A woman’s breasts are symbolic of feminity, youth and life. They nourish, nurture and comfort a woman’s children and they contribute to her sexuality and femininity. Sadly, cancer of the breast remains the commonest cancer in women in the last decade. Detecting breast lumps early can save your breast and cure the cancer.
In order to safely eliminate the possibility of breast cancer, it should be mandatory for every woman to examine her breasts on a monthly basis or go for regular checks. Fortunately, not all breast problems are breast cancer, benign breast disorders may arise as a result of the cyclical hormonal fluctuations that occur in every woman before menopause or during the menstrual cycle. These disorders are in fact part of a spectrum that extends from a normal state, to overt benign disease.
Cyclic pain is the most common type of breast pain. It may be caused by the normal monthly changes in hormones. This pain usually occurs in both breasts. It is generally described as a heaviness or soreness that radiates to the armpit and arm. The pain is usually most severe before a menstrual period and is often relieved when a period ends. Cyclic breast pain occurs more often in younger women. Most cyclic pain goes away without treatment and usually disappears at menopause.
Noncyclic pain is most common in women 30 to 50 years of age. It may occur in only one breast. It is often described as a sharp, burning pain that occurs in one area of a breast. Occasionally, noncyclic pain may be caused by a fibroadenoma or a cyst. If the cause of noncyclic pain can be found, treating the cause may relieve the pain.
iii. Solid Masses
Nipple discharge is any fluid that comes out of the nipple area in your breast.
Sometimes discharge from your nipples is okay and will get better on its own. You are more likely to have nipple discharge as you get older and if you have been pregnant at least once. Nipple discharge is usually not a symptom of breast cancer.
Here are some reasons for nipple discharge:
Cancers that can cause nipple discharge are:
Nipple discharge that is NOT normal is:
Nipple discharge is more likely to be normal if:
The color of the discharge does not tell you whether it is normal or not. The discharge can look milky, clear, yellow, green, or brown.
Exams and Tests
Tests that may be done may include:
In most cases, nipple problems are not breast cancer. These problems will either go away with the right treatment, or they can be watched closely over time. If unsure, make an appointment with your doctor to verify.
Warning signs to look out for in BSE
See your doctor if you have any of these warning signs. Most lumps or changes in the breast are not cancer but it is important that you see your doctor about them right away.
During the process, a female radiographer will put your breast between two flat plastic plates and compress for a few seconds. This is performed on one breast at a time. Some discomfort may be felt but it is important for the breast tissue to be compressed in order to take a clear X-ray.
You may want to have your examination 1 to 2 weeks after your menstrual period ends, if you are still menstruating; your breasts are less likely to be tender at that time.
This is the most common type of breast cancer (also known as Infiltrating or Infiltrating ductal carcinoma). It starts developing in the milk ducts of your breast, but breaks out of the duct tubes, and invades, or infiltrates the surrounding tissue of the breast. Over time, invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body. Invasive ductal carcinoma accounts for about 8 out of 10 of all invasive breast cancers. Although this can affect women at any age, it is more common as women grow older.
DCIS is an early form of breast cancer. You may hear it described as a pre-cancerous, intraductal or non-invasive cancer, which means the cancer cells are inside the milk ducts or in situ and have not developed the ability to spread either within or outside the breast.
Invasive lobular breast cancer starts in cells that make up the lobules at the end of the ducts. Breast tissue is made up of ducts and lobules where milk is made, stored and carried through to the nipple during breastfeeding.
Invasive lobular breast cancer is uncommon, and affects about 10-15% of all women with breast cancer. It can occur at any age, but more commonly affects women in the 45-55 year age group.
Men can also get invasive lobular breast cancer but this is very rare. It is generally no more serious than other types of breast cancer. However, it is sometimes found in both breasts at the same time and there is also a slightly greater risk of it occurring in the opposite breast at a later date.
In patients with inflammatory breast cancer, the reddened appearance is caused by breast cancer cells blocking tiny channels in the breast tissue called lymph channels.
The lymph channels are part of the lymphatic system involved in the body’s defence against infections. Inflammatory breast cancer is a rare type of breast cancer, accounting for only 1-2% of all breast cancers.
Paget’s disease of the breast is an uncommon form of breast cancer. This type of breast cancer starts in the breast ducts and spreads to the skin of the nipple and the areola the dark circle around the nipple. It occurs in around 1% of all women with breast cancer. Men can also get Paget disease but this is very rare.
Like all cells of the body, a man’s breast duct cells can undergo cancerous changes. But breast cancer is less common in men because their breast duct cells are less developed than those of women and because they normally have lower levels of female hormones that affect the growth of breast cells.
Hereditary breast cancer is cancer that runs in a family. Hereditary breast cancer can develop when a faulty gene is passed on from either parent. Most breast cancer is not hereditary. About 5% to 10% of breast cancers are thought to be hereditary, caused by abnormal genes passed from parent to child.
BRCA1 and BRCA2 genes
Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (Breast Cancer gene one) and BRCA2 (Breast Cancer gene two).
Everyone has BRCA1 and BRCA2 genes. The function of the BRCA genes is to repair cell damage and keep breast cells growing normally. But when these genes contain abnormalities or mutations that are passed from generation to generation, the genes don’t function normally and breast cancer risk increases. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers, or 1 out of every 10 cases.
There are four stages: stage 1 and 2 cancers are early; stage 3 cancers are locally advanced (large breast cancers greater than 5cm) and stage 4 cancers have spread to elsewhere (M+).
Part of the staging is to perform certain tests to determine whether the cancer has spread:
Metastases are little islands of tumour cells that have spread from the primary cancer and taken root in distant tissues and organs. It is these metastases that eventually cause death. Doctors detect metastases with various methods.
Note that a cancer has to be at least 5mm in size or be symptomatic for these tests to positive for cancer.
The aim of treatment is to stop any spread of the cancer and, if possible to remove all cancer from the body. In deciding on the most suitable treatment, your Doctor will consider the size of the tumour, the type of breast cancer and whether the tumour has spread to the lymph nodes or other parts of the body. The lymph nodes in the armpit are of particular importance.
(FALSE) Only about 5% to 10% of breast cancer cases are thought to be the result of gene defects (called mutations) inherited from a parent. The lifetime risk for breast cancer can be as high as 80% for members of some families who inherit certain mutations of BRCA genes. The risk is not nearly as high for most women with a family history of breast cancer. On average, having 1 first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a woman’s risk, and having 2 first-degree relatives triples her risk. About 20% to 30% of women with breast cancer have a family member with this disease (although most of these families do not have abnormal BRCA genes). This means that most women (70% to 80%) who get breast cancer do not have a family history of this disease.
(FALSE) The American Cancer Society no longer recommends that all women routinely perform monthly breast self-exams (BSE). Instead the Society emphasizes breast awareness, which means knowing how your breasts look and feel and being alert to any changes in your breasts that you may notice while showering, dressing, etc. Research has shown that breast awareness seems to be more effective for detecting breast cancer than a formal monthly BSE. When women find their own breast cancer it is usually while bathing, showering or dressing, and less often during a specific BSE. Women who still want to do monthly BSE in addition to being aware of breast changes throughout the month should ask their health care providers for instruction on how to do this exam most effectively.
Women who notice lumps or any other changes in their breasts should contact their doctor immediately even after a recent, normal mammogram. Although a woman’s awareness of changes in her breasts is important, having mammography done according to guidelines saves more lives, because mammograms can find many cancers that are far too small to be felt; it is these small cancers that are most likely to be curable.
(FALSE) Skin irritation or dimpling, nipple pain or retraction (turning inward), redness or scaliness of the nipple or breast skin, or a discharge other than breast milk can also be important warning signs for breast cancer. In one uncommon but aggressive form of breast cancer called inflammatory breast cancer, or IBC, women usually do not notice a lump, and the only symptoms may be redness and thickening of the skin covering the breast, sometimes together with swelling of the breast. It is important not to ignore these changes or assume they are the result of an infection. If you have breast changes like these, get checked by a doctor.
Cancer Prevention: Importance of A Healthy Lifestyle
Common Breast Problems
Breast Cancer Factsheet
Women Screening Timeline
Breast Self Examination
Dietary and Lifestyle Changes to prevent Cancer
Oncoplastic Surgery – The Art of Breast Cancer Management
Breast Cancer Fast Facts
1) Breast Care Begins With Being Breast Aware
Fuller Health Issue 4