Breast cancer - The most common invasive cancer in women

Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women . 1in 8 women is likely to develop breast cancer during her lifetime. Breast cancer can occur in both men and women but is more common in women. Advances in screening and treatment for breast cancer have improved survival rates dramatically. Awareness of the symptoms and the need for screening are important ways of reducing the risk.

Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women . 1in 8 women is likely to develop breast cancer during her lifetime. Breast cancer can occur in both men and women but is more common in women. Advances in screening and treatment for breast cancer have improved survival rates dramatically. Awareness of the symptoms and the need for screening are important ways of reducing the risk.
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Risk factor

The exact cause of breast cancer remains unclear. A breast cancer risk factor is anything that makes it more likely you'll get breast cancer. But having one or several breast cancer risk factors doesn't necessarily mean you'll develop breast cancer. Many women who develop breast cancer have no known risk factors other than simply being women.

Few of the factors that are associated with increased risk are –

Age - The risk of developing breast cancer increases with age.

Being female - Women are much more likely than men are to develop breast cancer. A personal history of breast conditions/ breast cancer - If you've had a breast biopsy that found lobular carcinoma in situ (LCIS) or atypical hyperplasia of the breast, you have an increased risk of breast cancer or If you've had breast cancer in one breast, there is an increased risk of developing cancer in the other breast.

A family history of breast cancer - Majority of people diagnosed with breast cancer have no family history of the disease. However, if there is a history of breast cancer in the family the risk of developing breast cancer increases. Inherited genes that increase cancer risk. Certain gene mutations that increase the risk of breast cancer can be passed from parents to children. The most well-known gene mutations are referred to as BRCA1 and BRCA2.
 

Radiation exposure-  

• With a history of radiation treatments to the chest as a child or young adult, the risk of breast cancer increases.
  Obesity - Being obese increases the risk of breast cancer.
  Menstrual History - Beginning of menstrual cycle earlier than 12 years of age and attaining late menopause, both these conditions are associated with increased risk of breast cancer. 
  Obstetric History - Having the first child after age 30 may have an increased risk of breast cancer.
  Infertility - Infertility is associated with greater risk of breast cancer than do women who have had pregnancies.
  Postmenopausal hormone therapy- Women who take hormone replacement therapy( estrogen and progesterone combination) have an increased risk of breast cancer.
   
• Signs & Symptoms - 
  
  Signs and symptoms of breast cancer may include
• A breast lump or thickening that feels different from the surrounding tissue
• Change in the size, shape or appearance of a breast
• Changes to the skin over the breast, such as dimpling
• A newly inverted nipple
• Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin
• Redness or pitting of the skin over the breast, like the skin of an orange.

Investigations & Diagnosis

Modalities used to diagnose breast cancer are as follows-

Breast exam. Your doctor will check both of your breasts and lymph nodes in your armpit, feeling for any lumps or other abnormalities. Mammogram. A mammogram is an X-ray of the breast. Screening Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram if something is detected then it is recommended for a diagnostic mammogram to further evaluation.

Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound helps to know whether a new breast lump is a solid mass or a fluid-filled cyst.

Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to make a diagnosis of breast cancer. During a biopsy, a specialized needle device guided by X-ray or another imaging test is used to extract a core of tissue from the suspicious area.

Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of the breast. A dye is injected before a breast MRI.

Self-Breast Examination - 

Breast self-exam, or regularly examining your breasts can be an important way to find any changes in breast cancer at an early stage when it’s more likely to be treated successfully. The best time to do a monthly self-breast exam is about 3 to 5 days after your period starts. Do it at the same time every month. The breasts are not as tender or lumpy during this time. If you have gone through menopause, do it on the same day every month.

How to do a breast self-exam:

Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Look for:

Step 2: Raise your arms and look for the same changes.

Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood).

Step 4: Feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping the fingers flat and together. Use a circular motion, about the size of a quarter.

Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast.

Step 5: Finally, feel your breasts while you are standing or sitting.

Treatment

The stage or the extent of breast cancer is an important factor in making decisions about the treatment.  Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of drug therapy. But the treatment options are affected by other information about your breast cancer, such as:

If the cancer cells contain hormone receptors (that is, if the cancer is ER-positive or PR-positive)

Drug therapy as part of the treatment. may include:

Chemotherapy –

Hormone therapy (tamoxifen, an aromatase inhibitor, or one followed by the other)  HER2 targeted drugs. Some combination of these. The types of drugs that might work best depend on the tumor’s hormone receptor status, HER2 status, and other factors.

Prevention –

There is no way to prevent breast cancer. However, certain lifestyle decisions can significantly reduce the risk of breast cancer as well as other types.