Cancer is a disease characterized by the uncontrolled growth and spread of abnormal cells in the body. Breast cancer specifically refers to cancer that forms in the cells of the breast. To understand breast cancer better, let’s first understand the basic structure of the breast.

How breast is structured?

A breast is made up of three main parts: Lobules, Ducts, and Connective Tissue.

Lobules: These are the glands within the breast responsible for producing milk. They are often referred to as milk glands or milk-producing glands. 

Ducts: These are the tubes or passages within the breast that carry milk from the lobules to the nipple during breastfeeding. 

Connective Tissue: This tissue provides structural support to the breast and surrounds the lobules and ducts. The connective tissue plays a crucial role in maintaining the integrity and function of the breast.

What is Breast Cancer?

Breast cancer starts when cells in the breast grow and divide too quickly, forming a lump called a tumor. If these abnormal cells spread to other parts of the breast or body, it’s called metastasis. This can happen through the bloodstream or lymphatic system, which helps fight infections.

Usually, breast cancer begins in the milk-producing glands called lobules or the ducts that carry milk to the nipple. Sometimes, it starts in the fatty and fibrous tissue of the breast.

Both women and men can get breast cancer, but it’s much more common in women. It’s a leading cause of cancer deaths among women worldwide, though mortality rates have been decreasing thanks to better awareness, regular screenings, and advanced treatments.

What are the different types of Breast Cancer?

The type of breast cancer depends on which part of the breast the cancer originated. This could be the milk ducts, the milk-producing lobules, the connective tissues etc.

Oncologists determine cancer types and subtypes so they can tailor treatment to be as effective as possible with the fewest possible side effects.

Common types of breast cancer include:

1. Ductal Carcinoma in Situ (DCIS): This is an early, treatable stage of breast cancer that begins in a milk duct. It’s the most common non-invasive type, but if untreated or mistreated, it can become invasive over time.
2. Invasive Ductal Carcinoma (IDC): This is the most common type of breast cancer, starting in a milk duct and spreading to surrounding breast tissue. It can also spread to other parts of the body.
3. Invasive Lobular Carcinoma (ILC): Beginning in milk-producing lobules, this type can spread beyond the lobules and to other parts of the body. It’s less common than IDC.
4. Inflammatory Breast Cancer (IBC): A rare and aggressive type causing redness, swelling, and warmth in the breast. It’s challenging to detect early and tends to strike earlier than other types.
5. Paget Disease of the Breast: A rare cancer affecting the nipple and areola, causing redness, itching, and sometimes discharge. It’s often linked with underlying invasive breast cancer.
6. Metaplastic Breast Cancer: Extremely rare and invasive, starting in a milk duct and forming large tumors with unusual cell appearances. It’s difficult to diagnose.
7. Angiosarcoma of the Breast: A rare tumor of breast tissue, occurring without a known cause or sometimes linked to previous breast radiation exposure.

Breast cancer subtypes:

Oncologists classify breast cancer subtypes by receptor cell status. Receptors are protein molecules in or on cells’ surfaces. They can attract or attach to certain substances in the blood, including hormones like estrogen and progesterone.

Estrogen and progesterone help cancerous cells to grow. Finding out if cancerous cells have estrogen or progesterone receptors helps Oncologists plan breast cancer treatment.

Subtypes include:

• ER-positive (ER+) breast cancers have estrogen receptors.
• PR-positive (PR+) breast cancers have progesterone receptors.
• HR-positive (HR+) breast cancers have estrogen and progesterone receptors.
• HR-negative (HR-) breast cancers don’t have estrogen or progesterone receptors.
• HER2-positive (HER2+) breast cancers, which have higher than normal levels of the HER2 protein. This protein helps cancer cells to grow. About 15% to 20% of all breast cancers are HER2-positive.

How do I know if I have breast cancer?

Breast cancer is one of the most common types of cancer affecting women worldwide. While it can also occur in men, it predominantly affects women. Early detection is key to successful treatment and improved outcomes. Understanding the signs and symptoms of breast cancer is crucial for timely diagnosis and intervention.

Following ae common signs and symptoms of breast cancer. Recognizing these potential warning signs can help to seek medical attention promptly.

1. Breast Lumps or Masses: Feeling a lump or mass in your breast or underarm area is one of the most common signs of breast cancer. However, not all lumps are cancerous, but it’s important to have any new or unusual lumps checked by a healthcare provider.
2. Changes in Breast Size or Shape: Noticeable changes in the size or shape of one or both breasts could be a sign of breast cancer. This may include swelling, asymmetry, or changes in contour.
3. Changes in the Skin: Breast cancer can cause changes in the skin texture or appearance of the breast. Look out for dimpling, puckering, thickening, redness, rash-like appearance, or peeling of the skin.
4. Nipple Abnormalities: Changes in the nipples, such as nipple retraction or inversion, persistent nipple tenderness, discharge (especially if it’s bloody or clear), or changes in nipple appearance, should be evaluated.
5. Breast Pain: While breast pain is not typically a common symptom of breast cancer, persistent, unexplained breast pain or discomfort should be assessed by a healthcare provider.
6. Swollen Lymph Nodes: Breast cancer can cause lymph nodes under the arm or around the collarbone to become enlarged or swollen. If you notice a lump or swelling in the armpit area, it should be evaluated.

It’s important to remember that experiencing one or more of these symptoms does not necessarily mean you have breast cancer. Many breast changes are benign (non-cancerous). However, if you notice any of these signs or symptoms, it’s essential to see a doctor for further evaluation.

Regular breast self-exams, clinical breast exams by healthcare providers, and screening mammograms are important for early detection and prevention of breast cancer.

If you have concerns about your breast health or notice any changes, don’t hesitate to seek medical attention. Early detection and treatment can significantly improve outcomes.

What factors contribute to the development of breast cancer?

Breast cancer can develop due to a combination of Genetic, Hormonal, Environmental, and Lifestyle Factors. While the exact cause of breast cancer is often unclear, several known risk factors can increase a person’s likelihood of developing the disease.

Here are some common causes and risk factors associated with breast cancer:

1. Genetic Factors: Inherited mutations in certain genes, such as BRCA1 and BRCA2, can significantly increase the risk of developing breast cancer. However, most cases of breast cancer are not hereditary.
2. Hormonal Factors: Hormonal imbalances, particularly high levels of estrogen, can contribute to the development of breast cancer. Factors that may increase estrogen levels include early menstruation, late menopause, hormone replacement therapy, and certain types of birth control pills.
3. Age: The risk of breast cancer increases with age, with the majority of cases occurring in women over the age of 50.
4. Family History: A family history of breast cancer, especially in first-degree relatives (such as a mother, sister, or daughter), can increase the risk of developing the disease.
5. Personal History: A personal history of breast cancer or certain benign breast conditions can increase the risk of developing breast cancer in the future.
6. Reproductive Factors: Factors such as never having children or having children later in life, as well as starting menstruation at an early age, may increase the risk of breast cancer.
7. Lifestyle Factors: Certain lifestyle choices, such as excessive alcohol consumption, smoking, being overweight or obese, and lack of physical activity, can increase the risk of breast cancer.
8. Environmental Factors: Exposure to radiation, such as radiation therapy for previous cancers, may increase the risk of developing breast cancer.

It’s important to note that having one or more risk factors does not necessarily mean that a person will develop breast cancer. Conversely, some individuals with no known risk factors may still develop the disease. Additionally, many cases of breast cancer occur in individuals with no family history of the disease. Regular screenings, early detection, and lifestyle modifications can help reduce the risk of breast cancer and improve overall breast health.

How is breast cancer diagnosed?

Diagnosing breast cancer typically involves a combination of medical history evaluation, physical examination, imaging tests, and tissue sampling (biopsy)

1. Medical History and Physical Examination:
   • During a medical history evaluation, the doctor will inquire about any symptoms, risk factors, or family history of breast cancer.
   • A thorough physical examination of the breasts and nearby lymph nodes helps detect any abnormalities such as lumps, changes in size or shape, or skin dimpling.
2. Imaging Tests:
   • Mammogram: A mammogram is a low-dose X-ray of the breast tissue used to detect abnormalities like masses or calcifications. It is a vital screening tool for early detection, especially for women aged 40 and older.
   • Breast Ultrasound: Ultrasound uses sound waves to produce images of breast tissue. It helps distinguish between solid masses and fluid-filled cysts.
   • Magnetic Resonance Imaging (MRI): MRI provides detailed images of the breast and is often used in conjunction with mammography for high-risk individuals or to further evaluate abnormalities found on other imaging tests.
   • Positron Emission Tomography-Computed Tomography (PET-CT) scans are instrumental in breast cancer diagnosis, providing comprehensive insights into disease progression and staging. By detecting metabolic activity, PET-CT scans pinpoint primary tumors, metastases, and lymph node involvement with remarkable precision.
3. Tissue Sampling (Biopsy):
   • If an abnormality is detected on imaging tests or during a physical examination, a biopsy is performed to obtain a tissue sample for further analysis.
   • Types of biopsies include:
     • Fine Needle Aspiration (FNA): A thin needle is used to withdraw cells from the suspicious area.
     • Core Needle Biopsy: A larger needle is used to remove small tissue samples.
     • Surgical Biopsy: A surgical procedure is performed to remove a larger portion of the suspicious tissue.
   • The tissue sample is then examined by a pathologist to determine if cancer is present, and if so, what type and subtype.
4. Immunohistochemistry:  Immunohistochemistry (IHC) are used to test hormone receptors. IHC is commonly used to diagnose cancer, predict treatment response and determine likely outcomes (prognosis) of the disease.
5. Genetic Tests: Genetic tests are used to identify mutations that cause breast cancer. These tests help determine a patient’s risk of developing breast cancer and guide treatment decisions. Understanding genetic predispositions enables tailored therapies, such as targeted medications and preventive measures like prophylactic surgery. Additionally, genetic testing indicates potential risk of breast cancer among family members. 

What are the stages of breast cancer?

Breast cancer staging helps determine the extent of the disease, guiding treatment decisions and predicting prognosis. Staging helps oncologists determine appropriate treatment plans, which may include surgery, chemotherapy, radiation therapy, hormone therapy, targeted therapy, or a combination of these approaches, tailored to the individual patient’s needs and disease characteristics.

TNM Staging: One of the most common ways of staging cancer is called the TNM system.

• T – Size of the tumor
• N – Status of the lymph nodes
• M – Spread or Metastasis of the cancer.  

The stages of breast cancer are typically categorized into the following:

• Stage 0: The disease is noninvasive, meaning it hasn’t spread from breast ducts to other parts of your breast.
• Stage I: There are cancerous cells in nearby breast tissue.
• Stage II: The cancerous cells have formed a tumor or tumors. The tumor is either smaller than 2 centimeters across and has spread to underarm lymph nodes or larger than 5 centimeters across but hasn’t spread to underarm lymph nodes. Tumors at this stage can measure anywhere between 2 and 5 centimeters across, and may or may not affect the nearby lymph nodes.
• Stage III: There’s breast cancer in nearby tissue and lymph nodes. Stage III is usually referred to as locally advanced breast cancer.
• Stage IV: Cancer has spread from your breast to areas like your bones, liver, lungs or brain.

How is breast cancer treated?

Breast cancer treatment is a comprehensive journey, encompassing surgery, adjuvant therapies, and emerging treatments tailored to each patient’s needs. Advances in medical science continue to expand treatment options and improve outcomes, offering hope and healing to individuals affected by breast cancer. Common modalities used in breast cancer treatment are – 

1. Surgical Interventions:
   • Lumpectomy: Also known as Breast-Conserving Surgery (BCS), this procedure involves removing the tumor and a small margin of surrounding tissue, preserving as much of the breast as possible.
   • Mastectomy: In cases where lumpectomy isn’t feasible, a mastectomy may be recommended, involving the removal of the entire breast tissue.
2. Adjuvant Therapies:
   • Chemotherapy: Administered orally or intravenously, chemotherapy targets rapidly dividing cancer cells throughout the body, reducing the risk of recurrence and metastasis.
   • Radiation Therapy: High-energy beams target the affected breast tissue or lymph nodes, destroying cancer cells and reducing the likelihood of recurrence.
   • Hormone Therapy: For hormone receptor-positive breast cancers, medications like tamoxifen or aromatase inhibitors are prescribed to block the effects of estrogen on cancer cells, slowing down tumor growth.
   • Targeted Therapy: Drugs like Herceptin target specific proteins present in certain types of breast cancer cells, disrupting their growth and spread.
3. Emerging Treatments:
   • Immunotherapy: Harnessing the body’s immune system to recognize and destroy cancer cells, immunotherapy shows promise in treating certain types of breast cancer.
   • Precision Medicine: Genetic testing helps identify specific mutations driving cancer growth, allowing for targeted therapies tailored to individual patients.
4. Supportive Care:
   Throughout treatment, supportive care plays a vital role in managing side effects and improving quality of life. Services like counseling, nutritional support, and physical therapy help patients navigate the physical and emotional challenges of treatment.

Breast cancer is the most common cancer among Indian women. The incidence of breast cancer in India has been steadily rising over the past few decades.

Statistics of Breast Cancer in India in year 2022 at a glance:

Top 5 Most Frequent Cancers In India (Year 2022):

What is Breast Cancer?