Breast cancer is the most common cancer worldwide in women, although it can also affect men. With 1.7 million women diagnosed with breast cancer in 2012, most of us know someone who has had this diagnosis. Again, early detection and treatment are important in combatting this disease.
Risk factors for developing breast cancer are family history and genetic changes called DNA mutations. Having a genetic mutation may increase chances of developing breast or ovarian cancer by 20 percent, which is double the breast cancer risk in the general population. However, most incidences of breast cancers do not stem from genetic factors at all; rather mutations were induced by environmental toxins and unhealthy lifestyles.
Other important risk factors are hormone replacement therapy. A new study by the Institute of Cancer Research announced that taking the combined hormone pill “estrogen plus progesterone” for five years may increase the risk of developing breast cancer by 2.7 times while taking it for fifteen years increases the risk by 3.3 times.
Breast cancer seems to be more prevalent in developed countries and is on the rise in Europe and North America. In 2012, East Africa had the lowest number of cases of breast cancer. The main reason for this discrepancy is thought to be processed foods and sedentary lifestyle most common in developed countries.
Often, breast cancer is lumped together as one disease, but there are different forms of breast cancers. Some are identified as aggressive (invasive) while others are not aggressive (non-invasive). Some are sensitive to estrogen, progesterone, while others are not. Some are genetically driven while others are environmentally caused.
Non-Invasive Breast Cancer:
The most common non-invasive breast neoplasm is Ductal carcinoma In Situ. This means there are abnormal cells in the milk ducts of the breasts. DCIS is caused by a genetic mutation in the milk ducts, however, these mutated cells can’t invade other breast tissue. Some signs of DCIS can be a lump in the breast, nipple discharge, or a rash on the breast that does not disappear. DCIS is non-life-threatening, but it does increase the risk for recurrent breast cancer.
Lobular carcinoma In situ or lobular neoplasia is not a common form of breast cancer. It is a localized abnormal cell multiplication in the lobes of the breasts. Signs of LCIS are often silent, as it does not cause a typical lump formation. It is also often missed on routine mammograms. Since LCIS is not true cancer, it often goes undiagnosed unless a biopsy of the breast is obtained for some other reason. Identification of breast disease in this stage is helpful as LCIS can increase the risk for breast cancer in the future by 7-11%.
Invasive Breast Cancer:
The most common invasive breast cancer is called Invasive Ductal Carcinoma. It accounts for more than 80 % of breast cancers. Invasive Ductal Carcinoma is a class of breast cancer that also has several sub-classes: Medullary, Mucinoid, Papillary, and Cribriform Carcinoma. In the early stages of Invasive Ductal Carcinoma, symptoms are usually absent. However, once it advances, breast swelling, small scaly, dry patches, dimpling of the breast, pain, or a lump in the underarm can be noticed. Some risk factors are: menstruation prior to 12 years of age, beginning menopause after 55 years of age, prior chest radiation therapy, and exposure to DES, diethylstilbestrol (given to pregnant women in the 1940-1970’s to reduce chances of miscarriage.
Invasive Lobular Carcinoma (ILC) is the second most common invasive breast cancer. It accounts for about 10% of all new breast cancer diagnosis. This cancer originates in the milk-producing lobes of the breast. ILC spreads in a star-like pattern, so it creates thickening and hardening of the breast, rather than a round lump. Other signs may be the nipple turning inward or skin changes of the breast. Risk factors for ILC are age greater than 55 years old, post-menopausal hormone replacement therapy, environmental triggers such as diet, sedentary lifestyle, toxins and chemicals, and—occasionally—hereditary genes.
There are several ways to diagnose breast cancer, and patients should have options. Knowing of these options can empower the patients to discuss and choose which is right for them.
Mammography is an x-ray performed on the breast tissue. This usually is considered only a screening test and is not used as a definitive diagnostic tool. Mammograms are no longer recommended annually. Instead, the US Preventative task force recommends biannual screening starting at age 50. In the UK, mammograms are recommended every three years, whereas doctors in Europe remain skeptical on regular use of mammograms.
Ultrasounds can also be useful in detecting breast cancer. Ultrasounds do not use radiation; rather reflect sound waves off the breast tissue. It can even be more accurate in diagnosing cancers such as ILC than mammograms. Ultrasound is not often used alone for screening purposes, however. Still, having an informed discussion with your health care provider regarding this option is highly encouraged.
Breast MRI- Magnetic Resonance Imaging, uses magnetic fields, radio waves, and a computer to obtain images of tissues. MRI is useful in that it measures the tumor size in the most reliable fashion, can detect additional parts of the tumor, and can detect the stage of the malignancy, which can help with better diagnosis, treatment, and survival. Currently, MR-Breast Screening is only used in Europe and not endorsed by the US Preventative task force. However, having an informed discussion with your health care provider is endorsed by numerous European studies.
Breast Thermography is a thermal image of the breast. It measures the temperature of breast tissue, which can differentiate between healthy tissue and cancerous growth. Advantages are that it is non-invasive, non-radiative, painless, and involves no intravenous contrast.
Self-Exams Although this has fallen by the wayside in the medical community, a person’s self-breast awareness is vitally important. Things to look out for once a month are skin changes, nipple inversions or discharge, and lumps of the breast or under the arms. Breast exams may sometimes be confusing to perform. One can do it standing up in the shower, in front of a mirror, or lying down. Make sure you check using the pads of your fingers and move in a circular fashion. For further information please see (http://www.nationalbreastcancer.org/breast-self-exam).
Breast cancer can be confusing and debilitating physically and mentally. Knowing the terminology of the disease and researching different methods of testing is important. Knowledge is wisdom, and wisdom is wealth. Invest in your health by gaining more knowledge regarding your body and symptoms. With the multiple screening options available, let us not adopt an apathetic approach, rather be proactive in faith, health, and knowledge.