Breast Cancer | Symptoms and Causes

Breast cancer is a topic that weighs heavily on many minds, especially here in India, where it's become the most common cancer among women. It happens when cells in the breast start to grow out of control, forming a tumor. While we usually hear about it in women, it's worth noting that men can get breast cancer too, although it’s much rarer.

In India, the rising cases of breast cancer can be attributed to various factors like lifestyle changes, urbanization, and even the fact that more people are aware and getting diagnosed. Globally, survival rates have been improving, largely due to advancements in early detection and treatment. However, for many Indian women, awareness and access to proper healthcare remain key to catching the disease early and managing it effectively.

What is Breast Cancer?

Breast cancer is a type of cancer that starts in the breast tissue. It is caused by mutations in breast cells that proliferate uncontrollably and can form tumours. It can develop in one or both breasts and is one of the most often diagnosed cancers after skin cancer.  Understanding breast cancer starts with knowing a little about the breast itself. The breast comprises lobules, which are the glands that produce milk, ducts that carry the milk to the nipple, and connective tissue, which includes both fibrous and fatty tissue. Breast cancer can start in any of these areas, but it most commonly begins in the ducts (known as ductal carcinoma) or in the lobules (lobular carcinoma).

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Different Types of Breast Cancer

Breast cancer isn’t one-size-fits-all. There are different types, and each requires a unique approach to treatment:

• Ductal Carcinoma In Situ (DCIS): This is an early, non-invasive type where the abnormal cells are confined to the lining of a breast duct.
• Invasive Ductal Carcinoma (IDC): This is the most common type. It starts in the ducts but then invades nearby breast tissue.
• Invasive Lobular Carcinoma (ILC): This starts in the lobules and spreads to surrounding breast tissue.
• Inflammatory Breast Cancer: Although rare, this aggressive form makes the breast look red, swollen, and feel warm.
• Triple-negative breast Cancer: A tougher type to treat because it lacks three common receptors used in many treatments.
• Male Breast Cancer: Rare, but men do have a small amount of breast tissue and can develop cancer there.
• Paget’s Disease of the Breast: A rare cancer that starts on the nipple and areola.
• Recurrent Breast Cancer: This is when breast cancer comes back after initial treatment.

Breast Cancer Signs and Symptoms to Watch Out For

Breast cancer symptoms can be different from person to person. Some people might not notice any signs at all. However, common symptoms include:

• A lump or area of thickened tissue in the breast or underarm.
• Changes in the size, shape, or appearance of the breast.
• A nipple that turns inward or flattens out.
• Skin dimpling or puckering, which can make the breast skin look like an orange peel.
• Redness, swelling, or a rash on the breast.
• Nipple discharge, especially if it's bloody.
• Peeling or scaling of the skin on the nipple or breast.

Nipple Changes

Paying attention to changes in your nipple is crucial. Things like discharge, inversion, or changes in the skin around the nipple can be early warning signs.

When Should You See a Doctor?

If you notice any unusual changes in your breasts, don’t wait to see your doctor. Early detection is critical and can make a huge difference in the effectiveness of treatment.

What Causes Breast Cancer?

The exact cause of breast cancer isn't completely understood, but it's likely due to a mix of genetic, environmental, and lifestyle factors. When breast cells’ DNA mutates or changes, it can lead to abnormal cell growth, which in turn can lead to cancer. Factors like age, hormonal changes, and family history can increase the risk.

Risk factors associated with breast cancer you should know

Several factors can increase the likelihood of developing breast cancer:

• Gender and Age: Women are much more likely to develop breast cancer, especially after age 40.
• Family History: If a close relative has had breast cancer, your risk goes up.
• Genetic Mutations: Inherited mutations in the BRCA1 and BRCA2 genes can significantly increase risk.
• Reproductive History: Early menstruation, late menopause, having your first child after age 30, or never having been pregnant can all raise your risk.
• Dense Breast Tissue: This can make it harder to detect cancer on a mammogram and is a risk factor itself.
• Hormone Replacement Therapy (HRT): Long-term use, particularly combined estrogen and progesterone therapy, may increase risk.
• Lifestyle Choices: Obesity, alcohol consumption, and lack of exercise can all contribute to a higher risk.
• Radiation Exposure: If you’ve had previous radiation treatment to your chest, your risk is higher.

Steps to Prevent Breast Cancer

While you can’t change some risk factors, you can take steps to reduce your risk:

What You Can Do

• Get Regular Screenings: Discuss with your doctor when to start regular screenings like mammograms. In India, it’s advised that women over 40 have mammograms every 1-2 years.

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• Know Your Breasts: Regular self-exams can help you become familiar with how your breasts normally look and feel, making it easier to notice any unusual changes.

How to Do a Breast Self-Exam

You can do a breast self-exam standing in front of a mirror, in the shower, or while lying down:

• Look in the Mirror: With your shoulders, straight and arms on your hips, check for any visible changes in size, shape, or color.
• Raise Your Arms: Look again for any changes with your arms raised above your head.
• Check for Discharge: Gently squeeze each nipple to see if there’s any discharge.
• Feel for Lumps: Use a firm, smooth touch with your first few fingers, covering the entire breast in a circular motion, starting from the outside and moving towards the nipple. Repeat this while lying down.

Some More Ways to Reduce the Risk of Breast Cancer

• Limit Alcohol: Try to limit your alcohol intake to one drink per day or less.
• Maintain a Healthy Weight: A balanced diet and regular exercise can help keep your weight in check.
• Exercise Regularly: Aim for at least 30 minutes of moderate exercise most days of the week.
• High-Risk Individuals: If you have a significant family history or genetic predisposition, discuss with your doctor the possibility of preventive medication or surgery.

Why Follow-Up Care is Important 

Regular follow-up care is vital for breast cancer survivors to detect any recurrence or new cancers early. Here’s why it matters:

• Catch Recurrences Early: Regular check-ups can help detect cancer that comes back after treatment.
• Monitor for New Cancers: It’s important to keep an eye out for new cancer in the opposite breast.
• Manage Side Effects: Long-term side effects, including those related to treatment-induced menopause, can be managed better with regular follow-ups.
• Support Quality of Life: Continuous follow-up care helps support overall quality of life and addresses any ongoing concerns.

Follow-Up Care Timeline

• First 5 Years: Visits every 6 months, or sooner if symptoms appear.
• After 5 Years: Annual visits up to 10 years, then every 2 years.
• High-Risk Individuals: Lifelong follow-up every 6 to 12 months.

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Breast Cancer Survival Rates and Outlook

Survival rates for breast cancer can vary, depending on several factors like the type of cancer, the stage at diagnosis, and individual health. On average, about 91% of people with breast cancer survive for at least five years after diagnosis. Here’s a general breakdown:

• Local Stage (Cancer confined to the breast): 99% five-year survival rate.
• Regional Stage (Cancer spread to nearby lymph nodes): 86% five-year survival rate.
• Distant Stage (Cancer spread to distant organs): 30% five-year survival rate.

Keep in mind, these numbers are averages. Each person’s experience with breast cancer is unique, and early detection and treatment greatly increase the chances of survival.

The Current Outlook

The outlook for those diagnosed with breast cancer is getting better all the time. With early detection and treatment, survival rates are high, and many people live long, healthy lives after their diagnosis.

The Role of Race and Ethnicity

In India, disparities in breast cancer outcomes often arise due to differences in healthcare access, awareness, and cultural factors. Globally, studies show that Black women, for example, are slightly less likely to develop breast cancer than white women but are more likely to die from it. These disparities highlight the need for equal access to education, screening, and treatment across all communities.

Final Thoughts

Breast cancer is a serious health issue, but with advances in medical research and increased awareness, survival rates are improving. Regular screenings, knowing your body, and early detection are key to improving outcomes. By taking preventive measures and staying informed, we can reduce the impact of breast cancer on individuals and society as a whole.

FAQs Related to Breast Cancer

1. What is breast cancer?

Breast cancer is one of the most prevalent malignancies affecting women and those who were assigned female at birth (AFAB). It occurs when malignant cells in the breasts multiply and become tumours. Approximately 80% of breast cancer cases are invasive, which means that a tumour can move from the breast to other parts of the body.

2. What causes breast cancer?

Breast cancer develops when breast cells mutate and become malignant cells, which proliferate and multiply to form tumors. They aren't sure what causes the transformation. However, research indicates that there are various risk factors that can raise your chances of having breast cancer. This includes:

1. Age: 55 years or older.
2. Sex: Women and those with AFAB are far more prone to develop the disorder than men.
3. Family history: If your parents, siblings, children, or other close relatives have breast cancer, you are at risk of acquiring it.
4. Genetics: Up to 15% of breast cancer cases are caused by inherited genetic alterations.
5. Smoking: Tobacco smoking has been related to numerous types of cancer, including breast cancer.
6. Alcoholic beverages: According to research, drinking alcohol may raise the risk of developing breast cancer.
7. Being obese.
8. Radiation exposure: If you have previously received radiation therapy, particularly to the head, neck, or chest, you are more likely to develop breast cancer.
9. Hormone replacement therapy: People who take hormone replacement therapy (HRT) are more likely to be diagnosed with the illness.

3. What are the signs and symptoms of breast cancer

Signs and symptoms of breast cancer might include:

1. A breast lump or enlarged patch of skin that feels different than the surrounding tissue.
2. A nipple that seems flat or bends inward. 
3. Colour changes on the breast skin. People with white complexion may have pink or red breasts. 
4. People with brown or black skin may notice that the breast skin is darker than the remaining skin on their chest, or that it appears red or purple.
5. Change in breast size, shape, or appearance. Skin changes over the breast, such as dimples or the appearance of an orange peel.
6. The skin on the breast may peel, scale, crust, or flake.

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4. What are phyllodes tumours?

Phyllodes tumours are an uncommon type of breast tumour. Unlike carcinomas, which form in the ducts or lobules of the breast, these cancers originate in the connective tissue (stroma).

Most are benign, however some are malignant (cancer).

5. What are the possible complications of breast cancer?

The most serious effect is metastatic breast cancer, which spreads to other parts of the body such as the brain, bones, liver, and lungs. According to studies, around one-third of women and AFAB who have early-stage disease get metastatic breast cancer.