Breast Cancer: Risk Factors, Symptoms, Diagnosis, and Treatment

The most common type of breast cancer is “ductal carcinoma”, which begins in the lining of milk ducts (thin tubes carrying milk from the breast's lobules to the nipple). Another type of breast cancer is “lobular carcinoma”, which begins in the lobules.

Breast cancer incidence in India has risen significantly, with the Globocan 2020 data indicating 178,361 new cases, making up 13.5% of all cancers in the country. From 1990 to 2016, the age-standardised incidence rate in women increased by 39.1%. To put it in simple terms, for every two women diagnosed with breast cancer, one is dying. There has been a significant shift in the paradigm because, 25 years ago, several patients were above 50; presently, 48% of patients are below 50. However, many patients are between 25 and 40 years old, an alarming trend.

What are the Risk Factors for Breast Cancer? 

Risk factors are significant determinants that can heighten an individual's vulnerability to cancer development. While risk factors frequently contribute to cancer, they don't always directly cause it. Some individuals possess multiple risk factors but never develop cancer, while others with no identifiable risk factors do, although this is rare. Taking proactive steps to understand and discuss these risk factors with a healthcare provider is crucial to managing one's health. 

Breast Cancer Risk Factors You Cannot Control

Breast cancer, a multifaceted disease, is influenced by various factors, some of which are beyond an individual's control. These include: 

Gender: One of the primary risk factors for breast cancer is gender. Women face a higher risk than men, although breast cancer can affect both.

Age: As individuals age, their risk of developing breast cancer increases. The majority of breast cancer cases occur in women over the age of 50.

Genetic Mutations

Certain genetic mutations, such as BRCA1 and BRCA2, can significantly elevate the risk of breast cancer. 

Family History

Individuals with close relatives, such as mothers, sisters, or daughters, who have experienced breast cancer may face a higher risk.

Individual History

If an individual has previously had breast cancer in one breast, their risk of developing it in the other breast or a new area within the same breast increases.

Race and Ethnicity

The risk of breast cancer can vary depending on racial and ethnic backgrounds. Certain groups may have a higher risk than others, although the underlying reasons for these differences are still under investigation.

Menstrual Period

Women who had an early onset of menstruation (before age 12) or experienced late menopause (after age 55) may have a slightly elevated risk of breast cancer due to prolonged exposure to oestrogen and progesterone.

Breast Cancer Risk Factors You Can Control

While some of these factors are beyond a person's control, there are certain lifestyle choices and measures that one can take to manage them. 

Weight

Obesity is associated with an increased risk of breast cancer, especially among postmenopausal women. Exercise regularly and adopt a balanced diet to mitigate this risk and maintain a healthy weight.

Alcohol Consumption

Even moderate alcohol consumption has been linked to an elevated risk of breast cancer.  Consider reducing your alcohol intake or abstaining to lower the risk of developing breast cancer.

Dietary Choices

A diet rich in fruits, vegetables, whole grains, and lean proteins provides essential nutrients and antioxidants that can help reduce breast cancer risk. Additionally, you may also want to limit the consumption of processed foods, sugary drinks, and red meat.

Physical Activity

Regular physical activity, such as brisk walking, jogging, or engaging in sports, can help control body weight and reduce breast cancer risk. Strive for at least 150 minutes of moderate-intensity exercise or 75 minutes of vigorous-intensity exercise per week.

Breastfeeding

Breastfeeding can reduce breast cancer risk, especially when done for an extended period. This is because breastfeeding provides hormonal changes that may protect against cancer development.

Hormone Levels

Long-term combined hormone replacement therapy (oestrogen and progesterone) used during menopause can increase breast cancer risk. Discuss the risks and benefits of the therapy with a healthcare provider, and explore non-hormonal alternatives if someone is considering HRT.

Oral Contraceptives

Some birth control pills containing hormones may slightly increase the risk of breast cancer. When considering contraceptives, discuss options with a healthcare provider, considering individual health and family planning needs.

Having Children

Women with no children or who had their first child after age 30 have a slightly higher breast cancer risk. Having many pregnancies and becoming pregnant at a young age reduces breast cancer risk.

Smoking

While not directly associated with breast cancer, smoking increases the risk of several other cancers and health conditions. Quitting smoking improves overall health and reduces the risk of multiple cancers.

Symptoms of Breast Cancer 

Breast cancer is a serious concern for women worldwide, and early detection plays a pivotal role in successful breast cancer treatment. While many factors contribute to the risk of developing breast cancer, it's crucial to be vigilant and take prompt action in recognising potential signs and symptoms. If anyone is seeking breast cancer treatment options or the expertise of a breast cancer specialist in Delhi or anywhere near you, it's essential to understand the warning signs.

• Lump in a Breast: A lump or mass in the breast is one of the most common signs of breast cancer. Regular self-examinations can help detect such lumps, and consulting a breast cancer specialist is crucial for a proper diagnosis and treatment plan.
• Unexplained Pain: Persistent pain in the armpits or breasts that is not associated with the menstrual cycle should raise concern.
• Skin Changes: Watch for unusual skin changes on the breast, such as pitting or redness resembling the texture of an orange. These skin abnormalities may indicate an underlying issue and should prompt a visit to a breast cancer specialist.
• Changes in Nipples: Changes in nipples can include the development of a rash around it or on it. If you suspect breast cancer, consulting a specialist for an evaluation is essential.
• Armpit Swelling: Swelling or a lump in one of the armpits can indicate potential issues with the nearby breast tissue. It's advisable to seek care at a breast cancer hospital in Delhi or anywhere to address concerns.
• Thickened Tissue: An area of thickened tissue within the breast may be a sign of concern. Early diagnosis and treatment at a reputable breast cancer hospital are critical.
• Nipple Discharge: If one of the nipples has an unusual discharge, especially if it contains blood, it should be examined by a breast cancer specialist to determine the cause and plan for breast cancer treatment if necessary.
• Breast Size or Shape Changes: Any noticeable alterations in the size or shape of the breast should be evaluated by a breast cancer specialist to assess the risk and discuss treatment options.
• Skin Abnormalities: Changes in the texture of the nipple or breast skin, including peeling, scaling, or flaking, may be indicative of breast cancer. Seek guidance from a reputable breast cancer hospital in Delhi or any location near you for further assessment and potential treatment.

Know more about Signs and symptoms of breast cancer and the treatment

How is Breast Cancer Diagnosed?

Women are usually diagnosed with breast cancer after a routine breast cancer screening or witnessing certain signs and symptoms. Below are examples of diagnostic tests and procedures for breast cancer:

Clinical Breast Examination (CBE) 

A healthcare provider performs a physical examination of the breasts to check for any unusual lumps, changes in skin texture, or nipple abnormalities.

Mammography

Mammography is an effective screening tool for breast cancer. It involves taking X-ray images of the breast tissue. Mammograms can often detect breast tumours before they can be felt by touch, especially in early-stage breast cancer.

Ultrasound

Ultrasound uses sound waves to create images of breast tissue. It is often used as a follow-up to a mammogram or when further evaluation of a breast abnormality is needed.

MRI (Magnetic Resonance Imaging)

Breast MRI is used in specific situations, such as when breast cancer is suspected but not clearly visible on mammography or ultrasound. It is also valuable for assessing the extent of the disease in certain cases.

Biopsy 

A biopsy is the definitive method for confirming the presence of breast cancer. It involves the removal of a sample of breast tissue or cells from a suspicious area. There are several types of breast biopsies:

• Fine-needle aspiration biopsy
• Core needle biopsy
• Vacuum-assisted biopsy
• Surgical biopsy (excisional or incisional)

Visit a cancer specialist hospital in Delhi where all these diagnostic tests are available.

After a Biopsy 

• Pathological Analysis: A pathologist examines the collected tissue or cells from the biopsy under a microscope. This analysis helps determine if the cells are cancerous and, if so, the type and aggressiveness of the cancer.
• Receptor Testing: Tests may be conducted on the cancer cells to check for hormone receptors (oestrogen and progesterone) and HER2/neu receptors. This information is crucial in treatment planning, as certain therapies target these receptors.

How to determine stages after diagnosis?

Once a diagnosis is made, tests are done to stage a disease:

• Chest X-ray: Utilised for imaging the chest area to identify and evaluate conditions such as lung infections, tumours, and other respiratory issues.
• USG Whole Abdomen: Ultrasonography of the entire abdomen, a non-invasive imaging technique, is used to assess the organs for abnormalities or disorders.
• CECT Chest and Abdomen: Contrast-enhanced computed tomography scan of the chest and abdomen provides detailed cross-sectional images for diagnosing and monitoring conditions like cancer or infections.
• PET-CT: Positron emission tomography combined with computed tomography, a nuclear medicine imaging technique, is used to detect and evaluate metabolic activity in tissues, aiding in cancer diagnosis and staging.

Breast Cancer Stages

Breast cancer stages range from 0 to IV, with each stage representing the extent to which the cancer has grown or spread. Understanding these stages is crucial for determining the most appropriate treatment approach. Here's a brief overview of each stage:

Stage 0: This stage is also known as carcinoma in situ. There are two types: Ductal carcinoma in situ (DCIS), where the cancer cells are confined to the ducts, and Lobular carcinoma in situ (LCIS), which is more of an indicator of increased breast cancer risk than a true cancer.

Stage I: This is an early stage of invasive breast cancer.

• Stage IA: The tumour measures up to 2 centimetres (cm) and has not spread outside the breast.
• Stage IB: Small clusters of breast cancer cells, between 0.2 mm and 2 mm, are found in the lymph nodes, and there may or may not be a small tumour in the breast.

Stage II: This stage is divided into subcategories IIA and IIB.

• Stage IIA: The tumour has spread to 1-3 axillary lymph nodes if it's smaller than 2 cm, or if it's between 2-5 cm, it hasn't spread to any lymph nodes.
• Stage IIB: The tumour has either spread to 1-3 axillary lymph nodes and is between 2 and 5 cm or is larger than 5 cm without lymph node involvement.

Stage III: Also known as locally advanced breast cancer. This stage has several subcategories:

• Stage IIIA: Cancer has spread to 4-9 axillary lymph nodes or has enlarged the internal mammary lymph nodes. The tumour may be any size.
• Stage IIIB: The tumour has invaded the chest wall or skin and may or may not have spread to up to 9 lymph nodes.
• Stage IIIC: Cancer is found in 10 or more axillary lymph nodes, nodes near the collarbone, or internal mammary nodes.

Stage IV: Known as metastatic breast cancer. At this stage, the cancer has spread beyond the breast and nearby lymph nodes to other parts of the body, such as the lungs, liver, bones, or brain.

What are the Treatment Options for Breast Cancer?

A multi-disciplinary team will be involved in a breast cancer patient's treatment. The main breast cancer treatment options may include:

Surgery

• Breast Conservation Surgery (BCS) with or without plastic surgery Reconstruction includes Lumpectomy: This procedure involves the removal of the tumour and a small portion of surrounding healthy tissue. It is often performed for early-stage breast cancer.
• Mastectomy: In a mastectomy, the entire breast is removed, along with adjacent armpit nodes. This may be necessary for larger tumours or cases where breast-conserving surgery is not an option.
• Sentinel lymph node biopsy: During surgery, nearby lymph nodes are often examined to determine if the cancer has spread beyond the breast. If nodules are negative, then axillary lymph node dissection is avoided. Thus, avoiding complications like arm edema, etc.

Radiation Therapy

Radiation therapy uses high-energy rays to target and kill cancer cells. It is commonly used after BCS or mastectomy to reduce the risk of cancer recurrence.

Chemotherapy

Chemotherapy involves the use of drugs to kill cancer cells or stop their growth. It is often recommended for breast cancer that has spread to lymph nodes or other parts of the body (metastatic breast cancer).

Targeted Therapy

Targeted therapy drugs specifically target certain molecules or pathways involved in cancer growth. These drugs are often used for breast cancers that overexpress certain receptors, such as HER2-positive breast cancer.

Hormone Therapy

Hormone therapy is used for hormone receptor-positive breast cancers. It works by blocking the effects of hormones (oestrogen and progesterone) on cancer cells or by reducing the body's hormone production.

Immunotherapy

Immunotherapy drugs can help the immune system recognize and attack cancer cells. While they are not the primary treatment for breast cancer, they may be used in certain cases, such as triple-negative breast cancer or HER2-positive breast cancer.

Adjuvant and Neoadjuvant Therapy

Adjuvant therapy is given after surgery to reduce the risk of cancer recurrence. Neoadjuvant therapy is given before surgery to shrink tumours and make them easier to remove.

Supportive Care

Supportive care includes managing the side effects of cancer treatment, addressing pain, and providing emotional support through counselling and support groups.

Can Breast Cancer Be Prevented? 

There is no sure way to prevent breast cancer. But few things like maintaining an ideal body weight, doing physical activity and consuming an ideal diet can reduce breast cancer risk.

Tumour Board 

At the Max Institute of Cancer Care (MICC), we recognize the unique nature of each cancer and individual patient. Our approach involves a collaborative effort, where a team of specialists in surgical oncology, radiation oncology, medical oncology, pathology, imaging, and related fields convene during Tumour Board meetings. Together, they thoroughly review each case, fostering a customised and joint decision-making process to formulate an individualised treatment plan.