Introduction

Breast cancer is among the most prevalent cancer in women globally, accounting for more than 1 in 10 new cancer diagnoses annually, and is the second most common cause of cancer death among women worldwide. Early-stage breast cancer is associated with a 5-year relative survival rate of approximately 99%. As the stage goes higher, the survival rate lowers with metastatic cancers carrying a 5-year relative survival rate of 32%. Thus, understanding the symptoms and risk factors of breast cancer becomes essential so that it may be diagnosed at the earliest. In this article, we are going to discuss the risk factors, symptoms and signs, ways of early detection and prevention, and diagnosis and management of breast cancer.

What is Breast Cancer?

Breast cancer develops when there is abnormal growth of cells in the breast tissue. The cells grow uncontrollably and form a tumour. Breast cancer can happen in men and women, but it is more prevalent in women.

Causes

The exact cause of the majority of breast cancers is unknown. Researchers have discovered several factors that increase the risk of breast cancer, but how some individuals who have no risk factors develop cancer, while others with risk factors do not, is not certain. The cancer likely occurs through intricate interaction between genetic and environmental factors.

Risk Factors

Although the exact cause of breast cancer remains unclear, a number of risk factors can contribute to a woman's risk of developing the disease. These include:

1. Family or personal history: Women who have a family or personal history of breast cancer are at higher risk of developing the disease.
2. Genetic mutations: Women with inherited genetic mutations, including BRCA1 and BRCA2, are at increased risk of developing breast cancer.
3. Age: There is an increased risk of breast cancer with advancing age, most commonly in women above 50 years. Risk of breast cancer is higher in older women but it can also occur in young women.
4. Dense breast tissue: Women having dense breast tissue are at an increased risk of developing breast cancer.
5. Exposure to radiation: Women who have received radiation therapy to the chest are at increased risk of developing breast cancer.
6. Hormone replacement therapy: Women who have received hormone replacement therapy are at increased risk of developing breast cancer. The risk is associated with hormone therapy drugs that contain estrogen and progesterone. The risk decreases when you discontinue taking these drugs.
7. Pregnancy and breast-feeding: Pregnancy lowers the risk of breast cancer. Women who have never given birth or have never done breastfeeding are at higher risk of breast cancer.
8. Obesity: Individuals with obesity are at higher risk of breast cancer.
9. Reproductive history: Beginning menstrual periods earlier than age 12 and beginning menopause later than age 55 leave women exposed to hormones for longer periods, increasing their chances of developing breast cancer.

Symptoms and Signs

The symptoms and signs of breast cancer may be different from woman to woman. Some of the common signs are:

1. A lump or thickening in the breast: One or more lumps or thickening in the breast or underarm area may be a symptom of breast cancer. The cancer lumps are typically hard, firm and solid. They can be painless, but not necessarily. Not all breast lumps are cancerous, but all breast lumps should to be checked by a healthcare professional.
2. Change in breast size or shape: Change in breast size or shape can be a symptom of breast cancer.
3. Dimpling or puckering of the skin: Alteration of the skin over the breast, for example, skin that appears dimpled, puckered or like an orange peel, is a symptom of breast cancer.
4. Redness or scaliness of the skin: Redness or scaliness of the skin on the breast can be a symptom of breast cancer.
5. Nipple discharge or change: Bloody discharge from nipple is a symptom of breast cancer. Change in nipple discharge is also a symptom of breast cancer.
6. Flattened or inverted nipple: A flattened or inward-turned nipple can be a sign of breast cancer.

Diagnosis and Treatment

Breast cancer may be diagnosed using a combination of physical examination, mammography, ultrasound, and biopsy. Breast cancer tends to metastasize to lung, liver, bones and brain. This may be identified by chest radiography, ultrasound, Computed Tomography (CT) scan and Positron Emission Tomography (PET) scan. The treatment of breast cancer varies according to the stage and type of cancer and also the general health of the woman.

1. Surgery: Surgery is usually the initial treatment for breast cancer. The aim of surgery is to eliminate the tumor and the involved tissue. There are two forms of surgery, Breast Conservation Surgery (BCS), which retains some portion of breast tissue and Mastectomy, where the whole breast is excised.
2. Radiation therapy: Radiation therapy employs high-energy beams to destroy cancer cells. It can be employed following surgery to eliminate any remaining cancer cells.
3. Chemotherapy: Chemotherapy employs drugs to destroy cancer cells. It can be employed prior to or following surgery to reduce the size of the tumor or eliminate any remaining cancer cells.
4. Hormone therapy: Hormone therapy employs drugs to inhibit the production of hormones that feed the growth of cancer cells.

Prevention and Early Detection

Although there are no guaranteed methods to prevent breast cancer, there are measures that can be taken to lower their risk:

1. Doing regular mammograms: Regular mammograms (as advised by the doctor) can identify breast cancer in its early stages, when it is most curable.
2. Doing breast self-examination monthly: Doing monthly breast self-examinations once in a month will make women more aware of their breasts and catch any changes or abnormalities. If a new change or lump is felt, it should be checked by a medical professional.

How to do breast self-examination

1. Stand in front of a mirror with your arms at your sides.
2. Look for changes in the skin, including dimpling, puckering, or orange peel texture.
3. Observe the shape and outline of each breast.
4. Check for the nipple that is turned inward.
5. Feel around each breast in a circular pattern using a combination of light and firm touch.
6. Feel around and over each nipple.
7. Repeat these steps with arms raised above your head.
8. Lie on your back with one arm above your head and a pillow under the other shoulder.
9. Use your finger pads to examine the breast and the area around it.

If you notice any lump, any change in the skin, breast shape or size or nipple discharge, consult a trained healthcare professional. 

When to do a Breast self-examination?

1. If you are menstruating, do a breast self-examination after your period.
2. If you are menopausal or have very unpredictable periods, choose one day each month.
3. Maintain a healthy weight: Maintaining healthy weight may decrease the risk of breast cancer.
4. Exercise regularly: Regular exercise can decrease the risk of breast cancer. Try to go for at least 30 minutes of exercise on most days of the week.
5. Avoid hormone replacement therapy: Avoiding hormone replacement therapy can decrease the risk of breast cancer. If therapy must be used, try to use the lowest dose for the shortest duration of time.
6. Stop smoking and drinking alcohol.

Conclusion

Breast cancer is a serious condition that affects millions of women globally. Although breast cancer is not curable, early diagnosis and treatment help considerably with survival and quality of life. Knowing the risk factors, symptoms, diagnosis and treatment for breast cancer can help women to decrease their risk of getting breast cancer and detect the condition in the early stages.

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References:

1. https://www.ncbi.nlm.nih.gov/books
2. https://www.cancer.org/cancer/types
3. https://www.mayoclinic.org/diseases-conditions