Breast Cancer: Symptoms, Causes, Risk Factors, Stages, and Treatment

When you think about cancer screening in women, one of the first organs that come to mind is a woman’s breasts. Breast cancer is one of the most significant health problems in women, especially if they have a family history.

In this article, we’re reviewing the most fundamental aspects of breast cancer. We’re giving you a brief walkthrough about the essentials and statistics of the disease. Then, we’re covering the signs and symptoms of breast cancer and how to do your self-exploration. You will also learn about the causes of breast cancer, the risk factors that contribute to the disease, and a summary of stages and medical treatment.

Breast cancer essentials

Breast cancer is the most common type of cancer in women and the leading cause of death by cancer in women who live in less-developed countries. Around 30% of cancers diagnosed every year in the United States are breast cancer. It mainly develops in women, but some men may also develop breast cancer.

In the early stage, breast cancer is asymptomatic, and patients may not experience discomfort or pain. Luckily, our screening technologies and doctor recommendations have led to earlier detection in most cases. Most women are diagnosed before their disease spreads or causes severe damage to the breast tissue.

The evaluation of this disease uses three steps:

Clinical examination performed by doctors and public awareness campaigns to detect breast nodules
Imaging studies, including ultrasound scants and mammography
Needle biopsy in case of a suspicious nodule

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Therapy often involves surgical resection of the mass, and different treatments follow to make sure that no trace of cancer is found in the rest of the body. The risk varies depending on the stage of cancer and other risk factors, but adjuvant chemotherapy can reduce mortality by 35 to 72%. Recent advances in medicine have also contributed to this improvement, and new drug development look for new alternatives with fewer side effects.

Signs and symptoms of breast cancer

Lung cancer in the early stages of development does not have any symptoms. Patients may not even feel discomfort or any particular sign. However, one of the earliest signs of breast cancer is the presence of a nodule in the breasts. Other patients do not notice any lump but then start experiencing signs and symptoms.

Thus, we can summarize the symptoms of breast cancer as follows:

Breast nodules

Not all breast nodules are breast cancer. In fact, only a minority of them will be breast cancer. However, they need to be evaluated by a doctor if you ever find one. Breast cancer nodules are not usually painful, and they do not come and go with your menstrual cycle. Nodules are more suspicious if they are very hard, irregular in shape, and if they are fixated on the muscles or the skin.

Change in the shape or size of the breasts

Some patients do not report any nodules, but they do have changes in the shape or size of the breasts. They start to mismatch, and the difference becomes noticeable over time.

Skin changes

They are more common as cancer grows. It can be a thickening of the skin, swelling, and redness, or skin dimpling. They result from a localized inflammation of the tissues and the creation of adherences to the skin.

Nipple abnormalities

It is usually a recent inversion of the nipple due to adherences of cancer to the skin. In other cases, we can find a spontaneous discharge of blood or ulceration of the nipple.

Axillary lump

In the case of cancer in the axillary section of the breast, it may become noticeable as the patient raises her hand. It looks like a small lump in the axilla.

Dilated veins and edema

It is possible to encounter other skin changes that point to a vascular change in the breast tissue. Dilated veins are often discovered by a skilled physician, but they are sometimes very noticeable. Edema is evidenced as an increase in size and may cause tenderness and redness of the skin.

Breathing problems

They are particularly common in women with advanced disease when cancer has spread to the lungs or is starting to compromise breathing.

Bone pain and other metastasis symptoms

Metastasis symptoms depend on the site of spread. The bones are commonly affected, causing bone pain and hypercalcemia. The patient may also have metastasis in the liver, causing abdominal distention and jaundice. Altered cognitive function and neurologic signs will be found in patients with a distant spread to the brain tissue.

How to perform your own self-examination routine?

If you want to perform a self-examination routine for breast cancer, you need first to look at the skin and see if there is any change in color, ulcers, dimpling of the skin, or changes in the nipples. Raise your arms and inspect the axilla, too.

With one hand raised, start palpating the breasts using the finger pads instead of the tip of the fingers. This increases your sensitivity. Perform the exam from the outside of the breast to the nipple with rotational movements. Use different degrees of pressure to examine more superficial and deeper layers. Then, examine your axilla and the area where the axilla joins the pectoral muscle.

What causes breast cancer?

Breast cancer is triggered by molecular alterations in breast tissue cells, usually epithelial cells in the breast ducts. These alterations have their origin in DNA changes and mutations that override cells’ natural function to divide only when needed and die if they detect alterations. This turns cancer cells into immortal cells that keep on dividing aggressively without restraint.

Several mutations have been found to trigger breast cancer, including mutations in the CDH1, MLH1, MLH2, STK11, TP53, and PTEN gene. Thus, a family history of cancer is particularly important because some patients carry more predispositions than others to display abnormalities in these genes.

Another cause of breast cancer has to do with hormones because breast cells respond and start growing in response to female sex hormones. Thus, women with a higher level of estradiol are more likely to have breast cancer. It may also be triggered by the use of hormone replacement therapy and exogenous hormones.

Risk factors

Cancer is a multifactorial disease, which means that many elements contribute to the problem, and we are often unable to trace back cancer to a single cause. Instead of avoiding the causes of breast cancer, it is more helpful to know about the risk factors.

Risk factors are circumstances and elements that increase the risk of a given disease or condition. In this case, the more risk factors for breast cancer you have, the more likely it will be to develop a malignant tumor.

The risk factors include:

Age: Increasing age is a common risk factor for breast cancer. The disease is more common in women after 40 years, and the risk increases as they age. The most affected age group is women of 50 years and older, with an incidence of 345 cases per 100,000 women. The second peak of incidence starts at age 70 years.
Family history: Having cases of breast cancer in your family increases the risk of the same disease in your case. If there’s a positive family history from your mother, you’re 4 times more likely to have breast cancer than the general population. If you have more than one first-degree relative with breast cancer, the risk is 5 times higher.
Reproductive factors: Not having any children or having them at a late age can increase the risk of breast cancer. The late age of menopause may also have the same effect.
Hormonal factors: High levels of sex hormones are associated with a higher rate of breast cancer. Thus, receiving hormone replacement therapy and taking oral contraceptives may increase the risk of this type of cancer.
Prior breast medical problems: Particularly, a prior case of breast cancer is associated with another tumor found in the contralateral breast. Women who had a solitary papilloma, breast hyperplasia, or a fibroadenoma with complex features may also double their risk of breast cancer as compared to the rest of the population. In contrast, benign fibrocystic changes of the breast are not associated with breast cancer in any way.
Lifestyle factors: The most important lifestyle risk factor is a diet consisting of processed foods and saturated fat. In contrast, the Mediterranean diet, a moderate intake of alcohol, and moderate consumption of red meat and sweets apparently have a protective effect against this type of cancer.
Obesity: The risk is higher if we follow a high-carbohydrate, high-fat diet, especially if combined with a sedentary lifestyle and obesity. Abdominal obesity is a significant risk factor, along with high insulin levels. Postmenopausal women would be at a higher risk if they gained over 20 kilograms of body weight from their initial weight when they were 18 years if they follow a western diet with moderate consumption of alcohol (more than 3 alcoholic beverages every week).
Environmental exposure: Similar to other cancers, environmental exposure to carcinogens such as radiation and tobacco smoke can increase the risk of breast cancer in women.

Stages of breast cancer

The staging of breast cancer is determined after evaluating the tumor, its spread to lymph nodes and distant organs. It uses the same TNM system as other types of cancer but adapted to breast cancer specifically.

TNM refers to Tumor (T), Lymph Nodes (N), and Metastasis (M). Each one describes the current state of the disease. After evaluating each element, the results are joined in a 5-stage category:

Stage 0: It is also known as carcinoma in situ. This type of cancer is causing no invasion to other parts of the breast or any adjacent tissue.
Stage I: This type of cancer is starting to invade surrounding tissue in the breast. Localized lymph nodes are sometimes taken in this disease. It is divided into IA (tumor of up to 2cm with no distant spread and no lymph nodes involved) and IB (tumor of up to 2cm with no distant spread and local lymph node involvement).
Stage II: Starting in stage II, breast cancer is larger than 2 centimeters and has spread to axillary lymph nodes (Stage IIA). In this group, we also have more invasive breast cancer that is up to 5cm and spreads to breastbone lymph nodes (Stage IIB).
Stage III: At this stage, we have a breast cancer larger than 5cm with severe lymph node involvement (Stage IIIA). This type of cancer can spread to the skin or the chest wall (Stage IIIB) or reach lymph nodes in the collarbone (Stage IIIC).
Stage IV: This stage includes invasive breast cancer that spreads to any area beyond the breasts, including distant metastasis.

Treatment options

Following diagnosis and staging of cancer, doctors will recommend different lines of treatment. In most cases, treatment options for breast cancer include surgery and radiotherapy. Chemotherapy is also used as adjuvant treatment, but only if there is a suspected or confirmed distant spread of cancer cells.

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The surgical approach to taking out the tumor can be lumpectomy (extraction of the tumor and its margins) or total mastectomy (extraction of the entire breast tissue). After that, radiation therapy is performed to make sure that no trace of cancer is left and reduce the recurrence rate. It can be either partial breast irradiation or external beam radiotherapy. This is the most common approach for ductal carcinoma in situ.

Chemotherapy and hormone therapy are usually recommended when suspecting an invasion or metastasis of breast cancer. They include drugs such as doxorubicin, docetaxel, methotrexate, and cyclophosphamide.

Aromatase inhibitors are also helpful, but they need to be administered with other treatments such as pamidronate or zoledronic acid and calcium-vitamin D supplements to increase bone mass in these patients.

Tamoxifen, raloxifene, and prophylactic mastectomy are sometimes considered in patients with a very high risk of breast cancer.

Your doctor will recommend one of these treatments depending on your circumstances, stage of cancer, and overall health.