Discovering Breast Cancer (Part 1) FAQs

Finding out (or suspecting) that you or a loved one has breast cancer can be a daunting experience. Upon discovery, it is perfectly understandable for someone to have many questions. Within this article, we will go over some general questions people may have. Keep in mind that everyone’s experience is different. If you suspect you (or a loved one) may have breast cancer, we highly recommend you talk with your doctor. They could guide you through this new health journey.

Why Does Breast Cancer Happens?

Cancer usually develops when breast cells start to grow abnormally. These cells then accumulate and form a lump/mass. There are many reasons and factors that can lead to the development of breast cancer (and they will vary between individuals). One can separate these factors into ones you can and cannot control.

Risks that you cannot control include:

- Gender: Men can also get breast cancer. However, this disease is generally more common in women.
- Age: As women age, the risk of developing breast cancer increases.
- Family history: Having a family history of breast cancer does not mean that someone will definitively get this disease. However, one should be aware that they are at a higher risk. According to the American Cancer Society, women who have a first-degree relative (mother, sister, or daughter) have a double probability of having breast cancer.
- Genetics: The American Cancer Society also states that about 5% to 10% of breast cancer cases are hereditary. Mutations in the BRCA1 and BRCA2 genes are believed to be the most common cause of hereditary breast cancer. Of course, other genes can also play a role.
- Getting your period at a young age: Having an early period can increase your risk of developing breast cancer. This increase in risk may be because one is exposed longer to hormones such estrogen or progesterone.
- Going through menopause at an older age: Going through menopause at a later stage may mean that you have gone through more menstrual cycles. As a result, prolonged exposure to estrogen and progesterone can increase your risk.
- Having dense breast tissue: Having denser breast tissue can increase your risk because it may make it harder to detect cancer in mammograms. Age, menopausal status, the use of certain drugs (including menopausal hormone therapy), pregnancy, and genetics can affect breast density.
- Radiation exposure: Going through treatments that require radiation exposure to the chest area may also increase your risk (specially if the exposure occurred at a younger age).
- Having a personal history of breast conditions: Some benign (non-cancer) breast conditions can increase someone’s risk of breast cancer (i.e., fibromatosis, adenosis, benign phyllodes tumors, etc.). Meanwhile, breast conditions such as atypical hyperplasia led to a moderately increased risk of developing breast cancer.

Risks that you can control include:

Alcohol: Like with other cancers, consumption of alcohol is linked to an increased risk of developing breast cancer.
Being overweight or obese: Having more fat tissue after menopause can raise estrogen levels and increase one’s risk. Studies have also shown that being overweight after menopause increases the risk of hormone receptor-positive breast cancer.
Keeping active: Physical activity influences body weight, inflammation, and hormone levels. Keeping active can lower one’s risk.
Smoking: Like many other cancers, smoking can increase the risk of developing breast cancer in women (especially if they are postmenopausal).
Pregnancy and breast-feeding: Studies show that breastfeeding can lower one’s risk of breast cancer. Breastfeeding tends to limit a woman’s total number of lifetime menstrual cycles. Not having children or having children after the age of 30 can also raise one’s risk.
Birth control: Some studies suggest that the increase of hormones from taking various forms of birth control can increase one’s risk.
Menopausal hormone therapy: The two main types of hormone therapy include combined hormone therapy and estrogen replacement therapy. The use of estrogen in these therapies increases the risk of developing breast cancer.
Breast implants: Breast implants have been linked to breast implant-associated anaplastic large-cell lymphoma, other lymphomas, and squamous cell carcinoma. These cancers mainly form around the scar tissue.

Where Does Breast Cancer Usually Begin?

Most breast cancer cells form in the ducts (tubes in the breast that transports breast milk to the nipple). They may also form in the lobules (where the milk is produced) and within the upper outer section of the breast- but cancer lumps can appear anywhere where there is breast tissue. They can also show up near the skin’s surface or deep within the area closer to the chest wall.

Where Does Breast Cancer Usually Spread?

Breast cancer can spread to any part of your body once it metastasizes. However, the most common areas breast cancer cells spread to are your lymph nodes, lungs, liver, bones, and (sometimes) the brain. First, breast cancer cells usually spread to the nearest surrounding areas (such as lymph nodes, armpits, or collarbone). As cells grow and spread, cancer cells can travel through the bloodstream or lymphatic system to other body parts.

What Is the Risk of Breast Cancer by Age?

Age is one of the factors that are attributed to the high risk of breast cancer. Generally, cancer risk increases amongst older individuals. Of course, this does not mean that younger individuals cannot get breast cancer. There are also other factors to consider. However, there is a general trend of older individuals having an increased risk of developing breast cancer. According to CDC, most breast cancers are found in women over 50.

What Are the 1st Signs of Breast Cancer?

Keep in mind that warning signs/symptoms will vary between people. Some of these signs/symptoms overlap with other conditions. We highly recommend you see your doctor receive an official diagnosis.

However, these are some of the general signs and symptoms you can look out for:

Lumps around the breast area or underarm
Skin changes, such as dimpled, puckering, or scaly skin
Change in size, shape, skin texture, or color of your breast
Nipple discharge other than breast milk (such as blood)
Nipple changes such as inversion, tenderness, or flaking
Pulling sensation or pain in the nipple or surrounding area
Thickening/swelling on parts of your breast or enlarged lymph nodes in the armpit

What Are the 5 Warning Signs of Breast Cancer?

We already discussed some early signs/symptoms people generally come across when dealing with breast cancer. However, we will go into more detail on the top 5 warning signs for breast cancer. They include:

1) New Lump in the Breast or Underarm (Armpit)

One of the most common signs or symptoms of breast cancer is the appearance of a lump around the breast area. Finding a breast lump does not mean that it is a definitive sign of breast cancer. There are other breast conditions (or hormonal changes) that can lead to the formation of a breast lump. However, we highly recommend you see a doctor as soon as you notice a lump.

2) Changes in the Shape or Size

Changes may be subtle (especially in the beginning stages). Spotting differences may also be difficult because breasts tend to naturally be asymmetrical. Breast cancer tumors often lead to swelling or expansion of the breast – which can change its shape. However, there are also other factors that can lead to changes within the breast. For example, hormonal changes may also lead to the alternation of the shape and/or size of the breast. As soon as you notice any abnormal changes, we highly recommend you go see your provider.

3) Skin Changes

Inflammatory cancer is usually the cause of dimpled or irritated skin. The lymph vessels within our bodies transport excess particles and fluids from the tissue to the bloodstream. However, cancer cells often lead to a blockage within these vessels. As a result, the skin begins to appear like the skin of an orange. Having red or flaky skin around the breast area (or the nipple) may also indicate breast cancer.

4) Nipple Discharge

Nipple discharge can be normal in pregnant or breastfeeding women (or other conditions). However, it should be a cause of concern when discharge is clear or bloody, occurs only in one breast, is accompanied by a lump, or suddenly appears without any clear explanation.

5) Nipple Retraction

Nipple retraction refers to when the nipple turns inward. An inwards nipple usually results from tumors forming in the duct behind the nipple.

Who Is Most at Risk of Breast Cancer?

Anyone can be at risk of having breast cancer. However, some people have a higher risk of developing breast cancer. Some factors to keep in mind include:

Gender: Women tend to have a higher chance of developing breast cancer in their life. Men can also have breast cancer. However, most cases occur in women.
Age: Breast cancer risk increases with age. Someone older may have a higher risk than someone young.
Being Obese or Overweight (especially after menopause): Research shows that fat tissue produces extra amounts of estrogen (associated with an increased risk of various cancers). Fat tissue also produces hormones known as adipokines (which can stimulate or inhibit cell growth). These hormones can affect the development of cancer cells. People struggling with obesity tend to have higher levels of blood glucose. High levels of glucose also increase the risk of developing various cancers.
Family history/Genetic factors: A woman’s risk increases if they have a close relative (mom, sister, or daughter) with breast cancer. Anyone who has a male relative with breast cancer also has a higher risk. An increase in risk is attributed to having a higher chance of inheriting genetic changes from either parent’s side of the family.
Previous history of breast cancer or other non-cancerous breast conditions: Women who have had breast cancer are at risk of having it return later in life. Other non-cancerous conditions (such as atypical ductal hyperplasia or lobular carcinoma in situ) are also associated with an increased risk of breast cancer.
Mutations in genes: Specific genetic mutations (such as the BRCA1 or BRCA2 mutation) are linked with increased risk. It can also mean that one may develop cancer at an earlier age (or be at a higher risk of developing other cancers).
Having dense breast tissue: Having dense breast tissue means that there is more connective tissue than fatty tissue. Thus, it can make it harder to detect breast cancer in a mammogram while it is still at an early stage.
Reproductive History: Early menstruation, late menopause, having children at an older age, or not having kids may increase one’s risk.

What Puts a Woman at High Risk for Breast Cancer?

Besides the factors that we already discussed above, there are other factors that may affect the development of breast cancer in women. These factors include:

Previous Radiation Exposure: Women who have had previous radiation exposure (especially around the chest area) before the age of 30 have an increased risk of cancer re-occurring later in life.
Not being Physically Active: People who do not exercise often are at a higher risk of developing cancer. The link between exercise and cancer development is still unclear. However, exercise can positively influence weight, hormones, and inflammation.
Taking Hormones: Hormone therapy that involves estrogen or progesterone (especially when taken after menopause for at least five years) may increase the risk of breast cancer. Of course, there is a need for research to find out how much-combined hormone therapy can increase one’s risk. Certain forms of birth control (especially those that involve hormones) can also increase one’s risk. For example, women who use oral contraceptives (such as birth control pills) may have a higher risk of breast cancer than women who have never used this type of contraceptive.
Drinking Alcohol: According to the American Cancer Society, women who have an average of 2-3 drinks per day have a 20% increased risk of developing breast cancer.

At What Age Do Females Get Breast Cancer?

As discussed above, age is one of the main factors associated with an increased risk of developing breast cancer. Older women tend to have a higher increased risk. However, this does not mean a younger individual cannot develop breast cancer. Other factors (such as inherited genetic mutations, receiving radiation therapy at a young age, having dense breasts, family history, etc.) also play a role.

Is Breast Cancer Curable?

One can effectively treat stage I breast cancer because it is detected early. Treatment generally consists of surgery or radiation (or a combination of the two). Hormone therapy is also an option because it blocks estrogen from attaching to the tissue or fueling cancer growth. There is also chemotherapy (which affects the whole body)- or targeted therapy (which targets a specific area). However, surgery and radiation are highly effective.

Can Breast Cancer Be Removed?

There are many treatment options now available to those diagnosed with breast cancer. We highly encourage you to meet with your doctor to find an effective treatment plan. Keep in mind- everyone is different (and at different cancer stages)- so one treatment may work better than others. The following treatments can be split into the following categories:

Local Treatments (treatment that treat the tumor without affecting the rest of the body). Treatments include:
- Surgery: Surgery is often a treatment option for those who:
  - Would like to remove as much of the cancer as possible (types of surgery include breast-conserving surgery or Mastectomy)
  - Know if the cancer has spread beyond the lymph nodes under the arm
  - Undergo breast reconstruction once the cancer has been removed
  - Help relieve symptoms of advanced cancer
- Radiation Therapy:
  - External beam radiation therapy: External beam radiation therapy is the most common type of radiation therapy where a machine focuses radiation on a specific area affected by cancer.
  - Brachytherapy (aka internal radiation): A device (containing radioactive seeds or pellets) is placed within the tumor bed for a short period of time.
- Systemic Treatments (Medications/drug treatments used to treat cancer cells). Treatments include:
  - Chemotherapy: Anticancer drugs are administered intravenously (through injection or infusion) or taken by mouth. Drugs travel through the bloodstream to reach and destroy cancer cells.
  - Hormone Therapy: Progesterone and estrogen may often play a role in helping advance the growth of cancer cells. Hormone therapy helps stop the hormones from attaching to receptors.
  - Targeted Drug Therapy: This treatment uses specific medications that target specific proteins that worsen the growth and spread of breast cancer cells. These medications specifically work to destroy or slow the growth of malignant cells. They can be administered through an IV, injection, or pill.
  - Immunotherapy: A treatment that uses medication to boost a person’s immune system to recognize and destroy cancer cells.
- Common Treatment Approaches
  - An individual’s treatment options will depend on many different factors (such as the type of cancer one has or what stage they are in). For example:
    - Treatment of breast cancer by stage: Generally, the more advanced the stage of breast cancer is, the more treatment may be required. Depending on the stage, specific treatments (or a combination) will vary by stage and breast cancer advancement.
    - Treatment of triple-negative breast cancer: Chemotherapy is the main choice of treatment for this type of breast cancer. Other treatments are also possible options. However, hormone therapy does not often work because these cancer cells don’t have estrogen or progesterone receptors and make little to no HER2 protein.
    - Treatment of inflammatory breast cancer: This type of cancer is generally considered to be Stage III breast cancer since cancer has reached the lymph vessels (causing changes to the skin). Treatments such as chemotherapy, targeted therapy, surgery, radiation, and even hormone therapy are possible options. If one has Stage IV inflammatory breast cancer, the treatments mentioned above are still possible options. Other possibilities also include immunotherapy or targeted drug therapy with a PARP inhibitor.
    - Treatment of breast cancer during pregnancy: If you are pregnant and have a breast cancer diagnosis- your treatment option may be limited. Surgery is a safe treatment option- and chemotherapy is generally given during the second and third trimesters. Radiation, hormone, and targeted therapy are usually put on hold until after the delivery of the baby.

We understand how stressful it can be when awaiting results and diagnosis. Know that you are not alone! There are many helpful resources available. If you or a loved one are struggling, please don’t hesitate to reach out. If interested, we have developed a health toolbox app. In the Febo app, you can access various health features (such as the symptom tracker, reliable health news, the ability to connect with others, etc.).

Part 2 of Our Breast Cancer FAQ’s? – Click Here

Sources: health.clevelandclinic.org, www.cdc.gov, www.nationalbreastcancer.org

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