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Breast cancer is still the most common cancer in women (1 in 8 women) as well as the leading cause of cancer death in women. Although it is the second most common cancer overall, breast cancer has a high 5-year survival rate (99% for localized breast cancer and 90% for invasive breast cancer) as breast cancer treatment has come a long way with increasing awareness and breast cancer screening. Earlier detection increases one’s chance of recovery (5-year survival rate of cancer spread to a distant part of the body = 27%).

What are the risk factors for breast cancer?

Increasing age
Female gender
Weight and Body Fat
- Postmenopausal women - a high BMI (>30kg/m2) INCREASES the risk
- Premenopausal - a lower BMI decreases the risk.
Tall stature
High Estrogen levels
Hormonal factors - use of menopausal hormonal replacement therapy (HRT), high levels of androgens, higher endogenous insulin levels and in utero exposure to diethystilbestrol increases the risk of breast cancer.
Reproductive factors - early menarche or later menopause, nulliparity and increasing age at first pregnancy.
Lifestyle factors - alcohol, smoking and night-shift work increases the risk of breast cancer
History of breast cancer - personal or familty history of breast cancer or inherited genetic mutations
Exposure to therapeutic ionizing radiation - especially at a young age (prepuberty: 10-14 years) increases the risk.

PROTECTIVE factors for breast cancer

Breastfeeding - for every 12 months of breastfeeding, there is a 4.3% reduction in relative risk of breast cancer.
Physical activity - regular exercise has modest protection against breast cancer especially in postmenopausal women. Moreover, it can help reduce other risk factors such as weight and insulin growth factor-1 levels.

Screening methods

Screening mammography is the primary imaging modality for early detection of breast cancer because it is the only method of breast imaging that consistently has been found to decrease breast cancer-related mortality. Mammography may detect cancer one and a half to four years before a cancer becomes clinically evident.

Breast self-examination is an easy method that an individual can do at home to check for any breast abnormality.

Signs & symptoms

Skin changes, such as swelling, redness, or other visible differences in one or both breasts
An increase in size or change in shape of the breast(s)
Changes in the appearance of one or both nipples
Nipple discharge other than breast milk
General pain in/on any part of the breast
Lumps or nodes felt on or inside of the breast

Symptoms more specific to invasive breast cancer are:

Irritated or itchy breasts
Change in breast color
Increase in breast size or shape (over a short period of time)
Changes in touch (may feel hard, tender or warm)
Peeling or flaking of the nipple skin
A breast lump or thickening
Redness or pitting of the breast skin (like the skin of an orange)
Red flags to see a doctor immediately

Types of breast cancer

Types of breast cancer are divided into invasive or non-invasive types. Ductal carcinoma in situ (DCIS) is a type of non-invasive breast cancer that starts in the milk ducts and has not grown into the rest of the breast tissue whereas breast cancer that has spread to surrounding breast tissue are known as invasive breast cancer such as triple-negative breast cancer and inflammatory breast cancer. Other types include angiosarcoma, phyllodes tumor, lymphoma and paget disease of the breast.

Treatment options

Treatment depends on the type and stage of breast cancer.

Surgery - lumpectomy (removal of the tumor and tissues around it) or mastectomy (removal of the whole breast) if breast-conserving therapy is not preferable
Radiotherapy - for high risk of local recurrence involving deep margins and pathologically involved axillary nodes.
Chemotherapy
Hormonal therapy - drugs used to prevent hormones from fuelling breast cancer growth
Targeted therapy - targets breast cancer cells that have high levels of HER2 protein.

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