What is Breast cancer | Sing & symptoms, stages, Causes

1. What is breast cancer?

Breast cancer is the uncontrollable growth of breast cells eventually leading to the formation of tumor mass of abnormal tissues.

2. Causes and risk factors of breast cancer

Changes of mutations in DNA (Deoxyribonucleic Acid, Which is a hereditary characteristic in humans and other organisms) can cause normal breast cells to become cancerous. Certain DNA changes are passed on from the parents (inherited) and consequently, can increase the likelihood of breast cancer.

Other lifestyle-related risk factors (such as what/ when/ where and how much is consumed including the habit of physical exercise developed as well as the quality of sleep enjoyed) also influence the chance of developing cancer. However, how much of these risk factors are responsible to cause normal cells to become cancerous is still unknown.

Women having certain special risk factors are more likely to develop breast cancer (as compared to men). The major risk factors that increase the chances of breast cancer are enumerated below.

2.1) Avoidable risk factors

Radiation exposure (Radiation is an energy that travels in the form of waves or high-speed particles. It occurs naturally in the sunlight. Man-made radiation is used In the X- rays, nuclear weapons, and nuclear power plants, and additionally, in cancer treatments. If exposed even to a small amount of radiation for a long time it may cause cancer of various types.)

• Obesity (It indicates the excessive body fat that invites the high risk of malignant diseases like diabetes, heart disease in addition to cancer of various types including breast cancer.)
• Smoking and alcohol (No other bad habits are as harmful as these 2 expensive bad habits. Only on account of smoking-related diseases, 1 person dies in the world every 10 seconds i.e. 3.16 million deaths annually according to the report of the World Health Organization 2015.)
• Processed meat (Examples are Bacon sausage, luncheon meats, hot dogs).
• Red meat (It includes beef, pork, lamb).

2.2) Unavoidable risk factors

• Gender (Breast cancer occurs mostly in case of females)
• Aging (As one age the risk of falling prey to any malignant disease including breast cancer becomes higher)
• The previous record (One has a history of breast problems or breast cancer faces a higher risk of developing breast cancer in the later stage of life).
• Inherited genes (It can increase the risk of one’s developing breast cancer.)

3. Breast Cancer Signs and symptoms

The first sign of breast cancer is the lump in the breast or underarm that persists after the menstrual cycle. Usually, it is painless, although it may feel a prickly sensation. Lumps are usually detected by the mammography test (It is a screening tool to detect early breast cancer in women experiencing no symptoms in the initial stage. Mammography is also used to detect and diagnose other breast-related diseases in women experiencing symptoms. such as lump pain, skin dimpling, or nipple discharge.)

Among the symptoms (which are subjective phenomena, unlike signs) are:

• Swelling of all parts of the breast (even if no distinct lump is seen or felt.)
• Skin irritation or dimpling (sometimes looks like an orange peel) is experienced.
• Breast or nipple pain is felt.
• Nipple retraction (turning inward) is observed.
• Redness in the breast.
• Dense breast tissue.
• Early-onset of menstruation.
• Late menopause (Menopause is the time that occurs in most women’s lives when menstrual periods stop permanently. As such they are no longer able to bear children. Normally it occurs between the ages 49- 52 years.)

Additional symptoms that are observed mainly in stage- 1 include:

• Bloody nipple discharge.
• Inverted nipple.
• Swollen lymph nodes (Lymph nodes are small clumps of immune cells that act as filters for the lymphatic system) in the neck or armpit.
• A change in the size or shape of the breast or nipple.

4. Types of breast cancer

4.1) DCIS (Ductal Carcinoma in Situ)

‘Carcinoma’ means cancer and in situ means in the original place. So ‘DCIS’ implies that the cancer cell growth starts from the milk duct. It is a common type of breast cancer that remains within the ducts as non-invasive cancer or, it can overstep the bounds of ducts.

4.2) IDC (Invasive Ductal Carcinoma)

It is also called infiltrating ductal carcinoma. It is the most common type of breast cancer. About 80% of breast cancers are invasive which spread into surrounding tissues.

Tubular Carcinoma of Breast: It is a subtype of IDC that begins from the inside of the breast milk duct. Subsequently spreads to the adjacent healthy tissues and looks very small in size.

Medullary Carcinoma of Breast: Like ‘Tubular Carcinoma of Breast’. It is also a subtype of IDC and begins from inside the breast milk duct. But it is less aggressive.

Mucinous Carcinoma of Breast: It is also a subtype of IDC. But it is rarely found. Under the microscope, the cancer cells look scattered

Papillary Carcinoma of Breast: It is also a subtype of IDC. But with treatment, it displays a good prognosis.

4.3) ILC (Invasive Lobular Carcinoma)

Breast cancer begins in the breast-producing glands (lobules) of the breast. "Invasive" implies that the cancer cells have broken out of the lobule (where they began from) and have a higher risk to travel to the lymph nodes and other areas.

4.4) Cribriform Carcinoma

It is a slow-growing carcinoma and the cancer cells resemble normal cells with a favorable prognosis. But pure invasive cribriform is possible to develop ‘breast cancer of stage- 4’.

5. Stages and consequent spread of breast cancer & stage-wise treatments

The stage of cancer in general and breast cancer, in particular, indicates the size of the tumor of abnormal cells and additionally. It indicates whether or not these cells are staying in the place of origin.

5.1) Stage- 0 breast cancer

Although at this stage, breast cancer is considered non-invasive, still the abnormal cells can be found in the lining of the breast milk duct which has not yet spread beyond the duct. Even at this stage, it does require immediate treatment, typically surgery or radiation or both. However, at this stage chemotherapy is not needed.

5.2) Stage- 1

In this stage breast cancer is evident. But it is confined only within the area where the cancer cells started to develop. The carcinoma detected in this stage can be healed effectively by surgery or radiation or a combination of both. However, additionally, hormone therapy may be needed depending on the type of breast cancer as well as the risk factors found (Hormone therapy is also known as SERD  i.e. ‘ Selective Estrogen Receptor Degrader’. Hormones like estrogen and progesterone are produced by glands in the body. These hormones normally help regulate body cycles like menstruation. However, the same hormones can cause cancer to grow. The pathologist usually performs the test on the suspected breast cells to determine. If the breast cells have receptors that feed on estrogen or progesterone stimulating their growth.

If the cancer cells have these receptors. Then the doctor may recommend hormone therapy drugs. such as blockers or inhibitors. Both the drugs destroy the cancer cells by cutting off the hormone supply. Estrogen is the primary female sex hormone and is responsible for the development and regulation of the female reproduction system. Progesterone is an endogenous steroid and a female sex hormone produced mainly in the ovaries following ovulation each month. The receptor is an organ or cell able to respond to light, heat and other external stimuli and as such transmits a signal to the sensory nerve).

Stage- 1A: In this sub-stage, the tumor is found smaller than 2 cm and has not spread to the lymph nodes.

Stage – 1B: In this sub-stage, the lymph nodes have cancer evidence with very small clusters of cells (2.0 mm)

5.3) Stage- 2

In this stage, the nearby lymph nodes will need to be checked by SLNB ( Sentinel Lymph Nodes Biopsy) or ALNB (Auxiliary Lymph Node Biopsy). Treatments are administered normally with BCS (Breast-Conserving Surgery). After the surgery, the women are usually treated with radiation therapy (the therapy uses high-energy rays to kill cancer cells). However, if chemotherapy (the therapy is generally given intravenously) is needed after surgery, radiation is delayed until chemo is done.

5.4) Stage- 3

In this stage, the tumor increases to more than 5 cm (2 inches) in size that gets into nearby tissues and even spreads across many nearby nodes. Stage – 3 breast cancer also includes inflammatory breast cancer (It is a rare but aggressive disease in which cancer cells block lymph vessels in the skin of the breasts) that has not spread nearby lymph nodes. Treatment of these cancers can be slightly different (from another stage- 3 breast cancers) which usually starts with chemotherapy.

There are mainly 2 approaches for the treatment of stage – 3 breast cancer as stated below:

5.4.1) Neoadjuvant chemotherapy: This is done before surgery. The treatment may shrink the tumor enough to have BCS (Breast-Conserving Surgery). If the tumor does not shrink, mastectomy (It is a medical term for the surgical removal of one or both the breasts to treat breast cancer or reduce the risk of further deterioration of carcinoma) is administered. Which also checks the nearby lymph nodes. In this stage, often radiation therapy is needed after surgery.

5.4.2) Surgery: In this stage breast cancer becomes fairly large and spreads into nearby tissues. Surgery is usually followed by adjuvant chemotherapy and/or hormone therapy or trastuzumab. Radiation therapy may also be needed after surgery.

5.5) Stage- 4

Before focusing on the treatment procedures. It is essential at first to highlight the development as well as the symptoms that arrive one after another in this stage which are:

Skin changes like dimpling or ulceration.

• Nipple discharge.
• Swelling of breast or arm.
• Large hard palpable lymph nodes under the arms or neck.
• Pain or discomfort.

In stage- 4 most women suffering from breast cancer are treated with systemic therapy (It can be infused intravenously or given as an injection or taken orally and before or after surgery. Systematic therapy usually includes targeted drugs, chemotherapy, hormone therapy, and immunotherapy) or with some combination of surgery and radiation therapy.

6. Survival rate of breast cancer

The implication for survival rate is explained thus :

For a particular stage, if the breast cancer patients have a survival rate of 70% (i.e. to survive at least for 5 years after diagnosis), then it implies that the chances of survival (at least for 5 years after diagnosis) for the breast cancer patients is 30% less as compared to the people who do not have breast cancer.

• Stage-0: The survival rate is 100% (to survive at least 5 years after diagnosis).
• Stage-1: Survival rate is near 100% (at least 5 years after diagnosis).
• Stage-2: Survival rate is  93% (at least 5 years after diagnosis).
• Stage-3: Survival rate is  72% (at least 5 years after diagnosis).
• Stage-4: Survival rate is  22% (at least 5 years after diagnosis).

For all breast cancer patients, the average survival rate (at least 5 years after diagnosis) is 93% (same as stage- 2). It declines to 83% ( when survival is assumed at least for 10 years after diagnosis)

7. Recurrence Rate of Breast cancer

Recurrence rate implies the percentage of patients of all types experiencing regional or local breast cancer recurrence (even after administering surgery, radiation therapy, etc).

• 1.7% ( Local recurrence within 5 years)
• 1.2% ( Local recurrence after 5 years)
• 0.8% (Chest wall recurrence within 5 years)
• 0.4% (Chest wall recurrence after 5 years)

8. Precautionary measure and mass awareness

“Forewarned is fare armed “ – runs the adage which holds in case of every one of us to remain alert. And aware of any risk or possibility of being attacked by malignant diseases including breast cancer. As a precautionary measure, one needs to follow some health rules and develop some healthy habits such as staying physically active and not being obese or overweight (through eating healthy foods and avoiding junk and unhealthy foods including expensive bad habits like smoking and alcohol). Additionally, it is essential to develop a healthy lifestyle like enjoying a quality sleep and rising early in the morning to take regular physical exercise. Further, any abnormal look in the breast or feeling of pain or uneasiness should immediately be brought to the notice of the oncologist.

9. Key world statistics

• 10.1) Breast cancer is mostly a feminine disease. Globally, out of 100 breast cancer patients on average, there are found 99 females against only 1 male patient.
• 10.2) During the period 2010- 14, for the diagnosed breast cancer patients, the average age was found 62 years. It was found 55- 64 years for females.
• 10.3) Most of the carcinoma cases occur in the case of males (over 60 years). In the case of females (over 50 years)
• 10.4) About 80% of breast cancer cases are IDC (Invasive Ductal Carcinoma).
• 10.5) Over 0.5 million women died of breast cancer all over the world in 2011 (According to Global Health Estimates of World Health Organization, 2013).
• 10.6) About 50% of breast cancer patients and 58% of deaths occur in less developed countries.
• 10.7) As for breast cancer patients, the average survival rate is the highest (80%) in the developed countries (Notably, North America, Sweden, and Japan). 60% in the middle-income countries and only 40% in the less developed countries.

Key Global Message: Although globally, the average mortality rate is declining in the case of breast cancer. But the disease remains a top malignancy particularly among the females in the developing. And the less developed countries where the majority of the cases are diagnosed in the stage when it is too late.

10. Concluding remarks

10.1) To fight breast cancer, treatments, and drugs with a specified dose. The frequency will depend on gender, age, general health condition, stage as well as the extent of the cancer spread, test results, etc.

10.2) It is known on all hands that “prevention is always better than cure”. But still, the fact remains that there is no 100% guarantee to prevent any malignant disease including breast cancer. However, the chances of malignancy can be minimized to a significant level by developing a healthy lifestyle through consuming healthy and nutritious foods as well as cancer prevention drugs in addition to regular physical workouts preferably after getting up from bed early in the morning.

10.3) For the rapid reduction of the death rate caused by breast cancer. Mass awareness always plays a very crucial role. In this connection, constant hammering on TV, radio, mass media (in addition to holding seminars, symposiums regularly) is needed to increase awareness. Mass awareness efforts additionally include a massive drive against smoking and alcohol. These 2 expensive bad habits give birth to all malignant diseases all over the world including breast cancer. Moreover, drugs and medicines as well as other treatment methods, although prevent and cure carcinoma to some extent. But veritably they involve huge costs in terms of both money and side effects. So precautionary measure including mass awareness is the best option.

Research

11.4) Researchers all over the world have been working hard to prevent. Detect and treat breast cancer to improve the quality of life of breast cancer patients and survivors. The major research areas are mainly determinate in the reduction of breast cancer risks. Developing effective testing methods and more importantly. Developing treatment quality and standards to minimize the overall death rate caused by carcinoma. However, the fruits and benefits of constant research are determinate only in the developed world (Notably the USA) due to amazing inventions in treatment methods, such as mammographic screening and early detection procedures as well as the availability of improved therapies and more importantly, easy access to healthcare services.

But sadly, in the developing and the less developed world. The treatment quality and more importantly. The access to healthcare facilities by the general public is lagging far behind. This puts retardation on the average life expectancy of people in general.