Breast cancer is the most common cancer among woman globally. 

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Breast cancer starts when cells in the breast begin to grow out of control.

These cells usually form a tumor that can often be seen on an x-ray or felt as a Breast lump.

 

The tumor is malignant (cancer) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer occurs almost entirely in women, but men can get breast cancer, too.

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Breast cancer survival rates have increased, and the number of deaths associated with this disease is steadily declining, largely due to factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease.

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Where breast cancer starts

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Although many types of breast cancer can cause a lump in the breast, not all do.  Many breast cancers are found on screening mammograms which can detect cancers at an earlier stage, often before they can be felt, and before symptoms develop.

 

There are other symptoms of breast cancer you should watch for and report to a health care provider.

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t’s also important to understand that most breast lumps are benign and not cancer (malignant). 

Non-cancerous breast tumors are abnormal growths, but they do not spread outside of the breast and they are not life threatening. But some benign breast lumps can increase a woman's risk of getting breast cancer. Any breast lump or change needs to be checked by a health care professional to determine if it is benign or malignant (cancer) and if it might affect your future cancer risk.

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A risk factor is anything that affects your chance of getting a disease, such as breast cancer. But having a risk factor, or even many, does not mean that you are sure to get the disease. 

Certain breast cancer risk factors are related to personal behaviors, such as diet and exercise. 

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Breast Cancer Risk Factors

 

1. Drinking alcohol

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Drinking alcohol is clearly linked to an increased risk of breast cancer.

The risk increases with the amount of alcohol consumed.

Compared with non-drinkers, women who have 1 alcoholic drink a day have a very small increase in risk.

Those who have 2 to 3 drinks a day have about a 20% higher risk compared to women who don’t drink alcohol.

Excessive alcohol consumption is known to increase the risk of other cancers, too.

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2. Being overweight or obese

Being overweight or obese after menopause increases breast cancer risk.

Before menopause your ovaries make most of your estrogen, and fat tissue makes only a small amount.

After menopause (when the ovaries stop making estrogen), most of a woman’s estrogen comes from fat tissue. Having more fat tissue after menopause can raise estrogen levels and increase your chance of getting breast cancer. 

Also, women who are overweight tend to have higher blood insulin levels.

Higher insulin levels have been linked to some cancers, including breast cancer.

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Still, the link between weight and breast cancer risk is complex.

For instance, risk appears to be increased for women who gained weight as an adult, but may not be increased among those who have been overweight since childhood. Also, excess fat in the waist area may affect risk more than the same amount of fat in the hips and thighs. Researchers believe that fat cells in various parts of the body have subtle differences that may explain this.

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3. Not being physically active

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Evidence is growing that regular physical activity reduces breast cancer risk, especially in women past menopause. The main question is how much activity is needed. Some studies have found that even as little as a couple of hours a week might be helpful , although more seems to be better.

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Exactly how physical activity might reduce breast cancer risk isn’t clear, but it may be due to its effects on body weight, inflammation, hormones, and energy balance.

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4. Childbirth status

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Women who have not had children or who had their first child after age 30 have a slightly higher breast cancer risk overall.

Having many pregnancies and becoming pregnant at an early age reduces breast cancer risk. Still, the effect of pregnancy seems to be different for different types of breast cancer. 

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5. Not breastfeeding

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Some studies suggest that breastfeeding may slightly lower breast cancer risk, especially if it’s continued for 1½ to 2 years. .

The explanation for this possible effect may be that breastfeeding reduces a woman’s total number of lifetime menstrual cycles (the same as starting menstrual periods at a later age or going through early menopause).

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6. Birth control

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Some birth control methods use hormones, which might increase breast cancer risk.

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Oral contraceptives: Most studies have found that women using oral contraceptives (birth control pills) have a slightly higher risk of breast cancer than women who have never used them. Once the pills are stopped, this risk seems to go back to normal over time. Women who stopped using oral contraceptives more than 10 years ago do not appear to have any increased breast cancer risk.

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Birth control shot: Depo-Provera is an injectable form of progesterone that’s given once every 3 months for birth control. Some studies have found that women currently using birth-control shots seem to have an increase in breast cancer risk, but it appears that there is no increased risk in women 5 years after they stop getting the shots.

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Birth control implants, intrauterine devices (IUDs), skin patches, vaginal rings: These forms of birth control also use hormones, which in theory could fuel breast cancer growth. Some studies have shown a link between use of hormone-releasing IUDs and breast cancer risk, but few studies have looked at the use of birth control implants, patches, and rings and breast cancer risk.

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When thinking about using hormonal birth control, women should discuss their other risk factors for breast cancer with their health care provider.

 

7. Hormone therapy after menopause

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Hormone therapy with estrogen (often combined with progesterone) has been used for many years to help relieve symptoms of menopause and help prevent osteoporosis (thinning of the bones). This treatment goes by many names, such as post-menopausal hormone therapy(PHT), hormone replacement therapy (HRT), and menopausal hormone therapy (MHT).

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There are 2 main types of hormone therapy. For women who still have a uterus (womb), doctors generally prescribe estrogen and progesterone (known as combined hormone therapyor HT). Progesterone is needed because estrogen alone can increase the risk of cancer of the uterus. For women who’ve had a hysterectomy (who no longer have a uterus), estrogen alone can be used. This is known as estrogen replacement therapy (ERT) or just estrogen therapy (ET).

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Combined hormone therapy (HT): Use of combined hormone therapy after menopause increases the risk of breast cancer. It may also increase the chances of dying from breast cancer. This increase in risk can be seen with as little as 2 years of use. 

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The increased risk from combined HT appears to apply only to current and recent users. A woman’s breast cancer risk seems to return to that of the general population within 5 years of stopping treatment.

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Estrogen therapy (ET): The use of estrogen alone after menopause does not seem to increase the risk of breast cancer much, if at all. But when used long term (for more than 15 years), ET has been found to increase the risk of ovarian and breast cancer in some studies.

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The decision to use HT should be made by a woman and her doctor after weighing the possible risks and benefits (including the severity of her menopausal symptoms), and considering her other risk factors for heart disease, breast cancer, and osteoporosis. If they decide she should try HT for symptoms of menopause, it’s usually best to use it at the lowest dose that works for her and for as short a time as possible.

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8. Age 

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A woman's risk of breast cancer increase with age.

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9. Breast cancer gene 1 (BRCA 1 ) and Breast cancer gene 2 (BRCA2 ) Mutation.

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The normal role of BRCA gene 1 &2 in our body is to repair damaged DNA in our cell; therefore, mutation of these genes (which impair their ability to fix DNA) can allow cancer to develop. Although the exact increase in breast cancer risk associated with BRCA mutations cannot be stataed with certainty, we do know that woman with BRCA gene mutations have a risk higher than the lifetime risk of 11-12 percent for the general female population. 

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If a daughter has a parent with a known BRCA 1 or 2 mutation, she has 50 percent chance of inheriting the altered BRCA gene and an increased likelihood to develop cancer and in the future she also has 50 percent chance of passing it on to her children.

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10. Exposure to mutagenic substance in the environment.

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Most DNA mutations that result in breast cancer are probably caused by exposure to various mutagenic substances in the environment; high dose radiation, carcinogens (cancer causing substances) consumed from food/ drink, and cigarette  smoke. 

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It is believed that about 90 percent of all breast cancers are the result of sporadic mutations in our DNA.

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11. Family history of breast cancer but no BRCA gene mutations

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If you have a strong family history of breast cancer (onset prior to age 45, two or more fisrt degree relatives affected) and you test negative for BRCA gene mutations you should still increase monitoring for early signs of breast cancer.

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12. Gender 

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Breast cancer is almost exclusively a women's disease.

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13. Menstrual Cycles

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Woman who begin menstruating at an early age (before age 12) and those who reach menopause after age 50 have an increased risk of breast cancer.

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14. Previous Breast cancer 

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Woman who have had breast cancer in one breast are 3 to 4 times as likely to develop breast cancer in other breast.

 

Prevention

 

Can I Lower My Risk of Breast Cancer?

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There is no sure way to prevent breast cancer.

But there are things you can do that might lower your risk.

Many risk factors are beyond your control, such as being female and getting older.

But other risk factors can be changed and may lower your risk.

 

For women who are known to be at increased risk for breast cancer, there are additional steps that might reduce the risk of developing breast cancer.

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1. Be physically active: 

Many studies have shown that moderate to vigorous physical activity is linked with lower breast cancer risk, so it’s important to get regular physical activity. 

Exercise most days of the week. Aim for at least 30 minutes of exercise on most days of the week

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Vigorous activities are performed at a higher intensity. They cause an increased heart rate, sweating, and a faster breathing rate. Activities that improve strength and flexibility, such as weight lifting, stretching, or yoga, are also beneficial.

 

2. Limit or avoid alcohol:

Alcohol also increases risk of breast cancer.

Even low levels of alcohol intake have been linked with an increase in risk of any cancers

Drink alcohol in moderation, if at all. Limit the amount of alcohol you drink to no more than one drink a day, if you choose to drink.

 

3. Breast exam

Ask your doctor about breast cancer screening.Discuss with your doctor when to begin breast cancer screening exams and tests, such as clinical breast exams and mammograms.

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4. Choose a healthy diet.

Women who eat a Mediterranean diet supplemented with extra-virgin olive oil and mixed nuts may have a reduced risk of breast cancer. The Mediterranean diet focuses mostly on plant-based foods, such as fruits and vegetables, whole grains, legumes, and nuts. People who follow the Mediterranean diet choose healthy fats, such as olive oil, over butter and fish instead of red meat.

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5. Breast-feed. 

Breast-feeding might play a role in breast cancer prevention. The longer you breast-feed, the greater the protective effect.

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5. Limit postmenopausal hormone therapy. 

Combination hormone therapy may increase the risk of breast cancer. Talk with your doctor about the benefits and risks of hormone therapy.To reduce the risk of breast cancer, use the lowest dose of hormone therapy possible for the shortest amount of time.

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5. Medicines to lower breast cancer risk

Prescription medicines can be used to help lower breast cancer risk in certain women at higher risk of breast cancer. 

Medicines such as tamoxifen and raloxifene block the action of estrogen in breast tissue.

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5. Preventive surgery. 

Women with a very high risk of breast cancer may choose to have their healthy breasts surgically removed (prophylactic mastectomy). They may also choose to have their healthy ovaries removed (prophylactic oophorectomy) to reduce the risk of both breast cancer and ovarian cancer.

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Is there a link between diet/vitamins and breast cancer risk?

The possible link between diet and breast cancer risk is not clear, but this is an active area of study. A diet that is rich in vegetables, fruit, poultry, fish, and low-fat dairy products has been linked with a lower risk of breast cancer in some studies. But it is not clear if specific vegetables, fruits, or other foods can lower risk. And most studies have not found that lowering fat intake has much of an effect on breast cancer risk.

But this does not mean that there’s no point in eating a healthy diet. A diet low in fat, low in processed and red meat, and high in fruits and vegetables can clearly have other health benefits, including lowering the risk of some other cancers.

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So far, no study has shown that taking vitamins or other supplements reduces the risk of breast cancer (or any other cancer).

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Signs and Symptoms

Signs and symptoms of breast cancer may include:

• A breast lump or thickening that feels different from the surrounding tissue

• Change in the size, shape or appearance of a breast

• Changes to the skin over the breast, such as dimpling

• A newly inverted nipple

• Peeling, scaling, crusting or flaking of the pigmented area of skin surrounding the nipple (areola) or breast skin

• Redness or pitting of the skin over your breast, like the skin of an orange

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Causes

Doctors know that breast cancer occurs when some breast cells begin to grow abnormally.

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Researchers have identified hormonal, lifestyle and environmental factors that may increase your risk of breast cancer. But it's not clear why some people who have no risk factors develop cancer, yet other people with risk factors never do.

 

It's likely that breast cancer is caused by a complex interaction of your genetic makeup and your environment.

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Diagnosis​

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Tests and procedures used to diagnose breast cancer include:

• Breast exam. Your doctor will check both of your breasts and lymph nodes in your armpit, feeling for any lumps or other abnormalities.

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• Mammogram. A mammogram is an X-ray of the breast. Mammograms are commonly used to screen for breast cancer. If an abnormality is detected on a screening mammogram, your doctor may recommend a diagnostic mammogram to further evaluate that abnormality.

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• Breast ultrasound. Ultrasound uses sound waves to produce images of structures deep within the body. Ultrasound may be used to determine whether a new breast lump is a solid mass or a fluid-filled cyst.

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• Removing a sample of breast cells for testing (biopsy). A biopsy is the only definitive way to make a diagnosis of breast cancer. During a biopsy, your doctor uses a specialized needle device guided by X-ray or another imaging test to extract a core of tissue from the suspicious area. Often, a small metal marker is left at the site within your breast so the area can be easily identified on future imaging tests.

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• Biopsy samples are sent to a laboratory for analysis where experts determine whether the cells are cancerous. A biopsy sample is also analyzed to determine the type of cells involved in the breast cancer, the aggressiveness (grade) of the cancer, and whether the cancer cells have hormone receptors or other receptors that may influence your treatment options.

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• Breast magnetic resonance imaging (MRI). An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. Before a breast MRI, you receive an injection of dye. Unlike other types of imaging tests, an MRI doesn't use radiation to create the images.

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Treatment

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Treatment of breast cancer are  invasive procedure, it means the procedure is  likely to put you harm from the side effects. However the treatment is done to prevent the cancer from spreading and also to prolonged life time survival. As all the procedure could not be avoided once you had Breast cancer, it is much better to prevent than to cure.

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Breast cancer treatment :

Breast cancer surgery
Chemotherapy for breast cancer
Radiation therapy for breast cancer