Breast Cancer

Breast Cancer is the most common malignant tumour occurring in women and statistically the second most common type of cancer after lung cancer in female and male. Breast cancer can develop in the breasts milk ducts or in the mammary glands.

Anatomy of the female breast

The female breast (latin "mamma") is made up of glands, fatty tissue and connective tissue. The breast lies over the pectoral muscles that overlie the thorax.  Breast milk is produced in the glandular lobules that are connected to the breasts glandular tissue. The milk ducts lead from the glandular lobules, located near the thorax, to the nipple.  Fatty tissue is embedded between glandular and connective tissue. The connective tissue keeps the breast elastic.

Risk factors

Women between the age of 40 and 50 are at risk of getting breast cancer, whereas younger women are seldom diagnosed. Apart from the age as risk factor, further risk factors are listed below:

• Genes: Due to genes, cell growth controlling genes may mutate causing an unregulated cell division and abnormalities of the breast tissue. Especially a mutation of the genes BRC1 and BRC2 ("Breast Cancer Gene") contribute to the development of breast cancer. 5-8% of women who have mutated BRC genes develop breast cancer.

• Hormonal Factors: Breast Cancer is a tumor strongly conditioned by hormones. Therefore hormonal preparations for hormone therapy such as those used during women`s menopause years should be avoided as they enhance the risk immensely. An early setting-in of the first monthly bleeding or a late menopause is also known to increase the risk factor. On the other hand hormones can also lower the risk, as in the case of pregnancy and breast feeding. The anti-baby pill, that influences female hormones, has not shown any sign of increasing the risk.

• Nuclear Radiation and Electromagnetic Radiation: A very high exposure of ionising radiation enhances the risk of breast cancer. But to be able to diagnose breast cancer at an early stage, a mammography is necessary. A mammography however works with doses of ionising radiation. Considering the risk of a mammography and the benefit of an early diagnosis of breast cancer, an early diagnosis outweighs the risk.

• Stress: Stress can affect the autonomic nervous system. High intensity stress over a long period of time may even lead to damages in our body, but it does not increase the risk of developing breast cancer.

• Lifestyle: Amongst the women who develop breast cancer, the number of those who regularly drink alcohol is higher than those who not. Thereby the amount of alcohol defines the risk. Smoking is also observed to be a risk factor. As well as obesity and lack of exercise.

How is Breast Cancer diagnosed?

Clinical check-up:

A woman should go for regular checkups. This is important, because the evolving of breast cancer can easily go unnoticed. There is neither pain nor discomfort. The first sign of a tumour, usually a lump in the breast tissue, is quite often noticed by the women herself. Other indications may include changes in the breast size or shape, skin dimpling, nipple inversion or nipple secretion.

Mammography: During a check-up a woman generally has to undergo a mammography screening as to detect any developed masses or micro calcification. Thereby a roentgenogram is made of both breasts front and sides.

Ultrasound: An additional ultrasound method is typically applied in the case of detected masses or micro calcification for further evaluation.

Magnetic Resonance Imaging (MRT): In the case of a breast tumour with an invasive lobular growth pattern a MRT is advised. Otherwise not. The method is applied to show up the boundaries of the tumour or if the chances are high that there are more than just one tumour. Hereby the breast is scanned in an MRI device before and after the intravascular injection of a contrast agent. The pre-contrast images are "subtracted" from the post-contrast images, and any areas that have increased blood flow are seen as bright spots on a dark background.

Biopsy: A negative mammography or ultrasound result is followed by a punch biopsy to extract cancer cells which are tested in the lab to find out if the tumour is benign or malign.

Classifying breast cancer

Lumps and swelling detected in our tissue are generally referred to as „tumor". A tumour can be benign or malign. A malign tumour is a cancer. A cancer is usually invasive, meaning a cancer tends to grow and spread to other parts of the body (metastasis) through the cardiovascular or lymphatic system.

Infiltrating ductal carcinoma (IDC): IDC refers to cancer cells within the breasts` milk ducts. This type of cancer is the most frequent and makes up 70-80% of all breast cancer types.

Invasive lobular carcinoma (ILC): ILC starts inside the milk-making glands (called lobules), but grows into the surrounding normal tissue inside the breast and is the second most frequent (10-15%) type of cancer.

Ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS): These two types of cancer are non- invasive cancers, which stay within the milk ducts or milk lobules in the breast. They do not grow into or invade normal tissues within or beyond the breast and do not spread to other parts of the body (metastasis). These are called in situ or pre-cancers.

A woman with breast cancer has an 85% chance of recovery, if the tumour has not yet spread to the lymph nodes. That is also the reason for the importance of an early diagnosis. Of course, other factors also play a role in the recovery. Such as, the stage the cancer is in; its size and the age of the patient. Younger women tend to have a poorer prognosis than post-menopausal women due to several factors. Their breasts are active with their cycles; they may be nursing infants, and may be unaware of changes in their breasts.