Is It Breast Cancer?

What is breast cancer?

Breast cancer is caused by an abnormal growth (tumor) in the breasts. A tumor can grow, and its cells invade the healthy lobules tissue surrounding it.

The cancer cells can also go into nearby blood vessels or lymph nodes, which are part of the body’s immune system. If that happens, the cancer can spread (metastasize) to other parts of the body, such as distant lymph nodes, organs, or bones.

Breast cancer usually affects women—breast cancer risk is very low in men but does occur. Women have a 1 in 8 chance of developing breast cancer in their lifetime, according to the American Cancer Society. Breast cancer prevention efforts have been successful in raising awareness and driving early mammograms and testing.

Most common symptoms

Typically, breast cancer does not have symptoms. For this reason, it is recommended that all women over age 40 get a breast cancer screening with a mammogram every 1 to 2 years.

The most common first symptom is a lump. The lump may be painful, painless, firm, mobile or fixed, and feel like it’s growing over time.

Occasionally, other lumps or swelling can be felt under the arm. This may mean it has spread to a lymph node under the arm.

Other less common symptoms include nipple discharge, nipple retraction, skin changes over the lump, or breast heaviness.

Sometimes, symptoms are more vague or bodywide, like unintended weight loss, recurring fevers (especially at night), new pain in bones, or extreme fatigue. When the symptoms are so vague, people may confuse them with just feeling “bad” and not realize it’s a sign of a serious underlying medical issue.

Main symptoms

• Lump in breast—can be painful or painless, often firm and fixed, but occasionally mobile. It can occur anywhere on the breast, including the lobules and the areola. It can grow over time and usually feels dense like a rubber ball.
• Unexplained weight loss—usually more than 5 to 10 lbs over a few months, with decreased appetite.
• Breast pain or heaviness: This can be a pain in one area of the breast or all-over pain and heaviness.
• Swelling underarms—usually painless swelling that can feel like a squishy rubber ball that is usually mobile to touch.

Other symptoms you may have

• Fatigue
• Nipple discharge
• Nipple skin changes
• Breast skin changes
• Bone pain

Risk factors

There are several genetic and lifestyle factors that can increase someone’s risk for breast cancer. But breast cancer can also happen in someone without any risk genes factors. This is why screening with a mammogram is so important.

• Family history. Certain inherited mutations passed down through birth can increase your risk of breast cancer. The most commonly inherited mutation occurs in a gene called “BRCA.” If you have a first- or second-degree relative (parents, siblings, aunts) with breast cancer, talk to your primary care doctor about genetic screening or getting screened with a mammogram earlier in your life.
• Having increased lifetime exposure to the estrogen hormone can increase your risk of breast cancer, because some types of breast cancer rely on estrogen to grow. This can happen when someone takes birth control pills with estrogen or hormone replacement therapy (which may be prescribed during menopause), of women who have an early first period (before the age of 11) or menopause very late (after the age of 55).
• Other lifestyle factors can increase your breast cancer risk, including not exercising regularly, obesity or being overweight, smoking tobacco or vaping products, or drinking excessive alcohol.

Next steps

If you feel a lump or have any of the other symptoms, schedule an appointment with your primary care physician or gynecologist to be seen within 1 to 2 weeks. If your doctor cannot fit you in, visit urgent care.

Breast cancer treatment

The first step in treating breast cancer is getting a diagnosis. This is done with a mammogram and breast biopsy, which is where your doctor removes some of the suspicious breast tissue with a needle and looks at it under an imaging microscope. Sometimes, specialized tests may be needed. This process can take from 1 to 3 weeks.

Your doctor will then refer you to a specialist who treats cancer, called an oncologist. The oncologist will determine the stage of cancer and treatment options. They may order X-rays or CT scans. This process can take about a week.

There are 4 stages of breast cancer, and each stage represents how much the cancer has grown within the body and changes the prognosis.

An “early stage cancer,” stages 1–3, has grown within the breast and nearby areas.

A “late stage cancer,” stage 4, metastasis has occurred outside the breast tissue. It may be in distant areas of the body, such as bones or organs.

Depending on the stage, treatment can last anywhere from a few weeks to lifelong. The goal of treatment may be to cure you (usually for stage 1 to 3 cancers) or to control the cancer long-term (usually for stage 4 cancers).

Treatment varies depending on the stage and type of breast cancer. Each type of treatment is given by a different type of physician. You may need to go to multiple specialists. They will consult with one another to come up with the best treatment plan for you. This process can take 1 to 3 weeks.

Treatment Plan

If you have a breast cancer diagnosis, here's an example patient treatment plan. Of course, different doctors, hospital services, and even locations (the United States vs the rest of the world) will vary in their approach. Further, research funds are flowing into breast cancer research, so treatments and protocols are always changing. But for now, here's a snapshot:

1. Surgery: removing cancer through a surgical procedure. This can range from a lumpectomy (removal of just the lump) to a full mastectomy (full breast removal). Your doctor may also do a sentinel node biopsy, where a tracer material helps the surgeon find the first few lymph nodes where cancer may have spread. These lymph nodes are removed and tested in the lab. If they are cancer free, then the cancer has likely not spread through the lymph vessels and further surgery to remove all lymph nodes may not be necessary. Last, breast reconstruction can be a component of treatment after the patient is cancer-free.
2. Chemotherapy: Chemotherapy is a systemic treatment that uses drugs to kill cancer cells throughout the body. It may be given before or after surgery, depending on the stage and type of cancer.
3. Radiation Therapy: Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors. It's often used after surgery to eliminate any remaining cancer cells in the breast or lymph nodes.
4. Hormone Therapy: For hormone-receptor-positive breast cancers, hormone therapy can block the production or absorption of hormones that fuel cancer growth. This treatment may be given after surgery or chemotherapy.
5. Targeted Therapy: Targeted therapies are designed to attack specific molecules within cancer cells, minimizing harm to healthy cells. These therapies may be used for certain types of breast cancer, such as HER2-positive or BRCA2-positive breast cancer.
6. Clinical Trials: Participating in clinical trials may provide access to experimental treatments or new approaches to standard treatments. Discuss this option with your oncologist if you're interested.

It's crucial to work closely with your healthcare team to develop a personalized treatment plan based on your unique circumstances, such as the type and stage of cancer, overall health, and personal preferences. Remember, early detection and regular screenings can significantly improve the prognosis of breast cancer patients' treatment.

Follow up

It is important to stick to the follow-up plan set by your oncology team. Usually there is regular follow up (monthly to every 3 months) in the first 5 years after a cancer diagnosis.

Visits become less frequent over time, though this can vary a lot. It depends on several factors such as stage, type of breast cancer, and type of therapy being given.

It's also important during this challenging time to lean on your support group - friends, loved ones, faith organizations, etc. Cancer is taxing not just physiologically but also psychologically. Having the courage to go through treatment is not easy so surrounding yourself with your emotional support team will be important to your success.

Preventative tips

You may be able to reduce certain risk factors for breast cancer by following these healthy lifestyle choices:

• Maintain an active lifestyle with regular exercise.
• Eat healthy and balanced meals.
• Maintain a healthy body weight and lose weight if you’re overweight.
• Avoid excessive alcohol use. Generally, this means no more than 8 drinks a week, or 4 drinks within 2 to 3 hours.
• Never smoke tobacco or use vaping products.
• Avoid medications that increase your exposure to estrogen (like birth control pills with estrogen and hormone replacement therapy).