Definition

Breast cancer is a disease in which cancer cells grow in the breast tissue.

Cancer occurs when cells in the body divide without control or order. If cells keep dividing uncontrollably, a mass of tissue forms. This is called a growth or tumor. The term cancer refers to malignant tumors. They can invade nearby tissue and spread to other parts of the body.

Although most people think of breast cancer as affecting women, men can develop breast cancer as well. Breast cancer in men can be more aggressive.

Breast Cancer

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Causes

The cause of breast cancer is unknown. Research shows that certain risk factors are associated with the disease.

Risk Factors

Factors that increase your risk for breast cancer include:

• Sex: female, although men can also get breast cancer
• Age: 50 or older
• Personal history of breast cancer
• Family members with breast cancer
• Changes in breast tissue, such as atypical ductal hyperplasia, radial scar formation, and lobular carcinoma in situ (LCIS)
• Changes in certain genes (BRCA1, BRCA2, and others)
• Race: Caucasian
• Increased exposure to estrogen over a lifetime through:
  • Early onset of menstruation
  • Late onset of menopause
  • No childbearing or late childbearing
  • Absence of breast-feeding
  • Taking hormone replacement therapy for long periods of time ( Prempro for more than four years)
  • Tobacco use
• Increased breast density (more lobular and ductal tissue and less fatty tissue)
• Radiation therapy before the age of 30 years old
• Overuse of alcohol

Note: Studies show that most women with known risk factors do not get breast cancer. Many women who get breast cancer have none of the risk factors listed above except age.

Symptoms

When breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause the following changes:

• A lump or thickening in or near the breast or in the underarm area or in the neck
• A change in the size or shape of the breast
• Nipple discharge or tenderness, or the nipple pulled back (inverted) into the breast
• Ridges or pitting of the breast skin (like the skin of an orange)
• A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly)

Note: These symptoms may also be caused by other, less serious health conditions. Anyone experiencing these should see a doctor.

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done.

Tests may include:

• Clinical breast exam—the size and texture of the lump is manually examined to determines whether the lump moves easily
• Mammography —x-rays of the breast used to see lumps or other changes in breast tissue
• Ultrasonography—the use of high-frequency sound waves to see whether a lump is a fluid-filled cyst or a solid mass
• Biopsy —removal of tumor tissue to be tested for cancer cells, types of biopsies for breast cancer include:
  • Fine-needle aspiration—removal of fluid and/or cells from a breast lump using a thin needle
  • Needle biopsy —removal of tissue with a needle from an area that looks suspicious on a mammogram but cannot be felt
  • Surgical biopsy:
    • Incisional biopsy—cutting out a sample of a lump or suspicious area
    • Excisional biopsy—cutting out all of a lump or suspicious area and an area of healthy tissue around the edges
• Tissue evaluation—breast cancer tissue is tested for the presence of estrogen and progesterone receptors, as well as the presence of HER2/neu; these are used to help plan therapy
• Genetic testing—blood is evaluated for the presence of specific gene mutations in certain patients

Treatment

Once breast cancer is found, staging tests are done. This will help to find out if the cancer has spread and, if so, to what extent.

Treatments include:

Prevention

Finding breast cancer early and treating it is the best way to prevent death from the disease. Breast cancer does not cause symptoms in the early stages. It is important to have screening exams and tests. These steps can help to find the cancer before symptoms appear.

• Women age 20 or older should perform a breast self-exam (BSE) every month
• Women between the ages of 20-39 should have a clinical breast exam by a health professional every three years
  • A breast exam should be performed more regularly if there is a family history or there have been previous breast biopsies
• Women age 40 and older should have a screening mammogram every year
  • Some advocate that a mammogram should be performed sooner for patients with a strong family history or whom have had previous breast biopsies performed
• After age 40, women should have a breast exam by a healthcare professional every year

Researchers are still studying the effectiveness of these measures. According to a study, getting regular mammograms starting at age 50 does appear to decrease deaths related to breast cancer.