Breast Cancer

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Breast Cancer

Breast cancer is a type of cancer that starts in the breast. It can start in one or both breasts. Cancer starts when cells begin to grow out of control. Any breast lump or change needs to be checked by a health care professional to determine if it is benign or malignant (cancer)

It’s important to understand that most breast lumps are benign and not cancer (malignant). Non-cancer breast tumors are abnormal growths, but they do not spread outside the breast. They are not life-threatening,

You can perform self checks for Breast Cancer at home, but should also have a regular exam.

Aledyandra Crespo Nieves, MD

What Is Breast Cancer?

Breast cancer is a type of cancer that starts in the breast. It can start in one or both breasts. Cancer starts when cells begin to grow out of control.

Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

It’s important to understand that most breast lumps are benign and not cancer (malignant). Non-cancer breast tumors are abnormal growths, but they do not spread outside the breast. They are not life-threatening, but some types of benign breast lumps can increase a woman’s risk of getting breast cancer. Any breast lump or change needs to be checked by a health care professional to determine if it is benign or malignant (cancer) and if it might affect your future cancer risk.

How breast cancer spreads:

Breast cancer can spread when the cancer cells get into the blood or lymph system and then are carried to other parts of the body.

The lymph (or lymphatic) system is a part of your body’s immune system. It is a network of lymph nodes (small, bean-sized glands), ducts or vessels, and organs that collect and carry clear lymph fluid through the body tissues to the blood. The clear lymph fluid inside the lymph vessels contains tissue by-products, waste material, and immune system cells.

The lymph vessels carry lymph fluid away from the breast. In the case of breast cancer, cancer cells can enter those lymph vessels and start to grow in lymph nodes. Most of the lymph vessels of the breast drain into:

  • Lymph nodes under the arm (axillary lymph nodes)
  • Lymph nodes inside the chest near the breastbone (internal mammary lymph nodes)
  • Lymph nodes around the collar bone (supraclavicular [above the collar bone] and infraclavicular [below the collar bone] lymph nodes)

If cancer cells have spread to your lymph nodes, there is a higher chance that the cells could have traveled through the lymph system and spread (metastasized) to other parts of your body. Still, not all women with cancer cells in their lymph nodes develop metastases, and some women with no cancer cells in their lymph nodes might develop metastases later.

Types of breast cancer:

There are many different types of breast cancer. The specific kind of cells determines the type in the breast that is affected. Most breast cancers are carcinomas. Adenocarcinomas are the most common breast cancers, such as ductal carcinoma in situ (DCIS) and invasive carcinoma. The cancers start in the gland cells in the milk ducts or the lobules (milk-producing glands). Other kinds of cancers can grow in the breast, like angiosarcoma or sarcoma, but are not considered breast cancer since they start in different breast cells.

Breast cancers are also classified by specific proteins or genes each cancer might make. After a biopsy, breast cancer cells are tested for proteins called estrogen receptors and progesterone receptors and the HER2 gene or protein. The tumor cells are also closely examined in the lab to determine their grade. The specific proteins found and the tumor grade can help decide cancer and treatment options.

Breast Cancer Signs and Symptoms:

Knowing how your breasts usually look and feel is an integral part of your breast health. Although having regular screening tests for breast cancer is essential, mammograms do not find every breast cancer. This means it’s also necessary for you to know what your breasts usually look and feel like, so you’ll be aware of any changes in your breasts.

The most common symptom of breast cancer is a new lump or mass (although most breast lumps are not cancer). A painless, hard mass with irregular edges is more likely to be cancer, but breast cancers can also be soft, round, tender, or even painful.

  • Other possible symptoms of breast cancer include:
  • Swelling of all or part of a breast (even if no lump is felt)
  • Skin dimpling (sometimes looking like an orange peel)
  • Breast or nipple pain
  • Nipple retraction (turning inward)
  • Nipple or breast skin that is red, dry, flaking, or thickened
  • Nipple discharge (other than breast milk)
  • Swollen lymph nodes under the arm or near the collar bone (Sometimes, this can be a sign of breast cancer spreading even before the breast’s original tumor is large enough to be felt.)

Many of these symptoms can also be caused by benign (non-cancerous) breast conditions. Still, it’s essential to have any new breast mass, lump, or other change checked by an experienced health care professional so the cause can be found and treated if needed.

Remember that knowing what to look for does not take regular screening for breast cancer. Screening mammography can often help find breast cancer early before symptoms appear. Finding breast cancer early gives you a better chance of successful treatment.

Can Breast Cancer Be Found Early?

Breast cancer is sometimes found after symptoms appear, but many women with breast cancer have no symptoms. This is why regular breast cancer screening is so important.

Imaging Tests to Find Breast Cancer:

Different tests can be used to look for and diagnose breast cancer. If your doctor finds an area of concern on a screening test (a mammogram), or if you have symptoms that could mean breast cancer, you will need more tests to know for sure if it’s cancer. These include:

  • Mammograms
  • Breast Ultrasound
  • Breast MRI
  • Newer and Experimental Breast Imaging Tests

Common treatment approaches:

Typically, treatment is based on the type of breast cancer and its stage. Other factors, including your overall health, menopause status, and personal preferences, are also considered.

Local treatments:

Some treatments, like surgery and radiation, are local, meaning they treat the tumor without affecting the rest of the body.

Most women with breast cancer will have surgery to remove the tumor. Depending on the type of breast cancer and how advanced it is, you might need other types of treatment as well, either before or after surgery, or sometimes both.

Systemic treatments:

Drugs used to treat breast cancer are considered systemic therapies because they can reach cancer cells almost anywhere in the body. Some can be given by mouth, injected into a muscle, or put directly into the bloodstream. Depending on the type of breast cancer, different types of drug treatment might be used, including:

  • Chemotherapy for Breast Cancer
  • Hormone Therapy for Breast Cancer
  • Targeted Drug Therapy for Breast Cancer
  • Immunotherapy for Breast Cancer

It’s important to discuss all of your treatment options, including their goals and possible side effects, with your doctors to help make the decision that best fits your needs. It’s also essential to ask questions if there’s anything you’re not sure about.

It is often a good idea to seek a second opinion if time permits. A second opinion can give you more information and help you feel more confident about the treatment plan you choose.

What are BRCA1 and BRCA2 Genes?

BRCA1 and BRCA2 are tumor suppressor genes, which means that they keep cells from growing too rapidly. Everyone has these genes. Changes or mutations in these genes mean they do not work properly and cells can grow out of control, which can lead to cancer.

How much do BRCA mutations increase the risk of cancer?

The risk of breast cancer for the average American woman is about 12% in her lifetime. Having a BRCA mutation greatly increases the risk. The estimated risk of breast cancer in women with a BRCA mutation is 45–85% by age 70 years.

The risk of ovarian cancer for the average American woman is about 2% in her lifetime. The estimated risk of ovarian cancer in women with a BRCA1 mutation is 39–46% by age 70 years. For women with a BRCA2 mutation, the risk of ovarian cancer by age 70 years is 10–27%.

Women who have a BRCA mutation also have an increased risk of cancer of the fallopian tube, peritoneum, pancreas, and skin (melanoma). Men who have a BRCA mutation have an increased risk of cancer of the breast, prostate, and pancreas.

Why don’t doctors test everyone for BRCA mutations?

BRCA testing is only recommended for people with a high risk of having BRCA mutations. It is important to remember that most cases of breast and ovarian cancer are not caused by gene mutations. If there is a low chance of finding a BRCA mutation, your ob-gyn or other health care professional may not recommend genetic testing.

What is multigene panel testing?

Multigene panel testing is a type of genetic testing that looks for mutations in several genes at once. This is different from single-gene testing, which looks for a mutation in a specific gene. Single-gene testing is often used when a known gene mutation is already in a family. You may consider genetic testing if your personal or family history shows an increased cancer risk.

How can I prevent cancer if I test positive for a gene mutation?

If you test positive for a gene mutation, you can discuss cancer screening and prevention options with your ob-gyn, genetic counselor, or other healthcare professionals. It may be helpful to have earlier or more frequent cancer screening tests to find cancer at an early and more curable stage. Risk reduction steps like medication, surgery, and lifestyle changes also may be recommended.

If I have a gene mutation, should I tell my family?

Having a gene mutation means you can pass the mutation to your children. Your siblings also may have the gene mutation. Although you do not have to tell your family members, sharing the information could be life-saving. With this information, your family members can decide whether to be tested and get cancer screenings early.

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