|Before discussing breast cancer, it’s important to be familiar with the anatomy of the breast. The normal breast consists of milk-producing glands that are connected to the surface of the skin at the nipple by narrow ducts. The glands and ducts are supported by connective tissue made up of fat and fibrous material. Blood vessels, nerves, and lymphatic channels to the lymph nodes make up most of the rest of the breast tissue. This breast anatomy sits under the skin and on top of the chest muscles.|
Breast cancer develops in the breast tissue, primarily in the milk ducts (ductal carcinoma) or glands (lobular carcinoma). The cancer is still called and treated as breast cancer even if it is first discovered after the cells have travelled to other areas of the body. In those cases, the cancer is referred to as metastatic or advanced breast cancer.
Breast cancer usually begins with the formation of a small, confined tumor (lump), or as calcium deposits (microcalcifications) and then spreads through channels within the breast to the lymph nodes or through the blood stream to other organs. The tumor may grow and invade tissue around the breast, such as the skin or chest wall. Different types of breast cancer grow and spread at different rates — some take years to spread beyond the breast while others grow and spread quickly.
Some lumps are benign (not cancerous), however these can be premalignant. The only safe way to distinguish between a benign lump and cancer is to have the tissue examined by a doctor through a biopsy.
Men can get breast cancer, too, but they account for just one per cent of all breast cancer cases. Among women, breast cancer is the most common cancer and the second leading cause of cancer deaths after lung cancer.
If eight women were to live to be at least 85, one of them would be expected to develop the disease at some point during her life. Two-thirds of women with breast cancer are over 50, and most of the remaining one-third are between 39 and 49.
Fortunately, breast cancer is very treatable if detected early. Localized tumors can usually be treated successfully before the cancer spreads; and in nine out of 10 cases, the woman will live at least another five years. However, late recurrences of breast cancer are common.
Once the cancer begins to spread, treatment becomes difficult, although treatment can often control the disease for years. Improved screening procedures and treatment options mean that at least seven out of 10 women with breast cancer will survive more than five years after initial diagnosis and half will survive more than 10 years.
In its early stages, breast cancer usually has no symptoms. As a tumor develops, you may note the following signs:
A lump in the breast or underarm that persists after your menstrual cycle. This is often the first apparent symptom of breast cancer. Lumps associated with breast cancer are usually painless, although some may cause a prickly sensation. Lumps are usually visible on a mammogram long before they can be seen or felt.
Pain or tenderness in the breast. Although lumps are usually painless, pain or tenderness can be a sign of breast cancer along with swelling of the arm pits.
Any change in the size, contour, texture, or temperature of the breast. A reddish, pitted surface like the skin of an orange could be a sign of advanced breast cancer.
A change in the nipple, such as a nipple retraction, dimpling, itching, a burning sensation, or ulceration. A scaly rash of the nipple is symptomatic of Paget’s disease, which may be associated with an underlying breast cancer.
Unusual discharge from the nipple that may be clear, bloody, or another colour. It’s usually caused by benign conditions but could be due to cancer in some cases.
What Are the Types of Breast Cancer?
The most common types of breast cancer are:
Invasive ductal carcinoma. This cancer starts in the milk ducts of the breast. Then it breaks through the wall of the duct and invades the fatty tissue of the breast. This is the most common form of breast cancer, accounting for 80 per cent of invasive cases
Ductal carcinoma in situ (DCIS) is ductal carcinoma in its earliest stage (stage 0). “In situ” refers to the fact that the cancer hasn’t spread beyond its point of origin. In this case, the disease is confined to the milk ducts and has not invaded nearby breast tissue. If untreated, ductal carcinoma in situ may become invasive cancer. It is often curable.
Infiltrating (invasive) lobular carcinoma. This cancer begins in the lobules of the breast where breast milk is produced, but has spread to surrounding tissues or other parts of the body. It accounts for about 10 per cent of invasive breast cancers.
Lobular carcinoma in situ (LCIS) is cancer that is only in the lobules of the breast. It isn’t a true cancer, but serves as a marker for the increased risk of developing breast cancer later. Thus, it is important for women with lobular carcinoma in situ to have regular clinical breast exams and mammograms.
In addition, there are several other less common types of breast cancer.
What Can you Do to Reduce your Risk?
Many factors can influence your breast cancer risk, and most women who develop breast cancer do not have any known risk factors or a history of the disease in their families. However, you can help lower your risk of breast cancer in the following ways—
- Keep a healthy weight.
- Exercise regularly (at least four hours a week).
- Get enough sleep.
- Don’t drink alcohol, or limit alcoholic drinks to no more than one per day.
- Avoid exposure to chemicals that can cause cancer (carcinigens).
- Try to reduce your exposure to radiation during medical tests like mammograms, X-rays, CT scans, and PET scans.
- If you are taking, or have been told to take, hormone replacement therapy or oral contraceptives (birth control pills), ask your doctor about the risks and find out if it is right for you.
- Breastfeed your babies, if possible.
Although breast cancer screening cannot prevent breast cancer, it can help find breast cancer early, when it is easier to treat. Talk to your doctor about which breast cancer screening tests are right for you, and when you should have them.
How Is Breast Cancer Diagnosed?
Doctors often use additional tests to find or diagnose breast cancer.
- Breast ultrasound. A machine uses sound waves to make detailed pictures, called sonograms, of areas inside the breast.
- Diagnostic mammogram. If you have a problem in your breast, such as lumps, or if an area of the breast looks abnormal on a screening mammogram, doctors may have you get a diagnostic mammogram. This is a more detailed X-ray of the breast.
- Magnetic resonance imaging (MRI). A kind of body scan that uses a magnet linked to a computer. The MRI scan will make detailed pictures of areas inside the breast.
- Biopsy. This is a test that removes tissue or fluid from the breast to be looked at under a microscope and do more testing. There are different kinds of biopsies (for example, fine-needle aspiration, core biopsy, or open biopsy).
If breast cancer is diagnosed, other tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. Whether the cancer is only in the breast, is found in lymph nodes under your arm, or has spread outside the breast determines your stage of breast cancer. The type and stage of breast cancer tells doctors what kind of treatment you need.
How Is Breast Cancer Treated?
Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. People with breast cancer often get more than one kind of treatment.
- Surgery. An operation where doctors cut out cancer tissue.
- Chemotherapy. Using special medicines to shrink or kill the cancer. The drugs can be pills you take or medicines given in your veins, or sometimes both.
- Hormonal therapy. Blocks cancer cells from getting the hormones they need to grow.
- Biological therapy. Works with your body’s immune system to help it fight cancer or to control side effects from other cancer treatments. Side effects are how your body reacts to drugs or other treatments.
- Radiation therapy. Using high-energy rays (similar to X-rays) to kill the cancer.
Male Breast Cancer
Male breast cancer is cancer that forms in the breast tissue of men. Though breast cancer is most commonly thought of as a woman’s disease, male breast cancer does occur.
Male breast cancer is most common in older men, though male breast cancer can occur at any age.
Men diagnosed with male breast cancer at an early stage have a good chance for a cure. Still, many men delay seeing their doctors if they notice unusual signs or symptoms, such as a breast lump. For this reason, many male breast cancers are diagnosed when the disease is more advanced.
It’s not clear what causes male breast cancer. Doctors know that male breast cancer occurs when some breast cells begin growing abnormally. These cells divide more rapidly than healthy cells do. The accumulating cells form a tumor that may spread (metastasize) to nearby tissue, to the lymph nodes or to other parts of the body.
Where breast cancer begins in men Everyone is born with a small amount of breast tissue. Breast tissue is made up of milk-producing glands (lobules), ducts that carry milk to the nipples and fat. Women begin developing more breast tissue during puberty and men do not. Because men are born with a small amount of breast tissue, they can develop breast cancer.
Types of breast cancer diagnosed in men include:
- Cancer that begins in the milk ducts. Ductal carcinoma is the most common type of male breast cancer. Nearly all male breast cancers begin in the milk ducts.
- Cancer that begins in the milk-producing glands. Lobular carcinoma is rare in men because men have few lobules in their breast tissue.
- Cancer that spreads to the nipple. In some cases, breast cancer can form in the milk ducts and spread to the nipple, causing crusty, scaly skin around the nipple. This is called Paget’s disease of the nipple.
Inherited genes that increase breast cancer risk
Some men inherit mutated genes from their parents that increase the risk of breast cancer. Mutations in one of several genes, especially a gene called BRCA2, put you at greater risk of developing breast and prostate cancers. The normal function of these genes is to help prevent cancer by making proteins that keep cells from growing abnormally. But if they have a mutation, the genes aren’t as effective at protecting you from cancer.
Meeting with a genetic counselor and undergoing genetic testing can determine whether you carry gene mutations that increase your risk of breast cancer. Discuss the benefits and risks of genetic testing with your doctor.
Tests and diagnosis
Diagnosing male breast cancer
If breast cancer is suspected, your doctor may conduct a number of diagnostic tests and procedures such as:
- Clinical breast exam. During this exam, your doctor uses his or her fingertips to examine your breasts and the areas around your armpits and your collarbone for lumps or other changes. Your doctor assesses how large the lumps are, how they feel, and how close they are to your skin and muscles.
- Mammogram. A mammogram is an X-ray of your breast tissue. To assess your breast tissue, your breast will be pressed flat as much as possible. During a mammogram, you stand in front of a machine with your shirt off. Two flat plastic plates come together to compress your breast tissue. A radiology technician takes the X-rays. The compression of the mammogram can be uncomfortable. Ask the technician what to expect and speak up if you’re feeling pain.
- Ultrasound. Ultrasound uses sound waves to create pictures of a suspicious breast mass. Your doctor may recommend an ultrasound in certain situations.
- Using a needle to remove cells for testing. A biopsy procedure involves removing a sample of suspicious tissue for laboratory testing. A breast biopsy is commonly done by inserting a needle into the breast lump and drawing cells or tissue from the area. When analyzed in a laboratory, your tissue sample reveals whether you have breast cancer and, if so, what type of breast cancer you have.
Determining the extent of the cancer If you’ve been diagnosed with breast cancer, your doctor will work to determine the extent (stage) of your cancer. Your cancer’s stage helps your doctor determine treatment options. Staging tests include blood tests and imaging tests, such as X-ray and computerized tomography (CT).
The stages of male breast cancer are:
- Stage I. The tumor is no more than 2 centimeters (cm) in diameter (3/4 inch) and hasn’t spread to the lymph nodes.
- Stage II. The tumor may be up to 5 cm (about 2 inches) in diameter and may have spread to nearby lymph nodes. Or the tumor may be larger than 5 cm and no cancer cells are found in the lymph nodes.
- Stage III. The tumor may be larger than 5 cm (about 2inches) in diameter and may involve several nearby lymph nodes. Lymph nodes above the collarbone may also contain cancer cells.
- Stage IV. Cancer at this stage has spread beyond the breast to distant areas, such as the bone, brain, liver or lungs.
- Modified from Centre for Disease Control and the Mayo Clinic Staff Researched by: Health Education & Promotion Unit Health Information Division (268) 562-2453/ 462-5685