Dr. Tariq Jagnarine
Family Medicine, Endocrinology/Diabetes
Cancer occurs when changes, called mutations, take place in genes that regulate cell growth. The mutations let the cells divide and multiply in an uncontrolled way. Breast cancer is cancer that develops in breast cells. Typically, the cancer forms in either the lobules or the ducts of the breast.
Lobules are the glands that produce milk, and ducts are the pathways that bring the milk from the glands to the nipples. Cancer can also occur in the fatty tissue or the fibrous connective tissue within the breast.
The uncontrolled cancer cells often invade other healthy breast tissue, and can travel to the lymph nodes under the arms. The lymph nodes are a primary pathway that help the cancer cells move to other parts of the body.
In 2020, there were 2.3 million women diagnosed with breast cancer, and there were 685,000 deaths globally. As at the end of 2020, there were 7.8 million women alive who were diagnosed with breast cancer in the past 5 years, making it the world’s most prevalent cancer. According to the latest WHO data published in 2020, breast cancer is the most common cancer seen in patients in Guyana, with a 22.6% incidence, and it is more prevalent in Indo-Guyanese women. Breast cancer can also be diagnosed in men.
The American Cancer Society (ACS) also estimates that, in 2019, more than 2,600 men were diagnosed with breast cancer, and approximately 500 died from the disease.
• 50% of new diagnosed breast cancers are explained by known risk factors
• 1 in 8 women with a new breast lump has cancer (1 in 100 if <40)
RISK FACTORS FOR BREAST CANCER
There are several risk factors that increase one’s chances of getting breast cancer. However, having any of these factors doesn’t mean there will definitely be development of the disease. Some risk factors can’t be avoided, such as family history; while other risk factors, such as quitting smoking, can be changed. Risk factors for breast cancer include:
• Age. The risk for developing breast cancer increases with age. Most invasive breast cancers are found in women over age 55 years.
• Drinking alcohol. Alcohol use disorder raises the risk of breast cancer.
• Having dense breast tissue. Dense breast tissue makes mammograms hard to read. It also increases the risk for breast cancer.
• Gender. White women are 100 times more likely to develop breast cancer than white men, and Black women are 70 times more likely to develop breast cancer than Black men.
• Genes. Women who have the BRCA1 and BRCA2 gene mutations are more likely to develop breast cancer than women who don’t. Other gene mutations may also affect their risk.
• Early menstruation. Having a period before the age of 12 years increases the risk for breast cancer.
• Giving birth at an older age. Women who have their first child after age 35 years have an increased risk for breast cancer.
• Hormone therapy. Women who took or are taking postmenopausal estrogen and progesterone medications to help reduce their signs of menopause symptoms have a higher risk for breast cancer.
• Inherited risk. If a close female relative has had breast cancer, it is an increased risk for developing it. Having no family history doesn’t exempt someone from getting breast cancer. In fact, most women who develop it have no family history of the disease.
• Late menopause starts. Women who start menopause after age 55 years are more likely to develop breast cancer.
• Never having been pregnant. Women who have never become pregnant or carried a pregnancy to full term are more likely to develop breast cancer.
• Previous breast cancer. Persons with previous breast cancer in one breast have an increased risk for developing breast cancer in the other breast, or in a different area of the previously affected breast.
• Night Shift Workers
SIGNS AND SYMPTOMS OF BREAST CANCER
In its early stages, breast cancer may not cause any symptoms. In many cases, a tumour may be too small to be felt, but an abnormality can still be seen on an ultrasound or mammogram.
If a tumour can be felt, the first sign is usually a new lump in the breast that was not there before. However, not all lumps are cancerous.
Each type of breast cancer can cause a variety of symptoms. Many of these symptoms are similar, but some can be different. Symptoms for the most common breast cancers include:
• A breast lump or tissue thickening that feels different than surrounding tissue, and has developed recently
• Breast pain
• Red, pitted skin over the entire breast
• Swelling in all or part of the breast
• A nipple discharge other than breast milk
• Bloody discharge from the nipples
• Peeling, scaling, or flaking of skin on nipples or breast
• A sudden, unexplained change in the shape or size of the breast
• Inverted nipple
• Changes to the appearance of the skin on the breasts
• A lump or swelling under the arm
Having any of these symptoms doesn’t necessarily mean it is breast cancer. For instance, pain in the breast or a breast lump can be caused by a benign cyst or other non-cancerous causes. However, if a lump is discovered in the breast, or persons are experiencing any of the symptoms mentioned, they should consult a health care provider for further examination and testing.
DIAGNOSIS OF BREAST CANCER
To determine if the symptoms are caused by breast cancer or a benign breast condition, a doctor will do a thorough physical exam in addition to a breast exam. The doctor may also request one or more diagnostic tests, to help understand the cause of the symptoms. Tests that can help diagnose breast cancer include:
• Ultrasound. A breast ultrasound uses sound waves to create a picture of the tissues deep in the breast. It is preferred in persons below the age of 30, since the breast tissue is denser and the ultrasound can help distinguish between a solid mass, such as a tumour, and a benign cyst.
• Mammogram. The most common way to see below the surface of the breast is with an imaging test called a mammogram. Many women aged 40 and older get annual mammograms to check for breast cancer.
• Breast biopsy. If breast cancer is suspected and a mammogram and an ultrasound can’t tell the cause of the mass, a breast biopsy is ordered. During this test, a tissue sample is removed from the suspicious area to be tested.
BREAST CANCER PREVENTION
While there are risk factors that cannot be controlled, following a healthy lifestyle, getting regular screening, and taking any preventive measures recommended can help reduce the risk for developing breast cancer.
• Lifestyle factors: Lifestyle factors can affect your risk for breast cancer. For instance, women who are obese have a higher risk for developing breast cancer. Maintaining a nutrient-dense diet and getting regular exercise as often as possible could help lose weight and lower the risk.
• Alcohol misuse also increases the risk. This can be having more than two drinks per day, or binge-drinking. However, one report that analysed worldwide research showed that even one drink per day increases the risk for breast cancer.
BREAST CANCER SCREENING
Having regular mammograms may not prevent breast cancer, but it can help reduce the chances that it will go undetected.
The ACS suggest that women of average risk can choose:
• To have yearly scans from the age of 40-54
• They may decide to switch to screenings every other year when they reach 55-74 years of age.
• Beyond 75 years of age, screenings are done only for women with an estimated life expectancy of 10 or more years.
The American College of Radiologists recommend screening every year, starting from 40 years of age.
Fortunately for women and men around the world, people are increasingly aware of the issues associated with breast cancer. Breast cancer awareness efforts have helped people:
• Learn what their risk factors are
• How they can reduce their level of risk
• What symptoms they should look for
• What kinds of screening they should be getting.
Join the world in bringing more awareness of breast cancer – with a theme that focuses on buddying up with one another, because no one should fight cancer alone.