Breast Cancer- Common Nightmare of Women

symbol of breast cancer awareness and breast cancer and title

Although all breast tumours are not malignant, breast cancer is more common among all other cancers in the female. It is a disease of elderly women, but quite common in middle-aged women. Early detection by increasing awareness as well as screening can reduce the chance of breast cancer mortality.

Breast cancer, the most common cause of death in middle-aged women, in Western countries. In England and Wales, 1 out of 12 women will develop the disease during her lifetime.
According to the American Cancer Society report in 2018, about 268,670 new cases of breast cancer were detected, among which 266,120 were female patients.

Factors that Elevated the Risk of Breast Cancer:

  • Age: common amongst elderly women but extremely rare below 20 years of age.
  • Sex: very rare among male.
  • Personal or family history of breast or ovarian cancer.
  • Genetic alteration (inherited mutation).
  • Early age of onset of menstruation and/ or late menopause.
  • Women who have never conceived.
  • First child after the age of 30 years.
  • Hormone replacement therapy (both Estrogen and Progestin).
  • Physical inactivity.
  • Obesity.
  • Alcohol consumption.
  • Benign breast condition like Atypical Hyperplasia.
  • High dose of radiation to the chest for the treatment of Lymphoma.

Protective Factors:

  • First child at an early age.
  • Breastfeeding for at least 1 year reduces the risk of breast cancer.

Clinical Presentation:

    Symptoms of Breast Cancer
  1. A painless hard lump is the commonest presentation.
  2. Swelling of the breast.
  3. Distortion of the breast.
  4. Ulceration.
  5. Tenderness i.e. pain in the breast.
  6. Peau d'Orange.
  7. Indrawing of the nipple.
  8. Abnormal nipple discharge.
  9. Metastatic features- Bone pain, Hemoptysis, Hepatomegaly (enlarged Liver), Ascites (distended abdomen).

How the Disease Spread/ Metastasized:

  • Direct spread to the overlying skin, pectoral muscle, chest wall.
  • Lymphatic spread: Axillary Lymph Node in 80-85% cases.
  • Through blood: Lumber vertebrae, Thoracic vertebrae, Ribs, Skull.

Types of Breast Cancer:

According to the site of origin, Breast cancer can be classified into Ductal Cell Carcinoma and Lobular Cell Carcinoma.
Breast cancer can also be classified into In Situ Cancer (that not involve the basement membrane) and Invasive Cancer.
Again, Invasive cancer is classified into, Grade I, Grade II, Grade III.
Grade I: well differentiated with a good prognosis.
Grade II: moderately differentiated.
Grade III: poorly differentiated with a bad prognosis.
In recent years, In situ cancer patient increases, because of increasing awareness and screening procedures, as a result, breast cancer mortality is reducing.
For this regard, the American Cancer Society recommends screening guidelines-

A. For Women at Average Risk:

Age Group 40-44 years: Have an option to start annual mammography (A low dose X-ray procedure).
Age Group 45-54 years: Should undergo annual mammography.
55 years or more: May transition to biennial mammography or continue annual mammography.

B. For High-Risk Women:

MRI should be done, in addition to Mammography from 30 years of age.

Mammography should be continued as long as overall health is good and life expectancy is 10 or more years. 
Besides these, every woman should examine the breast by herself for any palpable lump or visible change in the breast for at least once in a month.

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