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Breast cancer

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What is breast cancer?

Breast cancer is the most common cancer to affect women. It occurs most often in women over 50 years of age, but sometimes can also affect men, as men also have breast tissue that never fully develops. Breast cancer usually grows in the cells that produce milk and which line the milk ducts. These abnormal cells grow uncontrollably, and can spread beyond their natural boundaries. The cells can potentially spread to other sites within the body, such as the brain or liver.

Breast cancer is often diagnosed after finding a lump in the breast, although it can also be found by a screening test called a mammogram. Surgical intervention usually forms part of the treatment of breast cancer and it may be supplemented with radiotherapy, chemotherapy or hormonal treatments. Treatment of breast cancer has improved markedly over the past few decades, so most people will beat the disease.

Causes

The cause of breast cancer, as with other cancers, is damage to cellular DNA. This damage results in uncontrolled growth of these abnormal cells, which leads to formation of a tumor. Tumors can invade nearby tissue, or cancerous cells can separate from the tumor and spread throughout the body via the bloodstream or lymphatic system. The exact causes of this cellular damage in the breast are not known, but there are a number of proposed risk factors.

Risk factors

Risk factors for breast cancer include:

  • Age - after 30 years of age the risk increases. The large majority of breast cancers occur in women over the age of 50;
  • Family history - the majority of breast cancers are not hereditary, but family history does increase the risk for an individual, particularly if there are one or more close relatives (mother, sister) with breast cancer;
  • Genetics - there are genes that are associated with a high risk of developing breast cancer. These genes include BRCA1, BRCA2 and P53. These are rare and only make up a small percentage of overall breast cancers;
  • Ethnicity - Caucasian women tend to be affected more, but breast cancer is common in every ethnicity;
  • Previous breast cancer - people who have had breast cancer are more likely to develop it again than those who have not had it;
  • Alcohol - alcohol abuse increases the risk of developing many cancers, including breast cancer;
  • Smoking - smoking is likely to increase the risk of breast cancer;
  • Hormone replacement therapy (HRT) - when taken over a number of years HRT increases the risk of cancer. The risk of cancer increases with HRT that combines both progesterone and estrogen. However, taking HRT for less than three years or using HRT with only estrogen may not cause a significant increase in risk;
  • Late menopause - women who begin menopause after the age of 55 are at higher risk;
  • Not breastfeeding;
  • Never giving birth, or having children after the age of 30;
  • Obesity - people who are obese, especially postmenopausal women, are at increased risk;
  • The contraceptive pill - the pill provides only a very small increase in risk, and;
  • Exposure to radiation - this can be part of the reason people who have already had cancer are at increased risk of developing it again. Radiation from various scans and radiotherapy can increase breast cancer risk, but its use is also essential for diagnosing and treating the disease.

Types

The type of breast cancer is determined by the type of cell it starts in.

Ductal carcinoma

Most breast cancers are ductal carcinomas, which begin in the lining of the milk ducts in breast tissue. Ductal carcinomas can be further classified as follows:

Lobular carcinoma

This breast cancer originates in the lobules of the breasts, which are the glands that produce milk. Types of lobular carcinoma include:

Anatomy of the breast. 

Stages

Treatment outcomes can vary greatly, depending on the stage of cancer. Cancer is staged according to the size and location of the primary tumor and whether it has spread to lymph nodes or organs throughout the body.

Stage I

The tumor is 2 cm (0.79 inches) or less in diameter and small clusters may have spread to local lymph nodes.

Stage II

Stage IIA

Either a tumor that is 2 cm (0.79 inches) or less in diameter and has spread to 1-3 lymph nodes near the breast, or is 2-5 cm (0.79 to 1.97 inches) in diameter and has not spread to the lymph nodes.

Stage IIB

The tumor is 2-5 cm (0.79 to 1.97 inches) in diameter and the cancer has spread to the lymph nodes, or is greater than 5 cm (1.97 inches) in diameter and has not spread to the lymph nodes.

Stage III

Stage IIIA

A tumor of any size that has spread to 4-9 lymph nodes in the armpit or the breastbone, or a tumor larger than 5 cm (1.97 inches) in diameter, along with small clusters of cancer cells in lymph nodes, or a tumor greater than 5 cm (1.97 inches) in diameter that has spread to 1-3 local lymph nodes.

Stage IIIB

The tumor can be any size and has spread to the skin and/or the wall of the chest. It may also have spread to 9 or more lymph nodes in the armpit, or lymph nodes around the breastbone.

Stage IIIC

A tumor of any size that has spread to 10 or more lymph nodes in the armpit, or to lymph nodes around the breastbone or collarbone.

Stage IV

The cancer has spread to other body organs such as the lungs, bone, and brain.

Signs and symptoms

The following signs and symptoms of breast cancer may or may not be apparent:

Methods for diagnosis

Physical examination and breast awareness

Being aware of any changes in your breasts, such as lumps or changes in size or shape, can often be the first sign something is wrong and prompt you to see a doctor. A doctor or nurse will then perform a breast examination for lumps or changes in the breast and armpits.

There is no longer a recommendation for women to have routine examinations performed by a health professional.

Investigations

Most commonly, a mammogram and/or an ultrasound are used to detect breast cancer. If a suspicious mass is detected with scanning, it will be biopsied for a definitive diagnosis. If a cancer is confirmed, then other forms of imaging may be used to further detail the mass, or to help determine if the tumor has spread to lymph nodes, organs or bones.

Imaging

A range of different scans are used for diagnosing and monitoring breast cancer:

Tissue biopsy

A sample of breast tissue (biopsy) is removed using a needle, followed by microscopic examination by a pathologist. This can confirm and characterize the cancer, which can help in selecting treatment options.

Types of treatment

Surgery

Lumpectomy

A lumpectomy involves surgical removal of the cancerous tissue and some of the surrounding tissue. It is the least invasive of the surgical interventions for breast cancer and generally causes little or no change to the appearance of the breast.

Partial mastectomy

This involves the partial removal of some of the breast tissue, the amount of which varies according to the size and shape of the tumor. It may involve a quarter of the breast or a segment.

Mastectomy

This surgery is the complete removal of the breast. However, there are a number of ways that this can be defined:

Therapy

Chemotherapy

Chemotherapy works by attacking cancer cells and stopping their reproduction. Various medications are used, which can be administered intravenously or orally.

There are three general types of chemotherapy:

Side effects occur because chemotherapy can also affect healthy cells. Your doctor will monitor your dosage carefully to ensure the optimal therapeutic dosage is achieved.

Chemotherapy can slow down the development of breast cancer. 

Radiotherapy

In this type of therapy, focused X-rays are applied to the area where the tumor is located. Another form of radiation therapy is brachytherapy. This involves inserting a small, radioactive implant in the tumor or the nearby area, which deliver cell-destroying radiation directly into the tumor. Radiotherapy can be used alone, or in addition to surgery and/or chemotherapy.

Hormonal therapy

If the tumor contains receptors for estrogen or progesterone hormones, hormone therapy is often used to block the action or lower the production of these hormones that are otherwise involved in supporting the growth of cancerous cells. Aromatase inhibitors can be used to block estrogen production and tamoxifen and fulvestrant can be used to block estrogen receptors on cancer cells. This is not the same as hormone replacement therapy given to menopausal women.

Other

Some people diagnosed with breast cancer seek out complementary and alternative therapies. None of these alternative therapies are proven to cure cancer, but some can help people feel better when used together with conventional medical treatment. It is important to discuss any treatments with your doctor before starting them, since some complementary treatments can cause harm or interfere when combined with conventional cancer treatment.

Potential complications

Treatment side effects

There is a wide range of possible side effects from breast cancer treatments, including:

Advanced breast cancer

Breast edema

Inflammatory breast cancer can result in the swelling of the breast (edema).

Metastasis

This is when the cancer spreads to other parts of the body through the bloodstream and lymphatic system. Generally, once breast cancer has spread to distant sites, it is not curable. However, treatments can be used to slow down the disease.

Prognosis

The five-year survival rate for people with breast cancer is around 83%. In general, the smaller the tumor, the higher the survival rate. For women who survive the first year, the survival rate increases to 90% and for women who survive the first five years, the forward five-year survival rate further increases to 93%.

Five-year survival rates are calculated on people who were treated in the preceding five years. Advances in treatment since then might result in better outcomes for people with breast cancer today.

Prevention

Being aware of changes in your breasts is important for the early detection of breast cancer. It would be good to talk to your doctor about any changes in the size and shape of your breasts, or the formation of lumps. Getting regular mammograms once you reach 50 years of age, maintaining a healthy weight, quitting smoking and reducing alcohol intake are the best means of preventing breast cancer. If you have a family history of breast cancer, you can talk to your doctor or genetic counsellor regarding your specific situation.

References

  1. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010. Australian Government – Australian Institute of Health and Welfare. Accessed 22 September 2014 from link here
  2. Breast cancer | Cancer Australia. Accessed 12 July 2014 from link here
  3. Breast cancer chemo side effects?: Cancer Research UK?: CancerHelp UK. Accessed 12 July 2014 from link here
  4. Breast Cancer Diagnosis - National Breast Cancer Foundation. Accessed 12 July 2014 from link here
  5. Breast Cancer Diagnosis Symptoms & Signs - Cancer Council Victoria. Accessed 12 July 2014 from link here
  6. Breast cancer statistics | Cancer Australia. Accessed 12 July 2014 from link here
  7. Breast Cancer Treatment (PDQ®) - National Cancer Institute. Accessed 12 July 2014 from link here
  8. Cancer survival and prevalence in Australia: period estimates from 1982 to 2010 (full publication; 28 Aug 2012 edition) (AIHW) - DownloadAsset.aspx. Accessed 12 July 2014 from link here
  9. Endoscope-assisted brachytherapy for pancreatic cancer: From tumor killing to pain relief and drainage. Accessed 12 July 2014 from link here
  10. Hormone Therapy for Breast Cancer Fact Sheet - National Cancer Institute. Accessed 12 July 2014 from link here
  11. Radiation-Induced Complications after Breast Cancer Radiation Therapy: a Pictorial Review of Multimodality Imaging Findings. Accessed 12 July 2014 from link here

10 Most frequently asked questions (FAQs)

What is breast cancer?
Breast cancer occurs when abnormal cells develop and grow unchecked in the breast tissue. It is more common in women, but can occur in men as well.
What causes breast cancer?
Breast cancer is caused by damage to cells in the breast tissue. The exact causes of this damage aren't known, but the BRCA1, BRCA2 and TP53 genes are associated with a higher risk of developing the disease.
How is breast cancer diagnosed?
Breast cancer is diagnosed with scans such as mammograms, MRI and CT scans and a tissue biopsy.
How is breast cancer treated?
Treatment for cancer depends on the type and stage. In general, treatment involves surgery to remove the tumor, chemotherapy, radiotherapy and hormone therapy.
Is it possible for teenage girls and young women to get breast cancer?
It is possible for teenage girls and young women to get breast cancer, but it is very rare. If you are concerned, it is best to see a doctor.
Can breast cancer be inherited?
Inherited breast cancer cases account for about one in ten breast cancers.
If I have a lump in my breast, do I have breast cancer?
A lump in the breast does not necessarily mean you have breast cancer. There are other conditions that can cause lumps in the breast, such as cysts or abscesses.
What are the symptoms of breast cancer?
Sometimes breast cancer has no symptoms. When there are symptoms they include a lump in the breast, changes to the size and shape, or hardening and swelling of the breast. You may also experience a tightening in the nipple area and armpit pain, a rash around your nipples, or discharge from the nipple that isn't breastmilk.
Are there different types of breast cancer?
Yes. Breast cancer is described according to the area it originates in. Most breast cancers are ductal carcinomas, which originate in the lining of the milk ducts. Lobular carcinoma, which is less common, originates in the lobes of the breast.
What increases the chances of developing breast cancer?
Factors that can increase your chance of having breast cancer include: having hormone replacement therapy; not breastfeeding; drinking alcohol; being overweight; having late menopause, and; having certain genes associated with breast cancer.

Related topics

Cervical cancer

Cervical cancer is the name for cancers that form in the cervix, the lower part of the uterus where it meets the vagina. Most cases arise from human papillomavirus infection. Abnormal cells can form a tumour and spread to other parts of the body.

Ovarian cancer

Ovarian cancer is the name for cancers that arise in the ovaries, which are part of the female reproductive system. Abnormal cells can form tumours in the ovaries and spread to other parts of the body.

Bladder cancer

Bladder cancer is the name for cancers that arise in the tissues of the bladder, the organ that stores urine before it is expelled from the body during urination. Abnormal cells can form a tumour, affect urination and spread throughout the body.

Colorectal cancer

Colorectal cancer is the name for cancers that arise in the large intestine or rectum. Also known as colon cancer or colorectal cancer, bowel cancer can interfere with bowel function and spread to other parts of the body, such as the liver and lungs.

About this article

Title: Breast cancer

Author: Jonathan Meddings BMedLabSc (Hons)

First Published: 12 Oct 2014

Last reviewed: 17 Jan 2022

Category: Information on Breast cancer

Average rating: 4.7 out of 5 (1554 votes)

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