Reviewed By: Dr. Crystal Fancher

Breast cancer is the most commonly diagnosed cancer in women, excluding skin cancers. About 1 in 8 women will get breast cancer in their lifetime. This means that this disease will touch the lives of many patients and their families. The good news is that breast cancer deaths have continued to decrease over the years. While this decrease is due to many different factors, it is crucial to understand the importance of early detection in saving lives. In this comprehensive guide, we will walk you through breast cancer, from its basics to early warning signs, screening, diagnosis, treatment, and survivorship. Our goal is to provide a valuable resource for patients and their loved ones as they navigate this challenging journey.

Understanding Breast Cancer

Defining Breast Cancer

Breast cancer is a condition where abnormal cells in the breast begin to multiply and form a tumor. It can occur in both women and men, but it is most prevalent in women. These abnormal cells can invade nearby tissues and spread to other parts of the body through the bloodstream or lymphatic system.

Types of Breast Cancer

There are various types of breast cancer, with the two most common being ductal carcinoma and lobular carcinoma. Ductal carcinoma begins in the milk ducts, while lobular carcinoma starts in the lobules, the glands that produce milk. Other rarer forms also exist, each requiring tailored treatment approaches.

Potential Risk Factors

Breast cancer can affect anyone; however, certain factors may increase your risk. These factors include genetics, family history, hormonal influences, and lifestyle choices. Understanding these risk factors is essential for early detection and prevention.

Genetic Factors

Genetic Predisposition

Genetics can play a significant role in breast cancer risk. Some individuals may have inherited specific gene mutations that make them more susceptible to the disease. The most well-known genes associated with breast cancer are BRCA1 and BRCA2. These genes are responsible for repairing damaged DNA, and mutations in them increase the likelihood of developing breast cancer.

Genetic Testing

Genetic testing can help individuals determine if they carry mutations in the BRCA1 or BRCA2 genes or other related genes. It provides critical information that may influence screening and prevention strategies. If you have a family history of breast cancer, genetic testing can be a vital tool for early detection.

Lifestyle Factors

Diet and Exercise

Maintaining a healthy lifestyle through a balanced diet and regular exercise is not only beneficial for overall health but can also reduce the risk of breast cancer. A diet rich in fruits, vegetables, and whole grains, combined with regular physical activity, can be protective.

Alcohol and Hormone Replacement Therapy

Excessive alcohol consumption and hormone replacement therapy (HRT) can elevate the risk of breast cancer. Limiting alcohol intake and discussing the risks and benefits of HRT with your healthcare provider are important steps to consider.

Early Warning Signs

Recognizing the early warning signs of breast cancer is vital for early detection and successful treatment. These signs can manifest as visual and/or physical changes in the breast or underarm.

Visual and Physical Changes

Visual changes in the breast can include skin changes (like redness, orange peel appearance, or changes in texture), nipple changes (such as rash, scaling, or pulling in of the nipple), and alterations in breast size (either larger or smaller and including swelling). Other physical signs include lumps or thickening of tissue in the breast or underarm, nipple discharge, dimpling of the breast skin, or unexplained pain. Paying attention to any alterations, both visually or physically, is crucial. Any unusual changes should be promptly examined by a healthcare professional.

Screening and Diagnostic Tools

Breast cancer screening and diagnosis involve several methods and tools that healthcare providers use to detect and confirm the presence of cancer.

Mammography

Mammography is the cornerstone of breast cancer screening. It involves taking X-ray images of the breast and is recommended for women starting at age 40, but timing can depend on individual risk factors. Depending on the results of the mammogram, additional imaging, like ultrasound or MRI may be ordered to ensure an accurate diagnosis.

Ultrasound and MRI

Ultrasound uses high-frequency sound waves to create breast tissue images, making it valuable when mammography results are inconclusive or more detailed imaging is needed. Magnetic Resonance Imaging (MRI) offers detailed examination of blood flow in the breast and alterations can alert there is an abnormality. MRI is especially useful for assessing the extent of the cancer. Combining ultrasound and MRI with mammography provides a comprehensive breast health assessment, aiding healthcare providers and patients in making informed decisions.

Biopsy and Pathology

If a suspicious lump or abnormality is found, a biopsy is often required to confirm whether it is cancerous. Pathology plays a crucial role in diagnosing the specific type of breast cancer, which guides treatment decisions.

Stages of Breast Cancer

Breast cancer is staged from 0 to IV, with stage 0 indicating a non-invasive condition, while stage IV represents advanced cancer that has spread to other parts of the body.

Understanding the stage of your breast cancer can help determine appropriate treatment and provides insights into prognosis. Survival rates vary significantly at each stage, emphasizing the importance of early detection.

Treatment Options

Breast cancer treatment options are diverse and depend on the type and stage of cancer. Treatment can include a combination of the following approaches:

Surgery

Surgery is a key component in breast cancer treatment, allowing the removal of cancerous tissue. Various factors guide the choice of surgery, such as tumor size, type and stage of breast cancer, patient health, genetic predisposition, and personal preferences. For early-stage cases, breast conserving therapy (also known as lumpectomy or partial mastectomy) is often preferred, preserving the breast while removing the tumor. Conversely, mastectomy, removal of the entire breast, is considered for larger tumors or when a more extensive approach is necessary. It’s important to note that decision-making is individualized, requiring each patient to have an open dialogue with healthcare teams to determine the best course of action. If appropriate, the option for oncoplastic breast surgery (for breast conservation) or breast reconstruction (for mastectomy) can also be discussed to restore appearance and enhance emotional and physical well-being.

Radiation Therapy, Chemotherapy, and Targeted Therapy

In the comprehensive treatment of breast cancer, a multi-faceted approach combines surgery with radiation therapy, chemotherapy, and targeted therapy.

Radiation therapy, often used after surgery, is a precisely targeted and high effective way to destroy any possible remaining cancer cells in the breast or lymph nodes, minimizing damage to healthy tissue.

Chemotherapy, a systemic treatment, targets cancer cells throughout the body and may be recommended based on your type of cancer or spread of disease; but it can lead to side effects such as nausea and hair loss.

Targeted therapies, such as endocrine therapy or immunotherapy, offers a more precise approach that attacks specific cancer cell molecules or pathways, often for breast cancers with specific characteristics. It’s effective with fewer side effects than chemotherapy.

The treatment plan, including the choice and sequence of therapies, is tailored to each patient’s diagnosis, breast cancer type, and stage, and may involve combining these treatments for optimal results.

Hormone Therapy

Hormone therapy is often used for breast cancers that are hormone receptor-positive. Medications like Tamoxifen and aromatase inhibitors can be effective in blocking the hormones that fuel cancer growth. Tamoxifen interferes with estrogen’s influence on cancer cells and is particularly suitable for premenopausal women. Aromatase inhibitors, on the other hand, are often recommended for postmenopausal patients as they inhibit the production of estrogen, starving cancer cells of their essential growth hormone.

Immunotherapy

Immunotherapy represents a cutting-edge in the treatment of breast cancer. This innovative approach uses the body’s immune system to recognize and kill cancer cells, potentially providing more targeted and less invasive therapies. As this field evolves, it’s becoming increasingly evident that harnessing the immune system’s natural defenses may hold the key to more effective and less toxic treatments for breast cancer.

Survivorship and Follow-Up

Life after breast cancer treatment is a new chapter in your journey. It’s important to maintain regular follow-up appointments with your healthcare team to monitor your health and detect any recurrence early. Survivorship brings its unique challenges, so having coping strategies and support networks in place is crucial.

Conclusion

In conclusion, early detection of breast cancer is paramount. Understanding the risk factors, performing regular self-exams, and adhering to recommended screening guidelines can make a significant difference in your outcome. Remember that breast cancer is treatable, and advances in research and treatment options continue to improve the prognosis for patients. Stay proactive with your healthcare, and never underestimate the power of early detection.

About Dr. Crystal Fancher

Crystal E. Fancher, MD, is a surgical breast oncologist specializing in treating breast cancer patients and benign breast diseases. She is certified by the American Board of Surgery. Her medical services include novel treatments such as intraoperative radiation therapy and oncoplastic breast-conserving surgery. 