Breast cancer is the 2nd most common type of cancer in women (following skin cancer) and the 2nd most common cancer-related cause of death, following lung cancer. 1 in 8 women faces the possibility of developing breast cancer in the course of her life. This means that 12.5% of women will suffer from the particular type of cancer and 3.4% will die because of it.
Diagnosis - Prevention
Diagnosis and prevention are accomplished by means of:
- a self-examination
- a clinical examination (performed by the doctor)
- a mammogram
Self-examination (examination of the breasts by the woman herself) should be performed every month at the end of menstruation, starting at the age of 25. According to recent findings, it is not necessary for women to be trained at a specific way of how to examine themselves. What is necessary is that each woman familiarizes herself with the “composition - texture” of her breasts and their shape, in other words that she “gets to know” her breasts. If she spots any change, she should consult with a surgeon.
Suspicious spots that need to be examined further are:
- Palpable lumps in the breast or armpit
- “Fattened” areas in the breast or armpit
- Inverted nipples or skin concavities
- Nipple discharge
Clinical examination (for women of the medium risk group) is performed by the surgeon after the age of 20-30 years, once every 1-3 years for women below 40 years old and annually after that (along with the preventive mammogram).
Various studies have confirmed that early diagnosis of breast cancer through a mammogram increases survival rates, as mammograms detect around 80%-90% of asymptomatic cancer. Women should start having them at the age of 40 years and continue once a year (according to the instructions of the most Organizations dealing with breast conditions). When they should stop having them is a controversial issue. They usually stop at the age of 65-70 years or when their life expectancy is shorter than 5-10 years.
Breast nodules are more usual in middle and advanced ages than in young women. In general, it should be noted that only 1 in 10 nodules are malignant. In young women a breast nodule is extremely rarely cancerous. In cases of cancer, the smaller the size of the tumor, the greater the possibilities for healing. In these cases, the possibility that the woman keeps her breast, i.e. that a tumorectomy is performed instead of a mammectomy, is also greater.
It is the discharge secreted by the nipple when women are not pregnant or breastfeeding. Its color might be whitish, greenish, yellowish or even bloody. It may be secreted by one or both mammas, one or more pores, and flow of its own account or only after pressing the nipple. The discharge might be indicative of inflammation, papilloma or cancer. So, not all discharges mean cancer, but nonetheless an expert should be consulted.
It is the “turning of skin (or nipple) to the inside”. It may be caused by an inflammation or cancer. An expert should be consulted in this case as well.
How is breast cancer treated?
Breast cancer is treated through:
- a surgical procedure
- radiation therapy
- hormonal therapy
Surgical procedure might either mean a removal of the tumor (tumorectomy) or a removal of the entire mamma (mammectomy) and simultaneous removal of one or more lymph nodes from the armpit area. Every tumorectomy and in some cases mammectomy is followed by radiation therapy. In any case of mammectomy, the breast can afterwards be restored through plastic surgery. This restoration can be carried out immediately - right after mammectomy or later.
Genetic predisposition for breast cancer
Every human being is born with 2 groups of genes. Half are inherited by their mother and half by their father. In the cases of some families, cancer results from a “damage” called mutation in some of these genes.
So, it has been found that 2 genes, BRCA1 and BRCA2 play a crucial role in breast and ovaries cancer. When they have undergone mutation, the danger of exhibiting cancer is greater than 80%. The decision for a genetic testing to determine if these genes are mutated in a woman should be made by the specialized doctor based on the woman’s family history.
In case the genetic testing comes out negative, the danger for the woman is limited to that of the general public. If, however, it is positive, the woman is considered to belong to the high-risk group for development of breast or ovaries cancer. Until the age of 70 85% of the women who present a BRCA1 mutation will exhibit breast cancer and 65% will exhibit ovaries cancer. If the gene has not undergone mutation, they face the same risk as the general public. Then, the specialized doctor will discuss with the woman the existing alternatives as to prevention, as well as the consequences to her children.
Men and breast cancer
The rate is 100 cases of cancer in women to 1 case in men. Although breast cancer is rare in men, those who have cancer or a bad history can “pass on” the predisposition/risk to their children.
Other breast conditions
Not all breast nodules are necessarily cancer. To be precise, 9 in 10 times they are not. A palpable nodule might be a fibroadenoma, a cyst, a lipoma, a hematoma etc.
They are benign breast tumors. They usually appear in young women. Six in 10 nodules appearing in women below 20 years old are fibroadenomas. It is very common that they regress (disappear), but they might grow, as well. They do not need to be removed when it is certain that they are fibroadenomas, especially if they are smaller than 4 cm.
They are fluid-filled sacs inside the mamma, and can be shaped as the tissue grows old (usually appear after the age of 30 and especially before menopause). They are treated with fluid extraction and examination.
Pain in the mamma is called mastalgia. There are 2 types of mastalgia: The cyclical one (which is associated with menstrual period and is more intense before menstruation) and the non-cyclic one (which is not associated with menstrual period). Pain in the case of non-cyclic mastalgia might result from the mamma (e.g. inflammation, trauma) or be due to causes irrelevant to the mamma, which, however, have an effect on it (such as arthropathies, intercostal neuralgia). In cases of non-cyclic mastalgia the cause of pain is treated. In cases of cyclical mastalgia, the patient needs to be reassured, as the pain regresses within a few months. In a different case, changes in the lifestyle are recommended in the first place (caffeine take-in restriction, weight loss, exercise, correct application of the brassiere etc.), while, if the pain is insistent, drugs are administered.