Risk Factors for Breast Cancer
Symptoms of breast cancer
Evaluation & Treatment-Breast tumor
Self examination of breast
Causes of breast pain
Developing breast cancer depends on a combination of lifestyle and personal traits known as “risk factors.” The following risk factors are strongly related to the disease but having risk factor does not mean that a woman will have breast cancer.
Breast cancer especially in your mother, sister(s), or daughter(s), more so if they had it before age of 50
Personal History :
Age — in general, the older you are, the greater your risk
A history of benign breast disease that required biopsies
Other breast conditions: lobular carcinoma in situ (LCIS) or atypical hyperplasia.
Radiation therapy to chest before age of 30 is at increased risk of breast cancer.
Certain genome changes: Changes in certain genes, such as BRCA1 or BRCA2, substantially increase the risk of breast cancer
Reproductive and Menstrual History:
Never having borne a child
Having your first child after age 30
First menstrual period at an early age before 12
Late menopaue after 55
Life Style Factors:
Overweight or obese after menopause
Lack of physical activity
Lump or thickening of the breast
Dimpling or puckering of the skin
Change In skin color of the breast or its texture
Change in breast shape
Swelling, redness or heat in the breast
Discharge from the nipple
Retraction of the nipple
Women should have regular clinical breast exams and mammograms to find breast cancer early. Treatment is more likely to work well when breast cancer is detected early.
Clinical Breast Exam
Your health care provider looks for differences in size or shape between your breasts, skin of your breast is checked for a rash, dimpling, or other abnormal signs. Your nipples are inspected to check for fluid.
If you have a lump, your health care provider will feel its size, shape, and texture and mobility. Lumps that are soft, smooth, round, and movable are likely to be benign. A hard, oddly shaped lump that feels firmly attached within the breast is more likely to be cancer.
A mammogram is an x-ray of the breast. Screening mammogram is used to look for breast disease in women who are asymptomatic. Screening mammograms usually take 2 views (x-ray pictures taken from different angles) of each breast.
A diagnostic mammogram is used to diagnose breast disease in women who have breast symptoms or an abnormal result on a screening mammogram.
Limitations of mammograms
A mammogram cannot prove that an abnormal area is cancer. To confirm whether cancer is present, a small amount of tissue must be removed and looked at under a microscope. This procedure, called a biopsy.
Breast implants make it harder to see breast tissue on standard mammograms; do not work as well in WOMAN WITH DENSE BREAST pregnant women and women who are breast-feeding.
American Cancer Society now recommends MRI scans in addition to mammograms for screening in young woman with strong family history of breast cancer.
Ultrasound: may show whether a lump is solid, filled with fluid (a cyst), or a mixture of both. Cysts usually are not cancer. But a solid lump may be cancer.
MRI: MRI gives detailed pictures of breast tissue. These pictures can show the difference between normal and diseased tissue.
Aspiration (FNAC):Fine Needle Aspiration Cytology) A lump felt by examination and/or identified on a mammogram can be examined by aspiration. During this procedure, a fine needle is inserted in the lump and the aspirate is examined microscopically for presence of cancer cells. FNAC can also help in differentiating a solid from a cystic (fluid filled) lump.
Core biopsy: Doctor uses a wide needle to remove a sample of breast tissue.
Biopsy: If the lump is composed of solid tissue, biopsy may be performed to check for the presence of cancer cells. Biopsies can also be helpful in determining type of cancer and the best method of treatment.
You may receive more than one type of treatment. The treatment that’s right for you depends mainly on the stage of the cancer, the results of the hormone receptor tests, the result of the HER2/neu test, and your general health.
A. Surgery (Operative Procedures):
Various operative modes are used for treatment of breast cancer:
Lumpectomy: This means removal of the lump in the breast. This is usually the preferred mode of treatment in benign (non cancerous) lumps.
Partial Mastectomy: This involves removal of the cancerous lump with part of the surrounding breast tissue and the glands under the arm.
Simple Mastectomy: This operation involves removal of only the breast.
Modified radical mastectomy: This involves removing the entire breast and the lymph nodes or glands under the arm.
Radical Mastectomy: This includes removal of all breast tissues, the lymph nodes and the chest muscles. This operation is rarely performed these days.
Breast reconstruction: You may choose to have breast reconstruction to rebuild the shape of the breast. It may be done at the same time as the cancer surgery or later.
B. Radiation therapy:
Treatment of breast cancer with radiation therapy can destroy cancer cells. The type of radiation is chosen to suit the requirements of individual patient. A course of radiation is given over a period of weeks.
Chemotherapy is treatment of cancer with special drugs, which are able to kill cancer cells. Chemotherapy may be used alone or in combination with surgery or radiation therapy, depending on the extent of the tumor.
D. Hormone Therapy:
If lab tests show that the tumor has hormone receptors, then hormone therapy may be an option. Hormone therapy keeps cancer cells from getting the natural hormones (estrogen and progesterone) they need to grow.
E. Targeted Therapy:
Some women with breast cancer may receive drugs called targeted therapy. Targeted therapy uses drugs that block the growth of breast cancer cells.
Women older than 20 years should perform monthly breast self-examinations (BSE).
Pre-menopausal: Set a regular time to examine your breasts a few days after your period ends, when hormone levels are relatively stable and breasts are less tender.
Menopausal (has not had a period for a year or more): Pick a particular day of the month to do the exam, and then repeat your BSE on that day each month.
Facing a mirror: Visual exam
Stand before a mirror and compare breasts for differences in size, nipple inversion (turning in), bulging, or dimpling. Note any skin or nipple changes, such as a hard knot or nipple discharge.
Inspect your breasts in the following 4 steps, In these positions, your pectoral muscles are contracted, and a subtle dimpling of the skin may appear if a growing tumor has affected a ligaments:
With your arms at your sides
With your arms overhead
With your hands on hips – Press firmly to flex your chest muscles.
Bent forward – Inspect your breasts.
Manual exam: standing
Raise your left arm overhead
Use circular motion and gentle pressure to cover the entire breast area.
Take note of any changes in texture, color, or size, nipple discharge. Switch sides and repeat.
Best done in the shower with soapy hands.
Repeat same procedure for other breast.
Manual exam: Lying down
Place a pillow under your left shoulder.
Put your left hand under your head.
Check the entire breast area with the finger pads of your right hand.
Use small circles and follow an up-and-down pattern
Use light, medium, and firm pressure over each area of the breast.
Feel the breast with the surfaces of the second, third, and fourth fingers, moving systematically and using small, circular motions from the nipple to the outer margins.
Gently squeeze the nipple for any discharge.
Repeat these steps on your left breast using your right hand.
Most often the pain can be attributed to harmless causes such as puberty or pregnancy or cyclical pain associated with the menstrual cycle. Cancer is rarely the cause of breast pain.
Some causes of breast pain are:
Fibrocystic breast disease
Premenstrual syndrome, cyclic mastalgia
Normal hormonal fluctuations
Onset of puberty or menopause
Certain medications such as digoxin , methyldopa spironolactone and chlorpromazine
Infection in the breast (breast abscess, mastitis)