How Breast Cancer Starts
The breast is a highly complex part of the human body. The female breast goes through many changes over a lifetime from birth, puberty, pregnancy and breastfeeding, right through to menopause.
If you have been diagnosed with breast cancer, understanding the anatomy of the breast and the role each part has to play can be helpful to understand your diagnosis. It can also help you talk to your doctor about surgery and other treatment options.
In this piece we cover:-Understanding Breast Anatomy-Normal Breast Changes Through Life-How Does Cancer Start in the Breast?-How Does Cancer Spread Beyond the Breast?-Symptoms of Breast Cancer
Life Style And Dietary Cause
Sedentary life style, high dietary intake of fat obesity particularly in postmenopausal women may cause breast cancer. The use of alcohol is also another one cause of breast cancer. The risk increases with the amount of alcohol consumed. Women who consume two to five alcoholic beverages per day have a risk about one and a half times that of nondrinkers for the development of breast cancer.
What Does A Mammogram Show
A mammogram is a test used to examine the inside of the breasts, using a low dose X-ray. A trained clinician can interpret the images to identify any abnormal areas, masses or calcium deposits that may or may not indicate breast cancer. Mammograms performed on women who have no signs or symptoms of breast cancer are called screening mammograms. Mammograms that used to evaluate an abnormal breast symptom are called diagnostic mammograms.
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Mammography: Screening For Breast Cancer
Mammography is one of the best ways to detect breast cancer early. Mammography is designed to be sensitive enough to detect the possibility of cancer at an early stage, sometimes years before it can be felt. Because mammography is so sensitive, it may indicate cancer when none is presenta false-positive result. About 85 to 90% of abnormalities detected during screening are not cancer. Typically, when the result is positive, more specific follow-up procedures, usually a breast biopsy, are scheduled to confirm the result. Mammography may miss up to 15% of breast cancers. It is less accurate in women with dense breast tissue.
Breast tomosynthesis may be used with mammography to produce a clear, highly focused 3-dimensional picture of the breast. This technique makes it somewhat easier to detect cancer, especially in women with dense breast tissue. However, this type of mammography exposes women to almost twice as much radiation as traditional mammography.
Recommendations for routine screening with mammography vary. Experts disagree about
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When it should start
When a lump or another abnormality is detected in the breast during a physical examination or by a screening procedure Screening Breast cancer occurs when cells in the breast become abnormal and divide uncontrollably. Breast cancer usually starts in the glands that produce milk or the tubes that carry… read more , other procedures are necessary.
Other Risk Factors For Breast Cancer
Other factors that seem to increase risk include:
- not having children or having children after the age of 30
- early age at first period
- later age of natural menopause
- alcohol intake
- obesity or gaining a lot of weight after menopause
- using the contraceptive pill the risk is higher while taking the pill and for about ten years after stopping use
- using hormone replacement therapy also known as hormone therapy the risk increases the longer you take it, but disappears within about two years of stopping use.
Having some of these risk factors does not mean that you will get breast cancer. Most women with breast cancer have no known risk factors, aside from getting older. More research needs to be done before we can be definite about risk factors.
In men, the main risk factor is abnormal enlargement of the breasts due to drug, chemical or hormone treatments. Men with Klinefelters syndrome can also be at risk. A mans risk increases where there is a family history of male breast cancer or a strong family history of breast cancer.
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How Is Breast Cancer Diagnosed
During your regular physical examination, your doctor will take a thorough personal and family medical history. He or she will also perform and/or order one or more of the following:
- Breast examination: During the breast exam, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different than benign lumps.
- Digital mammography: An X-ray test of the breast can give important information about a breast lump. This is an X-ray image of the breast and is digitally recorded into a computer rather than on a film. This is generally the standard of care .
- Ultrasonography: This test uses sound waves to detect the character of a breast lump whether it is a fluid-filled cyst or a solid mass . This may be performed along with the mammogram.
Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue. Biopsies are performed using surgery or needles.
After the sample is removed, it is sent to a lab for testing. A pathologist a doctor who specializes in diagnosing abnormal tissue changes views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is and whether it has spread beyond the ducts or lobules .
What Body Systems Are Affected By Breast Cancer
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What Are The Chances Of Survival
It’s normal to wonder how long you might live. Doctors use the term “relative survival rate” to predict what percentage of people with certain stages of breast cancer will live for 5 years, compared to peers who don’t have breast cancer.
The 5-year relative survival rates for breast cancer are:
- 99% for early-stage cancers
- 86% for cancer that has spread in the area of the original tumor
- 27% for cancers that have spread to other parts of the body
These numbers are based on research done on large groups of people with breast cancer. Your survival rate could be different based on things like your age, health, and how well your cancer responds to treatment.
Stages Of Breast Cancer
When cancer is diagnosed, a stage is assigned to it, based on how advanced it is. The stage helps doctors determine the most appropriate treatment and the prognosis. Stages of breast cancer may be described generally as in situ or invasive. Stages may be described in detail and designated by a number .
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Where Is The First Place Breast Cancer Spreads
The first place that breast cancer commonly spreads to outside the breast are the lymph nodes in the armpit . Surgery is usually needed to remove one or more lymph nodes to help check for breast cancer spread. This operation to remove lymph nodes in the armpit is known as axillary surgery.
Breast cancer found in the lymph nodes will impact the breast cancers staging, and the treatment plan will often be affected as well.
If cancer is found in the lymph nodes, there is a higher chance that cells have travelled through the lymphatic system and bloodstream to spread to other parts of the body. In this instance, treatment with systemic therapies, such as chemotherapy, is likely to be recommended.
If cancer is found in a large number of axillary nodes, radiotherapy may also be recommended to kill any breast cancer cells that remain in the armpit but cannot be removed by surgery.
Emotional And Spiritual Care
End-of-life care also includes emotional, mental, and spiritual therapy. A personâs healthcare team may include social workers, counselors, mental health professionals, and religious or spiritual advisors.
According to the Anxiety and Depression Association of America, up to 40 percent of people with cancer experience serious mental distress. This may include anxiety, depression, panic attacks, and post-traumatic stress disorder .
Medications, therapy, religious or spiritual rituals, and support groups can help a person cope with mental health issues and stress during this difficult time.
Caregivers may also need help with stress, anxiety, and depression. The palliative care team can usually also provide support and advice to caregivers for their emotional needs.
The Breast Cancer Healthline app provides people with access to an online breast cancer community, where users can connect with others and gain advice and support through group discussions.
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About Metastatic Breast Cancer
Cancer begins when healthy cells change and grow out of control, forming a mass or sheet of cells called a tumor. A tumor can be cancerous or benign. A cancerous tumor is malignant, meaning it can grow and spread to other parts of the body. A benign tumor means the tumor can grow but will not spread.When breast cancer is limited to the breast and/or nearby lymph node regions, it is called early stage or locally advanced. Read about these stages in a different guide on Cancer.Net. When breast cancer spreads to an area farther from where it started to another part of the body, doctors say that the cancer has metastasized. They call the area of spread a metastasis, or use the plural of metastases if the cancer has spread to more than 1 area. The disease is called metastatic breast cancer. Another name for metastatic breast cancer is “stage IV breast cancer if it has already spread beyond the breast and nearby lymph nodes at the time of diagnosis of the original cancer.
Doctors may also call metastatic breast cancer advanced breast cancer. However, this term should not be confused with locally advanced breast cancer, which is breast cancer that has spread to nearby tissues or lymph nodes but not to other parts of the body.
Clinical Staging And Survival Rates Of Breast Cancer
Once breast cancer is diagnosed, tests are performed to determine the stage of the disease, which will impact the treatment patients receive. The clinical staging of breast cancer is identical across breast cancer subtypes according to the American Joint Committee on Cancer and the International Union for Cancer Control Tumor, Node, and Metastasis breast cancer staging system: Stage 0, Stage I, Stage II, Stage III and Stage IV, as detailed in .
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What Is The Lymphatic System
The lymphatic system helps to protect us from infection and disease. It also drains lymph fluid from the tissues of the body before returning it to the blood. The lymphatic system is made up of fine tubes called lymphatic vessels that connect to groups of lymph nodes throughout the body.
Lymph nodes are small and bean-shaped. They filter bacteria and disease from the lymph fluid. When you have an infection, lymph nodes often swell as they fight the infection.
Age At First Menstrual Period First Pregnancy And Menopause
The earlier menstruation begins , the higher the risk of developing breast cancer.
The later the first pregnancy occurs and the later menopause occurs, the higher the risk. Never having had a baby increases the risk of developing breast cancer. However, women who have their first pregnancy after age 30 are at higher risk than those who never have a baby.
These factors probably increase risk because they involve longer exposure to estrogen, which stimulates the growth of certain cancers.
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Other Treatment For Breast Cancer
Depending on the cancer, other treatment options can include:
- Radiotherapy use x-rays to kill any remaining cancer cells. Women who have had breast-conserving surgery often have a course of radiotherapy. Side effects can include a short-term reddening of the skin, which looks like sunburn, or longer-term thickening of skin.
- Chemotherapy cancer-killing medication is given intravenously . Chemotherapy can be offered to women with early breast cancer as an extra treatment to surgery, radiotherapy or both. Chemotherapy has side effects that will depend on the type of medication you have, but can include nausea, vomiting and hair loss.
- Hormone treatments many breast cancers are influenced by the sex hormones oestrogen and progesterone. Hormone treatment can reduce the chances of breast cancer developing again.
- Biological therapies strengthen the immune system to fight cancer. Several types of biological therapies are now used to treat breast cancer. Research is continuing and various types of therapies are being tested in clinical trials.
- Complementary and alternative therapies when used alongside your conventional cancer treatment, some of these therapies can make you feel better and improve quality of life. Others may not be so helpful and in some cases may be harmful. The Cancer Council Victoria booklet called Understanding complementary therapies can be a useful resource.
Immune And Excretory System:
When breast cancer reaches a later stage, it spreads to other lymph nodes as well. Underarms are the primary area that have an effect because these are in close proximity to it. A person may notice tenderness and swelling under the arms. The lymph nodes have an effect because of the lymphatic system. The system is responsible for transferring healthy lump throughout the body, and as a result, it is spread cancer cells to the body as well. In most cases, it affects the lung and liver throughout. The same can be in consideration through a chronic cough or other breathing difficulties.
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Looking For More Of An Introduction
If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:
- ASCO AnswersFact Sheet: Read a 1-page fact sheet that offers an introduction to metastatic breast cancer. This free fact sheet is available as a PDF, so it is easy to print.
- ASCO AnswersGuide:Get this free 52-page booklet that helps you better understand breast cancer. The booklet is available as a PDF, so it is easy to print.
- Cancer.Net Patient Education Video: View a short video led by an ASCO expert in metastatic breast cancer that provides basic information and areas of research.
Inflammatory Breast Cancer Symptoms
Unlike other breast cancers, inflammatory breast cancer rarely causes breast lumps and may not appear on a mammogram. Inflammatory breast cancer symptoms include:
- Red, swollen, itchy breast that is tender to the touch
- The surface of the breast may take on a ridged or pitted appearance, similar to an orange peel
- Heaviness, burning, or aching in one breast
- One breast is visibly larger than the other
- Inverted nipple
- No mass is felt with a breast self-exam
- Swollen lymph nodes under the arm and/or above the collarbone
- Symptoms unresolved after a course of antibiotics
Unlike other breast cancers, inflammatory breast cancer usually does not cause a distinct lump in the breast. Therefore, a breast self-exam, clinical breast exam, or even a mammogram may not detect inflammatory breast cancer. Ultrasounds may also miss inflammatory breast cancer. However, the changes to the surface of the breast caused by inflammatory breast cancer can be seen with the naked eye.
Symptoms of inflammatory breast cancer can develop rapidly, and the disease can progress quickly. Any sudden changes in the texture or appearance of the breast should be reported to your doctor immediately.
For women who are pregnant or breast-feeding, redness, swelling, itchiness and soreness are often signs of a breast infection such as mastitis, which is treatable with antibiotics. If you are not pregnant or nursing and you develop these symptoms, your doctor should test for inflammatory breast cancer.
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Certain Benign Changes In The Breast
Some changes in the breast seem to increase risk of breast cancer. They include
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Changes in the breast that required a biopsy to rule out cancer
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Conditions that change the structure, increase the number of cells, or cause lumps or other abnormalities in breast tissue, such as complex fibroadenoma Fibroadenomas of the Breast Fibroadenomas of the breast are small, smooth, solid, rounded noncancerous lumps composed of fibrous and glandular tissue. Fibroadenomas… read more , hyperplasia , atypical hyperplasia in the milk ducts or milk-producing glands, sclerosing adenosis , or papilloma
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Dense breast tissue, seen on a mammogram
Having dense breast tissue also makes it harder for doctors to identify breast cancer.
For women with such changes, the risk of breast cancer is increased only slightly unless abnormal tissue structure is detected during a biopsy or they have a family history of breast cancer.
Breast Cancer Gene Mutation
Mutations in two separate genes for breast cancer have been identified. Fewer than 1% of women have these gene mutations. About 5 to 10% of women with breast cancer have one of these gene mutations. If a woman has one of these mutations, her lifetime risk of developing breast cancer is about 50 to 85%. The risk of developiing breast cancer by age 80 is about 72% with a BRCA1 mutation and about 69% with a BRCA2 mutation. However, if such a woman develops breast cancer, her chances of dying of breast cancer are not necessarily greater than those of any other woman with breast cancer.
These mutations are most common among Ashkenazi Jews.
Women likely to have one of these mutations are those who have at least two close, usually first-degree relatives who have had breast or ovarian cancer. For this reason, routine screening for these mutations does not appear necessary, except in women who have such a family history.
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