Dr Sarthak Sidapara

Breast Cancer

What is Breast Cancer?

In simple terms, Breast Cancer is a disease in which the breast cells grow uncontrollably. In medical terms, it happens when malignant (cancerous) cells grow in the breast. Further, when these breast cancer cells fully grow, they metastasize (spread) to other parts of the body. Metastasis originates in the lymphatic system which helps to transport lymph (a fluid containing infection-fighting white blood cells) and other immune system cells throughout the body, to fight cancer. The undamaged metastasized cancer cells, move through the lymphatic vessels and settle in distant body locations, hence, forms new tumors, and keep the disease process in existence.

Symptoms for breast cancer

Some common symptoms of breast cancer are:

  • Lump formation in the breast
  • Changes in skin, such as swelling, irritation, or itchiness
  • Change in the shape and size of the breasts
  • Pain and tenderness, even if no lump is felt
  • Changes in the color and temperature of the breast
  • Effects on the nipple, like
  • Retraction (pulls inward)
  • Dimpling or peeling
  • Pain in the nipple area
  • Redness
  • Sore in the nipple
  • Nipple discharge other than breast milk

When to see a doctor

Consult a doctor, if you discover any lumps or other changes in your breast. A mammogram can be useful to detect the early signs of breast cancer.

Breast cancer causes

Abnormal growth of breast cells causes breast cancer. Hence, breast cancer is the result of mutation and unusual changes in genes that modulate healthy cell growth. The most commonly known are breast cancer gene 1 (BRCA 1) and breast cancer gene 2 (BRCA 2), which can increase the risk of breast cancer.

The abnormal cells divide themselves and continue to increase, forming a lump or mass. Cells spread through the breast to the lymph nodes or other parts of your body.

Many times, breast cancer starts with cells in the ducts (invasive ductal carcinoma). It can also begin in the glandular tissue known as lobules (invasive lobular carcinoma), or in other cells or tissue within the breast.

There are hormonal, lifestyle, and environmental factors identified by the researchers that can increase the risk of breast cancer. But, the reason why some people with risk factors develop cancer, yet other people with risk factors never do, is not known. Likely, breast cancer is caused by a complex interconnection between the genotype and the environment.

Breast cancer types

Breast cancer is divided into various types, depending on the cells identified in the breast that are affected.

1) Non-invasive breast cancers –Most breast cancers are carcinomas, which are tumors that begins in the epithelial tissue of the skin, or in the tissue that covers internal organs. The most common breast cancer is adenocarcinoma, which forms in milk-producing glands or milk ducts.

2) Invasive breast cancers –Most breast cancers are invasive (or infiltrating) breast cancer. It can spread in normal, healthy tissues surrounding the breasts. The most common ones are:

  • Invasive ductal carcinoma (IDC) – This cancer begins to grow in the milk duct and enters the fibrous or fatty tissue of the breast outside the duct. Being the most common type, it represents about 80% of all breast cancer diagnoses.
  • Invasive lobular carcinoma (ILC) – This cancer begins in the milk-producing glands (lobules) of the breast. This can spread to the lymph nodes and other areas as well. It represents about 10 to 15% of all invasive breast cancer.

There are some less common but serious breast cancers, which are developed in different ways, which affect their treatment procedure.

3) Triple-negative breast cancer (TNBC) – This cancer is referred to the cancer cells that do not have estrogen or progesterone receptors and accounts for about 10% to 15% of all breast cancers. The cancer cells do not build much of a protein called HER2.

4) Inflammatory breast cancer (IBC) – This type of cancer makes the breasts red, tender, and swollen. In this, the cells block lymph vessels in the skin of the breast. It accounts for about 1% to 5% of all breast cancers.


  • Paget’s disease of the Nipple– Paget’s disease of the nipple is rare breast cancer that causes eczema-like changes to the skin of the nipple and the areola (the dark circle around the nipple). Being rare, it accounts for only about 1-3% of all cases of breast cancer.
  • Phyllodes tumors– Phyllodes tumors are another rare breast cancer. They are a form of sarcoma as they grow in the connective tissue of the breast, not in the ducts. A second pathologist is required to get the confirmation as this cancer is the rarest.
  • Angiosarcoma – Sarcomas of the breast are rare accounting for less than 1% of all breast cancers. Angiosarcoma develops in cells that lining of the blood vessels or lymph vessels. It affects the skin and can appear as a bruise-like lesion that grows over time. The chances for it to occur is about 8-10 years after getting radiation treatment of the breast.

Breast cancer risk factors

Factors that are related to an increased risk of breast cancer include:

  • Gender – Breast cancers are more likely to develop in women than in men.
  • Increasing age– As your age increases, your risk of breast cancer increases too.
  • A personal history of breast cancer– If you have breast cancer in one breast, there is an increased risk of developing cancer in the other breast as well.
  • Family history– If your mother or sister were diagnosed with breast cancer, especially at a young age, your risk of breast cancer increases.
  • Radiation exposure – If you ever received radiation treatments to your chest as a child or young adult, your risk of breast cancer is increased.
  • Obesity – If you are overweight, increases your risk of breast cancer.
  • The menstrual cycle began at a younger age – If your period started before age 12, your risk of breast cancer increases.
  • Beginning menopause at an older age –Starting menopause after age 55, increases the risk of breast cancer.
  • Having your first child at an older age – Women who deliver their first child after age 30 can have an increased risk of breast cancer.
  • Drinking alcohol – Consuming alcohol increases the risk of breast cancer.

Complications of breast cancer

Though breast cancer surgery is safe, there can be several complications.

Psychological complications are:

  • Fear
  • Stress
  • Insomnia (trouble falling asleep)
  • Low sexual desire
  • Depression due to physical changes appearing from the intensive treatments

Secondary physical issues are:

  • Inflammation of lung tissue
  • Heart failure
  • Secondary Cancer can develop

Complications that can occur after the surgery are:

  • Hematoma (blood clotting outside of blood vessels)
  • Seroma (build-up of clear fluid in a tissue, organ, or body cavity)
  • Thinning of hair and hair loss due to chemotherapy
  • Nausea and vomiting after chemotherapy
  • Constipation or diarrhea

Tests to diagnose breast cancer

If any symptom is discovered, the doctor will suggest several tests, such as:

  • Mammograms – It is an x-ray of the breast that helps to detect any irregularity in the breast.
  • Breast Ultrasound – It is used to check the results of a mammogram. An ultrasound informs if the breast lump is a fluid-filled cyst or it is a solid tumor.
  • Biopsies – In this process tissue is removed from the suspicious area, and is tested under a microscope to check the presence of breast cancer.
  • Magnetic resonance imaging (MRI): This is used to find the magnitude of breast cancer. MRI is a procedure in which large magnets and radio frequencies are used to locate some small breast lesions missed by mammography. It captures multiple images of breast tissue.

Stages of breast cancer

Stage 1– Stage 1 is divided into two stages as 1(A) and 1(B)
  • Stage 1A: The tumor size is up to 2 centimeters, but the lymph node is not involved.
  • Stage 1B: The tumor size is less than 2 centimeters, but there are a small group of cancer cells, nearby lymph nodes. In case, there is no tumor but there are a small group of cells nearby lymph nodes, it is also assigned as part of this stage.
Stage 2 – Stage 2 is divided into two stages as 2(A) and 2(B).
Stage 2A: is allotted for any one of the following:
  • No tumor, but 1 to 3 lymph nodes under the arm or near the breastbone contain cancer cells.
  • Tumor size is up to 2 centimeters, in addition to cancer in lymph nodes under the arm.
  • Tumor size is between 2 and 5 centimeters, but the lymph node is not involved.
Stage 2B: is allotted for either of the following:
  • Tumor size is between 2 and 5 centimeters, plus a small group of cancer in 1 to 3 nearby lymph nodes.
  • The tumor size is larger than 5 centimeters, but the lymph node is not involved.
Stage 3 – Stage 3 is divided into three stages 3(A), 3(B), and 3(C).
Stage 3A: is assigned for either of the following:
  • Cancer in 4 to 9 nearby the lymph nodes, with or without a tumor.
  • Tumor size is larger than 5 centimeters, plus a small group of cancer cells in lymph nodes.
Stage 3B: the tumor has reached the chest wall, plus cancer may have:
  • Spread to or broken through the skin.
  • Spread up to 9 lymph nodes under the arm area or near the breastbone.
Stage 3C: There may not be a tumor in the breast, but if there is, it may have reached the chest wall or breast skin, plus:
  • 10 or more underarm lymph nodes.
  • Lymph nodes near the collarbone.
  • Lymph nodes under the arm and near the breastbone.
Stage 4 –

In stage 4, cancer has spread to distant parts of the body. Hence, itis considered advanced breast cancer or metastatic breast cancer. In this stage, cancer may be present in the lungs, brain, liver, or bones.

Breast cancer treatment options by stage

In stage 1, surgery is the main treatment for breast cancer. Breast-conserving surgery is referred if doctors can remove all of the tumors along with a lining of healthy tissue around it and still enough tissue will be there for the breast to look natural as before, after surgery.

Stage 2, requires 3 to 18 months or longer, in the active treatment of breast cancer. It may be as simple as surgery and six weeks of radiation or involve the full arrangement of chemo, radiation, and biologic therapies.

In stage 3, surgery, known as a mastectomy is referred to remove cancerous tissue along with the lymph nodes. Radiation therapy can also be used to damage cancerous cells or tumors. Chemotherapy is a common treatment for stage 3.

Systematic drugs are considered as the main treatment for stage 4. Some common treatments like surgery, radiation therapy, or regional chemotherapy are also used. It is important to address the mental health issues that a stage 4breast cancer diagnosis may cause.

Breast cancer preventions

Some of the preventions of breast cancer are:

  • Maintain a healthy weight
  • Do exercise regularly
  • Stop drinking alcohol, or limit alcohol consumption
  • Consult the doctor before taking birth control pills
  • Do breastfeed your children, if your breast produces milk
  • Eat healthy foods such as whole grains, fruits and vegetables, fish, eggs, and meat

Breast cancer during pregnancy

It is possible to be detected with breast cancer during pregnancy, however, it is rare and is not caused due to the pregnancy. Women who are diagnosed with breast cancer during pregnancy have great tension in concern with the safety of the unborn child. It can be a distressing and extremely difficult situation, but there is still hope for both mother and child, because of the multiple treatment options available.

Breast cancer survival rates

The survival rate for breast cancer is much higher when compared to any other cancers. Some of the survival rates are:

  • The 5-year survival rate of breast cancer is 90%.
  • The 10-year survival rate of breast cancer is 84%.
  • The 15-year survival rate of breast cancer is 80%.

Breast cancer treatment costs

If the patient has health insurance, breast cancer treatment is usually covered by health insurance, however, some plans might not cover individual drugs or treatments. If the patient does not have health insurance, breast cancer treatment basically costs $15,000 to $50,000 or more for a mastectomy or $17,000 to $35,000 or more for a lumpectomy followed by radiation.

Do not be worried about breast cancer. The survival rates of breast cancer are excellent but it needs to be diagnosed at an early stage.