Breast Cancer
Breast cancer is a disease in which cells in the breast grow out of control, forming a malignant tumor. It occurs primarily in women, but men can develop it too. There are several types of breast cancer, including ductal carcinoma (starting in the milk ducts), lobular carcinoma (in the milk-producing glands), and less common varieties. Breast cancer can be invasive, spreading to surrounding tissues, or non-invasive (in situ), remaining in its original location. Early detection through screening, advances in treatment, and better understanding of risk factors have significantly improved breast cancer outcomes, with many patients now achieving long-term survival and cure.
Causes
- Genetic mutations - Inherited mutations in certain genes, particularly BRCA1 and BRCA2, significantly increase breast cancer risk. These account for 5-10% of breast cancers.
- Family history - Having first-degree relatives (mother, sister, daughter) with breast cancer approximately doubles the risk, especially if they were diagnosed before age 50.
- Personal history - Women who have had breast cancer in one breast have a higher risk of developing it in the other breast or a different part of the same breast.
- Dense breast tissue - Having dense breasts (more glandular and fibrous tissue and less fatty tissue) increases breast cancer risk and makes detection on mammograms more difficult.
- Age - Risk increases with age, with most breast cancers diagnosed in women over 50.
- Reproductive history - Factors that increase lifetime exposure to estrogen, such as early menstruation (before age 12), late menopause (after 55), not having children, or having first child after age 30, slightly increase risk.
- Hormone therapies - Combined hormone replacement therapy for menopausal symptoms and certain oral contraceptives slightly increase breast cancer risk during use.
- Radiation exposure - Previous chest radiation, especially at a young age (such as for Hodgkin's lymphoma), increases breast cancer risk.
- Lifestyle factors - Obesity (particularly after menopause), physical inactivity, alcohol consumption, and smoking are associated with increased risk.
- Previous breast conditions - Certain benign breast conditions, such as atypical hyperplasia, can increase risk.
Signs and Symptoms
- A new lump or mass in the breast or underarm area
- Thickening or swelling of part of the breast
- Dimpling or irritation of breast skin
- Redness or flaky skin in the nipple area or the breast
- Pulling in of the nipple (retraction) or pain in the nipple area
- Nipple discharge other than breast milk, including blood
- Changes in the size or shape of the breast
- Pain in any area of the breast
- Swelling of all or part of the breast (even if no lump is felt)
- Skin changes resembling an orange peel (peau d'orange)
- Breast or nipple pain
- Swollen lymph nodes in the armpit
- Many women have no symptoms, which is why regular screening is important
Diagnosis
Clinical Breast Examination
A healthcare professional manually examines the breasts, checking for lumps, changes in size or shape, and other abnormalities. This may include visual inspection with arms at different positions and palpation of the breast tissue and lymph nodes.
Mammography
An X-ray examination of the breast that can detect tumors too small to feel. Digital mammography produces computer images, while 3D mammography (tomosynthesis) provides multiple images from different angles, improving detection in dense breast tissue. Mammography is the primary screening tool for early detection.
Breast Ultrasound
Sound waves create images of breast tissue, helping distinguish between fluid-filled cysts and solid masses. Ultrasound is often used as a complement to mammography, especially for women with dense breast tissue, and can guide biopsy procedures.
Magnetic Resonance Imaging (MRI)
Using magnetic fields and radio waves, MRI creates detailed images of breast tissue. It's particularly useful for women at high risk, those with dense breasts, or when clarification is needed after other imaging. Contrast material is typically injected to enhance abnormal tissues.
Biopsy
The definitive diagnostic procedure involves removing tissue samples for laboratory examination. Types include fine-needle aspiration, core needle biopsy, stereotactic biopsy, or surgical biopsy. Pathologists examine the tissue to determine if cancer is present, its type, grade, and characteristics like hormone receptor status.
Additional Tests
If cancer is diagnosed, additional tests like CT scans, bone scans, or PET scans may be performed to determine if the cancer has spread (metastasized). Genetic testing may be recommended if hereditary cancer is suspected. Laboratory analysis of tumor tissue helps guide treatment decisions.
Treatment Options
Surgery
Surgical options include breast-conserving surgery (lumpectomy), where only the tumor and some surrounding tissue are removed, or mastectomy, where the entire breast is removed. Lymph node evaluation is typically performed to check for cancer spread. Breast reconstruction may be performed immediately or later for women who undergo mastectomy. The choice between lumpectomy and mastectomy depends on tumor size, location, genetic factors, and patient preference.
Radiation Therapy
High-energy rays target and kill remaining cancer cells after surgery. External beam radiation delivers radiation from a machine outside the body, typically over several weeks. Brachytherapy places radioactive sources directly into the tumor site temporarily. Radiation is standard after breast-conserving surgery and sometimes recommended after mastectomy for higher-risk cancers. Newer techniques include partial breast irradiation and hypofractionated radiation, which reduce treatment duration.
Systemic Therapies
Treatments that reach cancer cells throughout the body include chemotherapy (drugs that kill rapidly dividing cells), hormone therapy (for hormone receptor-positive cancers, blocking hormones that fuel growth), targeted therapy (drugs that target specific proteins involved in cancer growth, like HER2), and immunotherapy (stimulating the immune system to recognize and destroy cancer cells). These may be given before surgery (neoadjuvant) to shrink tumors or after surgery (adjuvant) to reduce recurrence risk.
Supportive and Complementary Approaches
These address side effects and improve quality of life during and after treatment. Options include physical therapy for arm mobility after surgery, lymphedema management, pain management strategies, nutritional counseling, and mind-body approaches like meditation and yoga. Psychological support through counseling or support groups helps manage the emotional impact of diagnosis and treatment.
Home Remedies
Exercise and Physical Activity
Regular physical activity can help manage treatment side effects like fatigue and may improve outcomes. Start gently and gradually increase intensity as tolerated. Walking, swimming, and yoga are good options. Consult your healthcare team before starting any exercise program, especially if you've had surgery or are undergoing treatment.
Nutrition
Focus on a balanced diet rich in fruits, vegetables, whole grains, and lean proteins. Stay hydrated and limit alcohol consumption. During treatment, small, frequent meals may help manage nausea. If taste changes occur, experiment with different foods, seasonings, and temperatures. Consider consulting a dietitian for personalized advice.
Stress Management
Techniques like deep breathing, meditation, guided imagery, or progressive muscle relaxation can help reduce anxiety and improve sleep. Mind-body practices such as yoga, tai chi, or qigong combine gentle movement with stress reduction. Support groups, either in-person or online, provide connection with others facing similar challenges.
Symptom Management
For radiation skin changes, use gentle, fragrance-free soaps and moisturizers, avoid tight clothing, and protect the area from sun exposure. For lymphedema, elevate the affected arm, perform recommended exercises, and use compression garments if prescribed. For hot flashes from hormone therapy, layered clothing, staying hydrated, and avoiding triggers can help.
Sleep Hygiene
Establish a regular sleep schedule, create a restful environment, and develop a calming bedtime routine. Limit screen time, caffeine, and alcohol before bed. If night sweats are an issue, keep the room cool and have a change of clothes nearby. Discuss persistent sleep problems with your healthcare team, as they may suggest additional strategies or medications.
Preventive Care
- Perform monthly breast self-exams to become familiar with your normal breast texture and report any changes to your doctor.
- Follow recommended screening guidelines, which typically include mammograms starting at age 40 or 50 (depending on risk factors) and continuing regularly.
- Maintain a healthy weight through balanced nutrition and regular physical activity, as obesity increases post-menopausal breast cancer risk.
- Limit alcohol consumption to no more than one drink per day, as even moderate alcohol intake increases breast cancer risk.
- Stay physically active with at least 150 minutes of moderate activity or 75 minutes of vigorous activity weekly.
- Consider the risks and benefits of hormone replacement therapy with your doctor, as some forms can increase breast cancer risk.
- If you have a family history of breast cancer, discuss genetic counseling and testing with your healthcare provider.
- Breastfeed if possible, as longer periods of breastfeeding are associated with lower breast cancer risk.
- Avoid or limit exposure to environmental pollutants and chemicals that may have hormonal effects.
- For high-risk women, discuss preventive medications (chemoprevention) or prophylactic surgery with your healthcare provider.
Surgical Options
Lumpectomy (Breast-Conserving Surgery)
A surgical procedure that removes the tumor and a small margin of surrounding healthy tissue while preserving most of the breast. This is typically followed by radiation therapy to eliminate any remaining cancer cells. Sentinel lymph node biopsy or axillary lymph node dissection may be performed during the same operation to check if cancer has spread to nearby lymph nodes.
Learn More About This ProcedureMastectomy
Surgical removal of the entire breast. Types include simple mastectomy (removes breast tissue, nipple, and areola), skin-sparing mastectomy (preserves most skin for reconstruction), nipple-sparing mastectomy (preserves skin, nipple, and areola), and modified radical mastectomy (removes breast tissue and axillary lymph nodes). The choice depends on tumor size, location, genetic factors, previous radiation, and patient preference.
Learn More About This ProcedureLymph Node Surgery
Procedures to determine if cancer has spread to lymph nodes. Sentinel lymph node biopsy identifies and removes the first few lymph nodes where cancer would likely spread, minimizing complications. If these contain cancer, axillary lymph node dissection may be performed to remove more nodes for staging and treatment planning.
Learn More About This ProcedureBreast Reconstruction
Surgical rebuilding of the breast after mastectomy, performed either immediately or delayed. Options include implant-based reconstruction using silicone or saline implants, or autologous reconstruction using tissue from another part of the body (typically abdomen, back, buttocks, or thighs). Nipple reconstruction and tattooing may complete the process.
Learn More About This ProcedureProphylactic (Risk-Reducing) Surgery
For women at very high risk due to genetic mutations or strong family history, preventive removal of breast tissue may be considered. This includes bilateral prophylactic mastectomy (removing both breasts before cancer develops) and prophylactic oophorectomy (removing ovaries to reduce hormonal stimulation of breast tissue in high-risk women).
Learn More About This ProcedureSchedule a Consultation
If you're experiencing symptoms of breast cancer, our expert team is here to help you find the right treatment approach for your specific needs.