Breast Cancer: Symptoms, Risks & Treatments
Photo by National Cancer Institute on Unsplash
It is important for every woman to know how her breasts normally look and feel which is an important part of breast health. So, one must be aware of any changes in her breasts and to know the signs and symptoms of breast cancer. The most common sign of breast cancer is a new lump or mass (although most breast lumps are not cancer). A painless, hard mass that has irregular edges is more likely to be cancer, but breast cancers can be also soft, round, tender, or even painful. Other possible symptoms of breast cancer include:[1]
· Swelling of all or part of a breast
· Skin dimpling (sometimes looking like an orange peel)
· Breast or nipple pain
· Nipple retraction (turning inward)
· Nipple or breast skin that is red, dry, flaking, or thickened
· Nipple discharge (other than breast milk)
· Swollen lymph nodes under the arm or near the collar bone (Sometimes this can be a sign of breast cancer spread)
Higher Risk For Breast Cancer
Some of these factors can increase one’s risk more than others which include:[2]
Getting older
Having close relatives who have had breast cancer
Having a longer menstrual history (more total menstrual cycles)
Having had invasive breast cancer or ductal carcinoma in situ (DCIS) before
Being diagnosed with lobular carcinoma in situ (LCIS)
Being diagnosed with atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH)
Having a gene mutation linked to a family cancer syndrome (such as a BRCA mutation)
While one can’t change some breast cancer risk factors—family history and aging, for example—there are some risk factors that one can control.
· Lifestyle-related Risk Factors: Such as diet and physical activity, decisions about having children and taking medicines that contain hormones.
· Drinking Alcohol: It is clearly linked to an increased risk of breast cancer which increases with the amount of alcohol consumed. Women who have 1 alcoholic drink a day have about 7% to 10% increase in risk compared with those who don't drink, while women who have 2 to 3 drinks a day have about a 20% higher risk.
· Being Overweight Or Obese : Before menopause, a woman's ovaries make most of her estrogen, and fat tissue makes only a small part of the total amount. After menopause (when the ovaries stop making estrogen), most estrogen comes from fat tissue. Having more fat tissue after menopause can raise estrogen levels and increase the chances of getting breast cancer. Women who are overweight also tend to have higher blood insulin levels which have been linked to some cancers, including breast cancer.
· Physical Activity : Regular physical activity reduces breast cancer risk, especially in women past menopause. Even as little as a couple of hours a week might be helpful, although more seems to be better. Exactly how physical activity might reduce breast cancer risk isn’t clear, but it may be due to its effects on body weight, inflammation, and hormone levels.
· Not Having Children : Women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk overall. Having many pregnancies and becoming pregnant at a young age reduces breast cancer risk. Still, the effect of pregnancy on breast cancer risk is complex. For example, the risk of breast cancer is higher for about the first decade after having a child. The risk then becomes lower over time.
· Not Breastfeeding : Most studies suggest that breastfeeding may slightly lower breast cancer risk, especially if it continues for a year or more. A possible explanation for this effect is that breastfeeding reduces a woman’s total number of lifetime menstrual cycles (the same as starting menstrual periods at a later age or going through early menopause).
· Birth Control : Some birth control methods use hormones, which might increase breast cancer risk. Most studies have found that :-
· Oral Contraceptives: women using oral contraceptives (birth control pills) have a slightly higher risk of breast cancer than women who have never used them.
· Birth Control Shots: getting long-acting progesterone shots (such as Depo-Provera) every 3 months for birth control might increase breast cancer risk
· Birth Control Implants, Intrauterine Devices (IUDs), Skin Patches, Vaginal Rings: These forms of birth control also use hormones, which in theory could fuel breast cancer growth.
· Combined Hormone Therapy (HT): Use of combined hormone therapy (estrogen and progesterone) after menopause increases the risk of breast cancer. This increase in risk is typically seen after about 4 years of use.
· Estrogen Therapy (ET): Use of estrogen alone after menopause have had mixed results. Some have found a slightly higher risk, while others have found no increase in risk, or even a slight decrease in risk.
· Breast Implants : Breast implants have been linked with some types of cancer, including breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) and other lymphomas, as well as squamous cell carcinoma.
With Unclear Effects On Breast Cancer Risk
· Chemicals In The Environment: Chemicals in the environment that have estrogen-like properties are of special interest. For example, substances found in some plastics, certain cosmetics and personal care products, pesticides, and PCBs (polychlorinated biphenyls) seem to have such properties. In theory, these could affect breast cancer risk.
· Tobacco Smoke: Some studies have found that heavy smoking over a long time might be linked to a slightly higher risk of breast cancer particularly in women who started smoking before they had their first child. Both mainstream and secondhand smoke contain chemicals that, in high concentrations, may cause breast cancer particularly in premenopausal women.
· Night Shift Work: Women who work at night, such as nurses on a night shift, might have an increased risk of breast cancer. This effect may be due to changes in levels of melatonin, a hormone that’s affected by the body’s exposure to light.
· Antiperspirants: A myth that chemicals in underarm antiperspirants are absorbed through the skin, interfere with lymph circulation, and cause toxins to build up in the breast, eventually leading to breast cancer.
· Bras: Some rumors have suggested that bras cause breast cancer by obstructing lymph flow. There is no scientific or clinical basis for this claim.
· Induced abortion: Several studies have provided very strong data that neither induced abortions nor spontaneous abortions (miscarriages) have an overall effect on the risk of breast cancer.
Photo by National Cancer Institute on Unsplash
Breast Cancer-Treatment
If one has been diagnosed with breast cancer, the cancer care team must discuss treatment options with the patient. It’s important that one must think carefully about each of available choices and weigh the benefits of each treatment option against the possible risks and side effects. [3]
· Local Treatments: Some treatments, like surgery and radiation, are local, meaning they treat the tumor without affecting the rest of the body. Depending on the type of breast cancer and how advanced it is, one might need other types of treatment as well, either before or after surgery, or sometimes both.
· Systemic Treatments: Drugs used to treat breast cancer are considered systemic therapies because they can reach cancer cells almost anywhere in the body. Some can be given by mouth, injected into a muscle, or put directly into the bloodstream. Depending on the type of breast cancer, different types of drug treatment might be used, including:
Common Treatment Approaches
Typically, treatment is based on the type of breast cancer and its stage. Other factors, including overall health, menopause status, and personal preferences are also taken into account. [4]
Complementary And Alternative Treatment Methods
These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few. Complementary methods are treatments that are used along with regular medical care. Alternative treatments are used instead of standard medical treatment. Although some of these methods might be helpful in relieving symptoms or helping one feel better, many have not been proven to work. Some might even be harmful. [5]
Surgery: There are different types of breast surgery, which may be done for different reasons, depending on the situation. For example, surgery may be done to:
· Remove as much of the cancer as possible (breast-conserving surgery or mastectomy)
· Find out whether the cancer has spread to the lymph nodes under the arm (sentinel lymph node biopsy or axillary lymph node dissection)
· Restore the breast’s shape after the cancer is removed (breast reconstruction)
· Relieve symptoms of advanced cancer
The doctor may recommend a certain operation based on patient’s breast cancer features and her medical history, or one may have a choice about which type of surgery to have. There are two main types of surgery to remove breast cancer:
· Breast-Conserving Surgery-Lumpectomy, Quadrantectomy, Partial Mastectomy, Or Segmental Mastectomy: is surgery to remove the cancer as well as some surrounding normal tissue. Only the part of the breast containing the cancer is removed. How much breast is removed depends on where and how big the tumor is, as well as other factors. This surgery is also called a
· Mastectomy is a surgery in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also have both breasts removed in a double mastectomy.
Surgery For Advanced Breast Cancer: Although surgery is very unlikely to cure breast cancer that has spread to other parts of the body, it can still be helpful in some situations, either as a way to slow the spread of the cancer, or to help prevent or relieve symptoms from it. For example, surgery might be used: [5]
· When the breast tumor is causing an open wound in the breast (or chest)
· To treat a small number of areas of cancer metastases in a certain part of the body, such as the brain
· When an area of cancer is pressing on the spinal cord or in a bone that weakens it or causes it to break
· To treat a blockage in the liver
· To provide relief of pain or other symptoms
Radiation Therapy: Some women with breast cancer will need radiation, in addition to other treatments. It is treatment with high-energy rays (or particles) that destroy cancer cells. Depending on the breast cancer's stage and other factors, radiation therapy can be used in several situations:
· After breast-conserving surgery (BCS), to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.
· After a mastectomy, especially if the cancer was larger than 5 cm (about 2 inches), if cancer is found in many lymph nodes, or if certain surgical margins, such as the skin or muscle, have cancer cells.
· If cancer has spread to other parts of the body, such as the bones, spinal cord, or brain.
Types Of Radiation Therapy For Breast Cancer:
The main types are:
· External Beam Radiation Therapy(ERBT)
· Brachytherapy
Possible Side Effects Of Radiation are:
· Swelling in the breast
· Redness, skin peeling, darkening of the skin)
· Fatigue
· Breast becomes smaller and the skin becomes firmer or swollen.
· Women may not be able to breastfeed from the radiated breast.
· Can sometimes damage some of the nerves to the arm leading to numbness, pain, and weakness in the shoulder, arm, and hand.
· May cause lymphedema, a type of pain and swelling in the arm or chest.
· In rare cases, radiation therapy may weaken the ribs, which could lead to a fracture.
Chemotherapy For Breast Cancer: Chemotherapy (chemo) uses anti-cancer drugs that may be given intravenously (injected into the vein) or by mouth. The drugs travel through the bloodstream to reach cancer cells in most parts of the body. Sometimes, if cancer spreads to the spinal fluid, which surrounds and cushions the brain and spinal cord, chemo may be given directly into in this area (called intrathecal chemotherapy). Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended.
After Surgery (Adjuvant Chemotherapy): Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but can't be seen, even on imaging tests which may form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back.
Before Surgery (Neoadjuvant Chemotherapy): Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed, have many lymph nodes involved with cancer, or are inflammatory breast cancers.
Chemotherapy Drugs Used For Breast Cancer: In most cases, chemo has the greatest effect when more than one drug is used at a time. Often, combinations of 2 or 3 drugs are used out of following drugs:-
Anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence)
Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere)
5-fluorouracil (5-FU) or capecitabine (Xeloda)
Cyclophosphamide (Cytoxan)
Carboplatin (Paraplatin)
Ixabepilone (Ixempra)
Eribulin (Halaven)
Platinum agents (Cisplatin, carboplatin)
Vinorelbine (Navelbine)
Gemcitabine (Gemzar)
Antibody drug conjugates (Ado-trastuzumab emtansine [Kadcyla], Fam-trastuzumab deruxtecan [Enhertu], Sacituzumab govitecan [Trodelvy])
It is given one day a week for a few weeks or every other week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle for a total of 3 to 6 months.
Possible Side Effects Of Chemo For Breast Cancer: The most common possible side effects include and These side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting:
· Hair loss
· Nail changes
· Mouth sores
· Loss of appetite or weight changes
· Nausea and vomiting
· Diarrhea
· Fatigue
· Hot flashes and/or vaginal dryness from menopause caused by chemo
· Nerve damage
· Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:
· Increased chance of infections (from low white blood cell counts)
· Easy bruising or bleeding (from low blood platelet counts)
· Fatigue (from low red blood cell counts and other reasons)
· Menstrual Changes And Fertility Issues: For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause (not having any more menstrual periods) and infertility (not being able to become pregnant) may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss.
· Heart Damage: Some chemo drugs can cause permanent heart damage (called cardiomyopathy). The risk is highest if the drug is used for a long time or in high doses. Other heart failure risk factors, such as family history of heart problems, high blood pressure, and diabetes can also put you at risk if you receive one of these drugs.
· Nerve Damage (Neuropathy): Many drugs used to treat breast cancer, can damage nerves in the hands, arms, feet, and legs. This can sometimes lead to symptoms in those areas like numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases these symptoms go away once treatment is stopped, but in some women it might last a long time or may become permanent. There are medicines that could help with these symptoms.
· Hand-Foot Syndrome: Certain chemo drugs, can irritate the palms of the hands and the soles of the feet. This is called hand-foot syndrome. Early symptoms include numbness, tingling, and redness. If it gets worse, the hands and feet can become swollen and uncomfortable or even painful. The skin may blister, leading to peeling or even open sores. There is no specific treatment, although some creams or steroids given before chemo may help. These symptoms gradually get better when the drug is stopped or the dose is lowered.
· Chemo Brain: Some patients may have few problems with concentration and memory, which may last a long time. The symptoms most often last for a few years.
· Increased Risk Of Leukemia: Very rarely, certain chemo drugs, may cause a cancer of white blood cells. If this happens, it is usually within 10 years after treatment.
· Feeling Unwell Or Tired (Fatigue): Many women do not feel as healthy after chemo as they did before. Fatigue is another common problem for women who have received chemo. This may last a few months up to several years.
Hormone Therapy for Breast Cancer
Some types of breast cancer are affected by hormones, like estrogen and progesterone. The breast cancer cells have receptors (proteins) that attach to estrogen and progesterone, which helps them grow. Treatments that stop these hormones from attaching to these receptors are called hormone or endocrine therapy. Hormone therapy can reach cancer cells almost anywhere in the body and not just in the breast. It's recommended for women with tumors that are hormone receptor-positive. It does not help women whose tumors don't have hormone receptors (these tumors are called hormone receptor-negative)[6]
Hormone therapy is often used after surgery (as adjuvant therapy) to help reduce the risk of the cancer coming back. Sometimes it is started before surgery (as neoadjuvant therapy). It is usually taken for at least 5 years. Hormone therapy can also be used to treat cancer that has come back after treatment or that has spread to other parts of the body. About 2 out of 3 breast cancers are hormone receptor-positive. Their cells have receptors (proteins) for estrogen (ER-positive cancers) and/or progesterone (PR-positive cancers) which help the cancer cells grow and spread. Most types of hormone therapy either lower estrogen levels in the body or stop estrogen from helping breast cancer cells grow.
Breast cancer remains a significant global health concern, impacting millions of individuals each year. There are multifaceted nature of breast cancer, highlighting various risk factors. Moreover, advancements in diagnostic techniques have significantly improved early detection and treatment outcomes. Mammography, alongside emerging technologies like magnetic resonance imaging and molecular testing, plays a pivotal role in identifying breast cancer at its early stages, enabling prompt intervention and potentially improving patient prognoses. Moving forward, continued research into identifying additional risk factors, enhancing screening methods, and developing targeted therapies remains imperative. Furthermore, promoting awareness, advocating for increased screening accessibility, and fostering global collaboration among medical professionals and researchers is crucial in the ongoing fight against breast cancer. A comprehensive approach that integrates research, education, early detection, and accessible healthcare services is essential in combating breast cancer and reducing its impact on individuals and societies worldwide.
References
1. Polyak K. Breast cancer: origins and evolution. J Clin Invest. 2007;117:3155–3163.
2. "Breast Cancer". NCI. January 1980. Archived from the original on 25 June 2014. Retrieved 29 June 2014.
3. Majeed W, Aslam B, Javed I. et al. Breast cancer: major risk factors and recent developments in treatment. APJCP. 2014;15:3353–3358.
4. Chlebowski RT. Factors that modify breast cancer risk in women. UpToDate. 2021. Accessed at https://www.uptodate.com/contents/factors-that-modify-breast-cancer-risk-in-women on
5. National Cancer Institute. Physician Data Query (PDQ). Breast Cancer Treatment – Health Professional Version. 2021. Accessed at https://www.cancer.gov/types/breast/hp/breast-treatment-pdq on June 25, 2021.
6. National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Breast Cancer Risk Reduction. V.1.2021.