Breast Cancer – Here’s what you need to know

Breast cancer is cancer that forms in the cells of the breasts.

Breast cancer occurs when some breast cells begin to grow abnormally. These cells divide more rapidly than healthy cells do and continue to accumulate, forming a lump or mass. Cells may spread (metastasize) through your breast to your lymph nodes or to other parts of your body.

Breast cancer most often begins with cells in the milk-producing ducts (invasive ductal carcinoma). Breast cancer may also begin in the glandular tissue called lobules (invasive lobular carcinoma) or in other cells or tissue within the breast.

Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer. But it’s not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do. It’s likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

Inherited breast cancer- About 5 to 10 percent of breast cancers are linked to gene mutations passed through generations of a family.A number of inherited mutated genes that can increase the likelihood of breast cancer have been identified. The most well-known are breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2), both of which significantly increase the risk of both breast and ovarian cancer.

If you have a strong family history of breast cancer or other cancers, a blood test is recommended to help identify specific mutations in BRCA or other genes that are being passed through your family.

Types

  1. Angiosarcoma
  2. Ductal carcinoma in situ (DCIS)
  3. Inflammatory breast cancer
  4. Invasive lobular carcinoma
  5. Lobular carcinoma in situ (LCIS)
  6. Male breast cancer
  7. Paget’s disease of the breast
  8. Recurrent breast cancer

Symptoms

Signs and symptoms of breast cancer may include:

  1. A breast lump or thickening that feels different from the surrounding tissue
  2. Change in the size, shape or appearance of a breast
  3. Changes to the skin over the breast, such as dimpling
  4. A newly inverted nipple
  5. Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
  6. Redness or pitting of the skin over your breast, like the skin of an orange

See a doctor;

If you find a lump or other change in your breast — even if a recent mammogram was normal — make an appointment with your doctor for prompt evaluation.

Risk factors

A breast cancer risk factor is anything that makes it more likely you’ll get breast cancer. But having one or even several breast cancer risk factors doesn’t necessarily mean you’ll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women.

Factors that are associated with an increased risk of breast cancer include:

  1. Being female. Women are much more likely than men are to develop breast cancer.
  2. Increasing age. Your risk of breast cancer increases as you age.
  3. A personal history of breast conditions. If you’ve had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer.
  4. A personal history of breast cancer. If you’ve had breast cancer in one breast, you have an increased risk of developing cancer in the other breast.
  5. A family history of breast cancer. If your mother, sister or daughter was diagnosed with breast cancer, particularly at a young age, your risk of breast cancer is increased. Still, the majority of people diagnosed with breast cancer have no family history of the disease.
  6. Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2. These genes can greatly increase your risk of breast cancer and other cancers, but they don’t make cancer inevitable.
  7. Radiation exposure. If you received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
  8. Obesity. Being obese increases your risk of breast cancer.
  9. Beginning your period at a younger age. Beginning your period before age 12 increases your risk of breast cancer.
  10. Beginning menopause at an older age. If you began menopause at an older age, you’re more likely to develop breast cancer.
  11. Having your first child at an older age. Women who give birth to their first child after age 30 may have an increased risk of breast cancer.
  12. Having never been pregnant. Women who have never been pregnant have a greater risk of breast cancer than do women who have had one or more pregnancies.
  13. Postmenopausal hormone therapy. Women who take hormone therapy medications that combine estrogen and progesterone to treat the signs and symptoms of menopause have an increased risk of breast cancer. The risk of breast cancer decreases when women stop taking these medications.
  14. Drinking alcohol. Drinking alcohol increases the risk of breast cancer.
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Prevention

Breast self-exam– Become familiar with your breasts through breast self-exam for breast awareness. Women may choose to become familiar with their breasts by occasionally inspecting their breasts during a breast self-exam for breast awareness. If there is a new change, lumps or other unusual signs in your breasts, report to the doctor promptly. Breast awareness can’t prevent breast cancer, but it may help you to better understand the normal changes that your breasts undergo and identify any unusual signs and symptoms.

Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day, if you choose to drink.

Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week. If you haven’t been active lately, ask your doctor whether it’s OK and start slowly.

Limit postmenopausal hormone therapy. Combination hormone therapy may increase the risk of breast cancer. Some women experience bothersome signs and symptoms during menopause and, for these women, the increased risk of breast cancer may be acceptable in order to relieve menopause signs and symptoms. To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.

Maintain a healthy weight. If your weight is healthy, work to maintain that weight. If you need to lose weight, ask your doctor about healthy strategies to accomplish this. Reduce the number of calories you eat each day and slowly increase the amount of exercise.

Choose a healthy diet. Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer. The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts. People who follow the Mediterranean diet choose healthy fats, such as olive oil, over butter and fish instead of red meat.

Breast cancer risk reduction for women with a high risk

If your doctor has assessed your family history and determined that you have other factors, such as a precancerous breast condition, that increase your risk of breast cancer, you may discuss options to reduce your risk, such as:

Preventive medications (chemoprevention). Estrogen-blocking medications, such as selective estrogen receptor modulators and aromatase inhibitors, reduce the risk of breast cancer in women with a high risk of the disease.

Preventive surgery. Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed (prophylactic mastectomy). They may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer.

BREAST SELF-EXAM

Breast self-exam, or regularly examining your breasts on your own, can be an important way to find a breast cancer early, when it’s more likely to be treated successfully. While no single test can detect all breast cancers early, Breastcancer.org believes that performing breast self-exam in combination with other screening methods can increase the odds of early detection.

Breastcancer.org still believes that breast self-examination is a useful and important screening tool, especially when used in combination with regular physical exams by a doctor, mammography, and in some cases ultrasound and/or MRI. Each of these screening tools works in a different way and has strengths and weaknesses. Breast self-exam is a convenient, no-cost tool that you can use on a regular basis and at any age. We recommend that all women routinely perform breast self-exams as part of their overall breast cancer screening strategy.

How to do a breast self-exam: The five steps

Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips.

Here’s what you should look for:

Breasts that are their usual size, shape, and color

Breasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor’s attention:

Dimpling, puckering, or bulging of the skin

A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)

Redness, soreness, rash, or swelling

Step 2: Now, raise your arms and look for the same changes.

Step 3: While you’re at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).

Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.

Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you’ve reached the deep tissue, you should be able to feel down to your ribcage.

Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.

How to make breast self-exam part of your breast cancer screening strategy

Make it routine. The more you examine your breasts, the more you will learn about them and the easier it will become for you to tell if something has changed. Try to get in the habit of doing a breast self-examination once a month to familiarize yourself with how your breasts normally look and feel. Examine yourself several days after your period ends, when your breasts are least likely to be swollen and tender. If you are no longer having periods, choose a day that’s easy to remember, such as the first or last day of the month.

Get to know your breasts’ different “neighborhoods.” The upper, outer area — near your armpit — tends to have the most prominent lumps and bumps. The lower half of your breast can feel like a sandy or pebbly beach. The area under the nipple can feel like a collection of large grains. Another part might feel like a lumpy bowl of oatmeal.

Start a journal where you record the findings of your breast self-exams. This can be like a small map of your breasts, with notes about where you feel lumps or irregularities. Especially in the beginning, this may help you remember, from month to month, what is “normal” for your breasts. It is not unusual for lumps to appear at certain times of the month, but then disappear, as your body changes with the menstrual cycle (if you are still menstruating).

What to do if you find a lump

Don’t panic if you think you feel a lump in your breast? Most women have some lumps or lumpy areas in their breasts all the time, and most breast lumps turn out to be benign (not cancer). There are a number of possible causes of non-cancerous breast lumps, including normal hormonal changes, a benign breast condition, or an injury.

Don’t hesitate to call your doctor if you’ve noticed a lump or other breast change that is new and worrisome. This is especially true for changes that last more than one full menstrual cycle or seem to get bigger or more prominent in some way. If you menstruate, you may want to wait until after your period to see if the lump or other breast change disappears on its own before calling your doctor. The best healthcare provider to call would be one who knows you and has done a breast exam on you before — for example, your gynecologist, primary care doctor, or a nurse practitioner who works with your gynecologist or primary care doctor.

Know what to expect. At an appointment to evaluate a breast lump, your doctor will take a health history and do a physical exam of the breast, and will most likely order breast imaging tests. Ultrasound is often the first or only imaging test used to evaluate a lump in women who are under age 30 or are pregnant or breastfeeding. Both an ultrasound and a mammogram are typically recommended to evaluate a lump in women who are over age 30 and not pregnant or breastfeeding. If further testing is needed, your doctor may recommend additional imaging with MRI (magnetic resonance imaging), MBI (molecular breast imaging), and/or a biopsy. He or she may also refer you to a breast specialist (typically, a breast surgeon) for further evaluation.

Make sure you get answers. It’s important that your doctor gives you an explanation of the cause of the lump or other breast change and, if necessary, a plan for monitoring it or treating it. If you’re not comfortable with the advice of the first doctor you see, don’t hesitate to get a second opinion.

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Caren Nenooh

Author Caren Nenooh

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