Breast cancer is a major health concern for women worldwide. Though the condition has become far more treatable and sees higher five-year survival rates than before, over 1.7 million cases were detected in 2012. The disease also caused over half a million related deaths worldwide in the same year. Breast cancer presents some cardinal signs and symptoms in most cases. The disease can be detected clinically and with a variety of tests like mammograms, CT scans, MRIs, or breast cancer blood tests. However, before we jump into the details, let’s run through what cancer is: 

Breast Cancer

Breast cancer is cancer that affects either the lobes, ducts, fat, or the fibrous connective tissue present in the breast. Breast cancer can develop in any of these issues and is classified based on the tissues it originates from. Read on to know more about the types of breast cancer.

The Types of Breast Cancer

Cancers of the breast can be categorized as non-invasive or in-situ cancers, invasive cancers, and rare cancers.

• In-situ cancers: These cancers remain localized to the area they originate from and do not spread to the surrounding breast tissues. 

1. Ductal Carcinoma In-Situ or DCIS: This is cancer caused in the milk ducts. It is at a stage that hasn’t spread to the surrounding tissue. But left untreated it can become an invasive tumor.
2. Lobular Carcinoma In-Situ or LCIS: This is a growth found in the lobules of the breast that produce milk. These are localized growths that are precursors to cancer. While not a true cancerous growth, they elevate the risk of developing full-blown breast cancer eventually.

• Invasive Cancers: These types of cancer originate in one tissue and eventually invade surrounding regions of the breast. 

1. Invasive Ductal Carcinoma or IDC: This tumor originates in the ductal tissues of the breast and eventually invades the fatty tissues by breaking through the epithelial lining of the duct.
2. Invasive Lobular Carcinoma or LDC: Cancer first develops in the lobes of the breast and subsequently spreads to the rest of the breast depending on the progression. 
3. These cancers have other subtypes due to the complex nature of the milk glands and their tissues, and include the following:

• • • • Adenosquamous Carcinoma
      • Metaplastic Carcinoma
      • Medullary Carcinoma 
      • Mucinous Carcinoma 
      • Papillary Carcinoma 
      • Tubular Carcinoma
• 
  
• Rare Cancers: These are cancers that make up a minority of detected cases. A few types of rare breast cancers are:

1. Phyllodes Tumor: These are tumors that originate in the connective tissue of the breast instead of its ducts and lobes. They’re usually observed in women in their 30s or 40s.
2. Paget’s Disease of The Breast: This is another rare condition originating from the dermal tissue making up the nipple and areola. It results in darkened patches beyond the areola.
3. Inflammatory Breast Cancer: This is a severe and invasive form of breast cancer caused by epithelial tissues of the lymphatic system. These growths block the lymph vessels and cause inflammation and swelling of the breast. 
4. Angiosarcoma of The Breast: These are rare cancers that begin in the epithelial lining of blood vessels or lymph vessels, eventually invading surrounding tissue.
5. Triple-Negative Breast Cancer: Most breast cancers originating in the breast tissue have a hormonal component, and can be managed with hormone therapy since the tumors are influenced by female hormones like estrogen and progesterone for growth. However, triple-negative tumors are rare as they do not contain hormonal receptors or proteins that are influenced by hormonal factors. This rules out the possibility of treatment with hormone therapy. Triple-negative breast cancer makes up between 10 and 20% of reported breast cancers and also requires specialized breast cancer blood tests and other tests to confirm its presence. For a breast tumor to be triple-negative, it must lack estrogen & progesterone receptors and also lack HER2 proteins on cell surfaces. 
6. Male Breast Cancer: Men have rudimentary or undeveloped breasts. However, in some rare cases, men can develop breast cancer too. Less than 1% of the reported cases of breast cancer are those reported in men. 
7. Metastatic Breast Cancer: This is a stage of breast cancer where the condition has spread to other parts of the body and causes secondary cancers there.  

Symptoms of Breast Cancer

Many early-stage tumors cannot be felt on breast examination, however, they can be detected on breast cancer blood tests looking for markers, mammograms, sonograms, or breast MRIs and CT scans. As the tumors grow in size, breast cancers can most prominently be felt as lumps distinct from the surrounding breast tissue. Other symptoms can hint toward breast cancer. Though different types of breast cancers may present different symptoms, here’s a list of general symptoms to help you know if you need to pay a visit to the doctor: 

• Lumps in and around the breast 
• Lumps in the armpit region
• Change size or asymmetrical growth of a breast 
• Inverted nipple
• Swelling and pain in a small area of the breast or the whole breast
• Redness, warmth, and tenderness of the breast:
• Orange-peel like the pitted appearance of the skin over the breast 
• Dimpling and pigmentation of skin over the breast
• Flaking, crusting, and sloughing off of skin surrounding the areola
• Visibly dilated veins over the breast 
• Bloody discharges from the nipple
• Painful discharges of fluids from the breast that aren’t breast milk 
• Generalized pain in the breast

It is important to pay a visit to your healthcare provider the moment you notice any of these symptoms. In cases of breast cancer, time is of the essence. 

Symptoms of Breast Cancer

Risk Factors & Conditions Predisposing A Higher Chance of Breast Cancer

Based on a variety of clinical and statistical studies, experts link a few risk factors to the chances of developing breast cancer. Some of the common risk factors suggested by doctors are:

• Age: Middle-aged women are at a greater risk.
• Sex: Women are one hundred times more likely to develop breast cancer when compared to men.
• Race: Breast cancer is more prevalent in women of African origin when compared to women from other racial backgrounds. 
• Status of menopause: Post-menopausal women are at a higher risk. 
• Notable menstrual events: Women who menstruated for the first time at an earlier age are more likely to develop breast cancer. Breast cancer risk is also higher in women with delayed menopause. The condition’s risk is also elevated in women with irregular menstrual cycles.
• Medical history: Women with a history of other cancers or with a history of breast cancer in one breast have a higher chance of developing it on the other breast at a later date. 
• Family history: Women whose families, especially whose close female relatives have had breast cancer are predisposed to the condition.
• Maternal status: Women who have never given birth have a higher likelihood of developing breast cancer than women who have given birth. 
• Nature of the breast: Women with firmer and more fibrous tissue in the breasts have higher chances of missing out on the detection of existing lumps and growths. 
• Genetic predisposition: Certain genes create higher risks of developing breast cancer. 
• Physical factors: Certain chemicals and radiation like gamma rays may increase the chances of developing breast cancer. 
• Hormone therapy: Women who have received hormone therapy either in their adolescence, for birth control, or in the post-menopausal period are more likely to develop this condition.
• Lifestyle habits: Obesity, smoking, drinking, and synthetic drug abuse increase the overall risk of developing cancer. 

Breast Cancer Testing 

Your doctor can order a variety of tests ranging from breast cancer blood tests to breast biopsies to accurately decipher the nature of the tumor, its extent of spread, your overall treatment plan, and eventual recovery. Tests commonly recommended by oncologists are: 

• Breast Cancer Blood Tests: Your doctor can order a variety of breast cancer blood tests alongside other tests like mammograms and CT scans. Some commonly ordered breast cancer blood tests are:

1. Complete Blood Count: Blood cell counts like total erythrocyte count, leukocyte count, and platelet counts enable doctors to determine your physical health before diagnosis and treatment. These counts could also be taken during various stages of treatment to ascertain your health status.
2. Blood Chemistry: Liver function and kidney function tests are commonly ordered to check for abnormalities. Your doctor can even order serum electrolyte level tests, bone density tests, and other vital enzyme level tests to check for any variations. Any anomalies in these would suggest metastasis- the spread of breast cancer to other organs. 
3. Specific Markers: Cancer causes a few changes in the body that can be detected in the blood. It could be certain proteins, antigens, antibodies released by the immune system, or even be freely floating tumor cells. Your doctor could order any of these tests to look at your condition through a more specific process. 

• Mammograms: These are specialized imaging tests of your breast that use specialized low-intensity X-Rays to detect any abnormal growths or masses in your breast. These tests look for a phenomenon called microcalcification, a sign common to breast tumors. All middle-aged women are recommended to get annual mammograms to be vigilant of breast cancer, alongside regular breast examinations. 
• Breast Sonogram: This is an imaging technology that uses ultrasonic sound waves that bounce off of tissues to create a specialized image that helps doctors differentiate between different masses of tissues. 
• Breast CT Scans: CT scans or computed tomography uses specialized X-Rays to create images that give your doctor a precise idea about the presence of a tumor. The machine creates several images taken at various sections of the body to create a three-dimensional image of the region to aid doctors and surgeons in placing the tumor. 
• Breast MRI: Magnetic resonance imaging is a specialized test that uses the realignment of metallic ions in the body to an artificial magnetic field to produce imagery of the tissues in the body. Like CT scans, MRIs also take sectional images of each part of the body to help with a three-dimensional image. 
• Breast Biopsy: If none of the imaging tests are conclusive enough to give your doctor a clear idea if you have breast cancer, he might order a biopsy. A biopsy involves the removal of a small portion of the tumor and examining the tissue under a microscope to tell if the cells are cancerous. Biopsies are of various kinds and could be as simple as a simple puncture into the site, removing the fluid from the tumor, or a full-blown surgery to collect a sample. Depending on several risk factors, your doctor may recommend a biopsy. There are further complex tests carried out on the sample to completely ascertain the nature of the tumor. 

Breast Cancer Staging

Following tests, an assessment of your signs and symptoms, and the way the condition is presented in you, your doctor will make a diagnosis and proceed to stage the breast cancer. Breast cancer is staged from 0 to 4. Based on these stages, the doctor charts a treatment plan best fit for you. 

Stage 0: The cancer is localized to the breast ducts and hasn’t spread further. 

Stage 1: 

1. Stage 1A: The tumor is 2cm or lesser without affecting lymph nodes.
2. Stage 1B: While the tumor has spread to the lymph nodes, the primary tumor isn’t in the breast or less than 2cm.

Stage 2:

1. Stage 2A: Either the tumor is up to 5cm large without spreading to lymph nodes, or has spread to 2-3 lymph nodes and is smaller. 
2. Stage 2B: Either the tumor is bigger than 5cm or it is between 2 to 5cm large and has spread to the armpit lymph nodes. 

Stage 3: 

1. Stage 3A: Either the tumor has caused enlargements of the internal breast lymph nodes or spread to up to 9 armpit lymph nodes. The tumor could also be larger than 5cm and have spread to 3 armpit lymph nodes or the sternum lymph nodes.
2. Stage 3B: The tumor breaches the chest cavity or the skin and enlarges up to 9 nodes.
3. Stage 3C: The tumor has reached up to 10 armpit nodes, or has reached the clavicle/ collar bone nodes alongside enlarging internal breast nodes. 

• Stage 4: Cancer has spread to other organs or lymph nodes apart from ones around the breast. 

Breast Cancer Treatment & Outlook

Based on the type of tumor, the spread, and other bodily parameters, your doctor can suggest a variety of treatment options like hormone therapy, chemotherapy, radiation therapy, and even surgeries like mastectomy, where the affected breast is removed. Be sure to discuss all of your concerns with your doctor and your family members to help you through the process. Though breast cancer might seem worrisome, the survival rates have improved drastically. Be vigilant and learn to give yourself a breast exam, and be sure to take regular health checks to improve your overall health status.