Breast Cancer Breast cancer (BC) is a cancer arising in breast tissue. It is the second leading causes of death by cancer in women, following lung cancer. A woman has a life-time risk of developing invasive BC of about 1:8, or 13%. The breasts are made of fat glands, and fibrous tissue. 80% of BC occurs in the ducts. The most serious cancers are metastatic ones. Metastasis means that the cancer spreads from the place where it originates to other distant tissues. The most common place for BC to metastasize is the lymph nodes under the arm or above the collarbone on the same side of the cancer. Breast cancer causes - Gender (more common in females). - Age (the risk of BC increases with age). - A woman with a personal history of BC in one breast has a 3- to 4-fold greater risk of developing a new cancer in the other breast or in another part of the same breast. - Genetic causes – family history has long been known to be a risk factor for breast cancer. About 5-10% is believed to be hereditary, as a result of mutations, or changes in certain genes that are passed along by families, for example BRCA. - Hormonal causes – women who start their periods at an early age or experience a late menopause have a slightly higher risk of developing BC. Having no children may increase the risk of developing BC. Oral contraceptives have not been shown to definitively increase or decrease a woman’s life-time risk of BC. - Lifestyle and dietary causes – BC is more frequent in countries with a high dietary intake of fat, and obesity. - The use of alcohol is also an established risk factor for development of BC. Studies are also showing that regular exercise may actually reduce a woman’s risk of developing BC. - Environmental causes – radiation treatment increases the likelihood of developing BC but only after a long delay. Breast cancer symptoms Early BC has no symptoms. Most BC is discovered either by finding an abnormality on mammography or feeling a breast lump. Other possible symptoms are breast discharge, nipple inversion, or changes in the skin overlying the breast. When to seek medical care You should see your healthcare provider if you experience any of the following: -a breast lump - a lump in your armpit or above your collarbone that does not go away in about 2 weeks - developing a nipple discharge - noticing a new nipple inversion or skin changes over the breast Exams and tests Diagnosis of BC is usually comprised of several steps: - Examination of the breast including visual inspection and palpation - Mammography - Ultrasound (to evaluate a breast lump. Can demonstrate if the mass is filled with fluid or is solid) - Biopsy (a small piece of the tissue is taken for examination and testing by a pathologist to determine if cancer is present). Breast cancer treatment Surgery is the mainstay of treatment for BC. The type of surgery is based on a number of factors, including size and location of the tumour and the person’s overall health and personal wishes. Staging in BC is based on the size of the tumour, which parts of the breast are involved, how many lymph nodes are affected, and whether the cancer has metastasized to another part of the body. Breast cancer is staged from I to IV (I = non-invasive, IV = metastatic BC). Many women have treatment in addition to surgery, which may include radiation therapy, chemotherapy, or hormonal therapy. The decision about which additional treatments are needed is based upon the stage and type of cancer, the presence of hormonal receptors, and patient health and preferences. Follow-up Patients who have been diagnosed with BC need careful follow-up care for life. Initial follow-up care after completion of treatment is usually every 3 to 6 months for the first 2 to 3 years. This often includes careful breast examination, mammography, blood work, and possibly a chest X- ray or other studies. Other tests, such as bone scans or CT scans, are done as needed. Prevention The most important risk factors for the development of BC are age, sex, and genetics. Because women can do nothing about these risks, regular screening is recommended in order to allow early detection and thus prevent death from BC. Regular screening includes breast self examination, and mammography. Breast self examination is cheap and easy. Routine monthly examination may be helpful. The American Cancer Society recommends a breast examination by a trained healthcare provider once every 3 years starting at age 20, and then yearly after age 40. Mammograms are recommended every 1 to 2 years starting at age 40. For women at higher risk for the development of breast cancer, mammogram screening may start earlier, generally 10 years prior to the age at which the youngest close relative developed cancer.