04 Apr Breast cancer: a practical guide

The breast cancer is the second most common type of cancer among women across the world, after skin cancer. It develops from an uncontrollable growth of cells in the breast, causing groups of tissue called a tumors to form that can either be benign (no serious consequences for the organism) or malign (they spread to healthy tissues and affect your health).

Types of breast cancer  

According to the part of the breast where the tumor has developed, these are the most common types of breast cancer:

Cancers in situ

• Ductal carcinoma in situ: is a non-invasive or pre-invasive breast cancer. The cells that line the milk ducts to the nipple have transformed into cancer cells, but have not spread through the walls of the ducts to the nearby breast tissue.
• Lobular carcinoma in situ: cells that look like cancer cells grow in the lobules of the milk-producing glands of the breast, but do not go through the wall of the lobules.

Invasive breast cancer

This type of breast cancer occurs when the tumor spreads to the surrounding breast tissue. The most common types are:

• Infiltrating ductal carcinoma: starts in the cells that surround the ducts that transport milk to the nipple, penetrate the duct and invade nearby tissues. There is a risk of the cancer spreading to other parts of the body through the lymphatic system and the bloodstream.

• Invasive lobular carcinoma: begins in the milk ducts. It can metastasize to other parts of the body.

Causes of breast cancer

Breast cancer is caused by damaged genetic information, which is mostly likely due to a combination of biological and environmental factors. Here are some risk factors that can increase the likelihood of developing breast cancer:

• Genetic factors

Approximately 5 to 10% of breast cancers are related to genetic mutations that are passed down through the family. BRCA1 and BRCA2 are the most well-known breast cancer genes, which considerably increase the risk of both breast cancer and ovarian cancer.

• Age

The risk of breast cancer increases over the age of 45. Doctors recommend starting yearly mammograms at the age of 40.

• Factors related to exposure to radiation

The chances of getting breast cancer are higher if radiation treatment was given or in the early stages of adulthood.

• Postmenopausal hormone therapy

Taking hormone therapy medication that combines estrogen and progesterone to treat the signs and symptoms of menopause increases the risk of breast cancer.

Breast cancer symptoms

A general understanding of how a normal breast looks and feels, as well as regular checking of the breasts to detecting any significant changes in their appearance, are effective ways to detect possible symptoms of breast cancer and begin timely treatment. Possible symptoms of breast cancer include:

• Feeling a new mass or lump in the breast. See your doctor as soon as possible
• Swelling of the whole or part of the breast (although no defined lump is felt)
• Skin irritation or a holey texture (the texture resembles that of orange peel)
• Breast or chest pain
• Contraction of the nipples
• Redness, scaling, or thickening of the skin of the breast or nipple
• Nipple discharge other than breast milk

At this point it is extremely important to perform regular self-examination of the breasts to ensure a timely detection of any abnormalities:

1. Observation in the mirror with the arms by your sides: standing in front of a mirror with arms relaxed and down by your sides. Observe the size of both breasts, check that the skin is not excessively rough, has no reddened areas, or bumps or dimples. The nipples should not be retracted or sunken.
2. Observation with arms raised: clasp your hands behind the head. In this position, check that the lower contour of the breasts is circular, regular, and more or less symmetrical in both breasts.
3. Feeling the skin: with the left arm behind the head, use the right hand to feel the left breast and then vice versa. Use three middle fingers of the hand (index, middle and ring finger). In circles from the outside in, crossing the breast in vertical lines or crossing it in horizontal lines. Look for strange lumps, especially in the area that goes from the armpit to the breast.
4. Observation lying down: lying face up on the bed, feel the left breast following the instructions in the previous step.
5. Nipples: Compress the nipples with the index fingers and thumb to check if fluid comes out. If there is any type of fluid, observe its characteristics (transparent, milky or bloody) and report them to the doctor .

Breast cancer diagnosis

There are several tests and exams by which breast cancer can be detected even in its early stages. Early detection can make a difference in treatment, so it is important to perform regular medical check-ups or to seek medical assistance as soon as you experience unusual symptoms that don´t go away.

These are the tests that are usually used to diagnose this type of cancer:

• Breast exam: The doctor feels both breasts and underarm lymph nodes to check for nodules or other abnormalities.
• Mammography: an x-ray of the breast is taken and if an abnormality is detected, the doctor may recommend a diagnostic mammogram to evaluate this anomaly in greater detail.
• Ultrasound mammary: uses sound waves to produce images of deep structures of the body. If a recent breast nodule is a solid mass or a cyst filled with fluid, it will show it.
• Mammary cell analysis (biopsy): the most powerful test to detect this type of cancer. A specialized x-ray guided needle is used to remove a tissue nucleus from the suspicious area.
• Magnetic resonance imaging (MRI): a machine that uses a magnet and radio waves to produce images of the inside of the breasts. Before, an injection of a contrast dye will be applied.

Breast cancer treatments

Here are some conventional treatments for this type of cancer, some of which are more invasive than others:

Surgery

This procedure is used in most cases of breast cancer for different purposes and depending on the state in which the cancer is found. For example, a mastectomy is performed to remove as much cancerous tissue as possible, whilst doing everything possible to preserve the breast.

Surgery is also used to find out how much cancer has spread, by means of lymph node biopsy in the armpit. Alleviating symptoms such as pain in more advanced cases of breast cancer is another way in which surgical procedures are used.

Radiation

This treatment is used when the rate of progression of the disease is rapid or the size of the tumor is significant. uses high-energy rays or particles (such as x-rays) to kill cancer cells. There are two types of radiation: external radiation therapy (which uses a machine to irradiate the rays) and internal radiation or brachytherapy (a radioactive source is placed inside the body for a short time).

Chemotherapy

For this treatment, medication is administered orally or intravenously in order for the drugs reach the cancer cells through the bloodstream.

There are different times in which this treatment can be used:

• After surgery: to fight any remaining cancer cells after removing the larger part of the cancer cells during surgery or those that have regenerated and that were not detected during surgery.
• Before surgery: to reduce the size of the tumor as much as possible, to reduce the scale of the surgical procedure.
• Advanced cases: for those cases where the cancer cells have expanded outside of the area of the breast and armpit.

Hormone therapy

Some causes of this type of cancer are due to hormonal factors. The purpose of this treatment is to reach any cancer cell that is in the body. It is not for all patients, it is recommended for treating hormone-receptor-positive breast cancers (ER-positive and / or PR-positive).

Targeted therapy

Medication designed to block the growth and spread of cancer cells. It is different from chemotherapy because the drugs used in this therapy only attack specific proteins or genes, although they tend to complement each other.

Alternative and complementary treatments

These are complementary to conventional cancer treatments:

• Palliative care: specialized care focused on relieving pain and other symptoms of cancer. Interdisciplinary treatment incorporating the patient, their home environment and other specialists to offer treatment on various fronts (nutrition, physiotherapy, psychology, etc).
• Visualization and hypnosis: meditation and mind control techniques and exercises  for emptying the mind in order to reach a more relaxed and carefree mental state . Patients usually listen to recordings or are directed by a therapist.
• Biofeedback:  Electrodes are used in various parts of the body to measure the body’s response to stress. Stress points are identified to help the patient focus on relieving stress in those areas by means of massage, meditation exercises, etc.
• Expressive/creative therapies: Actions as simple as playing or listening to music, painting, reading, writing or any artistic activity that inspires the patient plays a fundamental role in their emotional well-being and in controlling stress during breast cancer treatment. Distract the mind and focus attention on positive activities that entertain and enrich.
• Medicinal cannabis*: The use of cannabis derivatives in complementary cancer treatments is becoming more and more common. Especially relieving the side effects from conventional treatments (nausea, vomiting, loss of appetite, pain), as well as problems caused by stress such as anxiety and sleep problems. Cannabis derivatives can help ease these symptoms.
• (*Always check to see if it is legal in your jurisdiction before obtaining any cannabis-based product.)