What is Breast Cancer?
Breast cancer is cancer in the breasts, and it can develop in both women and men. The breast is an organ that resides on top of the upper ribs, above the pectoral muscles. Breast cancer can affect one or both breasts at a time.
How it Begins
Like any cancer, breast cancer begins when a cell with damaged DNA begins to duplicate at a rapid rate due to the damage. These cells continue to divide unchecked, and eventually form a tumor. If left untreated, these cells will continue to grow into surrounding tissues, damaging them. These cells also can metastasize, or travel to other parts of the body and begin growing there.
There are several types of breast cancer; the type is dependent on which cells within the breast develop cancer. As you can see, the breast has many different tissue types within it. A breast consists of three main parts: connective tissue, which keeps everything together and contains fibrous and fatty tissues, lobules, which are the glands that produce milk, and ducts, which carry milk to the nipple. Most breast cancers originate in the lobules or the ducts.
Types of Breast Cancer
The two most common breast cancer types are named after the location they originate from.
- Ductal carcinoma is breast cancer that originated in the ducts, and if allowed to progress, grows outside of them into other parts of breast tissue.
- Lobular carcinoma is breast cancer that originated in the lobules. This can spread from the lobules to the closest breast tissue.
Both of these forms of breast cancer, as you may have noticed, are carcinomas. Carcinoma just means that cancer is a tumor that originated in epithelial cells (cells that line organs and tissues throughout the body).
When understanding breast cancer, it is also important to note the terminology that lets you know if the cancer has traveled elsewhere, or if it is remaining solely within the breasts. The term in situ refers to breast cancer that has not transferred from its originated point, while invasive is used to describe any type of breast cancer that has spread.
Some invasive, aggressive breast cancer types develop differently, which can greatly impact the treatment plan for a patient with the following:
- Triple-negative breast cancer is an aggressive type of breast cancer where the cancer cells do not contain estrogen or progesterone receptors. In addition, they do not make any, or they make way too much, of a protein called HER2. This type of cancer accounts for roughly 15% of all breast cancer, and it can be difficult to treat.
- Inflammatory breast cancer describes another aggressive breast cancer type. In this type of cancer, the cells block lymph vessels in the skin, which causes the breast to have an inflamed appearance. This is a rare type of breast cancer, accounting one to five percent of all breast cancers.
Signs and Symptoms
Every individual will have different symptoms of breast cancer, and some will not have any signs that they are afflicted at all. Symptoms include:
- Lump in breast or underarm
- Thickening or swelling of any part of the breast
- Irritation, dimpling of breast skin
- Redness or flaky skin around the nipple area
- Nipple pain, nipple pulling inward
- Unusual nipple discharge
- Any size or shape change in the breast
- Breast pain of any type
Risk Factors
In a short sense, any individual has a chance of developing breast cancer. Breast cancer has many risk factors that are, unfortunately, unable to be changed. On the bright side, however, there are many risk factors that are directly influenced by your behavior.
The unchangeable:
- Those of older age. Your risk for developing breast cancer increases as you age and is most seen in patients above the age of 50.
- Genetic mutations play a significant role. Women who have inherited BRCA1 and BRCA2 are at higher risk for both breast cancer, and ovarian cancer.
- Reproductive history is important. For women, starting menstrual periods before age 12 and beginning menopause after 55 cause the body to be exposed to hormones for a longer period, raising their risk.
- Breast density. The denser your breasts are, the more likely you are to develop breast cancer. Dense breasts consist of more connective tissue than fatty tissue, which also makes it harder to detect tumors on a mammogram.
- Personal medical history of breast cancer or a history of non-cancerous breast diseases.
- Family history of breast or ovarian cancer. If you have a direct blood relative that has been diagnosed, or multiple of them, then you are at an increased risk.
- Previous radiation therapy treatment. If you received radiation therapy to the chest or breasts before the age of 30 for whatever medical reason, you are at an increased risk.
- Exposure to diethylstilbestrol (DES). This was given to pregnant women between 1940 and 1971 in the United States to prevent miscarriage. Women who took DES, or those whose mothers did while pregnant with them, are at increased risk of developing breast cancer.
- For men, if you have Klinefelter syndrome, which is a rare genetic condition in which a male has an extra X chromosome. This can lead to the body making higher levels of estrogen and lower levels of androgens (hormones that help develop and maintain male sex characteristics).
- In addition for men, past injury that caused swelling in the testicles, or if you have had surgery that removed them, can increase your risk. Taking estrogen related drugs, which is common in prostate cancer treatment, can also increase your risk.
- The last factor specific to men is liver disease. Cirrhosis (scarring) of the liver can lower androgen levels and raise estrogen levels in men, increasing the risk of breast cancer.
Prevention: The Changeable Risk Factors
Physical inactivity is a prominent, yet controllable, risk factor for breast cancer. In general, those who are not physically active ate at increased risk for developing breast cancer, as well as many other types. Doctors recommend individuals should exercise 30 minutes a day. This could be a brisk walk outside, a powerlift at the gym, a short yoga session in your living room, or whatever else you desire that gets you up and moving. Exercising does not have to be an activity to dread. In fact, exercise releases hormones, such as endorphins, adrenaline, dopamine, and more, that are associated with the feeling of happiness.
Maintaining a healthy weight is important to mitigate adverse health effects and is crucial for reducing your risk of breast cancer. This is particularly true in the case for women following menopause. Being overweight or having obesity following menopause has an elevated risk than those at a healthy weight. Exercise can help with this, as can eating well. This applies for both underweight and overweight individuals – aim to achieve a healthy weight and a healthy body mass index, or BMI, to keep your body in the best state you can.
Drinking alcohol is another risk factor for developing breast cancer; studies show that there is a direct correlation between drinking alcohol and developing breast cancer. The more alcohol you drink, the higher your risk.
In addition, smoking is a risk factor that is entirely preventable. Smoking not only elevates your risk for developing lung cancer, but it also has a negative impact on your health overall and increases your risk for developing cancer in general.
These tips are all personal. Each of them you must choose to implement, and you must choose to commit to. This is not something you do for others; improving your personal health is a task you must do for yourself alone. If you find that you are lacking in one or more of these points, that does not mean you are doomed. Begin to implement them slowly and incorporate them into your life over time. If it is best for you, choose one to implement and stick to it. After mastering one, select another to add to your routine.
Reproductive history is less controllable, yet still within your own hands. Studies show that women who wait to have their first pregnancy after the age of thirty years old are at increased risk, and those that decide to never have children are at elevated risk as well. In addition, if you have children, breastfeeding them is one way to reduce your risk of developing breast cancer. Not breastfeeding your children raises your breast cancer risk.
Talking to your doctor is most necessary if you are at an increased risk of developing breast cancer and have those conversations with your loved ones about your family’s medical history to best understand your risks.
Screenings
You might be thinking, what is a screening, and how can it help?
The goal of a screening is to detect cancer early, so that it can be taken care of early. The later cancer is detected, the more likely it has developed into a stage that is more detrimental to your health. Screenings mitigate the likelihood of you developing a late-stage cancer, because screenings are typically conducted before the patient has any symptoms of the disease.
Individuals that are showing symptoms of breast cancer should schedule a screening immediately. Showing symptoms of breast cancer can be scary but scheduling a screening will allow the soonest possible diagnoses and the highest shot you have at survival, should the symptoms be caused by it.
There are numerous methods of monitoring your breast health.
Personal body awareness is crucial. Assess your breasts frequently to monitor their shape and size and be familiar with the way they look. A breast self-exam is personal, and can help you notice changes in your breast such as lumps, size changes, pain, coloration changes, etc. If something looks or feels abnormal, talk to your doctor about it.
A clinical breast exam is another option. This is completed by a doctor or nurse with your consent, for them to assess for any abnormalities like those previously mentioned.
A mammogram is the most common breast cancer screening, and it is just an x-ray of the breasts. Mammograms are an efficient method of detecting breast cancer early, as this is a preventative screening. It is recommended that women above the age of 50 complete a mammogram every two years, and you should begin discussing with your doctors in your 40s about when you will begin receiving them. Of course, if you are at an increased risk for developing breast cancer, or you notice breast abnormalities, it is common for mammograms to be completed at an earlier age.
Having a breast MRI, magnetic resonance imaging, is another method of screening for breast cancer. This test uses magnets and radio waves to create images of the breast. Breast MRIs are used in addition to mammograms for individuals at elevated risk of developing breast cancer.
Cost Management
Assistance Obtaining Health Insurance
The Affordable Care Act requires that health insurance policies cover mammograms with no cost sharing as a preventative service. If you need assistance signing up for health insurance under the Affordable Care Act, contact our sister organization Insure Georgia for personalized assistance here.
Free or low cost mammogram resources
Through the Georgia Department of Public Health’s Breast and Cervical Cancer Early Detection Program, uninsured Georgia residents under 200 percent of the federal poverty level are eligible for free mammogram screenings. These services are provided through your local health department and select medical providers across the state. For a complete list use the service locator available here.
In addition, many Federally Qualified Health Centers offer free or reduced cost cancer screenings. To find a center near you use the Find a Health Center search map available here.
Free Breast and Ovarian Cancer Genetic Screening
Georgia CORE and the Georgia Department of Public Health have teamed up to reduce disparities through a statewide initiative to screen more Georgians and increase access to testing, counseling and management for those who have an HBOC-related mutation. Access the screening tool here.
Breast Cancer Risk Assessment Tool
The Breast Cancer Risk Assessment Tool, available here, allows you to estimate a your risk of developing invasive breast cancer over the next 5 years and up to age 90 (lifetime risk).The tool uses a woman’s personal medical and reproductive history and the history of breast cancer among her first-degree relatives (mother, sisters, daughters) to estimate absolute breast cancer risk—her chance or probability of developing invasive breast cancer in a defined age interval.
All information for this article is retrieved from the Center for Disease Control website, as well as the website for the National Institute of Health.