Breast cancer

What is breast cancer?

The breast is a gland comprised of breast tissue itself (which is formed by lobes) and some supporting tissue called connective and fat. Milk is produced in the lobules of the breast tissue and ducts driven to its exit from the nipple.

Breast cancer is a malignant tumor that develops in the breast tissue (although there may be tumors in supporting tissues, but are not true breast cancers). If the tumor is contained in the lobes and ducts, it is called "in situ" or noninvasive. If tumor cells depart outside the ducts and lobules the tumor is invasive.

Frequency of breast cancer

It is the most common cancer among women and affects approximately one million women worldwide. It is the malignant tumor that causes more deaths among women in Spain. Its incidence in our country is about 46 cases per 100,000 inhabitants and more than 15,000 cases / year (it is estimated that one in every 11 to 12 women will develop breast cancer). Despite these figures, Spain is the second EU country with the lowest incidence of breast cancer. In men it can also be the tumor, although its effects are much lower (it is a rare cancer in males): less than 1%. The cure rate is around 60%.

Related Articles

Find interesting information in the following articles:

• Breast cancer in men
• Breast cancer treatment

Doctor visits

See cancer consultations on our users 'Ask the Doctor'

Some advices

View other items of interest:

• Breast self examination
• Early detection of tumors
• After cancer: periodic reviews

Age

The incidence increases with age and doubles every 10 years until the menopause . Ages with the highest incidence: 45-60 years. 75% of breast cancers occur in women over 40 years. It is estimated as a risk factor greater than 50 years old. This does not mean that breast cancer does not give in young women, but is much less common.

Geographical variation

It is less common in Asian countries (China, Japan), and more common in Western industrialized countries. Within the latter, it is less common in Latin or Mediterranean countries (Spain, Italy, Greece) than in the Anglo-Saxon or Nordic countries.

Studies in Japanese women who emigrated to the United States show that the frequency of breast cancer in these women is raised to approach the American country in one or two generations. This indicates a possible relationship between environmental factors and the type of life with breast cancer.

Reproductive factors, pregnancy

Women with first menstruation at an early age and late menopause are at increased risk of breast cancer. A menopause after age 55 gives twice as likely to develop breast cancer than women with menopause before age 45.

The incidence of this disease is higher in women who have not had children and where the first pregnancy occurs late. It is estimated that the risk of breast cancer in women who had their first child after age 30 is almost double that had it before age 20. The highest risk group is that of women who had their first child after 35 years.

Heritage

It is estimated that up to 10% of breast cancers are hereditary. This hereditary factor can be transmitted by both parents, and some members of the family can pass the altered gene without themselves develop cancer. They are not known with accuracy the set of genes involved in breast cancer, but some have been identified to play important role in these tumors as the BRCA gene.

Previous breast disease

Only the so-called atypical epithelial hyperplasia of the breast appears to increase the risk of breast cancer in women who have previously had.

Radiation

-Called ionizing radiation are known cause of development of breast cancer. This relationship is based on studies by mid-century with women or teenage girls who had received radiation to the chest by repeated exposures to X-rays as a diagnostic method or treatment. The risk of developing the tumor depends on the age at which received the radiation dose received by each ray exposure and the number of times they were exposed (total dose).

Lifestyle

They are continuing the studies being conducted on breast cancer and the acquisition of fats in the diet of people. Some suggest that olive oil (the Mediterranean diet) helps reduce the risk of developing the tumor; however, are factors that still need further study and longer term. Lately, the way research is focusing on soy consumption as protective against breast cancer.

The overweight

The overweight is associated with increased risk in postmenopausal women (up to twice as likely than non-obese).

The alcohol

The spirit not appear to be a clear factor in the development of breast cancer, although some studies relate it so inconsistent. It can have more influence on snuff , especially in cases of younger women where not frequent breast cancer, and yet present.

Hormones

There is much controversy about whether taking oral contraceptives increases the risk of breast cancer. Large studies fail to agree on a final form. As a guide, we can say that we have described a slightly higher risk in people taking these medications, but this risk is very small.

Hormone Replacement Therapy

Other hormone preparations taking women make up what is called hormone replacement therapy (HRT) . These are hormones which are administered to the menopausal women to relieve symptoms which occur in this period. With these hormones we are in the same situation as with oral contraceptives: studies give very different data arise, and do not allow to clarify one hundred percent if this treatment is a risk factor for breast cancer or not.

We can say as a general rule that the evidence we have now suggests that HRT does not increase the mortality from breast cancer, although one can not rule exhaustively for all women a slightly increased risk of developing the disease by this treatment.

What are the risk factors for developing breast cancer? Breast lump

In some cases, the first symptom is the appearance of a lump in the breast . The first thing to consider, not scare us is that not all lumps or nodules that appear in the breast are breast cancer. The woman grooming note, in the shower, or to get some clothes that rub against the bulge.

Skin changes

Sometimes, women notice a change in the skin of the chest area, dimpled or wrinkled, that changes over time. In advanced cases, it can take on the appearance of the skin of an orange. Sometimes this area or the entire breast may become red, enlarged (swollen).

Changes in the nipple skin

You may also notice changes in the skin of the nipple , which is inserted into the breast, which erodes or flaking (lose skin peeling), or have secretions by it, both milky, watery, or blood.

Involvement of axillary lymph

Another sign that may appear is leaving the involvement of lymph in the armpit, usually the affected breast: may receive one or more packages, they are only the nodes that have swelled as a result of the tumor.

What are the symptoms of breast cancer?

In the early stages of the disease, women do not experience any symptoms or apparent discomfort. So many breast cancers currently diagnosed, they are in women attending routine medical checkups or screening programs for breast cancer.

Physical exam

It consists of a first scan, both general and from both breasts, armpits and neck. This is achieved determine a lump in the breast or lymph nodes in the armpits.

Mammograms

We can say that are breast x-rays. Possibly the best evidence for the study of these glands. Identify abnormal areas in the breast, but do not always have to be breast cancer. You can give guidance on the benignity or malignancy of these abnormal areas, but not complete security. In young women mammograms are not very aclarativas, due to the different breast density of these women compared to other older; therefore, it is neither necessary nor useful to practice routine mammograms this group of young women.

Sonograms

The ultrasound can help in the study, determining whether a nodule is solid or liquid, size, etc. They are not useful as definitive evidence, but they are for other diseases, such as cysts.

Puncture fine needle aspiration (FNA)

It involves inserting a needle into a nodule previously detected. This needle allows collecting samples with cells of said node, which will be analyzed under a microscope. Sometimes there are changes on mammograms but can not feel nodes, so it is necessary to realize this aspiration mammographic or ultrasound guidance.

Biopsy

It may be that as many abnormal cells for diagnosis necessary area. Then the doctor will use taking biopsy . It involves taking a sample of breast tissue for microscopic observation. This process can be done under local or general anesthesia, depending on the situation of each patient and each case. There are times when it is decided to surgically remove the suspicious nodule, and analyze during the same surgery, so that whether to expand the surgical site, it can be done all at once, without having to return the patient to the operating room other time.

How is breast cancer diagnosed?

Before any changes just mentioned, it is important that women see your doctor. This can start a case study to advance tests then may have the specialist. In other cases, the doctor directly refers the patient to the specialist to be he who initiated the study.

Non-invasive carcinomas

Non-invasive carcinomas are those who have not exceeded some of the microscopic structures of the breast. Depending on where they originate, can be duct (intraductal) or lobules (intralobular). In turn, the duct may have different microscopic varieties. This type of non-invasive carcinomas is rare that generate metastases, but can get to be invasive (exceeding those breast structures).

Invasive carcinomas

Are invasive tumors that have exceeded a kind of barrier in the structure of the breast. Among them we are:

• The so-called invasive ductal, which is the most common type of all breast cancers (70-80%).
• There is also lobular, much less frequent.
• Medullary, mucinous, tubular, etc.: Other special types They are now less common.

Other malignant tumors

Other malignant tumors can occur in the chest, such as those originating in tissue that gives support to the mammary gland (connective tissue), and we called sarcomas. They are rare, and we can not say it's really a breast cancer.

What types of breast cancer are there?

We can find different classifications of breast cancer, catering to different characteristics of the same. To avoid confuse us, we will discuss what are the most common types are in the Spanish population, apart from other rarer cases.

Early breast cancer

It is one that is confined to the breast and / or armpit lymph the same side of the body.

Locally advanced breast cancer

Affected areas of the skin or chest wall near the breast ill, but has not spread beyond the breast and / or armpit. Their outlook is worse than the early type, and skin appearance is directly affected by the tumor, red, swollen. It is due to obstruction by cancer cells channel chest fluid drainage (lymphatics), this causing inflammation of the area that can not drain.

Advanced breast cancer

It is has spread beyond the breast and armpit, that is, it has spread to other areas or organs. For example, neck nodes, bones, liver, lungs, or brain.

How is breast cancer treated?

The treatment depends on the type of tumor and the stage of the disease is: involvement of lymph nodes, spreading to other organs, etc. Therefore, there are classifications of tumors depending on their length. To understand more easily, we can classify them into three groups:

Development of breast cancer

Initially, tumor cells are confined in the lobules or milk ducts, which as we call it allows non-invasive or "in situ".

The two main types, the ductal and lobular, are different when examined under a microscope, and also will be treated somewhat differently. Ductal complete treatment usually requires surgery and radiation or hormone treatment, while invasive lobular not only usually requires surgical removal, and some authors recommend only monitoring, without intervening.

Ductal carcinoma in situ, if not treated, gets to become invasive, spreading to the surrounding breast tissue. The time period in which this does occur, it appears months to years, ie, does not in days or weeks.

When you have developed an invasive cancer it is when there is risk of the cancer cells to spread to nearby lymph nodes, being the first to be affected nodes in the armpit on the same side of the body. Another area in which the tumor can spread through the blood vessels: the small cells invade vessels supplying the cancer, and from there can move to other body organs, causing the so-called metastasis. The most common sites of metastases localization of these are: bone , lung, liver and brain.

Can cancer be prevented?

Failure to meet one common cause to all breast cancers, means we can not safely avoid acquiring the disease. However, a number of events or factors that can help reduce the risk of acquiring or even as commonly said "take it on time."

The selective breast examination (programs for early diagnosis or screening for breast cancer) can reduce mortality, but the incidence of breast cancer, and only in the group of people with specific age at which programs are made screening.

These screening programs, also called breast cancer screening, usually made frequently in Spain. His intention is to diagnose as early breast cancer, to allow a treatment as quickly and efficiently as possible, and trying to reduce the risk of death from cancer female carrier. The age at which women should attend these programs is still being debated and varies across countries. For example, the American Cancer Society recommends that women come from forty. In other countries, the recommendation is made from 45 or 50. There is also controversy about how often to repeat the screening test (usually a mammogram), recommending each year, although depending on the age of women and the economic costs of screening programs in some areas are repeated every 2 or 3 years.

Women under 40 generally do not need to undergo such programs, since breast cancer below this age is rare (although we must not forget that cases occur in young girls), and besides, mammography in young women does not provide as good information as in older women, due to the higher density of breast tissue in young women, and can lead to unclear diagnoses.

From here we recommend to women that are cited in these screening programs that come to get tested because they constitute a benefit for themselves.