are rare.
  • Inflammatory breast cancer. This type of cancer is rare and different from other types of breast cancer. It is caused by obstructive cancer cells in the skins lymph vessels.
  • Paget disease of the breast, also known as Paget disease of the nipple. This cancer affects the skin of the nipple and areola .
  • Phyllodes tumors. These are rare, and most of these masses are not cancer. However, some are cancerous. These tumors begin in the breasts connective tissue, which is called the stroma.

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What Is Breast Cancer

Cells in the body normally divide only when new cells are needed. Sometimes, cells in a part of the body grow and divide out of control, which creates a mass of tissue called a tumor. If the cells that are growing out of control are normal cells, the tumor is called benign. If, however, the cells that are growing out of control are abnormal and don’t function like the body’s normal cells, the tumor is called malignant .

Cancers are named after the part of the body from which they originate. Breast cancer originates in the breast tissue. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast. It can also travel to other parts of the body and form new tumors, a process called metastasis.

Molecular Or Intrinsic Subtypes Of Breast Cancer

Breast cancer encompasses a heterogeneous and phenotypically diverse group of diseases. It is composed of several biological subtypes that have distinct behaviors and responses to therapy., , , , , Gene expression studies have identified several distinct breast cancer subtypes that differ significantly in prognosis as well as in the therapeutic targets present in the cancer cells. With the advance of gene expression profiling techniques, the list of intrinsic genes that differentiate these subtypes is now made up of several clusters of genes relating to estrogen receptor expression , human epidermal growth factor 2 expression, proliferation, and a unique cluster of genes called the basal cluster., , , , , Through a utilization of these understandings, breast cancers are usually divided into five intrinsic or molecular subtypes that are based on the expression pattern of certain genes .

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Mortality Rates And The Good News

In the past, IBC has a poor survival rate. Indeed, the 5-year overall survival rate was less than 5% with a median rate of just 15 months. One of the reasons for the low survival rate is that IBC is often at a late stage at the diagnosis.

Sadly, IBC has often already spread to the lymph nodes on diagnosis.

However, according to a more recent research study, over the last 30 years survival rates for IBC have improved significantly. The 15 year survival rate is now around 20% to 30%.

Specialists believe that the improvement in survival rates for breast cancer is due to changes in treatment.

These changes include:-

  • Preoperative chemotherapy surgery
  • Radiation treatment.
  • An improvement in the understanding of IBC on a molecular level over the last ten years.

In addition, a 2015 study compares survival trends of women with inflammatory breast cancer before and after the year 2006. The 3-year survival rate for those treated for IBC before October 2006 was around 63%. In comparison, for cases of IBC after 2006 the 3-year survival rate has risen to 82%.

The above statistics, are again, a testimony to the improvement in targeted treatment, in this case, particularly HER-2 therapy.

Gaining Or Losing Weight

What Is Cancer?

Losing or putting on weight may affect breast size, but doesnt always.

Sometimes girls put on weight during puberty. This is normal and its essential to have some body fat. Because breasts contain fatty tissue, gaining weight may increase the size of the breasts, and losing weight may make the breasts a bit smaller.

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Potential Signs Of Male Breast Cancer

Finding a lump or a swelling which may be painless

Dimpling or puckering of the skin around the breast region

Nipples turning inwards or retracted

The scaly skin around the breast and redness

Some discharge from the nipples

At times this type of cancer spreads to the lymph nodes under the arms or even around the collarbone region. It occurs as swelling or lump. This may happen even before a tumor in the breast is found which is large enough to be noticed or felt.

However, not all of these changes may indicate male breast cancer. But if these changes do occur, one should consult their doctor.

Why Does Breast Density Matter

Dense breasts make it harder for radiologists to detect breast cancers when they read a mammogram. Cancers typically show up as small white spots or masses on a mammogram. Dense breast tissue also appears white on a mammogram. Small areas of cancer can hide behind the dense tissue, and its challenging to tell the difference between normal, healthy tissue and abnormal growths. The organization DenseBreast-info.org compares it to trying to see a snowman in a blizzard. Fatty breast tissue appears dark on a mammogram, so areas of concern that show up white are much easier to see.

Mammograms can miss about half of cancers in women with dense breasts.3, 4 In addition, women with dense breasts are more likely to be diagnosed with breast cancer within the year after receiving a normal mammogram result, usually based on symptoms such as a lump or other breast changes.

Apart from hiding cancers on mammograms, dense breast tissue itself is associated with a higher risk of breast cancer. Doctors arent sure exactly why. Cancers develop in glandular tissue: the more glandular tissue there is, the greater the risk. Fibrous tissue may also produce growth factors that cause glandular tissue cells to divide and reproduce more than cells in fatty tissue do. Every time a cell divides, there is an opportunity for a mistake in the DNA to occur in the new cells and multiple mistakes can eventually result in cancer.

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How Cancer Spreads Into Surrounding Tissues

As a tumour gets bigger, it takes up more space in the body. The cancer can:

  • press on surrounding structures
  • grow into body structures nearby

This is called local invasion. Researchers don’t fully understand how cancer grows into the surrounding tissues

A cancer might grow out in a random direction from where it started. However, researchers know that tumours can spread into some tissues more easily than others. For example, large blood vessels that have strong walls and dense tissues such as cartilage are hard for tumours to grow into. So, tumours tend to grow along the ‘path of least resistance’. This means that they probably take the easiest route.

We know from research that there are 3 different ways that tumours may grow into surrounding tissues. A tumour probably uses all 3 of these ways of spreading. The way it uses most depends on:

  • the type of tumour
  • where the cancer is growing in the body

The 3 ways that tumours may grow into surrounding tissues are:

  • pressure from the growing tumour
  • using
  • cancer cells moving through the tissue

Myth: Using Underarm Antiperspirant Can Cause Breast Cancerfact: There Is No Evidence Of A Connection Between Underarm Antiperspirant And Breast Cancer But The Safety Of Antiperspirants Is Still Being Studied

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There have been persistent rumors that underarm antiperspirants, especially those containing aluminum and other chemicals, are absorbed into the lymph nodes and make their way into breast cells, increasing cancer risk. Shaving the underarms was thought to make this worse by creating tiny nicks that allow more of the chemicals to enter the body. Another theory was that antiperspirants, by stopping underarm sweating, can prevent the release of toxic substances from the underarm lymph nodes, also increasing cancer risk.

However, there is no evidence of a link between antiperspirant use and breast cancer. Still, some studies have found that women who use aluminum products under their arms are more likely to have higher concentrations of aluminum in breast tissue.2 If youre concerned about minimizing the use of chemicals under your arms, check out these tips in Are Antiperspirants Safe?

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Genetic Predispositions As Important Risk Factors Of Breast Cancer

At its most basic, a risk factor is defined as anything that affects individual’s chance of getting a disease, in this case breast cancer. Certain major risk factors for breast cancer are beyond individual’s control., , , , , , , , , , , For example, simply being a woman is the main risk factor for breast cancer as this disease is about 100 times more likely to occur in women than in men. Aging inevitably increases one’s risk of breast cancer as evinced by the fact that most breast cancers are diagnosed in women age 55 and older. Beyond the inherent risks of gender and aging as they relate to breast cancer, it has been well documented that a woman’s risk of developing breast cancer nearly doubles if she has a first-degree relative diagnosed with breast cancer. Close to 15% of US women who suffer from breast cancer also have a family member who has been diagnosed., ,

Although less common and less drastic in their increase of breast cancer risk than the BRCA mutations, inherited mutations in many other genes can also lead to breast cancer development., , , , , Some of the mutated genes include ATM , TP53 , CHEK2 , PTEN , CDH1 , STK11 , and PALB2 ., , , , ,

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