As these clinical signs are also present in benign breast diseases, consultation and advice with a professional specialized in the area is essential.
According to the National Cancer Institute (INCA), breast cancer is the type of cancer that most affects women and accounts for 29.5% of new cases of the disease in Brazil.
INCA data state that, in 2016, breast cancer led to the death of 16,069 women.
Also according to the Institute, about 59.7 million new cases of the disease will be counted in 2019.
What are the causes?
Only 10% of breast cancers are associated with known changes in our gene that favor the development of the disease. Generally, it is genes that have repair (control) activity in our DNA that are inactivated, causing this susceptibility
For most cases (another 90%), there is no single known cause. It is known that the influence of a set of factors triggers the onset of the disease.
Among the conditions and behaviors that most elevate the chances of the disease manifesting are:
Overweight or obesity;
Lack of physical activity;
Consumption of alcoholic beverages;
Exposure to ionizing radiation (present in radiotherapy and imaging tests).
Unmodifiable risk factors
In addition to behaviors and lifestyle habits, there are some conditions that are independent of patients, such as:
Being a woman is the main risk factor for the development of breast cancer.
With advancing age, a woman’s chances of developing breast cancer increase. They reach approximately 12% at 80 years of age.
About 5 to 10% of breast cancer cases are hereditary. The most common cause of hereditary breast cancer is a mutation (failure in our gene) inherited in the BRCA1 and BRCA2 genes.
Mutations in other genes, although less frequent, can also lead to hereditary breast cancer, such as ATM, TP53, CHEK2 (Li-Fraumeni syndrome), PTEN (Cowden’s disease), CDH1, and STK11 (syndrome of Peutz-Jeghers) among others.
The risk of breast cancer is higher among women with first-degree relatives (mother, sister or daughter) who have had the disease.
In such cases, the risk of the disease practically doubles. Having two first-degree relatives increases the possibility by about 3 times.
It should be noted that this risk is specific to each family and has other influences, such as the age at which the family member developed cancer. The earlier the age, the greater the family risk.
A woman who has already had breast cancer is at an increased risk of developing new breast cancer. This is different from a recurrence (return of the same tumor).
Race and ethnicity
White women are slightly more likely to develop breast cancer than those of other races.
The race data known in the literature are related to studies carried out in places such as the USA and Western Europe. As we live in a country with a history of diversified colonization and extensive racial miscegenation, it is more difficult to establish a relationship.
Breast density is a data obtained through the
mammography exam and is related to the proportion between the woman’s breast tissue (responsible for milk production) and adipose tissue (fat).
It is said that a breast is dense when it has a greater amount of breast tissue in relation to adipose tissue.
Women with dense breasts are at an increased risk of breast cancer compared to those with less dense breasts.
A number of factors can affect breast density, such as age, menopausal status, medication use, pregnancy and genetics.
Precursor lesions of breast cancer
Women diagnosed with certain benign breast conditions may have an increased risk of breast cancer.
These are lesions that, although still benign, pose a greater risk of developing breast cancer in the future.
Among them are the atypical ductal and lobular hyperplasias, which give a 3 to 5 times chance of developing the disease, and ductal and lobular carcinoma in situ of the breast, which results in a 10 times greater risk.
Although it has the name carcinoma, it is considered a precursor lesion because it has not yet acquired the ability to invade and send cells to other organs (metastases).
Today, there are already prophylactic (preventive) medications so that women, once diagnosed with these injuries, are no longer exposed to this risk
Hormonal regulation linked to the reproductive phase
Women who had early menarche (before age 12) or had
menopause after age 55 have a slightly increased risk of breast cancer.
The increased risk may be due to longer exposure to female hormones.
Women who have undergone radiation therapy to the chest up to the age of 20 as part of treatment for lymphoma (a type of cancer that affects the lymphatic system) are at an increased risk of breast cancer.
Some conditions and behaviors are observed to be linked to an increased risk of breast cancer, such as:
Women who have had no children or who have had their first child after the age of 30 have a slightly increased risk of breast cancer. Women who have many children and become pregnant at an early age reduce the risk of breast cancer.
Use of hormonal contraceptives
The use of hormonal contraceptive methods (regardless of the route of use) increases the risk of breast cancer. This risk is directly related to the time of use.
In the same way, the risk reduces with the interruption of use. Women who stopped using contraceptives more than 10 years ago do not appear to have any increased risk.
Hormone replacement after menopause
The use of hormone replacement for a long time (more than 5 years) can slightly increase the risk of breast cancer.
It has been shown that the concomitant use of estrogen and
progesterone over 5 years, increases the risk. In contrast, the use of estrogen alone does not appear to increase the risk of breast cancer.
Alcohol use is clearly associated with an increased risk of developing breast cancer. The risk increases with the amount of alcohol consumed.
Being overweight or being obese after menopause increases your risk of breast cancer.
Lack of physical activity
The practice of regular physical activity is directly related to better weight control and reduced risk of breast cancer.
Many studies have looked for a link between what women eat and the risk of breast cancer.
In a recent study, published in 2019, in which approximately 50,000 women were followed for 20 years, it was shown that the reduction in fat consumption significantly reduces the risk of breast cancer.
smoking is associated with a small increased risk of breast cancer.
Types of Breast Cancer
Breast cancer has several different types. Among them, we highlight the ductal carcinoma that originates in the mammary ducts, and the lobular carcinoma, that originate from the mammary lobes (both structures of the breasts).
These two types account for more than 90% of all cancers. Other less common types are medullary, cystic adenoid, papillary, cribiform and secretory carcinomas, although they all originate from breast tissue.
The breast is also affected by other more rare cancers, such as sarcomas (tumors originating from the breast’s supporting tissues), lymphomas and also metastases from cancers originating in other organs.
Inflammatory breast cancer: what is it?
Inflammatory carcinoma, or inflammatory cancer, is the same ductal or lobular breast carcinoma, but it manifests itself clinically in a very different way than usual.
While most cases are diagnosed by palpation of a painless lump in the breast, this type appears to simulate an inflammatory process with pain, swelling and redness in the breast.
Due to its appearance, it is often mistaken for mastitis (infection of the breast), which can delay its diagnosis.
It has a faster evolution (growth) and is invariably related to a worse prognosis.
Fortunately, inflammatory carcinoma accounts for less than 1% of all breast cancer cases.
This type of cancer starts in the breast ducts, has a very slow evolution and, as it grows, affects the skin, areola and nipple.
It is often confused with allergic processes that affect the areola and nipple.
Paget’s disease can happen in isolation or concomitantly with other breast cancers.
Staging: what are the stages of breast cancer?
Breast cancer, when diagnosed, is classified into stages according to its size in the breast, impairment of axillary lymph nodes (languages) and the presence or absence of distant metastases (in other organs).
These stages range from 0 (breast carcinomas in situ, which are still precursor lesions) to IV (where there is already evidence of distant metastasis)
Stages I, II and III still have several subdivisions according to the size of the tumor in the breast and the presence of compromised axillary lymph nodes.
This classification is useful for the doctor to define the most appropriate treatment.
Metastatic breast cancer
When breast cancer spreads to other parts of the body, it is called metastatic cancer.
In these cases, the disease has little chance of cure, but it can be controlled and guarantee a comfortable life for patients.
What is desired when treating a patient with breast cancer metastasis is to chronicle (that is, stabilize) the disease through the use of medications ranging from chemotherapy, hormonal blockers, target therapies and immunotherapies.
They make it possible to control the disease and, mainly, to maintain a quality of life.
What are the symptoms of breast cancer?
The most common symptom of breast cancer is the palpation of a
painless lump in the breast .
However, other less common symptoms can also serve as a warning for a possible diagnosis of cancer, such as:
Changes in the skin of a part of the breast (bumps or recesses);
Swollen and reddish skin;
Increased nodule in the armpit;
Thickening or retraction of the skin or nipple;
Clear or bloody discharge from the nipples (only when it comes out spontaneously);
Who has breast cancer feels pain?
Breast pain (known as mastalgia) is an extremely frequent and very little symptom associated with breast cancer. Hardly a woman who has only breast pain will have any relationship with breast cancer.
Most of the time, breast pain is caused by hormonal changes. They are more observable in the days leading up to menstruation or are associated with the use of some hormonal contraceptives.
It should be noted that even though she does not have a common association with breast cancer, in the presence of an episode of breast pain, the woman must seek a health professional to be evaluated, investigated and guided.
Is breast cancer curable?
most cases of breast cancer have a chance of cure .
However, for this to happen, it is necessary that the disease is diagnosed early and treatment is started as soon as possible.
Diagnosis: How do I know if I have breast cancer?
Usually, the diagnosis starts when the patient or the doctor perceives a breast change in the self-examination or clinical examination.
In some cases, it is in routine mammography that suspicion is raised. Thus, a series of tests are requested to investigate and characterize the nodule as malignant or benign.
Among the procedures indicated are:
The exam is part of the procedures that, after the age of 40, should become routine. It consists of a kind of
X-ray of the breasts, allowing a good view of the breast tissues.
It is worth remembering that mammography is the only test capable of diagnosing breast cancer in its initial stage, as nodules smaller than 1 cm cannot be palpated or felt yet.
Because of this, the Brazilian Society of Mastology recommends that women do an annual mammogram from the age of 40.
Painless and non-invasive, ultrasound is an auxiliary method to mammography that helps in diagnosis. It is with the aid of ultrasound that most breast biopsies are performed.
The exam can be ordered, according to medical advice, and is not necessary for all patients. For this reason, it is a complementary exam to the others.
The biopsy consists of the removal of a part or sample of the tissue, which is sent to the laboratory for analysis and confirmation of the diagnosis.
In general, a needle is used, with local anesthesia.
Surgical biopsy can also be performed when the use of the needle does not allow the sample to be collected. In that case, part or all of the nodule may be removed.
Treatments: what are the options?
To treat breast cancer, it is necessary to assess the type and stage of the disease. That done, the therapeutic definition can be determined individually.
The aim is always to cure the disease or reduce its impacts on the body, controlling it.
Based on this, treatments for the disease can be classified in two ways:
It should be noted that the treatment is always composed of a set of therapies that, in an aggregate manner, bring the patient the best prospect of success combined with the maintenance of their quality of life.
Psychological support, support from friends and family, as well as leisure activities are essential to promote better therapeutic success.
Local therapy for breast cancer
This type of therapy aims to treat the tumor where it is located and can be performed in two ways:
Older treatment modality, surgery is performed when the tumor is in its initial stage and in favorable conditions for its removal. It can be used as an initial method of treatment or after the use of chemotherapy or hormone blockers.
Even today, for most breast cancers, surgery is the main therapeutic method.
Widely used in localized tumors, radiotherapy is done through the use of ionizing radiation.
It is used both in cases where the woman has undergone conservative surgery (preserving most of the breast) and in some cases where the patient has undergone a mastectomy (total breast removal).
Radiotherapy works as an additive to surgery in the local control, reducing the risk of a breast cancer recurrence.
Systemic therapy for breast cancer
In this type of treatment, medicines are used in order to reach cancer cells, whether they are in any part of the body. Systemic therapy can be done in four ways:
It consists of the use of oral or intravenous drugs and aims to destroy, control or prevent cancer cells.
This form of treatment prevents the action of hormones in cancer cells leading to cell death. Thus, it acts by blocking the effects of these hormones.
Target therapy (monoclonal antibodies)
It is carried out through drugs that act by blocking specific sites (that is, sites) in the cancer cells, leading to the death of these cells.
New treatment modality that is still used for a few cases, but which will probably have its use greatly expanded in the coming years.
Consists of drugs that act on immune targets of the tumor, causing the weakening and death of tumor cells
Side effects of treatment: how to minimize them?
Treatments for breast cancer can cause several side effects, which can affect the patient’s routine. Know what they are and how to minimize them:
The manifestation of the side effects of chemotherapy depends on each person. It is possible that they are intense for some and mild for others.
hair loss , skin sores, nausea, vomiting and pain are the most common. These effects mostly occur due to the fact that chemotherapy affects healthy cells in our body in the same way as tumor cells.
Side effects of chemotherapy are also:
Intestinal alteration (diarrhea or constipation);
Changes in appetite;
It is important that each patient report the symptoms to the medical team, so that specific guidelines are passed on.
Among the options indicated to reduce these adverse effects are:
Reduce the burden of physical and professional activities, adapting to the patient’s tiredness;
Reinforce food with natural and healthy products (fruits, vegetables, proteins) with guidance from a nutrition professional whenever possible;
Eat more fractionally, reducing the amount of food eaten at once;
Wear comfortable clothes and shoes that promote safety (avoiding falls and improving movement).
The most common side effect of breast radiation therapy is skin reactions, such as redness, dryness of the skin and increased sensitivity.
Some women may experience
fatigue and sore throat throughout treatment.
During the radiotherapy period, it is essential that the patient follow the guidelines of the radiotherapist and only apply products on the breast with the indication of the professional.
Sometimes, the adverse effects are quickly mitigated after the end of treatment, but it is possible that, in some cases, they still take some time to improve.
Therefore, adopting some measures from the beginning of the therapy can help to minimize their appearance and intensity, such as:
Take care of the skin with warm baths and hydrants released by the medical team;
Completely avoid sun exposure from the area being irradiated;
Wear comfortable clothes and natural fabrics;
Do not use any product other than those instructed by your doctor;
Eat well and maintain good hydration.
Living with breast cancer
Breast cancer affects the patient’s routine in several ways. Whether due to treatment or even the psychological impact that the disease brings, in general, family patients and friends can have their routines changed in their daily lives.
Some suggestions help to minimize this impact:
Talk to your friends and family about the issue;
Talk to other people who are suffering or have suffered from breast cancer;
Find out as much information as possible about the condition;
Avoid doing things that demand a lot from you;
Make time for yourself, doing what you like and what makes you feel good.
What are the complications of breast cancer?
One of the main complications of breast cancer is recurrence, that is, the return of a tumor that has already been treated.
Among some possible complications resulting from the treatment of the disease:
Lymphedema is the accumulation of
lymphatic drainage resulting from surgical and radiotherapy treatments in the axilla nodes.
The total removal of the axillary lymph nodes (known as axillary emptying) and axillary radiotherapy are responsible for the lymphedema associated with the treatment of breast cancer.
It manifests itself with increased arm size, as well as thickening of the skin and local pain.
It should be noted that more modern surgical techniques, such as that of the sentinel lymph node, prevent women from being at risk of lymphedema.
The pain may occur due to changes in local sensitivity, which may be related to the surgical procedure or radiotherapy.
Decreased range of motion
In patients undergoing mastectomy, the range of motion may be reduced. This causes the shoulders to have limitations that affect the arms and, therefore, the patient’s autonomy.
Reduced muscle strength
Just as treatments can affect joint movement, it is possible to compromise muscle strength. This reduces the ability of muscle fibers to contract, which can compromise motor skills.
How to prevent breast cancer?
Although the causes of breast cancer have not yet been fully elucidated, taking preventive measures helps to reduce the risks of its development.
They not only help to reduce breast cancer, but also allow the prevention of a number of other diseases.
Among the preventive measures, the following stand out:
Practice physical activity;
Have a healthy eating;
Maintain adequate body weight;
Avoid the consumption of alcoholic beverages;
Maintain breastfeeding for at least 6 months;
Do not smoke;
Maintain periodic exams and consultations (annual mammography after 40 years);
Take care of health as a whole.
Is ductal ectasia cancer?
No. Ductal ectasia is a benign disease, which causes secretions due to the enlargement or dilation of the mammary ducts (channels that pass the milk). It is important to consult the specialist and evaluate the condition, but ectasia is not cancer and does not cause greater risks to the disease.
Invasive lobular carcinoma needs chemotherapy?
Treatment of an invasive lobular carcinoma may require chemotherapy. It is the doctor who will define the treatment strategy individually.