breast cancer

BREAST CANCER

Women's Imaging

What is Breast Cancer?

Breast cancer occurs when cells in your breast grow and divide in an uncontrolled way, creating a mass of tissue called a tumor.

Cancers are an overgrowth of cells and tissue that starts in one organ e.g. the breast, and then spreads (metastasizes) to other parts of the body where it usually leads to death. There are many different types of breast cancers and they don’t necessarily behave in the same way or respond to the same treatments. These days, a diagnosed cancer is studied in great detail so that the treatments are tailored to best destroy that particular cancer.

In 99.9% of breast cancer, there is NO known cause. There are risk factors that increase a person’s chances of developing a cancer but almost never an actual cause. The risk factors include family history, hormone replacement, obesity, smoking and having not had children.

Feeling a lump in the breast is the single most important symptom of a breast cancer! A lump usually feels like a pea / stone / marble under the skin. Any time that a woman feels a lump in the breast she must come in for a mammogram and/or ultrasound immediately. Nonetheless, the vast majority of palpable lumps are not breast cancer. Benign growths, cysts and normal lumpy breast tissue may all present as lumps.

Skin thickening and dimpling (looks like the peel of an orange), or a newly developed asymmetry of the breasts – one is higher/pulled up or has a dent in it. These signs always need to be further evaluated with mammogram and ultrasound.

Nipple discharge – the most concerning discharges are bloody or clear. Green/yellow/milky discharges are usually harmless. A discharge that comes out on its own is more worrying than one that comes out only when the nipple is squeezed. Discharges from both nipples are almost always harmless.

Pulling in of the nipple can be a sign of cancer but only if it is something new (weeks – months)

A peeling, dry rash of the nipple and areola is always a concern. Itching of the nipple without any visible change is harmless – usually due to hormonal change.

Even though most nipple problems are benign, evaluation with imaging is advised in all cases.

The purpose of a breast examination is to try find breast cancer as early as possible. Regular (monthly) self examination is an extremely valuable tool, although many women find it difficult on account of naturally lumpy breasts. If this is the case, do not stress. Make sure you come for your annual mammogram in addition to visiting your gynaecologist or general practitioner who will also perform a manual breast examination.

A breast cyst is a bubble of water that can vary in size from several millimetres to 5 centimetres in diameter. They are extremely common and almost always benign. Breast cysts can occasionally be painful, particularly if very large or inflamed. In that case, we will aspirate (draw out) the fluid from the cyst. If they are asymptomatic, we leave cysts alone.

Women's Imaging

Who Is At High Risk For Breast Cancer?

Women who have a family history of breast or ovarian cancer, women who haven’t had children, the overweight, and women who take hormones, have a higher risk of getting breast cancer.

Studies have shown that your risk for breast cancer is due to a combination of factors. The main factors that influence your risk include being a woman and getting older. Most breast cancers are found in women who are 50 years old or older.

Most women will get breast cancer even without any other risk factors that they know of.  Having a risk factor does not mean you will get the disease, and not all risk factors have the same effect. If a woman has a high risk of developing a breast cancer, she may need more intensive screening e.g. annual MRI or possibly genetic testing.  If you have breast cancer risk factors, talk with your doctor about screening options.

  • Family history of breast cancer are the most important risk factors for developing a breast cancer https://www.cdc.gov/cancer/breast/young_women/bringyourbrave/hereditary_breast_cancer/brca_gene_mutations.htm
  • Being overweight or having obesity after menopause – older women who are overweight or have obesity have a higher risk of getting breast cancer than those at a normal weight.
  • Taking hormones – some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise risk for breast cancer when taken for more than five years. Oral contraceptives are not known to increase breast cancer risk.
  • Reproductive history – having the first pregnancy after age 30, or never having a full-term pregnancy can raise breast cancer risk.
  • Previous biopsy that showed a high risk lesion e.g. Lobular Carcinoma in Situ(LCIS) or Atypical Ductal Hyperplasia (ADH)
  • Previous breast cancer – women who have had a previous cancer, and still have breast tissue i.e. they had a lumpectomy instead of a mastectomy, are at higher risk of developing a second breast cancer. Especially if they are younger than 50 and have dense breast tissue
  • Getting older. The risk for breast cancer increases with age. Most breast cancers are diagnosed after age 50.
  • Genetic mutations. Women who have inherited changes (mutations) to certain genes, such as BRCA1 and BRCA2, are at higher risk of breast and ovarian cancer.
  • Reproductive history. Starting menstrual periods before age 12 and starting menopause after age 55 expose women to hormones longer, raising their risk of getting breast cancer.
  • Having dense breasts. Dense breasts have more connective tissue than fatty tissue, which can sometimes make it hard to see tumors on a mammogram. Women with dense breasts are more likely to get breast cancer.
  • Personal history of breast cancer or certain non-cancerous breast diseases. Women who have had breast cancer are more likely to get breast cancer a second time. Some non-cancerous breast diseases such as atypical hyperplasia or lobular carcinoma in situ are associated with a higher risk of getting breast cancer.
  • Family history of breast or ovarian cancer. A woman’s risk for breast cancer is higher if she has a mother, sister, or daughter (first-degree relative) or multiple family members on either her mother’s or father’s side of the family who have had breast or ovarian cancer. Having a first-degree male relative with breast cancer also raises a woman’s risk.
  • Previous treatment using radiation therapy.Women who had radiation therapy to the chest or breasts (for instance, treatment of Hodgkin’s lymphoma) before age 30 have a higher risk of getting breast cancer later in life.