Breast cancer is a malignant condition of the breast. Usually, adenocarcinoma accounts for about 25 % to 32 % of female cancers in India. It is the most common type of cancer with increased survival rates, especially when diagnosed at the earliest.

Breast cancer is the leading cause of death in women between the ages of 40 and 55, and the mortality rate is found to drop with the declining trend of prescriptive hormone replacement therapy. In India, more than 50 % of breast cancer patients are suffering from either stage 3 or stage 4, and these patients have very slim chances of survival. The total number of cases is high within the age group of 30 to 50, but the overall risk of developing breast cancer is reduced by breastfeeding. It has been proven that the likelihood of developing breast cancer is reduced by approximately 4.3 % for every 12 months of breastfeeding, as this leads to fewer menstrual cycles and lesser exposure to estrogen.

This type of cancer is initially marked with a prominent lump or abnormality in either of the breasts, which becomes evident following nipple discharge, nipple retraction, skin dimpling, and asymmetric swelling.

It is often detected through self-examination, but the diagnosis is made by clinical examination and tests. Mammograms, ultrasound, Magnetic resonance imaging (MRI), hormone receptor test, HER2/ neu test, and breast biopsies are the frequently used tests to confirm the patient’s condition. It was earlier thought that breast cancer affects only females, but recent years have contradicted this myth by showing that men are equally likely to suffer from it.

Are there any Breast Cancer Stages?

Breast cancer is categorized into different stages based on the primary tumor’s size and location and its spread to the nearby lymph nodes or other parts of the body. This is frequently assessed by using the TNM (Tumor lymph Node Metastasis) and biomarker test. The different stages are :

• Stage 0 – It is also known as “ carcinoma in situ “ and is localized to the original place. The cancer cells are abnormal and non-invasive and can be treated when detected early.
• Stage 1 – The cancerous cells are contained within the region, where it began to develop first. The 5 – year relative survival rate of this stage of breast cancer is 100 %. It can be effectively treated and is classified as :
  1. Stage 1A – The tumor is less than 2 cm in size and has not spread to the lymph nodes
  2. Stage 1B – The tumor has spread to the lymph nodes.
• Stage 2 – In this stage, breast cancer is invasive and has extended to less than 4 axillary lymph nodes. It is further divided into stage IIA and stages IIB depending on the size of the tumor.
• Stage 3 – On progressing to the 3rd stage, cancer spreads to the nearby lymph nodes and muscles but not to the distant organs like the liver, lungs, and bones. It is further subdivided into :
  1. Stage 3A – Cancer clusters spread to at least 4 to 9 lymph nodes near the breastbone or underarm.
  2. Stage 3B – cancer has spread to the chest wall and has invaded up to 9 nearby lymph nodes.
  3. Stage 3C – Cancer has spread to more than 10 lymph nodes with signs of swelling, inflammation, and ulcers in the breast.
• Stage 4 – This stage is not curable but usually treatable. The tumor cells have spread to the body’s distant organs, such as the brain, bones, lungs, and liver.

Types:

The most common types of breast cancer are :

• Metastatic breast cancer is stage 4 breast cancer that has spread to other parts of the body, including the liver, lungs, bones, or brain. The tumor cells invade the neighboring healthy cells, migrate via the circulatory system, and get lodged in capillaries where new small tumors called micrometastases are formed.
• Ductal carcinoma in situ (DCIS) – It is early-stage cancer that is non-invasive. The abnormal tumor cells are restricted to the breast milk duct’s lining and do not spread to the surrounding breast tissue.
• Invasive ductal carcinoma – This type of cancer is the advanced DCIS stage as the tumor cells have spread beyond the ducts to other breast tissue parts. This type of cancer most often affects men and accounts for around 70 to 80 % of all breast cancer diagnoses.
• Triple-negative breast cancer – This type of cancer is more likely to affect African Americans, Hispanics, and those with a gene mutation in the BRCA1 gene. It is characterized by the absence of the three receptors known to fuel breast cancer growth – estrogen, progesterone, and hormone epidermal growth factor receptor 2 (HER-2).
• Inflammatory breast cancer – In this type, no distinct lumps or tumors can be felt on the breast except when the lymph vessels get blocked by the cancer cells. It is a stage 3 breast cancer that infiltrates the skin and lymph vessels of the breast.
• Male breast cancer – It is a rare form of cancer that most often affects older men. It is characterized by a painless lump in the breast tissue and discharges from the nipple. Mutations of the BRCA2 gene increases the risk of this type of cancer.
• Tubular carcinoma – It is diagnosed through a mammogram and is typically found in women aged above 50. The tumor cells feel like a spongy area of breast tissue rather than a lump in the breast.
• Paget disease of the breast or nipple – It is a rare form of cancer that begins in the nipple and then extends to the skin around the nipple (areola). It typically affects one breast only and is often mistaken for dermatitis and other noncancerous skin condition.
• Recurrent breast cancer occurs months or years after the initial cancer treatment, especially when the undetected cancer cells multiply. It can either be localized to the same region where the cancer was initially identified or affect the nearby region’s lymph nodes.

What Causes Breast Cancer?

The exact etiology of breast cancer remains unknown, but several risk factors are associated with this cancer. While risk factors such as family history, genetics, and age remain unavoidable causes, those that can be avoided, such as alcohol consumption and lifestyle habits, can be modified to reduce the likelihood of developing this cancer.

Are there any Symptoms of Breast Cancer?

• There is a dominant lump in the breast.
• Discharge from the nipples, which can be either bloody, brown, or serous discharge.
• There is a dominant breast mass.
• Inverted nipples/nipple retraction
• Skin dimpling
• Asymmetric swelling of the breast
• Lymph nodes changes
• Skin changes. Skin appears like an orange peel.
• Redness and pain around the nipples.
• Swelling around the armpit or the clavicle.

These exams are done at least once a month and help identify lumps and abnormalities in the breast at the earliest. To perform this, the breast is checked for any lumps and discharge while showering, in front of the mirror, and while lying down. The entire breast area and the armpits are thoroughly examined using the 3 middle fingers’ pads and visual examination.

How is Breast Cancer diagnosed?

The diagnostic tests performed for identifying breast cancer are :

• Mammograms – This is an x-ray of the breast. It is further divided into diagnostic mammograms and screening mammograms.
  • Screening mammogram – It is done routinely to detect breast cancer in women with no apparent symptoms
  • A diagnostic mammogram provides a more detailed x-ray of the breast and is done following suspicious results in the screening mammogram. It is much more time consuming than the screening mammogram as this gives a more accurate diagnosis compared to the former.
• Ultrasound – It is done when the breast self-exam and screening mammogram reveals a suspicious site in the breast. Penetrating sound waves that cannot be heard and cannot damage human tissues are used to picture the breast tissues. In this test, a cyst filled with a fluid appears differently than the lump felt by the self-exam.
• MRI (Magnetic Resonance Imaging) – If the initial diagnostic test does not provide satisfactory results, the doctors advise an MRI. This helps assess the extent of the disease. A special contrast dye is injected into the patient’s vein before the exam, and this helps to distinguish the normal breast cells from the diseased ones when the magnetic fields are used to get a detailed picture of the breast. It is frequently done together with mammography for women at a high risk of developing breast cancer.
• Breast biopsy – This test involves examining the tissue or fluid removed from the breast’s suspicious site by a pathologist. It is the only procedure that can definitively diagnose whether the cells are cancerous or not. It is of three types :
  • Fine-needle aspiration – It is used when the doctor detects a fluid-filled cyst that is easily accessible. A thin needle is used to collect the fluid from such cysts for microbiological evaluation by a pathologist.
  • Core needle biopsy – The patient is anesthetized for numbing their breast, and a larger needle is used to collect a small amount of suspicious tissue. The doctor often uses a marker to mark the biopsy location before the procedure, which helps locate the abnormal area if surgery is required later.
  • Surgical biopsy – The patient is made drowsy by the administration of medications intravenously. A larger amount of the suspicious breast tissue (one to two-inch) is removed along with a small amount of normal-looking tissue. It is not often recommended for diagnosing cancer.

Read more:

• What is the Wire localization biopsy of the breast?
• What is an Excisional biopsy of the breast?

Lab tests – 

Hormone receptor tests and HER2/neu tests are also done by pathologists to help with the initial prognosis.

• Hormone receptor tests – It is done for patients with invasive breast cancer. In hormone receptor tests, the breast tissue sample obtained from a biopsy is stained to see if the estrogen (ER) and progesterone (PR) receptors are present. If the results are positive for the receptors, then the patient is put on hormone therapy as they have a higher chance of complete recovery than the patients with ER and PR negative results.
• HER2/neu test – It looks for the presence of HER2 proteins made by the human epidermal growth factor receptor 2 genes. This test is also done on the breast biopsy samples and helps identify excess HER2 protein in the cancerous cells. There are four results for this test, namely :
  • 0 or 1+: HER2 protein is not in excess
  • 2+: Her2 proteins is in borderline (between normal and excess value)
  • 3+: Positive for HER2 protein overexpression
• Blood testing for HER2/neu – The blood sample is used to perform the test when there is a lack of tumor tissue. It is a part of the initial cancer diagnosis and is done to check the treatment’s effectiveness. If the initial level of serum HER2/neu is more than 15 ng/mL, and this falls after treatment, then the prescribed treatment method is considered to be effective.

What can put me at risk of developing breast cancer?

• Family history – The risk of breast cancer increases when the mother, sister, or first degree relative of the patient was diagnosed with breast cancer.
• Older adults are at higher risk – The risk of cancer increases with the individual’s age as most of the cases are diagnosed when the females reach 50 years of age.
• Women are more susceptible than men – This is because women’s breast cells are constantly exposed to the growth-promoting effects of the female hormones – estrogen and progesterone.
• Menarche before 12 years – This increases the risk due to the rapid onset of regular ovulatory menstrual cycles that, in turn, increases the lifetime exposure to the female hormones.
• Having the first child after 30 years – It serves as a risk factor as pregnancy at an older age causes the female to get exposed to a larger estrogen level in her lifetime.
• Never giving birth – Females who have not given birth to any child are at higher risk, but this is less than women who have given birth to only one child after 35 years.
• Ethnicity – White women are at higher risk than black women, but the latter’s mortality rate is higher than the former while suffering from breast cancer. Hispanic and Asian women are at a lower risk of developing breast cancer.
• Genetic mutations – Mutations of certain genes like BRCA1 and BRCA2 increase the chances of breast cancer.
• Other factors – Hormone replacement therapy and oral contraceptive pills containing estrogen and progesterone increases the risk of breast cancer, especially if they are taken for more than 5 years.
• Physical activity – Obese women and physically inactive people are at higher risk of developing breast cancer.
• Excessive alcohol consumption increases the chances of breast cancer by at least 15 % as alcohol increases estrogen levels and other hormones associated with hormone-receptor-positive breast cancer.
• Radiation therapy – Exposure of the breast and chest to radiation, such as for the treatment of Hodgkin’s lymphoma before the age of 30, increases the likelihood of developing breast cancer at the later stages in life.
• Higher breast density is another risk factor as these women have more connective tissue than adipose or fatty tissue, making it difficult to diagnose the tumors using a mammogram.
• Women who have not reached menopause until 54 years.

How is breast cancer treated? 

There are five treatment plans for breast cancer, and this includes a combination of either of the following :

• Surgery – This involves lumpectomy, mastectomy, breast reconstruction, and lymph node removal.
• Chemotherapy – Anthracyclines, taxanes, carboplatin, and 5-Fluorouracil are commonly used chemotherapy drugs for shrinking the tumor’s size before surgery.
• Radiation therapy – It is an adjuvant therapy that begins three to four weeks after the surgery. External and internal breast cancer radiations are utilized to kill cancer cells.
• Hormone therapy – Hormone blockers like Tamoxifen and hormone inhibitors are used to prevent breast cancer cells from receiving and using the body’s natural female hormones.
• Targeted therapy – Monoclonal antibodies like trastuzumab and lapatinib are used to block breast cancer cells’ growth by acting on abnormal proteins and receptors.

Complications if left untreated:

• Insomnia
• Fear and anxiety
• Loss of libido
• Depression
• Lungs inflammation
• Metastasis of cancer to other body parts
• Constipation
• Infertility
• Damage of the heart tissues

What can I do to prevent the chances of Breast Cancer?

Lifestyle tips for prevention:

• Avoid smoking tobacco and avoid alcohol consumption.
• Eat healthy food, avoid fatty foods.
• Wear well fitted inner garments
• Reduce stress (Read: Cancer Patients and Emotional Health)
• Exercise regularly
• Reduce intake of red meat and caffeine
• Take a sufficient amount of calcium and vitamin D as these minerals and vitamins help prevent breast cancer.
• Breastfeeding is known to decrease the risk.
• Avoid working late at night as studies have shown late-night work shifts increase the risk of developing breast cancer.
• Self-check yourself regularly

Frequently Asked Questions:

1. Is it curable?

Stage 0, 1, and 2 breast cancer are curable when detected at the earliest, but for stages 3 and 4, the chances of relapse are high even when after treatment as they are not completely curable.

2. What are the survival chances?

The 5-year relative survival for women with non-metastatic invasive breast cancer is 91 %, while that for invasive cancer that is localized to the breast alone is 99 %. The average 10-year survival rate for invasive breast cancer is 84 %.

3. What is the cost of treatment?

The diagnostic tests, surgery, and radiotherapy roughly cost around 5 to 6 lakh in India. The cost of at least six cycles of chemotherapy needed to keep the breast cancer in check is estimated to be around 20 lakhs.

4. Which hospitals to get treatment?

Check here:

• Top 38 Accredited Cancer Hospitals from India
•  Best Oncologists/Oncosurgeons in India

5. Do gender and age increase the risk of developing breast cancer?

Being a female above 50 years of age is considered a risk factor for breast cancer due to the increased exposure to female hormones such as estrogen.