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Incidence

Breast cancer is one of the commonest cancers among women worldwide with approximately 1.4 million new cases diagnosed every year. The chance of a woman having invasive breast cancer some time during her life is 1 in 8. The chance of dying from breast cancer is about 1 in 35. Breast cancer death rates have been going down. This is probably the result of finding the cancer earlier and better treatment.

Risk Factors

Many factors may influence the development of breast cancer, including:

  • Age: Most cases occur in women 50 or older; it is less common in women 35 or younger. Age is the most influential risk factor.
  • Family history: The risk is higher with a family history (especially mother, sister, and daughter) of breast and/or ovarian cancer.
  • Hormones /Childbirth The risk is higher if you had your first period before age 12, began menopause after age 55, never had children or had your first child after age 30. Postmenopausal use of hormonal therapy increases your risk of developing breast cancer.
  • Previous biopsy: If you’ve had abnormal breast biopsy results or benign breast diseases requiring biopsies, you may be at increased risk. Other breast diseases such as atypical hyperplasia, lobular or ductal carcinoma in situ are risk factors, too.
  • Education / Socioeconomic status: Women with a higher socioeconomic status and/or education tend to have fewer children and start childbearing after age 30 – both of which put them at higher risk.
  • Weight: Obesity or weight gain after menopause is a risk factor.
  • Genetic alterations: Inherited susceptibility genes BRCA1 and BRCA2 account for about five to ten percent of all breast cancer cases.

Other risk factors include

Oral contraceptive use, a diet high in saturated fats, physical inactivity, alcohol

Screening Tests

Breast cancer screening tests are performed on healthy women with no symptoms on a regular basis. Regular screening exams help catch cancer in its early stages, when it is much more likely to respond to treatment. Typical breast screening exams include:

  • Clinical breast exam: your physician will visually examine your breasts and manipulate them manually to feel for lumps or other breast changes. Clinical breast exams should be performed every one to three years beginning at age 20, and every year beginning at age 40.
  • Mammogram: Each breast is placed between two photographic plates and compressed, while an X-ray is taken of the breast tissue. Mammograms should be conducted every year beginning at age 40 and possibly earlier if a woman has certain risk factors such as inherited genetic mutations.

In addition to the screening exams above, women should also practice breast “self-awareness.” Becoming familiar with your breasts makes it much more likely that you will notice changes that may signal cancer or another health condition

Symptoms of Breast Cancer

Symptoms of breast cancer may vary from woman to woman. Women should be familiar with their breasts so that they know what feels and looks normal for them. Changes should be promptly reported to a health care provider. Many cancers are found by regular mammography after age 40 – before any symptoms are felt.

Symptoms include

  • Lump or mass in your breast
  • Enlarged lymph nodes in the armpit
  • Changes in breast size, shape, skin texture or color
  • Skin redness
  • Dimpling or puckering
  • Nipple changes or discharge
  • Nipple pulling to one side or a change in direction

Breast Cancer Diagnosis

There are several procedures that can be used to diagnose breast cancer. Not every procedure will be done for each patient. The evaluation is based upon the patient’s examination and physician recommendations.

Biopsy

a small sample of the suspicious area of the breast is removed for examination under a microscope. Biopsies can be done in the following ways:

Fine Needle Aspiration (FNA)

a thin, hollow needle is inserted into the breast to the tumor, and fluid and cells are removed from the tumor. While this test can help to determine if there is cancer present, it cannot determine if the cancer is invasive and additional biopsies may be needed if cancer is actually present.

Diagnostic Mammogram

this procedure is similar to the mammogram used for screening, but provides more detailed images of the breast tissue.

Magnetic Resonance Imaging (MRI)

images of the breast are created with powerful magnets that interact with a computer.

Ultra Sonomammogram

a special probe placed against the skin transmits sound waves, which bounce off breast tissue and are used create an image on a monitor.

TREATMENT

Surgery

Surgery is the most common treatment for breast cancer. Surgery to remove one or both breasts is called mastectomy. The entire breast is removed, along with any affected lymph nodes.

Breast-sparing surgery

is an attempt to save as much healthy breast tissue as possible. These procedures are best for treating early stage (I & II) tumors.

Radiation Therapy

Radiation therapy uses high-energy beams to destroy cancer cells. There are two types of radiation treatment for breast cancer:

  • External beam radiation the beams are aimed at the tumor from outside the body. Patients undergo radiation five days a week for a certain number of weeks.
  • Internal radiation tiny plastic tubes filled with radioactive material are implanted in the breast at the tumor site and are removed after several days. This procedure requires a hospital stay. Mammosite is a type of internal radiation.

Women who have undergone breast-sparing surgery and/or mastectomy may receive radiation afterwards to kill any lingering cancer cells. Radiation can also be used before surgery to shrink large tumors or to treat tumors in a difficult location.

Chemotherapy

Chemotherapy is the use of drugs, either alone or in combination, to kill cancer cells. In breast cancer, chemotherapy is most often used either before or after surgery, or as a primary treatment for cancer that has spread outside the breast at the time of diagnosis.

Hormone Therapy

Hormone therapy is used to prevent female hormones (estrogen, progesterone) from fueling the growth of breast tumors in some patients. Hormone therapy can involve taking drugs, either by mouth or through an injection. Tamoxifen is an example of a hormone therapy drug. Surgery to remove the ovaries in women who have not yet reached menopause is another type of hormone therapy.

Biologic Therapy

Biologic therapy is a drug treatment that helps the body’s immune system fight cancer. Trastuzumab is a type of biologic therapy that targets cells which produce excessive amounts of a protein called HER2. This protein is present in some breast cancer patients. It binds to the cells, shutting off HER2 production