Breast Cancer Symptoms, Causes & Treatment Options

Breast cancer is a relatively common form of cancer in women that originates from the breast tissue, which can be fatal if not treated. Symptoms include a painless lump in the breast or armpit, dimpling of the skin of the breast, nipple discharge or inversion, and changes to the skin of the breast, including redness and thickening.

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. References

What Is Breast Cancer?

Summary

Breast cancer (uncontrolled growth) commonly affects women over the age of 40. It is the second most common type of cancer in women and accounts for about one-quarter to one-third of all cancer diagnoses [1]. Women with breast cancer may or may not have a lump or dimpling of the skin of the breast, and usually, there is no pain in the breast. Therefore, it is important for all women to receive routine breast cancer screening. Catching breast cancer early improves the prognosis dramatically [2]. Treatments for breast cancer include surgery, chemotherapy, radiation therapy, hormone therapy, and antibody therapy.

Recommended care

Breast Cancer Symptoms

Main symptoms

The initial symptoms of breast cancer are typically hard to notice, and a person can have breast cancer without having any symptoms at all.

  • A painless lump in the breast
  • A painless lump in the armpit
  • Dimpling of the skin of the breast
  • Discharge from the nipple
  • Breast skin that “looks like an orange peel”
  • Nipple inversion
  • Redness of breast skin
  • Thickening of the skin of the breast

Other symptoms

If breast cancer continues to grow and eventually spreads beyond the breast (metastasize), it can go to the bones, lungs, liver, or the brain. When this happens, a wide range of symptoms may present, such as the following.

  • Weight loss
  • Fatigue
  • Bone and joint pain
  • Personality changes, confusion, and other neurologic problems
  • Death

Symptoms of Paget’s disease of the breast

In a specific subtype of breast cancer, Paget’s disease of the breast, a woman may experience the following symptoms in her breast [1].

  • Redness
  • Itching
  • Burning
  • Sensitivity
  • Discharge
  • Painless lump

Breast Cancer Causes

Breast cancer is a common condition in women. Breast cancer has a 100:1 predominance in women versus men. Approximately one in eight (12%) of women will develop breast cancer in their lifetimes if they reach the age of 80 years. Typically, women under 40 do not get breast cancer unless they have a particular genetic trait. There is no one cause of the disease; instead, it is thought that the development of breast cancer is controlled by a number of different risk factors, which are listed below. There are both strong genetic and environmental contributors to breast cancer, which means that both your inherited genes and your lifestyle can contribute to disease development. The disease starts as a “pre-malignant lesion.” This means that a small group of breast cancer cells attain changes in their DNA that allow them to grow uncontrollably. Eventually, this pre-malignant lesion can invade into the neighboring breast tissue and eventually gain access to the lymph ducts or to the blood, where it can metastasize (travel) to other places in the body.

Genetic risk factors

The following risk factors contribute to the development of breast cancer through your genes; however, it is very important to note that 85% of women with breast cancer have no family history of the disease [1].

  • Having two or more biological relatives (mother, sister, grandmother, aunt) who had breast cancer or a single male biological relative with breast cancer: Your risk increases with each additional relative who has/had the disease.
  • Having a biological relative who was diagnosed with breast cancer at younger than 50 years of age
  • Having a biological relative who had both breast and ovarian cancer
  • Having the BRCA1 or BRCA2 gene: Approximately 5 to 10% of breast cancers are attributed to these genetic mutations.
  • Having Ataxia Telangiectasia, Li-Fraumeni, Cowden, or Peutz-Jeghers Syndrome
  • Ashkenazi Jewish descent

Lifestyle risk factors

The following risk factors contribute to the development of breast cancer based on the way you live.

  • Obesity: Being overweight or obese poses a risk, especially if you carry more fat around your belly area or gain fat during adulthood.
  • Unhealthy eating: Diets high in saturated fats and refined carbohydrates (such as white flour and sugar) are associated with the development of breast cancer.
  • Not exercising enough
  • Drinking alcohol
  • Smoking tobacco
  • Exposures: Pesticides, radiation, carcinogens, and dietary estrogen may play a role in developing the disease. Of these, radiation to the chest, especially during adolescence, is the most prevalent risk factor.
  • Having your first child at an older age than average
  • Never being pregnant at all

Other risk factors

The following risk factors are outside of your control but still contribute to the risk of developing breast cancer.

  • Female sex: Females are 100 times more likely to develop breast cancer than men.
  • Increasing age
  • Becoming menopausal at an older age than average
  • Starting your period at an earlier age than average

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Treatment Options, Relief, and Prevention for Breast Cancer

Surgical treatment and further planning

The preferred approach to breast cancer treatment is the surgical removal of cancer. Successful surgery can cure breast cancer completely. Microscopic evaluation of a small sample of the tumor and of some lymph nodes helps your care team gain an understanding of how extensive the disease is. In addition, the surgeon can ensure that the entire tumor has been removed by sampling some of the margins (the area around the tumor) to make sure that it is not cancerous. The information obtained from the tumor, the margin, and the lymph nodes can be used together to determine a breast cancer stage. This staging can serve to guide future treatment options if necessary.

Additional therapies

Other information obtained from the tumor can help determine if you qualify for additional therapies. For example, the presence of some combination of the estrogen receptor (ER) and HER2 receptor on breast tumor tissue can make you eligible for the following [3].

  • Tamoxifen (Nolvadex) and raloxifene (Evista): These medications stop estrogen from binding to the estrogen receptor. This inability to bind decreases estrogen’s ability to cause cancer cells to grow.
  • Anastrozole (Arimidex): This medication prevents the conversion of testosterone to estrogen, which decreases the amount of estrogen available to influence breast cancer growth.
  • Trastuzumab (Herceptin): This medication decreases the signal for cancer cells to grow.

Mastectomy, lumpectomy, radiation, and chemotherapy

In cases of breast cancer that are already invasive, more breast tissue may need to be removed. This removal is referred to as “lumpectomy” (removal of a lump of invasive cancer) or partial or total “mastectomy” (removal of some or all of the breast). Sometimes, a “prophylactic” mastectomy/lumpectomy will be performed, which means that breast tissue will be removed before it has cancer in it to prevent it from developing cancer in the future.

Sometimes, additional therapy will be given to treat “micrometastases,” which are tiny groups of cancer cells that have traveled outside of the breast but are too small to see on imaging. While these cells clumps are tiny, they have the potential to develop new islands of cancer around the body. The additional therapies may include radiation therapy and/or chemotherapy.

Prevention

Preventing breast cancer is difficult since the illness is strongly driven by genetics and a number of lifestyle factors. However, it is crucial to prevent any early disease from becoming an advanced disease. The earlier breast cancer is caught, the better the chance for a cure or at least keeping the disease stable. This is why screening is a necessary method for catching breast cancer. The vast majority of breast cancers are discovered when a woman finds a lump in her breast during a self-examination. That said, the vast majority of lumps are not cancerous; so, finding a lump in your breast does not automatically mean you have cancer.

The most important form of screening for breast cancer is a regular mammogram. A mammogram is a type of X-ray that looks at the breast to determine if any areas are potentially cancerous or can become cancerous. These areas may be biopsied (sampled by a needle) in the future to determine if they are cancerous or not. Talk with your doctor about when you should start mammography, and always adhere to the mammography schedule, even if you are not worried about breast cancer. Also talk with your doctor about whether or not you should examine your own breasts for lumps, as the usefulness of this practice is debated.

Lifestyle changes

The following lifestyle modifications may help delay or prevent the development of breast cancer entirely [4].

  • Lose weight if you are overweight
  • Eat healthily: Reduce sugar, refined carbohydrate (white flour, tortillas, pastries, etc.), and saturated fat (animals and animal product) consumption. Trying to cut back on overly processed food will help you minimize your consumption of these three compounds.
  • Reduce or eliminate alcohol consumption: Try not to exceed one alcoholic beverage per day.
  • Be active: Aim for 30 minutes of exercise per day most days of the week. You can start off with a walking routine if you are new to exercising.
  • Avoid radiation and environmental toxins
  • Breastfeed your children
  • Talk with your doctor about hormone replacement therapy: There is a controversial opinion about whether or not hormone replacement therapy increases the risk of breast cancer with long term use.

When to Seek Further Consultation for Breast Cancer

If you feel a new lump in your breast or armpit, see a doctor promptly for an evaluation. Monitor your breasts for the signs and symptoms of breast cancer as indicated in the “Symptoms” section. In addition, if you feel fatigued, are losing weight unexpectedly, or are having joint pains, see a doctor.

References

  1. Mayo Clinic Staff. Breast cancer. The Mayo Clinic. May 22, 2019. Mayo Clinic Link

  2. Breast Cancer–Patient Version. National Cancer Institute. NCI Link

  3. Chalasani P. Breast Cancer. Medscape. Updated June 10, 2019. Medscape Link

  4. Mayo Clinic Staff. Breast cancer prevention: How to reduce your risk. The Mayo Clinic. Dec 1, 2018. Mayo Clinic Link