Breast cancer ranks first among cancers in terms of prevalence and impact on public health around the world, as statistics indicate that about 2.3 million cases were diagnosed in 2020. Breast cancer incidence and mortality rates vary greatly between countries and regions, which highlights the diverse challenges facing medical prevention and diagnostic efforts.
This article aims to provide a comprehensive view of breast cancer, starting from the causes and types, to the importance of early detection and available treatment options.
What is breast cancer?
Breast cancer is a disease in which cells in breast tissue grow out of control, and it is the most common type of cancer in women around the world.
Breast cancer occurs primarily in women, but it may also develop in men, although it is rare.
Breast cancer usually develops when abnormal cells in breast tissue begin to grow and divide uncontrollably, forming a mass of tissue.
Malignant breast tumors have the potential to invade nearby tissues and spread to other parts of the body, if left untreated.
The causes of the infection are still not fully understood, but there are some factors that may cause an increase in the risk of breast cancer, such as: age, genetic history, gender, and hormonal factors.
It is worth noting that the advanced technologies available today for early detection and treatment methods have greatly influenced the success rates in treating breast cancer.
Causes of breast cancer
There is no specific cause for breast cancer, but there are many factors that increase the risk of cancer, and these factors include the following.
- Biological factors include:
- Age: The probability of developing breast cancer increases with age, especially after the age of fifty and during menopause.
- Gender: Women are more susceptible to breast cancer in general.
- Family history: Having a hereditary history of breast cancer, especially in first-degree relatives such as the mother, increases the chances of infection.
- Genetic changes: Some genetic mutations, such as BRCA1 and BRCA2, significantly increase the risk of breast cancer.
- Breast density: Women with dense breast tissue are more likely to develop breast cancer.
- Pregnancy and breastfeeding: Factors related to pregnancy and breastfeeding, and changes associated with these stages, may affect the risk of breast cancer.
- Lifestyle, including:
- Obesity: Obese women are more likely to develop breast cancer, especially after menopause.
- Lack of physical activity: Not engaging in any physical activity increases the risk of breast cancer.
- Smoking and drinking large amounts of alcohol also increase the risk of infection.
- Hormone replacement therapy: Using hormonal treatments for long periods may increase the risk of developing this type of cancer.
It is important to note that the presence of one of these factors does not necessarily mean breast cancer, nor does the absence of any of these factors mean protection against infection, which necessitates every woman to follow prevention methods and periodic monitoring by specialists based on her individual condition.
Types of breast cancer
Breast cancer can appear in different types, each of which has specific characteristics and treatment methods.
Invasive ductal carcinoma (IDC).
This is the most common form of breast cancer, accounting for about 80% of cases.
Invasive lobular carcinoma (ILC).
This type of breast cancer originates in the milk-producing glands (lobules) rather than the ducts, and may spread to other parts of nearby breast tissue.
Ductal carcinoma in situ (DCIS).
It is an early form of breast cancer in which abnormal cells are confined to the milk ducts and have not spread to the surrounding tissues. That is, the cells in the milk ducts turn into malignant (cancerous) cells but remain in place (in situ).
However, this type may spread to other glands and tissues if it is not treated.
Lobular carcinoma in situ (LCIS).
It is a type of breast change that sometimes appears during a breast biopsy, in which cells that resemble cancer cells grow in the lining of the milk-producing glands (lobules) in the breast, but they do not invade the wall of the lobules, and do not spread to nearby tissues.
Triple-negative breast cancer (TNBC).
It is an aggressive form of cancer and accounts for about 10-15% of breast cancer cases.
The term triple-negative breast cancer refers to the fact that the cancer cells do not contain estrogen or progesterone receptors and also do not make a protein called HER2. The cells test negative in all three tests.
These cancers tend to be more common in women younger than 40, or those who have a gene mutation called BRCA1.
Inflammatory breast cancer
It is a rare but aggressive type of breast cancer that often appears as redness, swelling, warmth, and enlargement in the breast.
Paget’s disease of the breast
It is a rare type that affects the skin of the nipple and may spread to the areola.
It is worth noting that these are just some of the many types of breast cancer that exist, and each type is defined by the cells that turn into cancer cells in the breast.
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Symptoms of breast cancer
According to the Centers for Disease Control and Prevention (CDC), breast cancer symptoms vary from woman to woman, and some women may have no symptoms at all.
However, some common warning signs of breast cancer are noted, which include:
- The appearance of a new lump or bump in the breast or armpit area.
- Changes in the skin of the breast, such as it becoming irritated, red, or appearing like an orange peel.
- Thickening or swelling in part of the breast.
- Redness or peeling of the skin layer in the nipple and breast area.
- Persistent pain in the breast or nipple.
- A change in the size, shape, or texture of the breast and a feeling of heat when touched.
- Swelling or lumps in the lymph nodes under the armpit or around the shoulder near the collarbone.
- A feeling of tightness, pain or itching in the nipple and surrounding area.
- Change in the shape of the nipple, such as retracting or turning inward.
- Discharge from the nipple other than natural milk, such as blood or other secretions.
These symptoms may also appear in non-cancerous conditions, so it is best to consult a doctor if any unusual or familiar symptoms appear that may raise concern.
It is also noteworthy that the presence of a lump in the breast does not necessarily mean that you have cancer, as most lumps in the breast are benign (non-cancerous) lumps.
Symptoms of early breast cancer
Although many women do not have any symptoms at first, this changes based on the type and severity of the cancer.
General symptoms of breast cancer in its early stages may include:
- Very small, painless or visible lumps that appear on X-rays, which emphasizes the importance of regular examinations and regular mammograms, especially when there is a risk factor for cancer.
- Changes in breast size or shape.
- Swollen lymph nodes under the armpit suddenly and for no reason.
- Skin changes, such as redness or rash.
It must be remembered that most breast lumps are non-cancerous, and occur for other reasons, such as mastitis, menstruation, and blockage of the mammary glands, but if you notice the appearance of any bump, abnormal lump, or any of these symptoms, it is important to consult with a specialist doctor;
Breast pain or a burning sensation in the breast and nipple may be the first sign of inflammatory breast cancer or Paget's disease, which are among the rare types of breast cancer.
Early detection of breast cancer is crucial for successful treatment and improving outcomes. Awareness of common symptoms and understanding the importance of regular checkups can significantly impact cure rates.
Symptoms of breast cancer in men
Although breast cancer is more commonly associated with women, up to 1% of men can also develop the disease.
Symptoms of breast cancer in men may include:
- A painless lump or thick spot in the breast tissue.
- Changes in the nipple, such as discharge or pain and retraction.
- Skin changes, such as redness, peeling, or dimpling.
- Small bumps in the armpit (swollen glands).
It is important for men to be aware of these symptoms and seek medical care if they notice any of them or other abnormal changes.
What are the stages of breast cancer?
Breast cancer is classified into 5 stages, ranging from stage 0 to stage 4.
Stage zero breast cancer
It is the stage of localized breast cancer when breast cancer is detected early.
The two main types of non-invasive breast cancer include:
Ductal carcinoma in situ (DCIS).
Lobular carcinoma in situ (LCIS).
Stage 0 breast cancer is usually discovered through a mammogram or while breast tissue is examined for another condition.
These cases require immediate treatment to prevent breast cancer from progressing to the next stages. Treatment usually includes surgery to remove the abnormal cells, followed by radiation therapy or hormone therapy in some cases.
The first stage of breast cancer
Stage I is indicated by Roman numerals, and starting from this stage, it is called invasive breast cancer because it has broken out to attack healthy tissue, but it is still in the early stages and has not invaded the lymph nodes.
The tumor remains relatively small in size, usually less than 2 cm in diameter.
- In stage IA, the tumor is small, no larger than 2 cm, has not spread to the lymph nodes or other locations, and is still confined to fatty breast tissue.
- Stage IB includes two conditions:
- No lump in the breast but small groups of cancer cells in the lymph nodes.
- The presence of a breast tumor not exceeding 2 cm in size, with small groups of cancer cells in the lymph nodes.
Treatment for stage I breast cancer often includes surgical procedures, such as a lumpectomy or mastectomy, followed by radiotherapy and possibly complementary therapy, such as chemotherapy or targeted therapy, depending on the individual case.
Stage II breast cancer
Stage II breast cancer is characterized as having progressed at the same site, meaning the tumor has already grown larger, or may have spread to nearby lymph nodes.
- Phase IIA includes one of the following:
- The presence of a tumor smaller than 2 cm with cancer cells in the lymph nodes.
- The presence of a tumor between 2 and 5 cm, with or without the presence of any cancer cells that have reached the lymph nodes.
- Stage IIB includes one of the following:
- The presence of a tumor larger than 2 cm but not exceeding 5 cm with cancer in the lymph nodes.
- A tumor larger than 5 cm without cancer in the lymph nodes.
Treatment for stage II breast cancer often includes surgery, radiation therapy, and other treatments, which may include chemotherapy, targeted therapy, or hormonal therapy, depending on the characteristics of the individual tumor and the patient's overall health.
Stage III advanced breast cancer
Stage III breast cancer is considered advanced;
It can be divided into three subcategories: stage IIIA, IIIB and stage IIIC.
- Stage IIIA, may involve a tumor of any size with cancer in 4 to 9 axillary lymph nodes or in lymph nodes near the breastbone.
It may also include a large tumor without any cancer cells in the lymph nodes.
- Stage IIIB. The tumor may have grown in the chest wall or in the skin of the breast, causing changes in appearance or consistency, swelling or ulcers in the skin of the breast, and there may or may not be swollen lymph nodes.
- Stage IIIC, the cancer has spread to 10 or more axillary lymph nodes or to lymph nodes above or below the shoulders or near the breastbone.
Treatment for stage III breast cancer usually includes a combination of surgery, radiation therapy, chemotherapy, targeted therapy, and hormone therapy.
Stage IV breast cancer
Stage IV breast cancer is known as metastatic breast cancer, because the cancer cells have spread to distant organs, such as the bones, lungs, liver, or brain, and this is the most advanced and dangerous stage of breast cancer.
Treatment for stage IV breast cancer focuses on managing the disease and improving the patient's quality of life.
Does the size of the tumor determine its stage?
The stage of breast cancer is determined by several factors, including the size of the tumor, but it is not the only factor, as doctors also pay attention to whether it has spread to the lymph nodes, or reached other parts of the body.
These factors help doctors assess the extent of the disease and develop an appropriate treatment plan.
The most widely used system for staging breast cancer is the TNM system, which stands for:
- Tumor: T category describes the size and extent of the primary tumor, ranging from T0 (no evidence of tumor) to T4 (tumor present and invading the chest wall or skin).
- Node lymph node, N category indicates whether the cancer has spread to the lymph nodes, and ranges from N0 (no cancer in the lymph nodes) to N3 (cancer in ten or more axillary lymph nodes or suprascapular lymph nodes).
- Metastasis, M category represents whether the cancer has spread to distant organs.
In addition to the TNM score, doctors consider other factors when determining the stage of breast cancer.
Understanding the stage of breast cancer is crucial to determining appropriate treatment options and outcome expectations for patients.
Breast cancer detection
During the diagnostic process, the health care provider performs a physical examination and reviews the patient's medical history to determine the direction of his or her initial diagnosis.
Mammogram
Mammogram is the main tool used to detect and diagnose breast cancer.
In addition to a mammogram, your doctor may use other diagnostic techniques and tests to evaluate questionable results.
- Ultrasound or mammogram: Used to evaluate changes in breast tissue and differentiate between solid masses and fluid-filled masses.
- Magnetic resonance imaging (MRI): Provides detailed images of the breast, which helps assess the extent of the disease and evaluate treatment response.
- Biopsy: A procedure that involves extracting a small sample of breast tissue for laboratory analysis and evaluating it under a microscope to determine the characteristics of the tumor, such as its size and grade.
It is important to discuss the appropriate schedule and methods for screening with your health care provider based on individual risk factors and age.
Breast cancer treatment
Breast cancer treatment aims to remove or destroy cancer cells, prevent the spread of the disease, and reduce the risk of relapse. Treatment plans are customized based on factors such as the type and stage of cancer, the presence of hormone receptors, and the general health status of women with breast cancer.
Breast cancer surgery
Surgery is a common treatment option for breast cancer and may involve one or more procedures, including:
- Lumpectomy (breast-conserving surgery): Removing the cancer and some surrounding healthy tissue, leaving as much healthy breast tissue as possible.
- Mastectomy: Removal of the entire breast, which may include the nipple and areola.
Additional surgeries may include:
- Removing the first lymph nodes to which the cancer is likely to spread, or removing multiple lymph nodes in the armpit.
- Post-mastectomy breast reconstruction, which can be performed at the same time as cancer surgery or as a separate procedure.
Radiation therapy for breast cancer
Radiation therapy for breast cancer is a common and effective treatment that uses high-energy X-rays or other particles to kill cancer cells.
It is used to treat breast cancer at almost every stage and can help reduce the risk of breast cancer recurring after surgery, eliminating any remaining cancer cells.
Radiation therapy may also be used to relieve symptoms in advanced cases.
Chemotherapy for breast cancer
Chemotherapy involves the use of powerful drugs to kill cancer cells or slow their growth, often given before surgery to reduce the size of tumors, after surgery to eliminate remaining cells, or as the main treatment for advanced cancer.
Chemotherapy may be given alone or in combination with surgery or radiation therapy.
Hormonal treatment for breast cancer
Hormone therapy is used to treat breast cancer that shows positive hormone receptors.
Biological treatment for breast cancer
Biological treatments rely on enhancing the immune system's fight against cancer cells.
This treatment is usually used after resection to reduce the possibility of cancer returning, or before surgery to reduce the size of cancer cells and help control their spread to other areas of the body.
Cancer-directed (targeted) therapy
Targeted therapy uses medications that specifically target cancer cells without harming healthy cells.
Providing psychological and social support to women with breast cancer should not be ignored because this is an integral part of the treatment and recovery journey.
Ways to prevent breast cancer
Although breast cancer cannot be prevented or stopped, there are steps that individuals can take to reduce the risk of infection, which are represented by several factors, the most important of which are the following.
Healthy lifestyle choices
Adopting a healthy lifestyle can reduce the risk of breast cancer.
- Maintaining a healthy weight: There is a link between obesity and an increased risk of breast cancer, especially in post-menopausal women.
- Get regular physical activity: Aim for 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise each week.
- Limit alcohol consumption and smoking.
Breast self-examination
Regular self-breast examinations can help women become familiar with their breast tissue and detect any changes quickly.
Regular screening for breast cancer
Routine checkups are key to early detection and prevention.
In addition to discussing risk factors and recommending appropriate diagnostic tests based on individual needs, such as mammograms, which are recommended to be performed regularly, especially among women in the age group at risk of infection.
Frequently asked questions about breast cancer
We realize the importance of the topic of breast cancer and the many questions surrounding it, so our doctors are honored to provide satisfactory answers while encouraging you to follow us and communicate with any questions about breast cancer or any other medical conditions.
What are the most dangerous types of breast cancer?
Triple negative breast cancer (TNBC) is faster to grow and spread than other types of breast cancer.
How do I know I have breast cancer?
The only way to definitively diagnose breast cancer is through medical evaluation and diagnostic tests.
What does a malignant breast tumor look like?
Malignant breast tumors may appear as single or multiple solid masses and are often, but not always, painless.
The malignant mass is usually located in the upper outer quadrant of the breast, extending to the armpit, and may also cause changes in the appearance of the nipple, nipple pain, or dimpling or wrinkling of the skin.
However, it is important to note that not all breast lumps are cancerous, and some breast cancers may not cause any noticeable symptoms even if they are malignant.
When is breast pain serious?
Breast pain is a common symptom of breast diseases and is often not related to breast cancer. However, there are conditions that we should pay attention to, such as:
- The pain continues daily for more than two weeks.
- Pain develops in one specific area of the breast.
- The pain gets worse over time.
- The pain is accompanied by lumps or changes in the skin.
It is necessary to consult a healthcare provider if any of the above symptoms are present;
How painful is breast cancer?
Breast cancer is usually not a source of pain, especially in its early stages. However, as the disease progresses or if it spreads to other parts of the body, it may cause discomfort or pain.
Does breast cancer lead to death?
Breast cancer can be a fatal disease if it is not detected early and treated optimally.
But with the advancement of the fields of examination, diagnosis, and treatment, and increased awareness about the importance of periodic examinations, mortality rates decreased significantly.
Survival rates change depending on factors such as the stage and type of cancer, general health status, and specific tumor characteristics.
In conclusion, breast cancer is a complex disease that affects women and men around the world at high and serious rates, so understanding the causes, symptoms, types, and detection methods is crucial for early diagnosis and effective treatment.
Remember that knowledge and awareness are powerful weapons on your journey towards a healthier future.
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