Breast cancer is an uncontrolled growth of breast cells.

To better understand breast cancer, it helps to understand how any cancer can develop.
 
 
Cancer occurs as a result of mutations, or abnormal changes, in the genes responsible for regulating the growth of cells and keeping them healthy.

The genes are in each cell’s nucleus, which acts as the “control room” of each cell. Normally, the cells in our bodies replace themselves through an orderly process of cell growth: healthy new cells take over as old ones die out. But over time, mutations can “turn on” certain genes and “turn off” others in a cell. That changed cell gains the ability to keep dividing without control or order, producing more cells just like it and forming a tumor.

A tumor can be benign (not dangerous to health) or malignant (has the potential to be dangerous). Benign tumors are not considered cancerous: their cells are close to normal in appearance, they grow slowly, and they do not invade nearby tissues or spread to other parts of the body. Malignant tumors are cancerous. Left unchecked, malignant cells eventually can spread beyond the original tumor to other parts of the body.

The term “breast cancer” refers to a malignant tumor that has developed from cells in the breast. Usually breast cancer either begins in the cells of the lobules, which are the milk-producing glands, or the ducts, the passages that drain milk from the lobules to the nipple. Less commonly, breast cancer can begin in the stromal tissues, which include the fatty and fibrous connective tissues of the breast.

Breast cancer symptoms vary widely — from lumps to swelling to skin changes — and many breast cancers have no obvious symptoms at all. Symptoms that are similar to those of breast cancer may be the result of non-cancerous conditions like infection or a cyst.

Breast self-exam should be part of your monthly health care routine, and you should visit your doctor if you experience breast changes. If you’re over 40 or at a high risk for the disease, you should also have an annual mammogram and physical exam by a doctor. The earlier breast cancer is found and diagnosed, the better your chances of beating it.

The actual process of diagnosis can take weeks and involve many different kinds of tests. Waiting for results can feel like a lifetime. The uncertainty stinks. But once you understand your own unique “big picture,” you can make better decisions. You and your doctors can formulate a treatment plan tailored just for you.

In the following pages of the Symptoms and Diagnosis section, you can learn about:

• Understanding Breast Cancer – How breast cancer happens, how it progresses, the stages, and a look at risk factors.
• Screening and Testing – The tests used for screening, diagnosis, and monitoring, including mammograms, ultrasound, MRI, CAT scans, PET scans, and more.
• Types of Breast Cancer – The different types of breast cancer, including ductal carcinoma in situ (DCIS), invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC), inflammatory breast cancer, male breast cancer, recurrent breast cancer, metastatic breast cancer, and more.
• Your Diagnosis – The characteristics of the cancer — featured on your pathology report — that might affect your treatment plan, including size, stage, lymph node status, hormone receptor status, and more.

 

Breast Cancer Risk Factors

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

Genes are particles in cells, contained in chromosomes, and made of DNA (deoxyribonucleic acid). DNA contains the instructions for building proteins. And proteins control the structure and function of all the cells that make up your body.

Think of your genes as an instruction manual for cell growth and function. Abnormalities in the DNA are like typographical errors. They may provide the wrong set of instructions, leading to faulty cell growth or function. In any one person, if there is an error in a gene, that same mistake will appear in all the cells that contain the same gene. This is like having an instruction manual in which all the copies have the same typographical error.

BRCA1 and BRCA2 genes

Most inherited cases of breast cancer are associated with two abnormal genes: BRCA1 (BReast CAncer gene one) and BRCA2 (BReast CAncer gene two).

Everyone has BRCA1 and BRCA2 genes. The function of the BRCA genes is to repair cell damage and keep breast cells growing normally. But when these genes contain abnormalities or mutations that are passed from generation to generation, the genes don’t function normally and breast cancer risk increases. Abnormal BRCA1 and BRCA2 genes may account for up to 10% of all breast cancers, or 1 out of every 10 cases.

Having an abnormal BRCA1 or BRCA2 gene doesn’t mean you will be diagnosed with breast cancer. Researchers are learning that other mutations in pieces of chromosomes — called SNPs (single nucleotide polymorphisms) — may be linked to higher breast cancer risk in women with an abnormal BRCA1 gene as well as women who didn’t inherit an abnormal breast cancer gene.

Women who are diagnosed with breast cancer and have an abnormal BRCA1 or BRCA2 gene often have a family history of breast cancer, ovarian cancer, and other cancers. Still, most people who develop breast cancer did not inherit an abnormal breast cancer gene and have no family history of the disease.

You are substantially more likely to have an abnormal breast cancer gene if:

• You have blood relatives (grandmothers, mother, sisters, aunts) on either your mother’s or father’s side of the family who had breast cancer diagnosed before age 50.
• There is both breast and ovarian cancer in your family, particularly in a single individual.
• There are other gland-related cancers in your family such as pancreatic, colon, and thyroid cancers.
• Women in your family have had cancer in both breasts.
• You are of Ashkenazi Jewish (Eastern European) heritage.
• You are African American and have been diagnosed with breast cancer at age 35 or younger.
• A man in your family has had breast cancer.
• If one family member has an abnormal breast cancer gene, it does not mean that all family members will have it.

The average woman in the United States has about a 1 in 8, or a 12-13%, risk of developing breast cancer in her lifetime. Women who have an abnormal BRCA1 or BRCA2 gene (or both) can have up to an 80% risk of being diagnosed with breast cancer during their lifetimes. Breast cancers associated with an abnormal BRCA1 or BRCA2 gene tend to develop in younger women and occur more often in both breasts than cancers in women without these abnormal genes.

How do I check my breasts?

There’s no right or wrong way to check your breasts. Try to get used to looking at and feeling your breasts regularly. Remember to check all parts of your breast, your armpits and up to your collarbone.

What changes should I look and feel for?

Nobody knows your body like you do,so you’re the best person to notice any unusual changes.

• Changes in size or shape.
• Changes in skin texture such as puckering or dimpling.
• Inverted nipple.
• A lump or thickening of breast tissue.
• Redness or a rash on the skin/around the nipple.
• Discharge from one or both nipples.
• Constant pain in breast or armpit.
• Swelling in armpit/around collarbone.

Genetic testing

There are genetic tests available to determine if someone has an abnormal BRCA1 or BRCA2 gene. A genetic counselor also may order testing for an abnormal ATM, p53, CHEK2, PTEN, or CDH1 gene if it’s determined from your personal or family history that these tests are needed. For more information, visit the Breastcancer.org Genetic Testing pages.

Steps you can take

If you know you have an abnormal gene linked to breast cancer, there are lifestyle choices you can make to keep your risk as low it can be:

• maintaining a healthy weight
• exercising regularly
• limiting alcohol
• eating nutritious food
• never smoking (or quitting if you do smoke)

These are just a few steps you can take.

Review the links on the left side of this page for more options.

Along with these lifestyle choices, there other risk-reduction options for women at high risk because of abnormal genetics.

Hormonal therapy medicines: SERMs (selective estrogen receptor modulators) have been shown to reduce the risk of developing hormone-receptor-positive breast cancer in women at high risk. Tamoxifen and Evista (chemical name: raloxifene) are the two SERMs used in this way.

Tamoxifen has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in both postmenopausal and premenopausal women at high risk. Certain medicines may interfere with tamoxifen’s protective effects. Visit the tamoxifen page to learn more.

Evista has been shown to reduce the risk of first-time hormone-receptor-positive breast cancer in postmenopausal women. Visit the Evista page to learn more.
Hormonal therapy medicines do not reduce the risk of hormone-receptor-negative breast cancer.

More frequent screening: If you’re at high risk because of an abnormal breast cancer gene, you and your doctor will develop a screening plan tailored to your unique situation. You may start being screened when you’re younger than 40.

In addition to the recommended screening guidelines for women at average risk, a screening plan for a woman at high risk may include:

• a monthly breast self-exam
• a yearly breast exam by your doctor
• a digital mammogram every year starting at age 30 or younger
• an MRI scan every year
• Women with an abnormal breast cancer gene need to be screened twice a year because they have a much higher risk of cancer developing in the time between yearly screenings. For example, the Memorial Sloan-Kettering Cancer Center in New York, NY recommends that women with an abnormal BRCA1 or BRCA2 gene have both a digital mammogram and an MRI scan each year, about 6 months apart (say a mammogram in January and an MRI in June).

A breast ultrasound is another powerful tool that can help detect breast cancer in women with an abnormal breast cancer gene. This test does not take the place of digital mammography and MRI scanning.

Talk to your doctor, radiologist, and genetic counselor about developing a specialized program for early detection that addresses your breast cancer risk, meets your individual needs, and gives you peace of mind.

 

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Information thanks to BreastCancer.org