Understanding Breast Cancer and
How To Manage It

Your guide to understanding all aspects of breast cancer

“I have cancer. Cancer doesn’t have me.”
Marco Calderon

Early detection and diagnosis always increase your chances of receiving successful treatment and beating all forms of cancer – especially breast cancer. Detecting breast cancer early will significantly boost your odds of survival. Hence, it is important to adhere to the recommended screening protocol for your age group so that you and your physician can detect and test any anomalies or changes. 

You can read the section that details the various types of cancer before embarking on the journey to understand breast cancer better. Read more

Let’s understand
the anatomy first

The breast is the tissue covering the chest or pectoral muscles. The glandular tissue is made up of 15 to 20 sections called lobes, and each lobe has smaller structures called lobules. The lobules end in dozens of tiny bulbs that produce milk. This entire network of lobes, lobules, and bulbs are linked by thin tubes called ducts. The breast also contains a network of blood vessels, lymph vessels, and lymph nodes. This network drains lymph fluid and transports white blood cells. Groups of lymph nodes are found near the breast, under the arm, in the chest, and above the collar bone.

What is breast cancer?

Breast cancer often begins with cells in the ducts or in the glandular tissues. These cells grow in an abnormal or uncontrolled manner and form a malignant tumour. Cancer may sometimes spread or metastasize through the breast cells and tissue to the lymph nodes and to other parts of the body.

Types of Breast Cancer

It is helpful to understand how breast cancers are classified

Hormone receptor positive (estrogen and/or
progesterone receptor positive)

This category has cells containing a group of proteins that bind to a specific hormone. Some breast cancer cells may have receptors for the hormones estrogen or progesterone. Hence, these cells are hormone receptor positive and need estrogen or progesterone to grow. Knowing if the breast cancer is hormone receptor positive may help plan the appropriate treatment. Hormone receptor negative (estrogen and/or progesterone receptor negative) is the exact opposite and here some breast cancer cells will not have receptors for the hormones estrogen or progesterone. They do not need these to grow and hence do not stop growing when treated with hormones.

HER2/neu positive or HER2/neu negative

In this type, the cancer cells do not have a huge amount of a protein called HER2 on their surface. HER2 helps to control growth in normal cells. Cancer cells which are HER2 negative may grow slowly and are less likely to recur or spread to other parts of the body, as compared to cancer cells that have a large amount of HER2 on their surface. Hence, checking for the quantity of HER2 in some types of cancer cells may help plan the course of treatment.

Triple negative
(estrogen receptor, progesterone receptor, and HER2/ neu negative)

This type describes breast cancer cells which do not have estrogen receptors, progesterone receptors, or large amounts of HER2/neu protein. Hence, they are also called ER-negative PR-negative HER2/neu-negative breast cancer. Triple positive is the exact opposite – here the breast cancer cells have estrogen receptors, progesterone receptors and larger than normal quantity of HER2 receptors. Hence, the cancer cells are called triple positive.

It is important to know the estrogen receptor, progesterone receptor, and HER2 receptor status to choose the best treatment. There are drugs that can stop the receptors from attaching to the hormones estrogen and progesterone and stop the cancer from growing. Other drugs may be used to block the HER2 receptors on the surface of the breast cancer cells and stop the cancer from growing. 

Further, breast cancers may be invasive and non-invasive in nature.

Non-invasive breast cancers

Ductal sarcoma in situ (DCIS)1 is a non-invasive breast cancer. In this form of cancer, the abnormal cells grow in the milk ducts of the breasts and have not spread to the surrounding breast tissue.

Invasive breast cancers

Ductal sarcoma in situ (DCIS)1 is a non-invasive breast cancer. In this form In this form, the cancer has spread from the original site – milks ducts or lobules – into the surrounding breast tissue or even the lymph nodes. Invasive ductal carcinoma, which starts in the milk ducts of the breast is the most common invasive breast cancer. Invasive lobular carcinoma2 which starts in the lobules of the breast is the second most invasive form of breast cancer.not spread to the surrounding breast tissue.

What causes breast cancer?

Clinical practitioners and researchers do not know the exact causes of breast cancer. There are certain risk factors (detailed below) that can increase your chance of developing it; however, having one or more risk factors does not mean that you will definitely get breast cancer. On the other hand, having no risk factors also does not mean you will not get the disease. Breast cancer is likely to be caused by a combination of these factors, rather than just one.

What are the Risk Factors?

Although breast screening for cancer should be done as per your doctor’s recommendations, here are some factors that put women at higher risk and hence mandatory screening may be recommended by your physician. Being associated with a risk factor does not necessarily mean that you will develop breast cancer.

Some gene changes or inherited gene mutations, like changes in the breast cancer gene 1  or breast cancer gene 2

Women having a family history or a personal history of cancer

Certain genetic syndromes like Cowden syndrome or Li-Fraumeni

Regular exposure of the breast tissue to estrogen generated by your body. This may be caused by factors such as menstruating at an early age, never having given birth, having your first child at an older age, or starting menopause at a late age

Treatments involving radiation therapy to the breasts or chest

Obesity and high alcohol consumption also put you at higher risk for breast cancer

What Can be Done to Lower Your Risk of Getting Breast Cancer?

Making some key lifestyle changes are known to help reduce your risk of breast cancer. Evidence suggests that taking appropriate steps to avoid risk factors like obesity and excessive alcohol consumption may reduce the risk of breast cancer. Maintaining a healthy weight and regular exercise may also reduce the probability of getting breast cancer. Studies suggest that limiting post-menopausal hormone therapy may also reduce the risk of breast cancer. In certain cases, additional protective measures like risk-reducing mastectomy7 (which involves the removal of both breasts for women at extreme high risk, when there are no signs of cancer) and estrogen-only therapy post menopause have also been adopted to prevent breast cancer.

What are the Symptoms?

Some common symptoms of breast cancer include

A lump or thickening in or near the breast or underarm area

A change in the size or shape of the breast

A nipple turned inward into the breast

Unusual fluid secretion from the nipples

Dimples in the breast

Red or swollen skin changes on the breast, nipple or areola (the dark area of skin around the nipple)

Screening for breast cancer

Breast cancer may occur in both men and women, but it’s far more common in women.

 Self-exams are a convenient tool that you can use on a regular basis and at any age to check for abnormalities and keep a lookout for any lumps and other breast cancer symptoms. Routine breast self-exams are recommended as part of the overall breast cancer screening strategy.

STEP 1

Examine your breasts in the mirror with your shoulders straight and your arms on your hips. Look for any of the above symptoms.

STEP 2

Now raise your arms and examine your breasts.

STEP 3

Examine the nipples for any fluid or discharge.

STEP 4

Examine your breasts while lying down, using the palm of your hand and keeping the fingers flat and together. Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage.

STEP 5

Finally, examine your breasts while you are standing or sitting. Many women find it easier to examine themselves when the skin is wet and thus prefer to do this during or after a shower.

If you find a lump or other inexplicable change to your breast during a breast self-examination, make an appointment with your doctor for prompt evaluation.

Screening tests for breast cancer

Screening tests may be done when you have no cancer symptoms at all. 

The main objective of breast cancer screening is to detect precancerous changes in at the cellular level, which if untreated can lead to cancer. The secondary objective is to find the cancer at an early stage, when treatment is usually more successful. 

It is important to remember that your physician does not necessarily think you have cancer if he or she suggests a screening test. They could just be following a normal screening protocol for your age group.

The Clinical Breast Exam

What to expect

A clinical breast exam is part of a woman’s routine medical check-up. It involves a general examination of the body, to check for any health issues or signs of any diseases. The physician may discuss topics like your dietary and exercise habits, family history of cancer, past illnesses and treatments, if any. A breast exam is generally pain-free, unless you have a wound or underlying condition that causes pain to your breast area. It is important that you choose a doctor and clinical team that you are comfortable with to perform your check-up.

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              During a clinical breast exam: 

  • You will first be asked to undress the upper part of your body (down to your waist) and lie on your back on the examination table. Ask for a sheet or blanket to cover yourself while you wait for your doctor. 
  • Try to relax, as this will make the exam more comfortable for you.
  • Your doctor will look at your chest and feel your breasts, armpits and nearby tissues for lumps, unusual nipple discharge or skin changes. 
  • The examination should take about 5-10 minutes. If you experience any pain, be sure to inform your doctor.
The Mammogram

What to expect

A mammogram or x-rayof the breast is the most common screening test used to detect breast cancer. This test is adept at finding tumours which cannot be detected by physical breast examinations alone. If your doctor detects an abnormality during screening, he or she may suggest a diagnostic mammogram to evaluate the abnormality further. Many factors influence the successful outcome of a mammogram in detecting cancer – such as age and weight of the patient, size and location of tumour and breast tissue density – to name a few.

Everyone experiences mammograms differently. Some women feel pain during the procedure, while others feel nothing at all. It is normal to feel some discomfort and pressure against your breasts from the testing equipment. It is important that you choose a doctor and clinical team that you are comfortable with to perform your mammogram.

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              During a clinical breast exam: 

  • You will first be asked to undress the upper part of your body (down to your waist). Ask for a robe or blanket to cover yourself while you wait for the radiographer to arrive.
  • The radiographer will then position you so your breast is on the x-ray machine.
  • Next, your breast will be firmly pressed with a plate. This will help keep the area still so that a clear image can be taken. You might find this uncomfortable or even painful, but this will last only as long as the mammogram takes.
  • In most cases, you will have two x-rays of each breast taken, from different angles. Women who have very large or dense breasts might need extra x-rays to make sure that all the tissue is included.
Breast Ultrasound

What to expect

A breast ultrasoundis a painless procedure that utilizes sound waves to make images of the internal body organs. Ultrasounds are often used in addition to a mammogram, to detect if a breast lump is a fluid-filled sac (cyst) or a solid mass which might be cancerous. They also pinpoint the position of a tumour and this guides the physician to the exact spot to insert a needle during biopsy.

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              During a clinical breast exam: 

  • You will first be asked to undress the upper part of your body (down to your waist) and lie on your back on a bed or examination table. Ask for a robe or blanket to cover yourself while you wait for the specialist to arrive
  • The specialist will instruct you to place your arm over your head.
  • Next, the specialist will cover a small instrument with a special gel, and move it around your breast and the surrounding area. If your breasts are especially large or dense, they might use some pressure to get a clearer image.
  • The ultrasound should take about 10-15 minutes. If you experience any pain, be sure to inform your doctor.
Diagnostic tests for breast cancer

If the screening protocol detects abnormalities, your doctor may recommend further follow-up diagnostic tests to confirm if cancer is present. Refer to this section for more information about diagnostic tests for breast cancer. Read more

Staging Breast Cancer

If your doctor confirms that you have breast cancer, further tests may be done to study the cancer cells and determine

If the disease has spread beyond the breast (i.e. determine the stage of cancer)

How quickly the cancer will grow

How likely it is to spread through the body

What sort of treatments might work

The likelihood of the cancer to recur (come back).

The stage of your cancer is a key aspect in determining your treatment. Refer to this section to understand your cancer diagnosis and for more information about how breast cancer is staged. Read more

Treatment options for
breast cancer
The decision about the best course of treatment is based on these test results and the type, stage, grade and size of your tumour. Treatments like surgery, chemotherapy, hormone therapy and radiation therapy are some of the options used for breast cancer. Refer to this section to understand the types of cancer treatments for breast cancer and possible side effects. Read more
Your cancer journey
Everyone deals with a breast cancer diagnosis and treatment in a different way. Refer to this section, to understand various aspects of your cancer journey and the road to recovery. Read more
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