Cancer is the uncontrolled growth of abnormal cells in the body. Cancer develops when the body’s normal control mechanism stops working. Old cells do not die and instead grow out of control, forming new, abnormal cells. These extra cells may form a mass of tissue, called a tumor.
However, according to CDC, in 2015, the latest year for which incidence data are available, 1,633,390 new cases of cancer were reported, and 595,919 people died of cancer in the United States. For every 100,000 people, 438 new cancer cases were reported and 159 died of cancer. Figures released by the World Health Organization (WHO) has revealed that a total of 2,000 Ghanaian women were diagnosed of breast cancer in the year 2012.
Furthermore, breast cancer starts when cells in the breast begin to grow out of control. These cells usually form a tumor that can often be seen on an x-ray or felt as a lump. The tumor is malignant (cancer) if the cells can grow into (invade) surrounding tissues or spread (metastasize) to distant areas of the body. Breast cancer is the most common cancer among women.
Types of Breast Cancer
Inflammatory Breast Cancer
Inflammatory breast cancer is a rare type of cancer that often does not cause a breast lump or mass. As seen in this photo, it often causes thickening and pitting of the skin, like an orange peel. The affected breast may also be larger or firmer, tender, or itchy. A skin rash or reddening of the skin is common. These changes are caused by cancer cells blocking lymph vessels in the skin. Inflammatory cancer of the breast typically has a fast growth rate.
Invasive Ductal Carcinoma
Invasive (or infiltrating) ductal carcinoma (IDC) is the most common type of breast cancer. About 80% of all breast cancers are invasive ductal carcinomas. Invasive ductal carcinoma refers to cancer that has broken through the wall of the milk ducts and has invaded the breast tissues. Invasive ductal carcinoma can spread to the lymph nodes and possibly to other areas of the body.
Ductal Carcinoma in Situ (DCIS)
Ductal carcinoma in situ (DCIS) is considered to be a non-invasive or pre-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that starts in the skin or other tissue (including breast tissue) that line or cover the internal organs, and in situ means “in its original place.” The difference between DCIS and invasive cancer is that in DCIS, the cells have not spread through the walls of the milk ducts into the surrounding breast tissue.. DCIS is considered a ‘pre-cancer’, but some cases can transform into more invasive cancers.
Invasive Lobular Carcinoma
Invasive (or infiltrating) lobular carcinoma (ILC) is the second most common type of breast cancer after invasive ductal carcinoma. Lobular means that the cancer started in the milk-producing lobules, which empty out into the ducts that carry milk to the nipple. Invasive lobular carcinoma refers to cancer that has broken through the wall of the lobule and begun to invade the breast tissues. Invasive lobular carcinoma can spread to the lymph nodes and possibly to other areas of the body.
Mucinous (or colloid) carcinoma of the breast is a rare form of invasive ductal carcinoma. In this type of cancer, the tumor is composed of abnormal cells that “float” in pools of mucin, part of the slimy, slippery substance known as mucus. Mucus lines most of the inner surface of our bodies, such as our digestive tract, lungs, liver, and other vital organs. Breast cancer cells can produce some mucus. In mucinous carcinoma, mucin becomes part of the tumor and surrounds the breast cancer cells. “Pure” mucinous carcinomas make up only 2-3% of invasive breast cancers. Approximately 5% of invasive breast cancer tumors have a mix of mucinous components in addition to other types of breast cancer cells.
Triple-Negative Breast Cancers
Testing negative for estrogen receptors (ER-), progesterone receptors (PR-), and HER2 (HER2-) on a pathology report means the cancer is “triple-negative”. These negative results indicate the growth of the cancer is not supported by the hormones estrogen and progesterone, nor by the presence of too many HER2 receptors. Therefore, triple-negative breast cancer does not respond to hormonal therapy (such as tamoxifen or aromatase inhibitors) or therapies that target HER2 receptors, such as Herceptin. However, other medicines can be used to treat triple-negative breast cancer.
Paget’s Disease of the Nipple
Paget’s disease of the nipple is a rare form of breast cancer in which cancer cells collect in or around the nipple. The cancer usually affects the ducts of the nipple first then spreads to the nipple surface and the areola. A scaly, red, itchy, and irritated nipple and areola are signs of Paget’s disease of the nipple. One theory for the cause of Paget’s disease is that the cancer cells start growing inside the milk ducts within the breast and then break through to the nipple surface. Another possibility is that the cells of the nipple itself become cancerous.
Causes of Breast Cancer
Certain genes control the life cycle—the growth, function, division, and death—of a cell. When these genes are damaged, the balance between normal cell growth and death is lost. Normal breast cells become cancerous because of changes in DNA structure. Breast cancer is caused by cellular DNA damage that leads to out-of-control cell growth.
Genetics & Mutations
Inherited genes can increase the likelihood of breast cancer. For example, mutations of genes BRCA1 and BRCA2 (linked to an increased risk of breast and ovarian cancers) can inhibit the body’s ability to safe-guard and repair DNA. Copies of these mutated genes can be passed on genetically to future generations, leading to a genetically-inherited increased risk of cancer.
Breast cancer may be caused by environmental exposure. Sunlight can cause DNA damage that leads to breast cancer through ultraviolet radiation. So can air pollutants like soot, wood dust, asbestos, and arsenic, to name just a few.
Lifestyle choices can lead to breast cancer as well. Eating a poor diet, inactivity, obesity, heavy alcohol use, tobacco use including smoking, and exposure to chemicals and toxins are all associated with a greater breast cancer risk.
Medical treatment with chemotherapy, radiation, or immunosuppressive drugs used to decrease the spread of cancer throughout the body can also cause damage to healthy cells. Some “second cancers”, completely separate from the initial cancer, have been known to occur following aggressive cancer treatments.
Breast Cancer Symptoms
Breast cancer may or may not cause symptoms. Some women may discover the problem themselves, while others may have the abnormality first detected on a screening exam. Common breast cancer symptoms include the following:
• Non-painful lumps or masses
• Lumps or swelling under the arms
• Nipple skin changes or discharge
• Noticeable flattening or indentation of the breast
• Change in the nipple
• Unusual discharge from the nipple
• Changes in the feel, size, or shape of the breast tissue
Breast Cancer Prevention
- Breast Self-Exams
Experts recommend that women be aware of their breasts and notice any changes, rather than performing checks on a regular schedule. Women who choose to do self-exams should be sure to discuss the technique with their doctor. Note: A breast self-exam is a way to check your breasts for changes such as lumps or thickenings. Early breast cancer detection can improve your chances of surviving the disease. Any unusual changes discovered during the breast self-exam should be reported to your doctor.
Sometimes a breast ultrasound is ordered in addition to a mammogram. An ultrasound can demonstrate fluid-filled cysts that are not cancerous. Ultrasounds may also be recommended for routine screening tests in some women at a higher risk of developing breast cancer. During a breast ultrasound a small amount of water-soluble gel is applied to the skin over the area to be examined. Then, a probe is gently applied against the skin. You may be asked to hold your breath, briefly several times. The breast ultrasound takes about 10 minutes to complete.
Ultrasound Breast MRI
MRI (magnetic resonance imaging) is a technology that uses magnets and radio waves to create detailed, 3D images of the breast tissue. Before the test you may be injected through an intravenous line, in the arm, with a contrast solution (dye). The contrast solution will allow potential cancerous breast tissue to show more clearly. Radiologists are able to see areas that could be cancerous because the contrast tends to be more concentrated in areas of cancer growth.
Nevertheless, during a breast MRI the breasts are exposed as the patient lies flat on a padded platform with cushioned openings for the breasts. A breast coil surrounds each opening and works with the MRI unit to create the images. MRI imaging is a painless diagnostic tool. The test takes between 30 and 45 minutes.
Remember that the majority (about 80%) of breast lumps are not due to cancer. Cysts, benign tumors, or changes in consistency due to the menstrual cycle can all cause benign breast lumps. Still, it’s important to let your doctor know about any lumps or changes in your breast that you find.
Breast Cancer Biopsy
A biopsy is the most certain way to determine whether a breast lump is cancerous. Biopsies may be taken through a needle or through a minor surgical procedure. The results can also determine the type of breast cancer that is present in many cases (there are several different types of breast cancers). Treatments are tailored to the specific type of breast cancer that is present.
A needle biopsy uses a hollow needle to remove tissue or cell samples from the breast. A pathologist studies the samples under a microscope to see if they contain cancer. There are two types of needle biopsies: core need biopsy and fine needle aspiration (fine needle biopsy).
Core Needle Biopsy
If a lump can be felt in the breast (palpable mass), a core needle biopsy may be performed. The doctor will use a small amount of local anesthetic to numb the skin and the breast tissue around the area. The doctor will insert the needle and remove a small amount of tissue to be examined.
Ultrasound-Guided Core Needle Biopsy
This is one type of biopsy for lumps or abnormalities that cannot be felt (nonpalpable mass). A core needle is placed into the breast tissue and ultrasound helps confirm the exact location of the potential cancer so the needle is placed correctly. Tissue samples are then taken through the needle. Ultrasound can see the difference between cysts and solid lesions.
MRI-Guided Core Needle Biopsy
For this test, you will be given a contrast agent through an IV. Your breast will be numbed and compressed and several MRI images will be taken. The MRI images will guide the doctor to the suspicious area. A needle will be used in the biopsy device to remove tissue samples with a vacuum assisted probe.
If the lump is non palpable you could be also given a stereotactic biopsy. Using a local anesthetic, the radiologist makes a small opening in the skin. A needle is placed into the breast tissue, and imaging studies help confirm the exact placement. Tissue samples are taken through the needle.
A surgeon makes a cut (incision) in the breast to remove tissue.
Open Excisional Biopsy
This surgery removes an entire lump and the issue is examined under a microscope. If a section of normal breast tissue is taken all the way around a lump, it is called a lumpectomy. In this procedure, a wire is put through a needle into the area to be biopsied. The X-ray helps to make sure it is in the right location and a small hook at the end of the wire keeps it in position. The surgeon uses the wire as a guide to locate the suspicious tissue.
An incisional biopsy is very similar to an excisional biopsy, but less tissue is removed. Local anesthetic will be used and you will also get IV sedation. An incisional biopsy removes part of the tumor, which means that more surgery may be needed to remove the remaining cancer.
Note: Breast cancer is not just a woman’s disease. It is quite possible for men to get breast cancer, although it occurs less frequently in men. If any of the above symptoms is identified kindly visit your doctor. Thanks and Good luck.
By Okoene Chinenye Cynthia
Youth for Human Rights International (YHRI).
Youth for Human Rights Africa (YoHRA).