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Breast cancer

What is breast cancer?

Breast cancer is a malignant tumor of the breast. It is one of the most common cancers in the world and in India. Most cases develop in women over the age of 50 but younger women are sometimes affected. Breast cancer can also develop in men, although this is rare.

The breasts are made up of fat, connective tissue and glandular tissue made up of lobes. A network of ducts connects the lobes to the nipple. Breast cancer can develop from the cells that line the breasts, the lobules and draining ducts.

A woman’s breasts goes through many changes in the course of her monthly cycle and even through various stages of her life. Most changes are benign, but it is important to be breast aware, which means knowing what is normal for you and what changes to look out for.

Changes to be aware of:

• Size and shape – if one breast becomes larger, or lower; a change from the normal
• Nipples - if a nipple becomes inverted (pulled in) or changes position or shape
• Rashes - on or around the nipple
• Discharge - from one or both nipples
• Skin changes – puckering, dimpling or thickening of the skin on a part of the breast
• Swelling - under the armpit or around the collarbone
• Pain - continuous, in one part of the breast or armpit
• Lump or thickening - different to the rest of the breast tissue

Any different or unusual change in the breast should always be examined by a doctor. This is because even though most breast lumps are benign, they still need to be checked carefully to rule out the possibility of cancer. Also, if it is a cancer, the earlier the treatment is given, the more likely it is to be successful.

Types of breast cancer

Invasive or 'in situ'

Most breast cancers are diagnosed when a tumour has grown from within a duct or lobule into the surrounding breast tissue. These are called 'invasive' breast cancers. Some people are diagnosed when the cancerous cells are still totally within a duct or lobule. These are called 'carcinoma in situ' as no cancer cells have grown out from their original site. A carcinoma in situ is easier to treat and has a better outlook than an invasive cancer.

Grade of the cancerous cells

A sample of breast cancer tissue can be looked at under the microscope. By looking at certain features of the cells the cancer can be 'graded'. As a rough guide, the lower the grade, the better the cancer is likely to respond to treatments such as chemotherapy and radiotherapy.

Hormone responsive or non-hormone responsive

Breast cancer can be oestrogen-responsive or non-oestrogen responsive. The treatment options will differ accordingly.

Stage of the cancer

This does not describe a type of cancer, but indicates how much the cancer has grown and whether it has spread. As a general rule, the earlier the stage, the greater the chance of a cure and better outcome.

Causes

A cancerous tumour starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal and it multiplies 'out of control'.

Risk factors

Although breast cancer can develop for no apparent reason, there are certain 'risk factors' which increase the chance that breast cancer will develop. These include:

Ageing: The risk of breast cancer increases with age.

Where you live: The rate of breast cancer varies between countries. This may reflect genetic or environmental factors.

Family history: This means close relatives who have or have had breast cancer. In particular, if they were under the age of 50 when diagnosed.

If you have had a previous breast cancer.

Being childless, or if you had your first child after the age of 30.

Early age of starting periods.

Having a menopause over the age of 55.

Taking HRT (hormone replacement therapy).

Having dense breasts.

A past history of some benign breast diseases.

Lifestyle factors: taking little exercise, obesity after menopause, and excess alcohol.

Family history and genetic testing

About 1 in 20 breast cancers are caused by a 'faulty gene' which can be inherited. Breast cancer which is linked to a faulty gene most commonly affects women in their 30s and 40s. If you have a strong family history of breast cancer you may wish to discuss this with your doctor. Genetic testing to see if you have inherited certain 'faulty genes' is possible.

How is breast cancer diagnosed?

Initial assessment: A doctor will normally carry out a physical exam of the breasts and armpits to look for lumps or any other changes. A referral to a specialist is usual and tests such as a mammography (x-ray of the breast) or an ultrasound scan of the breast may be recommended.

Biopsy: A biopsy is when a small sample of tissue is removed from a part of the body. The sample is then examined under the microscope to look for abnormal cells. A specialist may take a biopsy with a fine needle which is pushed into the lump and some cells are withdrawn. Sometimes the doctor may be guided as to where to insert the needle with the help of a mammogram or ultrasound scan. Sometimes a small operation is needed to obtain a biopsy sample.

The biopsy sample can confirm or rule out breast cancer. Also the cells from a tumour can be assessed and tested to determine their grade and hormone responsiveness.

Assessing the extent and spread: To assess whether a confirmed cancer has spread further tests such as blood tests, an ultrasound scan of the liver, chest x-ray, a bone scan, other types of scans, etc. may be carried out.

Outlook

Some cancers are more serious than others, some are more easily treated than others (particularly if diagnosed at an early stage), and some have a better outlook (prognosis) than others.

In each case it is important to know exactly what type of cancer has developed, how large it has become, and whether it has spread. This will help in getting reliable information on treatment options and outlook.

Treatment can vary greatly from case to case and depends on many different factors. The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general.

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