Oncology

Understanding Breast Cancer

admin May 15, 2025

What Is Breast Cancer?

Breast cancer develops when cells in the breast grow uncontrollably, forming a tumour that can often be seen on an X-ray or felt as a lump. Although it primarily affects women, men can also develop breast cancer.

The disease typically begins in the milk-producing glands (lobules) or the ducts that carry milk to the nipple. Over time, these abnormal cells may invade nearby healthy tissue or spread to lymph nodes and other parts of the body through the bloodstream or lymphatic system.

Understanding the biology of breast cancer—including hormone receptor status and genetic characteristics—helps guide effective treatment plans.

Causes and Risk Factors

Breast cancer results from a combination of genetic, hormonal, and environmental factors. While the exact cause in many cases remains unknown, several risk factors are well established:

Age and Gender: Risk increases with age and is significantly more common in women.

Genetic Mutations: Inherited mutations in BRCA1 and BRCA2 genes greatly increased risk.

Family History: Having close relatives with breast or ovarian cancer raises your chances.

Reproductive History: Early menstruation (before age 12), late menopause (after 55), and having children later in life or not at all may increase risk.

Hormone Replacement Therapy (HRT): Long-term use of combined estrogen-progesterone therapy is associated with elevated risk.

Lifestyle Factors: Obesity, alcohol use, lack of physical activity, and smoking can all contribute.

While risk factors do not guarantee the development of breast cancer, awareness can promote earlier detection and prevention strategies.

Recognizing Symptoms

Breast cancer may not present symptoms in its early stages, which underscores the importance of regular screening. As the disease progresses, individuals may notice:

A new lump in the breast or underarm

Swelling of part or all the breast

Skin dimpling or irritation

Pain in the breast or nipple area

Nipple discharge (other than breast milk), possibly bloody

Change in the size or shape of the breast

Inverted nipple or nipple retraction

These symptoms can also be caused by benign conditions, but any persistent or unusual changes should prompt consultation with a healthcare provider.

Diagnostic Procedures

Screening Tests

Early detection through screening improves outcomes significantly. Common screening tests include:

Mammography: X-ray images of the breast can detect abnormalities before symptoms appear.

Breast MRI: Used in high-risk individuals to complement mammography.

Clinical Breast Exam and Self-Examination: Although not diagnostic, these can help identify suspicious changes.

Diagnostic Tests

If a screening test suggests an abnormality, further tests are performed:

Ultrasound: Helps distinguish between solid tumours and fluid-filled cysts.

Biopsy: Tissue is removed for laboratory analysis to determine if cancer is present.

Molecular and Genetic Testing: Evaluates hormone receptor status (ER, PR) and HER2 protein expression, which guide treatment.

Treatment Options

Treatment strategies for breast cancer are highly personalized, based on factors such as the type and stage of cancer, hormone receptor status, genetic findings, and patient preferences.

Surgical Options

Lumpectomy: Removal of the tumor and a small margin of surrounding tissue.

Mastectomy: Complete removal of one or both breasts, sometimes including lymph nodes.

Sentinel Node Biopsy: Removal of the first lymph node(s) to which cancer is likely to spread.

Axillary Lymph Node Dissection: Involves removing multiple lymph nodes when cancer is confirmed to have spread.

Radiation Therapy

Often used after surgery to destroy remaining cancer cells:

External Beam Radiation Therapy (EBRT): Focused on the whole breast or specific areas.

Intraoperative Radiation Therapy (IORT): Delivered during surgery in some cases.

Chemotherapy

Chemotherapy drugs kill or slow the growth of cancer cells. It is used before surgery (neoadjuvant) to shrink tumours or after surgery (adjuvant) to reduce the risk of recurrence.

Hormonal Therapy

For hormone receptor-positive breast cancers, therapies that block estrogen or lower its levels are highly effective:

Tamoxifen

Aromatase inhibitors (e.g., anastrozole, letrozole)

Ovarian suppression in premenopausal women

Targeted Therapy

Targeted drugs specifically attack cancer cells with minimal harm to normal cells. Common examples include:

HER2-targeted therapies: Such as trastuzumab (Herceptin), pertuzumab

CDK4/6 inhibitors: Useful in certain hormone receptor-positive cancers

Immunotherapy

Used primarily in triple-negative breast cancers, immune checkpoint inhibitors help the body recognize and attack cancer cells. This is a rapidly evolving area of treatment.

Prevention and Early Detection

Preventive strategies can significantly reduce the risk of breast cancer:

Genetic Counselling and Testing: For individuals with strong family histories.

Prophylactic Surgery: Such as preventive mastectomy or oophorectomy in high-risk cases.

Lifestyle Adjustments:

Maintain a healthy weight

Engage in regular physical activity

Limit alcohol intake

Quit smoking

Regular Screenings:

Mammograms as recommended based on age and risk

Breast exams and awareness of personal risk

Public health education and community outreach are essential for promoting these preventive behaviours, especially in underserved populations.

Shape Living with Breast Cancer

A breast cancer diagnosis affects all aspects of life, from emotional wellbeing to daily routines. With modern therapies, many people live full and productive lives during and after treatment.

Support Resources Include:

Oncology social workers and counsellors

Peer support groups and survivorship programs

Palliative care for managing symptoms and side effects

Fertility preservation counselling for younger patients

Nutrition and exercise programs to aid recovery

Long-term follow-up care focuses on monitoring for recurrence, managing side effects, and promoting overall health.

Conclusion

Breast cancer is a complex but increasingly treatable disease, thanks to advancements in diagnostics, treatment, and personalized care. Early detection and education remain cornerstones in improving outcomes and quality of life. For both patients and healthcare providers, staying informed is a powerful step toward better health and hope.