This Pink October, learn breast cancer’s early symptoms, risk factors, diagnosis, and treatment. A guide from ALMehwar Hospital: early detection matters.
Breast cancer is the most common type of cancer among women in many countries around the world, and it can affect women of all ages, with the risk increasing as women get older. Detecting, diagnosing, and treating the disease at the right time are among the most important factors in improving outcomes and reducing the risk of death.
To mark Breast Cancer Awareness Month in October, ALMehwar Hospital offers you this guide to understanding breast cancer, its most common symptoms, its risk factors, how it is diagnosed, its stages, and the main treatment options available.
What Is Breast Cancer?
Breast cancer is a disease that occurs when some breast cells begin to grow and divide abnormally. These cells accumulate and may form a tumor. Cancer can start in the milk ducts or in the lobules that produce milk, and it may then spread to surrounding tissue, the lymph nodes, or other parts of the body if it is not detected and treated.
Although most breast cancer cases occur in women, men can also develop it, though it is much less common. According to the World Health Organization, men account for about 0.5–1% of breast cancer cases.
What Are the Types of Breast Cancer?
Breast cancer can be classified in several ways, most importantly by where the tumor starts and by the characteristics of the cancer cells.
Types of Breast Cancer by Where the Tumor Starts
- Invasive ductal carcinoma: Starts in the milk ducts, then breaks through the duct wall and spreads into the surrounding breast tissue.
- Invasive lobular carcinoma: Starts in the milk-producing lobules and can spread to surrounding tissue.
- Ductal carcinoma in situ (DCIS): Abnormal cells confined within the milk ducts that have not spread to surrounding tissue.
- Inflammatory breast cancer: A rare type that can cause redness, swelling, and changes in the appearance of the breast skin.
- Paget’s disease of the breast: A rare type that starts in the nipple area and may cause skin changes or nipple discharge.
Breast Cancer by Receptors and Biological Characteristics
After a biopsy, the tumor is tested for certain characteristics that help the doctor determine its type and choose the right treatment. The most important include:
- Estrogen receptors (ER)
- Progesterone receptors (PR)
- HER2 protein
There are hormone receptor-positive tumors, HER2-positive tumors, and triple-negative tumors, which have no ER or PR receptors and no excess HER2. This information, along with other factors, helps determine the treatment plan.
What Are the Early Symptoms of Breast Cancer?
Breast cancer may not cause any noticeable symptoms in its early stages, so symptoms alone should not be relied on to detect it. Signs that call for a medical evaluation may include:
- A new lump or thickening in the breast or under the arm.
- A change in the size or shape of the breast.
- A change in the appearance of the breast skin, such as dimpling, redness, or a change in texture.
- A change in the shape of the nipple or the skin around it.
- Abnormal nipple discharge, especially bloody discharge.
- A new and persistent change in the shape of the breast or nipple.
Important: Having one of these symptoms does not necessarily mean you have breast cancer, but any new or unusual change deserves to be evaluated by a doctor.
What Are the Signs of Advanced Breast Cancer?
As the disease progresses, symptoms may become more noticeable, and the cancer may spread to the lymph nodes or other organs. Possible signs include:
- Dimpling or a visible change in the breast skin.
- Redness or swelling of the breast.
- A change in the nipple or nipple retraction.
- Swollen lymph nodes under the arm.
- Bone pain or other symptoms related to the spread of the disease to distant organs.
Advanced breast cancer may spread to areas such as the bones, liver, lungs, or brain, and symptoms vary depending on where it has spread.
Does Every Breast Lump Mean Cancer?
No. Most breast lumps are not cancerous and can be caused by benign conditions such as cysts, fibroadenomas, fibrocystic changes, and others.
However, the nature of a lump cannot be determined by how it feels or whether it is painful. Therefore, any new lump or unusual change should be evaluated by a doctor, who may order imaging or a biopsy depending on the case.
What Causes Breast Cancer?
There is no single cause that leads to breast cancer in all cases. The disease results from an interaction of genetic, biological, and hormonal factors, along with factors related to age and lifestyle.
It is important to know that having a risk factor does not mean you will inevitably develop the disease, and many women with breast cancer have no known family history or clear risk factor other than age and sex.
What Are the Risk Factors for Breast Cancer?
Factors That Cannot Be Changed
The main risk factors include:
- Getting older.
- Being female.
- A family history of breast cancer.
- Inherited gene mutations, such as BRCA1, BRCA2, and PALB2.
- A previous breast cancer or certain abnormal changes in breast tissue.
- Previous radiation exposure to the chest, especially at a young age.
- Certain factors related to reproductive and hormonal history.
Lifestyle-Related Factors
Risk may also be linked to certain factors that can be modified, including:
- Being overweight or obese, especially after menopause.
- Lack of physical activity.
- Drinking alcohol.
- Smoking.
- Using certain types of hormone therapy after menopause.
How Is Breast Cancer Diagnosed?
Diagnosis involves a series of steps determined by the doctor based on the patient’s age, symptoms, examination findings, and risk factors.
Clinical Breast Exam
The doctor usually begins by reviewing the symptoms and the patient’s medical and family history, then examines the breasts and the surrounding lymph nodes.
Mammogram
A mammogram (breast X-ray) is one of the most important breast cancer screening tests and can detect some changes and lumps before they can be felt. The need for it and its timing vary depending on age, risk level, and approved guidelines.
Breast Ultrasound
Ultrasound can be used to help evaluate certain changes or lumps in the breast, and it is often used alongside a mammogram when the doctor considers it appropriate.
Breast MRI
Breast MRI may be used in specific cases, including some women at higher risk or to help assess the extent of the tumor. The doctor decides whether it is needed based on the case.
Biopsy
A biopsy is the test that confirms cancer by examining a tissue sample under a microscope. A biopsy can be performed in different ways, and the doctor chooses the appropriate type based on the location and nature of the change.
A biopsy should not be delayed because of the misconception that it causes cancer to spread; it is an essential part of diagnosing breast cancer and determining its type.
Receptor and Biomarker Testing
After the diagnosis is confirmed, the cancer cells are tested to identify receptors such as ER, PR, and HER2, along with other markers that help the medical team choose the right treatment.
Genetic Testing
The doctor may recommend genetic testing in some cases, especially when there is a strong family history, a diagnosis at a young age, or other factors suggesting a possible inherited mutation.
What Are the Stages of Breast Cancer?
Breast cancer is classified into stages, but staging does not depend on tumor size alone. Doctors use the TNM system, which describes the size of the tumor, whether it has reached the lymph nodes, and whether it has spread to other sites, in addition to the tumor grade and biological characteristics such as hormone receptors and HER2.
Stage 0
Abnormal cells or non-invasive cancer, such as DCIS, are present inside the milk ducts with no evidence of invasion into surrounding tissue.
Stage 1
The cancer is usually at an early stage and is limited to the breast, or there may be very limited involvement of some nearby lymph nodes.
Stage 2
The tumor may be larger, or several nearby lymph nodes may be involved, with no distant spread.
Stage 3
The disease is more locally advanced and may involve a larger number of lymph nodes, the skin, or the chest wall, depending on the characteristics of the tumor.
Stage 4
This means the cancer has spread to distant parts of the body, such as the bones, liver, lungs, or brain. It is also known as metastatic breast cancer.
Therefore, the stage of breast cancer cannot be determined from the size of the lump alone, and it must be based on the doctor’s evaluation and the results of the necessary tests.
What Are the Treatment Options for Breast Cancer?
There is no single treatment that suits every case. The treatment plan is determined based on the type of tumor, its stage, its biological characteristics, and the patient’s overall health, and it may combine more than one type of treatment.
Breast Cancer Surgery
Surgical options include:
- Breast-conserving surgery: Removing the tumor along with some surrounding tissue while preserving most of the breast, when suitable for the case.
- Mastectomy: Removing the entire breast in cases that require it.
- Sentinel lymph node biopsy: To help determine whether the cancer has reached the nearby lymph nodes.
- Breast reconstruction: Can be performed in some cases during or after a mastectomy.
Radiation Therapy
Radiation therapy uses high-energy rays to destroy remaining cancer cells and reduce the risk of the disease returning in the treated area. It may be used after surgery or in other situations according to the treatment plan.
Chemotherapy
Chemotherapy uses drugs that travel through the bloodstream to different parts of the body. It may be given before surgery to shrink the tumor or after surgery to reduce the risk of recurrence, and it can also be used in some cases of advanced breast cancer. Not every breast cancer patient needs chemotherapy.
Hormone Therapy
Hormone therapy is used for some tumors that have hormone receptors, such as ER or PR. Medications used in this type of treatment include tamoxifen and aromatase inhibitors, and the doctor chooses the appropriate treatment based on the patient’s age, condition, and tumor type.
Targeted Therapy
Targeted therapy targets specific characteristics or proteins that help cancer cells grow. It is used for certain types of breast cancer, including some HER2-positive tumors or tumors with specific genetic changes.
Immunotherapy
Immunotherapy may be used in some cases of triple-negative breast cancer, and it may be given at certain stages before or after surgery or in some cases of metastatic disease, depending on the characteristics of the disease.
What Are the Chances of Recovering From Breast Cancer?
The chances of recovery and response to treatment vary greatly from one case to another and cannot be determined from the stage of the disease alone. Doctors take into account the type of breast cancer, its stage, the characteristics of the cancer cells, the patient’s age and overall health, and the response to treatment.
In general, detecting, diagnosing, and treating breast cancer at an early stage is linked to better outcomes, so paying attention to abnormal changes and keeping up with appropriate screening is important.
What Are the Complications of Breast Cancer and Its Treatment?
Some complications may occur because of the disease itself or as a result of treatment, including:
- Lymphedema: Swelling in the arm or hand due to damage to the lymphatic system.
- Pain or changes in sensation in the surgical area.
- Fatigue during or after treatment.
- Certain side effects related to chemotherapy, radiation therapy, hormone therapy, or targeted therapy.
- Psychological impact and changes in body image.
- Recurrence or spread of the disease in some cases.
Complications vary from one patient to another, and the medical team can put a plan in place to manage and monitor them.
How Can You Reduce Your Risk of Breast Cancer?
There is no way to guarantee complete prevention of breast cancer, but some risk factors can be reduced by:
- Maintaining a healthy weight.
- Exercising regularly.
- Avoiding smoking.
- Limiting or avoiding alcohol.
- Discussing hormone therapy after menopause with your doctor to understand its benefits and risks.
- Knowing your family history and discussing your risk with your doctor if several relatives have had breast or ovarian cancer.
For women at very high risk, the doctor may discuss additional risk-reducing options, such as certain preventive medications or preventive surgical procedures, based on an individual assessment of each case.
When Should You Get Screened for Breast Cancer?
Early detection recommendations vary depending on age, risk level, and medical and family history, so there is no single plan that suits all women.
Breast self-exam: Monthly starting at age 20, a few days after your period ends, to get to know how your breasts normally look and feel and to notice any changes.
Clinical breast exam: Every 1 to 3 years before age 40, then yearly after that.
Mammogram: Regularly starting at age 40 for women at average risk.
Women at higher risk: May need to start screening at a younger age and get screened more often, sometimes with an MRI.
Breast Cancer FAQs
Is Breast Cancer Painful?
Not necessarily. A breast cancer lump may be painless, so you should not wait for pain before seeing a doctor if you notice any new change in your breast.
Can Men Get Breast Cancer?
Yes, but it is rare compared to women. Any lump or change in the breast or nipple in a man requires a medical evaluation.
Can You Get Breast Cancer at a Young Age?
Yes, breast cancer can occur at a young age, although the risk increases with age. Assessing family history and genetic factors is important in some cases.
Does a Biopsy Cause Breast Cancer to Spread?
A biopsy should not be avoided because of this belief. It is an essential procedure for confirming the diagnosis and determining the type and characteristics of the tumor, and the doctor chooses the appropriate method for obtaining the sample.
Is Pregnancy Possible After Breast Cancer Treatment?
Pregnancy may be possible for many women after breast cancer treatment, but it depends on the type of treatment, age, fertility, and tumor type. The wish to become pregnant should be discussed with the medical team before or after treatment to determine the safe timing and the right plan.
Is a Mammogram Painful?
A mammogram may cause temporary pressure or discomfort during the exam, and the level of discomfort varies from woman to woman.
Can Breast Cancer Come Back After Treatment?
Breast cancer can come back in some cases, so follow-up after treatment depends on the type of disease, the treatment received, and the medical team’s recommendations. Follow-up may include clinical exams, imaging, and prescribed treatments as needed.
Why Choose ALMehwar Hospital for Breast Cancer Screening and Treatment?
At Al Mehwar Hospital, we are committed to providing comprehensive care that starts with evaluation and diagnosis and continues through treatment and follow-up, taking into account each patient’s needs and the treatment plan set by the medical team.
If you notice any new or unusual change in your breast, do not delay seeing a doctor.