Breast Cancer: All That You Need to Know
Dr. Nimmi Mahajan (she/her)

Dr. Nimmi Mahajan (she/her)

Oct 19General wellness

Breast Cancer: All That You Need to Know

This blog has been compiled by Komal Adhlaka, a content writer for Proactive For Her.

Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer, involving the nipple, areola, and ducts, and lobules ( breast glands). Breast cancer occurs almost entirely in women, but in rarely occurring cases, men can get breast cancer, too.

Cells in the case of breast cancer usually form a tumour that can often be seen on an x-ray (Mammograms) or felt as a lump. Most breast lumps are benign and not malignant. Non-cancerous breast tumours are abnormal growths that do not spread outside of the breast. However, some types of benign breast lumps can put women at high risks of getting breast cancer. Any seemingly abnormal changes in the breasts need to be checked by a healthcare professional to determine if it is benign or malignant (cancer).

How common is breast cancer?

  • Most common cancer in women in India.
  • 27.7% of all new cancers detected in women in India in the year 2018, were breast cancers.
  • One woman is diagnosed with breast cancer, in India, every 4 minutes
  • One woman dies of breast cancer, in India, every 8 minutes
  • As per the WHO report, 65% of women diagnosed with breast cancer are in the III or IV stages, in India. 

Types of breast cancer

Breast cancers can start from different parts of the breast.

  • In most cases, breast cancer may start in the ducts that carry milk to the nipple. These are called ductal cancers.
  • Lobular cancers start in the glands that make breast milk.
  • Paget’s disease of the nipple
  • Inflammatory Breast Cancer
  • Phyllodes tumor and angiosarcomas are other, less common breast cancers.

Possible causes of breast lumps include:

  • Infection or abscess - Abscesses can be painful. They are noncancerous and are usually caused by bacteria. The skin surrounding the breast can become red, and feel hot or solid. Breast-feeding women may develop breast abscesses.
  • Adenoma or fibroadenoma - Adenomas are the abnormal growths of the glandular tissue in the breast. Fibroadenomas are the most common types of adenoma in the breast. Fibroadenomas are generally round and firm with smooth edges and move easily under the skin. These may most likely affect women under the age of 30 years. They do not usually become cancerous.
  • Cysts - A breast cyst is a benign, or noncancerous, fluid-filled sac in the breast. Its texture is usually smooth and rubbery under the skin. Some breast cysts may be painless, while others are quite painful. Breast cysts rarely occur in women over 50 years. Cysts can be very small, only visible on an ultrasound scan. Cysts usually vary between 2.5 and 5 centimetres in size. A sebaceous cyst may occur if the ducts of sebaceous or oil glands become blocked. Sebaceous cysts do not usually need treatment, but the painful ones need to be removed.
  • Fat necrosis and lipoma - fat necrosis may occur when fatty tissue in the breast becomes damaged or breaks down. Noncancerous lumps can form in the breast which may be painful. There may be a nipple discharge and a dimpling of the skin over the lump.

A lipoma is a soft, noncancerous, movable lump that is generally painless. It is a benign, fatty tumour.

  • Breast cancer- Some breast lumps may have a distinct border, while others may seem like a general area of thickened tissue. A breast cancer lump or tumour usually has an irregular shape, firm, or hard consistency at times, and not easily moves unlike a Fibroadenoma, and it may seem like a deeply-sunk tissue within the breast.

Breast cancer is not usually painful, especially in the early stages. While malignant tumours may be painful, at times. They may cause other structures in the breast to be compressed and may ulcerate in advanced stages.

Self-Check for lumps

It is important for women to be familiar with their bodies and their breasts. Self-checking the breasts can help to recognize any problematic changes or lumps. The following guidelines will help women self-check their breasts:

  1. Check the size, shape, and look for any changes in the breasts by looking in the mirror.
  2. Raise the arms and repeat step 1.
  3. Check for any discharge from the nipples that may be watery, milky, yellow, or with blood.
  4. Feel the breasts with a firm, smooth motion while lying down, including under the arms and down to the ribcage.
  5. Repeat step 4 while standing or sitting, It may be easier in the shower, with soap applied to the hands.

Even though most breast lumps are benign, anything unusual should be checked by a doctor.

Warning signs of breast cancer

While some people may not have any signs or symptoms of breast cancer, some may experience certain changes in their breasts. Some warning signs of breast cancer are:

  • New lump in the breast or underarm (armpit).
  • Swelling of part of the breast.
  • Irritation or dimpling of breast skin.
  • Redness or flaky skin in the nipple area or the breast.
  • Pulling in of the nipple or pain in the nipple area.
  • Nipple discharge other than breast milk, including blood.
  • Any change in the size or the shape of the breast.
  • Pain in any area of the breast.

If you have any signs or symptoms, be sure to see your doctor right away.

Non-modifiable risk factors of breast cancer

  • Age. The risk for breast cancer increases with age, most breast cancers are diagnosed in women over 50.
  • Reproductive cycle. The early menstrual period cycle (before age 12) and starting menopause after age 55, exposes women to hormones longer, raising their risk of getting breast cancer.
  • Genetic mutations. Mutations in inherited genes such as BRCA1 and BRCA2.
  • Dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to identify tumours on a mammogram.
  • Family history of breast or ovarian cancer. Women may most likely develop the chances of breast cancer if they have a family history with first-degree male, or female relatives have it.
  • Personal medical history. Women who have had breast cancer may get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia, or lobular carcinoma in situ, may increase the risk of getting breast cancer.

Modifiable risk factors of breast cancer

  • Physical inactivity: Women with less or no physical activity have a higher risk of getting breast cancer.
  • Hormonal pills: Some forms of hormone replacement therapy (containing both estrogen and progesterone) taken during menopause can raise the risk for breast cancer when consumed for more than five years.
  • Post-menopausal weight: Older women who are overweight have a higher risk of getting breast cancer, than those at a normal weight.
  • Reproductive history: First pregnancy after age 30, not breastfeeding, and not having a full-term pregnancy can raise breast cancer risk.
  • Over-consumption of alcohol: Studies show that a woman’s risk for breast cancer increases with more alcohol consumption.

Who is at high risk for breast cancer?

Women with a family history of breast cancer or inherited changes in their BRCA1 and BRCA2 genes may have a high risk of getting breast cancer.

All women have BRCA1 and BRCA2 genes, but only some women undergo gene mutation. If either your mother or your father has a BRCA1 or BRCA2 gene mutation, you have a 50% chance of having it.

Not every woman who has a BRCA1 or BRCA2 gene mutation will get breast or ovarian cancer, but having a mutation increases the risk for these cancers.

How to reduce the risk of breast cancer?

While treatments and medical care for breast cancer keep getting better, these simple steps can help lower the risk of breast cancer. Not each one applies to every woman, but together they can bring about positive changes in their lifestyle:

 1. Keep a tab on body weight: Maintaining a healthy weight is an important step to reduce the chances of several illnesses, as being overweight can increase the risk of many different cancers, including breast cancer, especially after menopause.

2. Be physically active: Women who are physically active for at least 30 minutes a day have a lower risk of breast cancer. Regular exercise is also one of the best ways to help keep weight in check and regulate muscles, tissues and blood flow in the body

3. Have a diet rich in fruits and veggies: and avoid too much alcohol: A healthy diet with loads of fruits and vegetables can help lower the risk of breast cancer. Also, try to keep alcohol consumption to low levels (a drink a day or under).

4. Avoid smoking: Besides lowering the quality of life and increasing the risk of heart disease and stroke, smoking can contribute to an increased risk of at least 15 cancers – including breast cancer. If you smoke, suggest stopping as soon as you can.

5. Breastfeed: Breastfeeding for a total of one year or more (combined for all children) lowers the risk of breast cancer while also contributing well to the health of the baby.

6. Avoid birth control pills: The younger a woman is, the lower the risks of birth control pills are. Women on birth control pills, taken for a long time, have a slightly increased risk of breast cancer. Once consumption is stopped, the risk may go away.

7. Avoid post-menopausal hormones: Studies show that post-menopausal hormones have a mixed effect on health, increasing the risk of some diseases and lowering the risk of others, and both estrogen-only hormones and estrogen-plus-progestin hormones increase the risk of breast cancer. If women take hormones in the post-menopausal period, it should be for the shortest time possible.

What is screening?

Screening is looking for signs of disease before a person has symptoms. The goal of screening tests for breast cancer is to find cancer at an early stage when it can be treated easily.

Various tests to screen and diagnose breast cancer

The following tests and procedures may be used:

  1. Physical exam and health history: A general exam of the body to check for signs of any disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be considered.
  2. Clinical breast exam (CBE): An exam of the breast by a health professional, who carefully feels the breasts and under the arms for lumps or anything else that seems unusual.
  3. Mammogram: An x-ray of the breast. Several studies show that breast cancer screening with mammography is extremely helpful. It doesn’t help prevent cancer, but it can help detect cancer early. For most women, regular mammograms can begin at age 40, but specific recommendations vary by age and risk factors involved.
  • For age 40 – 44: You can choose to begin mammograms every year. It is important to talk to a doctor about the risk and benefits of mammograms at these stages.
  • For age 45 – 54: Annual Mammograms are recommended.
  • For age 55 or over: Mammograms are recommended every alternate year, or continued annually.
  1. Ultrasound exam: A procedure in which high-energy sound waves are bounced off internal organs. The echoes form a printable picture of body tissues called a sonogram.
  2. MRI (magnetic resonance imaging): A series of detailed pictures of both breasts is formed using a magnet, radio waves, and a computer. This procedure is also called nuclear magnetic resonance imaging (NMRI).
  3. Blood chemistry studies: A blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
  4. Biopsy: Cells or tissues are removed so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, a biopsy may be done. There are four types of biopsy used to check for breast cancer:
  • Excisional biopsy: The removal of an entire lump of tissue.
  • Incisional biopsy: The removal of part of a lump or a sample of tissue.
  • Core biopsy: The removal of tissue using a wide needle.
  • Fine-needle aspiration (FNA) biopsy: The removal of tissue or fluid, using a thin needle.

Treatment Options for breast cancer

Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.

  1. Surgery: Most patients with breast cancer have surgery to remove cancer, and sentinel lymph nodes during surgery.
  2. Radiation therapy: Radiation therapy uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:
  3. Chemotherapy: Chemotherapy uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping their division.
  4. Hormone therapy: Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors (proteins) that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy.
  5. Targeted therapy: Targeted therapy uses drugs or other substances to identify and attack specific cancer cells. They usually cause less harm to normal cells than chemotherapy or radiation therapy do. Monoclonal antibodies, tyrosine kinase inhibitors, cyclin-dependent kinase inhibitors, mammalian target of rapamycin (mTOR) inhibitors, and PARP inhibitors are types of targeted therapies used in the treatment of breast cancer.
  6. Immunotherapy: Immunotherapy is a type of biological therapy. It uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defences against cancer.

Myths and Facts about Breast cancer

MYTH: If I don’t have a family history of breast cancer, I won’t get it.

FACT: Most people diagnosed with breast cancer have no known family history.

MYTH: If you maintain a healthy weight, exercise regularly, eat healthily, and limit alcohol, you don’t have to worry about breast cancer.

FACT: Although these behaviours can help lower breast cancer risk, they can’t eliminate it.

MYTH: Wearing a bra can cause breast cancer.

FACT: There is no evidence that bras cause breast cancer.

MYTH: Using an underarm antiperspirant can cause breast cancer.

FACT: There is no evidence of a connection between underarm antiperspirants and breast cancer, but the safety of antiperspirants is still being studied.

MYTH: Carrying your cell phone in your bra can cause breast cancer.

FACT: There is no evidence of a connection between cell phones and breast cancer, but the safety of cell phones is still being studied

MYTH: Consuming too much sugar causes breast cancer.

FACT: There is no evidence that sugar in the diet causes breast cancer.

MYTH: Annual mammograms guarantee that breast cancer will be found early.

FACT: Although mammography is the best early detection tool we have, it doesn’t always find breast cancer at an early stage.

MYTH: Breast cancer always causes a lump you can feel.

FACT: Breast cancer might not cause a lump, especially when it first develops.

MYTH: Early-stage breast cancer rarely recurs.

FACT: Even with early-stage breast cancer, there is always some risk cancer will return.

MYTH: All breast cancer is treated pretty much the same way.

FACT: Treatment plans vary widely depending on the characteristics of cancer and patient preferences.

MYTH: Breast cancer only happens to middle-aged and older women.

FACT: Younger women can and do get breast cancer, as do men.

MYTH: When treatment is over, you’re finished with breast cancer.

FACT: Breast cancer can have a long-term impact on people’s lives and well-being.

Final Words

Most cancers take years to develop. Many things can affect your chance of getting breast cancer. You can’t control some risk factors, like getting older. But you can control many others. Two of the most important things you can do are making healthy choices and getting timely screening tests.

Breast cancer awareness has allowed people to learn what their risk factors are, how they can reduce their level of risk, what symptoms they should look for and what kind of screening they should be getting. Fortunately today, people are increasingly aware of the issues associated with breast cancer. For the unversed, Breast Cancer Awareness Month is held each October.

Disclaimer - This information is provided for educational purposes and should not be construed as medical advice. Please consult with your healthcare practitioners before undertaking any changes in your diet or adding supplements.

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