What is breast cancer? Breast cancer is actually a group of diseases in which cells in breast tissue change and randomly divide uncontrolled, typically resulting in a lump or mass. Most breast cancers begin in the lobules (milk glands) or in the ducts that connect the lobules to the nipple. we will discuss breast cancer symptoms as well.
This Month Is Breast Cancer Awareness Month, October is nationally recognized as Breast Cancer Awareness Month. Johnson County’s Veterans Referral Center joined the community in rallying for the cause(Breast Cancer).
In honor of Breast Cancer Awareness Month, the month for that is October, recently, the 47-year-old gorgeous actress Jennifer Garner shared a video of her annual mammogram appointment on Instagram, here in hopes of encouraging and to know to other women to get checked out.
What are the perfect signs and symptoms of breast cancer?
Breast cancer symptoms
Breast cancer typically has no symptoms when the tumor is very small and most easily treated, which is why screening is very important for early detection.
The most common breast cancer symptoms
The most common physical sign of this lump is that a painless lump. Sometimes breast cancer spreads to underarm lymph nodes and causes a lump or swelling, even before the first breast tumor is large enough to be felt.
There are very less and common signs and symptoms that actually include breast pain or heaviness; persistent changes, such as swelling, thickening, or dark red circles or redness of the skin; and nipple changes, such as spontaneous discharge (especially if bloody), scaliness, or retraction.
Any persistent change in the breast should be evaluated by a physician or doctor.
How is breast cancer diagnosed?
Breast cancer is typically detected either during cancer treatment or during screening, before symptoms have developed, or after a woman notices a lump.
Most masses were seen on a mammogram and most breast lumps turn out to be benign (not cancerous). When cancer is really suspected, tissue for microscopic analysis is usually obtained from a needle biopsy (fine-needle or larger core-needle) and really less often from a surgical biopsy.
The selection of the type of biopsy is based on multiple factors, including the size and location of the mass, as well as patient factors and preferences and resources.
What are the types of breast cancer?
Most (81%) breast cancers are invasive or infiltrating, which means the abnormal cells have broken through the walls of the glands or ducts where they originated and grown into surrounding breast tissue.
Although breast cancer was historically referred to as a single disease, it is now considered a group of diseases, consisting of four major molecular subtypes and at least 21 distinct histological subtypes (a type of tissue in which cancer originates) that differ in risk factors, presentation, response to treatment, and outcomes.
Histology is based on the size, shape, and arrangement of breast cancer cells. More than 75% of invasive breast cancers are now histologically categorized as “no special type,” historically called “ductal” carcinomas.
The most common special histologic subtype is invasive lobular carcinoma, representing about 15% of invasive breast cancers.
Tubular, mucinous, cribriform, and papillary carcinoma are rare breast cancer subtypes that are generally associated with favorable prognoses.
Inflammatory breast cancer is an uncommon but aggressive type of breast cancer that is characterized by swelling and redness of the skin of the breast.
Breast cancer molecular subtypes are determined through gene expression analysis, a costly and complicated process that is not currently standard clinical practice.
However, these subtypes can be approximated using routine methods for clinical evaluation of biological markers (ER, PR, HER2, and sometimes others). Hormone receptor-positive (HR+) cancers are those that test positive for ER or PR or both. Information about grade and proliferation (rate of cell division) is also sometimes used to assign subtypes.
The four main molecular subtypes are described below. It is worth noting that there are overlaps between categories and the clinical approximations do not perfectly correspond to the molecular breast cancer subtypes as described on the next page.
Let’s talk about how many women alive today have ever had breast cancer?
More than 3.8 million US women with a history of breast cancer were alive on January 1, 2019. Some of these women were cancer-free now, while others still had evidence of cancer and may have been undergoing treatment for breast cancer.
More than 150,000 breast cancer survivors are living with metastatic disease, three-fourths of whom were originally diagnosed with stage I-III.
Breast cancer in men is very rare, accounting for less than 1% of breast cancer cases of men in the US. However, since 1975, the incidence rate has increased slightly, from 1.0 cases per 100,000 men from 1975-1979 to 1.2 cases per 100,000 men from 2012-2016.
Male breast cancer
Men are more likely than women (51% versus 36%) to be diagnosed with advanced (regional- or distant-stage) breast cancer, which likely reflects delayed detection because of decreased awareness.
The death rate for male breast cancer has decreased slightly from 0.4 deaths per 100,000 men from 1975-1979 to 0.3 per 100,000 men during 2013- 2017 reflecting improvements in treatment.
Due to the infrequency of male breast cancer, much less is understood about the disease. Similar to women, male breast cancer risk increases with age. Other risk factors include radiation exposure, BRCA1/2 gene mutations, family history of breast or ovarian cancer, Klinefelter syndrome, testicular disorders, diabetes, gynecomastia (enlarged breasts), and obesity.
In contrast to female breast cancer, studies have found that smoking, alcohol consumption, and physical inactivity are not linked to male breast cancer.
Environmental and other risk factors for breast cancer
Radiation exposure has been shown to increase breast cancer risk in studies of atomic bomb survivors and females treated with high-dose radiation therapy to the chest between 10 and 30 years of age, such as for Hodgkin lymphoma.
This may be because breast tissue is most susceptible to carcinogens before it’s totally differentiated, which occurs with first childbirth. Breast cancer risk starts to rise about 8 years after radiation treatment and continues to be elevated for more than 35 years.
Although radiation treatments have evolved to include lower doses given over smaller areas, recent studies suggest that elevated breast cancer risk persists.
Night shift work
Most studies of nurses or any other night works who work night shifts and flight attendants who experience circadian rhythm disruption caused by crossing multiple time zones have found increased risks of breast cancer associated with long-term employment.
The elevated risk appears to be most strongly associated with shift working during early adulthood. Exposure to light at night disrupts the production of melatonin, a hormone that regulates sleep.
Experimental evidence suggests that melatonin may also inhibit the growth of small, established tumors and prevent new tumors from developing.
Based on the results of studies in humans and animals, the International Agency for Research on Cancer has concluded that shift work, particularly at night, is probably carcinogenic to humans.
There are greate factors that are not associated with breast cancer and its risk
There are persistent claims that women who have had an abortion are at increased risk for developing breast cancer based on early studies that have since been deemed methodologically flawed by the American College of Obstetricians and Gynecology.
Indeed, a large body of solid scientific evidence, including a review by a panel of experts convened by the National Cancer Institute in 2003, confirms that there is no link between breast cancer and abortion (either spontaneous or induced).
Although internet rumors have suggested that bras cause breast cancer by obstructing lymph flow, there is no scientific basis or evidence to support this claim.
A recent population-based study of more than 1,500 women found no association between wearing a bra and breast cancer.
No association has been found between breast implants and the risk of breast cancer; however, there is evidence that women with implants are at increased risk of a rare type of lymphoma.
In addition, breast implants can obstruct the view of breast tissue during mammography.
Women with breast implants should inform the mammography facility about the implants during scheduling so that additional x-ray pictures (called implant displacement views) may be used to allow for more complete breast imaging.
Chemoprevention and prophylactic surgery
- The use of drugs to reduce the risk of disease is called chemoprevention.
- Currently, the US Food and Drug Administration has approved two drugs to help lower the risk of breast cancer in high-risk women: tamoxifen and raloxifene (postmenopausal women only).
- These drugs are classified as selective estrogen receptor modulators (SERMs) because they block estrogen in some tissues of the body, but act like estrogen in others.
- A large meta-analysis, including more than 83,000 high-risk women, found that SERMs reduced breast cancer risk by 38% over 10 years.
- Although the benefit is limited to ER+ disease, these drugs lower the risk of both invasive cancer and DCIS.
- However, SERMs are associated with some side effects, including hot flashes, nausea, and fatigue. Premenopausal women taking tamoxifen can also experience menstrual changes.
- More serious side effects are rare but include blood clots and endometrial cancer.
- Clinical trials have shown that another class of drugs – aromatase inhibitors – also reduces breast cancer risk (by more than half) among high-risk postmenopausal women.
- As a result, the US Preventive Services Task Force recently expanded its recommendations to include aromatase inhibitors, as well as SERMS, for breast cancer risk reduction in high-risk women.
- Aromatase inhibitors can decrease bone density, so women taking these drugs must be monitored for osteoporosis.
- Women at very high risk of breast cancer (such as those with pathogenic BRCA gene variants) may elect prophylactic (preventive) mastectomy.
- Removal of both breasts reduces the risk of breast cancer by 90% or more. Prophylactic salpingo-oophorectomy (surgical removal of the fallopian tubes and ovaries) reduces the risk of ovarian cancer, but the benefit for breast cancer in high-risk women is less clear and may be limited to BRCA2 mutation carriers.
- Importantly, however, many women who elect prophylactic surgery would not have developed cancer. Women considering these options should discuss the benefits and limitations with their doctor, and a second opinion is strongly recommended.
Breast Cancer Screening
American Cancer Society recommendations for the early detection of breast cancer vary depending on a woman’s age and include mammography, as well as magnetic resonance imaging (MRI) for women at high risk.
The recommendations for average-risk women were most recently updated in 2015 (see box, opposite page); recommendations for women at increased risk will be updated in 2020.
- Mammography is a low-dose x-ray image of breast tissue.
- Although early mammographic images were on x-ray film, digital technology, in which a 2-dimensional (2D) image of breast tissue is captured electronically and viewed on a monitor, has largely replaced screen-film mammography.
- Digital mammography has improved sensitivity for women under age 50 and those with dense breast tissue.
- Early detection of breast cancer by mammography reduces the risk of breast cancer death and increases treatment options, including less extensive surgery and/or the use of chemotherapy with fewer side effects, and sometimes, the option to forgo chemotherapy.
- Combined analysis of breast cancer screening in randomized trials has demonstrated an overall reduction in breast cancer deaths of about 20%.
- More recent results from organized mammography programs in Europe and Canada indicate that the risk of breast cancer death was reduced by more than 40% among women who were screened.
- Women should also be informed of the limitations of mammography. Mammography will not detect all breast cancers, and some breast cancers detected by screening still have a poor prognosis.
- Mammography screening may also lead to overdiagnosis. That is, some breast tumors or lesions detected by mammography, particularly DCIS, would not have progressed or otherwise been detected without screening.
- Estimates of the prevalence of overdiagnosis vary widely because it cannot be directly measured.
- Mammography may also result in false-positive results, which lead to follow-up examinations, including biopsies when there is no cancer; false positives are more likely when women have their first screening.
- About 12% of women screened with modern digital mammography require follow-up imaging or biopsy, but most (95%) of these women do not have cancer.
- Cumulative radiation exposure from repeated mammograms may slightly increase the risk of breast cancer; however, the dose of radiation during a mammogram is relatively small and the benefit of screening likely outweighs any harm.
- Reducing radiation exposure through more effective imaging is an area of current research.
- The Affordable Care Act requires that Medicare and all new private health insurance plans fully cover screening mammograms without any out-of-pocket expense for patients.
- There are also programs, such as the CDC’s National Breast and Cervical Cancer Early Detection Program, that offer mammography services for low-income, uninsured, and underserved women.
- For more help, locating a free or very low-cost screening mammogram in your area, contact the American Cancer Society at 1-800-227-2345 number.
Best and perfect Guideline for Breast Cancer Screening
The recommendations below are for women at average risk of breast cancer (i.e., women without a personal history of breast cancer, a suspected or confirmed pathogenic genetic variation [e.g., BRCA1 or BRCA2], a strong family history, or a history of the previous radiotherapy to the chest at a young age).
All women or ladies should become familiar and connected with the potential benefits, limitations, and harms associated with breast cancer screening.
- Annual screening: Women should have the opportunity to begin annual screening at the age of 40 or between the ages of 40 and 44.
- To get an accurate result, Women ages 45 to 54 should be screened annually.
- Women ages 55 and older should transition to biennial screening or have the opportunity to continue screening annually.
- Women should continue their screening mammography as long as their overall health is good and they have a life expectancy of 10 years or more.
Prevalence of mammography
- In 2018, the prevalence of up-to-date mammography according to American Cancer Society recommendations was lower among Hispanic and Asian (55%-60%) women than NH black (66%), NH white, and AIAN (both 64%) women.
- However, studies have documented that self-reported survey data overestimate mammography screening prevalence, particularly among black and Hispanic women.
- Only 30% of uninsured women were up to date with breast cancer screening in 2018, compared to 64% of insured women.
- The prevalence of up-to-date breast cancer screening was 70% or higher among lesbian women, college graduates, and those ages 55-74 years.
- In 2016, by state, the prevalence of up-to-date mammography among women ages 45 and older ranged from 57% in Wyoming to 79% in Rhode Island.
Magnetic resonance imaging (MRI) FOr Breast Cancer
- Breast MRI uses high-powered magnets along with radio waves and computers to produce an image. In the year 2007, the American Cancer Society published recommendations for the use of MRI(Magnetic resonance imaging) for screening women at increased risk of breast cancer.
- Beginning at age 30, annual screening with MRI, in addition to mammography, is recommended for women with an estimated lifetime risk of breast cancer of at least 20%-25% due to the presence of a high-risk variation in the breast cancer susceptibility genes BRCA1 or BRCA2, a first-degree relative with a BRCA1 or BRCA2 mutation (if the woman herself has not been tested).
- A strong family history of breast and/or ovarian cancer, prior chest radiation therapy (e.g., for Hodgkin lymphoma), as well as women with Li-Fraumeni, Cowden, and Bannayan-Riley Ruvalcaba syndromes and their first-degree relatives.
- Women with an estimated 15%-20% lifetime risk, including women with dense breast tissue, should talk with their doctors about the benefits and limitations of adding MRI screening to their annual mammogram.
- MRI screening is not recommended for all women whose lifetime risk of breast cancer is less than 15%.
- Studies indicate that MRI is underutilized among high-risk women and overutilized by women who are not at high risk for breast cancer.
- MRI should supplement not replace mammography and should be done at facilities that are accredited by the American College of Radiology.
- Although MRI is more expensive than mammography, most major insurance companies will cover some portion of the cost of a woman is demonstrated to be at sufficiently high risk.
Breast Cancer Treatment
Treatment decisions are made jointly by the patient and the physician after consideration of the stage and biological characteristics of cancer, the patient’s age, menopausal status, and preferences, and the risks and benefits associated with each option.
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