Breast Cancer: Symptoms, Types & Stages, Risk Factors, Diagnosis, Treatment & Prevention

Breast cancer

Breast cancer is one of the most common types of malignancies found in the world accounting for one out of three cancer cases worldwide among females. In breast cancer, there is the development of rapidly dividing cancerous cells in the epithelium of the ducts and glandular tissues which form the breast giving rise to cancerous growth. Although it is mostly seen in females over the age of 50, it can also be seen in younger females and in males.

Signs and symptoms

Breast cancer may be associated with several symptoms and can even sometimes remain asymptomatic till a very late stage. The most common noticeable sign is the presence of a lump in the breast. 

Some other symptoms are:

  • Discharge from nipples 
  • Inversion of nipples 
  • Rash and redness around areola and nipples
  • Change in shape and size of the breasts
  • Swelling in the armpits 
  • Dimpling of skin over the breast
  • Crusting, peeling or flaking of the skin of the areola 
  • Pain in the breast 

Types of Breast Cancer

There can be different types of breast cancer depending on the type of breast tissue involved:

  • Ducts: These are tube-like structures that carry milk from glands to nipples.
  • Lobules: They have the milk-producing cells in them.
  • Fat cells and connective tissues: It gives support to the ducts and lobules.
  • Blood vessels: Responsible for blood supply in the breast.

So the different types of cancers are:

  • Invasive ductal carcinoma: The epithelial cells of the mammary ducts become cancerous. These cells can be localised or can spread to the surrounding breast tissue and even different organs in the body.
  • Invasive lobular carcinoma: Here, the epithelial cells of the mammary lobules responsible for the production of milk develop cancer.
  • Medullary carcinoma: Also develops in the epithelial cells of the milk duct of the breast
  • Angiosarcoma: In this, there is development of cancer in the blood vessels of breast tissue.

Stages of Breast Cancer

There are five total stages of breast cancer on the basis of the extent of the spread of the cancerous cells.

  • Stage 0: Here, the cancer cells are localised to their place of origin. They don’t infiltrate the basement membrane and the surrounding tissue of the breast. No lymph nodes are affected.
  • Stage 1: The tumour is less than 2 cm and lymph nodes are not involved.
  • Stage 2: The tumour can be larger in size with or without a few regional lymph nodes in the armpits being involved. 
  • Stage 3: The size of the tumour is larger with a large number of involved lymph nodes.
  • Stage 4: The tumour is of any size along with distant spread in the body (metastasis).

Risk factors of Breast Cancer

  • Gender: Females are more prone to breast cancer with the female: male ratio being 150:1.
  • Age: Like most cancers, the risk of breast cancer development increases after 50 years of age.
  • Genes: Mutations in genes like BRCA1, BRCA2, p53, etc. increase the risk, and these mutations have a tendency to run in families.
  • Medications: Oral contraceptives, exogenous oestrogen and progesterone administration increase the risk of cancer development.
  • Family history: A positive family history of breast or ovarian cancer.
  • Pregnancy: Early pregnancy is seen to lower the risk of developing whereas no pregnancy is linked to increased chances.
  • Radiation: Radiation exposure also has a role in the development of malignancy.
  • Obesity: Obesity increases the risk of development of breast and ovarian cancer.
  • Previous history: Breast cancer can relapse later in life even after treatment.

Diagnosis

Visiting a doctor is advised as soon as you feel any abnormal lump or changes in the shape or size of the breast. This is even of more importance when there is a family history of breast cancer. For these people, breast cancer screening is done regularly to ensure early diagnosis.

The diagnosis of breast cancer is done via scans like mammograms and ultrasound and later confirmed with a biopsy of the lump or abnormal tissue.

The common methods used in the diagnosis are:

  • Physical examination: The doctor will try to feel the tumour in the breast to try and identify features of malignancy as benign lumps are common in the breast. Changes in the overlying skin and the normal breast tissue are also identified.
  • Mammogram: This helps in identifying with some certainty the nature of the lump based on the calcium deposition in a malignant tumour. This is the most common method used in the screening of breast cancer.
  • Ultrasound can also be used to view the tumour and localise it. 
  • MRI for better imaging of the tumour and soft tissue of the breast. 
  • PET- CT scan: This helps in evaluating the amount of cancer spread in the body.
  • FNAC: This is a technique where cancerous cells are taken out with the help of a needle and microscopically examined. 
  • Biopsy: This is the gold standard technique for confirmation of malignancy where a small part of the affected breast tissue is obtained and microscopically examined for malignant changes.

Treatment

Depending upon the tumour size, and the amount of breast tissue affected and spread in the body the treatment protocol can be decided. 

The treatment options commonly used are:

  • Surgery: This can be of two types. Firstly, mastectomy, in which the complete breast is removed with or without the lymph nodes. This is usually done in advanced cases of breast cancer. Secondly, breast-conserving surgery, in which only the part of the breast tissue affected is removed.
  • Radiation: Rays with high energy are used to kill cancer cells.
  • Chemotherapy: Medications against the rapidly dividing cells are out in the body that specifically targets only the cancer cells and spares the non-cancerous ones.
  • Hormone therapy: Breast tumour needs hormones like oestrogen and progesterone to grow. These medicines block the activity of these hormones.
  • Targeted therapy: Target drugs against cancer cells and their receptors are administered
  • Immunotherapy: Induces antibodies that target the cancer cells

Prevention

There is no definitive way to completely eliminate the risk of cancer development but doing the following can help in reducing the risk:

General preventative methods:

  • Maintenance of a healthy BMI and regular exercise 
  • Minimal consumption of alcohol
  • Limiting hormone therapies after menopause 
  • Regular screening 
  • Learning self-breast examination

Specific preventive methods:

  • Prophylactic removal of breasts and ovaries: In case of BRCA gene positive

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