Breast cancer guide

October 10, 2017

Incidence of breast cancer is increasing, particularly in developing countries where the majority of cases are diagnosed in late stages.

We take a closer look at breast cancer, highlighting the symptoms, risks, diagnosis and treatment for the disease.

Breast cancer is a malignant tumour that forms in the cells of the breast. Over time, the cancerous tumour grows, it may invade surrounding tissue and spread to other areas of the body.

Breast cancer usually starts off in the inner lining of milk ducts (ductal carcinoma) or the lobules that supply them with milk (lobular carcinoma). Ductal carcinoma is the most common type of breast cancer.

If breast cancer is invasive, the cancer cells spread from the lobules or ducts and invade nearby tissue. With this type of cancer, the cancerous cells can spread to the lymph nodes, and to other organs, via the bloodstream or the lymphatic system.

This is when the cancer is confined to where it originally developed.
This type of breast cancer is often called ‘pre-cancerous’. This means that although the cancerous cells have not spread beyond their place of origin, they may eventually develop into invasive breast cancer.

People are often surprised to learn that men can get breast cancer, as they don’t think of men as having breasts. But, men have breast tissue which can develop into breast cancer. Male breast cancer is rare and it is often diagnosed later than breast cancer in women. This may be because men are less likely to be suspicious of any abnormality in the chest area, and are less willing to visit their doctors. Also, as men have less breast tissue, it is harder to detect abnormalities early, meaning tumours can spread to surrounding tissues.

Risk factors of male breast cancer include:

  • Breast cancer in a close female relative
  • History of radiation exposure of the chest
  • Enlargement of breasts
  • Taking oestrogen
  • A rare genetic condition called Klinefelter's syndrome
  • Severe liver disease
  • Diseases of the testicles such as mumps orchitis, a testicular injury, or an undescended testicle

As with breast cancer in women, prognosis of male breast cancer is predominantly influenced by tumour stage. So early detection and treatment are vital.

While the exact causes of breast cancer are unknown, some risk factors can impact on a woman's likelihood of developing the disease.

Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. Most women have some risk factors, but most women do not get breast cancer. If you have breast cancer risk factors, talk with your doctor about ways you can lower your risk and about screening for breast cancer.

Increasing age - The risk for breast cancer increases with age; most breast cancers are diagnosed after age 50.

Genetic mutations - Approximately 5% to 10% of breast cancers are thought to be hereditary, caused by abnormal genes passed from parent to child.

Menstrual history - Women who start their periods before age 12 are exposed to hormones longer, raising the risk for breast cancer.

Late or no pregnancy - Having the first pregnancy after age 30 and never having a full-term pregnancy can raise breast cancer risk.

Starting menopause after age 55 - Being exposed to oestrogen hormones for a longer time later in life raises the risk of breast cancer.

Sedentary lifestyle - Women who are not physically active have a higher risk of getting breast cancer.

Overweight and obesity - Women who are overweight or obese have a higher risk of getting breast cancer than those at a normal weight, this is especially true for women post-menopause.

Having dense breasts - Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumours on a mammogram.

Combination hormone therapy - Taking hormones to replace missing oestrogen and progesterone in menopause for more than five years raises the risk for breast cancer.

Oral contraceptives - Certain forms of oral contraceptive pills have been found to raise breast cancer risk.

History of breast cancer - Women who have had breast cancer are more likely to get breast cancer a second time.

Family history of breast cancer - A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast cancer.

Radiation therapy - Women who had radiation therapy to the chest or before age 30 have a higher risk of getting breast cancer later in life.

Alcohol consumption - Research consistently shows that drinking alcoholic beverages increases a woman's risk of breast cancer.

Race/Ethnicity - White women are slightly more likely to develop breast cancer than Black, Hispanic, and Asian women. But Black women are more likely to develop more aggressive, more advanced-stage breast cancer that is diagnosed at a young age.

Breast cancer symptoms vary widely, and many breast cancers may have no obvious symptoms at all. Symptoms that are similar to those of breast cancer may be the result of non-cancerous conditions like an infection or a cyst. Although the majority of lumps will be non-cancerous, it is essential that any lump is checked by a doctor or healthcare professional.

Consult with a doctor immediately if any of the following signs or symptoms are detected. The doctor, will conduct a physical exam, and then make a referral to a specialist if it is found that further assessment is needed.

  • A lump in the breast
  • Thickened tissue in the breast
  • Pain in the armpit or breast
  • Change in breast size or shape
  • Swelling in part of or the entire breast
  • Skin irritation or dimpling/pitting
  • Nipple rash
  • Nipple inversion
  • Nipple discharge
Breast cancer diagnosis generally occurs following a routine breast cancer screening, or after an individual detects breast cancer symptoms and speaks to their doctor about them.

Breast exam - The doctor will check both breasts, checking for lumps and abnormalities.

Mammogram - Commonly used for breast cancer screening. If anything unusual is found, the doctor may order a diagnostic mammogram.

Ultrasound - A scan which helps determine whether a lump or abnormality is a solid mass or a fluid-filled cyst.

Biopsy - A sample of tissue is surgically removed from the breast and sent to a lab for analysis. It the cells are found to be cancerous, the lab will determine the type and grade of breast cancer.

Breast MRI - This scan helps determine the extent of the cancer.

Early detection of breast cancer is crucial for successful treatment and recovery. Regular screening can assist early detection, increasing the likelihood of a positive outcome. Regular mammograms are crucial, but as mammograms do not find every breast cancer, it is important to be aware of breast changes and to know the signs and symptoms of breast cancer.

Breast self-exam should be part of your monthly health care routine, and you should visit your doctor if you experience breast changes.

Breast health begins with a sense of what’s normal for your breasts (breast awareness). To promote breast health, consider doing regular breast self-exams, know what’s normal for you and when to consult your doctor. With practice, you’ll discover how your breasts vary in sensitivity and texture at different times during your menstrual cycle. Perform breast self-exams at least once a month.

Look at your breasts in the mirror with your shoulders straight and your arms on your hips.
Look for:

  • Any irregularities in the usual size, shape, and colour of the breasts
  • Distortion or swelling
  • Dimpling, puckering, or bulging of the skin
  • Nipple inversion
  • Redness, soreness, rash, or swelling
Raise your arms above your head and look for the same changes.
Squeeze the nipple and check for discharge and lumps. Look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, yellow fluid or blood).
Lie down so the breast tissue spreads out evenly along the chest wall. Place a pillow under your right shoulder and your right arm behind your head. Using your left hand, move the pads of your fingers around your right breast gently in small circular motions covering the entire breast area and armpit.

Use light, medium, and firm pressure. Repeat these steps for your left breast.
Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your entire breast, using the same hand movements described in step 4.

Treatment for breast cancer depends on:

  • where the cancer is
  • the size of the tumour
  • how far the cancer has spread
  • the grade of the cancer
  • the patient’s general health and level of fitness
  • the age of the patient

A doctor will discuss the best treatment options with a patient, explaining the benefits and the possible side effects.

A multidisciplinary team will be involved in a breast cancer patient's treatment. The team may consist of an oncologist, radiologist, radiographer, specialist cancer surgeon, specialist nurse, pathologist and reconstructive surgeon.

  • Radiation therapy
  • Surgery
  • Biological therapy (targeted drug therapy)
  • Hormone therapy
  • Chemotherapy

Lifestyle changes can help reduce the risk of developing breast cancer.

Alcohol consumption – If alcohol is consumed, it should be in moderation.

Be physically active – Making time for physical activity is very important for overall health. Maintaining a physically active lifestyle and a healthy weight reduces the risk associated with breast cancer.

Diet – Research has shown that women who follow a healthy, well-balanced diet may reduce their risk of developing breast cancer.  A main meal should consist of three-quarters vegetables, beans or grains and one-quarter meat, fish or protein, try to choose water over other beverages.

Reduce salt intake and try to avoid too many sugar rich and processed foods.

Postmenopausal hormone therapy - Limiting hormone therapy may help reduce the risk of developing breast cancer. It is important for the patient to discuss the pros and cons thoroughly with her doctor.

Maintaining a healthy weight – People with a healthy bodyweight have a considerably lower chance of developing breast cancer compared to those who are obese and overweight.

Know your breasts – Examine your breasts regularly, and understand what is normal for your breasts so any abnormalities can be identified quickly.

Screen regularly – Attend regular breast screening, discuss with your doctor when to begin screening for breast cancer and how often.

To reduce the chances of getting breast cancer, it is essential to live an active life, consume a healthy diet and maintain a normal body weight. Make breast self-examination part of your monthly health care routine, and visit your doctor immediately if you experience breast changes. Early detection of breast cancer, through examination, screening and diagnostic tests is crucial for successful treatment and recovery.

Please take advantage of your Preventative Care benefit from Allianz Worldwide Care  – health is our most precious asset.