Breast Cancer

Breast Cancer

This article presents an overview of breast cancer in women with emphasis on symptoms and early detection. No other disease has received the significant public health efforts and media visibility, in recent years, as breast cancer has. Breast cancer is a significant concern for women in the United States. Breast cancer is the most common cancer diagnosed in women in the United States.

 

The top 10 most common cancers diagnosed in women in the United States from 2003-2007.

Although breast cancer is typically thought of as a “women’s disease”, about 1% of people diagnosed with breast cancer are men.

Breast cancer is the second leading cause of cancer death among women in the United States.

 

The top 10 most common causes of death from cancer in women in the United States from 2003-2007.

It should be noted from the above graphs that lung cancer is a much bigger threat to women’s health than breast cancer. This emphasizes the large impact that cigarette smoking has on women’s health. According to the centers for disease control and prevention (CDC), the leading causes of death in the United States in 2010 were:

  • Heart disease: 599,414
  • Cancer: 567,628
  • Chronic lower respiratory diseases: 137,353
  • Stroke (cerebrovascular diseases): 128,842

This should further emphasize that the overall concern for a woman’s health should be to decrease risk factors for heart disease and the commonest cancers. Breast cancer receives much publicity and media fanfare; however cigarette smoking cessation would have a much larger impact on women’s health nationally than more accurate mammogram techniques.

There are established risk factors for breast cancer that can alert a woman to her risk for breast cancer. Knowing that one is at an increased risk for breast cancer can lead to several different kinds of action plans. One might undergo screening for breast cancer with mammogram, physical examination and possibly MRI at a younger age and more frequently than recommended for the average risk woman.

More dramatic measures to reduce the risk of breast cancer might include hormone blocking medications and even “prophylactic” or pre-emptive removal of the breasts with surgery before a cancer is ever found. These are less common strategies but may be considered for women with a very strong family history of breast cancer and documented breast cancer genes such as the BRCA-I gene.

There is some controversy about precisely how much a certain risk factor actually contributes to the development of breast cancer. Some of these risk factors for breast cancer include:

  • Age (older women are at an increased risk of breast cancer. If a woman lives long enough, about 1 in 8 will eventually develop a breast cancer.)
  • Nulliparity (never having had children)
  • Having close relatives with breast cancer (the risk is increased most with “first-degree” relatives such as a sister or mother and further increased if more than one has had breast cancer)
  • Having abnormal BRCA1 or BRCA2 genes
  • Having had prior breast tumors or biopsies
  • Early menarche (early age at menstruation)
  • Older age at first pregnancy
  • Obesity

There are other factors that may increase the risk of breast cancer that are being evaluated. Hormone use is one of these. At the current time, research indicates that post-menopausal women given estrogen alone probably do not have an increased risk of breast cancer. Those given combined hormone therapy (estrogen and progesterone) do have an increased risk.

Cigarette smoking may increase the risk of breast cancer.

 

Some of these risk factors are modifiable and some are not. The most important risk factors for breast cancer (age and family history) are not modifiable. Thus, knowledge of these should help guide early screening and detection.

The other component of early detection is to be aware of the symptoms of breast cancer. Unfortunately, many of the symptoms of breast cancer are not specific to breast cancer and may be difficult to interpret. Some symptoms which might indicate breast cancer include:

  • A new lump in the breast
  • New dimpling of the skin of the breast
  • New inversion of the nipple
  • Bloody nipple discharge
  • Rash of the breast / thickening and redness of the breast skin

The actual risk of cancer with the above symptoms is actually small but they are changes that should not be dismissed and should be brought to the attention of your doctor. For example, bloody nipple discharge proves to be related to breast cancer about 5% of the time. This means that 95% of women complaining of bloody nipple discharge DO NOT have breast cancer. Similarly, some women think that any new rash of the breast might indicate cancer when this is quite rare.

With advanced breast cancer, more dramatic symptoms can occur such as:

  • Swollen “knots” (i.e. lymph nodes) in the armpit
  • Bone pain or unexplained fractures
  • Unexplained weight loss
  • Ulceration of the breast skin and foul odor with drainage

Concerning symptoms or risk factors should prompt investigation of the breasts for cancer. The usual and most efficient way to do this is by receiving a complete examination by a physician, a mammogram and often an ultrasound of any palpable lumps. The combined information obtained by these three tools is known as the “triple test.” Information from this should be able to either reassure the woman that only routine screening is needed, closer follow-up is needed, or a biopsy with a sample of cells is needed.

Breast biopsy is recommended when something on x-ray or examination is concerning for cancer. An x-ray cannot diagnose breast cancer and sample of the cells is needed for a diagnosis. This is in contrast to some other cancers such as kidney or pancreatic cancer where major treatment decisions and diagnosis can often be made from x-ray imaging alone.

Fortunately, there are more treatment options than ever for breast cancer and many breast cancers are very treatable and even curable.

REFERENCES:

  1. Katz, VL; Lentz GM; Lobo RA; Gershenson DM. (2007) Katz: Comprehensive Gynecology, 5th ed. Chapter 15. Philadelphia, PA: Mosby Elsevier
  2. www.womenshealth.gov/breast-cancer/what-is-breast-cancer/
  3. US Female College Students’ Breast Health Knowledge, Attitudes, and Determinants of Screening Practices: New Implications for Health Education.Early J, Armstrong SN, Burke S, Thompson DL.J Am Coll Health. 2011 Aug-Oct;59(7):640-7.PMID: 21823959
  4. www.cdc.gov/nchs/fastats/lcod.htm
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.